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Immune & Haematologic Disorders NURS 2016 Chapters: 33, 51-54 Anemia Anemia: lower than normal hemoglobin (normal is 120-180g/dL) 3 main categories: – Loss of red cells – Hypoproliferative – Hemotytic Symptoms of anemia are more apparent when onset is rapid. A person can tolerate a 50% decreased in RBC gradually, but rapid 30% decrease can cause vascular collapse. Assessment General: Weakness, fatigue, malaise Appearance: Pallor of skill and mucous membranes, tongue smooth red, beefy ulcerations at corner of mouth Appetite: Crave ice, starch Nutrition: lack of iron, B12, folic acid, vegetarians need to supplement B12 (comes from animal sources) Assessment Cont’ Cardiac Status: look for signs of increased cardiac load GI: N&V, coffee grounds, melena, diarrhea, anorexia, stool for OB Hx: menstrual cycle, alcohol and family hx Neuro: peripheral numbness, poor coordination, confusion Dietary Iron Iron deficiency anemia most common Sources: organ meats, black, pinto and garbonzo beans, leafy greens, raisins & molasses Vitamin C enhances absorption of iron from dietary sources Iron Supplements Ferrous Sulfate Take 1 hour before or 2 hours after meals (will not absorb with food) Increase intake of vitamin C Increase intake of fiber Stool will be dark Case Study Mark is 3 years old. His mother brings him to the clinic after a diagnosis of iron deficiency anemia after a routine examination by his family doctor. He is a very picky eater. He is to start oral iron therapy. Rheumatoid Arthritis Inflammatory disorder that primarily involves the synovial membrane of the joints Clinical Manifestations: – Joint pain – Swelling – Warmth – Erythema – Lack of function Nursing Diagnosis Pain Fatigue Impaired mobility Self-care deficit Disturbed sleeping pattern Disturbed body image Ineffective coping Interventions Relieving pain & discomfort Reducing fatigue Increasing mobility Facilitating self-care Improving sleep Improving body image Monitoring & managing potential complications Increasing knowledge of disease management Leukemia True cause is unknown Unregulated proliferation or accumulation of white blood cells (WBC) In the bone marrow, replacing normal marrow elements Classified as either lymphocytic or mylocytic according to the stem cell involved Classified as acute (abrupt onset) or chronic (evolves over months to years) Leukemia Clinical Manifestations: – – – – – – – – – – Weakness Fatigue Bleeding tendencies Petechiae Ecchymosis Vomiting Fever Infection Headache Pain Nursing Diagnoses Risk for infection & bleeding Impaired mucous membrane Pain & discomfort Imbalanced nutrition Risk for diarrhea Fluid imbalance Risk for excess fluid volume Risk for yperthermia Nursing Diagnoses Cont’ Fatigue & activity intolerance Impaired skin integrity Grieving Disturbed body image Self-care deficit Deficit knowledge Anxiety Impaired gas exchange Nursing Interventions Preventing Bleeding Preventing Infection Managing Mucositis Easing Pain & Discomfort Attaining & Maintaining Adequate Nutrition Management Fluid & Electrolyte balance Decreasing Fatigue & Deconditioning Improving Self Care Managing Anxiety & Grief Promoting Positive Body Image Encouraging Spiritual Well-being Human Immunodefinciency Virus (HIV) HIV Infection Retroviruses HIV asymptomatic HIV symptomatic Acquired Immunodeficiency Syndrome (AIDS) Risk factors: – Transmitted through bodily fluids Sexual intercourse (heterosexual or homosexual) Injection of IV drugs Transfusions Childbirth/breastfed Clinical Manifestations Respiratory: – SOB, dyspnea, cough, chest pain, fever are characteristic of pneumonia G.I.: – Loss of appetite, N&V, oral candidiasis, diarrhea Neuro: – Encephalopathy, peripheral neuropathy Clinical Manifestations Cont’ Integumentary: – Herpes simplex, flaking skin, skin cancers Reproductive: – Vaginal candidiasis, ulcerative sexually transmitted diseases (syphilis, herpes), PID, amenorrhea Other: – Fatigue, headache, night sweats, weakness, weight loss, dry cough, SOB, diarrhea, edema, swallowing difficulties, dementia, depression Assessment Dietary Status Skin & Mucous Membranes Respiratory Status Neurologic Status Fluid & Electrolytes Status Level of Knowledge Use of Alternative Therapies Nursing Diagnosis Impaired skin integrity Risk for infection Activity intolerance Disturbed thought processes Ineffective airway clearance Imbalanced nutrition Diarrhea Pain Social isolation Anticipatory grief Deficient knowledge Nursing Interventions Improving airway clearance Promoting skin integrity Maintaining perineal skin integrity Prompting usual bowel habits Preventing infection Relieving pain & discomfort Improving nutritional status Improving activity tolerance Maintaining thought processes Coping with grief Monitoring & managing complications