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Download Chapter 24 Nursing Care of Patients with Hematopoietic
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Nursing Care of Patients with Hematologic and Lymphatic Disorders Deficiency of Red Blood Cells, Hemoglobin, or Both ◦ Impaired Production ◦ Increased Destruction ◦ Blood Loss Reduced Capacity to Carry Oxygen to Tissues Dietary Deficiencies Hemolysis Hereditary Disorders Pallor Tachycardia Tachypnea Irritability Fatigue Dyspnea Pernicious Anemia ◦ Numb Hands or Feet ◦ Sore Tongue Iron Deficiency ◦ Mouth Fissures ◦ Glossitis ◦ Spoon-shaped Nails CBC with Microscopic Examination Bone Marrow Analysis Tests to Determine Source of Bleeding Eliminate Cause Dietary Changes Supplements Transfusions Activity Intolerance Imbalanced Nutrition Risk for Injury Impaired Oral Mucous Membranes Bone Marrow Does not Produce Adequate RBCs Causes ◦ Congenital ◦ Exposure to Toxins ◦ Chemotherapy Weakness Fatigue Pallor Dyspnea Headache Ecchymoses Petechiae Frank Bleeding Infection Death Diagnosis ◦ ◦ ◦ ◦ CBC Bone Marrow Biopsy TIBC Serum Iron Treatment ◦ Treat Cause ◦ Colony Stimulating Factors ◦ Steroids ◦ Bone Marrow Transplant Inherited Autosomal Recessive Disorder Diagnosis ◦ Sickledex Test ◦ Hemoglobin Electrophoresis ◦ CBC ◦ ESR Crisis Treatment ◦ ◦ ◦ ◦ ◦ Antibiotics Pain Management Transfusions Fluids Oxygen Avoid Risk of Reduced Oxygenation ◦ Exposure to Cold ◦ Infection ◦ Strenuous Exercise Low Dose Penicillin Frequent Transfusions Hydroxyurea Risk for Ineffective Tissue Perfusion Acute Pain Avoid ◦ ◦ ◦ ◦ ◦ ◦ ◦ Tight Clothing Strenuous Exercise Alcoholic Beverages Cold Temperatures Smoking Unpressurized Aircraft Exposure to Infection Overabundance of Red Cells Hemoglobin >18 mg/dL Hematocrit >55% Blood Becomes Thick ◦ Primary ◦ Secondary Hypertension Visual Changes Headache Vertigo Dizziness Tinnitus Bleeding Chest Pain Dyspnea Dark, Flushed Skin Itching Phlebotomy Low Dose Aspirin Chemotherapy Radiation Therapy Drink 3 Liters of Water Daily Avoid Restrictive Clothing Elevate Feet Report Signs and Symptoms of Iron Deficiency Report Signs and Symptoms of Bleeding Pathophysiology ◦ Accelerated Clotting ◦ Clotting Factors Depleted ◦ Bleeding Etiology ◦ Major Trauma Abnormal Bleeding Joint Pain Nausea and Vomiting Organ System Failure Convulsions Shock, Coma Death Easy Bruising Petechiae Blood in Urine Black Tarry Stools Bleeding from Nose or Gums New Onset of Painful Joints PT, PTT Platelet Count Hbg Hemoglobin, Creatinine Correct Underlying Cause Administer ◦ ◦ ◦ ◦ Blood FFP Platelets Cryoprecipitates Recognize and Report Bleeding Avoid Trauma and Further Bleeding Teach Patient and Family Pathophysiology ◦ Platelet Destruction by Immune System ◦ Risk for Bleeding Etiology ◦ Acute Viral Illness ◦ Drug Reaction ◦ Immune System Dysfunction Bleeding ◦ Petechiae ◦ Ecchymoses ◦ Bleeding Platelet Count Bleeding Time Bone Marrow Aspiration Steroids Chemotherapy Transfusions Vitamin K Chemotherapy Splenectomy Bleeding Precautions Recognize and Report Signs and Symptoms Bleeding Teach Patient and Family Use Electric Razor Use Soft Toothbrush Avoid Invasive Procedures, Injections Maintain Pressure if Blood Draw Essential Wear Shoes or Slippers Avoid Bumps and Bruises Avoid Aspirin and Nsaids Administer Stool Softener Handle Patient Gently Gentle Nose Blowing Pathophysiology ◦ Missing Clotting Factors A—Factor VIII B—Factor IX Etiology ◦ Heredity Bleeding ◦ ◦ ◦ ◦ Joints Muscles Subcutaneous Tissue Brain PTT Factor Levels Desmopressin Clotting Factors ◦ Factor VIII ◦ Factor IX Blood Transfusion Pain Ineffective Protection Risk for Ineffective Self Health Management Pathophysiology ◦ Increase in Immature WBCs ◦ Unable to Fight Infection Risk Factors ◦ Viruses ◦ Genetic Factors ◦ Radiation/Chemotherapy Acute Lymphocytic Leukemia Acute Myelogenous Leukemia Chronic Lymphocytic Leukemia Chronic Myelogenous Leukemia Fever Infection Pallor Weakness Tachycardia Palpitations Dyspnea Abdominal Pain Malaise Sternal/Rib Pain CNS Changes Bleeding CBC Bone Marrow Aspiration Lumbar Puncture Genetic Analysis Chemotherapy Radiation Therapy Bone Marrow Transplant Peripheral Blood Stem Cell Transplant Risk for Injury: Infection, Bleeding Fatigue Impaired Oral Mucous Membranes Knowledge Deficit Anxiety Pathophysiology ◦ Cancer of Plasma Cells in Bone Marrow ◦ Tumors Devour Bone Tissue ◦ Organ Invasion Etiology ◦ Unknown ◦ Occupational Exposures Bone Pain Fever Malaise Spinal Cord Compression Pathological Fractures Hypercalcemia Infection CBC, Blood Calcium Bone X-Rays Urine for Bence Jones Protein Bone Marrow Biopsy Steroids Chemotherapy Control of Serum Calcium Radiation Stem Cell Transplantation IV Pamidronate (Aredia) Risk for Infection Risk for Injury ◦ Fracture ◦ Complications of Immobility ◦ Hypercalcemia Cancer of Lymph System ◦ Presence of Reed-Sternberg Cells Etiology ◦ Viral ◦ Genetic ◦ Immune Dysfunction Painless Swollen Lymph Node Pruritis Pain Induced by Alcohol Fever Night Sweats Weight Loss Malaise Edema of Face and Neck Jaundice Nerve Pain Retroperitoneal Node Involvement Spleen, Liver, and Bone Involvement Biopsy ◦ Lymph Node ◦ Liver and Spleen ◦ Bone Marrow CT, Chest X-Ray Lung Bone Scan Lymphangiography CBC Stage I: Single Lymph Node or Site Stage II: Two or More Nodes on Same Side of Diaphragm Stage III: Nodes on Both Sides of Diaphragm Stage IV: Widely Disseminated Disease in Organs or Tissues Chemotherapy Radiation Therapy Impaired Comfort Activity Intolerance Risk for Infection Risk for Ineffective Coping Lymphoma Arising from B Cells and T Cells Absence of Reed-Sternberg Cells Etiology ◦ ◦ ◦ ◦ Some Viruses H Pylori Immune Dysfunction Occupational Exposures Painless Lymph Nodes Enlarged Tonsils and Adenoids Other Signs and Symptoms Similar to Hodgkin’s Disease Biopsy ◦ ◦ ◦ ◦ ◦ Lymph Nodes Tonsils Bone Marrow Liver Other Bone Scan CT, Chest X-ray, IVP MRI, PET Scan Lymphangiography CBC Liver Function Studies Serum Calcium Chemotherapy Monoclonal Antibodies Interferon Therapy Radiation Therapy Stem Cell Transplant Activity Intolerance Risk for Infection Risk for Ineffective Coping Hodgkin’s ◦ Less Common ◦ Age 15 to 40 and >55 ◦ Reed-Sternberg Cells ◦ Younger ◦ Good Prognosis ◦ Alcohol-induced Pain Non-Hodgkin’s ◦ More Common ◦ Usually >Age 50 ◦ Absence of ReedSternberg Cells ◦ Poorer Prognosis Surgical Removal of the Spleen Baseline Labs Blood Transfusion if Necessary Vitamin K Baseline Vital Signs Teach Coughing and Deep Breathing Monitor for Bleeding Monitor Vital Signs Administer Narcotics for Pain Encourage to Cough and Deep Breathe and Ambulate Bleeding Pneumonia Atelectasis Infection OPSI
