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MEDICAL SURGICAL NURSING II
VNRS B85
NURSING CARE OF CLIENTS WITH HEMATOLOGIC DISORDERS
Introduction:
This chapter focuses on disorders affecting the blood and blood-forming organs.
Disruptions of the hematopoietic system range from minor disruptions to life-threatening.
Clients with hematologic disorders need holistic nursing care, emotional support, and
care for problems involving major body systems.
Learning Outcomes:
Upon completion of this chapter, the student will be able to:
A.
Theory
1.
Relate the physiology and assessment of the hematologic system and
related systems to commonly occurring hematologic disorders.
2.
Describe the pathophysiology of common hematologic disorders.
3.
Explain nursing implications for medications and other treatments
prescribed for hematologic disorders.
4.
Discuss indications for and complications of bone marrow or stem cell
transplantation, as well as related nursing care.
5.
Compare and contrast the pathophysiology, manifestations, and
management of bleeding disorders.
6.
Describe the major types of leukemia and the most common treatment
modalities and nursing interventions.
7.
Differentiate Hodgkin’s disease from non-Hodgkin’s lymphomas.
Assignment:
LeMone-Burke Chapter 34
CHAPTER 34
LECTURE OUTLINE
NURSING CARE OF CLIENTS WITH HEMATOLOGIC DISORDERS
Commonly Occurring Hematologic Disorders
•Anemia
•Iron Deficiency Anemia
•Vitamin B12 Deficiency Anemia
•Folic Acid Deficiency Anemia
•Sickle Cell Anemia
•Thalassemia
•Acquired Hemolytic Anemia
Commonly Occurring Hematologic Disorders
•Glucose 6-Phosphate Dehydrogenase Anemia
•Aplastic Anemia
•Myelodysplastic Syndrome
•Polycythemia
•Multiple Myeloma
•Neutropenia
•Infectious Mononucleosis
Pathophysiology of Common Hematologic Disorders
•Anemia
–Decreased RBC production
–Increased RBC loss
–Increase RBC destruction
•Nutritional Anemias
–Nutrient deficits affect RBC formation or hemoglobin synthesis
–Inadequate diet
–Malabsorption of the nutrient
–Increased need for the nutrient
Pathophysiology of Common Hematologic Disorders
•Hemolytic Anemia
–Premature lysis of RBCs
– Hematopoietic activity increases
–Causes immature RBCs
•Sickle Cell Anemia
–Hereditary, chronic hemolytic anemia
–RBCs become abnormally crescent shaped or sickled
–Causes synthesis of an abnormal form of hemoglobin
–Autosomal recessively transmitted
–Sickle cell crisis
Pathophysiology of Common Hematologic Disorders
•Thalassemia
–Inherited disorders of hemoglobin synthesis
•Mediterranean, Asian, or African-American
–Results in RBCs called target cells
•Distinctive bull’s-eye appearance
•Acquired Hemolytic Anemia
–Hemolysis due to factors outside the RBC
•Mechanical trauma to the RBC
•Autoimmune disorders
•Bacterial or protozoal infection
•Immune system-mediated response
•Response to drugs, toxins, chemical agents, or venoms
Pathophysiology of Common Hematologic Disorders
•Glucose-6-Phosphate Dehydrogenase Anemia (G6PD)
–Hereditary defect in RBC metabolism
–Generally causes direct oxidation of hemoglobin
–Triggered by exposure to drugs
•Aspirin
•Sulfonamides
•Vitamin K derivatives
•Aplastic Anemia
–Bone marrow fails to produce all three types of blood cells
–Leading to pancytopenia
Pathophysiology of Common Hematologic Disorders
•Myelodysplastic Syndrome
–Abnormal appearing bone marrow and cytopenia.
–Causes refractory anemia
–Stem cells fail to reproduce and differentiate
–Genetic components of stem cells altered
–Ability to produce normal cells is lost
•Polycythemia
–Excess of RBCs (hematocrit higher than 55%)
–Types: Primary, secondary and relative
Pathophysiology of Common Hematologic Disorders
•Multiple Myeloma
–Malignancy in which plasma cells multiply uncontrollably
–Cells infiltrate bone marrow, lymph nodes, spleen
–Affected bones are weakened
–Pathologic fractures
•Neutropenia
–Development/ maturation of granulocytes in the bone marrow suppressed
–Number of circulating neutrophils falls rapidly
–Immunity is significantly reduced
Pathophysiology of Common Hematologic Disorders
•Infectious Mononucleosis
–Epstein-Barr viral invasion of oropharyngeal lymphoid tissues
–Usually benign and self-limiting
–Incubation period: 4 to 8 weeks
Nursing Implications
•Anemia
–Medications
•Iron replacement therapy for iron deficiency anemia
•Parenteral vitamin B12 for vitamin B12 deficiency anemia
•Folic acid supplementation
•Hydroxyurea for sickle cell anemia
•Erythropoietin
•Immunosuppressive therapy to treat aplastic anemia
–Treatments
•Blood
transfusion
–Nursing diagnoses
•Activity
intolerance
oral mucous membranes
•Risk for decreased cardiac output
•Self-care deficit
•Impaired
Nursing Implications
•Myelodysplastic Syndrome
–Treatments
•Frequent red blood cell transfusion
•Iron chelation therapy
•Administration of blood cell growth factors
•Platelet transfusion
•Antibiotic therapy
•Chemotherapy regimens
•Stem cell transplant is the only hope for a cure
–Nursing diagnoses
•Activity intolerance
•Risk for ineffective health maintenance
Nursing Implications
•Polycythemia
–Treatment
•Chemotherapeutic agents
•Smoking cessations
•Periodic phlebotomy
–Medications
•Antihistamines
•ASA
–Nursing diagnoses
•Decisional conflict regarding smoking cessation
•Pain
•Risk for ineffective tissue perfusion
Nursing Implications
•Multiple Myeloma
–Treatment
•No cure
•Induction chemotherapy
•Stem cell transplant
•Maintenance chemotherapy
–Nursing diagnoses
•Chronic pain
•Impaired physical ability
•Risk for injury
Nursing Implications
•Neutropenia
–Treatments
•Hematopoietic growth factor
•Antibiotics
•Isolation
–Primary nursing diagnosis
•Risk for infection
Nursing Implications
•Infectious Mononucleosis
–Treatment
•Bedrest
•Analgesic agents
–Nursing care
•Primarily educational
Bone Marrow or Stem Cell Transplantation
•Bone Marrow Transplant
–Allogeneic BMT
•Donor bone marrow
•Prior to transfusion leukemic cells are destroyed
–Autologous BMT (bone marrow rescue)
•Uses the client’s own remission bone marrow
•Administered in case of relapse occurs
•Lethal doses of chemotherapy or radiation are given
•Thawed marrow in administered
–Nursing care
•In both, client is critically ill
•Bone marrow is destroyed
•Potential complications include malnutrition, infection, and bleeding
Bone Marrow or Stem Cell Transplantation
•Allogeneic Stem Cell Transplant (SCT)
–Alternative to BMT
–Complete/sustained replacement of blood cell lines
•Nursing Care
–Complications is similar to those of BMT
Bleeding Disorders
•Thrombocytopenia
–Immune Thrombocytopenic Pupura (ITP)
•Manifestations—petechiae, purpura, bruising, epistaxis, hematuria, excess menstrual
bleeding, bleeding gums
–Thrombotic Thrombocytopenic Purpura (TTP)
•Manifestations—purpura, petechiae, headache, seizures, altered consciousness
–Heparin Induced Thrombocytopenia (HIT)
•Manifestations—bleeding, arterial thrombosis, venous thrombosis
Bleeding Disorders
•Hemophilia
–Manifestations—hemarthrosis, easy bruising, bleeding, hematuria, epistaxis, pain
•Disseminated Intravascular Coagulation (DIC)
–Manifestations—oozing to frank hemorrhage
Major Types of Leukemia
•Acute Lymphocytic (Lymphoblastic) Leukemia (ALL)
•
•Chronic Lymphocytic Leukemia (CLL)
•
•Acute Myeloid (Myeloblastic) Leukemia (AML)
•
•Chronic Myeloid (Myelogenous) Leukemia (CML)
Hodgkin’s Disease and Non-Hodgkin’s Lymphomas
•Hodgkin’s Disease
–Develops in a single lymph node or chain of nodes
–Spreads to adjoining cells
–Reed-Steinberg cells
–Immune system impairment
–Etiology
•Epstein-Barr virus
•Genetic factors
Hodgkin’s Disease and Non-Hodgkin’s Lymphomas
–Manifestations
•Painlessly enlarged lymph nodes
–Generally cervical or subclavicular
•Persistent fever, night sweats
•Fatigue, malaise
•Weight loss
•Pruritus
•Anemia
Hodgkin’s Disease and Non-Hodgkin’s Lymphomas
•Non-Hodgkin’s Lymphoma
–Do not contain Reed-Steinberg cells
–Etiology
•Often unknown
•Viral infections may play a role
–Manifestations
•Early similar to Hodgkin’s disease
•Fever, night sweats, fatigue, and weight loss are less common