Chapter 28: Nursing Care of Patients with Hematopoietic and Lymphatic Disorders – Flashcards
Unlock all answers in this set
Unlock answersquestion
Anemia
answer
Deficiency of Red Blood Cells, Hemoglobin, or both. -Impaired Production -Increased Destruction -Blood Loss Reduced Capacity to Carry Oxygen to Tissues -Weakness, SOB
question
Aplastic Anemia
answer
Impaired Production of RBC
question
Hemolytic or Sickle Cell Anemia
answer
Increased Destruction of RBC
question
Trauma, Cancer
answer
Massive or Chronic Loss of RBC
question
Anemia S&S =
answer
-pallor -tachycardia -tachypnea -irritability -fatigue -dyspnea
question
Pernicious Anemia
answer
Numb hands or feet, sore beefy red tongue
question
Iron Deficiency
answer
Mouth Fissures, Glossitis, spoon-shaped nails
question
Anemia Diagnosis=
answer
-CBC with Microscopic Examination -Iron panel (serum iron, ferritin, total iron binding capacity serum folate) -bone marrow analysis -tests to determine source of bleeding
question
Anemia Therapeutic Interventions
answer
-Eliminate cause -Dietary Changes -Supplements -Transfusions
question
Anemia Nursing Diagnosis-
answer
-activity intolerance -imbalanced nutrition -risk for injury -impaired oral mucous membranes
question
Aplastic Anemia definition
answer
Hypoplastic anemia-Bone marrow becomes fatty and does not produce adequate numbers of RBCs
question
Aplastic Anemia Causes=
answer
-congenital -exposure to toxins -chemotherapy -infection -autoimmune process
question
Aplastic Anemia
answer
Leads to pancytopenia
question
Aplastic Anemia S&S =
answer
-weakness -fatigue -pallor -dyspnea -headache -ecchymoses -petechiae -frank bleeding -infection -death
question
Aplastic Anemia Diagnosis
answer
-Bone Marrow Biopsy (marrow appears pale, fatty, yellow, instead of red) -TIBC level -CBC -Serum Iron
question
Aplastic Anemia Treatment
answer
Treat cause, transfusions, colony stimulating factors-erythropoietin, steroids-stim production, bone marrow transplant, prevent infection/bleeding
question
Sickle Cell Anemia
answer
-Inherited Autosoma Recessive Disorder -Fragile Cells with shorter life span of 10-20 days
question
Sickle Cell Anemia Etiology=
answer
-autosomal recessive inherited disorder -Most common in African American -Asymptomatic in infants until after 6 months
question
Sickle Cell Anemia S&S =
answer
-triggered by hypoxia, if sickling does not revers, it leads to sickle cell crisis: Infarctions, joint pain & swelling, abd pain, priapism, renal failure
question
Sickle Cell Anemia Diagnosis
answer
-Sickledex test- shows sickling -hemoglobin electrophoresis- shows hgb S -CBC-RBC lower, Hgb - lower -ESR -lower
question
Sickle Cell Anemia Crisis treatment
answer
-Antibiotics -Pain management -transfusions - fluids -oxygen
question
Sickle Cell Anemia Crisis Prevention
answer
avoid risk of reduced oxygenation -exposure to cold -infection-strenuous exercise Low Dose Penicillin Frequent Transfusions Hydroxyurea-helps to prevent sickling, but has life threatening side effects and long onset of action Bone Marrow Transplant-difficult due to antibodies
question
Sickle Cell Anemia Nursing Diagnoses
answer
-Risk for ineffective Tissue Perfusion -Acute Pain -Risk for non adherence to regimen
question
Sickle Cell Anemia Patient Education =
answer
-avoid tight clothing -strenuous exercise -alcoholic beverages -cold temperatures -smoking -unpressurized aircraft -exposure to infection -Keep vaccines current -refer to support group
question
Polycythemia
answer
-Overabundance of Red Cells -Hemoglobin > 18 mg/dL -Hematocrit>55% -Blood Becomes Thick **Two types: -Polycytemia vera (PV) Primary-genetic mutation -Secondary compensatory from long term hypoxia
question
Polycythemia S&S =
answer
*hypertension, *visual changes, * headaches, *vertigo *tinnitus, * bleeding *thrombosis, *chest pain *dyspnea *dark-flushed skin *itching *Dizziness
question
Polycythemia Therapy interventions
answer
-Phlebotomy to decrease viscosity -low dose Aspirin -Chemotherapy -Radiation Therapy
question
Polycythemia Patient Education
answer
-drink 3 liters water daily -avoid restrictive clothing -elevate feet -reports signs and symptoms of iron deficiency -report signs and symptoms of bleeding
question
Disseminated Intravascular Coagulation (DIC)
answer
-accelerated clotting in peripheral vessels -clotting factors/ Platelets depleted -severe bleeding
question
DIC- Etiology =
answer
major trauma-overwhelming infection, obstetrical complications, cancer-related, crushing/burn injuries, abd surgery
question
DIC- S&S =
answer
*abnormal bleeding *joint pain *nausea/vomiting *organ system failure *convulsions *shock *coma *death
question
ITP - NC Bleeding S&S =
answer
*easy bruising *petechiae *blood in urine *black tarry stools *bleeding from nose/gums *new onset of painful joints
question
DIC - Diagnostic Test =
answer
-PROLONGED- pt, ptt -DECREASED- platelet count -DECREASED- Hemoglobin -INCREASED- Creatinine
question
DIC - therapeutic interventions =
answer
correct underlying cause <--Early administer: blood, ffp, platelets, cryoprecipitates
question
DIC - Nursing Care =
answer
-recognize &report bleeding -avoid trauma &further bleeding -teach patient and family
question
Idiopathic Thrombocytopenic Purpura (ITP)
answer
-Platelet destruction by immune system -risk for bleeding
question
ITP - Etiology =
answer
-thought to be triggered by acute viral illness, (Rubella, Chick Pox, Hep C, HIV) -drug reaction -immune system dysfunction
question
ITP - S&S =
answer
-petechiae -ecchymoses -bleeding (nose,mouth, GI tract, can effect vital organs) *So thrombocytopenia with platelet count less than 20,000 with only a few hour life span*
question
ITP - Diagnosis =
answer
-Platelet Count= critical -Bleeding Time=prolonged -Bone Marrow Aspiration= short life span for platelets
question
ITP Therapeutic Interventions
answer
-Steroids= prolonged platelet life -Transfusions= for acute bleeding -Vitamin K= for acute bleeding -Chemotherapy -Splenectomy= after all other options exhaust
question
ITP - Nursing Care =
answer
-Bleeding Precautions -Recognize and report S&S of bleeding -Teach patient and family
question
ITP - NC- Bleeding Precautions =
answer
-Use Electric Razor -Use Soft Toothbrush -Avoid invasive procedures, injections -Maintain Pressure for at least 5 min if blood draw essential -wear shoes/ slippers -avoid bumps & bruises -avoid aspirin & Nsaids -Administer Stool Softener -Handle Patient Gently -Gentle Nose Blowing
question
Hemophilia =
answer
Missing Clotting factors prevent formation of a stable fibrin clot A-factor VIII deficiency (classic) *Most Common* B-factor IX deficiency (Christmas) May be mild or severe
question
Hemophilia Etiology =
answer
-Heredity, X-linked recessive trait -Daughter of affected father= 50% so are carriers -Sons with gene are born with it
question
Hemophilia S&S =
answer
*Bleeding* -joints -muscles -subcutaneous tissue -brain
question
Hemophilia Diagnosis =
answer
-PROLONGED Ptt -factor levels (determine which is absent) -No Cure
question
Hemophilia Therapeutic Interventions =
answer
-Desmopressin (DDAVP)-stimulates release of clotting -Replacement of Clotting Factors -Factor VIII -Factor IX -Blood transfusion after trauma or surgery -If patient says bleeding has started, & no signs are present...Still believe the patient
question
Hemophilia Nursing Diagnosis =
answer
-pain -ineffective protection -risk for ineffective self health management
question
Leukemia Pathophysiology =
answer
- Unknown cause -Increase in Immature WBCs- all types -Unable to Fight Infection -Anemic r/t lack of RBC production, bleeding becomes a problem as less platelets are produced
question
Leukemia Risk Factors =
answer
-Viruses -Genetic Factors -Radiation/Chemotherapy -Diagnosis may be made r/t infection that isn't clearing up
question
Leukemia Class/Types =
answer
*Classifications=* -Acute/Chronic -Lymphoid= lymphocyte involvement -Myeloid= stem cells of bone marrow -Acute Lymphocytic Leukemia- (ALL) (ALL)- lymphoblast, most common in children -Acute Myelogenous Leukemia- (AML) (AML)- myeloblastic, Over 60; poor prognosis -Chronic Lymphocytic Leukemia- (CLL) (CLL)- B&T Lymphocytes, Adults -Chronic Myelogenous Leukemia-(CML) (CML) Philadelphia Chromosome; Older Adults
question
Leukemia S&S =
answer
-Fever-general -Infection-general -Weakness/fatigue- general -Bleeding-general -Dyspnea -Abdominal Pain -Malaise -Sternal/Rib Pain -CNS Changes -Pallor -Tachycardia -Palpitations
question
Leukemia Diagnostic Test =
answer
--CBC (Points toward diagnosis, DECREASED Platelets, RBC, & Mature WBC) --Bone Marrow Aspiration (Confirm the Diagnosis) --Lumbar Puncture (checking for CNS involvement) --Genetic Analysis (Show Philadelphia Chromosome>CML)
question
Leukemia Therapeutic Interventions =
answer
-Chemotherapy -Radiation Therapy -Bone Marrow Transplant -Peripheral Blood Stem Cell Transplant
question
Leukemia Nursing Diagnoses pg.578 =
answer
-Risk for Injury;(Infection, Bleeding) R/T Pancytopenia -Fatigue R/T low RBC& Oxygenation, effects of treatment -Impaired Oral Mucous Membranes R/T Chemo & Pancytopenia -bleeding, ulcers, pain -Knowledge Deficit -Anxiety *be aware pt. can have anemia-thrombocytopenia-leukopenia Box 28-3 p.577 & Box—28-2
question
Multiple Myeloma =
answer
-most die within 3 months -Cancer of Plasma Cells in Bone Marrow -Tumors Devour Bone Tissue -Organ Invasion -most often effects men aged 50-70 *Cause: Unknown, Occupational Exposures
question
Multiple Myeloma S&S =
answer
-Bone Pain <--most common -Fever -Malaise -Spinal Cord Compression -Pathological Fractures- -Hypercalcemia (calcium is mobilized from the bones) -Infection= death from sepsis
question
Multiple Myeloma Diagnosis =
answer
-CBC -Blood Calcium (Calcium flushed out of bones into urine) -Bone X-Rays (Show holes in Bones "Swiss Cheese") -Urine (M-Type Globin's/Bence Jones Protein) -Bone Marrow Biopsy (Confirm & Stage )
question
Multiple Myeloma Therapeutic Interventions=
answer
*Managing the disease* --Steroids --Chemotherapy --Radiation --Stem Cell Transplantation *Controlling Symptoms* --IV Pamidronate (Aredia) Control of Serum Calcium; Goal- Below 10
question
Multiple Myeloma Nursing Diagnoses p.582
answer
-Risk for Infection -Risk for Injury -Fracture -Complications of Immobility -Hypercalcemia
question
Hodgkin's Disease pg. 582
answer
-Cancer of Lymph System -Presence of -Reed-Sternberg Cells -most curable *Etiology* -Viral -mononucleosis -Genetic -unknown -Immune Dysfunction
question
Hodgkin's Disease S&S=
answer
-Painless Swollen Lymph Node -common -Pruritis -Pain Induced by Alcohol -Fever -Night Sweats -Weight Loss -Malaise
question
Hodgkin's Disease S&S LATE=
answer
-Edema of Face and Neck -Jaundice -Nerve Pain -Retroperitoneal Node Involvement -Spleen, Liver, & Bone Involvement
question
Hodgkin's Disease Diagnosis=
answer
-Biopsy (of the easiest Lymph Node to assess) -Biopsy of Liver, Spleen, Bone Marrow -CT -Chest X-Ray -Lung -CBC -Bone Scan -Lymphangiography
question
Hodgkin's Disease Stages =
answer
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
question
Hodgkin's Disease = Therapeutic Interventions
answer
-Chemotherapy -Radiation Therapy
question
Hodgkin's/ Non-Hodgkin's Nursing Diagnosis =
answer
-Activity Intolerance R/T fatigue & anemia -Risk for Infection R/T BoneMarrow&SideEffects-treatment -Risk for Ineffective Coping R/T diagnosis, lifestyle changes
question
Non-Hodgkin's Lymphomas =
answer
-All other Lymphomas put into this category -Lymphoma Arising from B Cells and T Cells -Absence of Reed-Sternberg Cells *Etiology* -Some Viruses -H Pylori -Immune Dysfunction -Work Exposures
question
Non-Hodgkin's Lymphomas S&S =
answer
-Painless Lymph Nodes -Enlarged Tonsils and Adenoids -Other Signs and Symptoms Similar to Hodgkin's Disease * Review Summary p.586
question
Non-Hodgkin's Lymphomas Diagnosis =
answer
-Biopsy (Lymph Nodes, Tonsils, Bone Marrow, Liver) -PET Scan (extent of the disease) -Bone Scan -MRI -CT -Chest X-ray - IVP -Calcium (Elevated w/ Bone Lesions) -Lymphangiography -CBC -Liver Function Studies
question
Non-Hodgkin's Lymphomas Therapeutic Interventions =
answer
-Chemotherapy -Monoclonal Antibodies -Interferon Therapy -Radiation Therapy -Stem Cell Transplant
question
*HODGKIN'S* -Less Common -Age 15 to 40 and >55 -Reed-Sternberg Cells -Younger -Good Prognosis -Alcohol-induced Pain
answer
*NON-HODGKINS* -More Common -Usually >Age 50 -Absence of Reed-Sternberg Cells -Poorer Prognosis
question
Splenectomy-
answer
surgical removal of the spleen, sometimes used to treat selective hematologic disorders & to stage Lymphomas.
question
Splenectomy Pre-OP =
answer
-Baseline Labs -Blood Transfusion if Necessary -Vitamin K -Baseline Vital Signs -Teach Coughing & Deep Breathing
question
Splenectomy Post-OP =
answer
-Monitor for Bleeding -Monitor Vital Signs -Administer Narcotics for Pain -Encourage to Cough, Deep Breathe &Ambulate
question
Splenectomy Complications =
answer
-Bleeding -Pneumonia -Atelectasis -Infection -OPSI *Educate patient on need for yearly flu shot
question
The patient with which type of anemia must avoid strenuous exercise and cold temperatures?
answer
Sickle Cell
question
Patients with which disorders are at risk for hemorrhage?
answer
-ITP -Hemolytic Anemia -DIC -Aplastic Anemia -Multiple Myeloma
question
The patient with which disorder is most at risk for fractures?
answer
Multiple Myeloma
question
What assessment is most important for the patient with leukemia?
answer
Tempature
question
Which patient must be instructed about the risk of OPSI?
answer
Post-splenectomy patient
question
Splenomegaly
answer
Enlarged Spleen
question
Ecchymosis
answer
Bruising or Bleeding under the skin
question
Purpura
answer
Hemorrhage into the skin, mucous membranes or organs
question
Therapeutic Range for a Patient on INR?
answer
2-3
question
Normal Hematocrit Levels
answer
Man- 43 -49% Woman- 38 -44%
question
Normal WBC's ?
answer
4,500-11,000
question
Normal Platelet Level?
answer
150,000 - 450,000 *20,000 & Below CRITICAL*
question
Glossitis
answer
Inflamed tongue, seen in certain types of anemia
question
Normal pH of Blood?
answer
7.35 - 7.45
question
Hemolysis
answer
Destruction of RBC
question
Hemarthrosis
answer
Bleeding into the joints
question
Pancytoopenia
answer
Reduced count of all formed elements from Bone Marrow (RBC, WBC, Platelets )
question
Hemophilia
answer
Bleeding Disorder that results from lack of clotting factors
question
*Normal RBC* Increased--> Chronic Hypoxia Decreased--> anemia or blood loss
answer
Man- 4.71- 5.14 M Woman- 4.2- 4.87 M
question
Ptt Therapeutic Range
answer
1.5 - 2.0 times Normal
question
Pt Therapeutic Range
answer
..
question
-Packed RBC's
answer
Severe Blood loss or anemia
question
-Frozen RBC's
answer
Autotransfusion- taken from pt for future surgury prevention of febrile reactions
question
-Platelets
answer
Bleeding caused by Thrombocytopenia
question
-Albumin
answer
Hypovolemia caused by hypoalbuminemia
question
-Fresh Frozen Plasma
answer
Provides clotting factors for bleeding disorders; occasionally for volume replacement
question
-Cryoprecipitates
answer
Bleeding caused by specific missing clotting factors
question
-*Blood Transfusions * -Stay with pt for at least 1st 15MINS, watch for reaction -Most Common Reaction, Fever (Febrile Reaction) - If fever/symptoms occur STOP transfusion -> NS -Circulatory Overload r/t Rapid Transfusion in a short time. Old people most at risk for fluid overload.
answer
-RNs administer, LPNs may assist -2 person verification process -Only use Normal Saline NS with Blood -Timing 2 hrs, - 4 hrs MAX -Filters are used with blood administration tubing -Warmed 98.6- pts with severe bleeding, prevent hypothermia, which can cause heart dysrthythmias, & shivering, <--can destroy blood cells & platlets
question
-Before Blood Transfusion
answer
-Match the blood to the order -match the patient to the blood -check the patients vital signs
question
what circumstance places the pt at most risk for post op pneumonia following a splenectomy?
answer
Location of surgical incision
question
nurse response to describe DIC r/t why the pt is bleeding ?
answer
"pt is bleeding because his body's clotting factors have all been used up"
