Post on 15-Dec-2015
Nursing 210 Fluid and Cells
Nursing management of patients with hematologic dysfunction
Laurie Brown RN, MSN, MPA-HA, CCRN
Mean Corpuscular Hemoglobin (MCH)
Mean Corpuscular Volume (MCV)
Mean Corpuscular Hemoglobin Concentration (MCHC)
Red Cells
Drugs Impairing the Hematologic System
Drugs causing bone marrow suppression
Drugs causing hemolysis Drugs that disrupt platelet action Drugs that disrupt clotting action
Iron Deficiency Pernicious
Anemia Folic Acid
Deficiency Trauma Chronic loss
Sickle Cell Infectious
Agents Antibodies Aplastic Anemia G6PD Deficiency
ANEMIASANEMIAS
Pernicious Anemia
Vitamin B 12 Intrinsic Factor Cells mutate and become large Development of Neurological
problems
Clotting Problems
Thrombocytopenia Hemophilia Von Willebrand Disseminated Intravascular
Coagulation (DIC)
Heparin Administration Heparin loading dose Initial Maintenance Infusion Dosage calculation often
by patients weight
TransfusionAdministration
Identification Lab values Drs order verify Pt assessment IV site assessment Documentation Verify with 2nd RN Monitor VS Remain with the
patient
Automatic IV infuser pump Flow rate calculation Blood/Blood product w/tag 150 cc NS Blood Administration Set Gloves
Blood Bank
Patient name and I.D. number Unit number and ABO/Rh type
on bag with blood bag compatibility tag & bag unit/type
Verify expiration date on blood bag
Autologous Blood Transfusions
Preoperative autologous blood donation Acute normovolemic hemodilution Intraoperative autologous transfusion Postoperative blood salvage
Characteristics of Normal Cells Limited Cell Division Specific Morphology Small Nuclear-Cytoplasmic Ratio Perform Specific Differentiated Functions Adhere tightly together… Are nonmigratory Grow in an orderly and well
differentiated manner Are contact inhibited
Characteristics of Malignant Cells
Demonstrate rapid or continuous cellular division.
Show anaplastic morphology Have a large nuclear-cytoplasmic ratio Lose some or all differentiated functions Adhere loosely together Are able to migrate Grow by invasion Are not contact-inhibited
Leukemia
AML - Acute Myelogenous ALL - Acute Lymphocytic
CML - Chronic Myelogenous
CLL - Chronic Lymphocytic
FAB Leukemia Classification
French American British Classification
Historically distinguishing AML from ALL was a major clinical problem
Chemotherapy dependent on tissue type
Acute Leukemia NCCN Guidelines
National Comprehensive Cancer Network (NCCN) has issued guidelines for treatment of many cancers including Leukemia as well as other hematological malignancies
http://www.nccn.org/index.html
History of Myeloma Skeletal evidence of myeloma
obtained from Egyptian mummies First case described in 1844 1845 Dr Henry Bence Jones detected
heat properties of urinary light chains 1929 Bone marrow aspiration 1937 serum protein electrophoresis 1960 Alkeran and prednisone- first
treatment
What is Multiple Myeloma?
A cancer of the bone marrow The location where cells are produced
The affected cells are plasma cells Plasma cells produce antibodies
(proteins that fight off infection)
To Many Harmful Plasma Cells
Abnormal Plasma Cells are called Myeloma Cells and develop without warning
Myeloma cells collect in bones and cause “soft spots” where the cell is damaged
Effects of the blood Normal cells are not
being produced in the bone marrow
Bones are damaged Bone demineralization
(soft spots)