Ch 42: Hematological Interventions (per Amendolair)

8/8/2019 Ch 42: Hematological Interventions (per Amendolair)

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Interventionsfor Clientswith

HematologicProblems

Chapter 42


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Red Blood Disorders


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Anemia

Reduction in either the number of red blood cells,the amount of hemoglobin, or the hematocrit

Clinical sign (not a specific disease); amanifestation of several abnormal conditions

See Table 43-1 Common Causes ofAnemia

Elsevier items and derived items


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Anemias: RBC

Anemias Caused by Increase Destruction of RBC

Sickle Cell

Glucose-6-Phosphate Dehydrognenase Deficiency Anemia

Anemias resulting from Decrease Production of

RBC Iron Deficiency Anemia

Vitamin B12 Deficiency Anemia

Aplastic Anemia

Polycythemia Vera Myelodysplastic syndromes


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Anemias: WBC Disorders

Leukemia

Malignant Lymphomas Hodgkins Lymphoma

Non-Hodgkins Lymphoma

Multiple Myeloma


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Anemia: Coagulation Disorders

Platelet Disorders

Autoimune Thrombocytopenic Purpura

Thrombotic Thrombocytopenic Purpura

Clotting Factor Disoders

Hemophilia


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Sickle Cell Disease

Genetic disorder resulting in chronic anemia, pain,disability, organ damage, increased risk for infection,and early death

Formation of abnormal hemoglobin chains(Continued)



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Sickle Cell Disease (Continued)

Conditions causing sickling: hypoxia, dehydration,infections, venous stasis, low environmental bodytemperatures, acidosis, strenuous exercise, andanesthesia.



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Figure 43-01. Red blood cell actions under conditions of low tissue oxygenation

. HbA,H

emoglobin A; HbS, hemoglobin S.


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To have an autosomal recessive disorder, you inherit twomutated genes, one from each parent. These

disorders are usually passed on by two carriers. Their health is rarely affected, but they have one mutated

gene (recessive gene) and one normal gene (dominant gene) for the condition. Two carriers have a 25 percent

chance of having an unaffected child with two normal genes (left), a 50 percent chance of having an unaffected

child who also is a carrier (middle), and a 25 percent chance of having an affected child with two recessive

genes (right).


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Clinical Manifestations

Cardiovascular changes

Skin changes

Abdominal changes

Musculoskeletal changes

Central nervous system changes



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Interventions

Pain is the most common problem.

Drug therapy: 48 hours of intravenous analgesics

Oral hydration

Complementary and alternative therapies



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Potential for Sepsis

Interventions include:

Protection of the client from infection in sickle cell crisis

Drug therapy



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Potential for Multiple Organ Dysfunction

Interventions include:

Hydration

Oxygen therapy

Transfusion therapy



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Glucose-6-Phosphate Dehydrogenase (G6PD)Deficiency Anemia

Most common type of congenital hemolytic anemia

Hydration

Screening for this deficiency necessary beforedonating blood, because cells deficient in G6PD

can be hazardous



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Iron Deficiency Anemia

This common type of anemia can result fromblood loss, poor intestinal absorption, orinadequate diet.

Evaluate adult clients for abnormal bleeding.

Supplemental iron is the treatment.



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Vitamin B12 Deficiency Anemia

Anemia is caused by inhibiting folic acid transportand reducing DNA synthesis in precursor cells.

Vitamin B12 deficiency is a result of poor intake offoods containing vitamin B12.

(Continued)



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Vitamin B12 Deficiency Anemia (Continued)

Pernicious anemia is anemia caused by failure toabsorb vitamin B12 and lack of intrinsic factor;clients often exhibit paresthesia.



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Folic Acid Deficiency Anemia

Can cause megaloblastic anemia

Manifestations similar to those of vitamin B12deficiency, but nervous system functions remainnormal

(Continued)



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Folic Acid Deficiency Anemia (Continued)

Caused by:

Poor nutrition and chronic alcohol abuse

Malabsorption syndromes, such as Crohns disease

Drugs, including anticonvulsants and oral contraceptives,

that slow or prevent absorption of folic acid



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Aplastic Anemia

Deficiency of circulating RBC due to bone marrowfailure to produce RBC

Cause: Injury to immature RBC

Long term exposure to toxic agents and drugs Ionizing radiation exposure

Infection

Unknown

Fanconis anemia hereditary aplastic anemia

Associated with leukopenia and thrombocytopenia

Assess

Management


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Polycythemia Vera

Disease with a sustained increase in bloodhemoglobin

Massive production of red blood cells

Excessive leukocyte production

Excessive production of platelets

Assessment

Bone Marrow aspiration

Phlebotomy

Increased hydration

Anticoagulants are part of therapy



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In a bone marrow aspiration and biopsy, a doctoror nurse uses a thin needle to

remove a small amount of liquid bone marrow, usually from a spot in the back of

your hipbone called the posterior iliac crest. A bone marrow biopsy isoften taken at

the same time. Thissecond procedure removes a small piece of bone tissue and the

enclosed marrow.


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Leukemia

Type of cancer with uncontrolled production of immaturewhite blood cells in the bone marrow

Acute or chronic

Classified by cell type

Risk factors: ionizing radiation, exposure to certainchemicals and drugs, bone marrow hypoplasia, geneticfactors, immunologic factors, environmental factors



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Your body's lymphatic system is part of your immune system, which protects you

against infection and disease. It includes yourspleen, thymus, lymph nodes and

bonemarrow. In people with leukemia, the bone marrow produces a large number

of abnormal blood cells. These blood cells don't function properly and eventually

overwhelm production of healthy cells.


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Clinical Manifestations

Cardiovascular: heart rate is increased; bloodpressure is decreased.

Respiratory rate increases.

Skin grows pale and cool to the touch.

Intestinal manifestations include weight loss,nausea, and anorexia.

Central nervous system disturbances includeheadache.



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Laboratory Assessment

Decreased hemoglobin and hematocrit levels

Low platelet count

Abnormal white blood cell count, may be low, normal orelevated, but is usually quite high

Poorer prognosis: client with high white blood cell countat diagnosis

(Continued)



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Laboratory Assessment(Continued)

Definitive test: examination of cells obtained frombone marrow aspiration and biopsy



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Risk for Infections

Infection is a major cause of death in the clientwith leukemia, and sepsis is a commoncomplication.

Autocontamination

Cross-contamination



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Drug Therapy for Acute Leukemia

Induction therapy

Consolidation therapy

Maintenance therapy

New drug therapies

Drug therapy for infection



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Infection Protection

Frequent handwashing

Private room

HEPA filtration or laminar airflow system

Mask for visitor with upper respiratory infection(Continued)



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Infection Protection (Continued)

Minimal bacteria diet without uncooked foods

Monitoring of daily laboratory results

Assessment of vital signs

Skin care, respiratory care



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Bone Marrow Transplantation

Standard treatment for leukemia

Purges present marrow of the leukemic cells

After conditioning, new, healthy marrow given tothe client toward a cure

Sources of stem cells

Conditioning regimen

Transplantation



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Risk for Injury

Nadir: period of greatest bone marrow suppression Bleeding precautions Fatigue Interventions:

Diet therapy Blood replacement therapy Drug therapy Energy conservation



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Hodgkins Lymphoma

Cancer that starts in a single lymph node or asingle chain of nodes

Marker: Reed-Sternberg cell

Large, painless lymph node usually in the neck;

fever, malaise, night sweats One of the most curable cancers

Treatment: external radiation alone or withcombination chemotherapy



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Lymph nodes, such as these normal lymph nodes in the neck (left), are located

throughout your body. Swollen lymph nodes in the neck (right) sometimes indicate the

presence of Hodgkin's disease.


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Non-Hodgkins Lymphoma

All lymphoid cancers that do not have the Reed-Sternberg cell

More than 12 types of non-Hodgkins lymphoma

Low-grade lymphomas less responsive to

treatment; cures are rare Treatment: radiation therapy and multiagent

chemotherapy, or single-agent therapy withfludarabine



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Multiple Myeloma

White blood cell cancer that involves a more maturelymphocyte than either leukemia or lymphoma

Uncommon cancer

Manifestations: fatigue, easy bruising, bone pain,fractures, hypertension, increased infection,hypercalcemia, and fluid imbalance

Treatment: chemotherapy



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Autoimmune Thrombocytopenic Purpura

Large ecchymosis or petechial rash on arms, legs,upper chest, and neck

Diagnosed by decreased platelet count and largenumbers of megakaryocytes in the bone marrow

(Continued)



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Petechiae, a common sign of

idio

pathic throm

bo

cyto

penicpurpura, occur when small blood

vessels (capillaries) in the skin

begin to bleed. They appear as

tiny dots that range in color from

red to bluish purple.


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Autoimmune Thrombocytopenic Purpura (Continued)

Interventions include: Therapy to prevent bleeding

Drug therapy to suppress immune function

Blood replacement therapy

Splenectomy



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Thrombotic Thrombocytopenic Purpura

Rare disorder; platelets clump together abnormallyin the capillaries and too few platelets remain incirculation

Inappropriate clotting, yet blood fails to clot

properly when trauma occurs Plasma pheresis, infusion of FFP

Aspirin, alprostadil, plicamycin

Immunosuppressive therapy



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Hemophilia

Hemophilia A is deficiency of factor VIII andaccounts for 80% of cases.

Hemophilia B (Christmas disease) is deficiency offactor IX and accounts for 20% of cases.

For hemophilia Awith blood transfusion and factorVIII therapy, survival time has increased greatly.



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Transfusion Therapy

Pretransfusion responsibilities to prevent adversetransfusion reactions:

Verify prescription.

Test donors and recipients blood for compatibility.

Examine blood bag for identification.

Check expiration date.

Inspect blood for discoloration, gas bubbles, or cloudiness.



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Transfusion Responsibilities

Provide client education.

Assess vital signs.

Begin transfusion slowly and stay with client first15 to 30 minutes.

Ask client to report unusual sensations such aschills, shortness of breath, hives, or itching.

Administer blood product per protocol.



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Types of Transfusions

Red blood cell

Platelet transfusions

Plasma transfusions: fresh frozen plasma

Cryoprecipitate

Granulocyte (white cell) transfusions



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Transfusion Reactions

Clients can develop any of the followingtransfusion reactions:

Hemolytic

Allergic

Febrile Bacterial

Circulatory overload



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Autologous Blood Transfusion

Collection and infusion of clients own blood

Eliminates compatibility problems; reduces risk fortransmission of bloodborne disease

Preoperative autologous blood donation

(Continued)



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Autologous Blood Transfusion (Continued)

Acute normovolemic hemodilution

Intraoperative autologous transfusion

Postoperative blood salvage

Ch 42: Hematological Interventions (per Amendolair)

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Transcript of Ch 42: Hematological Interventions (per Amendolair)