Caring for Clients With Hematologic and Lymphatic Disorders

1. 20 Caring for Clients With Hematologic and Lymphatic Disorders

2. Anemia • Hemoglobin concentration or number of circulating RBCs decreased • Caused by • Impaired RBC formation • Excessive loss or destruction of RBCs

4. Anemia - Pathophysiology • Reduces the oxygen-carrying capacity of the blood • Causes tissue hypoxia • Body attempts to restore oxygen delivery

5. Pallor Angina Fatigue Dyspnea on exertion Night cramps Bone pain Headache Dizziness Dim vision Anemia - Manifestations

6. Blood Loss Anemia • Acute or chronic bleeding • Both lead to anemia • RBCs normal but reduced in number

7. Nutritional Anemia • Lack of nutrients for RBC formation or development • Iron deficiency • Cheilosis (cracks at corners of mouth) • Smooth, sore tongue • Pica • Vitamin B12 • Pernicious anemia • Paresthesias

8. Nutritional Anemia (continued) • Folic acid • Chronic malnourishment • Glossitis • Cheilosis • Diarrhea

9. Anemia of Chronic Disease • Seen in AIDs, rheumatoid arthritis, inflammatory bowel disease (IBD), chronic hepatitis, chronic renal failure (CRF) • Severity depends on the severity of underlying disease • Manifestations similar to iron deficiency anemia

10. Hemolytic Anemias • Premature destruction of RBCs • Intrinsic or acquired causes • Sickle cell disorders • Abnormal Hgb, changes shape • Intense pain, chest, back, joints

12. Sickle Cell Anemia

13. Thallassemia • Inherited; caused by abnormal Hgb synthesis • Liver and spleen enlarged • Target cells

14. Acquired Hemolytic Anemias • Damage by outside factors • Mechanical trauma • Antibody reactions • Immune responses • Drugs, toxins, chemical agents, venoms

15. Aplastic Anemia • Bone marrow fails to produce RBCs • Cause unknown • Pancytopenia

16. Anemia – Diagnostic Tests • CBC • Iron levels • Serum ferritin • Sickle cell screening • Hemoglobin electrophoresis • Schilling’s test • Bone marrow aspiration

17. Anemia – Nursing Implications Client Teaching Types of anemia Diet Medications Genetic counseling Follow-up appointments Support groups

18. Anemia - Treatment • Medications • Depends on type and cause • Iron replacement • Vitamin B12 • Folic acid • Hydroxyurea • Immunosuppressive therapy or androgens

19. Anemia – Treatment (continued) • Dietary Considerations • Iron that is readily absorbed • Iron sources • Blood Transfusions • Replace RBCs • Whole blood or packed RBCs

20. Anemia – Nursing Care • Assessment • Activity Intolerance • Vital signs • Rest periods • Energy conservation • Smoking cessation

21. Anemia – Nursing Care (continued) • Impaired Oral Mucous Membranes • Assess lips and tongue • Mouthwash • Frequent oral hygiene • Avoid alcohol-based mouthwashes • Petroleum jelly for lips • Avoid spicy foods • Encourage soft bland foods • Small high-protein balanced meals each day

22. Anemia – Nursing Care (continued) • Self-Care Deficit • Assist with ADL • Rest periods • Concerns about self-care

23. Anemia – Nursing Care (continued) • Evaluation • Independent ADL • Increased level of activity • Skin and oral mucous membranes • Diet

24. Myelodysplastic Syndrome • Group of stem cell disorders • Seen in older adults • Anemia, enlarged spleen

25. Polycythemia • Erythrocytosis • Abnormally high RBC count, high Hct • Blood sticky • Secondary form is the most common • Develops due to chronic hypoxemia or excess erythropoietin

26. Polycythemia Vera (continued) • Primary type • Production of all blood cells increased • Cause unknown • Insidious onset • Gangrene complication

27. Polycythemia - Treatment • Reduce blood viscosity and volume • Relieve symptoms • Phlebotomy to keep blood volume within normal levels • Chemotherapy

28. Polycythemia – Nursing Care • Teaching • Hydration • Prevent blood stasis • Elevate legs • Support stockings • Smoking cessation • Report S/S thrombosis

29. Leukemia • Group of malignant disorders of WBCs • Greater numbers of WBCs • Cause of most unknown • Classified by onset and duration: acute or chronic • Four types

31. Leukemia - Pathophysiology • Malignant transformation of a single stem cell • Cells proliferate slowly, nonfunctional WBCs • Bone marrow filled with leukemic cells • Leave bone marrow and infiltrate other tissues • Death from hemorrhage or infection

32. Leukemia - Manifestations • Anemia • Infection • Bleeding

33. Figure 20-5 The multisystem effects of leukemia.

34. Leukemia – Diagnostic Tests • CBC with differential and platelet count • Bone marrow

35. Leukemia – Nursing Implications Client Teaching Diagnosis, treatment, bone marrow, complications Cancer as a chronic illness Balance activity with rest Maintain weight and nutrition Hydration Prevent infection Oral hygiene

36. Leukemia – Nursing Implications (continued) Client Teaching (continued) Avoid crowds, sick people Avoid immunizations Reduce risk of bleeding or injury Avoid OTC medications that can cause bleeding Refer to social services, support groups, home health

37. Leukemia - Treatment • Chemotherapy • Destroy leukemic cells • Produce remission • Achieve remission, cure, relieve symptoms • Radiation therapy • Shrink lymph nodes • Biologic therapy • Interferons, interleukins • Colony-stimulating factors

38. Leukemia – Treatment (continued) • Bone marrow transplantation • Allogenic • Eliminate leukemic cells • Donor marrow transfused • Autologous • Own bone marrow withdrawn, treated, frozen, reinfused later

39. Leukemia – Treatment (continued) • Stem cell transplant • Donor treated with colony-stimulating factors to increase concentration of stem cells in blood • Blood removed from donor, given to patient

40. Leukemia – Nursing Care • Assessment • Recognize manifestations

41. Leukemia – Nursing Care (continued) • Risk for Infection • Infection precautions • Avoid invasive procedures • Report evidence of infection • Monitor vital signs • Report lab values • Explain precautions and restrictions

42. Leukemia – Nursing Care (continued) • Imbalanced Nutrition: Less than Body Requirements • Monitor weight • Promote food and fluid intake • Avoid procedures around meals

43. Leukemia – Nursing Care (continued) • Impaired Oral Mucous Membranes • Assess mouth • 1:1 solution saline/peroxide as mouthwash • Soft-bristle toothbrush • Medications for infection, pain • Avoid alcohol-based mouth washes

44. Leukemia – Nursing Care (continued) • Ineffective Protection • Monitor LOC • Report manifestations of bleeding • Avoid invasive procedures • Apply pressure to puncture sites • Avoid straining with bowel movement

45. Leukemia – Nursing Care (continued) • Anticipatory Grieving • Therapeutic communication • Manage stressful situations • Support groups for the grieving process

46. Leukemia – Nursing Care (continued) • Evaluation • Freedom from infection • Weight • Food intake • Oral mucous membranes • Bleeding • Coping

47. Malignant Lymphoma Cancer of lymph tissue Classified as Hodgkin or non-Hodgkin

48. Hodgkin Disease Most curable Painless progressive enlargement of one or more lymph nodes Reed-Sternberg cells Cause unknown

49. Non-Hodgkin Lymphoma More common Multiple lymph nodes involved

50. Malignant Lymphoma – Diagnostic Tests Chest x-ray Abdominal CT Biopsy Ann Arbor staging system Cotswold staging classification system