Chapter 4 Nursing Care of Patients with Hematologic Disorders

1. 1 Chapter 4Nursing Care of Patients with Hematologic Disorders

2. 2 Assessment and Diagnostic Findings Hematologic Studies: - CBC. - Hemoglobin and hematocrit. Bone Marrow Aspiration & Biopsy: - Assess the quantity and quality of each type of cell produced in the bone marrow.

3. 3 Anemia Anemia is the lack of sufficient circulating hemoglobin to deliver oxygen to tissues. Causes: - Chronic diseases. - Inadequate production of RBCs. - Destruction of RBCs. - Blood loss. - Deficits in nutrients. - Heredity.

4. 4 Anemia (cont’d) Types Of Anemia: 1. Folic Acid Deficiency Anemia. 2. Iron Deficiency Anemia. 3. A plastic Anemia. 4. Pernicious Anemia. 5. Sickle Cell Anemia. 6. Thalassemia. 7. Glucose-6- phosphate dehydrogenase (G6PD)

5. 5 Anemia (cont’d) Clinical Manifestations: 1. Pallor. 2. Fatigue, weakness. 3. Dyspnea. 4. Palpitations, tachycardia. 5. Headache, dizziness, and restlessness. 6. Slowing of thought. 7. Paresthesia.

6. 6 Anemia (cont’d) Nursing Management: 1. Direct general management toward addressing the cause of anemia and replacing blood loss as needed to sustain adequate oxygenation. 2. Promote optimal activity and protect from injury. 3. Reduce activities and stimuli that cause tachycardia and increase cardiac output. 4. Provide nutritional needs. 5. Administer any prescribed nutritional supplements. 6. Patient and family education

7. 7 Leukemia Leukemia: Is uncontrolled proliferation of white blood cells (WBCs) in the bone marrow. Types of Leukemia: - Acute myelogenous Leukemia (most common in adults) - Acute Lymphocytic Leukemia (most common in children) - Chronic Myelogenous Leukemia (uncommon before age 20) - Chronic Lymphocytic Leukemia (most common in persons 50 years of age and more)

8. 8 Leukemia (cont’d) Etiology: Underlying cause is unknown. Predisposing factors: - Exposure to radiations. - Chemical agents. - Heredity.

9. 9 Leukemia (cont’d) Signs & Symptoms: - Pallor, fatigue, weakness, fever, weight loss, abnormal bleeding and bruising, lymphadenopathy. - Splenomegaly, hepatomegaly, bone and joint pain, headache, and neurologic dysfunction.

10. 10 Leukemia (cont’d) Diagnostic Evaluation: - CBC and blood smear. - bone marrow aspiration and biopsy. Nursing Management: 1. Preventing infection. 2. Preventing and managing bleeding. 3. Patient education and health Maintenance. 4. Reducing pain. 5. Improving activity tolerance.

11. 11 Lymphoma Lymphomas are malignant disorders of the reticuloendotheial system that result in an accumulation of dysfunctional, immature lymphoid derived cells. They classified according to : - The predominant cell type. - The degree of malignant cell maturity. - Types of lymphomas (Hodgkin’s, Non- Hodgkin’s lymphomas)

12. 12 Lymphoma (cont’d) Hodgkin’s disease affects young adults, higher incidence among males than women. Non-Hodgkin’s disease affects men more than women , the incidence increases with age.

13. 13 Lymphoma (cont’d) Signs & Symptoms: 1. Painless and enlargement of lymph nodes (cervical, axilla, groin) 2. Fatigue, weight loss, chills, fever, night sweats, pruritus. 3. Dyspnea, dysphagia. 4. Splenomegaly and hepatomegaly

14. 14 Lymphoma (cont’d) Diagnostic evaluation: - lymph node biopsy to detect type. - CBC, bone marrow aspirate and biopsy to detect bone marrow involvement. - Liver and kidney function tests. - Ct scan.

15. 15 Lymphoma (cont’d) Nursing Management: 1. Administer analgesics as prescribed. 2. Maintain skin integrity. 3. Preserving oral and GI Tract Mucous Membranes. 4. Patient education and Health Maintenance.