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Hematologic Disorders & Nursing Priorities

Hematologic Disorders & Nursing Priorities. Keith Rischer RN, MA, CEN. Objectives for Today. Review pathophysiology related to hematologic cells and blood forming tissues Interpret significance of altered hematologic lab values Review commonly used medications that alter hematologic function

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Hematologic Disorders & Nursing Priorities

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  1. Hematologic Disorders &Nursing Priorities Keith Rischer RN, MA, CEN

  2. Objectives for Today • Review pathophysiology related to hematologic cells and blood forming tissues • Interpret significance of altered hematologic lab values • Review commonly used medications that alter hematologic function • Identify the patho, clinical manifestations, diagnostic tests, nursing priorities, and client education in clients with anemia, sickle cell anemia, leukemia, lymphomas, and multiple myeloma. • Identify the nursing priorities with blood transfusion and the most common transfusion reactions.

  3. Blood Cells • Hematopoesis: Red bone marrow • The blood forming tissue that produces the 3 major cell components of blood • Erythrocytes • Leukocytes • Thrombocytes

  4. Erythrocytes • Function • Transport of gases (O2 & CO2) • Erythropoesis • Normal Life span: 120 days • Norms • Hgb RBC • Women: 12-16 g/dl 4.0-5.0 mm3 • Men: 13.5-18n g/dl 4.5-6.0 mm3 • HCT • Women: 38-47% • Men: 40-54%

  5. Leukocytes • Types • Granulocytes (Also known as polymorphonuclearleukocytes) • Neutrophils • Eosinophils • Basophils

  6. Leukocytes • Monocytes agranular) • Lymphocytes B cells: mediate the humoral immune response • T cells: Mediate cellular immunity • Normal Blood Count of all WBC: 4,000-11,000/ul • Elderly considerations

  7. Thrombocytes (Platelets) • Function: • Aid in blood clotting • Maintain capillary integrity by working as “plugs” to close any openings in the capillary wall. • Normal Blood Count: 150,000-400,000 mm3

  8. Anemia • Mild • Hgb 10-14 g/dl • Moderate • Hgb 6-10 g/dl • Severe • Hgb < 6 g/dl

  9. Anemia:Causes Macrocytic • Pernicious Anemia (B12 deficiency) • Folate deficiency Microcytic • Iron deficiency anemia Normocytic • Blood loss • Sickle cell anemia

  10. Macrocytic Anemia Megaloblastic Anemias: Presence of large RBC’s) • Caused by defective DNA synthesis Two common types: 1. Cobalamin (vitamin B12 deficiency) • Pernicious anemia =most common cause. 2. Folic acid deficiency • Poor nutrition (Anorexia) • malabsorption in small bowel • ETOH • Hemodialysis PATIENT EDUCATION

  11. Microcytic Anemia: Iron Deficiency • Abnormal-small erythrocytes…decr. Hgb • Most common anemia • Manifestations • Pallor • Glossitis • fatigue • Dietary sources • Patient education

  12. Normocytic Anemia: Etiology Blood Loss • Acute • Chronic Extrinsic (acquired) hemolytic anemias – (damage to RBCs due to external factors) • Physical factors

  13. ED Case Study • 88 yr women w/dk tarry stools last 5 days. c/o weakness, nausea. • Pale, cool-initial VS 80-16-124/30….2 hours later 96-20-94/49 • Wbc 9.8, hgb 6.9 (was 12.7 2 weeks ago), hct 21.5, plt 176, INR 4.8 (was 2.1 2 weeks ago) • Nursing priorities

  14. Sickle Cell Anemia • Patho • Sickle Cell Crisis • Nsg Management • Pain control • Hydration • Patient Education • Hydration • Tx infection • Psychosocial

  15. Thrombocytopenia • Reduction of platelets below normal range • Normal = 150,000-400,000 mm3 • Etiology: • Immune Thrombocytopenic Purpura (ITP) • Heparin • Bone marrow suppression • Critical values • 50,000 or less- risk of bleeding • <20,000 spontaneous life threatening hemorrhages (brain bleed) • <10,000 transfusions recommended

  16. Clinical Manifestations • Petechiae • Purpura • Ecchymosis • Bleeding

  17. Nursing Management • If acute care-Peripheral IV established • No ASA products for pain control • Prevent/control acute bleeding • Platelet transfusions-assess for reaction • Steroids-pt. teaching • Education-signs of bleeding

  18. Blood Product Administration • Minimum 22 g.(blue hub) IV-prefer 20g. (pink) or 18g. (green) • Blood tubing with filter-use NS to prime/flush • Validate pt., type of blood product, expiration date, blood tag # • VS before, 15” after initiation, end of each • Infuse PRBC’s over 2 hours (appx 300cc/unit)

  19. Complications Blood Products • Circulatory Overload Acute Hemolytic Reaction • Chills, fever, flushing, tachycardia, SOB, hypotension, acute renal failure, shock, cardiac arrest, death Febrile-Nonhemolytic Reaction • Sudden onset of chills,fever, temp elevation >1 degree C. headache, anxiety Mild Allergic Reaction • Flushing, urticaria, hives

  20. Nursing Responsibilities • STOP transfusion • Maintain IV site-disconnect from IV and flush with NS • Notify blood bank/MD • Recheck ID • Monitor VS • Treat sx per MD orders • Save bag and tubing-send to blood bank

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