Anemia Flashcards
1
Q
Anemia: Goals
A
- Assume normal activities of daily living
- Maintain adequate nutrition
- Develop no complications related to anemia
2
Q
Anemia: Nursing Assessment
A
- Inquire about bruising easily, bleeding for an unusually long time, or chronic fatigue
- Note any history of blood transfusions
- Medications used or recent change in medication
- PMH & FH
- Systems & Diagnostics review
3
Q
Anemia: Nursing Implementation
A
- Dietary and lifestyle changes
- Blood or blood product transfusions
- Drug therapy
4
Q
Anemia: Nursing Diagnoses
A
Activity intolerance • Vital signs • Rest periods • Energy conservation • Smoking cessation
5
Q
Anemia: Potential Complication
A
Hypoxemia
• Monitor vitals
• Oxygen prn
• Rest
6
Q
Anemia: Ineffective Therapeutic Regimen Management
A
- Ineffective therapeutic regimen management
- Teach medication compliance
- Dietary replacement
7
Q
Anemia: Nursing Diagnoses; Imbalanced Nutrition
A
- Imbalanced nutrition: less than body requirements
- Collaboration with dietitian •Keep a food diary
- Monitor recorded intake
- Encourage increased intake of protein, iron, and vitamin C to provide nutrients needed for hematopoiesis.
- Small, frequent meals with snacks
8
Q
Anemia: Nursing Care; Self-Care Deficit
A
- Assist with ADLs
- Rest periods
- Concerns about self-care
9
Q
Anemia: Nursing Care; Impaired Oral Mucous Membranes
A
- 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
10
Q
Anemia: Nursing Care; Continuing Care and Teaching
A
- Types of anemia
- Diet
- Medications
- Genetic counseling
- Follow-up appointments
- Support groups
11
Q
Anemia: Gerontologic Considerations
A
- Common in older adults
- Chronic disease
- Nutritional deficiencies
- Signs and symptoms may go unrecognized or mistaken for normal aging changes
12
Q
Iron-Deficiency Anemia: Collaborative Care; Goals
A
- ↑ Intake of iron
- Nutritional therapy
- Replacement therapy
- Transfusion of packed RBCs
13
Q
Iron-Deficiency Anemia: Nursing Management; At-risk groups
A
- Premenopausal women
- Pregnant women
- Persons from low socio-economic backgrounds
- Older adults
- Individuals experiencing blood loss
14
Q
Iron-Deficiency Anemia: Nursing Management
A
- Diet teaching
- Supplemental iron
- Discuss diagnostic studies
- Emphasize compliance
- Iron therapy for 2-3 months after the hemoglobin levels return to normal
15
Q
Iron-Deficiency Anemia: Drug Therapy
A
- Oral iron
- Inexpensive
- Convenient
- Factors to consider
- Best absorbed as ferrous sulfate in an acidic environment
- Liquid iron should be diluted and ingested through a straw
- Side effects- Heartburn, constipation, diarrhea
16
Q
Cobalamin Deficiency: Collaborative Care
A
- Parenteral administration of cobalamin
- ↑ Dietary cobalamin does not correct the anemia
- Still important to emphasize adequate dietary intake
17
Q
Cobalamin Deficiency: Nursing Management
A
- Familial disposition
- Ensure injuries are not sustained due to the client’s diminished sensations to heat and pain
- Ensure client compliance with treatment
- Evaluate client for gastric carcinoma frequently
18
Q
Folate Deficiency: Nursing Management
A
- Assess for risk
- Replacement orally
- Nutrition therapy
19
Q
Aplastic Anemia: Nursing Management
A
- Preventing complications from infection and hemorrhage
- Untreated prognosis is poor
- 75% fatal
- Treatment options
- Bone marrow transplantation
- Immunosuppressive therapy
20
Q
Acute Blood Loss: Collaborative Care
A
- Replacing blood volume to prevent shock
- Identifying the source of the hemorrhage
- Stopping blood loss
- Correcting RBC loss
- Infection control
21
Q
Acute Blood Loss: Nursing Management
A
May be impossible to prevent if caused by trauma
Post-operative clients
• Monitor blood loss
No need for long-term treatment
22
Q
Chronic Blood Loss: Management
A
- Identify source
- Stop bleeding
- Possible use of supplemental iron
23
Q
Sickle Cell Disease (SCD): Nursing Management
A
- Alleviate symptoms of disease complications
- Minimize end target-organ damage
- No specific treatment for SCD
- Client teaching
- Avoid high altitudes, maintain fluid intake, treat infections, pain control
24
Q
Sickle Cell Disease: Nursing Management
A
- O2 for hypoxia and to control sickling
- Pain management
- Acute chest syndrome
- Antibiotics
- O2 therapy
- Fluid therapy
- Folic acid daily supplements
25
Sickle Cell Disease: Nursing Management
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Blood transfusions in crisis
Hydroxyurea: anti-sickling agent
• Erythropoietin in clients unresponsive to hydroxyurea
Bone marrow transplant
• Can cure some clients with SCD
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26
Leukemia: Collaborative Care; Goals
* attain remission
| * maintain optimal blood counts (hemoglobin, platelet) during and after completion of treatment
27
Leukemia: Collaborative Care; Chemotherapeutic treatment
* Induction therapy
* Intensification therapy
* Consolidation therapy
* Maintenance therapy
28
Leukemia: Chemotherapy Regimen; Combination chemotherapy
Combination chemotherapy:
• Mainstay treatment
• 3 purposes
• ↓ drug resistance
• ↓ drug toxicity to the client by using multiple drugs with varying toxicities
• Interrupt cell growth at multiple points in the cell cycle
29
Leukemia: Bone Marrow and Stem Cell Transplantation; Goal
Totally eliminate leukemic cells from the body using combinations of chemotherapy with or without total body irradiation
30
Leukemia: Bone Marrow and Stem Cell Transplantation
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Eradicates client’s hematopoietic stem cells
Replaced with those of an HLA-matched
• Sibling
• Volunteer
• Identical twin
• Client’s own stem cells removed before
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31
Leukemia: Nursing Management; Overall goals
* Understand and cooperate with the treatment plan
* Experience minimal side effects and complications of disease and treatment
* Feel hopeful and supported during the periods of treatment, relapse, and remission
32
Leukemia: Nursing Management
* Ongoing care is necessary to monitor for signs and symptoms of disease control or relapse
* Teach client and significant other
* Diligence in disease management
* Need for follow-up care
* When to seek medical attention
33
Leukemia: Nursing Care; Risk for Infection
* Infection precautions
* Avoid invasive procedures
* Report evidence of infection
* Monitor vital signs
* Report lab values
* Explain precautions and restrictions
34
Leukemia: Nursing Care; Imbalanced Nutrition
Less than Body Requirements
• Monitor weight
• Promote food and fluid intake
• Avoid procedures around meals
35
Leukemia: Nursing Care; Impaired oral Mucous Membranes
* Assess mouth
* 1:1 solution saline/peroxide as mouthwash
* Soft-bristle toothbrush
* Medications for infection, pain
* Avoid alcohol-based mouthwashes
36
Leukemia: Nursing Care; Ineffective Protection
* Monitor LOC
* Report manifestations of bleeding
* Avoid invasive procedures
* Apply pressure to puncture sites
* Avoid straining with bowel movement
37
Leukemia: Nursing Care; Anticipatory Grieving
* Therapeutic communication
* Manage stressful situations
* Support groups for the grieving process
38
Leukemia: Nursing Care; Teaching
* Diagnosis, treatment, bone marrow, complications
* Cancer as a chronic illness
* Balance activity with rest
* Maintain weight and nutrition
* Hydration
* Prevent infection
* Oral hygiene
39
Leukemia: Nursing Care
* 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
40
Leukemia: Nursing Management; Evaluation
* Cope effectively with diagnosis, treatment regimen, and prognosis
* Attain and maintain adequate nutrition
* Experience no complications
* Feel comfortable and supported
41
Hodgkin's Disease: Nursing and Collaborative Management
* Using diagnostic studies, a stage of disease is determined
* Disease may be localized or diffused
* Treatment depends on the nature and extent of the disease
42
Stages of Hodgkin's Disease
* Stage I- involvement of a single node
* Stage II- involvement of 2 or more nodes on the same side of the diaphragm
* Stage III- involvement of additional lymph node regions, organs or extralympathic
* Stage IV- widely spread disease
* A or B
43
Hodgkin's Disease: Nursing and Collaborative Management
Management focuses on selecting a treatment plan
Least amount of treatment to achieve a cure
• Minimize short- and long-term complications
44
Hodgkin's Disease: Nursing and Collaborative Management; Chemo/ Radiation
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Chemotherapy
• Combination
• Remission in >75%
Radiation
• Used for both
• Combined with chemotherapy
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45
Hodgkin's Disease: Nursing and Collaborative Management; Radiation/ Combination Chemo
Radiation therapy
• 95% of stage I or stage II clients cured with 4 to 6 weeks of radiation therapy
Combination chemotherapy
• Resistant disease or high risk of relapse
46
Hodgkin's Disease: Nursing and Collaborative Management
* Skin in radiation field needs attention
* Psychosocial considerations
* Fertility issues
* Long-term evaluation of client
* Consequences may not be apparent for many years
47
Hodgkin's Disease: Nursing and Collaborative Management; Risk of secondary malignancies
* 18% risk of secondary cancer at 15 years after treatment
* Most common
* Acute non-lymphoblastic leukemia
* Non-Hodgkin’s lymphoma
* Solid tumours
48
Non-Hodgkin's Disease: Treatment
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Treatment
• Radiation therapy
• Chemotherapy
More aggressive lymphomas are more responsive to treatment
• More likely to be cured
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49
Non-Hodgkin's Disease: Nursing Care; Impaired Skin Integrity/ Nausea
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Risk for Impaired Skin Integrity
• Measures to reduce itching
Nausea
• Antiemetics
• Measures to relieve/reduce nausea
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50
Non-Hodgkin's Disease: Nursing Care; Fatigue
* Assess malaise
* Encourage talking about disease
* Quiet activities
* Rest periods
* High-carbohydrate diet
* Fluids
51
Non-Hodgkin's Disease: Nursing Care; Disturbed Body Image
* Body image assessment
* Objective signs of altered body image
* Coping with alopecia
* Effects of illness on sexuality
* Support groups
52
Non-Hodgkin's Disease: Nursing Care; Teaching
* Treatment and effects of treatment
* Skin care
* New symptoms
* Complementary pain management strategies
* Rest and exercise
* Diet
* Canadian Cancer Society referral
