hematology Flashcards
clinical manifestations of severe anemia (<60g/L)
integument =pallor, jaundice, pruritus
eyes = icteria conjunctiva and sclera, retinal hemorrhage, blurred vision
mouth = glossitis, smooth tongue
cardiovascular = tachycardia, increase pulse pressure, systolic murmurs intermittent claudication, angina, HF, AMI
pulmonary = tachypnea, orthopnea, dyspnea at rest
neurological = headache, vertigo, irritability, depression, impaired thought process
GI = anorexia, hepatomegaly, splenomegaly, difficulty swallowing, sore mouth
msk = bone pain
general = sensitivity to cold, weight loss, lethargy
anemia acute and long term interventions
Ultimate goal of therapy is to address the cause of the anemia Acute interventions: Replace blood loss with RBC Volume replacement Drug therapy Oxygen therapy Long term interventions: Diet Lifestyle changes
anemia nursing interventions
Age related interventions: a decline in RBC is expected (10g/L males; 2g/L females) after age 70 Symptoms may include: Fatigue Ataxia Confusion Pallor Worsening cardiac or pulmonary issues
iron deficiency anemia etiology
Inadequate supplies of iron lacking from diet
Malabsorption (GI surgery),
Blood loss (peptic ulcer, gastritis, esophagitis, diverticuli, hemorrhoids, and neoplasia, menstrual bleeding, postmenopausal bleeding, pregnancy, chronic kidney disease)
Hemolysis (dialysis treatment
ida diagnostic studies
Lab Values: Hct, Hgb, Rbc count, reticulocyte count, serum iron, serum ferritin, serum transferrin, TIBC, stool for OB
Endoscopy and Colonoscopy are used to detect GI bleeding
Bone marrow biopsy if all other tests are inconclusive
ida collaborative care
Collaborative Care:
Identification and treatment of underlying cause
Drug Therapy
Oral: ferrous sulphate of ferrous gluconate
IM or IV: iron dextran, iron sucrose, sodium ferric gluconate (Ferriecit)
Nutritional Therapy
Transfusion of packed RBC’s
iron supplements
Daily dose of 150-200 mg of elemental iron given in divided doses (3-4)
Ferrous sulphate preferred over ferrous gluconate
May stain teeth; suggest use of straw
Should be taken an hour before food (if possible)
Vitamin C enhances absorption
Enteric coated pills are counterproductive
GI adverse effects: constipation, diarrhea, heartburn
Causes black stools
May need stool softener
If needing IM dose, use separate needle for drawing up medication and injecting (z-track method)
ida nutritional therapy
Organ meats
Other meats (tuna, halibut, turkey, oysters, lean ground beef, lamb chop)
Beans (black, pinto, and garbanzo)
Whole-grain breads, brown rice, bran flakes, oatmeal
Dried fruits
Leafy green vegetables
ida blood transfusion and hemorrhage
Acute loss of total blood volume (leading to hypovolemia shock)
Gradual blood loss: plasma increases thus diluting the RBC and ability to carry oxygen throughout the body
Clinical signs more important than lab values
Acute blood loss will result in hypotension before Hgb and Hct drop.
Once the body compensates with volume, the Hgb, Hct and RBC will drop (ratio changes not #)
Pain may be an important sign of internal bleeding; also numbness
ida fluid replacement
Fluid replacement may include: Dextran Hetastarch Albumin Crystalloid electrolyte solutions (lactated ringers, 0.9% NaCL) Blood products may include: Platelets Plasma Cryoprecipitate
sickle cell disease nursing interventions
Characterized by abnormal form of Hgb in the blood Collaborative Care aimed at: Preventing sequelae from the disease Alleviating symptoms of the disease Minimizing end target organ damage Promptly treating sequelae
patient teaching for sickle cell disease
Patient teaching:
Avoid triggers: high altitude, extreme temperatures
Minimize stress
Adequate fluid hydration
Treat infections promptly
Screen for retinopathy starting by preteen years (10 years old)
Immunizations should be up to date
sickle cell crisis interventions
Resp failure most common cause of death: careful monitoring
Encourage rest to reduce metabolic requirements
Deep vein thrombosis prophylaxis with anticoagulants
Fluids and electrolytes
Priapism: managed with pain meds, fluids and nifedipine
During aplastic crisis RBC exchange transfusion program may be implemented
sickle cell disease interventions for pain
Ongoing treatment for pain may result in tolerance by the pt; higher doses of opioids may be required
Folic acid supplements
NSAIDS, antineuropathic pain (TCA’s, antiseizure medications), local anesthetics, nerve blocks, transelectrodermal nerve stimulator (TENS), acupuncture, or a combination of these strategies
Bone marrow transplantation only cure; rarely done in Canada
Healthcare team: occupational therapist and physiotherapists may assist the pt with ongoing pain and resulting depression; psychologists may help with CBT
hemophilia collaborative care
- Prevent hemorrhage
No contact sports
Pt wears gloves when performing household chores to prevent cuts and abrasions
Pt learns to promptly treat bleeding
Pt learns to distinguish which bleeding can be treated at home and which requires medical treatment - Treat hemorrhage
Replace clotting factors: Factor VIII & IX
Fresh Frozen plasma rarely used anymore
Desmopressin acetate (DDAVP) for mild cases
Antifibrinolytic therapy (tranexamic acid)
Minor hemorrhage should be treated for 72 hrs - Treat symptoms from hemorrhage
Bedrest until pain, swelling resolves and movement returns to affected joints
