Hematology Alteration

8/6/2019 Hematology Alteration

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Nursing management of patient with blood

disorder

objective:

After four hours of lecture discussion, the level 1V student will be able to:Review the anatomy and physiology of the blood

Relate the diagnostic test result to the blood disorder

Discuss different blood disorder

Develop nursing care plan utilizing nursing process in caring patient with blooddisorders


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Anatomy and physiology of the blood

Blood

is an aqueous mixture consisting ofplasma and cells

- Is a sticky opaque fluid with a metallic taste- Is slightly alkaline, pH of 7. 35 7. 45

- Temp. of 38C or 100. 4 F

- 8% of body weight, volume in healthy males is 5 6 liters


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Plasma

- is a straw colored liquid consisting of approximately 90% water and 10

% protein


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Characteristics and function of formedelements of the blood

1. Erythrocytes (rbc)

- 4 6 million per mm

- Salmon colored biconcave disks, sacs of hgb. Most

organelles have been ejected

- Fxn: transport O2 bound to hgb molecules; also transport

small amount of co2


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2. Leukocytes (wbc)- 4000- 11, 000mm

- Granulocytes:

a. Neutrophils 40 70% of wbc; active phagocytes; number

increases rapidly during short-term or acute infectionsb. Eosinophils 1- 4% of wbc; kills parasitic worms; increase

during allergy attack; might phagocytize antigen-antibodycomplexes and inactivate some inflammatory chemicals


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c. Basophils 0- 1% of wbc- Granules contain histamine ( vasodilator chemicals) which is

discharge at sites of inflammation

Agranolucytes:

a. Lymphocytes-

20 45 % of wbc- Part of immune system; one group (B lymphocytes) produces

antibodies; other group (T lymphocytes) involved in graft rejection,fighting tumors and viruses, and activating B lymphocytes


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b. Monocytes 4 8% 0f wbc

-Active phagocytes that become macrophages in the tissues;

long-term clean-up; increase in number during chronic

infections such as TB


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3. Platelets- 250,000- 500,000

- Called megakaryocytes coz they are fragments of bizarre

multinucleate

- Needed for normal blood clotting; initiate clotting cascade by

clinging to broken area; helps to control blood loose from

broken blood vessels

- Accelerated by the hormone thrombopoietin


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How blood cell formulated?

-through hematopoiesis that occurs in red bone marrow or myeloid tissue

- In flat bones: skulls and pelvis, ribs, sternum and proximal epiphyses of thehumerus and femur

- Each type of blood cells- is produced in different numbers in response tochanging body needs and different stimuli

- Matured cells are discharge into the blood vessels surrounding the area

- All the formed elements arise from a common types of stem cells thehemocytoblast in red bone marrow

- The stem cells renews itself by mitosis


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What regulate the RBC?

- Erythropoietin circulates in the blood at all times and RBCS

are formed in constant rate.

- Kidney plays the major role in releasing this hormones, liverproduce some

NORMAL LIFESPAN FOR AN RBC = 120 DAYS


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hematocrit

- Is the % of blood cells in a volume of blood

- Normal value= 42% - 45% of blood volume


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HEMOSTASIS

- Stoppage of blood flow

- This response which is fast and localized involves many

substances normally present in plasma, as well as some thatare released by platelets and injured tissue cells.


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PHASES OF HEMOSTASIS

Platelet plug forms sticky and cling to the damage site, Anchoredplatelets release chemicals that attract more platelets to the site toformed a white thrombus or platelet plug.

Vascular spasm occur anchored platelet release serotonin whichcause the blood vessel s into spasm resulting to decrease blood lossafter clotting can occur

Coagulation event occur- release of thromboplastin. Coagulationtime = 3 to 6 minutes


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BLOOD TYPES

BLOOD GROUP - RBC ANTIGEN PLASMA ANTIBODIES- RECEIVED BLOOD

AB--------------------------------A,B----------------------------------NONE---------------------------------------------A,B,AB,O

B-------------------------------------B-------------------------------------ANTI A--------------------------------------------B,O

A-----------------------------------A-------------------------------------ANTI B------------------------------------------A,O

O------------------------------NONE-------------------------------ANTI A, B----------------------------------O, UNIVERSAL DONOR

Antigen is a substance that body recognizes as foreign, it stimulates the immune

system to release antibodies

RH BLOOD GROUP the RBC carry the-Rh antigen


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DISORDERS AFFECTINGTHE RBCS

POLYCYTHEMIA Secondary

- Increase RBC and Hgb production

- Compensatory response to chronic hypoxia:Hypoxia ->increase Erythropoietin production by the kidneys-

>stimulation of the bone marrow to increase RBC production


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POLYCYTHEMIA VERA/primary

Occurs most frequently in middle age and Jewish men

Hyperplasia of the bone marrow

Increase RBC (erythrocytosis); increaseWBC (leukocytosis);

increase platelets (thrombocytosis)Pathophysiology:

Increase rbc,wbc,platelet -> increase Bld.volume and Viscosity ->thromboembolism and capillary overdistention -> rupture - >hemorrhage ->hypovolemia; Organ infiltration -> hepatomegaly,Spleenomegaly,cerebral hypoxia,arthralgia


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Etiology

Unknown

Predisposing factors:

Long term hypoxia: COPD,CHF,SMOKING. LIVINGIN HIGHALTITUDE


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Signs and Symptoms:

Symptoms of two are the same

Headache, epistaxis, dizziness, tinnitus, blurred vision, fatigue,weakness, pruritus, exertional dyspnea, increased BP and pulse

Ruddy complexion, lips become reddish purple Petechia and bruises due to platelet dysfunction

Susceptible for thrombi formation

Causes hyperuricemia increase uric acid bld level

RBC count is over 6 million; Hgb over 18mg/dl, Hct over 55%

Increased risk for CVA and MI due to thromboembolism


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Nursing management

ASSESSMENT:

History taking for the s&s

Assess for nutritional status for inadequate dietary intake due to GIsymptoms of fullness and dyspepsia

Observe for bruises and changes in color

Check for neck vessels distention, listen apical, radial, pedal pulses

Check Homans signs and edema

Observe for dyspnea, epistaxis

Listen to the breath sound

Checked pupils responses and presence of numbness or tingling


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Nursing diagnosis

Ineffective Tissue Perfusion r/t decreased blood circulation

Knowledge deficit r/t disease process and treatment

Risk for injury r/t dizziness


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IRON DEFICIENCY ENEMIA:

- most common type of anemia and occurs when the body

does not have enough iron to synthesize functional hgb.

- Found frequently in premature or LBW infants, adolescentgirl, alcoholic and the elderly


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PATHOLOGY

Reduced O2 carrying capacity of the blood from nutrients

deficiencies that disrupts hematopoiesis or hemoglobin

synthesis


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Etiology:

- Decreased dietary intake

- Decreased iron absorption from GIT

- Chronic intestinal or uterine blood loss

- Increased bodily needs for iron such as during growth period

and pregnancy


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SIGNS AND SYMPTOMS:

Pallor Brittle hair, nails

Easy fatigability Syncope

Weakness Amenorrhea

Anorexia Cold sensitivity

Weight loss Tachycardia

Headache/dizziness Palpitation


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Planning

- The patient will relate disease process and treatment

- The patient will have increased circulation

- The patient will relate measures to avoid injury


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Nursing Intervention Explain the cause of disease, symptoms, side effect of medication

and possible complication, and any procedures to be done

Administer O2 as ordered check VS frequently

Assess Homan signs and thrombi formation

Positioning patient slowly to prevent dizziness

Allow ADL if patient is able

Provide HTP : to drink at least 3 L of H2O daily; elevate feet when resting;

avoid restrictive clothing; wear support hose; take medication as ordered;

report for chest pain, joint pain, fever or activity intolerance etc.

Keep appointment for laboratory test and physician checks


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Medical/surgical management

Phlebotomy removal of blood from the vein about 350-

500ml q other day til hct is 40%

Radioactive phosphorus and radiation therapy to decreasethe production of blood cells in the bone marrow


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Pharmacology

Busulfan (Myleran); Chlorambucil (Leukeran);

Cylophosphamide (Cytoxan) and mechlorethamine or

nitrogen mustard = to decrease bone marrow production Allopurinol (Zyloprim) = to decrease production of uric acid

Antihistamine = for pruritus

Analgesic


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Diet therapy

Increased calories and protein

Low in sodium to decrease fluid volume

Avoid iron containing food


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ANEMIAS

Decreased availability of oxygen to the tissue

TYPES of Anemia:

1. Iron deficiency2. Folate deficiency

3. Aplastic

4. Pernicious


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ETIOLOGY

Acute/chronic blood loss

Inadequate dietary intake of vitamins/minerals needed forRBC production

Decreased RBC production by the bone marrow

Increased destruction of RBC

Increased demands of vitamins/minerals needed for RBCproduction


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Signs and symptoms:

Pallor easy fatigability Tachycardia

weakness Palpitation

anorexia Dizziness weight loss Headache

syncope Paresthesia

brittle hair and nails Amenorrhea

Cold sensitivity


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Iron Deficiency AnemiaDescription: Microcytic, hypochromic anemia

From menses for females

GI bleeding for men

Assessment:- Vinson-Plummers Syndrome: stomatitis,dysphagia, atrophic glossitis (smooth,sore tongue)

- Cheilosis (cracks at the side of the lips)

- Koilonychia (spoon-shaped/concave fingernails)

- Pica (craving of non-edible substance

- Tinnitus

- Cardiovascular symptoms 7.5g/dl:increase PR, chest pain


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Nursing intervention

Promote rest to reduce O2 demands

Render oral care and good skin care

Diet: iron rich food


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Medical Mgt.

o Iron supplement: oral FeSO4; parenteral Imferon

o Oral should be given pc to prevent GI irritation

o Oral liquid iron to be administered with straw to prevent permanent staining of theteeth

o Vit. C increase iron absorptiono Do not administer with milk, antacid these will inhibit absorption

o Inferon: Z-track to prevent staining of the skin

o Do not massage site injection to prevent leakage of medication to subcu. layer

o Iron salt change color of stool to dark green or black

o Oxygen therapy

o Blood transfusion


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Folate deficiency anemia/megaloblastic anemia- Produced RBCs are abnormally large due to Vit 12 or folic acid

deficiency

Etiology:

Poor dietary intake Prolonged TPN

Eat Uncooked fruits and vegetables Malignancy

Alcoholism Chronic Hemodialysis

Chronic malnutrition Malabsorption

Pregnancy Anorexia nervosa


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Assessment Cracked lips, smooth, sore tongue and mild dirrhea

Same as pernicious anemia

Bone marrow analysis reveals hyperplasia

Poikilocytosis(abnormally-shaped RBC)

Extreme paleness, especially in mucous membrane Confusion, paresthesia in extremeties, lose of maintaining balance

Lose of position sense (proprioception

Mild jaundice, vilitigo, pemature of graying skin

(+)Schilling test

MANAGEMENT: Well balance diet, assess ambulation, gait and stability

Folic acid 1mg/day; instruct to avoid extreme hot or cold


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Pernicious anemia/B12 deficienccy Lack of intrinsic factor in gastric secretion

Is an autoimmune disease in which parietal cells are

destroyed and the gastric mucosa atrophies

Macrocytic, hyperchromic anemia

Onset 50 to 60 yrs. old

ETIOLOGY:

Gastric surgery

Crohns disease


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Pathophysiology

Decreased Intrinsic factor production by the parietal cells of

the stomach ->decreased Vit, B12 absorption ->decreased

RBC production -> decrease DNA synthesis in maturing

RBC -> impairment of cell integrity


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Diagnostic test

Schillings test

most definitive diagnostic test

- Oral radioactive Vit 12 is administered

- IM nonradioactive Vit 12. To push the radioactive Vit 12 into

the urine

- Collect 24 hours urine specimen

- Decreased excretion of Vit 12 in the urine indicates (+)


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Assessment

Beefy red, inflamed tongue ( most characteristic manifestation)

Achlorhydria( absence of free Hcl acid in the gastric juice

Tingling, numbness

Lack of balance, uncoordinated movement

Confusion

Paralysis

Depression, psychosis

Jaundice


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Collaborative MGT

Vit 12 im: daily for 7 days; weekly for 10 weeks; monthly

lifetime 100mg/Mos.

Hydrochloric acid p.o. for 1 week

Iron therapy

Blood transfusion as needed

Physical examination every 6 months


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Aplastic anemia- Hypoplasia of the bone marrow

- Fat replaces bone marrow

- Pancytopenia drop in the # of RBC: anemia,

leukopenia,thrombocytopenia

ETIOLOGY: cause unknown

- Congenital Medications Infection

- Acquired heavy metals Hepatitis

- Idiopathic


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Diagnostic test

Bone marrow aspiration/biopsy

Adult: posterior iliac crest the most common site

Prone position during the procedure

Brief, sharp pain is normally experienced as bone marrow isaspirated

Child: Tibia most common site

Side-lying position during the procedure

Apply pressure at the puncture site to prevent bleeding


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Medical treatment

-ATG (Atgam) antihymocyte globulin an Immunosuppressive

therapy to suppress the rxn causing the aplastic anemia and

allow the bone marrow to recover- Given OD through CVC for 7 to 10 days

- Transfusion of plt. and Packed RBC


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Surgical tx

BM transplant

Cyclosporine (sandimmune) an immnunosuppressant is

given for BMT to decrease the graft rejection


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Pharmacological tx

Antibiotic for infection

Steroids and Androgen used to stimulate the bone marrow


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Acquired Hemolytic Anemia

- Hemolysis or destruction of RBCS

ETIOLOGY:

Autoimmune rxn. arsenic

Radiation lead

Bld transfusion medication

Chemicals clostridium perfringens


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Signs and Symptoms

Mild fatigue Pallor

Elevated LDH Low Hb, Hct

Pallor Jaundice

Palpitation Hypotension

Dyspnea Back and joint pain


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MEDICAL MGT.

BT- blood transfusion

Erythrocytapheresis a procedure that removes abnormal

RBCSand replaces a healthy one


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Surgical tx

Splenectomy to stop destruction of RBC

Pharmacological:

- Corticosteroids to decrease the autoimmune response

- Folic acid to increase the production of RBC


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SICKLE CELL Disease/INHERITED HYMOLYTICANEMIA

Genetic disorder caused by recessive genes

Has an abnormal Hb. S instead of Hb A in the RBC

The person with one S gene (HbsA) has sickle cell

trait

The person with two S genes (Hbss) has sickle cell

disease


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Diagnostic Procedure

Sickledex or sickle cell test

- A screening test to infant to diagnose sickle cell disease

- If Hb S is present, a Hb electrophoresis is done to distinguishbetween sickle trait and sickle cell disease

- If the Hb electrophoresis test is negative, the client has thesickle cell trait and not sickle cell disease.


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Factors can precipitate sickle cell crisis

Dehydration Alcohol consumption

Fatigue Blood Loss

Infection Anesthesia Emotional stress Exposure to cold


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Effect of sickle cell to circulatory system

Obstruction of vessels and rupturing it and these become infarct andischemic that can cause: S &S

Chronic anemia Dyspnea

Cardiomegaly Arrhythmias

Fatigue Fever

Jaundice Severe pain

Chronic leg ulcer Loss of bld supply

Tachypnea Joint pain, swollen and tender

priapism


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Medical management

Antibiotics Genetic Counselling

Large amount of oral and IV fluid

Pharmalogical:

- Folic acid OD to assist in the production of RBC- Cetiedel citrate antisickling effect by changing the RBC membrane.

- Trental (Pentoxifylline) reduces blood viscosity, increase RBCflexibility, lengthens the time between sickle cell crises

- Blood transfusion during crisis

- Patient-Controlled Analgesia with morphine during crisis


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Nursing management Ineffective Tissue Perfusion r/t decreased # of RBC and decreased oxygenation

as evidenced by dyspnea, tingling sensation and numbness of LE

AdministerIV as ordered

Offer 8 to 10 glasses of H20/day

Monitor for symptoms of obstructed vessels such as: pain, legulceration, abdominal tenderness, dyspnea, confusion andblurred vision

Administered Blood. product as ordered

Close monitoring for possible BT RXN

Elevate head; administer O2 as ordered


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Alteration in comfort:Pain r/t occlusion of small vessels by sickled cellsas evidenced by---

Assess the severity, location and type of pain

Monitor analgesic administration by PCA pump

Support joints and LE with pillows

Keep bed linens off knees and ankles with a bed cradle


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Activity Intolerance r/t imbalance between O2 supply and demand asE/B weakness, fatigue, tingling and numbness

Assist with ADL

Teach the importance of alternating periods of rest with

activity


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Knowledge deficit r/t prescribed TX, disease process

Teach about the disease process

Assist to take medication

Explain the importance of avoiding stress and infection

Stress the importance od adequate rest in a routine basis

Explain to avoid high altitudes and nonpressurized airplane

Discuss the important of avoiding tight-fitting -, restrictive clothing andstrenuous exercise, smoking and cold temp

Advice to receive flue vaccine and pneumococcal vaccine


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White blood disorder

1. Leukemia

- Is a malignancy of blood-forming tissues in which the bone

marrow produces increased numbers of immature WBCthat are incapable of protecting the body from infections


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Two classification of Leukemia1. Acute leukemia 2. Chronic leukemia

subtype: subtype:

a.)AML Acute myelocytic leukemia a.)ALLAcute lymphocytic leukemia

-Malignant, affect monocytes, granulocytes, - Malignant proliferation of lymphoblasts

erythrocytes and platelets arising from a disorder of a single

common in adolescence and 55yrs of age lymphoid stem cell. Most common in

children

Survival: Survival:-1-3 yrs with chemo; 2-5 mos. if untreated - 5 yrs with chemo and radiation therapy;

50% can be cured

b.)CML Chronic myelocytic leukemia b.)CLL Chronic Lymphocytic Leukemia- caused byproliferation

- Malignancy of the myeloid cell of small, abnormal B-lymphocytes

that leads to uncontrolled proliferation WBC: between 20,000 and 100,000

of granulocytes; common in adult develop with advanced age

-Characterized by Philadelphia chromsomes

-W

BC count: 15,000-500,000

Survival:3 -5 yrs if without BM transplant Survival: 5 7 yrs.


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Pathophysiology

- Proliferation ofImmatureWBCS----Immune system

compromised state--production of RBCs and

Platelets Hypertrophy of the Bone marrow (bonepain) organ Infiltration: hepatomegaly;

Splenomegaly;renal insufficiency; hyperuricemia;

arthralgia; Increase ICP (meningeal infiltration)


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COLLABORATIVE MANAGEMENTMEDICAL MGT:

Chemotherapy Bone marrow transplantation Blood transfusion

NURSING INTERVENTION:

PROTECT FROM INFECTION: Reverse isolation/protective isolation; Practice

asepsis; Limit visitors; Do not allow people with infection to visit; Avoid fresh

fruits/fresh flowers in the unit; Avoid raw foods

PREVENTTRAUMA and BLEEDING: minimize parenteral injection, use small

needle, apply pressure at injection site for 5 mins.,support/handle body parts

gently,use soft-bristled toothbrush/soft swab, use electric razors, do not

administer ASA

CONSERVE ENERGY/O2 SUPPLY: adequate rest, Oxygen therapy


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RELATIONSHIP OF LAB. TESTTO LEUKEMIA SYMPTOMS

LAB RESULTS -- OVERALL SYMPTOMS -- SYMPTOMS MANIFESTATION

Immature WBCs - Persistent infections -- fever, chills

Decreased RBCs -Anemia

--fatigue, pallor, malaise,tachycardia, tachypnea

Decreased platelets --- Bleeding -- petechiae,bruising,

melena, gingival bleeding,

menorrhagia, epistaxis


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Chemotherapeutic agents to treat leukemiaTYPES OF LEUKEMIA: CHEMOTHERAPEUTIC AGENTS:ALL Vincristine(oncovin)

Prenisone(deltasone)

6-mercaptopurine or 6-MP(purinethol)

Methotrexate

AML daunorubicin Hcl(cerubidine)

cytarabine or era-C(cytosar

-U)6-thioquanine(thioguanine)

Doxorubicin Hcl(Adriamycin)

CLL Chlorambucil(Leukeran),COP(cytoxan,oncovin,prednisone

CML BUSULFAN(MYLERAN), HYDROXYUREA(HYDREA)

DAT(daunorubicin,ara-C, thioguanine


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AGRANULOCYTOSISDESCRIPTION - severely reduced number of granulocytes:basophils,

eosinophils, neutrophils

Etiology: medication toxicity, neoplastic disease, chemotherapy,

radiation therapy, bacterial and viral infection

Signs & symptoms:

headache Chills Fever fatigue

mucous membrane ulceration of the nose, mouth, pharynx, vagina,

and rectum

WBC and neutrophils is low


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Collaborative Mgt.

Culture and sensitivity if fever occur and ulceration

Blood transfusion to provide mature leukocytes

Filgrastin (Neopogen)- a human granulocyte colony

stimulating factors

Protective isolation

Antibiotic specific for cultured microorganism

Soft bland diet high in calories, protein and vitamins


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Nursing intervention Infection control:

Follow aseptic technique in any procedures

Environment must be kept very clean

Should avoid crowdsAvoid hot and cold temperature

Client reports any signs or symptoms of infection

Adequate amount of fluids

Monitor wbc

Provide rest between activities


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COAGULATION DISORDERS:

1. DISSEMINATED INTRAVASCULAR

COAGULATION

2. HEMOPHILIA

3. THROMBOCYTOPENIA


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DIC(DISSEMINATED INTRAVASCULAR COAGULATION)

- A syndrome and not a disease

- Occurs due to primary disease process or condition like:

burns, acute leukemia, metastatic cancer, polycythemia vera,pheochromocytoma, shock, acute infection, septic abortion,

abruptio placenta, BT rxn. and trauma

- A condition of alternating clotting and hemorrhaging


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Pathophysiology

- Primary disease stimulation of clotting

mechanism -- microthrombi formation process

and Fibrinolysis

Depletion of clotting factorsand Bleeding Obstruction of circulation

tendency leads to organ and tissue necrosis. In

bleeding - hemorrhage.


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Signs and Symptoms Purpura( reddish purple patches on the skin) chest and

abdomen

Oozing of blood from venipuncture, mucous membrane,

surgical wound Decreased urine output

Increased prothombine time and Partial thromboplastin time,thrombin time

Decreased fibrinogen and platelet count


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Collaborative Mgt. Lab. Test D DIMER test measures a fibrin split product that is

released when a clot breaks

Treatment of primary disease. Ex. Infection antibiotic,CA chemotherapy

Whole blood or blood products to normalize clotting factor levels

Platelets and Packed RBC Cryoprecipitate or fresh-frozen plasma to nomalize clotting factor

levels

Heparin to prevent the formation of more microthrombi

Aminocaproic acid (Amicar) to stop bleeding it inhibit the fibrinolyticprocess

**Fibrinolysis is the process of breaking fibrin apart


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Nursing Intervention Assess previous condition such infection, trauma, CA,

MonitorI&O closely and record

Monitor color, VS, peripheral pulses, neurological checks

If abdominal bleeding is suspected measure abdominal girthevery 4 hours

Assess surgical wounds, all body orifices for bleeding

Assess presence of pulmonary edema, hypotension

tachycardia, confusion restlessness, convulsion and coma


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Hemophilia- Is an inherited bleeding disorder in which there is a lack of

clotting factors

- The trait is carried on the recessive X chromsome a

mother is asymptomatic but can pass the trait to the sonwho manifest the symptoms

TYPES:

1. HEMOPHILIA A lacking of clotting factorsVIII

2. HEMOPHILIA B (CHRISTMAS DISEASE) lacking of

factorIX


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Three Classification of Hemophilia

1. Severe factor level less than 1% of

normal

2. Moderate factor level 1% to 5% normal

3. Mild factor level 40% normal


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Signs & Symptoms

Bleeding main symptom

Hemarthrosis bleeding into the joint -> causing pain

swelling, redness and fever Spontaneous ecchymoses and bleed from the mouth and

GIT & Urinary

Complication: INTRACRANIAL HEMORRHAGE


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COLLABORATIVE MGT. LAB. Test Partial thromboplastin time(PTT) result is prolonged

Diagnosed by deficient or absent blood level of factors VIII orIX

TX:

administration of clotting factors VIII & IX

Hemophilia A fresh frozen plasma and cryoprecipitate thathas factor VIII

Hemophilia B - fresh frozen plasma that contain factorIX


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Pharmacological

Desmopressin acetate (DDAVP)

Aminocaproic Acid (Amicar)

** To decrease fibrinolytic process


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Nursing InterventionDeficient knowledge r/t disease process:

Discuss ways to improve the safety of the clients home

environment

Advise not to take ASA

Encourage to use electric razor and soft-bristled toothbrush

Refer to genetic counselling

Encourage client to wear Medic-Alert bacelet


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Alteration in Comfort Pain r/t inflammation/swelling of tissue and joints

Assess for bruising, swelling and joint discomfort

Apply ice and pressure to bleeding site

Immobilize with a supportive device

Administer analgesic as ordered

Risk forInjury r/t altered clotting factors: Transfuse clotting factors as ordered

Encourage to avoid activities that may cause harm

Post emergency medical # for future need.

Prevent injuries: wear gloves, long-sleeved clothing when doinghousehold chores, participate in noncontact sport and activities


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Thrombocytopenia

- Is a decreased in the number of platelet in the blood

- The decrease may R/T: aplastic anemia tumors, leukemia and chemotherapy

Infection or viral illnessesIncreased platelet destruction as in DIC or thrombocytopenic purpura that

is either drug induced or idiopathic( occurring without cause)


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Signs and Symptoms Petechia Ecchymosis Bleeding from mucous membrane

Very low Platelet count ; Prolonged Bleeding Time

Hb, Hct is low; BMA shows mostly immature platelets

Collaborative Mgt:

Transfusion of platelet concentration Apheresis( removal of unwanted components) to remove the autoantibodies

Splenectomy - primary site of platelet destruction

Corticosteroids to prolong platelet life and strengthen the capillaries

Immunosuppressive drugs, gamma globulin, and Vit K

High fiver diet


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Nursing intervention Activity should be undertaken to prevent trauma

Assess level of pain on pain scale and coping ability

Monitor VS, neuro andmental status

Assess skin and excretions for signs of bleeding Handle very carefully in all nursing procedures

Teach to use razor for shaving, soft bristles toothbrush,

wear slippers at all time. Do not take ASA. Eat high fiver

diet, blow nose very gently


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Test questions Identification: Identify the ff: write the correct answer.1. Sickledex or Hb.Electrophoresis - are the diagnostic test for sickle cell anemia

2. Anemia decreased number of RBCs and low Hb and hct level

3. DIC is not a disease but a syndrome that occurs because of a clients having a primarydisease or condition

4. Hemophilia is a recessive X chromosome inherited bleeding disorder in which the client islacking clotting factors

5. Severe hemophilia one of the classification of hemophilia wherein the level factor is lessthan1% of normal

6. Agranulocytosis a severely reduced number of granulocytes(basophil, eosinophils, andneutrophils

7. Leukemia a malignancy of blood forming tissues in which the bone marrow producesincreased numbers of immatureWBC

8. Phlebotomy one of the treatment of polycytemia which is the removal of blood from a vein

9. Polycythemia is a disease in which there is an increased production of RBC

10. Iron deficiency Anemia - the most common type of anemia and occurs when the body doesnot have enough iron to synthesize functional Hb.


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Enumeration

Hematology Alteration

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