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Transcript of NUR202 ModuleBChapter43
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Interventions forHematologic Problems
NUR 202 Module B
Chapter 43
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Leukemia
Type of cancer with uncontrolled production of
immature white blood cells in the bone marrow
Acute or chronic
Classified by cell type Risk factors: ionizing radiation, exposure to
certain chemicals and drugs, bone marrow
hypoplasia, genetic factors, immunologic
factors, environmental factors
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Leukemia
Clinical Manifestations Cardiovascular: heart rate is increased; blood
pressure is decreased.
Respiratory rate increases. Skin grows pale and cool to the touch.
Intestinal manifestations include weight loss,
nausea, and anorexia.
Central nervous system disturbances include
headache.
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Leukemia
Laboratory Assessment Decreased hemoglobin and hematocrit levels
Low platelet count
Abnormal white blood cell count, may be low,
normal or elevated, but is usually quite high
Poorer prognosis: client with high white blood
cell count at diagnosis
(Continued)
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Leukemia
Definitive test: examination of cells
obtained from bone marrow aspiration
and biopsy
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Leukemia
Risk for Infections Infection is a major cause of death in the client
with leukemia, and sepsis is a common
complication. Autocontamination
Cross-contamination
Changes in immune function
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Leukemia
Drug Therapy for Acute Leukemia Induction therapy
Consolidation therapy
Maintenance therapy Indicated for ALL and APL
New drug therapies Gleevec for CML that is Philadelphia
Chromosome positive Drug therapy for infection
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Leukemia
Infection Protection Frequent handwashing
Private room
HEPA filtration or laminar airflow system
Mask for visitor with upper respiratory
infection
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Leukemia
Infection Protection (Continued) Minimal bacteria diet without uncooked
foods
Monitoring of daily laboratory results Assessment of vital signs
Skin care, respiratory care
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Leukemia
Bone Marrow Transplantation Standard treatment for leukemia
Purges present marrow of the leukemic cells
After conditioning, new, healthy marrow given
to the client
Sources of stem cells
Conditioning regimen Transplantation
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Leukemia
Sources of stem cells Allogeneic
Matched relative (sibling)
Unrelated HLA matched donor Autologous
Self
Syngeneic Identical twin
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Leukemia
Stem cell harvest Umbilical cord blood
Peripheral stem cell pheresis
Bone marrow harvest
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Leukemia
Risk for Injury Nadir: period of greatest bone marrow
suppression
Bleeding precautions
Fatigue Interventions:
Diet therapy
Blood replacement therapy
Drug therapy
Energy conservation
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Hodgkins Lymphoma
Cancer that starts in a single lymph node
or a single chain of nodes
Marker: Reed-Sternberg cell
Large, painless lymph node usually in the
neck; fever, malaise, night sweats
One of the most curable cancers
Treatment: external radiation alone or with
combination chemotherapy
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Non-Hodgkins Lymphoma
All lymphoid cancers that do not have the
Reed-Sternberg cell
More than 12 types of non-Hodgkins
lymphoma
Low-grade lymphomas less responsive to
treatment; cures are rare
Treatment: radiation therapy and multi-agent chemotherapy, or single-agent
therapy with fludarabine
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Multiple Myeloma
White blood cell cancer that involves a
more mature lymphocyte than either
leukemia or lymphoma
Uncommon cancer Manifestations: fatigue, easy bruising,
bone pain, fractures, hypertension,
increased infection, hypercalcemia, andfluid imbalance
Treatment: chemotherapy
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AutoimmuneThrombocytopenicPurpura(Continued) Interventions include:
Therapy to prevent bleeding
Drug therapy to suppress immune function
Blood replacement therapy
Splenectomy
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Thrombotic Thrombocytopenic
Purpura
Rare disorder; platelets clump together
abnormally in the capillaries and too few
platelets remain in circulation
Inappropriate clotting, yet blood fails toclot properly when trauma occurs
Plasma pheresis, infusion of FFP
Aspirin, alprostadil, plicamycin Immunosuppressive therapy
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Transfusion Therapy
Pretransfusion responsibilities to prevent
adverse transfusion reactions: Verify prescription.
Test donors and recipients blood forcompatibility.
Examine blood bag for identification.
Check expiration date.
Inspect blood for discoloration, gas bubbles,
or cloudiness.
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Types of Transfusions
Red blood cell
Platelet transfusions
Plasma transfusions: fresh frozen plasma
Cryoprecipitate
Granulocyte (white cell) transfusions
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Blood Compatibility Guide
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TransfusionResponsibilities Provide client education.
Assess vital signs.
Begin transfusion slowly and stay with
client first 15 to 30 minutes.
Ask client to report unusual sensations
such as chills, shortness of breath, hives,
or itching. Administer blood product per protocol.
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Affect of IV Fluids on RBCs
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Transfusion Reactions
Can occur when whole blood, PRBCs,
platelets, or FFP are given
5 types of reactions can occur: Hemolytic
Anaphylactic
Febrile
Circulatory overload Bacterial
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Transfusion Associated Graft VersusHost Disease
Rare occurrence
Life threatening 90% mortality rate
Prevention Use of irradiated blood
products
Manifestations Anorexia
Nausea
Thrombocytopenia
Vomiting
Chronic hepatitis
Weight loss
Recurrent infection
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Autologous BloodTransfusion Collection and infusion of clients own
blood
Eliminates compatibility problems;
reduces risk for transmission ofbloodborne disease
Preoperative autologous blood donation
(Continued)
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Autologous BloodTransfusion (Continued) Acute normovolemic hemodilution
Intraoperative autologous transfusion
Postoperative blood salvage
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Colony Stimulating Factors
Natural hormones that stimulate the bone
marrow to make more blood cells. Exogenous sources
Procrit Epogen