PT 728 Screening for Hematologic Disease

what is the most important indicator of dysfunction in the hematological system

- issues associated with physical effort

what are the important indicators of Hematologic disorders

- dyspnea

- chest pain

- palpations

- severe weakness

- fatigue

Hematological disorders may also affect what 2 systems

- nervous system

- integumentary system

what are the S/S of hematological disorders that occur in the nervous system

- headache

- drowsiness

- dizziness

what are the S/S of hematological disorders that occur in the integumentary system

- pale

- cyanotic

- bruising

- bleeding gums/mucosa

what do erythrocytes do

- transport oxygen and carbon dioxide

what are the erythrocyte disorders

- anemia

- polycythemia

- poikilocytosis

- anisocytosis

- hypochromia

what is poikilocytosis

- abnormally shaped erythrocytes

what is anisocytosis

- abnormal variations in size of erythrocytes

what is hypochromia

- erythrocytes deficient in hemoglobin

what are the causes of erythrocytosis

- high altitude

- dehydration

- pulmonary fibrosis

what are the symptoms/signs of erythrocytosis

- weakness

- fatigue

- headache

- lightheadedness

- dyspnea

what should we monitor for erythrocytosis

- monitor for fatigue with RPE and dyspnea scale

- monitor vitals

what are the causes of anemia

- hemorrhage

- bone marrow suppression

- renal disease

- pregnancy

what are the signs and symptoms of anemia

- orthostatic hypotension

- dizziness

- chest pain

- leg cramps with exercise

what should we monitor for anemia

- vital signs

- cardiac rhythm

- fatigue

- leg cramps

- cognitive impairments

what are the common vital sign changes with anemia

- increased resting pulse rate

- Blood pressure systolic stays the same diastolic will be much lower

what are the critical values for hemoglobin

-

what is polycythemia

- increased hemoglobin ( increased RBC)

what are the causes of polycythemia

- severe dehydration

- high altitude

- smoking

- heart failure

what are the signs and symptoms for polycythemia

- fatigue

- headache

- dizziness

- TIA

- Dysrhythmias

- bleeding

what should we monitor for with polycythemia

- vital signs

- cardiac rhythms

what additional interventions should we provide with a diagnosis of polycythemia

- fall prevention

- implement pacing strategies to reduce the load and prevent undue stress on the cardiovascular system

what are the primary symptoms of polycythemia

- SOB

- fatiuge

polycythemia can cause

stroke or TIA

what can cause low hemoglobin

- blood loss

- vitamin B-12

- Iron Deficiency

- bone marrow suppression

what are the signs and symptoms of low hemoglobin

- pallor

- tachycardia

- orthostatic hypotension

- dysrhythmias

what should we monitor with low hemoglobin

- talk with nursing prior to therapy

- monitor vitals **SpO2**

- check for orthostatic hypotension

_____ is an inherited autosomal recessive disorder that can form an abnormal formation of hemoglobin

- sickle cell anemia

what are the 2 key features of sickle cell anemia

- chronic hemolytic anemia

- vasoocculsion

what is a sickle cell crisis?

overexertion

how long does a sickle cell crisis tend to affect patients

5-6 days

where might sickle cell obstruct blood flow to

mostly brain, kidneys and bone

what are the symptoms of a sickle cell crisis

- Pain

- Fever

- Chills

- Nausea/Vomiting

- Joint swelling

- Numbness or tingling

- Difficulty concentrating

- Sudden vision loss

what are the 3 major types of leukocytes

- lymphocytes

- monocytes

- granulocytes

_____ produce antibodies and ract with antigens

- lymphocytes

____ are immature cells that leave the blood and travel to tissues to form macrophages

monocytes

_____ are lysing agents that digest foreign materials

- granulocytes

what is considered leukocytosis

- >10,000/mm3

what are the causes of leukocytosis

- infection

- immune system disorder

- bone marrow disease

- stress

what is the presentation of leukocytosis

- fever

- fatigue

- bleeding

- brusing

what are the PT considerations for leukocytosis

- timing of PT

- better to due early in the morning

what is considered leukopenia

-

what are the causes of leukopenia

- chemotherapy

- radiation

- infections

what is the presentation of leukopenia

- inflammation in or around mouth

- headache

- night sweats

what should we monitor for leukopenia

- s/s of infection

- fatigue

- fall preventions

when would leukocytes be lowest during treatment progression

- 7-14 days after chemo

what is the function of platelets

- primarily in hemostasis

- maintenance of capillary integrity

what is platelet disorders mainly affected by

- anticoagulation drugs

what is platelets also affected by

- foods

- exercise

- disease of the liver

what are the causes of thrombocythemia

- cancer

- splenectomy

- acute/chronic inflammation

what are signs and symptoms of thrombocythemia

- headache

- dizziness

- chest pain

- tingling in hands and feet

what should we screen for in thrombocythemia

- DVTs

what are the causes of thrombocytopenia

- hemorrhage

- oncologic diseases

- chemotherapy

- radiation

what are the signs and symptoms of thrombocytopenia

- petechia

- ecchymosis

- oral bleeding

what should we monitor for with thrombocytopenia

- education on fall prevention

- monitor for fatigue

what are the primary bleeding site for thrombocytopenia

- bone marrow or spleen

what are the secondary bleeding sites for thrombocytopenia

- blood vessels in skin, mucosa, and brain

_____ is a hereditary blood clotting disorder that causes abnormalities of functional plasma-clotting proteins

- hemophilia

______ is one of the most common clinical manifestations of hemophilia

hemiarthrosis

____ is bleeding in the joint

hemiarthrosis

what are the most common bleed sites for hemiarthrosis

- knee

- elbow

- ankle

- hip

- shoulder

what is the second most common clinical manifestations of hemophilia

- muscle hemorrages

what are common areas for muscle hemorrhage

- flexors

- iliopsoas

- gastroc

- flexors of the forearm

when having a patient flex their trunk and they experience severe pain this would indicate

- iliopsoas bleeding

when having rotating a patients hip gentle in any direction and severe pain is experienced what would this indicate

- hip hemorrhage

for hemophilia when would a physician referral be needed

- if any skin or mucous membrane symptoms occur

- any painful episodes develops in the muscles or joints

what are good cues to screen for a hematoloic disease

- previous history or current chemo or radiation

- chronic or long term use of aspirin or NSAIDs

- spontaneous bleeding of any kind

- recent surgery or transplant

- rapid onset of dyspnea, chest pain, weakness, and fatigue with palpitations