Hematologic

Accessory organs of blood formation

spleen and liver

Bone marrow aspiration/biopsy

follow-up care - teach to inspect site every 2 hrs for 24 hrs, avoid activity that could result in trauma

analgesic (aspirin-free) and ice packs

Assessment of hema issues, skin

pallor, jaundice, cyanosis in gums, conjunctiva, and nail beds

active bleeding from light pressure or petechiae

Assessment of hema issues, head and neck

pallor, ulcerations, or color changes in oral mucosa

inspect lymph nodes

Assessment of hema issues, respiratory

rate/depth of breathing

sob, fatigued easily, 10-word sentence w/o stopping for a breath

Assessment of hema issues, cardiovascular

weak or thready pulses

distended neck veins or edema

abnormal heart sounds or dysrhythmias

Assessment of hema issues, kidney and urinary

hematuria

CKD → anemia

Assessment of hema issues, musculoskeletal

rib/sternal tenderness (leukemia)

note any swelling and joint issues

Assessment of hema issues, abd

enlarged spleen = palpable, prone to rupture

stool sample (bloody, change in habits?)

Assessment of hema issues, CNS

vitamin b12 deficiency impairs function

Assessment of hema issues, psychosocial

learn which coping mechanisms have been successful

Causes of anemia

blood loss

impaired production

increased RBC destruction

combination

Anemia interventions

assess tachycardia, hypotension

provide periods of rest

administer o2 and monitor saturation

monitor fluid volume status

prevent infection

Sickle cell disease

cells are distorted into sickle shapes which clump together

autosomal recessive pattern of inheritance

most common in african americans

Sickle cell lab assessment

% of hgb S on electrophoresis

hct low during crisis

reticulocyte count, WBC high

Care of pt in sickle cell crisis

remove constrictive clothing

encourage stretching to promote venous return

do not raise the knee position of the bed

elevate head of bed no more than 30 degrees

administer o2 and pain meds as prescribed

infuse normal saline IV

be prepared to administer transfusion therapy

keep room temp comfy

check circulation in extremities every hr

Sickle cell evaluation

report pain to be maintained at an acceptable level

maintain perfusion and gas exchange to extremities and vital organs

remain free of infection, sepsis, and MODS

Key features of anemia general

pallor

cool to the touch

intolerant of cool temp

brittle/concave nails when chronic

Key features of anemia cardiovascular s/s

continuous rapid heartbeat that increases after meals and with activity

murmurs and gallops

orthostatic hypotension

Key features of anemia respiratory s/s

breathless on exertion

decrease o2 levels

Key features of anemia neuro s/s

fatigue

increased need for sleep

reduced energy levels

Sickle cell, G6PD, immunohemolytic anemia cause

genetic

Iron, b12, folic acid deficiency anemia cause

dietary problem

Aplastic anemia

infection, bone marrow disease

• ionizing radiation

• toxic chemical or drug exposure

Acquired autoimmune hemolytic anemia cause

autoimmune response

sickle cell or thalassemia

inherited enzyme deficiencies

Folic acid anemia cause

alc

celiac disease, gastric bypass, hemolytic anemia, short bowel syndrome

malnutrition

Iron deficiency anemia cause

bariatric surgery

blood loss

breast feeding

menstruation

pregnancy, recent delivery

surgery, trauma

Vitamin b12 deficiency anemia cause

lack of intrinsic factor due to:

• autoimmune disorder

• gastrectomy

• gastritis

malabsorption syndrome

surgery that removed the end of small intestine

Aplastic anemia interventions

depends on cause

blood transfusions

immunosuppressive therapy

G6PD anemia interventions

test those at high risks

hydration

osmotic diuretics

transfusions

Immunohemolytic anemia interventions

immunotherapy

splenectomy

immunosuppressive therapy w/ chemotherapy

Polycythemia Vera

cancer of RBCs; massive production of RBCs, excessive leukocyte and platelet production

Polycythemia Vera s/s

intense itching and dark purple or cyanotic facial skin/mucous membranes

Polycythemia Vera interventions

donating blood

apheresis (separates part of blood)

promote venous return

anticoagulants

Leukemia

blood cancer; results from a loss of normal cellular regulation → uncontrolled production of immature WBCs in the bone marrow

• fatigue due to reduced gas exchange and increased energy demands

• infection is a major cause of death

Leukemia risk factors

ionizing radiation, viral infection, exposure to chemicals/drugs

Leukemia lab assessments

low hgb/hct

low platelets

abnormal WBC count

bone marrow aspiration/biopsy (definitive)

blood clotting times

chromosome analysis

Leukemia treatment

stem cell transplant

• iliac crest from donor

• peripheral blood stem cells

• cord blood

Malignant lymphomas

hodgkins lymphoma

non-hodgkins lymphoma

Malignant lymphomas s/s

large, painless lymph nodes

fevers, drenching night sweats, unplanned weight loss

some have no symptoms at time of diagnosis

Malignant lymphomas interventions

external radiation of lymph node region

CAR-T therapy

radiation + chemo

Multiple myeloma

WBC cancer of mature b-lymphocytes

bone pain, fatigue, easy bruising

Thrombocytopenic purpura

destructive reduction of circulating platelets after normal platelet production → impaired clotting

Transfusion therapy; pretransfusion

review agency policy

verify prescription with another RN

test donors/recipients blood for compatibility

use two identifiers and verify with another RN

examine blood bag label, attached tag, and requisition slip for ABO and Rh compatibility

check expiration date/time with another RN

inspect blood for discoloration, gas bubbles, cloudiness

During transfusion

administer blood product using tubing to remove aggregates and possible contaminates

infuse blood products only with IV normal saline solutions because other could cause hemolysis

stay w/ pt for first 15-30mins since severe reactions can occur

infuse blood product at prescribed rate for transfusion type to avoid complications of fluid overload

monitor vital signs as often as agency policy and the pts condition indicates to identify early indications of adverse transfusion reactions

Types of transfusions

packed RBC transfusions

platelet transfusions

fresh frozen plasma transfusions

WBC transfusions

massive transfusion protocol

Packed RBC transfusions

2-4 hrs

replaces cells lost from trauma or surgery

Platelet transfusions

15-30mins

given for low platelet counts, active bleeding, scheduled invasive procedure

Fresh frozen plasma transfusions

15-30mins

replaces blood volume and clotting factors

WBC transfusions

1hr

given to neutropenic clients

Massive transfusion protocol

given when h/h levels are low

Acute transfusion reactions

febrile

hemolytic

allergic

bacterial

circulatory overload

transfusion associated graft vs host disease