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1 Hematologic Disorders & Nursing Priorities Keith Rischer RN, MA, CEN.

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Presentation on theme: "1 Hematologic Disorders & Nursing Priorities Keith Rischer RN, MA, CEN."— Presentation transcript:

1 1 Hematologic Disorders & Nursing Priorities Keith Rischer RN, MA, CEN

2 2 Objectives for Today Review pathophysiology related to hematologic cells and blood forming tissues Interpret significance of altered hematologic lab values Review commonly used medications that alter hematologic function Identify the patho, clinical manifestations, diagnostic tests, nursing priorities, and client education in clients with anemia, sickle cell anemia, leukemia, lymphomas, and multiple myeloma. Identify the nursing priorities with blood transfusion and the most common transfusion reactions.

3 3 Blood Cells Hematopoesis: Red bone marrow The blood forming tissue that produces the 3 major cell components of blood Erythrocytes Leukocytes Thrombocytes

4 4 Erythrocytes Function Transport of gases (O2 & CO2) Erythropoesis Normal Life span: 120 days Norms HgbRBC –Women: 12-16 g/dl4.0-5.0 mm3 –Men: 13.5-18n g/dl4.5-6.0 mm3 HCT –Women: 38-47% –Men: 40-54%

5 5 Leukocytes Types Granulocytes (Also known as polymorphonuclear leukocytes) –Neutrophils –Eosinophils –Basophils

6 Leukocytes 6 Monocytes agranular) Lymphocytes B cells: mediate the humoral immune response T cells: Mediate cellular immunity Normal Blood Count of all WBC: 4,000- 11,000/ul Elderly considerations

7 Thrombocytes (Platelets) 7 Function: Aid in blood clotting Maintain capillary integrity by working as plugs to close any openings in the capillary wall. Normal Blood Count: 150,000-400,000 mm3

8 8 Anemia Mild Hgb 10-14 g/dl Moderate Hgb 6-10 g/dl Severe Hgb < 6 g/dl

9 9 Anemia:Causes Macrocytic Pernicious Anemia (B12 deficiency) Folate deficiency Microcytic –Iron deficiency anemia Normocytic –Blood loss –Sickle cell anemia

10 10 Macrocytic Anemia Megaloblastic Anemias : Presence of large RBCs) Caused by defective DNA synthesis Two common types: 1. Cobalamin (vitamin B12 deficiency) –Pernicious anemia =most common cause. 2. Folic acid deficiency –Poor nutrition (Anorexia) –malabsorption in small bowel –ETOH –Hemodialysis PATIENT EDUCATION

11 11 Microcytic Anemia: Iron Deficiency Abnormal-small erythrocytes…decr. Hgb Most common anemia Manifestations Pallor Glossitis fatigue Dietary sources Patient education

12 12 Normocytic Anemia: Etiology Blood Loss Acute Chronic Extrinsic (acquired) hemolytic anemias – (damage to RBCs due to external factors) Physical factors

13 13 ED Case Study 88 yr women w/dk tarry stools last 5 days. c/o weakness, nausea. Pale, cool-initial VS 80-16-124/30….2 hours later 96-20-94/49 Wbc 9.8, hgb 6.9 (was 12.7 2 weeks ago), hct 21.5, plt 176, INR 4.8 (was 2.1 2 weeks ago) Nursing priorities

14 14 Sickle Cell Anemia Patho Sickle Cell Crisis Nsg Management Pain control Hydration Patient Education Hydration Tx infection Psychosocial

15 15 Thrombocytopenia Reduction of platelets below normal range Normal = 150,000-400,000 mm3 Etiology: Immune Thrombocytopenic Purpura (ITP) Heparin Bone marrow suppression Critical values 50,000 or less- risk of bleeding <20,000 spontaneous life threatening hemorrhages (brain bleed) <10,000 transfusions recommended

16 16 Clinical Manifestations Petechiae Purpura Ecchymosis Bleeding

17 17 Nursing Management If acute care-Peripheral IV established No ASA products for pain control Prevent/control acute bleeding Platelet transfusions-assess for reaction Steroids-pt. teaching Education-signs of bleeding

18 18 Blood Product Administration Minimum 22 g.(blue hub) IV-prefer 20g. (pink) or 18g. (green) Blood tubing with filter-use NS to prime/flush Validate pt., type of blood product, expiration date, blood tag # VS before, 15 after initiation, end of each Infuse PRBCs over 2 hours (appx 300cc/unit)

19 19 Complications Blood Products Circulatory Overload Acute Hemolytic Reaction Chills, fever, flushing, tachycardia, SOB, hypotension, acute renal failure, shock, cardiac arrest, death Febrile-Nonhemolytic Reaction Sudden onset of chills, fever, temp elevation >1 degree C. headache, anxiety Mild Allergic Reaction Flushing, urticaria, hives

20 20 Nursing Responsibilities STOP transfusion Maintain IV site-disconnect from IV and flush with NS Notify blood bank/MD Recheck ID Monitor VS Treat sx per MD orders Save bag and tubing-send to blood bank

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