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Nursing of Adults with Medical & Surgical Conditions Blood and Lymphatic Disorders.

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Presentation on theme: "Nursing of Adults with Medical & Surgical Conditions Blood and Lymphatic Disorders."— Presentation transcript:

1 Nursing of Adults with Medical & Surgical Conditions Blood and Lymphatic Disorders

2 Blood and Lymphatic Disorders w Laboratory Tests RBC (erythrocytes) 4-6 million/ Hemoglobin 10-20 gm/100ml Hematocrit 40-50 percent WBC 5,000-10,000/mm Platelets 150,000-400,000/mm

3 Anemia w Definition Disorder characterized by RBC and hemoglobin and hematocrit levels below normal range Causes delivery of insufficient amounts of oxygen to tissues and cells

4 Anemia w Types Blood loss (hemorrhage) Impaired production of RBC’s (bone marrow depression) Increased destruction of RBC’s (hemolysis) Nutritional deficiencies (long term iron deficiency)

5 Anemia w Signs & Symptoms Anorexia Cardiac dilation Disorientation Dyspepsia Dyspnea Exertional dyspnea Fatigue Headache Insomnia Pallor Palpitation Shortness of breath Systolic murmur Tachycardia Vertigo

6 Hypovolemic Anemia w Etiology/Pathophysiology Abnormally low circulating blood volume due to blood loss 500 ml loss can be tolerated 1000 ml loss can be severe complications Severity and signs and symptoms depend on how rapid the blood is lost

7 Hypovolemic Anemia w Signs & Symptoms Weakness Stupor Irritability Pale, cool, moist skin Hypotension Tachycardia (rapid, weak, thready pulse) Hypothermia Hemoglobin less than 10 gm/100ml Hematocrit less than 40 % H&H may not drop for several hours after blood loss

8 Hypovolemic Anemia w Treatment Control bleeding Treat shock O2, elevate lower extremities, keep warm Replace fluid blood transfusion, plasma, dextran, lactaed ringers Monitor vital signs

9 Pernicious Anemia w Etiology/Pathophysiology Absence of the intrinsic factor Intrinsic factor is essential for the absorption of vitamin B12 Deficiency of vitamin B12 affects growth and maturity of all body cells RBC’s in the bone marrow don’t mature RBC membrane ruptures easily Vitamin B12 is also related to nerve myelination may cause progressive demyelination and degeneration of nerves and white matter

10 Pernicious Anemia w Signs & Symptoms Extreme weakness Dyspnea Fever Hypoxia Weight loss Jaundice (destruction of RBC’s) Pallor GI complaints

11 Pernicious Anemia Dysphagia Sore, burning tongue Smooth and erythematous Neurological symptoms tingling of the hands and feet disorientation personality changes behavior problems partial or total paralysis

12 Pernicious Anemia w Treatment Vitamin B12 (cyanocobalamin) 1000 units daily for 1 week weekly for 1 month monthly for life Folic acid supplement Iron replacement RBC transfusion for severe anemia Diet high protein, vitamins, and minerals

13 Aplastic Anemia w Etiology/Pathophysiology Decrease of bone marrow function RBC production Primary congenital Secondary viral invasion medications chemicals radiation chemotherapy

14 Aplastic Anemia w Signs & Symptoms Pancytopenic all three major blood elements from the bone marrow are decreased (RBC, WBC, & Platelets) Repeated infections with high fevers Fatigue, weakness, malaise Dyspnea Palpitations Bleeding tendencies petechiae, ecchymossis, bleeding gums, epistaxis, GI & GU bleeds

15 Aplastic Anemia w Treatment Identify & remove cause Platelet transfusion for severe thrombocytopenia Splenectomy for hypersplenism Hypersplenism can cause destruction of platelets Steroids and androgens stimulate bone marrow Antithymocyte globulin stimulates bone marrow Bone marrow transplant

16 Iron Deficiency Anemia w Etiology/Pathophysiology RBC’s contain decreased levels of hemoglobin Excessive iron loss caused by chronic bleeding; intestinal, uterine, gastric

17 Iron Deficiency Anemia w Signs & Symptoms Pallor Fatigue Weakness Shortness of breath Angina S/S of heart failure Glossitis Pagophagia (desire to eat ice, clay, starches) Headache Paresthesia Burning tongue

18 Iron Deficiency Anemia w Treatment Ferrous Sulfate 900 mg daily Oral or injection (z-tract) Ascorbic acid enhances absorption of iron Diet high in iron Organ meats –liver, kidney, heart, tongue Muscle meats (esp dark meat from poultry) Fish Eggs Green leafy vegetables Whole grains Dried beans

19 Sickle Cell Anemia w Etiology/Pathophysiology Most common genetic disorder in the U.S. Occurs predominantly in African Americans 1out of 10 have trait; 1 out of 500 have disease An abnormal, crescent shaped RBC contains hemoglobin S (Hg-S) Severe, chronic, incurable condition Disease Homozygous –has two Hg-S genes; one from each parent Trait Heterozygous –has one Hg-S gene from one parent and one Hg-A gene from the other parent

20 Sickle Cell Anemia w Signs & Symptoms Precipitating Factors Dehydration Change in oxygen tension in the body –infection, overexertion, cold, alcohol, smoking Loss of appetite Irritability Weakness Abdominal enlargement pooling of blood in the liver, spleen and other organs Join and back pain Edema of extremities

21 Sickle Cell Anemia w Treatment No specific treatment Alleviate symptoms Oxygen Rest Fluids oral and IV Analgesics Bone marrow transplant Experimental

22 Agranulocytosis w Etiology/Pathophysiology Severe reduction in the number of granulocytes (basophils, eosinophils, & neutrophils) WBC less than 200/mm 3 Medications analgesics, antibiotics, antiepileptics, antihistamines, antineoplastic agents, antithyroid drugs, diuretics, phenothiazides, sulfonamides Chemotherapy Radiation Neoplastic disease Viral and bacterial infections

23 Agranulocytosis w Signs & Symptoms S/S of infection fever, chills, headache, fatigue Ulcerations of mucous membranes Bronchial pneumonia Urinary tract infection

24 Agranulocytosis w Treatment Identify and remove cause of bone marrow depression Prevent or treat infections Meticulous handwashing Strict asepsis

25 Leukemia w Etiololgy/Pathophysiology Malignant disorder of the hematopoietic system Excess leukocytes accumulate in the bone marrow and lymph nodes bone marrow produces immature cells Cause unknown Possible causes include genetic, virus, exposure to radiation, or chemotherapy Classification Acute or Chronic Proliferating cells (lymphocytic, monocytic, etc.)

26 Leukemia w Signs & Symptoms Anemia pallor, fatigue, malaise Thrombocytopenia petechiae, epistaxis, bruising, occult blood Leukopenia fever, upper resp. infections, Enlarged lymph nodes Splenomegaly

27 Leukemia w Treatment Chemotherapy Radiation Bone marrow transplant Medications Leukeran hydroxyurea corticosteroids Cytoxan

28 Thrombocytopenia w Etiology/Pathophysiology Abnormal hematological condition in which the number of platelets is reduced below 100,000 mm 3 Decreased production aplastic anemia, leukemia, tumors, chemotherapy Decreased survival antibody destruction, infection, viral invasion

29 Thrombocytopenia w Signs & Symptoms Petechiae Ecchymoses Platelets below 100,000 bleeding mucous membranes bleeding internal organs Platelets below 20,000 serious bleeding risks

30 Thrombocytopenia w Treatment Corticosteriod therapy Splenectomy Gamma globulin Immunosuppressive drugs Platelet transfusions Avoid trauma

31 Hemophilia w Etiology/Pathophysiology Hereditary coagulation disorder, characterized by a disturbance of clotting factor Hemophilia A most common Factor VIII is absent Hemophilia B Deficiency of Factor IX X-linked hereditary trait affects mainly males females are carriers

32 Hemophilia w Signs & Symptoms Internal & external bleeding Hemarthrosis bleeding into the joint; esp knees, ankles, and elbow Excessive blood loss from small cuts and dental procedures

33 Hemophilia w Treatment Minimize bleeding avoid trauma Relieve pain No aspirin Transfusions Factor VIII or IX concentrate –human-derived products –can be treated to inactivate viruses Cryoprecipitate (rich in factor VIII) –human-derived product Manufactured factor VIII or IX

34 von Willebrand’s Disease w Etiology/Pathophysiology Inherited bleeding disorder characterized by abnormally slow coagulation of blood and spontaneous episodes of GI bleeding, epistaxis, and gingival bleeding Mild deficiency of factor VIII Common during Postpartum Menorrhagia Post operative Post truama Similar to hemophilia; not limited to males

35 von Willebrand’s Disease w Treatment Cryoprecipitate Fibrinogen Fresh plasma Desmopressin (DDAVP) Synthetic of the human antiduiuretic hormone, vasopressin Causes an increase in factor VIII release from storage sites in the body Same nursing interventions as for hemophilia

36 Disseminated Intravascular Coagulation (DIC) w Etiology/Pathophysiology Overstimulation of clotting and anticlotting processes in response to disease or injury Septicemia Obstetrical complications Malignancies Tissue trauma Transfusion reaction Burns Shock Snake bites

37 Disseminated Intravascular Coagulation (DIC) Primary disorder initiates generalized intravascular clotting, which overtimulates fibrinolytic mechanisms The hypercoagulability is followed by a deficiency in clotting factors with subsequent hypocoagulability and hemorrhaging

38 Disseminated Intravascular Coagulation (DIC) w Signs & Symptoms Bleeding Mucous membranes Venipuncture sites Surgical sites GI & GU tracts All orifices Dyspnea Hemoptysis Diaphoresis Cold, mottled digits Purpura on the chest and abdomen Petechiae

39 Disseminated Intravascular Coagulation (DIC) w Treatment Treat underlying cause Cryoprecipitate Heparin Protect from bleeding and trauma

40 Multiple Myeloma w Etiology/Pathophysiology Malignant neoplastic immunodeficiency disease of the bone marrow Tumor, composed of plasma cells, destroys osseous tissue Bone marrow becomes overcrowded and unable to produce erythrocytes, platelets, and leukocytes Onset is gradual and insidious

41 Multiple Myeloma w Signs & Symptoms Bone pain Ribs, spine, and pelvis Pathological fractures Infection Anemia Bleeding Hypercalcemia Calcium and phosphorus drain from bones Renal failure Myeloma protein causes kidney damage Destruction of cells causes hyperuricemia

42 Multiple Myeloma w Treatment Symptomatic; not curable Radiation Chemotherapy Alkeran Cytoxan Leukeran Carmustin Vincristine Adriamycin Dexamethasone Corticosteroids IV fluids

43 Lymphangitis w Etiology/Pathophysiology Inflammation of one or more lymphatic vessels Usually occurs from acute streptococcal or staphylococcal infection in an extremity

44 Lymphangitis w Signs & Symptoms Fine red streaks from the affected area in the groin or axilla Edema Chills Fever Local pain Headache Myalgia

45 Lymphangitis w Treatment Penicillin Hot, moist heat Elevate extremity

46 Lymphedema w Etiology/Pathophysiology Primary or secondary disorder Accumulation of lymph in the soft tissue Obstruction Increase in amount of lymph Removal of lymph channels and nodes

47 Lymphedema w Signs & Symptoms Massive edema and tightness of affected extremity Pain

48 w Treatment Diuretics Antibiotics Compression pump Elastic stocking or sleeve Restricted sodium diet Avoid constrictive clothing Meticulous skin care Lymphedema

49 Malignant Lymphoma w Etiology/Pathophysiology Non-Hodgkin’s Lymphoma Neoplastic disorder of lymphoid tissue Tumors usually start in lymph nodes and spread to lymphoid tissue in the spleen, liver, GI tract, and bone marrow

50 Malignant Lymphoma w Signs & Symptoms Painless, enlarged cervical lymph nodes Fever Weight loss Anemia Pruritus Susceptiblity to infection Complications Pleural effusion, bone fractures, and paralysis Fatigue Malaise Anorexia

51 Malignant Lymphoma w Treatment Accurate staging of the disease is crucial to determine treatment regimen Radiation Initial treatment when localized Chemotherapy Cytoxan, Oncovin adriamycin bleomycin, methotrexate Treatment when not localized Bone marrow transplant Tumor necrosis factor (TNF) Direct cell toxicity Stimulates bone marrow w Hodgkin’s Disease w Etilology/Pathophysiology w Inflammatory or infectious process that develops into a neoplasm w Affects males twice as frequently as females w Reed-Sternberg cells w Large, abnormal, multinucleated cells in the lymphatic system replace the normal cells w Signs & Symptoms w Enlargement of cervical lymph nodes w Anorexia w Weight loss w Pruritus w Low-grade fever w Night sweats w Anemia w Leukocytosis

52 Hodgkin’s Disease w Etilology/Pathophysiology Inflammatory or infectious process that develops into a neoplasm Affects males twice as frequently as females Reed-Sternberg cells Large, abnormal, multinucleated cells in the lymphatic system replace the normal cells

53 Hodgkin’s Disease w Signs & Symptoms Enlargement of cervical lymph nodes Anorexia Weight loss Pruritus Low-grade fever Night sweats Anemia Leukocytosis Increased WBC

54 Hodgkin’s Disease w Treatment Depends on the staging process Chart on page 280 Stage I or II (localized) Radiation Stage III or IV (generalized) Chemotherapy Combination

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