Nursing Management: Hematologic Problems Chapter 31 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

2 Anemia  Definition and Classification Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

3 Anemia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Causes of anemia. GI, Gastrointestinal.

4 Anemia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table Relationship of Morphologic Classification and Etiologies of Anemia.

5 Anemia  Clinical Manifestations  Integumentary changes  Cardiopulmonary manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

6 Nursing Management: Anemia  Nursing Assessment  Nursing Diagnoses  Planning  Nursing Implementation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

7 Gerontologic Considerations: Anemia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

8 Anemia Caused by Decreased Erythrocyte Production Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Sequence of events in extravascular hemolysis.

9 Iron-Deficiency Anemia  Etiology  Clinical Manifestations  Diagnostic Studies  Collaborative Care  Drug therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

10 Nursing Management: Iron-Deficiency Anemia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

11 Thalassemia  Etiology  Clinical Manifestations  Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

12 Megaloblastic Anemias  Cobalamin (Vitamin B 12 ) Deficiency  Etiology  Clinical Manifestations  Diagnostic Studies  Collaborative Care  Folic Acid Deficiency Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

13 Nursing Management: Megaloblastic Anemia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

14 Anemia of Chronic Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

15 Aplastic Anemia  Etiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

16 Aplastic Anemia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table Causes of Aplastic Anemia.

17 Aplastic Anemia  Clinical Manifestations  Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

18 Nursing and Collaborative Management: Aplastic Anemia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

19 Anemia Caused by Blood Loss Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

20 Acute Blood Loss  Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

21 Acute Blood Loss Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table Clinical Manifestations of Acute Blood Loss.

22 Acute Blood Loss  Diagnostic Studies  Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

23 Nursing Management: Acute Blood Loss Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

24 Chronic Blood Loss Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

25 Anemia Caused by Increased Erythrocyte Destruction Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

26 Sickle Cell Disease  Etiology and Pathophysiology  Types of sickle cell disease  Sickling episodes Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

27 Sickle Cell Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Sickle cell hemoglobin aggregates into long chains and alters the shape of the RBC.

28 Sickle Cell Disease  Clinical Manifestations  Complications Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

29 Sickle Cell Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Clinical manifestations and complications of sickle cell disease.

30 Sickle Cell Disease  Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

31 Nursing and Collaborative Management: Sickle Cell Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

32 Acquired Hemolytic Anemia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

33 Other RBC Disorders Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

34 Hemochromatosis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

35 Polycythemia  Etiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

36 Polycythemia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Differentiating between primary and secondary polycythemia. EPO, Erythropoietin; N, normal.

37 Polycythemia  Clinical Manifestations and Complications  Diagnostic Studies  Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

38 Nursing Management: Polycythemia Vera Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

39 Problems of Hemostasis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

40 Thrombocytopenia  Etiology and Pathophysiology  Immune thrombocytopenic purpura  Thrombotic thrombocytopenic purpura  Heparin-induced thrombocytopenia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

41 Thrombocytopenia  Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

42 Thrombocytopenia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Acute idiopathic thrombocytopenic purpura commonly manifests with purpuric lesions of this kind, although they may often be widespread by the time medical attention is sought.

43 Thrombocytopenia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

44 Thrombocytopenia  Diagnostic Studies  Collaborative Care  Immune thrombocytopenic purpura  Thrombotic thrombocytopenic purpura  Heparin-induced thrombocytopenia  Acquired thrombocytopenia from decreased platelet production Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

45 Nursing Management: Thrombocytopenia  Nursing Assessment  Nursing Diagnoses  Planning  Nursing Implementation  Health promotion  Acute intervention  Ambulatory and home care  Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

46 Hemophilia and Von Willebrand’s Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table Comparison of Types of Hemophilia.

47 Hemophilia and Von Willebrand’s Disease  Clinical Manifestations and Complications Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

48 Hemophilia and Von Willebrand’s Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Severe ecchymoses in a person with hemophilia following a fall.

49 Hemophilia and Von Willebrand’s Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Acute hemarthrosis of the knee is a common complication of hemophilia.

50 Hemophilia and Von Willebrand’s Disease  Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

51 Hemophilia and Von Willebrand’s Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table Laboratory Results in Hemophilia.

52 Hemophilia and Von Willebrand’s Disease  Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

53 Nursing Management: Hemophilia  Nursing Implementation  Health promotion  Acute intervention  Ambulatory and home care  Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

54 Disseminated Intravascular Coagulation  Etiology and Pathophysiology Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

55 Disseminated Intravascular Coagulation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig The sequence of events that occur during disseminated intravascular coagulation (DIC).

56 Disseminated Intravascular Coagulation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Disseminated intravascular coagulation (DIC) resulting from staphylococcal septicemia. Note the characteristic skin hemorrhage ranging from small purpuric lesions to larger ecchymoses.

57 Disseminated Intravascular Coagulation  Clinical Manifestations  Diagnostic Studies  Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

58 Disseminated Intravascular Coagulation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Intended sites of action for therapies in disseminated intravascular coagulation (DIC). AT III, Antithrombin III; CPR, cardiopulmonary resuscitation; FSPs, fibrin split products. *Recombinant form of activated protein C.

59 Nursing Management: Disseminated Intravascular Coagulation  Nursing Diagnoses  Nursing Implementation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

60 Neutropenia  Clinical Manifestations  Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

61 Nursing and Collaborative Management: Neutropenia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

62 Gerontologic Considerations: Thrombocytopenia and Neutropenia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

63 Myelodysplastic Syndrome  Etiology and Pathophysiology  Clinical Manifestations  Diagnostic Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

64 Nursing and Collaborative Management: Myelodysplastic Syndrome Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

65 Leukemia  Etiology and Pathophysiology  Classification  Acute myelogenous leukemia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

66 Leukemia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Complications of acute leukemia. Spreading cellulitis of the neck and chin in this woman with acute myelogenous leukemia results from streptococcal and candidal infection. She was at risk because of previous chemotherapy and prolonged neutropenia.

67 Leukemia  Classification, continued  Acute lymphocytic leukemia  Chronic myelogenous leukemia  Chronic lymphocytic leukemia  Other leukemias Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

68 Leukemia  Clinical Manifestations  Diagnostic Studies  Collaborative Care  Drug therapy  Hematopoietic stem cell transplantation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

69 Nursing Management: Leukemia  Nursing Assessment  Nursing Diagnoses  Planning  Nursing Implementation  Acute intervention  Ambulatory and home care  Evaluation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

70 Lymphomas Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table Comparison of Hodgkin’s Lymphoma and Non-Hodgkin’s Lymphoma.

71 Hodgkin’s Lymphoma  Etiology and Pathophysiology  Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

72 Hodgkin’s Lymphoma Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Hodgkin’s lymphoma (stage IIA). This patient has enlargement of the cervical lymph nodes.

73 Hodgkin’s Lymphoma  Diagnostic and Staging Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

74 Nursing and Collaborative Management: Hodgkin’s Lymphoma Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Staging system for Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. Stage I, involvement of single lymph node (e.g., cervical node). Stage II, involvement of two or more lymph nodes on one side of diaphragm. Stage III, lymph node involvement above and below the diaphragm. Stage IV, involvement outside of diaphragm (e.g., liver, bone marrow). The stage is followed by the letter A (absence) or B (presence) to indicate significant systemic symptoms (e.g., fever, night sweats, weight loss).

75 Non-Hodgkin’s Lymphoma  Etiology and Pathophysiology  Clinical Manifestations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

76 Non-Hodgkin’s Lymphoma Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig Non-Hodgkin’s lymphoma involving the spleen. The presence of an isolated mass is typical.

77 Non-Hodgkin’s Lymphoma  Diagnostic and Staging Studies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

78 Nursing and Collaborative Management: Non- Hodgkin’s Lymphoma Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

79 Multiple Myeloma  Etiology and Pathophysiology  Clinical Manifestations  Diagnostic Studies  Collaborative Care Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

80 Nursing Management: Multiple Myeloma Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

81 Disorders of the Spleen Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

82 Blood Component Therapy  Administration Procedure  Blood Transfusion Reactions  Acute transfusion reactions  Acute hemolytic reactions  Febrile reactions  Allergic reactions  Circulatory overload  Sepsis  Transfusion-related lung injury (TRALI)  Massive blood transfusion reaction Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

83 Blood Component Therapy  Blood Transfusion Reactions, continued  Delayed transfusion reactions  Infection  Autotransfusion Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.