1 Nursing Care of Patients with Hematologic Disorders

2 Assessment and Diagnostic Findings Hematologic Studies: Hematologic Studies: - CBC. - CBC. - Hemoglobin and hematocrit. - Hemoglobin and hematocrit. Bone Marrow Aspiration & Biopsy: Bone Marrow Aspiration & Biopsy: - Assess the quantity and quality of each type of - Assess the quantity and quality of each type of cell produced in the bone marrow. cell produced in the bone marrow.

3 Anemia Anemia is the lack of sufficient circulating hemoglobin to deliver oxygen to tissues. Anemia is the lack of sufficient circulating hemoglobin to deliver oxygen to tissues. Causes: Causes: - Chronic diseases. - Chronic diseases. - Inadequate production of RBCs. - Inadequate production of RBCs. - Destruction of RBCs. - Destruction of RBCs. - Blood loss. - Blood loss. - Deficits in nutrients. - Deficits in nutrients. - Heredity. - Heredity.

4 Anemia (cont’d)  Types Of Anemia: 1. Folic Acid Deficiency Anemia. 1. Folic Acid Deficiency Anemia. 2. Iron Deficiency Anemia. 2. Iron Deficiency Anemia. 3. A plastic Anemia. 3. A plastic Anemia. 4. Pernicious Anemia. 4. Pernicious Anemia. 5. Sickle Cell Anemia. 5. Sickle Cell Anemia. 6. Thalassemia. 6. Thalassemia. 7. Glucose-6- phosphate dehydrogenase (G6PD) 7. Glucose-6- phosphate dehydrogenase (G6PD)

5 Anemia (cont’d) Clinical Manifestations: Clinical Manifestations: 1. Pallor. 1. Pallor. 2. Fatigue, weakness. 2. Fatigue, weakness. 3. Dyspnea. 3. Dyspnea. 4. Palpitations, tachycardia. 4. Palpitations, tachycardia. 5. Headache, dizziness, and restlessness. 5. Headache, dizziness, and restlessness. 6. Slowing of thought. 6. Slowing of thought. 7. Paresthesia. 7. Paresthesia.

6 Anemia (cont’d)  Nursing Management: 1. Direct general management toward addressing the cause of anemia and replacing blood loss as needed to sustain adequate oxygenation. 1. Direct general management toward addressing the cause of anemia and replacing blood loss as needed to sustain adequate oxygenation. 2. Promote optimal activity and protect from injury. 2. Promote optimal activity and protect from injury. 3. Reduce activities and stimuli that cause tachycardia and increase cardiac output. 3. Reduce activities and stimuli that cause tachycardia and increase cardiac output. 4. Provide nutritional needs. 4. Provide nutritional needs. 5. Administer any prescribed nutritional supplements. 5. Administer any prescribed nutritional supplements. 6. Patient and family education 6. Patient and family education

7 Leukemia Leukemia: Is uncontrolled proliferation of white blood cells (WBCs) in the bone marrow. Leukemia: Is uncontrolled proliferation of white blood cells (WBCs) in the bone marrow. Types of Leukemia: Types of Leukemia: - Acute myelogenous Leukemia (most common in - Acute myelogenous Leukemia (most common in adults) adults) - Acute Lymphocytic Leukemia (most common in - Acute Lymphocytic Leukemia (most common in children) children) - Chronic Myelogenous Leukemia (uncommon before age 20) - Chronic Myelogenous Leukemia (uncommon before age 20) - Chronic Lymphocytic Leukemia (most common in - Chronic Lymphocytic Leukemia (most common in persons 50 years of age and more) persons 50 years of age and more)

8 Leukemia (cont’d) Etiology: Etiology: Underlying cause is unknown. Underlying cause is unknown.  Predisposing factors: - Exposure to radiations. - Exposure to radiations. - Chemical agents. - Chemical agents. - Heredity. - Heredity.

9 Leukemia (cont’d) Signs & Symptoms: Signs & Symptoms: - Pallor, fatigue, weakness, fever, weight loss, abnormal - Pallor, fatigue, weakness, fever, weight loss, abnormal bleeding and bruising, lymphadenopathy. bleeding and bruising, lymphadenopathy. - Splenomegaly, hepatomegaly, bone and joint pain, - Splenomegaly, hepatomegaly, bone and joint pain, headache, and neurologic dysfunction. headache, and neurologic dysfunction.

10 Leukemia (cont’d) Diagnostic Evaluation: Diagnostic Evaluation: - CBC and blood smear. - CBC and blood smear. - bone marrow aspiration and biopsy. - bone marrow aspiration and biopsy.  Nursing Management: 1. Preventing infection. 1. Preventing infection. 2. Preventing and managing bleeding. 2. Preventing and managing bleeding. 3. Patient education and health Maintenance. 3. Patient education and health Maintenance. 4. Reducing pain. 4. Reducing pain. 5. Improving activity tolerance. 5. Improving activity tolerance.

11 Lymphoma Lymphomas They classified according to : Lymphomas They classified according to : - The predominant cell type. - The predominant cell type. - The degree of malignant cell maturity. - The degree of malignant cell maturity. - Types of lymphomas (Hodgkin’s, Non- - Types of lymphomas (Hodgkin’s, Non- Hodgkin’s lymphomas) Hodgkin’s lymphomas)

12 Lymphoma (cont’d) Hodgkin’s disease affects young adults, higher incidence among males than women. Hodgkin’s disease affects young adults, higher incidence among males than women.  Non-Hodgkin’s disease affects men more than women, the incidence increases with age.

13 Lymphoma (cont’d) Signs & Symptoms: Signs & Symptoms: 1. Painless and enlargement of lymph nodes (cervical, 1. Painless and enlargement of lymph nodes (cervical, axilla, groin) axilla, groin) 2. Fatigue, weight loss, chills, fever, night sweats, 2. Fatigue, weight loss, chills, fever, night sweats, pruritus. pruritus. 3. Dyspnea, dysphagia. 3. Dyspnea, dysphagia. 4. Splenomegaly and hepatomegaly 4. Splenomegaly and hepatomegaly

14 Lymphoma (cont’d)  Diagnostic evaluation: - lymph node biopsy to detect type. - lymph node biopsy to detect type. - CBC, bone marrow aspirate and biopsy to detect - CBC, bone marrow aspirate and biopsy to detect bone marrow involvement. bone marrow involvement. - Liver and kidney function tests. - Liver and kidney function tests. - Ct scan. - Ct scan.

15 Lymphoma (cont’d) Nursing Management: Nursing Management: 1. Administer analgesics as prescribed. 1. Administer analgesics as prescribed. 2. Maintain skin integrity. 2. Maintain skin integrity. 3. Preserving oral and GI Tract Mucous Membranes. 3. Preserving oral and GI Tract Mucous Membranes. 4. Patient education and Health Maintenance. 4. Patient education and Health Maintenance.