1. Nursing 210 Fluid and Cells Nursing management of patients with hematologic dysfunction Laurie Brown RN, MSN, MPA-HA, CCRN

2. Development of Blood Cells

4. Hemoglobin and Hematacrit Hb: Women: 12-16 Men: 13.5-18 Hct: Women: 38-47% Men: 40-54%

5. Complete Blood Count White Blood Cells (WBC) 5,000-10,000

6. WBC Differential Neutrophil Eosinophil Basophil Lymphocyte Monocyte 50-70% 2-5% 0-2% 20-40% 4-8%

7. CBC Platelet Count 150,000-400,000

8. Mean Corpuscular Hemoglobin (MCH) Mean Corpuscular Volume (MCV) Mean Corpuscular Hemoglobin Concentration (MCHC) Red Cells

9. Clotting Extrinsic Intrinsic

10. Heparin PTT Coumadin PT or INR Protamine sulfate Vitamin K

11. Drugs Impairing the Hematologic System Drugs causing bone marrow suppression Drugs causing hemolysis Drugs that disrupt platelet action Drugs that disrupt clotting action

12. ANEMIAS “Can Not Make” “Lost” “Destroyed”

13. Iron Deficiency Pernicious Anemia Folic Acid Deficiency Trauma Chronic loss Sickle Cell Infectious Agents Antibodies Aplastic Anemia G6PD Deficiency ANEMIAS

14. Sickle Cell Anemia Pain Control Sickle cell crisis Rational for orders Nursing orders

15. Pernicious Anemia Vitamin B 12 Intrinsic Factor Cells mutate and become large Development of Neurological problems

16. Clotting Problems Thrombocytopenia Hemophilia Von Willebrand Disseminated Intravascular Coagulation (DIC)

17. DIC “Imbalance between the process of coagulation and anticoagulation”

18. Treatment

19. Heparin Administration Heparin loading dose Initial Maintenance Infusion Dosage calculation often by patients weight

20. Transfusion Administration Identification Lab values Drs order verify Pt assessment IV site assessment Documentation Verify with 2 nd RN Monitor VS Remain with the patient

21. Automatic IV infuser pump Flow rate calculation Blood/Blood product w/tag 150 cc NS Blood Administration Set Gloves

22. Blood Bank  Patient name and I.D. number  Unit number and ABO/Rh type on bag with blood bag compatibility tag & bag unit/type  Verify expiration date on blood bag

23. Autologous Blood Transfusions Preoperative autologous blood donation Acute normovolemic hemodilution Intraoperative autologous transfusion Postoperative blood salvage

24. Characteristics of Normal Cells Limited Cell Division Specific Morphology Small Nuclear-Cytoplasmic Ratio Perform Specific Differentiated Functions Adhere tightly together… Are nonmigratory Grow in an orderly and well differentiated manner Are contact inhibited

25. Characteristics of Malignant Cells Demonstrate rapid or continuous cellular division. Show anaplastic morphology Have a large nuclear-cytoplasmic ratio Lose some or all differentiated functions Adhere loosely together Are able to migrate Grow by invasion Are not contact-inhibited

26. Leukemia AML - Acute Myelogenous ALL - Acute Lymphocytic CML - Chronic Myelogenous CLL - Chronic Lymphocytic

27. FAB Leukemia Classification French American British Classification Historically distinguishing AML from ALL was a major clinical problem Chemotherapy dependent on tissue type

28. Acute Leukemia NCCN Guidelines National Comprehensive Cancer Network (NCCN) has issued guidelines for treatment of many cancers including Leukemia as well as other hematological malignancies http://www.nccn.org/index.html

29. Bone Marrow Aspiration Bone marrow biopsy Bone marrow aspiration

30. Lymphoma Hodgkin’s lymphoma Non-Hodgkin’s lymphoma

31. Multiple Myeloma Gammopathy “M” Protein called a tumor marker

32. History of Myeloma Skeletal evidence of myeloma obtained from Egyptian mummies First case described in 1844 1845 Dr Henry Bence Jones detected heat properties of urinary light chains 1929 Bone marrow aspiration 1937 serum protein electrophoresis 1960 Alkeran and prednisone- first treatment

33. What is Multiple Myeloma? A cancer of the bone marrow The location where cells are produced The affected cells are plasma cells Plasma cells produce antibodies (proteins that fight off infection)

34. To Many Harmful Plasma Cells Abnormal Plasma Cells are called Myeloma Cells and develop without warning Myeloma cells collect in bones and cause “soft spots” where the cell is damaged

35. Effects of the blood Normal cells are not being produced in the bone marrow Bones are damaged Bone demineralization (soft spots)

36. Symptomatic Multiple Myeloma Calcium Renal Anemia Bone