1. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 42 Care of Patients with Hematologic Problems

2. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Anemia Reduction in either the number of RBCs, amount of hemoglobin, or hematocrit Clinical sign (not specific disease); manifestation of several abnormal conditions

3. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Cardiovascular Effects of Anemia Orthostatic hypotension Tachycardia (increasing with activity, after meals) Murmurs and gallops Decreased pulse pressure

4. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Transfusion Responsibilities Pretransfusion: ◦ Verify prescription ◦ Test donor’s/recipient’s blood for compatibility ◦ Examine blood bag for identification ◦ Check expiration date ◦ Inspect blood for discoloration, gas bubbles, cloudiness

5. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Transfusion Responsibilities Provide patient education Assess vital signs Begin transfusion slowly, stay with patient first 15 to 30 minutes Ask patient to report unusual sensations (e.g., chills, shortness of breath, hives, itching) Administer blood product per protocol Assess for hyperkalemia

6. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. A 27-year-old female with a history of sickle cell disease (SCD) comes to the ED with abdominal pain that is rated as a “9” on a 0-to-10 scale. Physical assessment shows that she is grimacing and guarding her abdomen and has a fever of 103°F, a pale yellow hard palate, and several very small ulcers on her lower extremities. What is the priority problem that must be addressed immediately? A. Acute pain B. Hyperthermia C. Potential for infection D. Decreased tissue perfusion

7. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Thirty minutes later, the patient is diagnosed with acute sickle cell crisis. She continues to have pain. Which drugs would be prescribed for pain control at this time? (Select all that apply.) A. Meperidine IV push prn B. Morphine sulfate IV push scheduled doses C. Acetaminophen orally or rectally D. Hydromorphone IV push scheduled doses E. Morphine sulfate SR orally or IM scheduled doses

8. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Three hours later, the patient is admitted to the acute medical care unit. Laboratory studies for the patient are ordered. What result do you anticipate? A. Hct 40% B. HbS 90% C. WBC 7000/mm 3 D. Total bilirubin 0.5 mg/dL

9. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 1. The provider’s orders include hydroxyurea (Droxia). Two hours later when you administer the medication, the patient asks you about the purpose of this drug. What is your best response? 2. What follow-up laboratory value would you be sure to monitor while the patient is taking hydroxyurea?

10. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Four days later, the patient is preparing for discharge. Which teaching points would you be sure to go over with the patient and her family? (Select all that apply.) A. Drink at least 3 to 4 liters of fluid daily. B. Alcoholic beverages may be consumed moderately. C. Be sure to get a flu shot annually. D. Avoid temperature extremes of hot or cold. E. Engage in mild low-impact exercise three times a week when not in crisis. F. Take acetaminophen at the first sign of infection.

11. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Chapter 42 Audience System Response Questions 11

12. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Question 1 A 23-year-old African-American male with a history of sickle cell disease had an emergent open reduction and internal fixation of his right femur after a car crash. What is the initial postoperative nursing priority? A. Ensuring adequate IV hydration B. Treating the patient’s pain C. Titrating oxygen to an S PO 2 >95% D. Examining the surgical incision for signs and symptoms of infection

13. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Question 2 What is a priority nursing intervention in the care of an older patient with a history of diverticular disease and pernicious anemia? A. Encouraging a diet high in vitamin B 12 B. Preventing falls C. Turning the patient every 2 hours D. Monitoring intake and output

14. Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Question 3 A patient with polycythemia vera is admitted with reports of shortness of breath, hypertension, and loss of pulses in her right foot. A priority nursing intervention would be: A. Evaluate the patient for hypertensive crisis B. Administer oxygen by nasal cannula C. Elevate her lower extremities on pillows D. Evaluate current hydration status