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Medical-Surgical Nursing curriculum Hematologic (Blood) System and Disorders focuses on the Pathophysiology, Diagnostic Labs, and Nursing Interventions

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Medical-Surgical Nursing curriculum Hematologic (Blood) System and Disorders focuses on the Pathophysiology, Diagnostic Labs, and Nursing Interventions

Institution
Bsn Nursing
Course
Bsn Nursing

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Page 1 of 31


Medical-Surgical Nursing curriculum Hematologic (Blood)
System and Disorders



focuses on the Pathophysiology, Diagnostic Labs, and
Nursing Interventions

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, Page 2 of 31




Red Blood Cell (RBC) Disorders




In a severely anemic patient, the nurse would expect to find


a. dyspnea and tachycardia.
b. cyanosis and pulmonary edema.
c. cardiomegaly and pulmonary fibrosis.
d. ventricular dysrhythmias and wheezing.
a




Rationale: Patients with severe anemia (Hgb level less than 6 g/dL) exhibit the
following cardiovascular and pulmonary manifestations: tachycardia, increased pulse
pressure, systolic murmurs, intermittent claudication, angina, heart failure,
myocardial infarction, tachypnea, orthopnea, and dyspnea at rest.
When obtaining assessment data from a patient with a microcytic,
hypochromic anemia, the nurse would question the patient about


a. folic acid intake.
b. dietary intake of iron.
c. a history of gastric surgery.
d. a history of sickle cell anemia.
b




Rationale: Iron-deficiency anemia is a microcytic, hypochromic anemia.
Nursing interventions for a patient with severe anemia related to peptic ulcer
disease include (select all that apply)


a. instructions for high-iron diet.

, Page 3 of 31


b. taking vital signs every 8 hours.
c. monitoring stools for occult blood.
d. teaching self-injection of erythropoietin.
e. administration of cobalamin (vitamin B12) injections.
a, c




Rationale: Stool occult blood test is performed to determine the cause of iron-
deficiency anemia that is related to gastrointestinal bleeding. Iron is increased in the
diet. Teach the patient which foods are good sources of iron. If nutrition is already
adequate, increasing iron intake by dietary means may not be practical. The patient
with iron deficiency related to acute blood loss may require a transfusion of packed
red blood cells (RBCs).
The nursing management of a patient in sickle cell crisis includes (select all
that apply)


a. monitoring CBC.
b. optimal pain management and O2 therapy.
c. blood transfusions if required and iron chelation.
d. rest as needed and deep vein thrombosis prophylaxis.
e. administration of IV iron and diet high in iron content.
a, b, c, d




Rationale: Complete blood count (CBC) is monitored. Infections are common with
elevated WBC counts, and anemia may occur with low hemoglobin levels and low
RBC counts. O2 may be administered to treat hypoxia and control sickling. Rest may
be instituted to reduce metabolic requirements, and prophylaxis for deep vein
thrombosis (with anticoagulants) is prescribed. Transfusion therapy is indicated
when an aplastic crisis occurs. Patients may require iron chelation therapy to reduce
transfusion-produced iron overload. Pain occurring during an acute crisis is usually
undertreated; patients should have optimal pain control with opioid analgesics,
nonsteroidal antiinflammatory agents, antineuropathic pain medications, local
anesthetics, or nerve blocks.

, Page 4 of 31


A complication of the hyperviscosity of polycythemia is


a. thrombosis.
b. cardiomyopathy.
c. pulmonary edema.
d. disseminated intravascular coagulation (DIC).
a




Rationale: The patient with polycythemia may experience angina, heart failure,
intermittent claudication, and thrombophlebitis, which may be complicated by
embolization. These manifestations are caused by blood vessel distention, impaired
blood flow, circulatory stasis, thrombosis, and tissue hypoxia, which is caused by the
hypervolemia and hyperviscosity. The most common serious acute complication is
stroke, caused by thrombosis.
When caring for a patient with thrombocytopenia, the nurse instructs the
patient to


a. dab his or her nose instead of blowing.
b. be careful when shaving with a safety razor.
c. continue with physical activities to stimulate thrombopoiesis.
d. avoid aspirin because it may mask the fever that occurs with
thrombocytopenia.
a




Rationale: Patients with thrombocytopenia should avoid aspirin because it reduces
platelet adhesiveness, which contributes to bleeding. Patients should not perform
vigorous exercise or lift weights. If a patient is weak and at risk for falling, supervise
the patient when he or she is out of bed. Blowing the nose forcefully should be
avoided. The patient should gently pat the nose with a tissue if needed. Instruct
patients not to shave with a blade; an electric razor should be used.
The nurse would anticipate that a patient with von Willebrand disease
undergoing surgery would be treated with administration of vWF and

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