Summary NUR 3980 Final Exam Review Notes

HEMATOLOGY DISORDERS: 9 Questions
BONE MARROW ASPIRATION AND BIOPSY
 Indications
o Determine cause of blood disorders (anemia, thrombocytopenia)
o Diagnose infections within the bone marrow such as leukemia or to
stage cancers or lymphoma.
Pre-Procedure Intraprocedure Post-Procedure
 Explain procedure  Administer a  Apply pressure to site to control
 Obtain informed sedative (if bleeding
consent prescribed, taking  Use sterile dressing to cover site
 Patient needs to kidney function into  Bedrest is to be maintained for 30-
be placed in side- consideration- 60 minutes
lying position geriatric patients)  Monitor for infection or bleeding
 Education, there  Cleanse site with  Apply ice to minimize bleeding and
may be pressure antiseptic solution bruising
or brief pain  Keep sterility  Analgesics for pain, NO ASPIRIN or
during aspiration  Assist with procedure medications that affect clotting
as needed  Teach to report: excessive bleeding
or infection
 Check site daily
 Keep dressing clean, dry and intact.
 Nursing Interventions

ANEMIA
 General signs and symptoms
o Pallor
o Fatigue or weakness
o Dyspnea
o Palpitations, tachycardia
o Headache, dizziness and restlessness
o Slowing of thought
o Paresthesia
 Microcytic is hypochromic – most common is iron deficiency anemia
 Macrocytic is hyperchromic – usually Megaloblastic B12 deficiency
7

, Causes
 Decreased RBC production
o Deficient nutrients
 Iron
 Cobalamin
 Folic acid
o Decreased erythopoeitin
o Decreased iron availability
 Blood loss
o Chronic hemorrhage
 Bleeding duodenal ulcer
 Colorectal cancer
 Liver disease
 Acute trauma
 Ruptured aortic aneurysm
 GI Bleed
 Increased RBC Destruction
o Hemolysis
 Sickle cell disease
 Medication (Aldomet [methyldopa])
 Incompatible blood
 Trauma (cardiopulmonary bypass)

Hyperproliferative anemias
Marrow cannot produce an adequate number of erythrocytes
Type Pathophysiology Lab Findings Signs/Symptoms Treatment
Pernicious  Vitamin B12  Decreased B12  Dyspepsia  B12 replacement
megaloblast deficiency from level =  Anorexia  Cyanocobalamin 1,000
ic lack of intrinsic increased MCV  N/V micrograms IM
“Cobalamin” factor for  Elevated  Abdominal pain injection monthly
Scandinavia absorption methylmalonic  Smooth beefy  Never use RBC
ns and acid and red tongue transfusion
African homocysteine  Weakness,
Americans levels paresthesia of
Middle aged  Low reticulocyte feet and hands,
or later count ataxia, impaired
thought process
 Vibratory and
position senses
decreased
Folate  Decreased folic  Decreased folate  Dyspepsia  Oral folic acid 1-5
deficiency acid intake levels =  Anorexia mg/day PO
 Impaired increased MCV  N/V
absorption  Abdominal pain
 Alcohol impairs  Smooth beefy
folate red tongue
metabolism in  No neurologic
live causing problems
depletion
 Decreases in
folate impair
DNA synthesis
and increase
erythroblast

, deaths
Iron  Chronic blood  Decreased  Cold hands and  Iron replacement
deficiency loss, failure to reticulocytes, feet therapy: ferrous
recapture iron iron, ferritin, iron  Brittle nails sulfate 32 mg PO tid
from recycled saturation and  Dizziness  Parenteral iron therapy
RBC MCV  Fatigue if oral route is
 Demands for  Increased TIBC  Hair loss intolerable, poor
iron exceed (total iron  Restless leg enteral absorption or
iron intake binding syndrome continued blood loss
 Decreased iron capacity)  IV iron therapy
intake results in requires monitoring for
use and hypersensitivity
depletion of
iron stores,
causing
decreased Hgb
production
Decreased  Kidney disease  Decreased  Pale skin  Erythropoietin
erythropoiet can impair erythropoietin  Blue color to replacement
in erythropoietin level whites of eyes
production production  Normal MCV and  Mouth ulcers
which MCH
decreases RBC  Increased
production creatinine level
Aplastic  Immune  Decreased  Unexplained  Immunosuppressive
Anemia response reticulocyte bruising therapy: cyclosporine,
mediated by count  Nosebleeds, corticosteroids,
cytotoxic T cells  Decreased WBC, bleed gums antithymocyte globulin
 Target cells in Hgb, Hct, and  Stem cell transplant
bone marrow platelets
causing cell
death and bone
marrow failure
 Hereditary or
acquired


Anemia Related to Chronic Disease

Type Pathophysiology Lab Findings Treatment
Can be related to: Marked by three defects  Normal MCV and  Treat the underlying
 Aids  Decreased MCHC cause
 Malignancy erythrocyte lifespan  Low serum Iron
 SLE  Ineffective bone  Low or normal TIBC
 Chronic Kidney marrow response to  Normal or high
Disease erythropoietin ferritin
 Chronic Liver  Altered iron
Disease metabolism
 R.A.

, Hemolytic Reaction Hereditary Anemia
Premature destruction of erythrocytes
Type Pathophysiology Lab Findings Signs and Treatment
Symptoms
Autoimmune  Inherited and  Presence of  Jaundice  Immunosuppressi
hemolytic anemia acquired result in schistocytes  Dark- ve therapy:
acquired by hemolysis within  Increased colored corticosteroids
extrinsic insults the blood vessels spherocyte urine  Acquired: remove
 Infection and/or lymphoid level  Fever insult/treat
 Medication tissues  Increased  Heart underlying
 Venom reticulocytes murmur disorder
 Trauma




Thalassemia  Caused by cellular  Decreased  Facial bone  Monitor ferritin
 Group of abnormalities of MCV deformities regularly to
inherited the Hgb structure  Fragmented  Full assess for iron
forms of  Imbalance RBC’s cheekbones overload
autoimmun between the beta  Increased  Depressed  Never use iron
e hemolytic and alpha chain reticulocyte nose bridge therapy
anemia  RBC membrane is count  Overgrowth  Transfusion
damaged of upper therapy with
 Ineffective RBC jaw PRCB’s
production  Abdominal
 Hemolysis swelling

Sickle Cell  Inherited disorder  Anemia  Swelling of  Transfusion
Disease  Abnormal resulting from hands and therapy with
hemoglobin chronic feet RBC’s
*Sickle cell crisis: polymerizes when hemolysis (dactylitis)  Monitor ferritin
precipitated by deoxygenated  Reticulocytosi  Frequent regularly to
infection and creating RBC’s s, infection assess for
stress priority with rigid and leukocytosis  Delayed overload
treatment distorted shapes and growth or  Hydroxyurea
 Hydration causing thrombocytosi puberty (antimetabolite
 Pain and o Hemolytic Anemia s are common  Vision medication used
infection o Pain  High bilirubin problems to help prevent
manageme o Organ failure  High lactate the formation of
nt dehydrogenas sickle-shaped
Increases risk of e RBC)
stroke due to  Peripheral
Vaso-occlusion* blood smear
may revel
sickle cells
 Patients at risk for anemia
o Iron deficiency
 Pregnancy
 Middle aged males
 Women in reproductive years
 GI blood loss
 Peptic ulcer disease
 Gastritis
 Esophagitis
 Diverticuli
 Hemorrhoids