Chapter 25
-Identify the key clinical manifestations of infectious respiratory conditions such as
tuberculosis (TB), pneumonia, COVID-19, influenza, anthrax, and peritonsillar abscesses.
-Describe the diagnostic tests used for each condition and their significance in confirming a
diagnosis.
-Compare the pharmacological and non-pharmacological treatments for each condition.
-Explain priority nursing interventions for each condition.
-Discuss patient education, infection control measures, and nursing responsibilities for each
infectious respiratory condition.
-Identify warning signs that require immediate intervention and outline appropriate
emergency responses.
Chapter 26
-Recognize signs and symptoms of pulmonary embolism (PE), acute respiratory failure,
ARDS, severe COVID-19, and chest trauma-related conditions.
-Identify major risk factors for pulmonary embolism, ARDS, and severe COVID-19,
including
immobility, infections, trauma, and pre-existing conditions.
-Understand diagnostic tools for respiratory emergencies.
-Describe appropriate interventions including oxygen therapy, mechanical ventilation,
anticoagulation, thrombolysis, and chest tube placement.
-Implement nursing priorities such as monitoring oxygenation, preventing complications,
recognizing emergency signs, and providing psychosocial support.
-Evaluate treatment outcomes by assessing gas exchange, hemodynamic stability,
prevention of complications, and patient recovery progress.
Chapter 34
-Plan nursing interventions for transfusing blood products.
Transfusion Therapy Pretransfusion Responsibilities
-Review agency policy
-Verify prescription with another RN
-Test donor’s/recipient’s blood for compatibility Rh + blood can take blood that does not have rh
factor (-) in it
-Use two identifiers for patients who receive transfusion; verify with another RN
-Examine blood bag label, attached tag, and requisition slip for ABO and Rh compatibility with
the client
,-Check expiration date/time with another RN
-Inspect blood for discoloration, gas bubbles, cloudiness
** Stay with pt firs 15 min of infusion that’s when reactions happen**
-Recognize safe care of the client with hematologic conditions.
-Analyze assessment and diagnostic findings to generate solutions and prioritize nursing
care for patients with hematologic conditions.
-Use clinical judgment to plan evidence-based nursing care to promote perfusion and
immunity and prevent complications in patients with hematologic conditions.
Sickle Cell Disease:
Managing Pain: Most common symptom of a SD crises
-Pain management is based on past pain hx, previous drug use, disease complications, and
current pain assessment.
-Drug therapy via admin of IV analgesics. Morphine and hydromorphone are given IV on a
routine schedule or by an infusion pump using PCA. Once relief is is obtained, the IV dose can
be tapered and the drug can be given PO. Avoid PRN schedules because they do not provide
adequate relief.
-Hydroxyurea: (Mainstay of management as is reduces vasocclusive occurrences) reduces
number of sickling and pain episodes by stimming production of fetal hemoglobin which helps
oxygen bind. This drug is a teratogen, pregnancy test will be done before this drug is started and
pt must adhere to BC for at least 1 month after D/C. Drug also suppresses immune system, so
must monitor CBC for drug toxicity is important. Can increase pts rick for leukemia and skin
cancer, particularly long term complications shuld be discussed before therapy is started.
-L-Glutamine Powder: used in tx of SCD. Higher levels of glutamine in RBC lowers oxidative
stress. Cellular response decreases sickling rates and increased RBC lifespan thus reducing or
delaying complications of SCD. Drug is a powder that is mixed with 8 oz(326ml) fluid
-Crizanlizumab; A monoclonal antibody that prevents adhesion and reduces freq of vasocc Rq
2 infusions given over a 30 min period at week 0 and 2 and monthly infusions thereafter
Hydration: helps reduce duration of pain episodes—urge pt to drink water/juices. Fluids are
infused until pt blood osmolarity normalizes.
Integrative therapies: keeping room warm, using distraction and relaxation, positioning with
support for painful areas, aromatherapy, therapeutic tough, and warm soaks or compresses can
help to reduce pain perception.
,Preventing Sepsis, MODS, and Death
-If fever started on prophylactic abx (penicillin, erythromycin if allergy to pen.)
-Frequent thorough hand washing
-Mask any time any one enters room
-Strict asepsis for invasive procedures
-Monitor daily CBC/white cell
-Inspect mouth at least Q8h for lesions indicating fungal or viral infection
-Listen to lungs at least Q8h
-Inspect urine for s/s of infection
-V/S at least Q4h to assess for fever
-Receive pneumonia vaccine, annual flu, and covid vaccines
-Continued blood vessel occlusion by clumping of sickled cells increases risk for MODS. Acute
chest syndrome in which a vasocclusive event causes infiltration and damage to the pulmonary
system is a major cause of death in adults with SCD make prevention of heart and lung damage a
priority!
-Remove restrictive clothing and instruct pt to avoid keeping the knees and hips flexed
-Ensure oxygen is nebulized to prevent dehydration.
Transfusion: Can be helpful to dilute HbS levels. Iron overload may occur used with caution
Red blood cell exchange (RBCX) or therapeutic erythrocytapheresis: can quickly reduce amount
of HbS w/o threat of iron overload and multilobe involvement
Anemia
Iron Deficiency Anemia *Most Common*
-Increasing oral intake of iron from food (red meat, organ meat, green leafy veg, yolk, kidney
beans, raisins)
-Oral supplementation; can be taken w/food if GI distress occurs
, *Iv ferumoxytol – risk for anaphylaxis(ensure eupiment and meds to tx it are in roomand stay w/
pt during infusion and 30 min after infision) if undergoing MRI. Notify radiologist pt has
receives within past 3 mo. as it can create a brighter signal on scan.
Folic Acid Deficiency Anemia
-First identify high risk adults (older adults, pts w/severe alcohol misuse, malnourished,)
-A diet rich in folic acid and B12 prevent deficiency.
-Once diagnosed anemia is managed w/scheduled folic acid replacement therapy.
Vitamin B-12 Deficiency Anemia
-Teach pt to increase foods rich in B12 (animal proteins, fish, eggs, nuts, dairy products, dried
beans, citrus fruits, and leafy green veg)
-Vit. Supplement may be RX is anemia is severe
Aplastic Anemia (A rare condition in which the body stops producing enough new blood cells.
Aplastic anemia develops as a result of bone marrow damage. The damage may be present at
birth or occur after exposure to radiation, chemotherapy, toxic chemicals, some drugs, or
infection)
-For drug induced: D/C the drug and possible drug transfusion, used when life threatening
bleeding b/c of low platelet counts. Unnecessary infusions increase chance for immune reactions
-If the problem is transient the therapy is D/C until as soon as bone marrow begins to produce
RBC.
-If chemo/radiation is the causative agent it may be stopped.
-Immunosuppressive therapy : helps pts who have the types of aplastic anemia with a disease
course similar to that of autoimmune problems; antithymocyte globulin (ATG) and cyclosporine
can be used along side corticosteroids to suppress immune system.
-Bone Marrow stimulants; filgrastim, pegfilgrastim, and epoetin alfa to stim bone marrow often
used in tandem w/ immunosuppressant therapy.
-Hematopoietic stem cell transplantation with donor cells is the most successful method of tx for
aplastic anemia that does not respond to other therapies.
G6PD Anemia
-Managed best by preventing occurrence and with supportive care when symptoms are present.
-If a triggering agent is identified it should be DC immediately and avoided in the future.
-Pts esp men should be tested for problem prior to receiving drugs that can cause hemolytic
reactions
-Hydration esp important during a severe episode of hemolsyis. Hydration helps to prevent
debris and hemoglobin from collecting in the kidney tubules, which can lead to AKI
-Transfusions are needed when anemia is present and kidney function is normal
Acquired Autoimmune hemolytic
Anemia of Chronic Disease
Anemia r/t blood loss
-Identify the key clinical manifestations of infectious respiratory conditions such as
tuberculosis (TB), pneumonia, COVID-19, influenza, anthrax, and peritonsillar abscesses.
-Describe the diagnostic tests used for each condition and their significance in confirming a
diagnosis.
-Compare the pharmacological and non-pharmacological treatments for each condition.
-Explain priority nursing interventions for each condition.
-Discuss patient education, infection control measures, and nursing responsibilities for each
infectious respiratory condition.
-Identify warning signs that require immediate intervention and outline appropriate
emergency responses.
Chapter 26
-Recognize signs and symptoms of pulmonary embolism (PE), acute respiratory failure,
ARDS, severe COVID-19, and chest trauma-related conditions.
-Identify major risk factors for pulmonary embolism, ARDS, and severe COVID-19,
including
immobility, infections, trauma, and pre-existing conditions.
-Understand diagnostic tools for respiratory emergencies.
-Describe appropriate interventions including oxygen therapy, mechanical ventilation,
anticoagulation, thrombolysis, and chest tube placement.
-Implement nursing priorities such as monitoring oxygenation, preventing complications,
recognizing emergency signs, and providing psychosocial support.
-Evaluate treatment outcomes by assessing gas exchange, hemodynamic stability,
prevention of complications, and patient recovery progress.
Chapter 34
-Plan nursing interventions for transfusing blood products.
Transfusion Therapy Pretransfusion Responsibilities
-Review agency policy
-Verify prescription with another RN
-Test donor’s/recipient’s blood for compatibility Rh + blood can take blood that does not have rh
factor (-) in it
-Use two identifiers for patients who receive transfusion; verify with another RN
-Examine blood bag label, attached tag, and requisition slip for ABO and Rh compatibility with
the client
,-Check expiration date/time with another RN
-Inspect blood for discoloration, gas bubbles, cloudiness
** Stay with pt firs 15 min of infusion that’s when reactions happen**
-Recognize safe care of the client with hematologic conditions.
-Analyze assessment and diagnostic findings to generate solutions and prioritize nursing
care for patients with hematologic conditions.
-Use clinical judgment to plan evidence-based nursing care to promote perfusion and
immunity and prevent complications in patients with hematologic conditions.
Sickle Cell Disease:
Managing Pain: Most common symptom of a SD crises
-Pain management is based on past pain hx, previous drug use, disease complications, and
current pain assessment.
-Drug therapy via admin of IV analgesics. Morphine and hydromorphone are given IV on a
routine schedule or by an infusion pump using PCA. Once relief is is obtained, the IV dose can
be tapered and the drug can be given PO. Avoid PRN schedules because they do not provide
adequate relief.
-Hydroxyurea: (Mainstay of management as is reduces vasocclusive occurrences) reduces
number of sickling and pain episodes by stimming production of fetal hemoglobin which helps
oxygen bind. This drug is a teratogen, pregnancy test will be done before this drug is started and
pt must adhere to BC for at least 1 month after D/C. Drug also suppresses immune system, so
must monitor CBC for drug toxicity is important. Can increase pts rick for leukemia and skin
cancer, particularly long term complications shuld be discussed before therapy is started.
-L-Glutamine Powder: used in tx of SCD. Higher levels of glutamine in RBC lowers oxidative
stress. Cellular response decreases sickling rates and increased RBC lifespan thus reducing or
delaying complications of SCD. Drug is a powder that is mixed with 8 oz(326ml) fluid
-Crizanlizumab; A monoclonal antibody that prevents adhesion and reduces freq of vasocc Rq
2 infusions given over a 30 min period at week 0 and 2 and monthly infusions thereafter
Hydration: helps reduce duration of pain episodes—urge pt to drink water/juices. Fluids are
infused until pt blood osmolarity normalizes.
Integrative therapies: keeping room warm, using distraction and relaxation, positioning with
support for painful areas, aromatherapy, therapeutic tough, and warm soaks or compresses can
help to reduce pain perception.
,Preventing Sepsis, MODS, and Death
-If fever started on prophylactic abx (penicillin, erythromycin if allergy to pen.)
-Frequent thorough hand washing
-Mask any time any one enters room
-Strict asepsis for invasive procedures
-Monitor daily CBC/white cell
-Inspect mouth at least Q8h for lesions indicating fungal or viral infection
-Listen to lungs at least Q8h
-Inspect urine for s/s of infection
-V/S at least Q4h to assess for fever
-Receive pneumonia vaccine, annual flu, and covid vaccines
-Continued blood vessel occlusion by clumping of sickled cells increases risk for MODS. Acute
chest syndrome in which a vasocclusive event causes infiltration and damage to the pulmonary
system is a major cause of death in adults with SCD make prevention of heart and lung damage a
priority!
-Remove restrictive clothing and instruct pt to avoid keeping the knees and hips flexed
-Ensure oxygen is nebulized to prevent dehydration.
Transfusion: Can be helpful to dilute HbS levels. Iron overload may occur used with caution
Red blood cell exchange (RBCX) or therapeutic erythrocytapheresis: can quickly reduce amount
of HbS w/o threat of iron overload and multilobe involvement
Anemia
Iron Deficiency Anemia *Most Common*
-Increasing oral intake of iron from food (red meat, organ meat, green leafy veg, yolk, kidney
beans, raisins)
-Oral supplementation; can be taken w/food if GI distress occurs
, *Iv ferumoxytol – risk for anaphylaxis(ensure eupiment and meds to tx it are in roomand stay w/
pt during infusion and 30 min after infision) if undergoing MRI. Notify radiologist pt has
receives within past 3 mo. as it can create a brighter signal on scan.
Folic Acid Deficiency Anemia
-First identify high risk adults (older adults, pts w/severe alcohol misuse, malnourished,)
-A diet rich in folic acid and B12 prevent deficiency.
-Once diagnosed anemia is managed w/scheduled folic acid replacement therapy.
Vitamin B-12 Deficiency Anemia
-Teach pt to increase foods rich in B12 (animal proteins, fish, eggs, nuts, dairy products, dried
beans, citrus fruits, and leafy green veg)
-Vit. Supplement may be RX is anemia is severe
Aplastic Anemia (A rare condition in which the body stops producing enough new blood cells.
Aplastic anemia develops as a result of bone marrow damage. The damage may be present at
birth or occur after exposure to radiation, chemotherapy, toxic chemicals, some drugs, or
infection)
-For drug induced: D/C the drug and possible drug transfusion, used when life threatening
bleeding b/c of low platelet counts. Unnecessary infusions increase chance for immune reactions
-If the problem is transient the therapy is D/C until as soon as bone marrow begins to produce
RBC.
-If chemo/radiation is the causative agent it may be stopped.
-Immunosuppressive therapy : helps pts who have the types of aplastic anemia with a disease
course similar to that of autoimmune problems; antithymocyte globulin (ATG) and cyclosporine
can be used along side corticosteroids to suppress immune system.
-Bone Marrow stimulants; filgrastim, pegfilgrastim, and epoetin alfa to stim bone marrow often
used in tandem w/ immunosuppressant therapy.
-Hematopoietic stem cell transplantation with donor cells is the most successful method of tx for
aplastic anemia that does not respond to other therapies.
G6PD Anemia
-Managed best by preventing occurrence and with supportive care when symptoms are present.
-If a triggering agent is identified it should be DC immediately and avoided in the future.
-Pts esp men should be tested for problem prior to receiving drugs that can cause hemolytic
reactions
-Hydration esp important during a severe episode of hemolsyis. Hydration helps to prevent
debris and hemoglobin from collecting in the kidney tubules, which can lead to AKI
-Transfusions are needed when anemia is present and kidney function is normal
Acquired Autoimmune hemolytic
Anemia of Chronic Disease
Anemia r/t blood loss
