Chapter 38 Hematologic Disorders and Oncologic Emergencies Unit 8 Multisystem Alterations Seventh Edition Linda D. Urden Kathleen M. Stacy Mary E. Lough Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc.

Overview of Coagulation and Fibrinolysis  Coagulation mechanism  Clot formation Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 2

Overview of Coagulation and Fibrinolysis (Cont.) Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 3

Overview of Coagulation and Fibrinolysis (Cont.)  Regulatory mechanisms  Feedback systems  Thrombin inhibition  Fibrinolysis Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 4

Quick Quiz! What is the ability of the body to control bleeding and clotting? A. Coagulation B. Fibrinolysis C. Hemostasis D. Thrombosis Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 5

Disseminated Intravascular Coagulation  Description  Etiology  Pathophysiology Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 6

Disseminated Intravascular Coagulation (Cont.) Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 7

Disseminated Intravascular Coagulation (Cont.)  Assessment and diagnosis  Clinical manifestations  Laboratory findings Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 8

Disseminated Intravascular Coagulation (Cont.)  Medical management  Prevention  Maintaining organ perfusion  Slowing consumption of coagulation factors Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 9

Disseminated Intravascular Coagulation (Cont.)  Nursing management  Supporting patient’s vital functions  Initiating bleeding precautions  Providing comfort and emotional support Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 10

Thrombocytopenia  Description  Etiology  Pathophysiology Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 11

Thrombocytopenia (Cont.)  Assessment and diagnosis  Clinical manifestations  Laboratory findings  Medical management  Nursing management Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 12

Heparin-Induced Thrombocytopenia  Description  Etiology  Pathophysiology Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 13

Heparin-Induced Thrombocytopenia (Cont.)  Assessment and diagnosis  Clinical manifestations  Laboratory findings  Medical management  Direct thrombin inhibitors (DTIs) Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 14

Heparin-Induced Thrombocytopenia (Cont.)  Nursing management  Decreasing the incidence of heparin exposure  Maintaining surveillance for complications  Educating the patient and family Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 15

Sickle Cell Anemia  Description  Etiology  Pathophysiology Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 16

Sickle Cell Anemia (Cont.)  Assessment and diagnosis  Clinical manifestations  Laboratory studies Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 17

Sickle Cell Anemia (Cont.)  Medical management  Prevent infection  Pain management  Transfusion therapy  Administration of hydroxyurea Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 18

Sickle Cell Anemia (Cont.)  Nursing management  Supporting patient’s vital functions  Maintaining surveillance for complications  Educating the patient and family Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 19

Quick Quiz! Sickle cell anemia (SCA) is an autosomal recessive genetic disorder. When two carriers of SCA have a child, what is the chance that they will have a child with SCA? A. 25% B. 50% C. 75% D. 100% Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 20

Tumor Lysis Syndrome  Description  Complication of cancer treatment  Etiology  Associated with the use of cancer treatment agents  May rarely occur spontaneously Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 21

Tumor Lysis Syndrome (Cont.)  Pathophysiology  Hyperuricemia  Hyperkalemia  Hyperphosphatemia and hypocalemia Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 22

Tumor Lysis Syndrome (Cont.) Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 23

Tumor Lysis Syndrome (Cont.)  Assessment and diagnosis  Clinical manifestations  Laboratory findings  Other diagnostic tests Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 24

Tumor Lysis Syndrome (Cont.)  Medical management  Adequate hydration  Metabolic imbalances  Life-threatening complications Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 25

Tumor Lysis Syndrome (Cont.)  Nursing management  Monitoring fluid and electrolytes  Maintaining surveillance for complications  Educating the patient and family Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 26

Quick Quiz! What is a high level of uric acid in the blood called? A. Hyperkalemia B. Hyperphosphatemia C. Hypocalcemia D. Hyperuricemia Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 27

Anemia of Critical Illness  Etiology  Blood conservation strategies  Minimizing blood loss  Managing oxygen delivery and consumption  Stimulating production of red blood cells (RBCs)  Encouraging safer transfusions and alternative agents Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 28

Summary  Coagulation and fibrinolysis  Hemostasis: ability of the body to control bleeding and clotting  Four actions are involved in achieving hemostasis Local vasoconstriction Platelet aggregation; platelet plug formation Fibrin mesh formation Clot dissolution Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 29

Summary (Cont.)  Disseminated intravascular coagulation (DIC)  Characterized by bleeding and thrombosis; if untreated, results in death  Medical management: identification of underlying cause; provision of hemodynamic support; and administration of blood, blood components, and medications  Nursing management: initiating bleeding precautions, providing comfort and emotional support, and watching for complications Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 30

Summary (Cont.)  Idiopathic thrombocytopenia purpura (ITP)  Caused by autoimmune response resulting in destruction of existing platelets  Medical management: administration of glucocorticoids, immunoglobulin, and platelets  Nursing management: initiating bleeding precautions, providing comfort and emotional support, and watching for complications Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 31

Summary (Cont.)  Heparin-induced thrombocytopenia (HIT)  Type 1: more common, milder, and transient  Type 2: result of autoimmune response to heparin administration; more severe than type 1  Medical management: discontinuation of all heparin, initiation of alternative anticoagulant, and treatment of thrombosis  Nursing management: providing comfort and emotional support and watching for complications Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 32

Summary (Cont.)  Sickle cell anemia (SCA)  Hereditary disease in which red blood cells form an abnormal sickle or crescent shape  Medical management: prevention of infection, management of pain, and administration of RBCs and hydroxyurea  Nursing management: supporting the patient’s vital functions, providing comfort and emotional support, watching for complications, and educating patient and family Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 33

Summary (Cont.)  Tumor lysis syndrome (TLS)  Occurs when a large number of neoplastic cells are rapidly killed  Medical management: preservation of renal function and treatment of electrolyte disorders  Nursing management: providing comfort and emotional support and watching for complications Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 34

Summary (Cont.)  Anemia of critical illness (ACI)  Occurs as a result of inflammation, iron deficiency, trauma, surgery, gastrointestinal bleeding, and from iatrogenic blood loss from diagnostic testing  Blood conservation strategies Minimizing blood loss Managing oxygen delivery and consumption Stimulating production of RBCs Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 35