Chapter 27 Hematopoietic and Lymphatic System Function, Assessment, and Therapeutic Measures

Review of A&P Blood ▫Plasma ▫Red Cells ▫White Cells ▫Platelets

Review of A & P

Aging Changes

History Reason for Seeking Care Family History Diet History Medications Occupational/ Exposure Fatigue Bleeding Tendencies Respiratory Symptoms Skin Changes Lymphadenopathy

Physical Assessment Vital Signs LOC Skin Color Signs of Bleeding Lymph Nodes Fingernails Bowel Sounds

Diagnostic Tests Blood Tests Coagulation Tests Bone Marrow Biopsy Lymphangiography Lymph Node Biopsy

Blood Products Packed Red Blood Cells Frozen Red Blood Cells Platelets Albumin Fresh Frozen Plasma Cryoprecipitates

Transfusion Safety Steps Assessment Identification Filtering Washed Warmed

Transfusion Complications Febrile Reaction Urticarial Reaction Hemolytic Reaction Anaphylactic Reaction Circulatory Overload

Nursing Care of Patients with Hematologic and Lymphatic Disorders Chapter 28

Anemia Deficiency of Red Blood Cells, Hemoglobin, or Both ▫Impaired Production ▫Increased Destruction ▫Blood Loss Reduced Capacity to Carry Oxygen to Tissues

Etiologies Dietary Deficiencies Hemolysis Hereditary Disorders

Signs and Symptoms Pallor Tachycardia Tachypnea Irritability Fatigue Dyspnea

Signs and Symptoms (cont’d) Pernicious Anemia ▫Numb Hands or Feet ▫Sore Tongue Iron Deficiency ▫Mouth Fissures ▫Glossitis ▫Spoon Shaped Nails

Diagnosis CBC with Microscopic Examination Bone Marrow Analysis Tests to Determine Source of Bleeding

Therapeutic Interventions Eliminate Cause Dietary Changes Supplements Transfusions

Nursing Diagnosis Activity Intolerance Imbalanced Nutrition Risk for Injury Impaired Oral Mucous Membranes

Sickle Cell Anemia Inherited Autosomal Recessive Disorder

Sickle Cell Anemia (cont’d) Diagnosis ▫Sickledex Test ▫Hemoglobin Electrophoresis ▫CBC ▫ESR Crisis Treatment ▫Antibiotics ▫Pain Management ▫Transfusions ▫Fluids ▫Oxygen

Signs and Symptoms

Crisis Prevention Avoid Risk of Reduced Oxygenation ▫Exposure to Cold ▫Infection ▫Strenuous Exercise Low Dose Penicillin Frequent Transfusions Hydroxyurea

Patient Education Avoid ▫Tight Clothing ▫Strenuous Exercise ▫Alcoholic Beverages ▫Cold Temperatures ▫Smoking ▫Unpressurized Aircraft ▫Exposure to Infection

Disseminated Intravascular Coagulation Pathophysiology ▫Accelerated Clotting ▫Clotting Factors Depleted ▫Bleeding Etiology ▫Major Trauma

Signs and Symptoms Abnormal Bleeding Joint Pain Nausea and Vomiting Organ System Failure Convulsions Shock, Coma Death

Bleeding: Signs and Symptoms Easy Bruising Petechiae Blood in Urine Black Tarry Stools Bleeding from Nose or Gums New Onset of Painful Joints

Hemorrhage of the Skin

Diagnostic Tests PT, PTT Platelet Count Hbg BUN, Cr

Therapeutic Interventions Correct Underlying Cause Administer ▫Blood ▫FFP ▫Platelets ▫Cryoprecipitates

Nursing Care Recognize and Report Bleeding Avoid Trauma and Further Bleeding Teach Patient and Family

Bleeding Precautions Use Electric Razor Use Soft Toothbrush Avoid Invasive Procedures, Injections Maintain Pressure If Blood Draw Essential Wear Shoes or Slippers

Bleeding Precautions (cont’d) Avoid Bumps and Bruises Avoid Aspirin and NSAIDS Administer Stool Softener Handle Patient Gently Avoid Nose Blowing

Hemophilia Pathophysiology ▫Missing Clotting Factors  A—Factor VIII  B—Factor IX Etiology ▫Heredity

Signs and Symptoms Bleeding ▫Joints ▫Muscles ▫Subcutaneous Tissue ▫Brain

Diagnosis PTT Factor Levels

Therapeutic Interventions Clotting Factors ▫Factor VIII ▫Vactor IX Blood Transfusion

Leukemia Pathophysiology ▫Increase in Immature WBCs ▫Unable to Fight Infection Risk Factors ▫Viruses ▫Genetic Factors ▫Radiation/Chemotherapy

Types Acute Lymphocytic Leukemia Acute Myelogenous Leukemia Chronic Lymphocytic Leukemia Chronic Myelogenous Leukemia

Signs and Symptoms Fever Infection Pallor Weakness Tachycardia Palpitations Dyspnea Abdominal Pain Malaise Sternal/Rib Pain CNS Changes Bleeding

Diagnosis CBC Bone Marrow Aspiration Lumbar Puncture Genetic Analysis

Therapeutic Interventions Chemotherapy Radiation Therapy Bone Marrow Transplant

Hodgkin’s Disease Cancer of Lymph System ▫Presence of Reed-Sternberg Cells Etiology ▫Viral ▫Genetic ▫Immune Dysfunction

Signs and Symptoms Painless Swollen Lymph Node Pruritis Pain Induced by Alcohol Fever Night Sweats Weight Loss Malaise

Late Signs and Symptoms Edema of Face and Neck Jaundice Nerve Pain Retroperitoneal Node Involvement Spleen, Liver, and Bone Involvement

Diagnosis Biopsy ▫Lymph Node ▫Liver and Spleen ▫Bone Marrow CT, Chest X-Ray Lung Scan Bone Scan Lymphangiography CBC

Staging Stage I: Single Lymph Node or Site Stage II: Two or More Nodes on Same Side of Diaphragm Stage III: Nodes on Both Sides of Diaphragm, generalized throughout the body Stage IV: – Widely Disseminated Disease in Organs or Tissues

Therapeutic Interventions Chemotherapy Radiation Therapy

Comparison of Lymphomas Hodgkin’s ▫Younger ▫Less Debilitated ▫Fever and Night Sweats Likely ▫Local or Regional Spread Non-Hodgkin’s ▫Older ▫More Debilitated ▫Fever and Sweats Less Likely ▫Usually Advanced

Splenectomy Surgical Removal of the Spleen

Preoperative Care Baseline Labs Blood Transfusion If Necessary Vitamin K Baseline Vital Signs Teach Coughing and Deep Breathing

Postoperative Care Monitor for Bleeding Monitor Vital Signs – notify MD of abnormals Administer Narcotics for Pain Encourage to Cough and Deep Breathe and Ambulate

Complications of Splenectomy Bleeding Pneumonia Atelectasis Infection OPSI