Immune & Haematologic Disorders NURS 2016 Chapters: 33, 51-54

Anemia Anemia: lower than normal hemoglobin (normal is g/dL) Anemia: lower than normal hemoglobin (normal is g/dL) 3 main categories: 3 main categories: –Loss of red cells –Hypoproliferative –Hemotytic Symptoms of anemia are more apparent when onset is rapid. A person can tolerate a 50% decreased in RBC gradually, but rapid 30% decrease can cause vascular collapse. Symptoms of anemia are more apparent when onset is rapid. A person can tolerate a 50% decreased in RBC gradually, but rapid 30% decrease can cause vascular collapse.

Assessment General: Weakness, fatigue, malaise General: Weakness, fatigue, malaise Appearance: Pallor of skill and mucous membranes, tongue smooth red, beefy ulcerations at corner of mouth Appearance: Pallor of skill and mucous membranes, tongue smooth red, beefy ulcerations at corner of mouth Appetite: Crave ice, starch Appetite: Crave ice, starch Nutrition: lack of iron, B12, folic acid, vegetarians need to supplement B12 (comes from animal sources) Nutrition: lack of iron, B12, folic acid, vegetarians need to supplement B12 (comes from animal sources)

Assessment Cont’ Cardiac Status: look for signs of increased cardiac load Cardiac Status: look for signs of increased cardiac load GI: N&V, coffee grounds, melena, diarrhea, anorexia, stool for OB GI: N&V, coffee grounds, melena, diarrhea, anorexia, stool for OB Hx: menstrual cycle, alcohol and family hx Hx: menstrual cycle, alcohol and family hx Neuro: peripheral numbness, poor coordination, confusion Neuro: peripheral numbness, poor coordination, confusion

Dietary Iron Iron deficiency anemia most common Iron deficiency anemia most common Sources: organ meats, black, pinto and garbonzo beans, leafy greens, raisins & molasses Sources: organ meats, black, pinto and garbonzo beans, leafy greens, raisins & molasses Vitamin C enhances absorption of iron from dietary sources Vitamin C enhances absorption of iron from dietary sources

Iron Supplements Ferrous Sulfate Ferrous Sulfate Take 1 hour before or 2 hours after meals (will not absorb with food) Take 1 hour before or 2 hours after meals (will not absorb with food) Increase intake of vitamin C Increase intake of vitamin C Increase intake of fiber Increase intake of fiber Stool will be dark Stool will be dark

Case Study Mark is 3 years old. His mother brings him to the clinic after a diagnosis of iron deficiency anemia after a routine examination by his family doctor. He is a very picky eater. He is to start oral iron therapy. Mark is 3 years old. His mother brings him to the clinic after a diagnosis of iron deficiency anemia after a routine examination by his family doctor. He is a very picky eater. He is to start oral iron therapy.

Rheumatoid Arthritis Inflammatory disorder that primarily involves the synovial membrane of the joints Inflammatory disorder that primarily involves the synovial membrane of the joints Clinical Manifestations: Clinical Manifestations: –Joint pain –Swelling –Warmth –Erythema –Lack of function

Nursing Diagnosis Pain Pain Fatigue Fatigue Impaired mobility Impaired mobility Self-care deficit Self-care deficit Disturbed sleeping pattern Disturbed sleeping pattern Disturbed body image Disturbed body image Ineffective coping Ineffective coping

Interventions Relieving pain & discomfort Relieving pain & discomfort Reducing fatigue Reducing fatigue Increasing mobility Increasing mobility Facilitating self-care Facilitating self-care Improving sleep Improving sleep Improving body image Improving body image Monitoring & managing potential complications Monitoring & managing potential complications Increasing knowledge of disease management Increasing knowledge of disease management

Leukemia True cause is unknown True cause is unknown Unregulated proliferation or accumulation of white blood cells (WBC) Unregulated proliferation or accumulation of white blood cells (WBC) In the bone marrow, replacing normal marrow elements In the bone marrow, replacing normal marrow elements Classified as either lymphocytic or mylocytic according to the stem cell involved Classified as either lymphocytic or mylocytic according to the stem cell involved Classified as acute (abrupt onset) or chronic (evolves over months to years) Classified as acute (abrupt onset) or chronic (evolves over months to years)

Leukemia Clinical Manifestations: Clinical Manifestations: –Weakness –Fatigue –Bleeding tendencies –Petechiae –Ecchymosis –Vomiting –Fever –Infection –Headache –Pain

Nursing Diagnoses Risk for infection & bleeding Risk for infection & bleeding Impaired mucous membrane Impaired mucous membrane Pain & discomfort Pain & discomfort Imbalanced nutrition Imbalanced nutrition Risk for diarrhea Risk for diarrhea Fluid imbalance Fluid imbalance Risk for excess fluid volume Risk for excess fluid volume Risk for yperthermia Risk for yperthermia

Nursing Diagnoses Cont’ Fatigue & activity intolerance Fatigue & activity intolerance Impaired skin integrity Impaired skin integrity Grieving Grieving Disturbed body image Disturbed body image Self-care deficit Self-care deficit Deficit knowledge Deficit knowledge Anxiety Anxiety Impaired gas exchange Impaired gas exchange

Nursing Interventions Preventing Bleeding Preventing Bleeding Preventing Infection Preventing Infection Managing Mucositis Managing Mucositis Easing Pain & Discomfort Easing Pain & Discomfort Attaining & Maintaining Adequate Nutrition Attaining & Maintaining Adequate Nutrition Management Fluid & Electrolyte balance Management Fluid & Electrolyte balance Decreasing Fatigue & Deconditioning Decreasing Fatigue & Deconditioning Improving Self Care Improving Self Care Managing Anxiety & Grief Managing Anxiety & Grief Promoting Positive Body Image Promoting Positive Body Image Encouraging Spiritual Well-being Encouraging Spiritual Well-being

Human Immunodefinciency Virus (HIV) HIV Infection HIV Infection Retroviruses Retroviruses HIV asymptomatic HIV asymptomatic HIV symptomatic HIV symptomatic

Acquired Immunodeficiency Syndrome (AIDS) Risk factors: Risk factors: –Transmitted through bodily fluids Sexual intercourse (heterosexual or homosexual) Sexual intercourse (heterosexual or homosexual) Injection of IV drugs Injection of IV drugs Transfusions Transfusions Childbirth/breastfed Childbirth/breastfed

Clinical Manifestations Respiratory: Respiratory: –SOB, dyspnea, cough, chest pain, fever are characteristic of pneumonia G.I.: G.I.: –Loss of appetite, N&V, oral candidiasis, diarrhea Neuro: Neuro: –Encephalopathy, peripheral neuropathy

Clinical Manifestations Cont’ Integumentary: Integumentary: –Herpes simplex, flaking skin, skin cancers Reproductive: Reproductive: –Vaginal candidiasis, ulcerative sexually transmitted diseases (syphilis, herpes), PID, amenorrhea Other: Other: –Fatigue, headache, night sweats, weakness, weight loss, dry cough, SOB, diarrhea, edema, swallowing difficulties, dementia, depression

Assessment Dietary Status Dietary Status Skin & Mucous Membranes Skin & Mucous Membranes Respiratory Status Respiratory Status Neurologic Status Neurologic Status Fluid & Electrolytes Status Fluid & Electrolytes Status Level of Knowledge Level of Knowledge Use of Alternative Therapies Use of Alternative Therapies

Nursing Diagnosis Impaired skin integrity Impaired skin integrity Risk for infection Risk for infection Activity intolerance Activity intolerance Disturbed thought processes Disturbed thought processes Ineffective airway clearance Ineffective airway clearance Imbalanced nutrition Imbalanced nutrition Diarrhea Diarrhea Pain Pain Social isolation Social isolation Anticipatory grief Anticipatory grief Deficient knowledge Deficient knowledge

Nursing Interventions Improving airway clearance Improving airway clearance Promoting skin integrity Promoting skin integrity Maintaining perineal skin integrity Maintaining perineal skin integrity Prompting usual bowel habits Prompting usual bowel habits Preventing infection Preventing infection Relieving pain & discomfort Relieving pain & discomfort Improving nutritional status Improving nutritional status Improving activity tolerance Improving activity tolerance Maintaining thought processes Maintaining thought processes Coping with grief Coping with grief Monitoring & managing complications Monitoring & managing complications