1. Nursing Care of Patients with Hematologic and Lymphatic Disorders

2.  Deficiency of Red Blood Cells, Hemoglobin, or Both ◦ Impaired Production ◦ Increased Destruction ◦ Blood Loss  Reduced Capacity to Carry Oxygen to Tissues

3.  Dietary Deficiencies  Hemolysis  Hereditary Disorders

4.  Pallor  Tachycardia  Tachypnea  Irritability  Fatigue  Dyspnea

5.  Pernicious Anemia ◦ Numb Hands or Feet ◦ Sore Tongue  Iron Deficiency ◦ Mouth Fissures ◦ Glossitis ◦ Spoon-shaped Nails

6.  CBC with Microscopic Examination  Bone Marrow Analysis  Tests to Determine Source of Bleeding

7.  Eliminate Cause  Dietary Changes  Supplements  Transfusions

8.  Activity Intolerance  Imbalanced Nutrition  Risk for Injury  Impaired Oral Mucous Membranes

9.  Bone Marrow Does not Produce Adequate RBCs  Causes ◦ Congenital ◦ Exposure to Toxins ◦ Chemotherapy

10.  Weakness  Fatigue  Pallor  Dyspnea  Headache  Ecchymoses  Petechiae  Frank Bleeding  Infection  Death

11.  Diagnosis ◦ CBC ◦ Bone Marrow Biopsy ◦ TIBC ◦ Serum Iron  Treatment ◦ Treat Cause ◦ Colony Stimulating Factors ◦ Steroids ◦ Bone Marrow Transplant

12.  Inherited Autosomal Recessive Disorder

13.  Diagnosis ◦ Sickledex Test ◦ Hemoglobin Electrophoresis ◦ CBC ◦ ESR  Crisis Treatment ◦ Antibiotics ◦ Pain Management ◦ Transfusions ◦ Fluids ◦ Oxygen

15.  Avoid Risk of Reduced Oxygenation ◦ Exposure to Cold ◦ Infection ◦ Strenuous Exercise  Low Dose Penicillin  Frequent Transfusions  Hydroxyurea

16.  Risk for Ineffective Tissue Perfusion  Acute Pain

17.  Avoid ◦ Tight Clothing ◦ Strenuous Exercise ◦ Alcoholic Beverages ◦ Cold Temperatures ◦ Smoking ◦ Unpressurized Aircraft ◦ Exposure to Infection

18.  Overabundance of Red Cells  Hemoglobin >18 mg/dL  Hematocrit >55%  Blood Becomes Thick ◦ Primary ◦ Secondary

19.  Hypertension  Visual Changes  Headache  Vertigo  Dizziness  Tinnitus  Bleeding  Chest Pain  Dyspnea  Dark, Flushed Skin  Itching

20.  Phlebotomy  Low Dose Aspirin  Chemotherapy  Radiation Therapy

21.  Drink 3 Liters of Water Daily  Avoid Restrictive Clothing  Elevate Feet  Report Signs and Symptoms of Iron Deficiency  Report Signs and Symptoms of Bleeding

22.  Pathophysiology ◦ Accelerated Clotting ◦ Clotting Factors Depleted ◦ Bleeding  Etiology ◦ Major Trauma

23.  Abnormal Bleeding  Joint Pain  Nausea and Vomiting  Organ System Failure  Convulsions  Shock, Coma  Death

24.  Easy Bruising  Petechiae  Blood in Urine  Black Tarry Stools  Bleeding from Nose or Gums  New Onset of Painful Joints

26.  PT, PTT  Platelet Count  Hbg  Hemoglobin, Creatinine

27.  Correct Underlying Cause  Administer ◦ Blood ◦ FFP ◦ Platelets ◦ Cryoprecipitates

28.  Recognize and Report Bleeding  Avoid Trauma and Further Bleeding  Teach Patient and Family

29.  Pathophysiology ◦ Platelet Destruction by Immune System ◦ Risk for Bleeding  Etiology ◦ Acute Viral Illness ◦ Drug Reaction ◦ Immune System Dysfunction

30.  Bleeding ◦ Petechiae ◦ Ecchymoses ◦ Bleeding

31.  Platelet Count  Bleeding Time  Bone Marrow Aspiration

32.  Steroids  Chemotherapy  Transfusions  Vitamin K  Chemotherapy  Splenectomy

33.  Bleeding Precautions  Recognize and Report Signs and Symptoms Bleeding  Teach Patient and Family

34.  Use Electric Razor  Use Soft Toothbrush  Avoid Invasive Procedures, Injections  Maintain Pressure if Blood Draw Essential  Wear Shoes or Slippers

35.  Avoid Bumps and Bruises  Avoid Aspirin and Nsaids  Administer Stool Softener  Handle Patient Gently  Gentle Nose Blowing

36.  Pathophysiology ◦ Missing Clotting Factors  A—Factor VIII  B—Factor IX  Etiology ◦ Heredity

37.  Bleeding ◦ Joints ◦ Muscles ◦ Subcutaneous Tissue ◦ Brain

38.  PTT  Factor Levels

39.  Desmopressin  Clotting Factors ◦ Factor VIII ◦ Factor IX  Blood Transfusion

40.  Pain  Ineffective Protection  Risk for Ineffective Self Health Management

41.  Pathophysiology ◦ Increase in Immature WBCs ◦ Unable to Fight Infection  Risk Factors ◦ Viruses ◦ Genetic Factors ◦ Radiation/Chemotherapy

42.  Acute Lymphocytic Leukemia  Acute Myelogenous Leukemia  Chronic Lymphocytic Leukemia  Chronic Myelogenous Leukemia

43.  Fever  Infection  Pallor  Weakness  Tachycardia  Palpitations  Dyspnea  Abdominal Pain  Malaise  Sternal/Rib Pain  CNS Changes  Bleeding

44.  CBC  Bone Marrow Aspiration  Lumbar Puncture  Genetic Analysis

45.  Chemotherapy  Radiation Therapy  Bone Marrow Transplant  Peripheral Blood Stem Cell Transplant

46.  Risk for Injury: Infection, Bleeding  Fatigue  Impaired Oral Mucous Membranes  Knowledge Deficit  Anxiety

47.  Pathophysiology ◦ Cancer of Plasma Cells in Bone Marrow ◦ Tumors Devour Bone Tissue ◦ Organ Invasion  Etiology ◦ Unknown ◦ Occupational Exposures

48.  Bone Pain  Fever  Malaise  Spinal Cord Compression  Pathological Fractures  Hypercalcemia  Infection

49.  CBC, Blood Calcium  Bone X-Rays  Urine for Bence Jones Protein  Bone Marrow Biopsy

50.  Steroids  Chemotherapy  Control of Serum Calcium  Radiation  Stem Cell Transplantation  IV Pamidronate (Aredia)

51.  Risk for Infection  Risk for Injury ◦ Fracture ◦ Complications of Immobility ◦ Hypercalcemia

52.  Cancer of Lymph System ◦ Presence of Reed-Sternberg Cells  Etiology ◦ Viral ◦ Genetic ◦ Immune Dysfunction

53.  Painless Swollen Lymph Node  Pruritis  Pain Induced by Alcohol  Fever  Night Sweats  Weight Loss  Malaise

54.  Edema of Face and Neck  Jaundice  Nerve Pain  Retroperitoneal Node Involvement  Spleen, Liver, and Bone Involvement

55.  Biopsy ◦ Lymph Node ◦ Liver and Spleen ◦ Bone Marrow  CT, Chest X-Ray  Lung  Bone Scan  Lymphangiography  CBC

56.  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  Stage IV: Widely Disseminated Disease in Organs or Tissues

57.  Chemotherapy  Radiation Therapy

58.  Impaired Comfort  Activity Intolerance  Risk for Infection  Risk for Ineffective Coping

59.  Lymphoma Arising from B Cells and T Cells  Absence of Reed-Sternberg Cells  Etiology ◦ Some Viruses ◦ H Pylori ◦ Immune Dysfunction ◦ Occupational Exposures

60.  Painless Lymph Nodes  Enlarged Tonsils and Adenoids  Other Signs and Symptoms Similar to Hodgkin’s Disease

61.  Biopsy ◦ Lymph Nodes ◦ Tonsils ◦ Bone Marrow ◦ Liver ◦ Other  Bone Scan  CT, Chest X-ray, IVP  MRI, PET Scan  Lymphangiography  CBC  Liver Function Studies  Serum Calcium

62.  Chemotherapy  Monoclonal Antibodies  Interferon Therapy  Radiation Therapy  Stem Cell Transplant

63.  Activity Intolerance  Risk for Infection  Risk for Ineffective Coping

64.  Hodgkin’s ◦ Less Common ◦ Age 15 to 40 and >55 ◦ Reed-Sternberg Cells ◦ Younger ◦ Good Prognosis ◦ Alcohol-induced Pain  Non-Hodgkin’s ◦ More Common ◦ Usually >Age 50 ◦ Absence of Reed- Sternberg Cells ◦ Poorer Prognosis

65. Surgical Removal of the Spleen

66.  Baseline Labs  Blood Transfusion if Necessary  Vitamin K  Baseline Vital Signs  Teach Coughing and Deep Breathing

67.  Monitor for Bleeding  Monitor Vital Signs  Administer Narcotics for Pain  Encourage to Cough and Deep Breathe and Ambulate

68.  Bleeding  Pneumonia  Atelectasis  Infection  OPSI