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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 Fatigue
Family History
Bleeding Tendencies
Diet History
Respiratory Symptoms
Medications
Occupational/ Exposure Skin Changes
Lymphadenopathy
Physical Assessment

Vital Signs Lymph Nodes


LOC Fingernails
Skin Color Bowel Sounds
Signs of Bleeding
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
Chapter 28

Nursing Care of Patients


with Hematologic and
Lymphatic Disorders
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 (contd)
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 (contd)
Diagnosis Crisis Treatment
Sickledex Test Antibiotics
Hemoglobin Pain Management
Electrophoresis Transfusions
CBC Fluids
ESR 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 (contd)

Avoid Bumps and Bruises


Avoid Aspirin and NSAIDS
Administer Stool Softener
Handle Patient Gently
Avoid Nose Blowing
Hemophilia
Pathophysiology
Missing Clotting Factors
AFactor VIII
BFactor 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 Dyspnea
Infection Abdominal Pain
Pallor Malaise
Weakness Sternal/Rib Pain
Tachycardia CNS Changes
Palpitations Bleeding
Diagnosis
CBC
Bone Marrow Aspiration
Lumbar Puncture
Genetic Analysis
Therapeutic Interventions
Chemotherapy
Radiation Therapy
Bone Marrow Transplant
Hodgkins 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 CT, Chest X-Ray


Lymph Node Lung Scan
Bone Scan
Liver and Spleen
Lymphangiography
Bone Marrow 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

Hodgkins Non-Hodgkins
Younger Older
Less Debilitated More Debilitated
Fever and Night Fever and Sweats Less
Sweats Likely Likely
Local or Regional Usually Advanced
Spread
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