Assessment and Management of Patients With Hematologic Disorders.ppt MMNBBWE KIUUYW KLUIYUGSW KKJ
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Feb 26, 2025
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About This Presentation
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Slide Content
Assessment and Management of
Patients With Hematologic Disorders
Patients With Hematologic Disorders
Question
Is the following statement True or False?
Hematopoiesis is the complex process of the formation and
maturation of blood cells.
Is the following statement True or False?
Hematopoiesis is the complex process of the formation and
maturation of blood cells.
Answer
True
Hematopoiesis is the complex process of the formation and
maturation of blood cells.
True
Hematopoiesis is the complex process of the formation and
maturation of blood cells.
Hematologic System
The blood and the blood forming sites, including the
bone marrow and the reticuloendothelial system
Blood
Plasma
Blood cells
Hematopoiesis
The blood and the blood forming sites, including the
bone marrow and the reticuloendothelial system
Blood
Plasma
Blood cells
Hematopoiesis
Blood Cells
Erythrocyte—RBC
Leukocyte—WBC
Neutrophil
Monocyte
Eosinophil
Basophil
Lymphocyte—T lymphocyte and B lymphocyte
Thrombocyte—platelet
Erythrocyte—RBC
Leukocyte—WBC
Neutrophil
Monocyte
Eosinophil
Basophil
Lymphocyte—T lymphocyte and B lymphocyte
Thrombocyte—platelet
Hematopoiesis
Hemostasis
Refer to fig. 33-3
Refer to fig. 33-3
Question
What type of anemia results from red blood cell destruction?
A.Bleeding
B.Hemolytic
C.Hypoproliferative
D.None of the above
What type of anemia results from red blood cell destruction?
A.Bleeding
B.Hemolytic
C.Hypoproliferative
D.None of the above
Answer
B
Bleeding results from red blood loss. Hemolytic anemia
results from red blood cell destruction. Hypoproliferative
anemia results from defective red blood cell production.
B
Bleeding results from red blood loss. Hemolytic anemia
results from red blood cell destruction. Hypoproliferative
anemia results from defective red blood cell production.
Anemias
Lower than normal hemoglobin and fewer than normal circulating
erythrocytes. A sign of an underlying disorder
Hypoproliferative: defect in production of RBCs
Due to iron, vitamin B
12,
or folate deficiency, decreased erythropoietin production,
cancer
Hemolytic: excess destruction of RBCs
Due to altered erythropoiesis, or other causes such as hypersplenism, drug-induced
or autoimmune processes, mechanical heart valves
May also be due to blood loss
Lower than normal hemoglobin and fewer than normal circulating
erythrocytes. A sign of an underlying disorder
Hypoproliferative: defect in production of RBCs
Due to iron, vitamin B
12,
or folate deficiency, decreased erythropoietin production,
cancer
Hemolytic: excess destruction of RBCs
Due to altered erythropoiesis, or other causes such as hypersplenism, drug-induced
or autoimmune processes, mechanical heart valves
May also be due to blood loss
Manifestations
Depend upon the rapidity of the development of the anemia, duration of the
anemia, metabolic requirements of the patient, concurrent problems, and
concomitant features
Fatigue, weakness, malaise
Pallor or jaundice
Cardiac and respiratory symptoms
Tongue changes
Nail changes
Angular cheilosis
Pica
Depend upon the rapidity of the development of the anemia, duration of the
anemia, metabolic requirements of the patient, concurrent problems, and
concomitant features
Fatigue, weakness, malaise
Pallor or jaundice
Cardiac and respiratory symptoms
Tongue changes
Nail changes
Angular cheilosis
Pica
Medical Management
Correct or control the cause
Transfusion of packed RBCs
Treatment specific to the type of anemia
Dietary therapy
Iron or vitamin supplementation—iron, folate, B
12
Transfusions
Immunosuppressive therapy
Other
Correct or control the cause
Transfusion of packed RBCs
Treatment specific to the type of anemia
Dietary therapy
Iron or vitamin supplementation—iron, folate, B
12
Transfusions
Immunosuppressive therapy
Other
Nursing Process: The Care of the Patient with
Anemia—Assessment
Health history and physical exam
Laboratory data
Presence of symptoms and impact of those symptoms on patient’s life;
fatigue, weakness, malaise, pain
Nutritional assessment
Medications
Cardiac and GI assessment
Blood loss—menses, potential GI loss
Neurologic assessment
Anemia—Assessment
Health history and physical exam
Laboratory data
Presence of symptoms and impact of those symptoms on patient’s life;
fatigue, weakness, malaise, pain
Nutritional assessment
Medications
Cardiac and GI assessment
Blood loss—menses, potential GI loss
Neurologic assessment
Nursing Process: The Care of the Patient with
Anemia—Diagnoses
Fatigue
Altered nutrition
Altered tissue perfusion
Noncompliance with prescribed therapy
Anemia—Diagnoses
Fatigue
Altered nutrition
Altered tissue perfusion
Noncompliance with prescribed therapy
Collaborative Problems/Potential
Complications
Heart failure
Angina
Paresthesias
Confusion
Complications
Heart failure
Angina
Paresthesias
Confusion
Nursing Process: The Care of the Patient with
Anemia—Planning
Major goals include decreased fatigue, attainment or maintenance of
adequate nutrition, maintenance of adequate tissue perfusion, compliance
with prescribed therapy, and absence of complications .
Anemia—Planning
Major goals include decreased fatigue, attainment or maintenance of
adequate nutrition, maintenance of adequate tissue perfusion, compliance
with prescribed therapy, and absence of complications .
Interventions
Balance physical activity, exercise, and rest.
Maintain adequate nutrition.
Patient education to promote compliance with medications and nutrition.
Monitor VS and pulse oximetry, provide supplemental oxygen as needed.
Monitor for potential complications.
Balance physical activity, exercise, and rest.
Maintain adequate nutrition.
Patient education to promote compliance with medications and nutrition.
Monitor VS and pulse oximetry, provide supplemental oxygen as needed.
Monitor for potential complications.
Question
Is the following statement True or False?
Leukocytosis refers to a decreased level of leukocytes in the circulation.
Is the following statement True or False?
Leukocytosis refers to a decreased level of leukocytes in the circulation.
Answer
False
Leukocytosis refers to an increased level of leukocytes in the circulation.
Leukopenia refers to a decreased level of leukocytes in the circulation.
False
Leukocytosis refers to an increased level of leukocytes in the circulation.
Leukopenia refers to a decreased level of leukocytes in the circulation.
Leukemia
Hematopoietic malignancy with unregulated proliferation of leukocytes
Types:
Acute myeloid leukemia
Chronic myeloid leukemia
Acute lymphocytic leukemia
Chronic lymphocytic leukemia
Hematopoietic malignancy with unregulated proliferation of leukocytes
Types:
Acute myeloid leukemia
Chronic myeloid leukemia
Acute lymphocytic leukemia
Chronic lymphocytic leukemia
Acute Myeloid Leukemia (AML)
Defect in stem cell that differentiate into all myeloid cells: monocytes,
granulocytes, erythrocytes, and platelets
Most common nonlymphocytic leukemia
Affects all ages with peak incidence at age 60
Prognosis is variable
Manifestations: fever and infection, weakness and fatigue, bleeding
tendencies, pain from enlarged liver or spleen, hyperplasia of gums, bone
pain
Treatment aggressive chemotherapy—induction therapy, BMT or PBSCT
Defect in stem cell that differentiate into all myeloid cells: monocytes,
granulocytes, erythrocytes, and platelets
Most common nonlymphocytic leukemia
Affects all ages with peak incidence at age 60
Prognosis is variable
Manifestations: fever and infection, weakness and fatigue, bleeding
tendencies, pain from enlarged liver or spleen, hyperplasia of gums, bone
pain
Treatment aggressive chemotherapy—induction therapy, BMT or PBSCT
Chronic Myeloid Leukemia (CML)
Mutation in myeloid stem cell with uncontrolled proliferation of cells—
Philadelphia chromosome
Stages: chronic phase, transformational phase, blast crisis
Uncommon in people under 20, with increased incidence with age. Mean age:
55–60
Life expectancy of 3–5 years
Manifestations: initially may be asymptomatic, malaise, anorexia, weight loss,
confusion or shortness of breath due to leukostasis, enlarged tender spleen,
or enlarged liver
Treatment: imatinib mestylate (Gleevec) blocks signals in leukemic cells that
express BCR-ABL protein; chemotherapy, BMT or PBSCT
Mutation in myeloid stem cell with uncontrolled proliferation of cells—
Philadelphia chromosome
Stages: chronic phase, transformational phase, blast crisis
Uncommon in people under 20, with increased incidence with age. Mean age:
55–60
Life expectancy of 3–5 years
Manifestations: initially may be asymptomatic, malaise, anorexia, weight loss,
confusion or shortness of breath due to leukostasis, enlarged tender spleen,
or enlarged liver
Treatment: imatinib mestylate (Gleevec) blocks signals in leukemic cells that
express BCR-ABL protein; chemotherapy, BMT or PBSCT
Acute Lymphocytic Leukemia
Uncontrolled proliferation of immature cells from lymphoid stem cell
Most common in young children, boys more often than girls
Prognosis is good for children; 80% 5-year event-free survival, but drops with
increased age
Manifestations: leukemic cell infiltration is more common with this leukemia,
with symptoms of meningeal involvement and liver, spleen, and bone marrow
pain
Treatment: chemotherapy, imatinib mestylate (if Philadelphia chromosome
positive), BMT or PBSCT, monoclonal antibody therapy
Uncontrolled proliferation of immature cells from lymphoid stem cell
Most common in young children, boys more often than girls
Prognosis is good for children; 80% 5-year event-free survival, but drops with
increased age
Manifestations: leukemic cell infiltration is more common with this leukemia,
with symptoms of meningeal involvement and liver, spleen, and bone marrow
pain
Treatment: chemotherapy, imatinib mestylate (if Philadelphia chromosome
positive), BMT or PBSCT, monoclonal antibody therapy
Chronic Lymphocytic Leukemia
Malignant B lymphocytes, most of which are mature, may escape apoptosis,
resulting in excessive accumulation of cells
Most common form of leukemia
More common in older adults, effects men more often
Survival varies from 2 to 14 years depending upon stage
Manifestations: lymphadenopathy, hepatomegaly, splenomegaly; in later
stages anemias and thrombocytopenia; autoimmune complications with RES
destroying RBCs and platelets may occur, B symptoms include fever, sweats,
weight loss
Treatment: early stage may require no treatment, chemotherapy, monoclonal
antibody therapy
Malignant B lymphocytes, most of which are mature, may escape apoptosis,
resulting in excessive accumulation of cells
Most common form of leukemia
More common in older adults, effects men more often
Survival varies from 2 to 14 years depending upon stage
Manifestations: lymphadenopathy, hepatomegaly, splenomegaly; in later
stages anemias and thrombocytopenia; autoimmune complications with RES
destroying RBCs and platelets may occur, B symptoms include fever, sweats,
weight loss
Treatment: early stage may require no treatment, chemotherapy, monoclonal
antibody therapy
Nursing Process: The Care of the Patient with
Leukemia—Assessment
Health history
Assess symptoms of leukemia, and for complications of anemia, infection, and
bleeding
Weakness and fatigue
Laboratory tests
Leukocyte count, ANC, hematocrit, platelets, electrolytes, culture reports
Leukemia—Assessment
Health history
Assess symptoms of leukemia, and for complications of anemia, infection, and
bleeding
Weakness and fatigue
Laboratory tests
Leukocyte count, ANC, hematocrit, platelets, electrolytes, culture reports
Nursing Process: The Care of the Patient with
Leukemia—Diagnoses
Risk for bleeding
Risk for impaired skin integrity
Impaired gas exchange
Impaired mucous membrane
Imbalanced nutrition
Acute pain
Hyperthermia
Fatigue and activity intolerance
Impaired physical mobility
Leukemia—Diagnoses
Risk for bleeding
Risk for impaired skin integrity
Impaired gas exchange
Impaired mucous membrane
Imbalanced nutrition
Acute pain
Hyperthermia
Fatigue and activity intolerance
Impaired physical mobility
Nursing Process: The Care of the Patient with
Leukemia—Diagnoses
Risk for excess fluid volume
Diarrhea
Risk for deficient fluid volume
Self-care deficit
Anxiety
Disturbed body image
Potential for spiritual distress
Grieving diagnoses
Deficient knowledge
Leukemia—Diagnoses
Risk for excess fluid volume
Diarrhea
Risk for deficient fluid volume
Self-care deficit
Anxiety
Disturbed body image
Potential for spiritual distress
Grieving diagnoses
Deficient knowledge
Collaborative Problems/Potential
Complications
Infection
Bleeding
Renal dysfunction
Tumor lysis syndrome
Nutritional depletion
Mucositis
Depression
Complications
Infection
Bleeding
Renal dysfunction
Tumor lysis syndrome
Nutritional depletion
Mucositis
Depression
Nursing Process: The Care of the Patient with
Leukemia- Planning
Major goals may include absence of complications, attainment and
maintenance of adequate nutrition, activity tolerance, ability for self-care
and to cope with the diagnosis and prognosis, positive body image, and an
understanding of the disease process and its treatment.
Leukemia- Planning
Major goals may include absence of complications, attainment and
maintenance of adequate nutrition, activity tolerance, ability for self-care
and to cope with the diagnosis and prognosis, positive body image, and an
understanding of the disease process and its treatment.
Interventions
Interventions related to risk of infection and bleeding
Mucositis
Frequent, gentle oral hygiene
Soft toothbrush, or if counts are low, sponge-tipped applicators
Rinse only with NS, NS and baking soda, or prescribed solutions
Perineal and rectal care
Interventions related to risk of infection and bleeding
Mucositis
Frequent, gentle oral hygiene
Soft toothbrush, or if counts are low, sponge-tipped applicators
Rinse only with NS, NS and baking soda, or prescribed solutions
Perineal and rectal care
Improving Nutrition
Oral care before and after meals
Administer analgesics before meals
Appropriate treatment of nausea
Small, frequent feedings
Soft foods that are moderate in temperature
Low-microbial diet
Nutritional supplements
Oral care before and after meals
Administer analgesics before meals
Appropriate treatment of nausea
Small, frequent feedings
Soft foods that are moderate in temperature
Low-microbial diet
Nutritional supplements
Lymphoma
Neoplasm of lymph origin
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma
Neoplasm of lymph origin
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma
Hodgkin’s Disease
Unicentric origin
Reed–Sternberg cells
Suspected viral etiology, familial pattern, incidence early 20s and again after
age 50
Excellent cure rate with treatment
Manifestations: painless lymph node enlargement, pruritis; B symptoms:
fever, sweats, weight loss
Treatment is determined by stage of the disease and may include
chemotherapy and/or radiation therapy
Unicentric origin
Reed–Sternberg cells
Suspected viral etiology, familial pattern, incidence early 20s and again after
age 50
Excellent cure rate with treatment
Manifestations: painless lymph node enlargement, pruritis; B symptoms:
fever, sweats, weight loss
Treatment is determined by stage of the disease and may include
chemotherapy and/or radiation therapy
Non-Hodgkin's Lymphoma (NHL)
Lymphoid tissues become infiltrated with malignant cells, spread is
unpredictable and localized disease is rare.
Incidence increases with age, with average age being 50 to 60.
Prognosis varies with type of NHL.
Treatment is determined by type and stage of disease, and may include
interferon, chemotherapy, and/or radiation therapy.
Lymphoid tissues become infiltrated with malignant cells, spread is
unpredictable and localized disease is rare.
Incidence increases with age, with average age being 50 to 60.
Prognosis varies with type of NHL.
Treatment is determined by type and stage of disease, and may include
interferon, chemotherapy, and/or radiation therapy.
Question
What should any elderly patient be evaluated for whose
chief complaint is back pain and has an elevated total
protein level?
A.Anemia
B.Leukemia
C.Multiple myeloma
D.Non-Hodgkin’s lymphoma
What should any elderly patient be evaluated for whose
chief complaint is back pain and has an elevated total
protein level?
A.Anemia
B.Leukemia
C.Multiple myeloma
D.Non-Hodgkin’s lymphoma
Answer
C
Any elderly patient whose chief complaint is back pain and
has an elevated total protein level should be evaluated
for possible myeloma.
C
Any elderly patient whose chief complaint is back pain and
has an elevated total protein level should be evaluated
for possible myeloma.
Multiple Myeloma
Malignant disease of plasma cells in the bone marrow with destruction of bone
M protein and Bence–Jones protein
Median survival 3 to 5 years, no cure
Manifestations: bone pain, osteoporosis, fractures, elevated serum protein
hypocalcaemia, renal damage renal failure, symptoms of anemia, fatigue,
weakness, increased serum viscosity, and increased risk for bleeding and
infection
Treatment may include chemotherapy, corticosteroids, radiation therapy,
biphosphonates
Malignant disease of plasma cells in the bone marrow with destruction of bone
M protein and Bence–Jones protein
Median survival 3 to 5 years, no cure
Manifestations: bone pain, osteoporosis, fractures, elevated serum protein
hypocalcaemia, renal damage renal failure, symptoms of anemia, fatigue,
weakness, increased serum viscosity, and increased risk for bleeding and
infection
Treatment may include chemotherapy, corticosteroids, radiation therapy,
biphosphonates
Bleeding Disorders
Primary thrombocythemia
Thrombocytopenia
Idiopathic thrombocytopenia purpura (ITP)
Hemophilia
Acquired coagulation disorders: liver disease, anticoagulants, vitamin K
deficiency
Disseminated intravascular coagulation (DIC)
Bleeding precautions
Primary thrombocythemia
Thrombocytopenia
Idiopathic thrombocytopenia purpura (ITP)
Hemophilia
Acquired coagulation disorders: liver disease, anticoagulants, vitamin K
deficiency
Disseminated intravascular coagulation (DIC)
Bleeding precautions
Question
Is the following statement True or False?
Disseminated intravascular coagulation is not a disease but a sign of an
underlying condition.
Is the following statement True or False?
Disseminated intravascular coagulation is not a disease but a sign of an
underlying condition.
Answer
True
Disseminated intravascular coagulation is not a disease but a sign of an
underlying condition.
True
Disseminated intravascular coagulation is not a disease but a sign of an
underlying condition.
DIC
Not a disease but a sign of an underlying disorder.
Severity is variable; may be life-threatening.
Triggers may include sepsis, trauma, shock cancer abrupto placenta, toxins,
and allergic reactions.
Altered hemostasis mechanism causes massive clotting in microcirculation. As
clotting factors are consumed, bleeding occurs. Symptoms are related to
tissue ischemia and bleeding.
Laboratory tests.
Treatment: treat underlying cause, correct tissue ischemia, replace fluids and
electrolytes, maintain blood pressure, replace coagulation factors, use
heparin.
Not a disease but a sign of an underlying disorder.
Severity is variable; may be life-threatening.
Triggers may include sepsis, trauma, shock cancer abrupto placenta, toxins,
and allergic reactions.
Altered hemostasis mechanism causes massive clotting in microcirculation. As
clotting factors are consumed, bleeding occurs. Symptoms are related to
tissue ischemia and bleeding.
Laboratory tests.
Treatment: treat underlying cause, correct tissue ischemia, replace fluids and
electrolytes, maintain blood pressure, replace coagulation factors, use
heparin.
Nursing Process: The Care of the Patient with
DIC—Assessment
Be aware of patient who are at risk for DIC and assess for signs and symptoms
of the condition.
Assess for signs and symptoms and progression of thrombi and bleeding.
DIC—Assessment
Be aware of patient who are at risk for DIC and assess for signs and symptoms
of the condition.
Assess for signs and symptoms and progression of thrombi and bleeding.
Nursing Process: The Care of the Patient with
DIC—Diagnoses
Risk for fluid volume deficient
Risk for impaired skin integrity
Risk for imbalanced fluid volume
Ineffective tissue perfusion
Death anxiety
DIC—Diagnoses
Risk for fluid volume deficient
Risk for impaired skin integrity
Risk for imbalanced fluid volume
Ineffective tissue perfusion
Death anxiety
Collaborative Problems/Potential
Complications
Renal failure
Gangrene
Pulmonary embolism or hemorrhage
Acute respiratory distress syndrome
Stroke
Complications
Renal failure
Gangrene
Pulmonary embolism or hemorrhage
Acute respiratory distress syndrome
Stroke
Nursing Process: The Care of the Patient with
DIC—Planning
Major goals may include maintenance of hemodynamic status, maintenance of
intact skin and oral mucosa, maintenance of fluid balance, maintenance of
tissue perfusion, enhanced coping, and absence of complications.
DIC—Planning
Major goals may include maintenance of hemodynamic status, maintenance of
intact skin and oral mucosa, maintenance of fluid balance, maintenance of
tissue perfusion, enhanced coping, and absence of complications.
Interventions
Assessment and interventions should target potential sites of organ damage.
Monitor and assess carefully
Avoid trauma and procedures which increase risk of bleeding, including
activities which would increase intracranial pressure.
Assessment and interventions should target potential sites of organ damage.
Monitor and assess carefully
Avoid trauma and procedures which increase risk of bleeding, including
activities which would increase intracranial pressure.
Therapies for Blood Disorders
Anticoagulant therapy
Splenectomy
Therapeutic apheresis
Therapeutic phlebotomy
Blood component therapy
Anticoagulant therapy
Splenectomy
Therapeutic apheresis
Therapeutic phlebotomy
Blood component therapy
Blood Transfusion Administration
Review patient history including history of transfusions and transfusion
reactions; note concurrent health problems and obtain baseline assessment
and VS
Perform patient teaching and obtain consent
Equipment: IV (20-gauge or greater for PRBCs) and appropriate tubing, normal
saline solution
Procedure to identify patient and blood product
Monitoring of patient and VS
Post procedure care
Nursing management of adverse reactions
Review patient history including history of transfusions and transfusion
reactions; note concurrent health problems and obtain baseline assessment
and VS
Perform patient teaching and obtain consent
Equipment: IV (20-gauge or greater for PRBCs) and appropriate tubing, normal
saline solution
Procedure to identify patient and blood product
Monitoring of patient and VS
Post procedure care
Nursing management of adverse reactions
Complications
Febrile nonhemolytic reaction
Acute hemolytic reaction
Allergic reaction
Circulatory overload
Bacterial contamination
Transfusion related acute lung injury
Delayed hemolytic reaction
Disease acquisition
Complications of long-term transfusion therapy
Febrile nonhemolytic reaction
Acute hemolytic reaction
Allergic reaction
Circulatory overload
Bacterial contamination
Transfusion related acute lung injury
Delayed hemolytic reaction
Disease acquisition
Complications of long-term transfusion therapy
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