Chapter_032_LO.ppt Chapter-42-Endocrine-and-thyroid-disorder-I.ppt

Chapter-42-Endocrine-and-thyroid-disorder-I.ppt

1. 1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Chapter 32
Hematologic Disorders

2. 2Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Learning Objectives
•List the components of the hematologic system and describe
their role in oxygenation and hemostasis.
•Identify data to be collected when assessing a patient
with a disorder of the hematologic system.
•Describe tests and procedures used to diagnose disorders
of the hematologic system and nursing considerations
for each.
•Describe nursing care for patients undergoing common
therapeutic measures for disorders of the hematologic
system.
•Describe the pathophysiology, signs and symptoms,
medical diagnosis, and medical treatment for selected
disorders of the hematologic system.
•Assist in planning nursing care for a patient with a disorder
of the hematologic system.

3. 3Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Anatomy and Physiology of the
Hematologic System

4. 4Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Structures and Components of the
Hematologic System
•Bone marrow
•Liver
•Spleen
•Blood
•Red blood cells (erythrocytes)
•Platelets (thrombocytes)
•Clotting factors
•Plasma

5. 5Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 32-1

6. 6Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Physiologic Functions of the
Hematologic System
•Oxygenation
•Red blood cells transport oxygen from the lungs to
the tissues and carbon dioxide from the tissues
back to the lungs for excretion
•Hemoglobin in red blood cells combines with
oxygen and carbon dioxide to accomplish
oxygenation

7. 7Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Physiologic Functions of the
Hematologic System
•Hemostasis
•Control of bleeding
•Blood vessel constricts; reduces bleeding
•Platelets adhere to the injured blood vessel, forming an
unstable platelet plug
•Coagulation initiated, forming a stable fibrin matrix, (scab)

8. 8Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Figure 32-2

9. 9Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Age-Related Changes
•Bone marrow becomes less productive
•Hematologic function not affected unless a
person is unusually stressed with trauma, a
chronic illness, or treatment for cancer
•In conditions necessitating a higher production
of blood cells, bone marrow usually responds
to the increased demand, given time

10. 10Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Nursing Assessment of the
Hematologic System

11. 11Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Chief Complaint and History of
Present Illness
•Inquire about bruising easily, bleeding for an
unusually long time, or chronic fatigue
•May be the symptoms of an underlying
hematologic disorder

12. 12Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Past Medical History
•Cancer or prior cancer treatment, human
immunodeficiency virus (HIV) infection, liver
disease, kidney disease, malabsorption
disease, prolonged bleeding or delayed healing
with surgery or dental extractions, a history of
blood transfusion, prosthetic heart valves, or
indwelling venous access device, indicating that
the patient needed long-term venous access
•Note any history of blood transfusions
•Medications used or recent change in
medication

13. 13Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Family History
•Sickle cell disease or hemophilia
•Death of a family member at a young age for
reasons other than trauma may indicate a
genetic hematologic disorder

14. 14Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Review of Systems
•Changes in skin color, skin dryness, pruritus
(itching), and brittle fingernails or toenails
•Dizziness, vertigo, confusion, and pain
•Headaches
•Changes in vision
•Epistaxis, hemoptysis, dyspnea, heart
palpitations, or chest pain
•Changes in eating habits, including appetite or
episodes of nausea or vomiting

15. 15Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Review of Systems
•Bleeding or pain in the mouth, gums, or tongue
•Normal bowel function and recent changes
•Blood in the urine
•Unusually heavy menses
•Joint pain
•Fatigue or cold intolerance

16. 16Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Functional Assessment
•Occupation and hobbies
•Self-concept
•Activity and exercise
•Sleep and rest
•Interpersonal relationships
•Coping and stress
•Perception of health

17. 17Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Physical Examination
•Measure vital signs, height, and weight
•General survey
•Patient’s responsiveness, mood, expression, and
posture
•Any reddened, swollen, or painful areas
•Skin
•Note general color
•Describe bruising
•Head and neck
•Signs of bleeding in eyes, ears, nose, mouth, throat
•Cracking at the corners of the mouth

18. 18Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Physical Examination
•Thorax
•Lungs
•Assess respiratory rate and effort
•Auscultate breath sounds
•Heart and vascular system
•Assess heart rate, resting blood pressure, and adaptation of
blood pressure to position changes
•Abdomen
•Inspect/palpate the abdomen for distention and tenderness
•If stool specimen available, guaiac test for microscopic blood
•If patient can provide urine sample, it can be tested for blood

19. 19Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Diagnostic Tests and Procedures
•Blood tests
•Red blood cell count
•Hemoglobin (Hb or Hgb)
•Hematocrit (Hct)
•Platelet counts
• Bone marrow biopsy

20. 20Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Common Therapeutic Measures

21. 21Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Therapeutic Action
•Nursing actions for the patient at Risk for Injury
from low red blood cell counts
•See Box 32-3, p. 575

22. 22Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Therapeutic Action
•Nursing actions for the patient at Risk for Injury
from bleeding
•See Box 32-4, p. 579

23. 23Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Blood Product Transfusion
•Typing for transfusions
•Sample sent for typing and crossmatching
•Type A, B, AB, or O; either Rh positive or Rh
negative
•O negative: universal donors because their blood
does not contain any of the A, B, or Rh antigens and
can safely be given to anyone
•AB positive: universal recipients because blood
contains the A, B, and Rh antigens; they can safely
receive any type of blood

24. 24Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Blood Product Transfusion
•Transfusions of packed red blood cells
•Consent signed before any blood transfusion
•Blood sample drawn; sent for type and crossmatch
•Policies for administering blood products vary; be
familiar with and follow your institution’s policies
•Autologous transfusion: using the patient’s own
blood
•Patient donates blood several times before procedure
•Blood is stored by the blood bank and reinfused into the
patient if needed intraoperatively or postoperatively

25. 25Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Blood Product Transfusion
•Platelet transfusion
•When platelet count falls <20,000 cells/mm
3

•Patient must give signed consent
•Sample sent to the blood bank for typing
•Policies for administering blood products vary; be
familiar with and follow your institution’s policies

26. 26Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Blood Product Transfusion
•Fresh frozen plasma transfusions
•Plasma separated from whole blood by
centrifugation and quickly frozen
•Contains all the clotting factors as well as the
plasma proteins
•Cryoprecipitate contains only fibrinogen and factor
VIII; can be further separated out from plasma and
administered alone

27. 27Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Blood Product Transfusion
•Reactions to blood transfusions
•Four main types
•Hemolytic
•Anaphylactic
•Febrile
•Circulatory overload
•Symptoms
•Back or chest pain, fever, chills, decreased blood pressure,
urticaria, wheezing, dyspnea, or coughing during the
transfusion

28. 28Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Blood Product Transfusion
•Reactions to blood transfusions
•Interventions
•Stop transfusion immediately; keep intravenous line open
with normal saline
•Immediately notify physician, nursing supervisor, blood
bank
•Be prepared to administer oxygen, epinephrine, Solu-
Cortef, furosemide (Lasix), antipyretics as prescribed by
physician
•Save the unused portion of the blood bag for the blood
bank
•Be prepared to collect blood and urine samples from the
patient for evaluation

29. 29Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.
Colony-Stimulating Factors
•Naturally occurring hormones that stimulate the
bone marrow to produce more blood cells
•Erythropoietin (Epogen)
•Stimulates bone marrow to produce more red blood cells
•Effects on the hematocrit not apparent for several days;
not an option for patients immediately needing to elevate
their red blood cell counts