Health Alterations – Hematologic System

Blood has three functions
Transportation, regulation and protection
Blood cells
RBCs erythrocytes
WBCs leukocytes
Platelets

Hemostasis – blood clotting process
Think of this as an equilibrium type of state: Without hemostasis, we have interruption of our clotting process.
Pediatrics =
High incidence of iron deficiency,
Lead poisoning
Infections
Elderly
Elderly have a decrease in red marrow and the number of stem cells cause of age.
Problems with clotting, oxygen transport and fighting infections.
Hb levels decrease
Nutritional intake of iron may be decreased.
Hemoglobin levels in the elderly
Their T-cells in lymphocytes are also decreased
The elderly
Also have issues with clotting and oxygen transport.
taking a History
Did they have a transplant?
Do they have sickle cell?
Do they have history of blood disorders
What medications are they on, herbal and prescribed
What surgeries have they had?
Ask about GI and malabsorption difficulties.
What are their risk factors:?
Any cardiogenic history?
What kind of nutrition and elimination history?
Are they vegetarian?.
Activity – rest and fatigue.
Signs and symptoms – are they having any bruising, petechiae, ecchymosis. Color of their mucosa, and skin,
Having any behavioral changes? LOC,
Diagnostic studies (page 655)
CBC – lab look at this, counts and shapes of cells.
Diagnostic studies
Hemoglobin (Hb) Norms = Female 11-16, male 13-17
Hematocrit (Hct) Norms = Female 35–47, male 39-50.
Diagnostic studies
RBCs. Indicies;… MCV = volume; … MCHC saturation.
Diagnostic studies
WBC count and diff = Drs are looking for shift to right or left. Normal count is 4,000 to 11,000. Less than 4,000, patient is considered neutropenic. Greater than 11,000 shows possible infection. (we need to give reverse isolation to someone with greater than 11,000 WBCs
Diagnostic studies
Platlet count We look at for coagulation. Normal count is 150,000 to 400,000. If it is less than 150,000, we are thinking thrombocytopenia. People who are at risk to bleed spontaneously.
Hemoglobin
measures gas carrying capacity also
Lymph nodes,
During examination: if you cannot palpate them, they are normal.
If you can slightly palpate them, investigation is warranted. They should be soft, and mobile.
If they are hard, enlarged and fixed, they are in trouble.
Diagnostics
Erythrocyte sedimentation rate ( ESR) = suggesting inflammation somewhere in the body.
Diagnostics
Blood typing = universal blood is O- negative. Blood typing is always checked before a surgery.
Disgnostics
Prothombin time (PT) A bleeding time. If too much Coumadin is given during surgery, Antidote is Vitamin K to stop it.
Diagnostics
Partial thromboplastin time (PTT) We check this if we are giving a patient Heparin Antidote is Protamine Sulfate
Diagnostics
Iron (TIBC) Iron binding time = provides measurement of all proteins that bind or transport iron between tissues and marrow. If the patient has iron deficiency, the doctor will order this test.
Biopsies – bone marrow and lymph node

Biopsy Important… Very painful. Need a consent for this procedure. It is very invasive. Marrow biopsy is taken from the posterior iliac crest.

Lymph node biopsy = can either be open or closed.
Open means the lymph node is removed and looked at under a microscopelosed means the lymph node is aspirated.

Bone marrow biopsies
When the patient comes back from the procedure of biopsy, the important thing to remember is the patient must be put lying down on the side of the biopsy in order to use the body weight for pressure against the biopsy site for 30 to 60 minutes.
Anemia
a deficiency of red blood cells. (erythrocytes). We look at the Hb quantity and it actually determines the serverity of the disease.
Anemia
Anemia
We look at the . Hct and teh causes are generally blood loss. or impaired production of the red blood cells or the destruction of RBCs
Anemia
We need to determine the cause in order to treat.
Blood loss
Caused by impaired production of RBCs, medications have big side effects with the production. Alcoholism can cause anemia, Lead poisoning can cause anemia, Kidney disease can cause anemia. Dialysis can cause anemia. We give dialysis patients RBCs after or during treatments some times.
Manifestations of anemia
Depends on the body’s response for hypoxia.
severe anemia
hb as low as 6 indicates severe anemia. May include jaundice and pruritis. Icteric conjunctivae and sclera will have a yellow tinge also.
severe anemia
When urine looks icteric (sort ob golden brown, it is from the destruction of red blood cells) which come out in the urine.
Anemia
causes the tongue to become red, smooth and glossy looking. (inflammation indication).
clinical manifestations caused by the body’s response to tissue hypoxia.
mild anemia shows:
hb 10-14 g/dl
may be asymptomatic
palpitations
exertional dyspnea
mild fatigue
clinical manifestations caused by the body’s response to tissue hypoxia.
Moderate – anemia shows:
Hb 6 to 10g/dl
Increased palpitations
dyspnea
fatigue
clinical manifestations caused by the body’s response to tissue hypoxia.
Severe anemia shows:
Hb of 6 and below.
Pallor, jaundice, pruritus
Icteric conjunctiva and sclera
retinal hemorrhage
blurred vision
clinical manifiestations caused by the body’s response to tissue hypoxia.
Glossitis, smooth tongue
tachycardia, tachypnea, dyspnea ( heart rate goes faster to compensate)
Headache, vertigo, irritability, depression, altered throught process.
angina from a big volume loss
Clinical manifestations caused by the body’s response to tissue hypoxia.
Anorexia, hepatospolenomegaly, sore mouth, difficult swallowing.
clinical manifestations caused by the body’s response to tissue hypoxia.
Bone pain, sensitive to cold, wt loss, lethargic.
Iron deficiency anemia – decreased erythrocyte production
Found in 30% of the worlds population.
Occurs in the very young
Poor diets
Women in their reproductive years. 22 g of iron loss during menses. 45 Ml blood loss during menses.
Iron deficiency anemia –
1 mg of iron is lost through feces, sweat, and urine a day.
Replacing iron
if stored iron is not replaced, Hb production is reduced.
Etiology
Inadequate ditary intake
Malabsorption afgter GI surgery ( mostly duodenal surgery).
Hemolysis – destruction of red blood cells.
Pregnancy
Chronic renal failure – and dialysis treatments.
Clinical manifestations specific to iron deficiency
Pallor – most common – face
Glossitis – second most common – tongue inflammation
Chelitis – inflammation of the lips from vomiting
Headaches, paresthesias, and burning sensation of the tongue – need to supplement iron.
Diagnostics
orbHb/Hct
RBC count and morphology – look under microscope
Reticulocytes – immature RBCs.
Serum iron, serum ferritin – iron
Total iron binding capacity – TIBC
Guaiac testing – looking for sources of bleeding – can be done of the GI tube, NG tube, and stools. Microscopic blood in these places.
Endoscopy. Upper GI looking for source of bleeding.
Colonoscopy. – looking for hemoccult blood
Interventions =
Identify the cause – we want to treat the cause
Increase dietary iron – red meats
Iron supplements – ferrous sulfate, taken with vitamin C one hour before a meal. Ascorbic acid helps with absorption.
DO NO TAKE with food. Iron binds with food and does not get absorbed.
Liquid iron – usually pediatrics
Parenteral – IV or IM.
Interventions
Never give iron with calcium – it alters absorption.
Interventions
Iron has severe side effects.
Constipation
Heartburn.
Iron changes the color of stools.
May use stool softeners.
Thalassemia – genetic disorder
genetic disorder of inadequate production of hemoglobin
Hemolysis also occurs – the destruction of RBCs.
Abnormal Hb synthesis.
High incidence amont African American and Mediterranean orignins.
Clinical manifestations of talassemia
Mild jaundice
pale
physical and mental growth is retarded.
Spleno-/hepatomegaly – enlargement of tghe spleen
Thickening of the carnium and maxillary cavity.
clinical manifestations – interventions
Thalassemia minor – no iron is given these patients because their body usually adapts to the lower hemoglobin.
Clinical manifestations – interventions
Thalassemia major – need complete glood transfustions to keep the hemoglobin at at-least 15 .
Clinical manifestations – interventions
Drug used for thalassemia is IV Desferal.
This drug binds to iron given to thalassemia patients.
clinical manifestations – interventions
Sometimes a splenectomy is done in severe cases of thalassemia. We do not give iron supplements to these patients cuz their liver is already enlarged.
a patient’s lab results indicate increased fibrin split products. An appropriate nursing action is to monitor the pat for:
Bleeding.
Reviewing the results of an 83 yo patients blood tests, which findings are of most concern to the nurse?
PTT of 60 seconds
A patient with a bone marrow disorder has an over production of myeloblasts. The nurse would expect the results of a complete blood cell count to include increased:
Basophils, neutrophils, eosinophils.
During the nursing assessment of a patient with anemia, the nurse asks the patient about a history of:

Stomach surgery

rationale: parietal cells of the stomach secrete intrinsic factor, a substance necessary for the absorption of vitamin B 12

Patterned findings identified by the nurse during assessment. Health perception – health management
Family history of hematologic disorders, alcohol and cigarettes
Specific findings identified by the nurse during assessment. Nutritional and metabolic
Deficiencies of iron, vitamin B 12, folic acid, GI bleeding, petechiae, fever, lymph swelling.
Specific findings identified by the nurse during assessment of Elimination patterns
Frankly bloody or dark starry stools, and dark or bloody urine.
Specific findings identified by the nurse during assessment. Activity – exercise
Fatigue and weakness, change in ability to perform ADL’s
Specific findings identified by the nurse during assessment. Sleep-rest.
Fatigue relieved by sleep.
specific findings identified by the nurse during assessment. Cognitive – perceptual
Pain, especially in the joints, bones, paresthesias, numbness, tingling, mental status, hearing and vision.
specific findings identified by the nurse during assessment. Self perception – self concept.
Altered self-perception cuz of lymph node changes.
specific findings identified by the nurse during assessment – Role – relationship
Home or work exposure to radiation or chemicals, military history.
specific findings identified by the nurse during assessment. – Sexuality – reproductive
menstrual history – characteristics of bleeding, intrapartum/postpartum bleeding and impotence.
specific findings identified by the nurse during the assessment – coping – stress tolerance
Lack of support to meet daily needs, methods of coping with stress.
specific findings identified by the nurse during assessment – value- belief.
values conflict with treatment, especially blood products and bone marrow.
Using light pressure with the index and middle fingers, the nurse cannot palpate any of the pt’s superficial lymph nodes. The nurse:
Records this finding as normal.
During physical assessment of a patient with thrombocytopenia, the nurse would expect to find:
Petechiae and purpura. Rationale. Petechiae shows up when platelets are low.
a patient with a hematologic disorder has a smooth, shiny red tongue. The nurse would expect the patients laboratory results to include:
Hb 9.6g/dl
Rationale: the smooth, red, shniny tongue is an indication of iron deficiency anbemia.
A patient is being treated with chemotherapeutic agents. The nurse revises patgient’s care plan based on the CBC results of
Hematocrit of 38%
Rationale count of 150,000 or below is considered thrombopenic and could place the pt at risk for bleeding .
Identify the type of condition indicated by each of the following lab studies results.
Serum iron: 40 mcg/dl (normals 50-150) indicates iron deficiency anemia
Identify the type of condition indicated by the following lab studies.
ESR: 30 mm/hr
rationale – indicates an inflammatory condition.
Identify the type of condition indicated by the following lab studies.
Increased band neutrophils – infection
Identify the type of condition indicated by the following lab studies.
Activated PTT: 60 seconds = Done to monitor heparing therapy.
Identify the type of condition indicated by the following lab studies.
Indirect bilirubin = 2.0 mg/dl to monitor the hemolysis of RBCs.
Identify the type of condition indicated by the following lab studies.
. Bence-Jones protein in urine.
looking fo multiple myeolomas.
If a patient with blood type O Rh+ is given AB Rh- blood, the nurse would expect.
The anti A and anti B antibodies in the donated blood to hemolyze in the patient’s O Rh+ blood.
A patient is undergoing a contrast CT of the spleen. Before this test, it is important for the nurse to ask the patient about:
iodine sensitivity.
rationale: Contrast involves the use of an iodine based dye. Pt could have an allergy/sensitivity it.
When teaching a patient about a bonemarrow examination, the nurse explains that:
The patient will experience a brief, very sharp pain during aspiration of the bonemarrow.
A lymph node biopsy is most often performed to diagnose:
Neoplastic cells in the lymph nodes
rationale: Leukemias may infiltrate lymph nodes
a patient with a hemoglobin level 7.8 g/dl and has cardiac palpitation, a heart rate of 102 and an increased reticulocyte count. At this severity of anemia, the nurse would also expect the patient to manifest.
dyspnea
PRIORITY DECISION
76 yo woman has an Hb of 7.3 and is experiencing ataxia and confusion on admission to the hospital. A priority nursing intervention for the patient is to:
keep top bedside rails up and call bell in close reach.
During the physical assessment of the patient with severe anemia, which of the following findings is of the most concern to the nurse?
Dyspnea at rest
rationale: Dyspnea at rest indicates the patient is making an effort to provide adequate amount of oxygen to the tissues.
A nursing diagnosis that is appropriate for patients with moderate to severe anemia if any etiology is:
activity tolerance related to decreased hemoglobin and imbalance between oxygen supply and demand.
rationale: symptoms of hypoxia are due to decreased Hb.
Autosomal recessive genetic basis.
thalassemia
Hypoxia – induced change in RBCs
Sickle cell
Responds to treatment with erythropoietin
anemia of chronic disease
most common type of anemia
Iron deficiency anemia
megaloblastic cells without neurologic involvement
Folic acid deficiency
Autoimmune related disease
Cofalamin deficiency ( vit B 12)
May occur with removal of the duodenum
cobalamin deficiency
Altered globin synthesis of hemoglobin
talassemia
Lack of intrinsic factor
cobalamin deficiency
Associated with vascular occlusion and tissue infection.
Sickle cell
decreased in all blood cells
aplastic anemia
May be caused by adrenal hypofunction
anemia of chronic disease
associated with chronic blood loss
iron deficiency anemia
genetic condition of the RBC
thalassemia
Oral contraceptives a continuing factor
folic acid deficiency
explain lab findings in anemias : reticulocyte count
increased in chronic blood loss but decreased in cobalamin deficiency
bilirubin levels
are increased in sicled cell anemia but are normal in acute blood loss.
mean cell volume (MCV)
increase in folic acid deficiency but decreased in iron deficiency anemia
When teaching the patient about a new prescription of oral iron supplements the nurse instructs the patient to:
increase fluid and dietary fiber intake.
In teaching the patient with pernicious anemia about the disesae, the nurse explains that it results from a lack of:
intrinsic factor
rationale: Pernicious anemia is a vitamin B 12 deficiency that results when parietal cells in the stomach fail to secrete enough intrinsic factor to absorb ingested cobalamin. Extrinsic factor is cobalamin.
During the assessment of a patient with cobalamin deficiency, the nurse would expect to find that the patient has:
Paresthesia of the hands and feet. rationale: weakness, paresthesias, impaired thought process are charactgeristic of vitamin B 12 deficiency.
The nurse determines that teaching about pernicious anemia has been effective when the patient says
This condition can kill me unless I take injections of vit B 12 the rest of my life.
The strict vegetarian is at highest risk for the development of
cobalamin deficiency anemia
A patient with aplastic anemia has a nursing diagnosis of impaired oral mucous membranes, the etiology of this diagnosis can be related to the effects of a deficiency of:
Platelets
RBCs
WBCsrationale: anemia may cause inflammed painful tongue,

Nursing interventions for the pateint with aplastic anemia are directed toward the prevention of the complications of:

hemorrhage and infection

rationale: hemorrhage from thrombocytopenia and infection from neutropenia are the GREATEST RISKS of the patient with aplastic anemia.

The most reliable way to evaluate the effect and degree of blood loss in the patient with hemorrhage is with
Lab data
A patienbt who has acutge blood loss but normal vital signs at rest and increased heart rate and postural hypotension with exercise has lost approximately ____ of the total blood volume.
True —- 30%
The anemia that follows acute blood loss is _____
True—– IRON
In addition to the general symptoms of anemia, the patient with a hemolytic anemia also manifests _______.
True —– JAUNDICE
A major concern in hemolytic anemia is maintenance of ____________ function.
True ——-LIVER
The anemia of sickle cell disease is caused by
accelerated breakdown of abnormal RBCs.
rationale: the RBC life time is 10-15 days.
A patient with sickle cell anemia asks the nurse why the sickling crisis does not stop when oxygen therapy is started.
The nurse explains that: when RBCs sickle, they occlude small vessels which causes more local hypoxia and more sickling.
a nursing intervention that is indicated for the patgient during a sickle cell crisis is:
administrtion of large doses of continuous opioid analgesics.
During discharge teaching with a patient with newly diagnosed sickle cell disease, the nurse teaches the patient to
seek early medical interventions for upper respiratory infections.
Genetic counseling and family planning is indicated for a couple when one of them has
thalassemia
Immune thrombocytopenia purpura is characterized by increased platelet destruction of the
spleen
The most common acquired thrombocytopenia is _______thrombocytopenic purpura (ITP)
immune
TTP is characterized by ______ platelets, _____ RBCs and _________ agglutination function of platelets
decreased, decreased, increased.
A classic clinical manifestation of thrombocytopenia that the nurse would expect to find on physicl exam of the patient:
Petechiae
Patients with platelet deficiencies usually bleed from _________, whereas those with diminished clotting factors experience _______.
superficial sites, deep or internal bleeding.
Treatment of _________ involves weekly phlebotomy for 2-3 years.
hemachromatos
The nurse suspects hepaqrin induced thrombocytopenia and thrombosis syndrome when the patient receiving heparin requires __________ heparin to masintain therapeutic activated thromboplasltin times.
increased.
In providing care for a patient hospitalized with an acute exacerbation of polycythemia vera, the nurse gives priority to which of the following activities?
promoting leg exercises and ambulation.
rationale: Thrombus and emboli are major complications of polycythemia vera cuz increased hypervolemia and increased hyperviscosity.
A patient has a platelet count of 50,000 and is diagnosed with immune thrombocytopenia purpura. The nurse anticipates that initial treatment will include:
Corticosteroids. they are used in initial treatment of idiopathic thrombocytopenia purpura.
PRIORITY DECISION
A patient is admitted to the hospital for evaluation and gtreatment of thrombocytopenia. Which of the following actions is most important for the nurse to implement?
Monitoring the pateint for headaches, vertigo, and confusion. ( evaluate for CNS alterations)
The nurse caring for a patient with heparin-induced thrombocytopenia identifies risk for bleeding as the PRIORITY nursing diagnoses. Identify the nursing interventions that should be implemented.
1 monitor for signs and symptoms of bleeding (check IV) (wounds), and scretions.
2. Monitor ordered coagulation studies.
3.Avoid injections
4. Use an electric razor.
5. Protect Pt from trauma
6. Administer ordered blood products
7. avoid aspirin and other anti-coagulants
In reviewing the lab results of a patient with hemophilia A (classic) the nurse would expect to find
a prolonged paretial thromboplastin time ( PTT)
rationale: this occurs when there is a deficiency in the clotting factors.
A patient with hemophilia comes to the clinic for treatment. The nurse will prepare to administer
actor concentrates
A patient wit hemophilia is hospitalized with acute knee pain and swelling. The appropriate nursing intervention for the patient includes;
Placing the patient on bed rest and applying ice to the joint.
rationale: During acute bleeding episodes, it is important to totally rest the joint and slow the bleeding with iceing.
A patient has a WBC count of 2300/ul and a neutrophil percentage of 40%.
1. Does thge patient have leukopenia? Yes, WBC is below 4,000.
2. What is the patients neutrophil count? 920 (2300+40%).
3. Does the pt have neutropenia? Yes, neutrophils less than 1,000.
4. What is the pt’s risk for developing a bacterial infection ? Moderate – neutropenia of 500 to 1000.
The most important method for identifying the presence of infection in a neutropenic patient is:
frequent temperature monitoring.
rationale: elvaluate temp is of the most significance in recognizing an infection.
The major method of preventing infection in the patient with neutropenia is use of:
Strict hand washing by all persons in contact with the patient.
myelodysplastic syndrome differs from acute leukemia in that MDS;
has a slower disease progression.
types of leukemias
Chronic lymphocytic leukemia ( CLL)
Acute myelogenous leukemia (AML)
Acute lymphocytic leukemia (ALL)
Lymphadenopathy, splenomegaly and hepatomegaly are common clinical manifestations of leukemia that are due to:
infiltration of the organs by increased numbers of WBCs in the blood.
rationale: All leukemias cause some degree of hepatosplenomegaly because of the filtration of these organs.
Leukemic cells and bonemarrow stem-cells are elminated with chemotherapy and total body radiation and new bonemarrow cells from a donor are infuse
Stem-cell transplants always involve combinations of chemo and total body radiation to eliminate leukemic cells
PRIORITY DECISIOIN
What are the priority nursing diagnoses for the patient with newly diagnosed chrornic lymphocytic leukemia?
Anxiety and risk for infection.
Characteristics of Hodgkins lymphoma (HL) or non-Hodgkins (NHL) or both (B):
a: multiplel histopathologic classifications (NHL)
b: Presence of Reed-Sternberg cells (HL)
c: Treated with radiation and chemotherapy (B)
d: Affects all ages (NHL)
e. Originates in lymph nodes in most patients (HL)
f: Often widely disseminated at time of diagnosis (NHL)
g: alcohol-induced pain at the site of disease (HL)
h: Primary initial clinical manifestation is painless lymph node enlargement (B).
i: Greater than 90% cure rate in stage I disease. (HL)
j: Associated with Epstein-Barr virus (HL)
Staging of lymphomas is important to _______.
determine treatment.
Nursing management of the patient undergoing treatment for Hodgkins disease include measures to prevent _____.
infection.
Multiple myeloma is characterized by proliferation of malignment activated _____that destroy the ______.
B-cell; bones.
Two important nursing interventions in the care of patients with multiple myeloma are increasing fluids to manage _________ and careful handling of the patient to prevent ________ fractures.
hypercalcemia, pathologic.
Following a splenectomy for the treatment of immmune thrombocytopenia purpura (ITP). the nurse would expect the patients laboratory test results to reveal.
increased platelets
rationale: when spleen is gone, platelets increase significantly.
While receiving a unit of packed RBCs, the patient develops chills and a temperature of 102.2. The PRIORITY ACTION for the nurse to take is.
Stop the transfusion and removes the IV catheter.
rationale: chills, fever are symptoms of an acute hemolytic or febrile transfusion reaction.
A patient with thrombocytopenia with active bleeding is to receive two units of platelets. To administer the platelets, the nurse:
agitates the bag periodically during the transfusion.,
Rationale: Because platelets adhere to the plastic bags and the bag should be agitated occasionally.
match characteristics with their related transfusion reactions.
May restart transfusion with antihistamine therapy in mild cases.
allergic reaction.
match characteristics : may be avoided by leukocyte reduction filters.
Acute hemolytic reaction.
Match characteristics: Acute renal failure may occur
Acute hemolytic reaction.
Match characteristics: Destruction of donor RBCs.
Acute hemolytic reaction
Match characteristics: Hypothermia common
massive blood transfusion reaction.
match characteristics: Hypocalcemia and Hyperkalemia
massive blood transfusion reaction.
match characteristics: Epinephrine used for severe reaction.
Allergic reaction.
match characteristics: leukocyte or plasma protein incompatibility.
Febrile reaction.
match characteristics: ABO incompatibility
Acute hemolytic reaction.
match characteristics: May occur in cardiac and renal insufficiency.
Circulatory overload.
A person who lives at a high altitude may normally have an increased RBC coiunt because.
hypoxia caused by decreased atrosphere oxygen stimulates erythropoiesis.
Malignant disorders that arise from granujlocytic cells in the bonemarrow will have the primary effect of causing
decreased phagocytosis of bacteria
An anticoagulant such as warfarin (coumadin) that interferes with prothombin production will alter the clotting mechanism during
activation of thrombin
When reviewing laboratory results of an 83 yo, patient with an infection, the nurse would expect to find
minimal leukocytosis
Significant information obtain from the patients health history that relates to the hematologic system includes
jaundice
While assessing the lymph nodes, the nurse
lightly palpate superficial lymph nodes with the pads of the fingers. Hemochromatosis
If a lymph node is palpated, which of the following is a normal finding?
Firm, mobile nodes
Nursing care for a patient immediately following a bonemarrow biopsy and aspiration includes.
a- administering analgics as necessary.
b- instructing on need to lie still with a sterile pressure dressing intact.
c- monitoring vital signs and assessing the site for excess drainage or bleeding.
Hemochromatosis
an iron overload
polycythemia
production and presence of increased numbers of RBC
Thrombocytopenia
a reduction of platelets below 150,000.
Thrombocytopenic purpura
most common. acquired thrombocytopenia is a syndrome of abnormal destruction of circulating platelets termed idiopathic thrombocytopenia purpura.
Hemophilia and Von Willebrands disease
Hemophilia is an x-linked recessive genetic disorder caused by defective coagulation factor.
Hemophilia A
Factor VIII factor IX
Neutropenia
decreased in the total WBC count
causes: Drug induced, hematologic disorders, autoimmune disorders, infection, miscellaneous.
In a severely anemic patient, the nurse would expect to find
dyspnea and tachycardia
When obtaining assessment data from a patient with a microcytic, hypochromic anemia, the nurse would question the patient about
dietary intake of iron.
Nursing interventions for a patient with severe anemia related to peptic ulcer disease would include
monitoring stools fo guaiac
instructions for high-iron diet
The nursing management of a patient in sickle cell crisis includes
monitoring of CBC
blood transfusions if required for iron chelation
rest as needed and deep vein thrombosis prophylaxis
A complication of the hyperviscotity of polychthemia is
thrombosis
When providing care for a patient with thrombocytopenia the nurse instructs the patient to
dab his or her nose instead of blowing
The nurse would anticipate the patient with von Willebran disease undergoing surgery would be treated with administration of vWF and
factor VIII
DIC is a disorder which
a disease process stimulates coagulation processes with resultant thrombosis as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage.,
Priority nuyrsing actions when caring for a hospitalized patient with a new-onset temperature of 102.2 and severe neutopenia include
administering the prescribed antibiotic STAT
drawing peripheral and central line blood cultures
taking a full set of vital signs and notifying the physician immediately.
Because myelodysplastic syndrome arises from the pluripotent hematopoietic stem cell in the bone marrow, laboratory results of nurse would expect to finde include
a deficiency of all cellular blood components
The most common type of leukemia in older adults is
chronic lymphocytic leukemia
Multiple drugs are often used in combination to treat leukemia and lyumphoma because
the drugs work by different mechanisms to maximize killing of malignant cells.
The nurse is aware that a major difference between Hodgkins lymphoma and non-Hodgkins lymphoma is that
non-Hodgkin’s lymphoma can manifest in multiple organs
A patient with multiple myeuloma becomes confused and lethargic. The nurse would expect that these clinical manifestations may be explained by diagnostic results that indicate
hypercalcemia
when reviewing the patient’s hematologic laboratory values after a splenectomy, the nurse would expect to find
increased platelet count
Complications of transfusions that can be decreased by the use of leukocyte depletion or reduction of RBC transfusion are
transmission of cytomegalovirus and fever.

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