Anemia
What is Megaloblastic anemia?
What medications are used to treat Metaplastic anemia?
What foods are high in B12?
MEGALOBLASTIC ANEMIAS
• FOLIC ACID DEFICIENCY
• DIETARY DEF OR ETOH ABUSE
• VITAMIN B12 DEFICIENCY
Low RBC and high MVC with nutritional deficit Characterized by the production of abnormally large erythrocytes called megaloblasts. Because these cells are abnormal, many are sequestered (trapped) while still in the bone marrow, and their rate of release is decreased.
Megaloblastic anemia is a form of macrocytic anemia. Macrocytic anemia is a blood disorder that causes your bone marrow to make abnormally large red blood cells. It's also a type of vitamin deficiency anemia.
Medications: Folate and B12
Foods high in B12:
Animal Liver and Kidneys
Clams
Sardines
Beef
Fortified Cereals
Tuna
Fortified nutritional yeast
Trout
Salmon
Fortified non-dairy milk
Milk and dairy
eggs
What is thrombocytopenia?
Can result from decreased platelet production, increased platelet destruction, or increased consumption of platelets. Platelets are blood cells whose major function is to help your blood clot and keep you from bleeding or hemorrhaging.
What is chronic lymphocytic leukemia (CLL)?
What are the signs and symptoms of CLL? Name 2
Cancer of the blood and bone marrow. There is an overproduction of the WBC resulting in crowding out the the production of normal cells. Resulting in low RBC and platelets.
Signs/ Symptoms
Frequent infections
Fatigue,
unsteady gait,
pallor
weight loss and Anorexia
Bone pain
Bruising,
petechiae
What is the common cause of acute hemolytic reaction?
labeling & pt identification
IMPORTANT to follow policy labeling at bedside ensure correctness
What are 2 nursing interventions for THROMBOCYTOPENIC Precautions?
• Avoid non-steroidal anti-inflammatory drugs, such as Indocin, Advil and Motrin, unless prescribed by the physician who is aware of your platelet count.
• If you are on any blood thinning medication, such as Coumadin or Heparin, notify your physician.
• Do not take any medications by injection into your muscle (IM injection). • Do not take any medication or temperature rectally.
• Do not use rectal dilators. Avoid straining, bending at the waist or lifting heavy objects.
• Avoid activities that can cause injury to your skin (e.g., peeling crawfish, opening oysters and crabs, yard work, etc.).
Use a soft bristled toothbrush. Avoid flossing.
• Do not blow your nose forcefully. • Avoid constipation and straining to have a bowel movement.
Drink plenty of fluids.
Increase fiber in your diet.
Use stool softeners.
Do not use enemas or suppositories.
If unable to relieve constipation with the above suggestions, notify your physician.
• Avoid all beverages containing alcohol.
• Use an electric razor (no razor blades).
• Avoid any activity that can put you at risk of injury (contact sports, etc.).
• Avoid all aspirin or medication containing aspirin.
What happens in the kidneys in anemia?
What are 2 manifestations of Anemia?
If the kidney detects low levels of oxygen, as occurs when fewer red cells are available to bind oxygen (i.e., anemia), erythropoietin levels increase
Manifestations of Anemia
•Tachycardia
•Shortness of Breath
•Fatigue, weakness, malaise
•Pallor or jaundice
•Cardiac, GI, neurologic and respiratory symptoms
•Stomatitis-inflammation of mouth and
•Glossitis- inflammation of the Tongue
•Nail changes-Pallor
•Angular cheilitis
•Pica
What is Disseminated intravascular coagulation?
What is happening?
•In disseminated intravascular coagulation, abnormal clumps of thickened blood (clots) form inside blood vessels. These abnormal clots use up the blood's clotting factors, which can lead to massive bleeding in other places. Causes include inflammation, infection, and cancer.
•Symptoms include blood clots and bleeding, possibly from many sites in the body.
•The goal is to treat the underlying cause and provide supportive care through intravenous fluids and blood transfusions.
•Triggers may include sepsis, trauma, shock, cancer, abruptio placentae, toxins, and allergic reactions
•Not a disease but a sign of an underlying disorder
What are the differences between acute leukemia and chronic leukemia?
What is the Diagnostic procedure for diagnosis?
Acute: Immature nonfunctioning WBS, Abrupt onset, Common in children treatment: Aggressive
Chronic: Mature cells with reduced function, slow onset, older adults treatment: observe
Both have High WBS, Low H/H and Low platelets
Diagnostic procedure: Bone Marrow Biopsy taken from the posterior iliac crest
What is Febrile, Nonhemolytic blood transfusion s/sx?
•Most common, reaction to donor antibodies
•Chills/fever (mild to moderate) ~ 2 hours after
What are the nursing interventions for HEMOPHILIA?
Provide emotional support and reassurance when indicated. Encourage the patient to verbalize feelings and concerns. Assist with the use of positive coping strategies.
Encourage the patient's participation in care and decision-making to promote feelings of control over the situation.
Emphasize positive aspects of the patient's status.
Institute safety precautions to reduce the risk of injury.
Provide opportunities for rest; cluster activities to promote rest; institute energy-conservation measures.
Inspect skin and mucous membranes closely for evidence of bruising and hematoma formation.
Assist with measures to promote routine activities within the limits of the disease.
Apply antiembolism or sequential compression stockings to prevent VTE if the patient is hospitalized.
Obtain specimens for laboratory testing, as ordered.
Assess quality-of-life issues.
For immunizations, use a small-gauge needle and apply pressure and ice for 5 minutes. Avoid intramuscular injections.
Institute rest and splinting with joint bleeding followed by active range of motion and strengthening exercises once bleeding is resolved.
Screen for and assess the patient's pain using facility-defined criteria that are consistent with the patient's age, condition, and ability to understand.
Treat the patient's pain, as needed and ordered, using nonpharmacologic, pharmacologic, or a combination of approaches.
Reassess and respond to the patient's pain by evaluating the response to treatment and progress toward pain management goals
bleeding precautions: INJECTIONS, ORAL CARE, BLEEDING.
What is pernicious anemia?
What medication is required?
•Can not absorb B12- B12 Deficiency Anemia
•Lack of intrinsic factor secreted in the gastric mucosa
•Megaloblastic Anemia (Anemia associated with Vitamin B 12 or Folic Acid Deficiency)
•s/Sx
•Glossitis-inflamed red smooth tongue
•Extreme weakness
•Jaundice-pale yellow skin
Lifelong pernicious anemia requires lifelong vitamin B12
What is neutropenia?
What are the nursing interventions- name 2
Bone marrow doesn't make enough neutrophils.
Place a notice on your door. Before entering your room, everyone needs to follow certain steps to protect you. This notice explains what they should do.
Wash their hands. The staff will wash their hands with soap and water before entering and leaving your room. They’ll also wear gloves.
Leave reusable equipment in your room. Thermometers and other reusable devices will be kept in your room. You’ll be the only person who uses them.
Give you specific foods. When you’re neutropenic, you can’t eat foods that might have bacteria, like unwashed fruit or rare-cooked meat. The staff might put you on a neutropenic diet.
Avoid rectal medical procedures. The rectal area is extremely sensitive, so the staff won’t give you suppositories or enemas.
What are the s/Sx of Acute Myeloid Leukemia versus Chronic Myeloid Leukemia? State 2
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 67 years
Prognosis is highly variable
Manifestations: fever and infection, weakness and fatigue, bleeding tendencies, pain from enlarged liver or spleen, hyperplasia of gums, bone pain
Chronic Myeloid Leukemia
Uncommon in people younger than age 20 years, with increased incidence with age; mean age: 64 years
Manifestations: initially may be asymptomatic, malaise, anorexia, weight loss, confusion or shortness of breath caused by leukostasis, enlarged tender spleen, or enlarged liver
What is an Acute Hemolytic blood transfusion reaction?
•Most dangerous, incompatibility reaction
•Most commonly due to clerical, labeling error
•Fever, chills, flushing, SOB, itching, hives, restlessness, Torso/back/chest pain, flank pain, hypotension
•Discontinue immediately, CV support
Name 2 interventions for Sickle Cell Disease.
Encourage the patient to talk about fears and concerns.
If a male patient develops sudden, painful priapism, reassure him that such episodes are common and have no permanent harmful effects; anticipate administering a phosphodiesterase-5 inhibitor, as ordered.
Ensure that the patient receives adequate amounts of folic acid-rich foods, such as green, leafy vegetables.
Encourage adequate fluid intake; anticipate the need for IV fluid replacement therapy. If IV fluid replacement is necessary, ensure a patent IV access and perform IV site care according to facility guidelines.
Apply warm compresses, warmed thermal blankets, and warming pads or mattresses to painful areas unless the patient has neuropathy.
Carefully position and support painful areas.
Maintain bed rest during acute episodes; cluster care activities to allow for uninterrupted periods of rest; employ energy conservation measures to minimize fatigue.
Apply antiembolism stockings or sequential compression stockings to prevent VTE.
What is Iron Deficiency Anemia?
What are the causes of Iron Deficiency Anemia?
Iron deficiency anemia is a common type of anemia. Anemia is a condition in which blood doesn't have enough healthy red blood cells to carry oxygen throughout the body. The condition occurs when the body either doesn't get enough iron or loses too much iron.
There might be no symptoms at first. Symptoms might include extreme tiredness, weakness, headache, dizziness, shortness of breath, brittle nails and poor appetite.
Treatment includes taking iron supplements and treating underlying causes.
IRON: Iron Supplementation: advised to take iron supplements on an empty stomach for better absorption. Iron pills may cause stomach problems, such as heartburn, nausea, diarrhea, constipation, and cramps. Be sure to drink plenty of fluids and eat fruits, vegetables, and fiber daily. Iron pills can change the color of your stool to a greenish or grayish-black. This is normal.
What are the 4 leading causes of iron deficiency anemia?
What is the most common cause of iron-deficiency anemia? Losing blood is the most common reason people develop iron-deficiency anemia. Some common reasons include: Bleeding in your gastrointestinal (GI) tract, which may cause bright red blood, or dark, tarry or sticky appearing stool
Primary Nursing Interevevntrion:
Occult
Occult can determine blood in stool emesis. Blood loss can result in low H/H
What is HEMOPHILIA?
a medical condition in which the ability of the blood to clot is severely reduced, causing the sufferer to bleed severely from even a slight injury. The condition is typically caused by a hereditary lack of a coagulation factor, most often factor VIII
What is a stem cell transplant?
A procedure in which a patient receives healthy stem cells (blood-forming cells) to replace their own stem cells that have been destroyed by treatment with radiation or high doses of chemotherapy.
Stem cell transplantation (SCT), sometimes referred to as bone marrow transplant, is a procedure in which a patient receives healthy stem cells to replace damaged stem cells.
What is the most common reaction in blood transfusions?
circulatory overload
What is a symptom of circulatory overload?
What are the key assessments to evaluate in lymphoma?
Enlarged lymph node. Enlarged axillary lymph nodes, fevers no chills, weight loss, night sweats, and infections.
What is Sickle Cell Disease?
Name 2 collaborative problems or complications with Sickle cell disease.
Congenital hemolytic disease that results from a defective hemoglobin (Hb) molecule (HbS) that causes red blood cells (RBCs) to become sickle or crescent shaped
Impairment of circulation (vaso-occlusive crisis), resulting in chronic ill health (pain, fatigue, dyspnea on exertion, swollen joints), periodic crises, long-term complications, and premature death
No cure existsCollaborative Problems and Potential Complications of Sickle Cell Disease
•Hypoxia, ischemia, infection
•Dehydration
•CVA
•Anemia
•Acute and chronic kidney disease
•Heart failure
•Impotence
•Poor compliance
•Substance abuse
What are Bleeding Precautions and state 2?
Use a soft toothbrush or toothettes with gentle brushing.
Do not blow your nose too hard or scratch the inside of your nose.
Shave with an electric razor—do not use a razor blade.
Do not walk barefoot. Wear slip resistant footwear.
Wear Medical Alert r/t medications or disease
Be careful not to fall or bruise yourself by bumping into objects.
Be careful when using sharp objects such as scissors.
Do not push too hard while having bowel movements. We will give you stool softeners and laxatives if ordered by your doctor
Do not use enemas, suppositories or tampons.
Apply firm pressure to any area of bleeding for at least 5minutes.
Talk to your nurse, doctor or physical therapist about what exercises are safe for you.
Let your doctor or nurse know right away if you have:
Bleeding from any body part, that will not stop with 5 minutes of pressure
Headache
Abdominal pain
Dark bowel movements
Your menstrual period
Petecchiae (small, red spots on skin)
Bruising
Blood in your stools or urine
In Lymphoma what is the diagnostic tool for Hodgkin's verse Non-Hodgkin's?
What is lymphoma?
Reed-Sternberg
cancer within the lymph system the body's fighting network: Lymph, spleen, and the thymus gland.
What is a CBC and what are the general ranges for a CBC? What is the function?
WBC 5-10,00 fight infection
Hemoglobin 12-18 carries 02
Hematocrit 36-54 blood volume
Platelets 140,00-400,000 clotting
RBC 4-6 million
What is the Primary Nursing intervention when assessing for iron deficiency anemia?
Primary Nursing Interevevntrion:
Occult
Occult can determine blood in stool emesis. Blood loss can result in low H/H