University of Babylon\College of Nursing
Medical-Surgical Nursing \ Adult Nursing
Assist lecturer
Haider H.
BSN, MSN
HEMATOLOGICAL DISORDER
Blood:
* The heart pumps 5-6 liters of blood per minute through the circulatory system.
* Blood is an aqueous mixture consisting of plasma and cells.
Plasma :
* A straw-colored liquid consisting of approximately 90% water and 10% proteins.
* The proteins are albumin, globulins, and fibrinogen.
Red blood cells :
* Also called erythrocites, these are the most numerous blood cells in the body.
* RBCs in conjunction with the respiratory and circulatory systems oxygenate body tissues.
* Hematocrit is the percentage of blood cells in a volume of blood.
White blood cells:
* Also called leukocytes, these fight infection and assist with immunity.
* An increased number of WBCs (leukocytosis) may signify the presence of an infection, inflammation, tissue necrosis, or leukemia.
* A decreased number (leukopenia) may indicated bone marrow failure, a massive infection, dietary deficiency, drug toxicity, or autoimmune disease.
Platelets :
* Platelets (thrombocytes) are nonnucleated, granular, ovoid, or spindle-shaped cell fragments that are active in the clotting mechanism of the body.
Red blood cells disorders
:- anemia -:
* Anemia is a common blood disorder in which the client has a decreased number of RBCs and a low hemoglobin level.
* Causes are a decreased production of RBCs, an increased destruction of RBCs, or loss of blood.
* Types include: Iron-deficiency, hypoplastic (aplastic), pernicious, acquired hemolytic anemia, and sickle-cell.
Iron Deficiency Anemia
* Most common type. Body does not have enough iron to synthesize functional Hgb.
* Symptoms are fatigue, loss of appetite, decreased ability to concentrate, and pallor.
Hypo plastic (A plastic) Anemia
* The bone marrow decreases or stops functioning in a client with aplastic anemia.
* Develops without a known cause and thought to be genetic.
* Secondary aplastic anemia caused by exposure to viruses, chemicals, radiation, or medications.
* Clients are extremely ill.
Pernicious Anemia
* An autoimmune disease in which the parietal cells of the gastric mucosa are destroyed and the gastric mucosa atrophies, so that Vitamin B12 cannot be absorbed.
* Symptoms include extreme weakness, sore tongue, numbness and tingling of extremities, edema of the legs..
Acquired Hemolytic Anemia
* In hemolytic anemias, hemolysis, or destruction of RBCs.
* Causes include autoimmune reaction, radiation, blood transfusion, chemicals, arsenic, or medications.
* Symptoms include mild fatigue and pallor or, more severely jaundice, palpitations, dyspnea, and back and joint pain.
Sickle Cell Anemia
* Also known as Inherited Hemolytic Anemia, this genetic disorder has abnormal hemoglobin S rather than hemoglobin A.
* Condition occurs most frequently in African Americans.
* Symptoms are enlarged heart, fatigue, jaundice, chronic leg ulcers, dyspnea, and arrhythmias.
* Sickle cell crisis, which occurs periodically, involves severe pain and fever.
General clinical manifestation for anemia:
a- Dyspnea, chest pain, muscle pain or cramping
b- Tachycardia, weakness, fatigue, general malaise
c- pallor of skin and mucous membranes (sclera ,oral mucosa).
d- Jaundice (megaloblastic ,hemolytic anemia )
e- Smooth, red tongue (iron deficiency anemia )
f- Beefy ,red, sore tongue (megaloblastic anemia )
g- Ulceration in the corner of the mouth .
Diagnostic studies:
a- General hematological studies, Hb, RBCs, hematocrit.
b- Serum iron level.
c- Serum vitamin B12 and folate level.
d- Bone marrow aspiration and biopsy.
Nursing management
1-Maintain pt, diet (vitamin B12,iron,folate)
2-Avoid activity that causes increase heart rate and cardiac output
3-Monitoring vital signs
4-Administer oxygen and medication or transfusion as prescribed.
5-Psychological support to reduce anxiety .
white blood cells disorder
:- Leukemia -:
* A malignancy of blood-forming tissues in which the bone marrow produces increased numbers of immature white blood cells that are incapable of protecting the body from infections.
* The increased numbers of WBCs crowd out the other cells in the bone marrow, causing a decreased production of RBCs and platelets, resulting in anemia and bleeding.
Classifications of Leukemia
* Acute (rapid onset; quick treatment necessary for good prognosis
1. Acute myeloid leukemia
2. Acute lymphocytic leukemia
* Chronic: prognosis depends on severity of the disease at time of diagnosis).
1. Chronic myelogenous leukemia
2. Chronic lymphocytic leukemia
Etiology :
* Unknown cause
* Genetics
* Virus
* Exposure to the chemicals ,radiations
* Altered immune system
Clinical manifestations :
* Petechiae ,ecchymosis
* Frequently infections
* Stomatitis , gingivitis
* Elevated temperature
* Enlargement lymph node ,spleen, liver
* Joint ,abdomen pain
* Night sweats
* Melena and hematemesis
* Jaundice , tachycardia , hypotension
Diagnostic studies :
o Decrease RBCs, platelet,Hb and increase ESR,WBCs
o Bone marrow biopsy ,large number of immature WBCs
Nursing management :
* Maintain pt. diet
* Administer O2 and I.V fluid
* Assess cardiovascular, respiratory , renal and fluid balance.
* Keep the patient in semi-fowler position
* bead rest Maintain
* Encourage the pt. to express feeling about body image changes or fear from death
* Psychological support to reduce anxiety
* Avoid I.M injection, enema, rectal temp
* Provide chemotherapy