Garcia Lorca

ASSESSMENT AND MANAGEMENT OF PATIENTS WITH HEMATOLOGICAL DISORDERS
Prepared and presented by Prof. R. Camacho, MSN NURS 2233 Fundamentals of Adult Care II

INTRODUCTION
Hematological disorders or diseases are the result of impaired production or function , or the abnormal destruction of any type of blood cell. The type and severity of the disorder determine the impact it has on the health ofthe individuals.

INTRODUCTION
These disorders can have effects that range from minor disruptions in daily activities to major life-threatening crises.
Clients with hematologic disorders need holistic nursing care, including emotional support and care for problems involving major body systems.

ANEMIA
Caused by a reduction in either the number of RBCs, the amount of hemoglobin (Hgb) orthe hematocrit (Hct)

CAUSES
Dietary problems Genetic disorders Bone marrow disease Excessive bleeding Inadequate RBC production Increased RBC destruction Defective Hgb
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TYPES OF ANEMIA
Sickle Cell Glucose-6-phosphate dehaydrogenase (G6PD) Autoimmune hemolytic anemia Vitamin B12 deficiency anemia Folic acid deficiency anemia

Aplastic anemia

Iron deficiency anemia
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Acute orchronic blood loss Menorrhagia GI bleeding (ulcers and tumors) Increased hemolysis Defective hemoglobin (sickle cell anemia) Impaired glycolysis – (G6PD anemia) Immune disorders or destruction (transfusions or autoimmune diseases) Mechanical trauma to RBCs (problems with heart valves

RISKS FACTORS FOR ANEMIA

Risks Factors for Anemia
Dietary Inadequacy Iron deficiency Vitamin B12 deficiencyFolic acid deficiency Pica (persistent eating of substances not normally considered as food) Bone Marrow suppression Exposure to radiation Aplastic anemia

SICKLE CELL ANEMIA

SICKLE CELL ANEMIA
Genetic disorder most common in African Americans. Results in chronic anemia, pain, disability, organ damage, increased risk for infection and early death. The main problem with this type of anemia isthe formation of abnormal hemoglobin chains.
Normal hemoglobin contains 98% - 99% of HbA 9 (normal hemoglobin)

SICKLE CELL ANEMIA
In this type of anemia about 40% of the total hemoglobin contains abnormal beta chains (HbS). The cells assume a sickle shape, become rigid, clump together and form masses of sickled RBCs that block blood flow, which leads to hypoxia. Sickled cells return to thenormal shape in the presence of oxygen. The client with sickle cell disease will have periods of extensive cellular sickling called crises.

CLINICAL MANIFESTATIONS
Hematological Fragile RBC – clumped under low tissue oxygenation Tissue hypoxia and ischemia – pain and enlarged spleen Respiratory Pulmonary infarcts – chest pain and Pneumonia Genitourinary Renal ischemia – decreased urineconcentration Cardiac Cardiac ischemia – MI, chest pain and HF

SICKLE CELL ANEMIA
Diagnostic tests
Complete blood count (CBC) Hgb, Hct, RBC and WBC Iron levels and total iron-binding capacity Sickle cell tests Hemoglobin electrophoresis Separates the normal hemoglobin from the abnormal one ECG CT Scan PET and MRI 12

NURSING DIAGNOSIS
Acute Pain related to poor tissue oxygenation Chronic Painrelated to join destruction Potential for Sepsis Potential for Multiple Organ Dysfunction and Death.
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NURSING INTERVENTIONS
Administer O2 Administer pain medication – as prescribed

Hydrate the client with normal saline IV and with beverages of choice (without caffeine) orally Remove constrictive clothing
Encourage the client to keep extremities extended to promote venous return
14Nursing Interventions
De not raise the knee gatch of the bed.

Elevate the head of the bed no more than 30degrees.
Keep the room temp. at or above 72°F.

Avoid taking BP with external cuff.
Check circulation in extremities every hour: pulse oximetry or fingers and toes, capillary refill, peripheral pulses and toe temperature

PHARMACOLOGY THERAPY
Analgesics IV - Morphine for about 48...