Chapter 46: Care of the Patient With a Blood or Lymphatic Disorder

When dose von Willebrand disease generally occur and how is it treated?

Genetic mutations which cause impairment in the synthesis or function of von Willebrand factor. -increase circulating vWF: DDAVP, plasma-derived vWF concentrate -inhibit fibronlysis (ex. aminocaproic acid) -OCPs for menorrhagia (estrogen increased vWF and factor 8, reduced blood flow to the endometrium) -topical therapy

What it means when patient with aplastic anemia is said to be pancytopenic?

It means that all the three major blood elements (red cells, white cells, and platelets) from the bone marrow are reduced or absent.

Describe the nursing interventions when treating a patient with agranulocytosis.

Monitor the patient conscientiously to detect the earliest signs of infection so that therapy may be initiated promptly. Restrict visitors and prevent personnel with colds from caring for the patient. Meticulous hand hygiene by medical and nursing personnel and strict asepsis are mandatory.

Define thrombocytopenia and describe its clinical manifestations.

Mucosal, cutaneous bleeding Menorrhagia Metorrhagia Persistent bleeding from superficial cuts Petechiae Purpura Ecchymosis

Explain the treatment for sickle cell anemia.

No specific treatment--alleviate symptoms Oxygen, Rest, Fluids, Analgesics, Bone marrow transplant

How is pernicious anemia medically managed?

Oral vitamin B12 replacement is ineffective if there is an absence of intrinsic factor in the stomach or a malabsorption problem in the ileum. Cyanocobalamin (B12) injections, folic acid supplement, and iron replacement are ordered. If the anemia is severe, the patient may be transfused with packed RBCs. The standard treatment includes initiating vitamin B12 replacement therapy; without it, these individuals will die within 1 to 3 years. Treatment is 1000 units of vitamin B12 administered intramuscularly daily for 2 weeks, and then weekly until the Hct is normal, and finally monthly for life.

What is the Schilling test and what does it measure?

The Schilling test is used to diagnose pernicious anemia (anemia caused by impaired intestinal absorption of vitamin B12, which is needed to make RBCs). In the Schilling test, radioactive vitamin B12 is administered and measured before and after parenteral injection of intrinsic factor (a glycoprotein normally secreted by the stomach that is necessary for intestinal absorption of cyanocobalamin [vitamin B12]), by examination of the urinary excretion of vitamin B12. Normal findings are excretion of 8% to 40% of radioactive vitamin B12 within 24 hours.

What are the three actions that take place during hemostasis?

The hemostasis response is fast, localized, and carefully controlled. It involves many clotting factors normally present in plasma as well as some substances that are released by platelets and injured tissue cells. During hemostasis, 3 steps occur in rapid sequence: (1) vascular spasm, (2) platelet plug formation and (3) coagulation, or blood clotting. Blood loss at the site is permanently prevented when fibrous tissue grows into the clot and seals the hole in the blood vessel.

Describe the three critical functions of blood.

blood transports oxygen to cells, removes waste products from sells, and delivers nutrients throughout the body.

Describe the difference between lymphangitis and lymphedema.

lymphangitis inflammation of lymphatic vessel or vessels. lymphedema is a primary or secondary disorder characterized by accumulation of lymph in soft tissue and edema.