Chapter 33: Management of patients with nonmalignant hematologic disorders

A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify?

Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels

A client with sickle cell crisis is admitted to the hospital in severe pain. While caring for the client during the crisis, which is the priority nursing intervention?

Administering and evaluating the effectiveness of opioid analgesics

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process due to thrombocytopenia in a client with leukemia? a.) Applying prolonged pressure to needle sites or other sources of external bleeding b.) Monitoring temperature at least once per shift c.) Eliminating direct contact with others who are infectious d.) Implementing neutropenic precautions

Applying prolonged pressure to needle sites or other sources of external bleeding

The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency?

B12; The medication metformin (Glucophage) increases the client's risk for developing B12 deficiency because the medication inhibits the absorption of B12.

When teaching a client with iron deficiency anemia about appropriate food choices, the nurse encourages the client to increase the dietary intake of which foods?

Beans, dried fruits, and leafy, green vegetables (Food sources high in iron include organ meats (e.g., beef or calf liver, chicken liver), other meats, beans (e.g., black, pinto, and garbanzo), leafy and green vegetables, raisins, and molasses. Taking iron-rich foods with a source of vitamin C (e.g., orange juice) enhances the absorption of iron.)

The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron?

C

A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the physician to order?

CBC

what is pica

Eating non-food items including ice, starch, or dirt, common in patients with iron deficiency. Iron deficiency patients may also have a smooth red tongue

causes of inherited hemolytic anemia- enzyme deficiencies

Glucose-6-phosphate dehydrogenase deficiency

what symptoms may be present in a patient with megaloblastic anemia?

Jaundice; angular cheilosis (ulcerated corners of the mouth); and brittle, ridged, concave nails, The tongue may be beefy red and sore

During a routine assessment of a patient diagnosed with anemia, the nurse observes the patient's beefy red tongue. The nurse is aware that this is a sign of what kind of anemia?

Megaloblastic

The nurse is instructing the client with sickle cell disease about the use of an inhaled vasodilator that may reduce sickling. What medication is the nurse instructing the client about?

Nitric oxide

The nurse is caring for an older adult client who has a hemoglobin of 9.6 g/dL and a hematocrit of 34%. To determine where the blood loss is coming from, what intervention can the nurse provide?

Observe stools for blood.

causes of abnormal hemoglobin- inherited hemolytic anemia

Sickle cell disease, Thalassemia

who is more likely to have symptoms of anemia? someone with a sedentary lifestyle, or someone who has significant demands on their lives?

Someone who has significant demands on their lives

clinical manifestations of neutropenia

There are no definite symptoms of neutropenia until the patient develops an infection. A routine CBC with differential, as obtained after chemotherapy treatment, can reveal neutropenia before the onset of infection.

In many situations, aplastic anemia occurs when

a medication or chemical is ingested in toxic amounts. However, in a few people, it develops after a medication has been taken at the recommended dosage

what is the main cause of death in young adults with sickle cell anemia?

acute chest syndrome

what is the most common hematologic disorder?

anemia

A client with sickle cell anemia has a a.) normal hematocrit. b.) low hematocrit. c.) normal blood smear. d.) high hematocrit.

b.) low hematocrit.

While assessing a client, the nurse will recognize what as the most obvious sign of anemia? a.) Tachycardia b.)Pallor c.) Flow murmurs d.) Jaundice

b.)Pallor

Antacids or dairy products should not be taken with iron, why?

because they greatly diminish its absorption

The most common cause of iron deficiency anemia in men and postmenopausal women is

bleeding from ulcers, gastritis, inflammatory bowel disease, or GI tumors. The most common causes of iron deficiency anemia in premenopausal women are menorrhagia (i.e., excessive menstrual bleeding) and pregnancy with inadequate iron supplementation.

In hypoproliferative anemias, the ______ ________ does not produce adequate numbers of erythrocytes. Decreased erythrocyte production is reflected by a low or inappropriately normal ________ _____.

bone marrow; reticulocyte count

A client admitted to the hospital with abdominal pain, anemia, and bloody stools reports feeling weak and dizzy. The client has rectal pressure and needs to urinate and move their bowels. The nurse should help them: a.) to the bedside commode. b.) to a standing position so he can urinate. c.) onto the bedpan. d.) to the bathroom.

c.) onto the bedpan.

The major goals for the patient with anemia may include

decreased fatigue, attainment or maintenance of adequate nutrition, maintenance of adequate tissue perfusion, compliance with prescribed therapy, and absence of complications

The impact of even mild anemia on function in older adults is significant and may include...

decreased physical performance, decreased mobility, increased frailty, increased rates of depression, increased risk for falling, and delirium

What are some complications of severe anemia?

heart failure, paresthesias, and delirium

where is folate found?

in green vegetables and liver. Thus, folate deficiency occurs in people who rarely eat uncooked vegetables. Alcohol increases folic acid requirements, and, at the same time, patients with alcoholism usually have a diet that is deficient in the vitamin.

what types of medications can decrease iron absorption?

proton pump inhibitors, H2 blockers

complications of sickle cell anemia

pulmonary hypertension, stroke, acute chest syndrome, reproductive problems.

sequestration crisis

results when other organs pool the sickled cells. Although the spleen is the most common organ responsible for sequestration in children, most children with SCD have had a splenic infarction by 10 years of age, and the spleen is then no longer functional . In adults, the common organs involved in sequestration are the liver and, more seriously, the lungs.

strict vegetarians are at risk for which type of anemia?

risk for megaloblastic anemias if they do not supplement their diet with vitamin B12.

Aside from the severity of the anemia itself, several factors influence the development of anemia-associated symptoms:

the rapidity with which the anemia has developed, the duration of the anemia (i.e., its chronicity), the metabolic requirements of the patient, other concurrent disorders or disabilities (e.g., cardiac or pulmonary disease), and complications or concomitant features of the condition that produced the anemia.

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

"I will receive parenteral vitamin B12 therapy for the rest of my life."

causes of inherited hemolytic anemia- red blood cell membrane abnormality

- Acanthocytosis - Hereditary elliptocytosis - Hereditary spherocytosis - Stomatocytosis

decreased production of neutrophils causes

- Aplastic anemia, due to medications or toxins - Chemotherapy - Metastatic cancer, lymphoma, leukemia - Myelodysplastic syndromes - Radiation therapy

causes of acquired hemolytic anemia- antibody related

- Autoimmune hemolytic anemia - Iso-antibody/transfusion reaction - Cold agglutinin disease

Collaborative Problems/Potential Complications of anemia may include?

- Heart failure - Angina - Paresthesias - Confusion - Injury related to falls - Depressed mood

It is usually possible to determine whether the presence of anemia in a given patient is caused by destruction or by inadequate production of erythrocytes on the basis of what factors

- The bone marrow's ability to respond to decreased erythrocytes (as evidenced by an increased reticulocyte count in the circulating blood) - The degree to which young erythrocytes proliferate in the bone marrow and the manner in which they mature (as observed on bone marrow aspirate) - The presence or absence of end products of erythrocyte destruction within the circulation (e.g., increased bilirubin level, decreased haptoglobin level)

There are three types of sickle cell crisis in the adult population

- acute vaso-occlusive crisis - aplastic crisis - sequestration crisis

increased destruction of neutrophils causes

- Bacterial infections - Hypersplenism - Immunologic disorders (e.g., systemic lupus erythematosus) - Medication induced - Viral disease (e.g., infectious hepatitis, mononucleosis)

causes of acquired hemolytic anemia- Not antibody related

- Disseminated intravascular coagulationa - Hypersplenism - Infection <Bacterial <Parasitic - Liver disease - Mechanical heart valve - Microangiopathic hemolytic anemia - Paroxysmal nocturnal hemoglobinuria - Toxins - Trauma - Uremia

what are three different types of anemia?

- Hypo proliferative (resulting from defective RBC production) - Bleeding (resulting from RBC loss) - Hemolytic (resulting from RBC destruction

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?

Erythrocytes that are microcytic and hypochromic

secondary polycythemia

caused by excessive production of erythropoietin. This may occur in response to a reduced amount of oxygen, which acts as a hypoxic stimulus, as in heavy cigarette smoking, obstructive sleep apnea (OSA), chronic obstructive pulmonary disease (COPD), or cyanotic heart disease, or with conditions such as living at a high altitude or exposure to low levels of carbon monoxide. It can also result from certain hemoglobinopathies (e.g., hemoglobin Chesapeake),

Which patient does the nurse recognize as being most likely to be affected by sickle cell disease? a.) A 26-year-old Eastern European Jewish woman b.) An 18-year-old Chinese woman c.) A 28-year-old Israeli man d.) A 14-year-old African American boy

d.) A 14-year-old African American boy

The most common symptom and complication of anemia is ______

fatigue

Older adults often cannot respond to anemia as well as younger individuals, in that heart rate and cardiac output do not increase as quickly; thus, what symptoms may be seen more readily in older adults who are anemic?

fatigue, dyspnea, and confusion

Aplastic anemia

rare disease caused by a decrease in or damage to marrow stem cells, damage to the microenvironment within the marrow, and replacement of the marrow with fat.

Medical management of acute chest syndrome

red cell transfusion, antimicrobial therapy, bronchodilators, inhaled nitric oxide therapy, and when respiratory failure ensues, mechanical ventilation. Risk of acute chest syndrome can be reduced by the use of incentive spirometry during episodes of vaso-occlusive crisis and red cell transfusion preoperatively

Patients with pernicious anemia develop a smooth, sore, ___ ______ and mild diarrhea. They are extremely pale, particularly in the ________ ____________. They may become _____________; more often, they have paresthesias in the extremities

red tongue; mucous membranes; confused

What are factors necessary for erythrocyte formation?

iron, vitamin B12, folic acid, erythropoietin

acute chest syndrome

manifested by fever, respiratory distress (tachypnea, cough, wheezing), and new infiltrates seen on the chest x-ray

ineffective granulocytopoiesis cause

megaloblastic anemia

aplastic crisis

results from infection with the human parvovirus. The hemoglobin level falls rapidly and the marrow cannot compensate, as evidenced by an absence of reticulocytes

causes of neutropenia

- decreased production of neutrophils - ineffective granulocytopoiesis - increased destruction of neutrophils

acute vaso-occlusive crisis

results from entrapment of erythrocytes and leukocytes in the microcirculation, causing tissue hypoxia, inflammation, and necrosis due to inadequate blood flow to a specific region of tissue or organ. When perfusion is resumed, substances are released (e.g., free radicals, free plasma hemoglobin) that cause oxidative damage to the vessel. In turn, the endothelium of the vessel becomes dysfunctional and vasculopathy develops