Assessment of Hematologic DisordersPhysical Assessment

Assess the whole body Look for problems with tissue perfusion and oxygenation Some assessment findings are less reliable when seen in an older adult Need – Stethoscope, BP Cuff, Penlight

Skin Pallor or Jaundice in mucous membranes an nail beds Pallor or cyanosis of the gums, conjunctivae, and

palmar creases indicates decreased Hgb levels and poor tissue oxygenation

Gums – Assess for active bleeding in response to light pressure, or brushing teeth, any lesions or draining areas

Petechiae (pinpoint hemorrhagin lesions) & echymoses (bruises) – bruises may cluster together

Bleeding from NG tubes, endotracheal tubes, central lines, peripheral IVs or Foleys

Skin turgor Itching? – can indicate hematologic dz Culture – easier to see in dark skinned

-Pallor and cyanosis – oral mucous membranes, conjunctiva of the eye -Jaundice – roof of the mouth -Petechiae – palms of the hands/soles of the feet -Bruises – seen as darker areas of skin and palpated as slight swellings or irregular skin surfaces, ask about pain when palpating

Head & Neck Check for pallor and ulceration of mouth mucosa Tongue – completely smooth (pernicious anemia),

beefy red (nutritional deficiencies) Assess for sclera jaundice Inspect and palpate all lymph nodes (does it remove or

remain fixed in position?, enlarged? pain?)Respiratory Blood problems reduce oxygen delivery so they lungs

work harder to maintain tissue perfusion Assess rate and depth of respirations – while pt is at

rest, doing mild physical activity (10 word sentence without stopping for a breath, fatigued easily, sob on rest or exertion, need extra pillow at night?

Cardiovascular Blood problems cause the heart to work harder to maintain tissue perfusion

Look for chest heaves, distended neck veins, edema, signs of phlebitis

Listen for murmurs, gallops, irregular rhythms, abnormal blood pressure (systolic is lower than normal = anemia, excess RBCs = higher BP)

In severe anemias the heart tries to compensate for a continuous reduction in oxygen delivery (enlargement of R ventricle, heart dz)

Renal and Urinary Bleeding may present as gross or occult hematuria (blood in urine)

Voided sample: color (may be grossly bloody red or dark brownish gold urine) and proteins (urine dipstick, increases protein content if there is protein and blood in urine)

Musculoskeletal Rib or sternal tenderness (sign of leukemia – cancer of the blood) – occurs when the bone marrow greatly overproduces cells therefore increasing the pressure in the bones

Look at skin over superficial bones (ribs and sternum) by applying firm pressure with the fingertips

Assess Range of Motion for joints Document any swelling, joint pain, or motion limitation

Abdominal Spleen – usually not palpable (lies just beneath the abdominal wall, under the ribs on the left side)

Enlarged spleen – occurs with many hematologic problems and is detected by percussion but palpation is more reliable, can be IDed by its movement during respiration.

Spleen palpation – have the patient lie relaxed, supine position while you stand on the patient’s right and palpate the ULQ (gentle and caution, could be tender and rupture easily)

Liver – palpate liver’s edge in RUQ of abdomen Hepatic enlargement – often occurs with hematologic

problems, may be palpable as much as 4-5 cm below the R costal margin, usually not palpable in the epigastrium

Chronic bleeding GI ulcer or polyp – if under stomach or the small intestine then blood may not be visible in the stool, OR such a small amount is passed each day that the patient is not aware (so OBTAIN A STOOL SPECIMEN for occult testing)

CNS Examine cranial nerves and test neurological function Vitamin B12 def – impairs cerebral, olfactory, spinal

cord and peripheral nerve function (severe chronic def can cause permanent neuro degeneration)

Many neuro problems in pts with leukemia – r/t bleeding, infection, tumor spread

Head trauma in hematologic disorder pt – expand to include frequent neuro checks and mental status exams

Other Fever Chills Night sweats