NUR202 ModuleBChapter43

8/14/2019 NUR202 ModuleBChapter43

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Interventions forHematologic Problems

NUR 202 Module B

Chapter 43


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Leukemia

Type of cancer with uncontrolled production of

immature white blood cells in the bone marrow

Acute or chronic

Classified by cell type Risk factors: ionizing radiation, exposure to

certain chemicals and drugs, bone marrow

hypoplasia, genetic factors, immunologic

factors, environmental factors


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Leukemia

Clinical Manifestations Cardiovascular: heart rate is increased; blood

pressure is decreased.

Respiratory rate increases. Skin grows pale and cool to the touch.

Intestinal manifestations include weight loss,

nausea, and anorexia.

Central nervous system disturbances include

headache.


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Leukemia

Laboratory Assessment Decreased hemoglobin and hematocrit levels

Low platelet count

Abnormal white blood cell count, may be low,

normal or elevated, but is usually quite high

Poorer prognosis: client with high white blood

cell count at diagnosis

(Continued)


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Leukemia

Definitive test: examination of cells

obtained from bone marrow aspiration

and biopsy


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Leukemia

Risk for Infections Infection is a major cause of death in the client

with leukemia, and sepsis is a common

complication. Autocontamination

Cross-contamination

Changes in immune function


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Leukemia

Drug Therapy for Acute Leukemia Induction therapy

Consolidation therapy

Maintenance therapy Indicated for ALL and APL

New drug therapies Gleevec for CML that is Philadelphia

Chromosome positive Drug therapy for infection


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Leukemia

Infection Protection Frequent handwashing

Private room

HEPA filtration or laminar airflow system

Mask for visitor with upper respiratory

infection


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Leukemia

Infection Protection (Continued) Minimal bacteria diet without uncooked

foods

Monitoring of daily laboratory results Assessment of vital signs

Skin care, respiratory care


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Leukemia

Bone Marrow Transplantation Standard treatment for leukemia

Purges present marrow of the leukemic cells

After conditioning, new, healthy marrow given

to the client

Sources of stem cells

Conditioning regimen Transplantation


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Leukemia

Sources of stem cells Allogeneic

Matched relative (sibling)

Unrelated HLA matched donor Autologous

Self

Syngeneic Identical twin


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Leukemia

Stem cell harvest Umbilical cord blood

Peripheral stem cell pheresis

Bone marrow harvest


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Leukemia

Risk for Injury Nadir: period of greatest bone marrow

suppression

Bleeding precautions

Fatigue Interventions:

Diet therapy

Blood replacement therapy

Drug therapy

Energy conservation


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Hodgkins Lymphoma

Cancer that starts in a single lymph node

or a single chain of nodes

Marker: Reed-Sternberg cell

Large, painless lymph node usually in the

neck; fever, malaise, night sweats

One of the most curable cancers

Treatment: external radiation alone or with

combination chemotherapy


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Non-Hodgkins Lymphoma

All lymphoid cancers that do not have the

Reed-Sternberg cell

More than 12 types of non-Hodgkins

lymphoma

Low-grade lymphomas less responsive to

treatment; cures are rare

Treatment: radiation therapy and multi-agent chemotherapy, or single-agent

therapy with fludarabine


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Multiple Myeloma

White blood cell cancer that involves a

more mature lymphocyte than either

leukemia or lymphoma

Uncommon cancer Manifestations: fatigue, easy bruising,

bone pain, fractures, hypertension,

increased infection, hypercalcemia, andfluid imbalance

Treatment: chemotherapy


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AutoimmuneThrombocytopenicPurpura(Continued) Interventions include:

Therapy to prevent bleeding

Drug therapy to suppress immune function

Blood replacement therapy

Splenectomy


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Thrombotic Thrombocytopenic

Purpura

Rare disorder; platelets clump together

abnormally in the capillaries and too few

platelets remain in circulation

Inappropriate clotting, yet blood fails toclot properly when trauma occurs

Plasma pheresis, infusion of FFP

Aspirin, alprostadil, plicamycin Immunosuppressive therapy


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Transfusion Therapy

Pretransfusion responsibilities to prevent

adverse transfusion reactions: Verify prescription.

Test donors and recipients blood forcompatibility.

Examine blood bag for identification.

Check expiration date.

Inspect blood for discoloration, gas bubbles,

or cloudiness.


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Types of Transfusions

Red blood cell

Platelet transfusions

Plasma transfusions: fresh frozen plasma

Cryoprecipitate

Granulocyte (white cell) transfusions


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Blood Compatibility Guide


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TransfusionResponsibilities Provide client education.

Assess vital signs.

Begin transfusion slowly and stay with

client first 15 to 30 minutes.

Ask client to report unusual sensations

such as chills, shortness of breath, hives,

or itching. Administer blood product per protocol.


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Affect of IV Fluids on RBCs


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Transfusion Reactions

Can occur when whole blood, PRBCs,

platelets, or FFP are given

5 types of reactions can occur: Hemolytic

Anaphylactic

Febrile

Circulatory overload Bacterial


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Transfusion Associated Graft VersusHost Disease

Rare occurrence

Life threatening 90% mortality rate

Prevention Use of irradiated blood

products

Manifestations Anorexia

Nausea

Thrombocytopenia

Vomiting

Chronic hepatitis

Weight loss

Recurrent infection


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Autologous BloodTransfusion Collection and infusion of clients own

blood

Eliminates compatibility problems;

reduces risk for transmission ofbloodborne disease

Preoperative autologous blood donation

(Continued)


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Autologous BloodTransfusion (Continued) Acute normovolemic hemodilution

Intraoperative autologous transfusion

Postoperative blood salvage


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Colony Stimulating Factors

Natural hormones that stimulate the bone

marrow to make more blood cells. Exogenous sources

Procrit Epogen

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NUR202 ModuleBChapter43