6. hematologic failure

Management of PatientsWith Hematologic

Disorders

ARIEL M. ORTUOSTE, RN, MAN

LEARNING OBJECTIVES

1. Describe the process of hematopoiesis.2. Describe the processes involved in maintaining hemostasis.3. Differentiate between the hypoproliferative and the hemolytic anemias and compare and contrast the physiologic mechanisms, clinical manifestations, medical management, and nursing interventions for each.

4. Use the nursing process as a framework for care of patients with anemia.5. Compare the leukemias, their incidence, physiologic alterations, clinical manifestations, management, and prognosis.6. Use the nursing process as a framework for care of patients with acute leukemia.7. Use the nursing process as a framework for care of patients with lymphoma or multiple myeloma.

8. Use the nursing process as a framework for care of patients with bleeding disorders.9. Identify therapies for blood disorders, including the nursing implications for the administration of blood and blood components

Anatomic and Physiologic Overview

• The hematologic system consists of the blood and the sites where blood is produced, including the bone marrow and the reticuloendothelial system (RES).

• Blood is a specialized organ that differs from other organs in that it exists in a fluid state. Blood is composed of plasma and various types of cells

• Plasma is the fluid portion of blood; it contains various proteins, such as albumin, globulin, fibrinogen, and other factors necessary for clotting, as well as electrolytes, waste products, and nutrients.

BLOOD

• The cellular component of blood consists of three primary cell types

• RBCs (red blood cells or erythrocytes), • WBCs (white blood cells or leukocytes),

and • platelets (thrombocytes).

• EDUCATIONAL VIDEOS\What's Inside of Blood_.mp4

Blood CellsCELL TYPE MAJOR FUNCTIONWBC (Leukocyte) Fights infection

Neutrophil Essential in preventing or limitingbacterial infection via phagocytosis;average life span is 2 to 4 h

Monocyte Enters tissue as macrophage; highlyphagocytic, especially against fungus;immune surveillance

Eosinophil Involved in allergic reactions(neutralizes histamine); digests foreignproteins

Basophil Contains histamine; integral part ofhypersensitivity reactions

CELL TYPE MAJOR FUNCTION

T lymphocyte Responsible for cell-mediated immunity;recognizes material as “foreign”(surveillance system)

B lymphocyte Responsible for humoral immunity;many mature into plasma cells toform antibodies

Plasma cell Secretes immunoglobulin (Ig, antibody);most mature form of B lymphocyte

CELL TYPE MAJOR FUNCTION

RBC (Erythrocyte) Carries hemoglobin to provide oxygento tissues; average life span is 120 days

Platelet (Thrombocyte) Fragment of megakaryocyte, not reallya cell; provides basis for coagulationto occur; maintains hemostasis; averagelife span is 10 days