tabloski ch21 lecture

Gerontological NursingGerontological Nursing

CHAPTER

THIRD EDITION

The Hematologic System

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

1. Describe age-related changes that affect hematologic function.

2. Recognize the impact of age-related changes on hematologic function.

Learning Objectives

3. Identify risk factors to health for the older person with hematologic problems.

4. Interpret the unique presentation of hematologic problems in the older person.

Learning Objectives

5. Devise appropriate nursing interventions directed toward helping older adults with hematologic problems develop self-care abilities.

6. Identify and prioritize appropriate nursing interventions to care for the older person with hematologic problems.

Introduction

• The hematologic system is responsible for many functions in the body and serves as a medium of exchange between the outside environment and the body’s internal environment.

• The main function of the circulating blood is to carry oxygen and nutrients to, and remove carbon dioxide and waste products from the internal organs and peripheral tissue.

Introduction

• Blood transports other substances such as hormones, proteins, solutes, water, and medications to sites where they are needed.

• Blood carries various ions, oxygen, and carbon dioxide to the renal and respiratory systems.

• Blood consists of red blood cells, white blood cells, platelets, and plasma.

Introduction

• Erythrocytes, or red blood cells (RBCs), have a life span of about 120 days. They are flexible, concave disks that arise from stem cells in the bone marrow.

• Erythrocytes contain hemoglobin, a protein that binds with oxygen to form oxyhemoglobin.

Introduction

• Anemia occurs whenever the hemoglobin content of the blood is insufficient to satisfy body demands.

Common Disorders

• Anemia• Microcytic Anemia• Normocytic Anemia• Macrocytic Anemia• Sickle Cell Anemia

Transfusions

• Some care providers attribute lack of energy to aging and fail to diagnose anemia.

• Severe anemia may be present for long periods of time and avoid detection.

• Severe anemia can lead to myocardial infarction, falls, confusion, and other serious complications.

Chronic Myeloproliferative Disorders

• These classic disorders include primary thrombocythemia, polycythemia vera, and myelofibrosis.

Chronic Myeloproliferative Disorders

• Hematologic malignancies–Hematologic malignancies arise when

immature lymphoid and myeloid cells are overproduced with associated bone marrow failure.

–Careful monitoring of radiation exposure is mandatory for all healthcare workers caring for older persons receiving radiation treatments or diagnosis by X-ray.

Hematologic Malignancies

• All infections, fevers, and night sweats should be reported to the healthcare provider and treated aggressively and promptly.

• Palliative care with the emphasis on pain management and symptom control; referral to hospice and emotional support will be needed by the older person and family.

Lymphomas

• A malignant lymphoma is a neoplastic tumor affecting the lymphoid tissue.

• The disease is diagnosed by the presence of excess lymphocytes and progressive enlargement of the lymph nodes.

• The major types of lymphoma are Hodgkin’s disease and non-Hodgkin’s lymphoma.

Nursing Assessment

• The nursing assessment of an older person with hematologic problems includes a complete review of the older person’s past medical history and current health status.

• The complaints of an older person with anemia or a blood disorder may be vague and often confused with normal changes of aging or symptoms of chronic disease.

Nursing Assessment

• The nurse can play a key role in advising the older person to seek treatment and report symptoms to the healthcare provider.

Nursing Assessment

• Referral to a healthcare provider for a complete health assessment is indicated for older persons who might be experiencing anemia. A complete physical examination, electrocardiogram, test of thyroid function (as chronic hypothyroidism may be related to anemia), and complete blood count with differential are indicated.

Nursing Assessment

• Nursing diagnoses that may be associated with an older person experiencing anemia or other hematologic problems include, but are not limited to:–Activity Intolerance–Risk for Falls–Risk for Poisoning

Drug Toxicity

Nursing Assessment

• Nursing diagnoses that may be associated with an older person experiencing anemia or other hematologic problems include, but are not limited to:–Risk for Infection–Altered Nutrition

Less Than Body Requirements

– Impaired Skin Integrity

Nursing Assessment

• Nursing diagnoses that may be associated with an older person experiencing anemia or other hematologic problems include, but are not limited to:– Ineffective Breathing Pattern–Anxiety–Hopelessness

Hypercoagulability and Anticoagulation

• Deep vein thrombosis (DVT) and pulmonary embolism can lead to myocardial infarction and stroke, and the incidence increases with age.

• The older person is more at risk.

Anticoagulant Medications

• Heparin is the most widely used anticoagulant.

• Warfarin is frequently used for anticoagulation in the prevention or treatment of DVT.

• The older person is more likely to experience bleeding complications.

Anticoagulant Medications

• Frequent monitoring is required to safely titrate dosage during the induction period.

• All serious or significant bleeding requires emergency treatment and evaluation.

Nursing Assessment

• The following nursing diagnoses may be associated with an older person experiencing potential hypercoagulability:–Activity Intolerance–Risk for Falls and Injury–Risk for Poisoning

Drug Toxicity

–Risk for Infection

Nursing Assessment

• The following nursing diagnoses may be associated with an older person experiencing potential hypercoagulability:–Potential Risk-Prone Health Behaviors–Risk for Noncompliance to Laboratory

Monitoring Procedures

Complementary and Alternative Therapies

• Herbal remedies for anemia include the following:–Dong quai–Spirulina–Quinoa–Gentian

• No scientific evidence of effectiveness has been shown for any of these remedies.

tabloski ch21 lecture

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