Nursing 210 Fluid and Cells

Nursing management of patients with hematologic dysfunction

Laurie Brown RN, MSN, MPA-HA, CCRN

Development of Blood Cells

Hemoglobin and Hematacrit

Hb: Women: 12-16

Men: 13.5-18

Hct: Women: 38-47%

Men: 40-54%

Complete Blood Count

White Blood Cells (WBC) 5,000-10,000

WBCDifferential

NeutrophilEosinophilBasophilLymphocyteMonocyte

50-70%2-5%0-2%20-40%4-8%

CBC

Platelet Count150,000-400,000

Mean Corpuscular Hemoglobin (MCH)

Mean Corpuscular Volume (MCV)

Mean Corpuscular Hemoglobin Concentration (MCHC)

Red Cells

Clotting Extrinsic Intrinsic

Heparin

PTTCoumadin

PT or INR

Protamine sulfate

Vitamin K

Drugs Impairing the Hematologic System

Drugs causing bone marrow suppression

Drugs causing hemolysis Drugs that disrupt platelet action Drugs that disrupt clotting action

ANEMIASANEMIAS “Can Not

Make” “Lost” “Destroyed”

Iron Deficiency Pernicious

Anemia Folic Acid

Deficiency Trauma Chronic loss

Sickle Cell Infectious

Agents Antibodies Aplastic Anemia G6PD Deficiency

ANEMIASANEMIAS

Sickle Cell Anemia

Pain Control Sickle cell crisis Rational for orders Nursing orders

Pernicious Anemia

Vitamin B 12 Intrinsic Factor Cells mutate and become large Development of Neurological

problems

Clotting Problems

Thrombocytopenia Hemophilia Von Willebrand Disseminated Intravascular

Coagulation (DIC)

DIC

“Imbalance between the process of coagulation and anticoagulation”

Treatment

Heparin Administration Heparin loading dose Initial Maintenance Infusion Dosage calculation often

by patients weight

TransfusionAdministration

Identification Lab values Drs order verify Pt assessment IV site assessment Documentation Verify with 2nd RN Monitor VS Remain with the

patient

Automatic IV infuser pump Flow rate calculation Blood/Blood product w/tag 150 cc NS Blood Administration Set Gloves

Blood Bank

Patient name and I.D. number Unit number and ABO/Rh type

on bag with blood bag compatibility tag & bag unit/type

Verify expiration date on blood bag

Autologous Blood Transfusions

Preoperative autologous blood donation Acute normovolemic hemodilution Intraoperative autologous transfusion Postoperative blood salvage

Characteristics of Normal Cells Limited Cell Division Specific Morphology Small Nuclear-Cytoplasmic Ratio Perform Specific Differentiated Functions Adhere tightly together… Are nonmigratory Grow in an orderly and well

differentiated manner Are contact inhibited

Characteristics of Malignant Cells

Demonstrate rapid or continuous cellular division.

Show anaplastic morphology Have a large nuclear-cytoplasmic ratio Lose some or all differentiated functions Adhere loosely together Are able to migrate Grow by invasion Are not contact-inhibited

Leukemia

AML - Acute Myelogenous ALL - Acute Lymphocytic

CML - Chronic Myelogenous

CLL - Chronic Lymphocytic

FAB Leukemia Classification

French American British Classification

Historically distinguishing AML from ALL was a major clinical problem

Chemotherapy dependent on tissue type

Acute Leukemia NCCN Guidelines

National Comprehensive Cancer Network (NCCN) has issued guidelines for treatment of many cancers including Leukemia as well as other hematological malignancies

http://www.nccn.org/index.html

Bone Marrow Aspiration

Bone marrow biopsy Bone marrow aspiration

Lymphoma

Hodgkin’s lymphoma Non-Hodgkin’s lymphoma

Multiple Myeloma

Gammopathy “M” Protein

called a tumor marker

History of Myeloma Skeletal evidence of myeloma

obtained from Egyptian mummies First case described in 1844 1845 Dr Henry Bence Jones detected

heat properties of urinary light chains 1929 Bone marrow aspiration 1937 serum protein electrophoresis 1960 Alkeran and prednisone- first

treatment

What is Multiple Myeloma?

A cancer of the bone marrow The location where cells are produced

The affected cells are plasma cells Plasma cells produce antibodies

(proteins that fight off infection)

To Many Harmful Plasma Cells

Abnormal Plasma Cells are called Myeloma Cells and develop without warning

Myeloma cells collect in bones and cause “soft spots” where the cell is damaged

Effects of the blood Normal cells are not

being produced in the bone marrow

Bones are damaged Bone demineralization

(soft spots)

Symptomatic Multiple Myeloma

Calcium Renal Anemia Bone