MCC NURSING
BY: DIANA BLUM MSN
 Blood is a type of connective tissue
 Transports nutrition
 Transports oxygen
 Transports hormones
 Immunological aspects also
important
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Critical to body defense
Maintains temperature
Controls PH
Removes toxins
Regulates electrolytes
 Hematopoiesis:
 Bone Marrow:
 Stem Cell:
 Plasma: straw colored liquid that suspends blood cells
 Leukocyte: warrior cell that fights infection and invasion.
 Reticulocyte: immature RBC
 WBC: another name for a leukocyte
 RBC: gives blood it color. Transports oxygen to cell and co2 to lungs
 Erythrocyte: another name for RBC
 Platelet: found in plasma. Works with clotting factors to help prevent bleeding.
 Responsible for removing excess
fluid protein and large particles
from cells
 Main functions:
 fluid balance maintenance
 Defense
 Fat absorber
 Stores 20-40 ml blood
 Removes old cells
 Filters and destroys antigens
before they enter system
 Stores platelets (1/3 of body’s
store)
 Stopping of blood flow
 2 phases:
 Primary
 Secondary
 Hemoglobin is low
 Oxygen is low
 Not a disease but an underlying
condition
 2 types: hypoproliferative and
hemolytic
 Hypoproliferative: marrow can’t produce
adequate erythrocytes
 Lack of factors, chemicals, marrow
damage
 Hemolytic: premature destruction of
erythrocytes. Leads to tissue hypoxia
 Abnormality like sickle cell, direct injury
 Stimulation of RBCs by
erythropoietin
 Erythropoietin: hormone produced
by kidneys during periods of
hypoxia to ensure growing tissues
will have sufficient oxygen.
 Based on:
 Marrow ability to respond to decreased
erythrocytes
 Manner of maturity for young
erythrocytes
 The presence or absence of end products
of erythrocyte destruction within the
circulation
 Rapidity with the anemia has
developed
 Duration of anemia
 Metabolic requirements of patient
 Other disorders
 Cardio: tachycardia, hypoxia, MI
symptoms
 Respiratory: SOB in varying
degrees
 Neuro: headache, poor
concentration, vertigo, irritibility,
confusion
 Compensation also may occur
 Prioritize activities
 Plan rest periods
 Eats healthy foods rich in iron,
vitamins, and proteins
 Use nutrition supplements as
needed
 Report palpitations, dizziness,
dyspnea
 Monitor vitals
 Monitor edema
 Monitor neuro status
 Safety techniques
 Low RBC
 Low HGB andHCT
 Low serum Iron level
 Low ferritin level
 High TIBC level
 Results from diet low in iron
 Results from body not absorbing enough iron from GI tract
 Not enough hemoglobin made as result
 s/s: sore tongue, brittle nails, fatigue, pallor, orthostatic changes (in severe
cases)
 Dx: bone marrow aspiration, lab work
 Tx: iron supplements, iron rich foods (liver, oysters, red meat, fish, dried fruits,
legumes, dark green veggies, whole grain breads and cereal)---orange juice or
other vitamin C product will enhance iron absorption
 What is the major side effect of IV iron?
 Pts don’t become severely anemic
til creatinine levels exceed
3mg/100ml
 Hematocrit decreases
 Causes:
 shorted RBC lifespan
 Deficiency of erythropoietin
 Long term hemodialysis
 Tx: monitor serum levels of iron,
hematocrit, and vitals
 Only inflammation, infection, and
malignancy cause
 It is nonprogressive
 Develops over 6-8 weeks
 Many don’t require treatment
 Most cases are idiopathic
 Infection and pregnancy,
medication, chemicals or radiation
can trigger
 Airplane glue, arsenic, pestisides
 Complete failure of the bone
marrow
 Low RBC count
 Low WBC
 Low Platelet cts
 S/S: pallor, fatigue, tachycardia,
sob, hypotension,
prolonged/spontaneous bleed,
frequent infections, purpura,
retinal hemorrhages are common
 Tx: transfusion of RBC and Platelet,
antibiotics, corticosteroids, bone
marrow transplant, ICU setting,
monitor for signs and symptoms of
infection and bleeding,
neutropenic precautions
 Pt does not absorb vitamin B12
from stomach
 Higher incidence of gastric cancer
 Pt may lack intrinsic factoressential for b12 absorption
 Assess hx: gastrectomy, crohn’s,
family history,etc.
 s/s: weakness, sore tongue,
numbness of hand and feet
 Tx: B12 injections monthly,
endoscopy q1-2 years---if
untreated can develop heart
failure and lead to death
 Monitor oral cavity, and skin. Monitor for
jaundice, monitor gait, provide small
frequent bland diet
 Dx: Obtain shilling test
 Most frequent in SE Asian, African,
and Mediterranean descent
 Folate is in green leafy veggies and
liver
 Alcohol increases need for folic
acid
 S/S same as pernicious anemia
except no neuro symptoms
 Dx: folate level
 Tx: replacements
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RBCs normally disc shaped
In sickle cell they are sickle shaped
Easily rupture
Obstruct blood flow
Genetic in nature
Most common in African
Americans
 Sickle cell is recessive (inherit from
mom and dad)
 http://www.youtube.com/watch?v
=R4-c3hUhhyc
Sickle cell anemia
 4 types:
 sickle crisis: most common---obstructive
 aplasic crisis---from infection from
parvovirus
 Hyperhemolytic---massive rbc destruction
 sequestrian crisis---result from other organs
pooling sickled cells
 Spleen is most common
 Also in liver and lungs
 S/S: tachycardia, fever, decreased HGB,
infiltrates on chest x-ray
 Pulomary HTN is a symptom that is not usually
detected until damage is irreversible
 Monitor x-rays, CT scan, Echo, HGB level
 Tx: treat symptoms, Bone marrow transplant,
transfusions, Hydroxyurea, Arginine
 http://www.youtube.com/watch?v=qe59a
r-GZmg
 This is a deficiency in the gene that
is essential for membrane stability
 Hemolysis only occurs with
stressful situations
 Mostly affects african americans,
greek or italian decent as well as
asians and jewish origins
 Inherited on x chromosome
 S/S: asymptomatic, or jaundice,
pallor, hemoglobinuria
 Dx: serum G-6-PD
 Tx: stop offending med,
transfusion, educate about meds
to avoid, instruct to wear medic
alert bracelet
 Too many RBCs produced
 Blood more viscous
 s/s: headache, dizziness, ringing in
the ears, blurred vision, ruddy
complexion, HTN, pruritis, gout
problems, burning fingers and toes
 DX: o2 sat, CBC with DIFF
 Complications: CVA, MI, BLEED
issues
 Tx: hydroxyurea, interferon, plavix,
ASA
 Treat symptoms
 Teach pt: don’t cross legs, quit
smoking, stay active, minimal
alcohol, avoid excess iron
 TX: phlebotomize blood
 Enough RBCs made but they are
destroyed once they are released
into circulation
 Causes: infection, drug reaction,
cancer
 s/s: pallor, fatigue, tachycardia,
sob, hypotension, jaundice, high
bilirubin levels
 Positive direct coombs antiglobulin
test
 Tx: blood transfusions,
corticosteroids, spleenectomy
 Recovery in few days to weeks
 Defect in the WBC stem cell
 Abnormal reproductions
 Unknown cause, may be from
chemical or radiation exposure
 Symptom onset is abrupt
 http://www.youtube.com/watch?v
=FJOYAaygQFE
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Defective stem cell
Incidence rises with age 60+
Prognosis variable
Younger pts may survive 5 years
S/S: fever, infection, weakness,
fatigue, bleed tendency, pain
 Dx: no warning, CBC
 Complications: bleeding
(petechiae, ecchymosis), infection,
DIC
 TX: chemo, transfusions, infection
treatment, growth factor agents,
bone marrow transplant, palliative
care
 Uncommon in pts under 20
 Life expectancy 3-5 years
 s/s: asymptomatic, dyspnea, mild
confusion, enlarged liver, wt loss,
anorexia
 Tx: tyrosine kinase inhibitor, avoid
antacids and grapefruit juice,
interferon, cytosine, leukopheresis,
bone marrow transplant, Gleevac
 Most common in young kids 4-14
 Uncommon
 s/s: decreased cbc counts, pain,
enlarged liver, enlarged spleen,
headache, vomiting
 Tx: bone marrow transplant,
chemo, corticosteroids
 Complications: infection
 Common in older adults
 Most common form in US and
Europe
 More frequent in men
 s/s: asymptomatic,
lymphadenopathy, pain,
hepatomegaly, spleenomegaly,
anemia, fevers, drenching sweats,
wt loss, infections
 Tx: treat symptoms, chemo,
monoclonal antibodies
 Characterized by reed- sternberg
cells in the lymph nodes
 Highest occurance is in 20s and50s
 Men are more likely than women
to have
 Tx: radiation, chemo, bone marrow
transplant, stem cell transplant
 Survival rates vary
 5 yr survival rate is 82%
 6th most common type of cancer
and cancer death in US
 Avg age of dx is 60
 Stages
 Low grade
 Intermediate grade
 High grade
 The higher the grade the more
aggressive
 Tx: chemo, radiation, bone marrow
transplant, stem cell transplant
 5 year survival rate is 52%
 Cancer of the plasma cells
 Most common over the age of 60
 No known cause
 Genetics and radiation exposure play a part
 s/s: bone pain, hyperuricemia (kidneys), anemia,
hypercalcemia, fractures, spinal cord compression,
renal failure
 Diagnosis: radiographs, serum and urine protein
electrophoresis, bone marrow biopsy
 No known cure
 Tx: chemo and radiation to treat symptoms,
vertebroplasty, antiemetics, pain management
 http://www.mhhe.com/biosci/esp/2002_general/Esp/folder_str
ucture/tr/m1/s7/trm1s7_3.htm
 Too few platelets
 Causes: cancer treatment
 Too many platelets being
destroyed
 Causes: idiopathic thrombocytopenic
purpura, thrombic thrombocytopenic
purpura
 Dx: bone marrow bx, CBC
 s/s: petechiae, purpura, gingival
bleed, epistaxis, prolonged
bleeding
 Tx: transfusions, spleenectomy,
chemo, stop med that is causing,
stop ETOH, treat infection
 Most common among kids and
young girls
 Usually 1-6 wks after viral infection
 Cause unknown, h. pylori may play
role
 s/s: asymptomatic, low platelet
count, petechiae, hemoptysis
 Dx: bone marrow bx, platelet ct
 Tx: stop med, immune globulin,
chemo, prednisone, spleenectomy
 Nsg: assess lifestyle, teach
symptoms, avoid constipation,
avoid valsalva, avoid teeth flossing,
use only electric razors, use only
soft bristled tooth brush, monitor
for osteoporosis
 Example of drug induced immune
mediated thrombocytopenia
 Rare
 Related to heparin therapy
 Tx: observation, assessment,
monitor lab values, stop heparin
immediately
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Medical emergency
Causes extensive blood clots
TX: plasmaphoresis
Complication: multi organ FX
95%death rate if not treated
 Most common inherited bleeding
disorder
 1-2% international population
 s/s: Mucosal and cutaneous
bleeding, porlonged bleed times
 Tx: DDAVP, FFP, Cryoprecipitate,
bleed precautions
 Genetic
 Lack of blood clotting factor
 1-2 cases per 20,000 persons
 Types
 A: factor VIII is missing-higher incidence
 B: factor IX is missing
 Trait is carried on x chromosome
 Rare for women to have
 s/s: uncontrolled bleed especially in joints, skin, GI tract
 Tx: no cure. Transfusions, pain treatment (IV morphine is
common)..monitor for addiction to opiods.
 http://www.youtube.com/watch?NR=1&feature=endscreen&v=pVHb
MuBK8CI
 Not a disease
 Triggers: sepsis, trauma, cancer,
shock, abruptio placentae, allergic
reactions
 Life threatening condition
 Initially coag time is normal
 S/S: are manifested in organs with
either clots or bleeding. Bleeding
from all orifaces(tear ducts, gums,
IV sites, rectum, urethra, etc.)
 Dx: PT, PTT, D-Dimer
 Tx: treat the cause, replace fluids,
o2, fix electrolyte imbalances,
administering vasopressors are
vital, cryoprecipitate to replace
factor 5 and 7, FFP, heparin
 http://www.youtube.com/watch?v
=kNSwGUqaVgs
 Universal donor= O
 Does not contain A, B, or Rh antigens
 Universal recipients= AB+
 Blood contains A, B, and RH antigens
 Usually blood banks exactly match
the pt blood
 http://www.youtube.com/watch?v
=G_-9_CF02qI
 Pt needs 18 or 20 gauge IV needle so cells are not lysed
(destroyed)
 Prior to administration, blood needs to be checked by 2
licensed nurses. Check the expiration date, name, medical
record number, type of blood, blood band id, pt birthday
 Check vitals prior to administration
 **blood must be initiated with in 30 minutes of arrival from lab
to floor
 Use blood tubing for administration
 Monitor for blood reactions
 Monitor vitals continuously during administration
 Hemolytic: fever, chills, nausea, dyspnea, chest pain, back pain, hypotension
 Antigen/antibody rx to transfusion
 Happens shortly after initiation
 Tx: stop the transfusion, call md, supportive therapy to maintain HR and BP
 Anaphylactic: urticartia, wheezing, dyspnea, hypotension
 Type 1 hypersensitivity rx to plasma proteins
 Occurs within 30 minutes of initiation
 Tx: stop transfusion, call md, be ready for epi and steroids
 Febrile: fever, chills
 Recipients antibodies rx to donor leukocyte
 Occurs within 30-90minutes of initiation
 Tx: stop infusion, call md
 Circulatory overload: cough, frothy sputum, cyanosis, decreased BP
 cardio system is unable to manage the additional fluid load
 Occurs anytime during transfusion and up to several hours after completion
 Tx: stop infusion, call for help, be prepared for code, be prepared to administer oxygen and Lasix
 Minimize the # of invasive
procedure
 Avoid prolonged tourniquet use
 Avoid IM injections
 Instruct the client to use soft
bristled tooth brush
 No strait edge razor shaving only
use electric razor
 Avoid NSAIDS
ANY QUESTIONS???