VILLANOVA UNIVERSITY
COLLEGE OF NURSING
NUR 3112
NURSING CARE OF ADULTS RELATED TO HEMATOLOGIC FUNCTION
RBCs / Erythrocytes
Main role = Transport O2 Begin Life as Reticulocytes
Life Span = 120 days
Factors needed for RBC Production (Erythropoiesis)
1. Genetic Ability
2. Healthy Bone Marrow / Healthy Kidneys / Healthy GI
3. Proper Intake of Fe, B12, Folic Acid
Erythropoiesis Decreased # of RBCs
Hypoxia
Stimulation of Kidney
Erythropoietin
Stimulation of Bone Marrow
Platelets = Thrombocytes
Blood Coagulation / Hemostasis / Thrombus Formation
2/3 of Platelets in Circulation 1/3 in Spleen Life Span = 10 Days
Injury
Platelets Aggregate to Site
Form a Plug
Bleeding Stopped
Lalonde’s Model
Anemia Reduced RBC Volume and/or Reduced RBC Concentration
Causes: Excess Blood Loss
Excessive Destruction
Alteration in Production
Anemia classified by : 1. Etiology (Causes) 2. Morphology
The RBC differential gives us info. about the morphology
Common Anemias
Iron Deficiency Pernicious Hemolytic Hypoplastic (Aplastic)
Health History - Anemia
Chief Complaint = Fatigue, but mild anemia is ASYMPTOMATIC!
Medical History medications Family & Allergy History
Differentiating -Used to Determine the Type of Anemia
Treatment (of anemia in general)
Correct the Cause Give Medication Transfuse O2 PRN
Iron Deficiency Anemia Most Common Type
Women (10-15 % of pre-menopausal & 30% of pregnant & lactating women)
Microcytic, Hypochromic
Signs & Symptoms Acute - Increased Heart Rate, Increased Respiratory Rate, DOE,
Vertigo, Pale Membranes/Nails, Fatigue, Decreased Concentration, Cold, Decreased
Libido Chronic - Asymptomatic to brittle hair/nails Chronic Severe - Dysphagia,
Stomatitis, Tongue Inflammation
Diagnosis: Decreased RBC , Hgb & Hct Blood Smear - Decreased MCV Decreased
MCHC Increased Iron Binding (TIBC) Increased Reticulocyte Count
RX Correct Deficiency Dietary RX Bleeding Iron Replacement Oral (Ferrous sulfate
(Feosol), Fergon)
Z Track SE = constipation - use stool softeners PRN O2 to
Maximize Arterial Saturation
Nursing DX
Pernicious Anemia (Megaloblastic)
Symptoms: Acute - DOE, Palpitations, Tachycardia, Degenerative Change in
Cerebral Cortex and Cord- Paresthesia, Unsteady Gait, Clumsiness, Irritability,
Dizziness, Lesions, Gingivitis Chronic - Brittle Nails, Smooth Tongue,
Numbness/Tingling of Extremities. Fatigue, Dysphagia, Anorexia, Weight Loss,
Jaundice, Gingivitis
Diagnosis Blood Smear
Gastric Analysis - Decreased Gastric Secretions… Atrophic
Gastritis Schillings Test
Trial of B12 - Symptoms Relieved
Decreased Hgb,
Erythrocytes Bone Marrow Decreased Folate Level
RX
B12 Replacement
O2 to Maximize Arterial Saturation
Nursing DX
2
Hemolytic Anemia
Breakdown of RBCs shortened life span of RBCs destruction of them by immune
system not replaced as quickly as they’re destroyed
Symptoms Acute - Fever, Chills, Vision Changes, Pain in Abd., Back, Joints,
Palpitations, SOB Chronic - Pale, Fatigue, DOE, Dizzy, Jaundice, Arthritis, Renal
Failure, Skin Ulcers, Enlarged Spleen, Liver, Lymphatics, Parasthesias, Decreased Urine
Output
Diagnosis Decreased Hgb & Hct Altered immune factors (Autoantibodies present)
Increased Bilirubin Increased Urine and Fecal Urobilinogen Bone Marrow - Hyperplasia
Increased Reticulocyte Count Decreased Serum Haptoglobin
RX Treat the Cause Corticosteroids O2 PRN Volume Replacement PRN and to flush
kidneys Transfuse Folic Acid Splenectomy Erythrocytophoresis
Nursing DX
Aplastic Anemia
Symptoms: Acute - Fever, Infection, Bleeding, Dizziness, Neutrophils, DOE,
Weakness Chronic - Weakness, Fatigue, Pallor, Dysphagia, Numbness / Tingling
Extremities
Diagnosis CBC with Diff - Decreased Hgb, RBCs, WBCs, Platelets
Prolonged
Bleeding Bone Marrow - Hypocellular Decreased Reticulocyte Count
RX
Treat the Cause Transfuse - packed cells / frozen plasma / platelets Bone
Marrow Transplant Antibiotic Treatment Corticosteroids O2 - severe anemia
Nursing DX
Causes of Thrombocytopenia
Decreased Platelet Production
Increased Platelet Destruction
Splenomegaly
Thrombocytopenia
Purpora HIV Infection
Drug Induced
DX of Thrombocytopenia History & PE Platelet Count Bleeding Time Bone
Marrow Aspiration Hgb & Hct Bone Marrow Aspiration Taken from Iliac Crest or
Sternum Done to Assess for Abnormal Cells / Evaluate Response to Treatment
Bone Marrow Aspiration: Nursing Care Pretest
3
During Test
Posttest
RX of ITPP
Corticosteroids Platelet Transfusions IV Immunoglobulin Danazol
(an androgen - also suppresses immune response) Immunosuppressives Thrombopoietin
Plasmapheresis & Plasma Exchange Splenectomy
Nursing Care for ITPP Observe for and Prevent Hemorrhage Prevent Complications
Bed rest Prevent Injury Prevent Constipation and UTI Nursing Care Related to RXs
Treatments Related to Blood Loss PRN
Post-Splenectomy
Hemorrhage
Infection
Thrombosis
Blood Products Packed RBCs Frozen RBCs Platelets
Albumin Cryoprecipitates & Commercial Concentrates
Community Blood Resources
Efforts to Ensure Safe & Effective Transfusions
Compatability of blood types
Transfusion Process
Transfusion Reactions
BE:10/02
4
Fresh-Frozen Plasma (FFP)