Chapter 42
Care of Patients with
Hematologic Problems
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Anemia
Reduction in either the number of RBCs,
amount of hemoglobin, or hematocrit
 Clinical sign (not specific disease);
manifestation of several abnormal
conditions

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Cardiovascular Effects of Anemia
Orthostatic hypotension
 Tachycardia (increasing with activity, after
meals)
 Murmurs and gallops
 Decreased pulse pressure

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Transfusion Responsibilities

Pretransfusion:
◦
◦
◦
◦
◦
Verify prescription
Test donor’s/recipient’s blood for compatibility
Examine blood bag for identification
Check expiration date
Inspect blood for discoloration, gas bubbles,
cloudiness
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Transfusion Responsibilities
Provide patient education
 Assess vital signs
 Begin transfusion slowly, stay with patient
first 15 to 30 minutes
 Ask patient to report unusual sensations
(e.g., chills, shortness of breath, hives,
itching)
 Administer blood product per protocol
 Assess for hyperkalemia

Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
A 27-year-old female with a history of sickle cell disease (SCD) comes to
the ED with abdominal pain that is rated as a “9” on a 0-to-10 scale.
Physical assessment shows that she is grimacing and guarding her
abdomen and has a fever of 103°F, a pale yellow hard palate, and several
very small ulcers on her lower extremities.
What is the priority problem that must be addressed immediately?
A. Acute pain
B. Hyperthermia
C. Potential for infection
D. Decreased tissue perfusion
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Thirty minutes later, the patient is diagnosed with acute
sickle cell crisis. She continues to have pain.
Which drugs would be prescribed for pain control at this
time? (Select all that apply.)
A. Meperidine IV push prn
B. Morphine sulfate IV push scheduled doses
C. Acetaminophen orally or rectally
D. Hydromorphone IV push scheduled doses
E. Morphine sulfate SR orally or IM scheduled doses
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Three hours later, the patient is admitted to
the acute medical care unit. Laboratory
studies for the patient are ordered.
What result do you anticipate?
A. Hct 40%
B. HbS 90%
C. WBC 7000/mm3
D. Total bilirubin 0.5 mg/dL
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
1.
2.
The provider’s orders include hydroxyurea
(Droxia). Two hours later when you
administer the medication, the patient asks
you about the purpose of this drug. What
is your best response?
What follow-up laboratory value would
you be sure to monitor while the patient
is taking hydroxyurea?
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Four days later, the patient is preparing for discharge. Which
teaching points would you be sure to go over with the
patient and her family? (Select all that apply.)
A. Drink at least 3 to 4 liters of fluid daily.
B. Alcoholic beverages may be consumed moderately.
C. Be sure to get a flu shot annually.
D. Avoid temperature extremes of hot or cold.
E. Engage in mild low-impact exercise three times a week
when not in crisis.
F. Take acetaminophen at the first sign of infection.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Chapter 42
Audience System Response Questions
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
11
Question 1
A 23-year-old African-American male with a history of sickle
cell disease had an emergent open reduction and internal
fixation of his right femur after a car crash. What is the initial
postoperative nursing priority?
A.
B.
C.
D.
Ensuring adequate IV hydration
Treating the patient’s pain
Titrating oxygen to an SPO2 >95%
Examining the surgical incision for signs and symptoms of
infection
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Question 2
What is a priority nursing intervention in the care of an
older patient with a history of diverticular disease and
pernicious anemia?
A.
B.
C.
D.
Encouraging a diet high in vitamin B12
Preventing falls
Turning the patient every 2 hours
Monitoring intake and output
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Question 3
A patient with polycythemia vera is admitted
with reports of shortness of breath,
hypertension, and loss of pulses in her right
foot. A priority nursing intervention would be:
A. Evaluate the patient for hypertensive crisis
B. Administer oxygen by nasal cannula
C. Elevate her lower extremities on pillows
D. Evaluate current hydration status
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.