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Focus on Anemia:

Focus on Anemia Nursing Management: Hematologic Problems Elinda Steury, MSN, RN, CCRN


2 Objectives 1.  Assessment of a client with a Hematologic Disorder 2.  Identify differences of Hematologic Disorders including pathophysiology for clients across the life span ( anemias , coagulation disorders). 3. Nursing interventions for diverse clients (cultural, developmental, and socioeconomic) with a complex Hematologic Disorder 4. Assimilate pharmacological and non-pharmacological interventions related to complex Hematologic disorders. 5. Discuss diagnostic tests and interventions associated with complex Hematologic disorders 6. Apply the nursing process to the care of clients experiencing a complex Hematologic disorder.

Hematopoiesis Myeloid and lymphoid lines: development of the formed elements of the blood:

3 Hematopoiesis Myeloid and lymphoid lines: development of the formed elements of the blood


Anemia A deficiency 1. 2. 3. Diverse causes 1. 2. 3.

Causes of Anemia:

Causes of Anemia


Anemia RBC function 1. 2.

Erythrocyte Production:

Erythrocyte Production Erythropoietin (EPO) is a glycoprotein primarily produced in the kidneys (10% in the liver)

Anemia (Cont’d):

Anemia (Cont’d) Classified as Morphologic Cellular characteristics Descriptive, objective laboratory information Etiologic Underlying cause

Anemia Clinical Manifestations:

Anemia Clinical Manifestations Caused by the body’s response to tissue hypoxia Hemoglobin (Hb) levels are used to determine the severity of anemia

Anemia :

Anemia Integumentary Manifestations Pallor Jaundice Pruritus Cardiopulmonary Manifestations Inc. H/R, Resp Rate, inc. stroke

Anemia Clinical Manifestations:

Anemia Clinical Manifestations Mild = Hb 10 to 14 g/dl Moderate = Hb 6 to 10 g/dl Severe = Hb <6 g/dl

Anemia Nursing Assessment:

Anemia Nursing Assessment Subjective Data Important health information Past health history Medications Surgery or other treatments Functional health patterns

Anemia Nursing Assessment (Cont’d):

Anemia Nursing Assessment (Cont’d) Objective Data General Integumentary Respiratory Cardiovascular Gastrointestinal Neurologic

Anemia Nursing Management :

Anemia Nursing Management Goals Correct cause of anemia Assume normal activities of daily living Maintain adequate nutrition Develop no complications related to anemia

Anemia Nursing Implementation:

Anemia Nursing Implementation Dietary and lifestyle changes Blood or blood product transfusions Drug therapy Oxygen therapy Patient teaching Nutrition intake Compliance with drug therapy

Anemia Gerontologic Considerations:

Anemia Gerontologic Considerations Common in older adults 1. 2. Signs and symptoms may go unrecognized or mistaken for normal aging changes

Anemia Nursing Diagnoses:

Anemia Nursing Diagnoses Activity intolerance Imbalanced nutrition: Less than body requirements Ineffective therapeutic regimen management Potential complication: Hypoxemia

Iron-Deficiency Anemia:

Iron-Deficiency Anemia One of the most common chronic hematologic disorders Iron is present in all RBCs as heme in hemoglobin and in a stored form Heme accounts for two thirds of the body’s iron

Iron-Deficiency Anemia Etiology :

Iron-Deficiency Anemia Etiology Inadequate dietary intake Malabsorption Blood loss Hemolysis

Iron-Deficiency Anemia Clinical Manifestations:

Iron-Deficiency Anemia Clinical Manifestations General manifestations of anemia common finding: second most common:

Iron-Deficiency Anemia Diagnostic Studies:

Iron-Deficiency Anemia Diagnostic Studies Laboratory findings Decrease in: Hb, Hct MCV serum iron, TIBC, bilirubin Stool guaiac test Endoscopy Colonoscopy

Iron-Deficiency Anemia Collaborative Care:

Iron-Deficiency Anemia Collaborative Care Goal is to treat the underlying disease

Iron-Deficiency Anemia Drug Therapy:

Iron-Deficiency Anemia Drug Therapy Oral iron Inexpensive Convenient Factors to consider IV IM

Iron-Deficiency Anemia Nursing Management:

Iron-Deficiency Anemia Nursing Management At-risk groups Premenopausal women Pregnant women Persons from low socioeconomic backgrounds Older adults Individuals experiencing blood loss

Iron-Deficiency Anemia Nursing Management (Cont’d):

Iron-Deficiency Anemia Nursing Management (Cont’d) Diet teaching Supplemental iron Discuss diagnostic studies Emphasize compliance Iron therapy

Thalassemia Etiology and Clinical Manifestations:

Thalassemia Etiology and Clinical Manifestations Population: An autosomal recessive: Thalassemia Minor: Heterozygous Thalassemia Major: Homozygous

Thalassemia Collaborative Care:

Thalassemia Collaborative Care Diagnostic tests: Interventions: Treatments: Complications:

Megaloblastic Anemias:

Megaloblastic Anemias Megaloblastic Anemias (macrocytic): Nutritional anemia resulting in defective DNA synthesis in RBCs Primary Causes: 1. 2.

Cobalamin Deficiency Etiology :

Cobalamin Deficiency Etiology Intrinsic factor (IF) IF is required for cobalamin absorption in the small intestine Causes:

Cobalamin Deficiency Clinical Manifestations :

Cobalamin Deficiency Clinical Manifestations General symptoms of anemia Neuromuscular manifestations

Cobalamin Deficiency Diagnostic Studies :

Cobalamin Deficiency Diagnostic Studies RBCs are macrocytic &Abnormal shapes contributing to to erythrocyte destruction Decreased s erum cobalamin levels Normal Folate levels Schilling test

Cobalamin Deficiency Collaborative Care :

Cobalamin Deficiency Collaborative Care Parenteral or Intranasal Depending on Cause: Increase in dietary cobalamin does not correct the anemia Still important to emphasize adequate dietary intake

Cobalamin Deficiency Nursing Management :

Cobalamin Deficiency Nursing Management Familial disposition Prevent injuries related to the patient’s diminished sensations

Folic Acid (Folate) Deficiency :

Folic Acid ( Folate ) Deficiency Megaloblastic anemia Characterized by macrocytic RBCs Folic acid is required for DNA synthesis

Folic Acid Deficiency (Cont’d) :

Folic Acid Deficiency (Cont’d) Causes: Clinical Manifestations: Diagnostic Findings: Treatment:

Anemia of Chronic Disease:

Anemia of Chronic Disease Underproduction of RBCs Mild shortening of RBC survival

Anemia of Chronic Disease:

Anemia of Chronic Disease Underproduction of RBCs Mild shortening of RBC survival

Anemia of Chronic Disease (Cont’d):

Anemia of Chronic Disease (Cont’d) Causes End-stage renal disease Primary factor: ↓ Erythropoietin Chronic liver disease Chronic inflammation Malignant tumors Chronic endocrine diseases

Anemia of Chronic Disease (Cont’d):

Anemia of Chronic Disease (Cont’d) Anemia of chronic disease findings ↑ Serum ferritin ↑ Iron stores Normal folate and cobalamin levels

Anemia of Chronic Disease (Cont’d):

Anemia of Chronic Disease (Cont’d) Treating underlying cause is best Rarely blood transfusions Erythropoietin therapy

Aplastic Anemia:

Aplastic Anemia Pancytopenia Decrease of all blood cell types RBCs White blood cells (WBCs) Platelets Hypocellular bone marrow

Aplastic Anemia Etiology:

Aplastic Anemia Etiology Low incidence Manageable with erythropoietin or blood transfusion Can be a critical condition Hemorrhage Sepsis

Aplastic Anemia Clinical Manifestations:

Aplastic Anemia Clinical Manifestations Gradual or sudden Onset Symptoms caused by suppression of any or all bone marrow elements General manifestations of: anemia Neutropenia Thrombocytopenia

Aplastic Anemia Diagnostic Studies:

Aplastic Anemia Diagnostic Studies Confirmed by laboratory studies Normocytic, normochromic anemia

Aplastic Anemia Nursing Management:

Aplastic Anemia Nursing Management Preventing complications from infection and hemorrhage Untreated prognosis is poor 75% fatal Treatment options Bone marrow transplantation Immunosuppressive therapy

Acute Blood Loss:

Acute Blood Loss Result of sudden hemorrhage 1. 2. 3. Concerns 1. 2.

Acute Blood Loss Clinical Manifestations:

Acute Blood Loss Clinical Manifestations Tachycardia Postural Hypotension Tachypneic Fatigue Pain Internal hemorrhage Tissue distention, organ displacement, nerve compression

Acute Blood Loss Diagnostic Studies:

Acute Blood Loss Diagnostic Studies Laboratory data do not adequately assess RBC problems for 2 to 3 days

Acute Blood Loss Collaborative Care:

Acute Blood Loss Collaborative Care Replacing blood volume Identifying the source of the hemorrhage and stopping it Correcting RBC loss

Acute Blood Loss Nursing Management:

Acute Blood Loss Nursing Management May be impossible to prevent if caused by trauma Postoperative patients Monitor blood loss No need for long-term treatment

Chronic Blood Loss:

Chronic Blood Loss Reduced iron stores Bleeding ulcer Hemorrhoids Menstrual and postmenopausal blood loss

Chronic Blood Loss:

Chronic Blood Loss Management Identify source Stop bleeding Possible use of supplemental iron

Hemolytic Anemia:

Hemolytic Anemia Destruction or hemolysis of RBCs at a rate that exceeds production Third major cause of anemia Intrinsic hemolytic anemia Abnormal hemoglobin Enzyme deficiencies RBC membrane abnormalities

Hemolytic Anemia (Cont’d):

Hemolytic Anemia (Cont’d) Extrinsic hemolytic anemia Acquired Physical Immune reactions Infectious agents/meds/toxins Sites of hemolysis Intravascular Extravascular

Hemolytic Anemia Clinical Manifestations:

Hemolytic Anemia Clinical Manifestations Jaundice: Destroyed RBCs cause increased bilirubin Renal: Accumulation of hemoglobin molecules can obstruct renal tubules Tubular necrosis Spleen and liver: Hyperactive with macrophage phagocytosis of the defective RBCs cause enlargement

Hemolytic Anemia Diagnostic Studies:

57 Hemolytic Anemia Diagnostic Studies Diagnostic studies Hb (decreased) Neutrophils (increased) bili ( increased) Nursing Management/Interventions:




Hemochormatosis Causes Clinical Manifestations Diagnostic Test Treatment plan Nursing Management




Polycythemia Etiology and pathophysiology Clinical manifestations/ complications


Polycythemia Diagnostic studies Collaborative care

Polycythemia in review:

Polycythemia in review


Polycythemia Complications Nursing Managment

Problems of Hemostasis: Vascular endothelium, Platelet and Coagulation Disorders:

Problems of Hemostasis : Vascular endothelium, Platelet and Coagulation Disorders

Three Major Disorders of Hemostasis:

Three Major Disorders of Hemostasis Thrombocytopenia Hemophilia & Von Willebrand’s Dz. DIC


Thrombocytopenia Etiology and pathophysiology Immune thrombocytopenic purpura (ITTP) Clinical manifestations Diagnostic studies

PowerPoint Presentation:

Treatment of ITTP


Thrombocytopenia Thrombotic thrombocytopenic purpura (TTP) Clinical manifestations Diagnostic studies

PowerPoint Presentation:

Treatment of TTP


Thrombocytopenia Heparin-induced thrombocytopenia and thrombosis syndrome (HITTS) Clinical manifestations Diagnostic studies

PowerPoint Presentation:

Treatment of HITTS

Thrombocytopenia (cont’d):

Thrombocytopenia (cont’d) Collaborative care Immune thrombocytopenic purpura Thrombotic thrombocytopenic purpura Heparin-induced thrombocytopenia and thrombosis syndrome Acquired thrombocytopenia from decreased platelet production

Nursing Management Thrombocytopenia:

Nursing Management Thrombocytopenia Nursing assessment Nursing diagnoses Planning Nursing implementation Health promotion Acute intervention Ambulatory and home care Evaluation

Hemophilia and Von Willebrand Disease Etiology:

Hemophilia and Von Willebrand Disease Etiology Hemophilia VonWillebrand’s

Hemophilia: Clinical Manifestations and diagnostic Studies:

Hemophilia: Clinical Manifestations and diagnostic Studies

Nursing Management Hemophilia:

Nursing Management Hemophilia Nursing implementation Health promotion Acute intervention Ambulatory and home care Evaluation

Hemophilia Nursing Diagnoses:

Hemophilia Nursing Diagnoses Risk for Injury RT trauma, dental & surgical treatments Risk for fluid volume deficit RT excessive fluid losses – hemorrhagic losses Risk for Pain RT nerve compression from hematomas, nerve damage or hemorrhage into joint space Altered Protection RT abnormal blood profile AEB altered clotting Ineffective Family Coping RT prolonged nature of condition

Disseminated Intravascular Coagulation:

Disseminated Intravascular Coagulation Etiology and pathophysiology Clinical manifestations Diagnostic studies Collaborative care

PowerPoint Presentation:


DIC: Treatment:

DIC: Treatment

Nursing Management Disseminated Intravascular Coagulation:

Nursing Management Disseminated Intravascular Coagulation Nursing diagnoses Nursing implementation

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