NURSING MANAGEMENT OF HAEMOPOIETIC DISORDERS

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NURSING MANAGEMENT OF HAEMOPOIETIC DISORDERS:

NURSING MANAGEMENT OF HAEMOPOIETIC DISORDERS PRESENTED BY KIRAN RANDHAWA ARMY COLLEGE OF NURSING

INTRODUCTION :

INTRODUCTION COMMONLY ENCONTERED HAEMOPOIETIC DISORDERS ARE ANEMIA , POLYCYTEMIA , LEUKEMIA , SICKLE CELL ANEMIA , MEGALOBLASTIC ANEMIA , APLASTIC ANEMIA ,THROMBOCYTOPENIA ETC . NURSING MANAGEMENT OF PATIENTS WITH THESE DISORDERS REQUIRES SKILL ASSESSMENT AND MONITORING AS WELL AS METICULOUS CARE AND TEACHING TO PREVENT DETERIORATION AND COMPLICATIONS .

ANEMIA:

ANEMIA IRON DEFICIENCY ANEMIA MEGALOBLASTIC ANEMIA APLASTIC ANEMIA SICKLE CELL ANEMIA THALASSEMIA AND THALASSEMIA MAJOR

IRON DEFICIENCY ANEMIA:

ASSESSMENT PAST HEALTH HISTORY PHYSICAL EXAMINATION SURGERY OR OTHER TREATMENT IRON DEFICIENCY ANEMIA

NURSING DIAGNOSES:

ACTIVITY INTOLERENCE R/T WEAKNESS , FATIGUE , AND GENERAL MALAISE GOAL : PARTICIPATION IN ACTIVITY WITH IN TOLERENCE NSG INTERVENTIONS ASSESS THE LEVEL OF FATIGUE AND NORMAL SLEEP PATTERN , DETERMINE ACTIVITIES THAT CAUSE FATIGUE NURSING DIAGNOSES

CONT… :

ASSIST THE PATIENT TO PRIORITIZE ACTIVITIES. ASSESS THE LEVEL OF FATIGUE & NORMAL SLEEP PATTERN,. ENCOURAGE CONDITIONING EXERCISE TO INCREASE STRENGTH & INDURANCE CONT…

CONT… :

CONT… 2. IMBALANCED NUTRITION, LESS THAN BODY REQUIREMENT, R/T INADEQUATE INTAKE OF ESSENTIAL NUTRIENTS. GOAL : MAINTENANCE OF ADEQUATE NUTRIONAL INTAKE. NSG INTERVENTIONS : ASSESS DIET FOR INCLUSION OF FOODS RICH IN IRON.

CONT… :

CONT… DIETARY TEACHING SESSIONS SHOULD BE INDIVIDULISED, INCLUDING CULTURAL ASPECTS R/T FOOD PREFERENCE & FOOD PREPARATIONS. ADVICE THE PATIENT TO AVOID ALCOHOL. DIETARY SUPPLIMENTS MAY BE PRESCRIBED.

CONT.. :

CONT.. 3.INEFFECTIVE TISSUE PERFUSION R/T INADEQUATE BLOOD VOLUME OR HEMATOCRIT. GOAL : MAITANENCE OF ADEQUATE TISSUE PERFUSION. NSG INTERVENTIONS : ASSESS PATIENT FOR PALPITATION ,CHEST PAIN ,DIZZINESS& SHORTNESS OF BREATH ,MINIMIZE ACTIVITIES THAT CAUSE THESE SYMPTOMS.

CONT.. :

ELEVATE HEAD OF BED & PROVIDE SUPPLEMENTAL OXYGEN AS ORDERED. MONITOR VITAL SIGNS & FLUID BALANCE. LOST VOLUME IS REPLACED WITH TRANSFUSION & I.V FLUIDS. CONT..

PATIENT EDUCATION :

PATIENT EDUCATION PROPER NUTRITION & GOOD SOURCES OF IRON, SELECT WELL- BALANCED DIET. TO TAKE IRON ON EMPTY STOMACH WITH FRUIT JUICE . ENCOURAGE FOLLOW-UP LAB STUDIES. KEEP IRON MEDICATIONS AWAY FROM CHILDREN.

MEGALOBLASTIC ANEMIA :

MEGALOBLASTIC ANEMIA ASSESSMENT ASSESS FOR PALLOR ,TACHYCARDIA, DYSPNEA ON EXCERTION, EXERCICE INTOLERENCE TO DETERMINE PATIENTS RESPONSE TO ANEMIA. ASSESS FOR PARESTHESIA GAIT DISTURBANCE, CHANGES IN BOWEL & BLADDER FUNCTION, ALTERED THOUGHT PROCESS. NUTRITIONAL HISTORY.

NURSING DIAGNOSIS :

NURSING DIAGNOSIS 1. DISTURBED THOUGHT PROCESS R/T NEUROLOGICAL DYSFUNCTION IN THE ABSENCE OF VIT B 12. GOAL : IMPROVING THOUGHT PROCESS. NSG INTERVENTIONS : ADMINISTER PARENTRAL VIT B12 AS PRESCRIBED. PROVIDE PATIENT WITH QUIET, SUPPORTIVE ENVIRONMENT, REORIENT TO TIME, PLACE & PERSON IF NEEDED.

CONT.. :

GIVE INSTRUCTIONS & INFORMATION IN SHORT, SIMPLE SENTENCES & REINFORCE FEQUENTLY. CONT..

CONT... :

CONT... 2 . IMPAIRED SENSORY PERCEPTION (KINESTHETIC) R/T NEUROLOGICAL DYSFUNCTION IN THE ABSENCE OF VIT B 12. GOAL: MINIMIZING THE EFFECTS OF PARESTHESIA. NSG INTERVENTIONS : ASSESS EXTENT & SEVERITY OF PARESTHESIA, IMBALANCE, OR OTHER SENSORY ALTERATIONS.

CONT.. :

CONT.. REFER PATIENT FOR PHYSICAL THERAPY & OCCUPATIONAL THERAPY AS APPROPRIATE. PROVIDE SAFE ENVIRONMENT ;MAKE SURE PERSONAL BELONGINGS ARE WITH IN REACH ; PROVIDE ASSISTANCE WITH ACTIVITIES AS NEEDED.

CONT.. :

CONT.. 3. IMBALANCED NUTRITION LESS THAN BODY REQUIREMENT R/T INADEQUATE INTAKE OF FOLIC ACID. GOAL : MAINTANENCE OF ADEQUATE NUTRITIONAL INTAKE. NSG INTERVENTIONS : ASSESS DIET FOR FOOD RICH IN FOLIC ACID. DIETARY SESSIONS SHOULD BE INDIVIDUALISED.

CONT… :

CONT… ASSIST ALCOHOLIC PATIENTS TO OBTAIN COUNSELING & ADDITIONAL MEDICAL CARE AS NEEEDED

PATIENT EDUCATION :

PATIENT EDUCATION ADVICE PATIENT THAT MONTHLY VIT B12 ADMINISTRATION SHOULD BE CONTINUED FOR LIFE. TEACH THE PATIENT TO SELECT BALANCED DIET . ENCOURAGE PATIENT TO FOLLOW UP PERIODICALLY TO MONITOR CBC.

APLASTIC ANEMIA :

APLASTIC ANEMIA ASSESSMENT PAST MEDICAL HISTORY MONITOR FOR SIGNS OF BLEEDING & INFECTION

NURSING DIAGNOSES:

NURSING DIAGNOSES 1.RISK FOR INFECTION R/T PANCYTOPENIA GOAL: MINIMIZE THE RISK FOR INFECTION NSG INTERVENTIONS CARE OF THE PATIENT IN PROTECTIVE ENVIRONMENT . ENCOURAGE GOOD PERSONAL HYGEINE.

CONT… :

CONT… MONITOR VITAL SIGNS. MINIMIZE INVASIVE PROCEDURES 2.RISK FOR INFECTION R/T BLEEDING GOAL :MINIMIZE THE RISK OF BLEEDING NSG INTERVENTIONS USE SOFT TOOTHBRUSH , ELECTRIC RAZOR FOR SHAVING , KEEP NAILS SHORT BY FILING. AVOID IM INJECTION & OTHER INVASIVE PROCEDURES.

CONT…:

CONT… PREVENT CONSTIPATION . CONTROL BLEEDING BY APPLYING PRESSURE TO SITE. ADMINISTER BLOOD PRODUCT REPLACEMENT AS ORDERED.

PATIENT EDUCATION :

PATIENT EDUCATION TEACH PATIENT HOW TO MINIMIZE THE RISK OF INFECTION . TEACH PATIENT HOW TO MINIMIZE RISK OF BLEEDING . TEACH PATIENT TO TAKE ONLY PRESCRIBED MEDICATIONS. AVOID ASPIRIN & NSAIDS ETC .

SICKLE CELL ANEMIA:

SICKLE CELL ANEMIA ASSESSMENT HISTORY OF POSSIBLE DEHYDRATION , HYPOXIA , INFECTION & OTHER PPT EVENT . CHARACTERSTIC OF PAIN OBSERVE FOR PALLOR & JAUNDICE , CHANGES IN VITALS , ULCERS , SKIN LESIONS ETC ENLARGEMENT OF LIVER & SPLEEN ,TENDERNESS OF FEETS & HANDS

NURSING DIAGNOSES:

NURSING DIAGNOSES ACUTE PAIN R/T TISSUE HYPOXIA DUE TO AGGLUTINATION OF SICKLE CELLS WITHIN BLOOD VESSELS GOAL :RELIEF OF PAIN NSG INTERVENTIONS CAREFULLY POSITION & SUPPORT PAINFUL AREA. DISTRACT THE MIND OF THE PATIENT

CONT…:

BATH WITH WARM WATER , APPLYING LOCAL HEAT OR MASSAGE. MAINTAIN BED REST . GIVE PRESCRIBED MEDICATIONS . CONT…

CONT…:

CONT… 2. INEFFECTIVE TISSUE PERFUSION R/T INCREASED BLOOD VISCOSITY GOAL :MAINTENANCE OF ADEQUATE TISSUE PERFUSION NSG INTERVENTIONS ADMINISTER OXYGEN ADMINISTER BLOOD FOR SEVERE ANEMIA

CONT…:

CONT… 3. ACTIVITY INTOLERENCE R/T ANEMIA GOAL : PARTICIPATION IN ACTIVITY WITH IN TOLERENCE NSG INTERVENTIONS MAINTAIN BED REST THEN INCREASE ACTIVITY GRADUALLY TO INCREASE ENDURANCE . ENCOURAGE REST PERIODS , ALTERNATING WITH ACTIVITY . ENCOURAGE GOOD EATING HABITS , SLEEP & RELAXATION .

CONT…:

4. RISK FOR INFECTION GOAL : PREVENTING & MANAGING THE INFECTION NSG INTERVENTIONS ASSESS THE PATIENT FOR SIGNS OF DEHYDRATION . ADMINISTER ANTIBIOTICS AS PRESCRIBED . CONT…

CONT…:

CONT… GIVE METICULOUS CARE TO OPEN WOUND IF ANY . BARRIER NURSING .

PATIENT EDUCATION :

PATIENT EDUCATION GENETIC COUNSELING TO THE FAMILY . INSTRUCT FAMILY HOW TO RECOGNISE THE SIGNS OF DEHYDRATION . ENCOURAGE GOOD DENTAL HYGEINE . INSTRUCT ON PREVENTIVE CARE INCLUDING CHILDHOOD IMMUNIZATION & SCREENING TESTS .

CONT…:

WARN AGAINST TRIPS TO MOUNTAINS OR UNPRESSURIZED PLANES THAT WILL DECREASE OXYGEN CONCENTRATION . ENCOURAGE A CALM , EMOTIONALLY STABLE ENVIRONMENT . CONT…

THALASSEMIA & THALASSEMIA MAJOR :

THALASSEMIA & THALASSEMIA MAJOR ASSESSMENT FAMILY HISTORY ASSESS FOR SYSTEMIC COMPLICATIONS OF THALASSEMIA -SPLENOMEGALY -HEPATOMEGALY -ENDOCRINE ABNORMALITIES -CARDIAC COMPLICATIONS MEASURE GROWTH & DEVELOPMENT PARAMETERS

NURSING DIAGNOSES :

NURSING DIAGNOSES INEFFECTIVE TISSUE PERFUSION R/T ABNORMAL HAEMOGLOBIN GOAL : MAINTENANCE OF ADEQUATE TISSUE PERFUSION NSG INTERVENTIONS ADMINISTER BLOOD TRANSFUSION AS ORDERED . CHECK FOR ALLERGIC REACTION , FEBRILE , CICULATORY OVERLOAD OR HEMOLYTIC REACTION.

CONT…:

MONITOR FOR CV STATUS FOR COMPLICATIONS –MONITOR APICAL PULSE , BP & RESPIRATION ,ASSESS EDEMA . CONT…

CONT…:

CONT… 2. ACTIVITY INTOLERENCE R/T BONE PAIN , CARDIAC DYSFUNCTION & ANEMIA GOAL: MINIMIZING ACTIVITY INTOLERENCE NSG INTERVENTIONS ENCOURAGE PARTICIPATION IN ACTIVITIES THAT DOESNOT REQUIRE SIGNIFICANT STRENUOUS ACTIVITY.

CONT…:

CONT… FACILITATE PHYSICAL & OCCUPATIONAL THERAPY CONSULATION TO DEVELOP AN ACCEPTABLE EXERCISE PLAN .

CONT…:

CONT… 3. RISK FOR INFECTION R/T PROGRESSIVE ANEMIA GOAL : PREVENTING INFECTION NSG INTERVENTIONS ADMINISTER PRESCRIBED ANTIBIOTICS. FEVER OF 102 F SHOULD BE REPORTED IMMEDIATELY.

PATIENT EDUCATION :

PATIENT EDUCATION GENETIC COUNSELLING PROVIDE DETAILED INSTRUCTION ABOUT: - PREVENTION & TREATMENT OF INFECTION -MEDICATION -DIETARY MODIFICATION TO LIMIT IRON INTAKE -SIGNS OF COMPLICATIONS

CONT…:

RESTRICT ACTIVITY THAT INCREASES THE RISK FOR INFECTION . CONT…

HEMOPHILIA:

HEMOPHILIA ASSESSMENT OBTAIN HISTORY OF & OBSERVE FOR UNUSUAL BLEEDING –ECHYMOSIS , PROLONGED BLEEDING FROM MUCOUS MEMBRANES & LACERATIONS , HEMATOMAS , HEMATURIA , RECTAL & GI BLEEDING ASSESS JOINTS FOR SWELLING , WARMTH , TENDERNESS , ROM , CONTRACTURES , & MUSCLE ATROPY

NURSING DIAGNOSES:

NURSING DIAGNOSES 1.RISK FOR DEFICIENT FLUID R/T HEMORRHAGE GOAL :PREVENTING HYPOVOLEMIA THROUGH CONTROL OF BLEEDING NSG INTERVENTIONS PROVIDE EMERGENCY CARE FOR BLEEDING -APPLY PREESURE & COLD ON THE AREA IMMOBILIZE & ELEVATED ABOVE HEART LEVEL

CONT…:

CONT… ADMINISTER RECOMBINANT FACTOR VIII OR FACTOR IX COAGULATION CONCENTRATE . APPLY FIBRINOLYTIC AGENTS TO WOUND FOR ORAL BLEEDING MONITOR VITAL SIGNS & TREAT FOR SHOCK IF PATIENT BECOMES HYPOTENSIVE

CONT…:

2.INEFFECTIVE PROTECTION R/T INABILITY OF BLOOD TO CLOT GOAL: PROVIDING PROTECTION AGAINST BLEEDING NSG TNTERVENTIONS AVOID RECTAL TEMPERATURE , USE AXILLARY , ORAL OR EXTERNAL EAR ROUTE AVOID INJECTIONS IF POSSIBLE - ADMINISTER MEDICATIONS ORALLY CONT…

CONT…:

CONT… -SC ROUTE IS PREFERRED OVER IM -APPLY PRESSURE TO INJECTION SITE FOR 10 TO 15 MINUTES THEN APPLY A PRESSURE DRESSING WITH SELF ADHESIVE GAUZE 3. IMPAIRED PHYSICAL MOBILITY R/T REPEATED HEMARTHROSES GOAL :PRSERVING MOBILITY NSG INTERVENTIONS

CONT…:

CONT… TREAT HEMARTHROSIS OR MUSCLE BLEED IMMOBILIZE THE JOINT IN A POSITION OF SLIGHT FLEXION ELEVATE THE AFFECTED PART ABOVE THE LEVEL OF HEART APPLY ICE PACKS ADMINISTER SHORT COURSE OF CORTICOSTERIODS AS ORDERED TO RELIEVE INFLAMMATION

CONT…:

CONT… 4. ACUTE PAIN R/T BLEEDING INTO THE JOINT & MUSCLES GOAL: RELIEVING PAIN NSG INTERVENTIONS BE AWARE THAT INCREASED PAIN USUALLY MEANS THAT BLEEDING CONTINUES ADMINISTER OR TEACH ADMINISTERATION OF ACETAMINOPHEN DURING ACUTE PHASE . NSAIDS MAY BE USED FOR CHRONIC PAIN

CONT…:

CONT… FOR CHRONIC PAIN , CONSIDER SUCH ALTERNATIVES AS HYPNOSIS , RELAXATION TECHNIQUES , & DIVERSIONAL THERAPY

SUMMERISATION :

SUMMERISATION INTRODUCTION FE DEFICIENCY ANEMIA MEGALOBLASTIC ANEMIA APLASTIC ANEMIA SICKLE CELL ANEMIA THALASEMMIA &THALASEMMIA MAJOR HEMOPHILIA

BIBLIOGRAPHY :

BIBLIOGRAPHY WILKINS & WILLIAMS LIPPINCOTT, “MANUAL OF NURSING PRACTICE “ , 8 TH ED , JAYPEE BROTHERS MEDICAL PUBLISHERS LTD. , PHILADELPHIA , Pp –1638 –1644 MOSBY , “COMPRIHENSIVE REVIEW OF NURSING FOR NCLEXRN” , 17 TH ED , LOUIS LONDON PHILADELPHIA , SYDNEY TORONTO , Pp-934 –936 SUDDARTH & BRUNNER , “MEDICAL SURGICAL NURSING “ , 10 TH ED , LIPPINCOTT WILLIAMS &WILKINS , Pp –918 –930

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