Professional Documents
Culture Documents
- onset
abrupt or gradual?
since childhood or recent
allergen triggered response?
Seasonal?
How long do the allergic
manifestations last? Relieved or persist
once the allergen is removed?
quality and quantity= how severe? Massive
bleeding? How long does it last?
How long do the bleeding episodes last and how
severe they are?
Does blood ooze from a site or does sudden
massive bleeding occur?
How often do bleeding episodes occur and how
long do they last?
What does the client do to stop them?
Is there any break in skin integrity?
Swelling? Edema? Fever? Pain? Tenderness?
Pruritus? Redness? Or drainage?
Note allergic manifestations such as rhinitis,
sneezing, nasal stuffiness, postnasal drip, sore
throat, voice changes, hoarseness, wheezing,
persistent cough, dyspnea, malaise, fatigue, tearing
severity and location= rest can alleviate
fatigue? Bleeding of joints?
Can rest alleviate fatigue? (s/sx of anemia)
Ask how activities and activity tolerance
changed over time
Does the client bruise easily?
Has bleeding in the joints?
Number and saturation of sanitary pads
anaphylactic reactions? Or simple allergic
response?
precipitating factors
Anticoagulant? – bleeding
Bone Marrow suppression – anemia, leukemia, and
thrombocytopenia
Antineoplastic drugs? Antibiotics? Radiation?
Infectious agents? Corticosteroids or
immunosuppressive drugs?
Allergic triggers (inhalants such as pollens and
dust, contact agents such as dyes and cosmetics,
ingested agents such as foods and drugs, injectable
agents such as drugs, vaccine and insect venom)
aggravating and relieving factors
salicylates containing OTC may aggravate bleeding
what relieves allergic manifestations
3. Past Medical History
a. Major illnesses and hospitalization
• Previous hematologic problems
• Surgical procedures that may
affect the hematologic system
• Liver problems
• Any bleeding disorders
How long was the bleeding problem? Do any
members of the family have a history of bleeding?
Is bleeding linked with any specific event or
procedure? Does it occur with menses or following
minor trauma? Any frequency of nose bleeding?
Does he bruise easily? Any petechiae?
How severe are any of the bleeding episodes? What is
the durations?
Any history of hepatic/ splenic or renal disease?
Recently taken medications?
- ruddy skin
- jaundice
- dry skin, brittle, spoon shaped with longitudinal
ridges
petechiae
purpura and ecchymoses
rashes, urticaria, pruritus
2. EYES
- visual disturbances (anemia and polycythemia)
- blindness (retinal hemorrhage related to
thrombocytopenia and bleeding do)
- scleral jaundice (hemolytic anemia)
3. EARS
- vertigo, tinnitus (severe anemia)
- bleeding in auditory canal
(bleeding do)
4. NOSE
- epistaxis (thrombocytopenia
and bleeding disorders)
► 5. MOUTH
► - smooth, glossy, bright red tongue and sore tongue
(pernicious and Fe def. anemia)
► - gingival bleeding (thrombocytopenia and bleeding
disorders)
.
6. LUNGS
- dyspnea, orthopnea (anemia)
7. CARDIOVASCULAR SYSTEM
- tachycardia, palpitation, murmurs, angina (anemia)
8. GIT
- dysphagia (mucous membrane atrophy due to iron def.
anemia)
- abdominal pain( bleeding)
- hepatomegaly, splenomegaly (hemolytic anemia)
- hematemesis, melena (thrombocytopenia and bleeding
disorders)
9. GUT
- hematuria (bleeding disorders)
-amenorrhea and menorrhagia
(iron def. and bleeding do)
10. MUSCULOSKELETAL
- backpain (hemolysis)
- joint pain (hemophilia)
-sternal tenderness and bone pain
(sickle cell crisis)
11. NERVOUS SYSTEM
-headache, confusion
(anemia, polycythemia)
-brain hemorrhage
(thrombocytopenia and bleeding disorders)
-peripheral neuropathy,
paresthesis, loss of balance (pernicious
► Anemia – characterized by paloor, weakness and
lightheadedness, severe anemia manifests with
chronic severe fatigue, exertional dyspnea,
headache or vertigo
► Bleeding d/o –petechiae, purpura and ecchymosis,
spontaneous bleeding from the nose, gingival,
vagina, and rectum, oozing of blood from cuts and
venipuncture sites, jaundice, conjunctival
hematemesis, hematuria and back and flank pain
► Hemophilia – lifelong bleeding tendencies such as
excessive bleeding and circumcision or dental
extraction, repeated episodes of spontaneous
bleeding into joints and lifethreatening bleeding
► Immunodeficiencies – hx of recurrent infxns esp
of mucous membranes (oral cavity, anorectal,
genitourinary, respiratory); poor wound healing,
diarrhea
DIAGNOSTIC
PROCEDURES:
1. Complete Blood Count
a. RBC count- # of RBCs/ mm3 of blood, to diagnose anemia and
ploycythemia
b. Hemoglobin- # of grams of hgb/ 100ml of blood; to measure
the oxygen-carrying capacity of the blood
c. Hematocrit – expressed in %; measures the volume of RBCs in
proportion to plasma; used also to diagnose anemia and
ploycythemia and abnormal hydration states
d. RBC indices- measure RBC size and hemoglobin content
a. MCV (mean corpuscular volume)
b. MCH (mean corpuscular hemoglobin)
c. MCHC (mean corpuscular hemoglobin concentrarion)
e. Platelet count- # of Platelet/ mm3; to diagnose
thrombocytopenia and subsequent bleeding tendencies
f. WBC count- of WBCs/ mm3 of blood; to detect infection or
inflammation
g. WBC Differential count- determines proportion of each WBC in
a sample of 100 WBCs; used to classify leukemias
► 2. Peripheral Blood Smear- to
determine the variations/ abnormality
in RBCs, WBCs and Platelets: normal
size and shape (normocytes) and
Picture 4
normal color (normochromic)
Normocytic-normochromic
3. DIRECT ANTIGLOBULIN EST (Coomb’s
Test) – used in cross matching blood when
transfusion reaction occurs, test umbilical
cord for Erythroblastosis fetalis and
diagnose acquired hemolytic anemia
4. INDIRECT ANTIGLOBULIN TEST-
identifies antibodies to RBC antigens in the
serum of clients who have greater than
normal chance of developing transfusion
reactions.
5. RETICULOCYTE COUNT
- used to determine the responsiveness of the
bone marrow to the depletion of circulating
RBCs (probably due to hemolytic anemia or
hemorrhage)
Bone Marrow Aspiration
BONE MARROW
ASPIRATION and
BIOPSY- used to
determine size and shape
of RBCs, WBCs and platelet
precursors and to examine
various maturational
abnormalities.
NURSING RESP:
Preprocedure - explain the purpose, obtain
consent
- inform client of pain or of what to
expect
- give sedatives as ordered