Trances by Jamaica Maga

PPT: BLOOD DISORDERS 4. Hemoglobin

- Male: 14-18 g/dL
HEMATOLOGY - Female: 12-16 g/dL
- Study of blood and blood forming tissues
- Key components of hematologic system are: ERYTHROCYTES/ RED BLOOD CELLS
 Blood
- Composed of hemoglobin
 Blood forming tissues
- Erythropoiesis (RBC production)
o Bone marrow
 Stimulated by hypoxia
o Spleen
 Controlled by erythropoietin (hormone
o Lymph system
synthesized in kidney)
- Hemolysis (destruction of RBCs)
FUNCTIONS OF THE BLOOD
 Releases bilirubin into blood stream
1. Transportation
 Normal lifespan of RBC: 90-120 days
- Oxygen
- Nutrients LEUKOCYTES/ WHITE BLOOD CELLS
- Hormones 5 TYPES:
- Waste Products
2. Regulation 1. Basophils
- Fluid, Electrolyte 2. Eosinophils
- Acid-Base balance 3. Neutrophils
3. Protection 4. Monocytes
- Coagulation 5. Lymphocytes
- Fight Infections TYPES AND FUNCTIONS OF LEUKOCYTES
COMPONENTS OF BLOOD
• GRANULOCYTES
1. PLASMA
1. Neutrophil
- 55%
- Protein (7%): Albumin (58%), Globulin (38%), - Phagocytosis, Early phase of inflammation
Fibrinogen (4%) 2. Eosinophil
- Water (91%) - Phagocytosis, allergic response
- Other Solutes (2%): Ions, Nutrients, Waste 3. Basophil
- Inflammatory response and immune stimuli,
Products, Gases, Regulatory Substances
2. BLOOD CELLS Secrete heparin which prevents abnormal
- 45% clotting
- Three types: • AGRANULOCYTES
 Erythrocytes/ RBC
1. Lymphocyte
 Leukocytes/ WBC
- T cells (Cell mediated)
 Thrombocytes/ Platelets
2. Monocyte
NORMAL VALUES
- B cells (humoral immunity)
1. Platelets
- Phagocytosis: cellular immune response
- 150, 000- 400,000/ µl
- Dies after 10 days THROMBOCYTES/ PLATELETS
2. Leukocytes - Must be present for clotting to occur
- 4,000- 11,000 - Involved in hemostasis
- Neutrophils, Eosinophils, Basophils,
Lymphocytes, Monocytes NORMAL CLOTTING MECHANISMS
3. Erythrocytes • HEMOSTASIS- process to prevent and stop bleeding
- Male: 4.5- 5.5 x 106/ℓ
1. Vascular Response
- Female: 4.0-5.0 x 106/ℓ
- Vasoconstriction
- Dies after 90-120 days
 Trances by Jamaica Maga

- Serotonin, Epinephrine, Lipoprotein secretion • SPLEEN

- Contraction of blood vessels
- Located in upper L quadrant of abdomen
2. Platelet response
- Functions
- Adherence of platelet to collagen fibers
1. Hematopoietic function
- Adenosine diphosphate causes platelets to
- Produces fetal RBCs
breakdown and stick together
2. Filter function
- Form clumps (agglutination)
- Filter and reuse certain cells
3. Plasma Clotting Factors
- The spleen sequesters the old, worn RBC’s,
- Factors I-XIII
thereby removing them from the circulation
- Intrinsic Pathway
3. Immune function
- Extrinsic Pathway
- Lymphocytes, monocytes
- Firm clot forms
4. Storage function
ANTI-COAGULATION - 30% platelets stored in spleen
- Elements that interfere with blood clotting EFFECTS OF AGING ON THE HEMATOLOGIC SYSTEM
- Counter mechanism to blood clotting—keeps
• CBC Studies
blood liquid and able to flow
- ↓ Hemoglobin (Hb or Hgb)
STRUCTURESS OF THE HEMATOLOGIC SYSTEM
- ↓ response to infection (WBC)
• ORGANS - Platelets= no change
- Bone Marrow • Clotting Studies
- Liver
- ↓ PTT
- Lymph System
ASSESSMENT OF THE HEMATOLOGIC SYSTEM
• BONE MARROW
• Subjective Data
- Soft substance in core of bones
- Blood cell production (Hematopoiesis): The - Important Health Information
production of all types of blood cells generated  Past health history
by a remarkable self-regulated system that is  Medications
responsive to the demands put upon it  Surgery or other treatments
- RBCs • Functional Health Patterns
- WBCs
- Platelets - Health perception- health management
- Nutritional- metabolic
• LIVER - Elimination
- Receives 24% of the cardiac output (1500mL of - Activity- exercise
blood each minute) - Sleep-rest
- Liver has many functions - Cognitive- perceptual
- Hematologic functions: - Self-perception- self- concept
 Liver synthesis plasma proteins including - Role- relationship
clotting factors and albumin - Sexuality- reproductive
 Liver clears damaged and non- - Coping- Stress tolerance
functioning RBCs/ erythrocytes from - Value-belief
circulation • Objective Data
- Physical Examination
 Skin
 Eyes
 Mouth
 Lymph nodes
 Trances by Jamaica Maga

 Heart and Chest • CLINICAL MANIFESTATIONS

 Abdomen
1. Pallor
 Nervous System
2. Fatigue, weakness
 Musculoskeletal System
3. Dyspnea
DIAGNOSTIC STUDIES OF THE HEMATOLOGIC SYSTEM 4. Palpitations, Tachycardia
5. Headache, dizziness, and restlessness
• COMPLETE BLOOD COUNT (CBC)
6. Slowing of thought
 WBCs 7. Paresthesia- burning or prickling sensation
- Normal 4,000- 11,000 µ/ℓ
• NURSING MANAGEMENT
- Associated with infection, inflammation, tissue
injury or death 1. Promote optimal activity and protect from injury
- Leukopenia- ↓WBC 2. Reduce activities and stimuli that cause
- Neutropenia- ↓ neutrophil count tachycardia and increase cardiac output
 RBC 3. Provide nutritional needs
- Male: 4.5- 5.5 x 106/ℓ 4. Administer any prescribed nutritional
- Female: 4.0-5.0 x 106/ℓ supplement
 HEMATOCRIT 5. Patient and family education
- The hematocrit is the percent of whole blood
• NURSING ACTIONS (for a px who is anemic or suffered
that is composed of red blood cells. The
blood loss)
hematocrit is a measure of both the number of
red blood cells and the size of red blood cells. - Administer oxygen as prescribed
 PLATELET COUNT - Administer blood products as prescribed
- Normal 150,000- 400,000 - Administer erythropoietin as prescribed
- Thrombocytopenia- ↓ platelet count - Allow for rest between periods of activity
- Spontaneous hemorrhage likely when count is - Elevate the px’s head on pillows during episodes
below 20,000 of SOB
 Pancytopenia- Decrease in number of RBCs, - Provide extra blankets if the px feels cool
WBCs, and platelets ANEMIA caused by DECREASED ERYTHROCYTE
• RADIOLOGIC STUDIES PRODUCTION

- CT/MRI of lymph tissues 1. Iron Deficiency Anemia

2. Thalassemia
• BIOPSIES
3. Megaloblastic Anemia
- Bone marrow examination
IRON DEFICIENCY ANEMIA
- Lymph node biopsies
• Etiology
ANEMIA
1. Inadequate dietary intake
- Anemia is a reduction in the number of RBCs, the
- Found in 30% of the world’s population
quantity of hemoglobin, or the volume of RBCs
2. Malabsorption
- Because the main function of RBCs is
- Absorbed in duodenum
oxygenation, anemia results in varying degrees
- GI surgery
of hypoxia
3. Blood loss
- Prevalent conditions
- 2 mls of blood contain 1mg iron
o Blood loss
- GI, GU losses
o Decreased production of erythrocytes
4. Hemolysis
o Increased destruction of erythrocytes
 Trances by Jamaica Maga

• Clinical Manifestations THALESSEMIA

- Most common: pallor - Malformed red blood cell
- Second most common: inflammation of the - Autosomal Recessive
tongue (glossitis)
• Etiology
- Cheilitis
- Sensitivity to cold - Autosomal recessive genetic disorder of
- Weakness and fatigue inadequate production of normal hemoglobin
- Found in Mediterranean ethnic groups
• Diagnostic Studies
• Clinical Manifestations
- CBC
- Iron studies diagnostics - Asymptomatic → major retardation → life
- Iron levels: Total iron-binding capacity (TIBC), threatening
Serum Ferritin - Splenomegaly, hepatomegaly
- Endoscopy/ Colonoscopy • Collaborative Care
Cheilosis- A disorder of the lips marked by scaling and - No specific drug or diet are effective in theating
fissures at the corners of the mouth; caused by a lack of thalassemia
(deficiency) of riboflavin - Thalassemia minor- body adapts to ↓ Hgb
- Thalassemia major- blood transfusions with IV
• Collaborative Care
deferoxamine (used to remove excess iron from
- Treatment of underlying disease/ problem the body)
- Replacing iron
- Diet MEGALOBLASTIC ANEMIAS
- Drug therapy - Characterized by large RBCs which are fragile
 Iron replacement and easily destroyed
o Oral iron - Common forms of megaloblastic anemia
 Feosol, DecFerrum, etc 1. Cobalamin Deficiency
 Absorbed best in acidic 2. Folic Acid Deficiency
environment
COBALAMIN (VIT. B12) DEFICIENCY
 GI effects
o Parenteral iron - Cobalamin Deficiency: formerly known as
 IM or IV PERNICIOUS ANEMIA
 Less desirable than PO - Vitamin B12 (Cobalamin) is an important water-
soluble vitamin
• Nursing Management
- Intrinsic factor (IF) is required for cobalamin
- Assess cardiovascular and respiratory status absorption
- Monitor VS
• Causes
- Recognizing s/sx bleeding (monitor stool, urine
and emesis for occult blood - Gastric mucosa not secreting IF
- Diet teaching- foods rich in iron - GI surgery → loss of IF- secreting gastric mucosal
- Provide periods of rest cells
- Supplemental iron - Long-term use of H2-histamine receptor blocker
- Discuss diagnostic studies cause atrophy or loss of gastric mucosa
- Emphasize compliance - Nutritional deficiency
- Iron therapy for 2-3 months after the - Hereditary defects of cobalamin utilization
hemoglobin levels return to normal • Clinical Manifestations
- General symptoms of anemia
- Sore tongue
- Anorexia
 Trances by Jamaica Maga

- Weakness FOLIC ACID DEFICIENCY

- Paresthesia of the feet and hands
- Altered thought processes
- Confusion→ dementia
• Diagnostic Studies
- RBCs appear large
- Abnormal shapes
- Structures contributes to erythrocyte
destruction
- Schilling Test: a medical investigation used for
patients with Vit. 12 deficiency. The purpose of
the test is to determine if the patient has
pernicious anemia.
• Dx: SCHILLING’S TEST
- STAGE 1: Oral Vitamin B12 plus intramuscular
vitamin B12
 Oral Dose: patient is given radiolabels Vit.B12
(The most commonly used radiolabels are 57Co
and 58Co
 An IM injection of unlabeled vitamin B12 is
given an hour later
 The patient’s urine is then collected over the
next 24 hours to assess the absorption
 A normal result shows at least 10% of the
radiolabeled vitamin B12 in the urine over the
first 24 hours
 In patients with impaired absorption, less than
10% of the radiolabeled vitamin B12 is detected
• Collaborative Care
- Parenteral administration of cobalamin
- ↑ Dietary cobalamin does not correct the
anemia (still important to emphasize adequate
dietary intake)
- Intranasal form of cyanocobalamin (Nascobal) is
available
- High dose oral cobalamin and SL cobalamin can
be used
• Nursing Management
- Familial disposition
- Early detection and treatment can lead to
reversal of symptoms
- Potential for injury r/t patient’s diminished
sensations to heat and pain
- Compliance with medication regime
- Ongoing evaluation of GI and neuro status
- Evaluate patient for gastric carcinoma frequently
- Folic Acid Deficiency also cause megaloblastic
anemia (RBCs that are large and fewer in n
umber)
- Folic Acid required for RBC formation and
maturation
- Causes
- Poor Dietary Intake
- Malabsorption syndromes
- Drugs that inhibit absorption
- Alcohol abuse
- Hemodialysis
- Clinical Manifestations are similar to those of
cobalamin deficiency
- Insidious Onset: progress slowly
- Absence of neurologic problems
- Treated by folate replacement therapy
- Encourage to eat foods with large amounts of
folic acid (leafy green vegetable, liver,
mushrooms, oatmeal, peanut butter, red beans)
ANEMIA OF CHRONIC DISEASE
- Underproduction of RBCs, shortening of RBC
survival
- 2nd most common cause of anemia (after iron
deficiency anemia)
- Generally develops after 1-2 months of
sustained disease
- Causes
 Impaired renal function
 Chronic, inflammatory, infectious or malignant
disease
 Chronic liver disease
 Folic acid deficiencies
 Splenomegaly
 Hepatitis
APLASTIC ANEMIA
- Characterized by Pancytopenia
- ↓ of all blood c ell types (RBC, WBC, Platelets)
- Hypo-cellular bone marrow
• Etiology
- Congenital (Chromosomal alterations)
- Acquired (Results from exposure to ionizing
radiation, chemical agents, viral and bacterial
infections)
- Low incidence (Affecting 4 of every 1M persons)
 Trances by Jamaica Maga

- Manageable with erythropoietin or blood CHRONIC BLOOD LOSS

transfusion
• Sources/ Symptoms
- Can be a critical condition (Hemorrhage, Sepsis)
- Similar to iron deficiency anemia
• Clinical Manifestations
- GI bleeding, hemorrhoids, menstrual blood loss
- Gradual development
• Diagnostic Studies
- Symptoms caused by suppression of any or all
bone marrow elements - Identifying source
- General manifestations of anemia: - Stopping bleeding
 Fatigue • Collaborative Care
 Dyspnea
 Pale skin - Supplemental iron administration
 Frequent or prolonged infections ANEMIA caused by INCREASED ERYTHROCYTE
 Unexplained or easy bruising DESTRUCTION
 Nosebleed and bleeding gums
 HEMOLYTIC ANEMIA
 Prolonged bleeding from cuts
1. Sickle Cell disease (peds)
 Dizziness
2. Acquired Hemolytic Anemia
 Headache
3. Hemochromatosis
• Diagnosis 4. Polycythemia
- Blood Tests (CBC) SICKLE CELL ANEMIA
- Bone Marrow Biopsy
• SICKLE CELL CRISIS “SICKLE”
• Treatment
 Because RBCs are “sickle” shaped in individuals
- Identifying cause with sickle cell disease, it is more difficult for
- Blood transfusions them to maneuver through blood vessels. When
- Antibiotics sickled RBCs get obstructed in vessels, it causes
- Immunosuppressant (neural, sandimmune) excruciating pain called a Sickle Cell Crisis
 Corticosteroids (Medrol, solu-medrol) (episode)
- Bone Marrow stimulants - Significant blood loss (Surgery, trauma, etc.)
 Filgrastim (Neupogen) - Illness
 Epoetin alfa (Epogen, Procrit) - Climbing or flying to HIGH altitudes
- Bone marrow transplantation - Keeping continued STRESS
• Nursing Management - Low fluid intake (dehydration)
- Elevated temperature (fever, exercise) or COLD
- Preventing complications from infection and
hemorrhage
- Prognosis is poor if untreated (75% fatal)
ANEMIA CAUSED BY BLOOD LOSS
1. Acute Blood Loss
2. Chronic Blood Loss
ACUTE BLOOD LOSS
- Result of sudden hemorrhage (trauma, surgery,
vascular disruption)
- Collaborative Care - Sickle Cell disease: is a genetic disorder that
 Replacing blood volume affects erythrocytes (RBC) causing them to
 Identifying source of hemorrhage become sickle or crescent shaped
 Stopping blood loss
 Trances by Jamaica Maga

- The effects of this condition due to an • Complications

abnormality of the hemoglobin molecules
- Accumulations of hemoglobin molecules can
found in erythrocytes
obstruct renal tubules → tubular necrosis
• Clinical Manifestations
• Treatment
- Irritability
- Elimination the causative agent
- Pallor
- Hepatosplenomegaly • Potential Nursing Dx for Px with Anemia
- Jaundice 1. Activity Intolerance r/t weakness, malaise m/b
- Growth retardation difficulty tolerating ↑’d activity
- In OLDER CHILDREN 2. Imbalance nutrition: less than body
 Pain (joint, back, and abdominal) requirements r/t poor intake, anorexia, etc. m/b
• Management wt loss, ↓ serum albumin, ↓ iron levels, vitamin
deficiencies, below ideal body wt.
- Goal is to avoid sickling
3. Ineffective therapeutic regimen management
- Use regional technique if possible
r/t lack of knowledge about
- Promote supplemental oxygen and IV fluids
nutrition/medications etc. m/b ineffective
- Use warming blanket to prevent
lifestyle/diet/ medication adjustments
vasoconstriction; must avoid hyperthermia also,
4. Collaborative Problem: Hypoxemia r/t ↓Hgb
as it promotes sickling
- Use vasopressors to support BP if necessary HEMATOCHROMATOSIS

SEQUENCE OF EVENTS IN HEMOLYSIS - Iron overload disease

- Over absorption and storage of iron causing
damage especially to liver, heart, and pancreas

ACQUIRED HEMOLYTIC ANEMIA

POLYCYTHEMIA
• Causes
- Polycythemia is a condition in which there is a
- Medications net increase in the total number of RBCs
- Infections - Overproduction of RBC may be due to
• Manifestations  A primary process in the bone marrow (a so-
called Myeloproliferative syndrome)
- S/sx of anemia  May be a reaction to chronically ↓ O2 levels
 Malignancy
 Trances by Jamaica Maga

• Complications • Collaborative Management

- ↑ blood viscosity of blood
- → hemorrhage and thrombosis
• Treatment
- Phlebotomy
- Myelosupressive agents: A number of new
therapeutic agents such as, interferon alfa-2b
(Intron A) therapy, agents that target platelet
number (e.g., anagrelide [Agrylin]), and platelet
function (e.g., aspirin).
PPT: BLOOD DISORDERS AFFECTING THE RBCs
POLYCYTHEMIA
- Increased rbc and hgb production
- Compensatory response to chronic hypoxia
• Causes
- Increase fluid intake to reduce blood viscosity
- Monitor for signs and symptoms of bleeding
- Monitor for signs and symptoms of thrombo-
embolism:
 Angina
 Claudication
 Thrombophlebitis
 Pruritus
- Administer analgesic as ordered
- Administer antihistamine to decrease pruritus
- Therapeutic phlebotomy to reduce circulating
volume.
- Chemotherapy to inhibit hyperactivity of the
bone marrow
- Patient teaching: Avoid high altitude (mountains,
airplane travel)
- Low oxygen levels in high altitudes tend to
stimulate the kidneys to increase secretion of
erythropoietin. This causes RBC production.
ANEMIAS

POLYCYTHEMIA VERA - Acute or chronic blood loss

- Inadequate dietary intake of vitamins and
- Hyperplasia of the bone marrow minerals needed for RBC production
- Increased RBC (erythrocytosis) - Decreased RBC production by the bone marrow
- Increased WBC (leukocytosis) (e.g. aplastic anemia)
- Increased Platelets (thrombocytosis) - Increased destruction of RBC (e.g. hemolytic
- Cause is unknown; associated with genetics anemia, severe infection, cancer)
- Increased risk of CVA and MI due to - Increased demands of vitamins and minerals
thromboembolism needed for RBC production (e.g. infants,
adolescents, pregnant clients)
• Anemia con’t
- The primary problem in anemia is decreased
availability of oxygen to the tissues
• Types of Anemia
1. Iron deficiency anemia
2. Folate deficiency anemia
3. Aplastic anemia
• Sign and Symptoms 4. Pernicious anemia
- Ruddy Complexion • Clinical Manifestations
- Headache and Dizziness
- Pallor
- Fatigue
- Easy fatigability
- Blurred Vision
- Weakness
- Hepatosplenomegaly
- Anorexia
 Trances by Jamaica Maga

- SOB reactions like nausea, vomiting, epigastric pain,

- Headache/ Dizziness pallor, drowsiness.
- Tachycardia/ Palpitations - Iron may cause constipation. Increase fluid
- Syncope intake
- Brittle hair and nails - Oxygen therapy for SOB (shortness of breath)
- Paresthesia - Promote rest to reduce oxygen demands of
- Cold sensitivity tissues. This is the priority nursing intervention
- Amenorrhea - Provide good oral care. To prevent and relieve
stomatitis
IRON DEFICIENCY ANEMIA
- Provide good skin care. To prevent pressure
- Microcytic, hypochromic anemia sore, especially among bedridden clients.
- ASSESSMENT: Vinson—Plummer’s Syndrome: - Diet: Iron — rich foods.
 Stomatitis  Organ meats, lean meat, egg yolk
 Dysphagia  Beans or Green, leafy vegetables
 Atrophic glossitis (smooth, sore tongue)  Raisins; other dried fruits
 Cheilosis (cracks at the side of the lips)
FOLATE DEFICIENCY ANEMIA (MEGALOBLASTIC
 Koilonychia (spoon- shaped or concave
ANEMIA)
fingernails)
 PICA (craving of non-edible substances like clay, - This is due to chronic deficiency of folic acid.
laundry starch, ice, uncooked rice, etc.) - Folate is present in green leafy vegetables
 Tinnitus - Absorbs in the jejunum
 Cardiovascular symptoms (if Hgb= 7.5 g/dL or - Causes:
below): ↑ PR, Chest pain, SOB, CHF - Poor dietary intake
- Rarely eat uncooked (raw) fruits and vegetables
• Collaborative Management
- Alcoholism
- BT if necessary - Chronic malnutrition
- Iron supplement - Pregnancy
 Oral - Anorexia nervosa
 Ferrous Sulfate. Given after meals to - Malabsorption
prevent GI irritation - Malignancy
 Ferrous Gluconate. Given before meals. - Prolonged TPN
These do not cause GI irritation - Chronic hemodialysis
 Ferrous Fumarate. Given before meals for
• Clinical manifestations
adequate absorption
 Parenteral - Cracked lips, sore tongue.
 Iron Dextran (Imferon). Administered by Z- - Macrocytic, hyperchromic RBCs.
track method to prevent staining of the skin. - Decreased RBC, hemoglobin, hematocrit,
Do not massage site of injection. To prevent increased MCV and MCHC
leakage of medication into the
• Collaborative Management
subcutaneous layer.
- Oral liquid iron to be administered with straw to - Well-blanched diet that includes green
prevent permanent staining of the teeth. vegetables (asparagus, broccoli, spinach), yeast,
- Vitamin C increases iron absorption, e.g. orange liver and other organ meats, some fresh fruits;
juice avoid over — cooking vegetables.
- Do not administer with tea, milk, antacid. These - Folic acid 1 mg./day per orem as prescribed.
will inhibit absorption of iron. - Note: Folic acid deficiency among pregnant
- Iron salts change color of stool to dark green or clients may cause congenitally acquired neural
black. This is harmless. These can cause adverse tube defects (spina bifida)
 Trances by Jamaica Maga

PERNICIOUS ANEMIA - The test involves administration of small amount

of radioactive B12 orally and 24-hour urine
- A type of megaloblastic anemia associated with
collection to measure uptake. Decreased
Vit. B12 deficiency
excretion of vitamin B12 in the urine supports
- It is also called megaloblastic anemia or
the diagnosis of pernicious anemia
macrocytic, hyperchromic anemia
- Causes are gastric surgery, Chrohn’s disease, • Clinical Manifestations
autoimmune gastric mucosa atrophy
- “Beef red, inflamed tongue”- this is the most
- Decreased intrinsic factor production by tie
characteristic manifestation.
parietal cells of the stomach causes decreased
- Neurologic involvement due to destruction of
Vit. B12 absorption. Vit. B12 has to bind with
axons of neurons: paresthesia, lack of balance,
intrinsic factor so that it can be absorbed in the
uncoordinated movements, paralysis, altered
small intestine.
thought processes, bladder and bowel
- Decreased Vitamin B12 absorption results to the
dysfunction, psychiatric symptoms caused by
following:
cerebral dysfunction.
- Decreased RBC production.
- Jaundice due to faulty erythropoiesis.
- Decreased DNA synthesis in maturing RBCs; the
RBCs do not divide normally so, they grow big • Collaborative Management
resulting to megaloblastic cells. - Monthly vitamin B12 1M for life. Oral vitamin
- Impaired integrity of cells in the Gl tract (mouth, B12 cannot be absorbed because of inadequate
stomach, anus), vagina, and axon of neurons. intrinsic factor.
• Pathophysiology - Folic acid (Folvite), up to 1 mg/day PO.; given IM
to patients with malabsorption.
- Decreased INTRINSIC FACTOR production by the
- Ferrous Sulfate (Feosol) or Ferrous Gluconate
parietal cells of the stomach VITAMIN B12
(Fergon) 0.3g TID PO PRN
absorption
- Hydrochloric acid (HCI), 4 to 10 ml. PO, well
- Decreased RBC production
diluted in water TID (three times a day) with
- Decreased DNA synthesis in maturing RBC
meals during first week of vitamin B12 therapy.
(megaloblastic cells)
- Blood transfusion as needed.
- Impairment of integrity of cells, (mouth,
- Physical examination every 6 months for
stomach, anus, vagina, axon of neurons)
hematologic studies and GI evaluation. The client
• Diagnostic Test may develop hematologic or neurologic relapse
if therapy is inadequate
- Tubeless Gastric Analysis: Diagnex blue /
- Note: Patients with pernicious anemia have
Azuressin tablet per orem
higher incidence of gastric cancer and thyroid
- Collect urine specimen
dysfunction; periodic stool examinations for
- Blue - HCI is present - (-) Pernicius Anemia
occult blood, gastric cytology, and thyroid
- X Blue - (-) HCL (Achlorhydria) - (+) Pernicius
function tests are done
Anemia
- Notes: APLASTIC ANEMIA
 HCL and intrinsic factor are both produced by the
- Is a disorder characterized by bone marrow
parietal cells of the stomach.
hyploplasia or aplasia resulting in pancytopenia
 CBC and blood smear show decreased
(decreased numbers of RBCs, WBCs, and
hemoglobin and hematocrit; with unusually
platelets).
large RBCs.
- The causes of aplastic anemia are as follows:
 Gastric analysis shows volume and acidity of
congenital (Fanconi anemia); exposure to
gastric juice are diminished.
chemical toxins; idiopathic; ionizing radiation;
 Schilling's Test. This is the most definitive
viral infections, especially hepatitis; certain
diagnostic test for pemicious anemia.
drugs (e.g., Chloramphenicol)

- Bone marrow aspiration and biopsy show bone
marrow is fatty, hypocellular or empty with
greatly reduced or absent hematopoiesis.
• Clinical Manifestations
- From anemia: pallor, weakness, fatigue,
exertional dyspnea, palpitations.
- From infections associated with neutropenia:
fever, headache, malaise; abdominal pain,
diarrhea; adventitious breath sounds; erythema,
pain, exudates at wounds or sites of invasive
procedures.
- From thrombocytopenia: bleeding from gums,
nose, gastrointestinal, or genitourinary tracts;
purpura, petechiae, ecchymoses.
• Collaborative Management
- Bone marrow transplantation
- Immunosuppressive therapy:
- Corticosteroids
- Sandimmune (Cyclosporine)
- Cytoxan (Clyclophosphamide) ATG (anti-
thymocyte globulin)
- ALG (antilymphocyte globulin) Imuran ( Azathio-
prine) Tacrolimus (Prograf).
- Blood transfusion as necessary
- Assess for signs and symptoms of tissue hypoxia,
infection, and bleeding
- Frequent rest periods to reduce oxygen
demands of tissues
- To minimize risk of infection:
- Implement Reverse / Protective Isolation.
Provide private room; practice strict
handwashing
- Encourage good personal hygiene including good
oral care daily, shower or bath with mild soap,
and perirectal care after using the toilet
- Monitor vital signs including temperature
frequently; notify health care provider of fever.
- Avoid eating raw foods; do not permit fresh
fruits or fresh flowers in the client's unit
- Limit visitors, do not allow people with signs and
symptoms of infection to visit the client
- Avoid crowds. To prevent contacting infections
especially respiratory infections
- Minimize invasive procedures or possible trauma
to skin or mucous membranes.
Trances by Jamaica Maga
- To minimize risk of bleeding
 Use soft toothbrush for mouth care; electric
razor for shaving, keep nails short by filing
 Avoid intramuscular (1M) injectms and other
invasive procedures
 Prevent constipation by use of stool softener
(Colace/Docussate Na) as prescnbed
 Restrict activity based on platelet count and
active bleeding
 Monitor pad count for menstruating patient;
avoid use of vaginal tampons.
 Control bleeding by applying pressure to the site,
using ice packs and prescribed topical
hemostatic agents
 Advise client to use water — soluble lubricants
as needed, during sexual intercourse
THALASSEMIA MAJOR (COOLEY’S ANEMIA)
- It is the most severe of beta-thalassemia
syndromes. Beta — thalassemia refers to an
inherited hemolytic anemia, characterized by a
reduction or absence of beta — globulin chain in
hemoglobin synthesis.
- This RBC has a decreased amount of hemoglobin,
resulting in a fragile RBC with a short lifespan
- The disease is most prevalent in the
Mediterranean basin, Middle East, Southeast
Asia and Africa. In the US, it is most common in
children of Italian, Greek and Southeastern Asian
ancestry
• Clinical Manifestations
- Expansion of bone marrow cavities of the bone.
This is due to increase in erythroid activity, in an
attempt to overcome the increased rate of
destruction of RBC's. There is tinning of the bony
cortex. These lead to skeletal deformities
(frontal and maxillary bossing), growth
retardation, pathologic fractures
- Hemosiderosis. This is increased iron level in the
blood, which may be deposited on organ tissues
especially in tie heart. This is due to rapid
destruction of RBCs, decreased production of
hemoglobin, and increased absorption of dietary
iron caused by the body's response to anemia
• Collaborative Management
- Frequent and regular blood transfusion of
packed RBCs.
 Trances by Jamaica Maga

- Iron chelation therapy with Desferal AUTOIMMUNE IDIOPATHIC THROMBOCYTOPENIA

(Deferoxamine). This reduces the toxic side PURPURA (ITP)
effects of excess iron; increases excretion
- It is an acute or chronic bleeding disorder that
through urine and feces. Be alert for visual and
results from immune destruction of platelets by
hearing deficits associated with use of Desferal.
antiplatelet antibodies
- Splenedomy, To reduce rate of hemolysis of
- It usually follows viral infection in children
RBCs.
- Decrease dietary iron. • Clinical manifestations
- Monitor cardiovascular status. (CHF is a usual - Bruising
cause of death). - Petechiae
- Relieve bone pain (e.g. NSAlDs). - Bleeding from nares and gums
- Avoid contact sports (skateboarding, football, - Menorrhagia (excessive menstrual bleeding).
soccer, etc.) to reduce risk Of fracture.
- Encourage prompt medical anention for fever or • Collaborative Management
signs of infection. The primary goal of treatment is a safe platelet count
PPT: BLEEDING DISORDERS - Platelet transfusion
BLEEDING DISORDERS - High dose of corticosteroids, IV immunoglobulins
(IVIG), Danazol (Danacrine), Imuran
1. Thrombocytopenia (Azathloprine), Oncivun (Vincristine), Velban
2. Idiopathic Thrombocytopenic Purpura (ITP) (Vinblastine)
3. Disseminated Intravascular Coagulation (DIC) - Splenectomy removes potential sit for
4. Von Willebarnd’s Disease sequestration and destruction of platelets
THROMBOCYTOPENIA - Bleeding precautions

- A decreased in circulating platelet count (less

than 100, 000/ cu.mm
• Causes
- Decreased Platelet production
- Increased platelet destruction
- Abnormal distribution of platelets in the spleen
- Dilutional thrombocytopenia after hemorrhage,
RBC transfusions
• Clinical Manifestations
- Petechiae, Ecchymosis
- Bleeding in the nose, GI and GU tracts,
respiratory system, and within CNS
DISSEMINATED INTRAVASCULAR COAGULATION (DIC)
• Collaborative Management
- Is an acquired thrombotic and hemorrhagic
- Treat underlying æuse.
syndrome
- Platelet transfusion.
- DIC is not a disease but a sign of an underlying
- Steroids or IV immunoglobulins.
condition. DIC may be triggered by sepsis,
- Bleeding precautions.
trauma, cancer, shock, abruptio placenta, toxins,
- Evaluate urine, stool and emesis for gross and
or allergic reactions. It is potentially life-
occult blood
threatening
- Avoid use of ASA and NSAlDs. These medications
- This result in widespread clotting in small vessels
may cause bleeding
of the body with consumption of clotting factors
 Trances by Jamaica Maga

and platelets, so that bleeding and thrombosis VON WILLEBRAND’S DISEASE

occur simultaneously
- It is an inherited (autosomal dominant) or
• Causes acquired bleeding disorder characterized by
decreased level of Von WIllebrand factor and
- Overwhelming infections, e.g., bacterial sepsis.
prolonged bleeding time
- Obstetric complications: abruptio placenta,
- Von Willebrand factor enhances platelet
eclampsia, amniotic fluid embolism, retention of
adhesion as first step in clot formation, also acts
dead fetus.
as carrier of factor VIII in blood
- Massive tissue injury: bums, trauma, fractures,
major surgery, fat embolism. • Clinical Manifestations
- Vascular and circulatory collapse, shock.
- Bruising, gingival bleeding, epistaxis,
- Hemolytic transfusion reaction.
menorrhagia.
- Malignancy: particularly of lung, colon, stomach,
- Prolonged bleeding from cuts or after dental and
pancreas
surgical procedures.
• Clinical Manifestations - Bleeding time — prolonged; Von WilIebrand's
factor — decreased; Factor Vlll — decreased.
 Signs of ABNORMAL CLOTTING
 Coolness and mottling of extremities • Collaborative Management
 Acrocyanosis (cold, mottled extremities)
- Factor Vlll replacement via infusions of
 Dyspnea adventitious breath sounds, chest
cryoprecipitate.
pain
- Amicar (antifibrinolytic agent) to stabilize clot
 Altered mental status
formation before dental procedures and before
 Acute renal failure (hematuria)
minor surgery.
 Pain (related to bowel infarction)
- Desmopressin (DDAVP), to manage mild to
 Signs of abnormal bleeding
moderate bleeding.
 Oozing, bleeding from sites of procedures,
- Institute bleeding precautions.
IV catheter insertion sites, seizure lines,
 Avoid use of plain razor, hard toothbrush or
mucous membranes, orifices
floss, IM injections, tourniquets, rectal
 Internal bleeding leading to changes in vital
procedures or suppositories
organ functions, altered VS
- Administer stool softeners to prevent
 Dx result: low platelet count, PT, PTT
constipation.
prolonged; fibrinogen level decreased
- Restrict activity and exercise when platelet count
• Collaborative Management is less than 20,000/cu.mm., or when active
bleeding occurs.
- Treat underlying cause. Institute bleeding
- Monitor pad count and amount of saturation
precautions.
during menses.
- Replacement Therapy:
- Avoid use of ASA, NSAlDs.
 Fresh frozen plasma replaces clotting factors.
- Use of direct and steady pressure at bleeding site
 Platelet transfusions.
if bleeding occurs
 Cryoprecipitate replaces clotting factors and
fibrinogen. HIV (HUMAN IMMUNODEFICIENCY VIRUS)/ AIDS
- Supportive measures: fluid replacement, (ACQUIRED IMMUNO-DEFICIENCY SYNDROME)
oxygenation, maintenance of BP and renal
- High risk
perfusion.
- Homosexual Anal Intercourse
- Heparin therapy inhibits clotting component of
- Bisexual Males- Anal intercourse
DIC.
- IV drug users
- Note: Cerebral hemorrhage is most common
- Infants: HIV- Infected Parents
cause of death in DIC. Consider that all seriously
- Blood/ Blood products before 1985
ill patients are at risk to DIC.

• Sign and Symptoms
- Fever
- Diarrhea
- Muscles Aches
- G.l. Cramps
- Rashes
- Weight loss
- Night sweats
- Persistent generalized lymphadenopathy (PGL)
 When HIV antibodies are present
- Night sweats
- Fever
- Weight loss
- Edema
BLOOD
- Fatigue
- Abnormal T4— T8 cells ratio
• Diagnostic Test
 ELISA test
- (+) result indicates HIV infection (HIC
seropositive)
- False (+) multiple BT/pregnancy
- False (-) window period (few weeks- 3 months)
 Western Blot
- (+) result indicates AIDS
• Implementation among HEALTH CAREGIVERS
- Practice strict handwashing
- Wear gloves when coming in contact with body
secretions
- Avoid recapping of needles
- Use heavy plastic bags to be used for articles
contaminated with body fluids (biohazard bag/
red bag)
- Use of 1:10 Bleach / Water Solution
- Boiling equipment (20 minutes)
- Dishwashing (hot water, air drying).
- Laundry (use bleach)
PLASMA
- Do not share razors, toothbrush. These are
contaminated with body secretions.
• Implementation among CLIENTS
- Client Education and Counseling
- Disease transmission: blood and body fluids
- Advise client to practice safe sex as follows:
- Abstinence.
- Mutual, monogamous sexual relationship. o
Avoid multiple partners
- Use of soluble lubricants and condoms
Trances by Jamaica Maga
- Prevention of infections
- Self — care
- Provide psychosocial care. Pharmacotherapy:
AZT (Retrovir / Zidovudine)
 Side Effects: Malaise, Nausea and Vomiting,
Headache, Fever, Insomnia, Myalgia
 Toxic Effects: Bone Marrow Suppression (serum
level determination should be done at regular
basis); weekly CBC should also be monitored
 Precautions:
- Avoid pregnancy
- Do not donate blood, sperm, organ
PPT: CARE OF CLIENTS WITH BLOOD DISORDERS
- The blood consists of blood cells and fluid called
plasma
- Transports gases, nutrients, metabolic waste,
blood cells, immune cells and hormones
throughout the body
- The formed elements in the blood include:
1. RBCs or erythrocytes
2. WBCs or Leukocytes
3. Platelets or Thrombocytes
- Blood in adult human is approx. 5 Liters
- Whole blood is heavier and more vicious than
water
- Hematocrit – is the percentage of blood cell
volume generally 45%
- Plasma – a straw colored fluid, watery substance
mixed with vitamins, minerals, amino acids,
electrolytes, hormones and wastes, about 55%
found in the blood
- The percentage of blood volume varies: Adipose,
Body Size, fluid and electrolytes
- Blood components can be separated by
centrifuging them
- Clear, straw colored fluid
- Liquid portion of the blood
- Proteins found in Plasma:
 Albumin – regulate the movement of water
controlling blood volume and controlling blood
pressure
 Globulins – Transports lipids and Fat soluble
vitamins
 Trances by Jamaica Maga

 Fibrinogen – Largest but least of plasma - However, when a clot forms (called formation),
proteins; functions in blood coagulations Fibrinogen is formed (Fibrin) these are insoluble
(clumping) threads of protein.
- A blood clot forms a series of events:
RED BLOOD CELLS/ ERYTHROCYTES
Prothrombin (a normal component of plasma
- Transports oxygen and carbon dioxide to and produced in the liver) is converted into Thrombin
from tissues in the presence of Ca++
- Contains Hemoglobin (Hgb) – The O2 carrying - The Thrombin then triggers a series of reactions
substance that gives blood its red color that convert fibrinogen into fibrin, causing a
- Have an average lifespan of 90-120 days. blood clot
- The spleen breaks down the old, worn-out RBC - This is how Bruises (Hematoma), caused by
thereby removing them from the circulation – an blood leaks within a damaged tissue are healed
iron containing compound hgb is released - If a clot has filled a large area (Large Blood
- The surface of each RBC carries antigens that vessels) it is surgically removed.
determines a persons blood group A, B, AB, O. - If the clot dislodges from the blood vessels, it is
- When O2 binds with Hgb – Bright Red called embolus and may block blood flow
- When O2 is deficient – Dark Red causing an alteration.
- Test performed – RBC count
- Change in number of RBCs affect the amount of
O2 being carried
- Erythropoietin – a hormone regulates rbc
production
- When O2 is deficient, kidneys and liver release
erythropoietin to make RBC.
- RBC production requires vitamin B12, Folic Acid
and Iron.
PLATELET/ THROMBOCYTES
- Play a major role in hemostatis (Blood Clotting)
- Considers cell fragments (incomplete cells)
- Formed in the red bone marrow
- Life span – 10 days
- 3 Stage Process in the Stoppage of bleeding:
1. VASCULAR SPASM- constriction of blood vessels
by the smooth muscles contracting, slowing
blood flow
2. PLATELET AGGREGATION/PLUG- is a clump of
platelets that stick to the collagen in connective
tissue that has been cut (damaged site) WHITE BLOOD CELLS/ LEUKOCYTES
3. COAGULATION- causes a blood clot and is result - Protects against diseases; fights infection
of clotting factors; Fibrin threads forms to trap - Broken down into 2 groups
RBCs and eventually dissolve when injury is 1. Granulocytes- leukocytes with granular
healed cytoplasm
- Time: Blood clot usually forms within 3-6 2. Agranulocytes- leukocytes without granular
minutes cytoplasm
BLOOD COAGULATION • GRANULOCYTES (Polymorphonuclear Leukocytes)
- In normal bodies, Anticoagulants do not allow - Include Neutrophils, Eosinophils, Basophils
blood to clot.
 Trances by Jamaica Maga

- Serves as the body’s first line of cellular defense

against foreign organism
- Neutrophils are phagocytic; engulf, ingest and
digest foreign materials
- Eosinophils participates in allergic response, kill
specific parasites, control allergic response
- Basophils secrete histamine in response to Rh BLOOD GROUPS
certain inflammatory and immune stimuli. They
also secrete heparin (a blood thinner) which - Named after the Rhesus Monkey.
prevents abnormal clotting in the blood vessels - These are antigens (Factors) in human blood as
to increase blood flow to the injured tissues well as monkey blood
- These antigens are inherited as well
• AGRANULOCYTES (Mononuclear Leukocytes) - Rh Negative (Rh-) – No Rh antigens
- Include monocytes and lymphocytes - Rh Positive (Rh+) – There is atleast 1 type of Rh
- Monocytes perform phagocytosis, engulfing antigen
large particles; produced in the red bone BLOOD TYPING
marrow.
- Lymphocytes – Produced in the red bone
marrow and lymphatic system organs; produces
antibodies providing immunity
- B Cells – Humoral Immunity
- T Cells – Cell mediated immunity
HUMAN BLOOD GROUPS
- Antigen – a foreign substance that immune
system recognizes
- Antibodies – Y shaped proteins secreted by
WBCs that attach to antigens
- Agglutination – clumping caused by antibodies
binding to antigens on RBCs
- RBC Surface Proteins:
 A Antigen
 B Antigen
 Rh Antigen
ABO BLOOD GROUPS
- The presence or absence of antigens on the
surface of RBCs
- These antigens are A, B, or A and B
- These are a direct result of a persons blood type,
which is inherited
- If a person has antigen A, he has type A Blood
- If a person has antigen B, he has type B blood NEOPLASTIC BLOOD DISORDERS
- If a person has antigen A and B, he has type AB
blood LEUKEMIA AND LYMPHOMA
- If a person lacks antigens, the he has Type O - Leuko – “white cells” emia- blood
blood - Lympho – Lymph nodes/Lymphocytes ; oma
(cancer)
- Gene problems

- Ca arises in the red bone marrow in the flat
bones
- Stem cells – can make blood cells
- RBC – 2M per second
- PC – 4M per second
- WBC – 100k per second
- Lymphocyte line – Lymphomas (T cells; B Cells)
Lymph nodes ; Leukemia
- Myeloid line – Leukemia
LEUKEMIAS
- Are acute or chronic malignant disorders of the
blood and bone marrow.
- Results in the accumulation of dysfunctional,
immature cells that are caused by loss of
regulation of cell division.
- The primary problem in leukemia is proliferation
• Collaborative Management
of immature WBCs. The client becomes immune
compromised (low resistance to infection)
- There is decreased production of RBCs and
platelets. Decreased production of RBCs causes
signs and symptoms of decreased oxygenation
like pallor, fatigue, weakness, palpitations,
faintness, weight loss, shortness of breath
- Decreased production of platelets causes
abnormal bleeding like nose bleeding, rectal
bleeding, bruising, ecchymosis, visual changes
(due to retinal bleeding).
• Classified as ACUTE or CHRONIC
1. Acute Lymphocytic Leukemia (ALL)
2. Acute Myelogenous Leukemia (AML)
3. Chronic Lymphocytic Leukemia (CLL)
4. Chronic Myelogenous Leukemia (CML
• Causes of Leukemia
 Idiopathic or unknown
 Viral Infections
 Familial Susceptibility
 Genetic Disorders (Down Syndrome etc.)
 Exposure to ionizing radiation
 Exposure to certain chemicals and toxins
ACUTE LYMPHOCYTIC LEUKEMIA/ ACUTE
LYMPHOBLASTIC LEUKEMIA (ALL)
- Most common in children, with peak incidence
between ages 2 and 9.
- Childhood ALL is often cured with chemotherapy
alone, if detected early.
Trances by Jamaica Maga
- Hypertrophy of the bone marrow causes bone
pain
- Organ infiltration by immature WBCs causes
hepatomegaly, splenomegaly, renal
insufficiency, hyperuricemia, arthralgia (joint
pain), and increased intracranial pressure (due to
meningeal infiltration).
- Hepatosplenomegaly causes abdominal pain.
- Leukostasis (high numbers of circulating
leukemic cells) causes infiltration and weakening
of blood vessel walls, with high risk for rupture
and bleeding, including intracranial hemorrhage
- Tumor lysis syndrome (rapid destruction of large
numbers of malignant cells) leads to alterations
in electrolytes (hyperuricemia, hyperkalemia,
hyperphosphatemia, and hypocalcemia
- Avoid exposure to all sources of stagnant water
(e.g. flower vases, denture cups, water pitchers,
humidifiers and plants). These are good media
for bacterial growth.
- Encourage or assist with personal hygiene mouth
care, perirectal care, daily shower or bath with
mild soap.
- Monitor vital signs every 4 hours, especially body
temperature. Report fever of 1010F or 380C and
above. Fever indicates infection.
- Assess respiratory function every 4 hours.
Neutropenic clients are prone to bacterial or
fungal pneumonia.
- Assess for changes in mental status like
restlessness, irritability, confusion, headache or
changes in level of consciousness. These changes
are often the first subtle signs of sepsis.
- Avoid invasive procedures if possible, e.g.,
urinary catheterization. Use strict aseptic
technique if procedure is unavoidable. Risk of
infection from invasive procedure is high.
- Prevent rectal trauma by avoiding rectal
temperature, enema or suppositories. Use Sib
and barrier cream for patient with diarrhea and
hemorrhoids. Use stool softeners as needed to
prevent constipation. Perianal area is high — risk
site for infection, including rectal abscesses.
- Obtain cultures of suspended infected sites or
body fluids. To reveal bacterial, fungal or viral
pathogens
 Trances by Jamaica Maga

- Avoid crowds. Immunocompromised clients can

easily be contaminated with infection, especially
in crowded places.
- Avoid raw or undercooked foods. Raw or
undercooked foods increase bacterial of the Gl
tract.
- Assess for signs of bleeding at least every 8
hours.
- Provide soft toothbrush for mouth care
- To minimize damage to mucous membrane
- Use only an electric razor for shaving
- Keep fingernails and toenails short and smooth
- Lubricate skin with mild soap. To minimize skin
excoriation
- The other manifestations of Hodgkin's disease
- Avoid 1M injections, and other invasive
are as follows: fever, chills, general malaise,
procedures.
night sweats, weight loss, pruritus, pain due to
- Use stool softeners to prevent constipation.
pressure on nerves, edema due to decreased
Straining at stool causes redal bleeding
venous and lymph drainage, abdominal pain due
- Teach avoidance of constipation with increased
to splenomegaly and hepatomegaly, cough,
fluid and fiber
dyspnea and dysphagia due to enlarged
- Monitor pad count during menstruation. Avoid
mediastinal nodes
use of vaginal tampon
- (Avitene, Fibrindex, Thrombinar) to site • Collaborative Management for Hodgkin’s Disease
- Promote bedrest during bleeding episode
- Radiation therapy
- Avoid use of ASA and NSAlDs - Chemotherapy
- Platelet transfusion as necessary, when platelet - MOPP regimen:
count is less than 20,0Ø/Q1.mm. or with active
 Mustargen (Nitrogen mustard)
bleeding
 Oncovin (Vincristine)
- Teach client to avoid contact sports and other  Procarbazine (Matulane)
activities likely to cause injury  Prednisone
MALIGNANT LYMPHOMAS - ABVD regimen:
 Adriamycin (Doxorubicin)
- A neoplastic disorder affecting the lymph nodes.
 Bleomycin (Blenoxane)
It is characterized by painless lymphadenopathy
 Vinblastine (Velban)
and splenomegaly. The cause is unknown
 Dacarbazine (DTIC)
- The main problem is infection. This is due to
- Bone marrow transplantation
inability of the lymph nodes to produce normal
- Priority is prevention of infection
lymphocytes
- There are two types of lymphomas, namely • Care of the Client receiving radiation therapy
Hodgkin's and non-Hodgkin's diseases
- Avoid rubbing powders, deodorants, lotions or
- Non-Hodgkin's lymphomas are lymphosmas or
ointments or application of to treated areas.
Burkitt's (stem cell) lymphoma
- Keep treated areas clean and dry, bathing the
- Hodgkin's disease is more common among male areas with tepid water and mild soap
adolescents, young adults, and after age 60
- Encourage wearing loose — fitting clothes, to
years. It is characterized by presence of Reed-
prevent skin irritation.
Sternberg cells as detected by lymph node
- Protect skin from exposure to sun, chlorine, and
biopsy
temperature extremes
- Frequent small meals, using bland and soft diet
at mild temperatures

- Avoid irritants such as alcohol, tobacco, spices,
extreme f temperatures (very hot or very cold) to
prevent ulcers in the oral mucosa
- Note: Chemotherapy for non-Hodgkin’s disease
are as follows:
- CAOP
 Cytoxan (Cyclophosphamide)
 Adriamycin (Doxorubicin)
 Oncovin (Vincristine)
 Prednisone
- BACOP
 Blenoxane (Bleomycin)
 Adriamycin (Doxorubicin)
 Cytoxan (Cyclophosphamide
 Oncovin (Vincristine)
 Prednisone
BLOOD TRANSFUSION THERAPY
NURSING INTERVENTIONS
1. Verify doctor’s order. Inform the client and
explain the purpose of the procedure.
2. Check for cross matching and typing. To ensure
compatibility
3. Obtain and record baseline vital signs
4. Practice strict asepsis
5. At least 2 licensed nurse check the label of the
blood transfusion. Check the following:
 Serial number
 Blood component
 Blood type
 Rh factor
 Expiration date
 Screening test (VDRL, HBsAg, malarial smear) –
this is to ensure that the blood is free from
blood-carried diseases and therefore, safe from
transfusion.
6. Warm blood at room temperature before
transfusion to prevent chills.
7. Identify client properly. Two Nurses check the
client’s identification.
8. Use needle gauge 18 to 19 to allow easy flow of
blood.
9. Use BT set with special micron mesh filter to
prevent administration of blood clots and
particles.
10. Start infusion slowly at 10 gtts/min. Remain at
bedside for 15 to 30 minutes. Adverse reaction
usually occurs during the first 15 to 20 minutes.
Trances by Jamaica Maga
11. Monitor vital signs. Altered vital signs indicate
adverse reaction (increase in temp, increase in
respiratory rate)
12. Do not mix medications with blood transfusion
to prevent adverse effects. Do not incorporate
medication into the blood transfusion. Do not
use blood transfusion lines for IV push of
medication.
13. Administer 0.9% NaCl before; during or after BT.
Never administer IV fluids with dextrose.
Dextrose based IV fluids cause hemolysis.
14. Administer BT for 4 hours (whole blood, packed
RBC). For plasma, platelets, cryoprecipitate,
transfuse quickly (20 minutes) clotting factor can
easily be destroyed.
15. Observe for potential complications. Notify
physician.
COMPLICATIONS
1. Allergic reaction
 Hives, Generalized Pruritus, Wheezing or
anaphylaxis (rarely)
2. Febrile, Non-Hemolytic
 Temperature rise during or shortly after
transfusion, chills, headache, flushing, anxiety
3. Septic Reaction
 Rapid onset of high fever and chills, vomiting,
diarrhea, marked hypotension
4. Circulatory Overload
 Dyspnea, Cough, Rales, Jugular Vein distention
5. Hemolytic reaction
 Fever, Chills, Low back pain, Flank pain,
Headache, Nausea, Flushing, Tachycardia,
Tachypnea, Hypotension, Hemoglobinuria
(cola-colored urine)
NURSING INTERVENTION (COMPLICATIONS)
1. If blood transfusion reaction occurs: STOP THE
TRANSFUSION.
2. Start IV line (0.9% NaCl)
3. Place the client in Fowler’s position if with
Shortness of Breath and administer O2 therapy.
4. The nurse remains with the client, observing
signs and symptoms and monitoring vital signs as
often as every 5 minutes.
5. Notify the physician immediately.
6. The nurse prepares to administer emergency
drugs such as antihistamines, vasopressor, fluids,
and steroids as per physician’s order or protocol.
 Trances by Jamaica Maga

7. Obtain a urine specimen and send to the

laboratory to determine presence of hemoglobin
as a result of RBC hemolysis.
8. Blood container, tubing, attached label, and
transfusion record are saved and returned to the
laboratory for analysis.