SPECIAL MEDICAL

CONDITIONS 4
NICA 
*BLOOD
DISORDERS
 LEUKEMIA
• Leukemia is a blood cancer caused by a rise in
the number of white blood cells in your body.
The bone marrow produces abnormal white
blood cells, which don't function properly.
 LEUKEMIA SYMPTOMS
• Weakness or fatigue
• Bruising or bleeding easily- wound takes time to heal
• Fever or chills
• Infections that are severe or keep coming back
• Pain in your bones or joints
• Headaches
• Vomiting
• Seizures- due to very high fever
• Weight loss
• Night sweats
• Shortness of breath
• Swollen lymph nodes or organs like your spleen
 LEUKEMIA CAUSES AND RISK
FACTORS
• No one knows exactly what causes leukemia.
• Smoke
• Are exposed to a lot of radiation or certain chemicals
• Had radiation therapy or chemotherapy to treat cancer
• Have a family history of leukemia
• Have a genetic disorder like Down syndrome
 TYPES
• *Acute leukemia happens when most of the abnormal blood
cells don’t mature and can’t carry out normal functions. It
can get bad very fast.
• Sudden and very fast; cells do not mature

• *Chronic leukemia happens when there are some immature

cells, but others are normal and can work the way they
should. It gets bad more slowly than acute forms do.
• Lymphocytic (or lymphoblastic) leukemia involves
bone marrow cells that become lymphocytes, a kind of
white blood cell.

• Myelogenous (or myeloid) leukemia involves the

marrow cells that create red blood cells, platelets, and
other kinds of white blood cells.
• *Acute lymphocytic leukemia (ALL) or Acute
lymphoblastic leukemia. This is the most
common form of childhood leukemia. It can
spread to your lymph nodes and central nervous
system.
• Acute myelogenous leukemia (AML). This is the
second most common form of childhood
leukemia and one of the most common forms for
adults.
• Chronic lymphocytic leukemia (CLL)-RARE.
This is the other most common form of adult
leukemia. Some kinds of CLL will be stable for
years and won’t need treatment. But with others,
your body isn’t able to create normal blood cells,
and you’ll need treatment.
• REMISSION-has cancer but not active.
• Chronic myelogenous leukemia (CML). With
this form, you might not have noticeable
symptoms. You might not be diagnosed with it
until you have a routine blood test. People 65 and
older have a higher risk of this type.
 MAJOR GOALS
• Put them in reverse isolation room- to avoid transmission of
the infection
• Absence of pain.
• Attainment and maintenance of adequate nutrition.
• Activity tolerance.
• Ability to provide self-care and to cope with the diagnosis
and prognosis.
• Positive body image.
 INTERVENTIONS
• Health history. The health history may reveal a range of
subtle symptoms reported by the patient before the problem
is detectable on physical examination.

• Physical examination (incl. Vital Signs). A thorough,

systematic assessment incorporating all body systems is
essential.
• Education- self-care
• Infection- infection control, proper wound care
• Promote good nutrition
• Infection control. Control infection by placing the patient in a
*Reverse Isolation room*and instituting neutropenic precautions
• Skincare. Provide thorough skin care by keeping the patient’s skin
and perianal area clean, applying mild lotions and creams to keep
skin from cracking and drying, and thoroughly cleaning skin before
all invasive skin procedures.
• Prevent constipation by providing adequate hydration, a high-
residue diet, stool softeners, and mild laxatives, and by encouraging
walking.
• Control mouth ulceration by checking often for obvious ulcers
(Stomatitis) and gum swelling, and by providing frequent mouth
care and saline rinses.
• Psychological support.
• Minimize stress by providing a calm, quiet atmosphere that is
conducive to rest and relaxation.
 HEMOPHILIA
• a rare disorder in which your blood doesn't clot
normally because it lacks sufficient blood-clotting
proteins (clotting factors). If you have hemophilia, you
may bleed for a longer time after an injury than you
would if your blood clotted normally
• the greater health concern is deep bleeding inside
your body, especially in your knees, ankles and
elbows;

• that internal bleeding can damage your organs and

tissues, and may be life-threatening
 CAREGIVER INTERVENTION
• Make sure toys are soft
• Soft bristle toothbrush
 RISK FACTORS
• Family history of bleeding (genetic)

• Being male (more symptomatic)

 *CLASSIC SYMPTOMS OF
HEMOPHILIA
• *Bleeding/ excessive bleeding
 3 FORMS OF HEMOPHILIA
•A

•B

•C
 TYPE A
• Hemophilia A is the most common type of hemophilia, and
it’s caused by a deficiency in factor VIII.
• Hemophilia A comes from your genes. You can inherit it
from your parents. Or it can happen if a certain gene
changes before you're born. This change is called a
spontaneous mutation.
• The hemophilia A gene mutation happens on the X
chromosome. Women get one X chromosome from their
mother and one from their father. Men get an X from their
mother and a Y from their father.

• it occurs predominantly in males; females usually are

asymptomatic carriers
 HEMOPHILIA A SYMPTOMS
• Mild hemophilia A. An episode of heavy bleeding:

• After you have surgery or another procedure, like having a

tooth pulled.
• After childbirth
• After a serious injury (ex. vehicular)
• During your period
• Moderate hemophilia usually means you:

• Bleed a lot when injured. (Epistaxis: nose bleeding)

• Bleed without an injury (spontaneous bleeding).
• Bruise easily.
• Bleed a lot after a vaccination.
• Frequent episodes of bleeding, often into the joints and muscles,
without being able to figure out a specific cause
• Prolonged headache
• Throwing up
• Sleepiness/tiredness
• Sudden weakness or problems walking
• Double vision
• Convulsions or seizures
• Shock
• Death
 TYPE B
• Christmas Disease

• hereditary bleeding disorder caused by a lack of blood

clotting factor IX. Without enough factor IX, the
blood cannot clot properly to control bleeding.
• RARE
• Hemophilia type B is about four times rarer than
type A and can affect all ethnic groups equally.
 HEMOPHILIA B SYMPTOMS
• Mild cases may go unnoticed until later in life.
Symptoms may first occur after surgery or injury.
Internal bleeding may occur anywhere.
• Bleeding into joints with associated pain and swelling
• Blood in the urine or stool (MELENA-stool; HEMATURIA-
urine)
• Bruising
• Gastrointestinal tract and urinary tract bleeding
• Nosebleeds
• Prolonged bleeding from cuts, tooth extraction, and surgery
• Bleeding that starts without cause
 TYPE C
• also known as plasma thromboplastin antecedent (PTA)
deficiency or Rosenthal syndrome

• a mild form affecting both sexes, due to factor XI deficiency

• predominantly occurs in Ashkenazi Jews

 HEMOPHILIA C
SYMPTOMS
• Oral bleeding
• Nosebleeds
• Blood in the urine
• Post-partum bleeding (20% of cases)
• Tonsils (bleeding)
• Menorrhagia: abnormal menstruation, more than
normal
 INTERVENTIONS
• Check for Vital Signs
• Assess for joint swelling and ability to move affected limb; Assess
for limited ROM, contractures, and bony changes in the joints
when bleeding has stopped.

• Relieve pain. Immobilize joints and apply elastic bandages to the

affected joint if indicated; elevate affected and apply a cold
compress to active bleeding sites, but must be used cautiously in
young children to prevent skin breakdown.
• Maintain optimal physical mobility. Provide gentle, passive
ROM exercise when the child’s condition is stable;
• educate on preventive measures, such as the application of
protective gear and the administration of factor products;
and
• refer for physical therapy, occupational therapy, and
orthopedic consultations, as required.
• Assist in the coping of the family. Encourage family
members to verbalize problem areas and develop solutions
on their own;
• encourage family members to express feelings, such as how
they deal with the chronic needs of a family member and
coping patterns that help or hinder adjustment to the
problems.
• Prevent bleeding. Monitor hemoglobin and
hematocrit levels; anticipate or instruct in the need
for prophylactic treatment before high-risk situations,
such as invasive diagnostic or surgical procedures, or
dental work
• Prevent injury. Utilize appropriate toys (soft, not pointed or
small sharp objects); for infants, may need to use padded
bed rail sides on crib; avoid rectal temperatures; provide
appropriate oral hygiene (use of a water irrigating device;
use of a soft toothbrush or softening the toothbrush with
warm water before brushing; use of sponge-tipped
toothbrush); and avoid contact sports such as football,
soccer, ice hockey, karate.
 HYPOGLYCEMIA
• Hypoglycemia refers to low levels of sugar, or glucose,
in the blood. Hypoglycemia is not a disease, but it can
indicate a health problem.

• Occurs when there is not enough glucose, or sugar, in

the blood.
 CAUSES
• some medications, like those used in adults and children
with kidney failure
• excess amounts of alcohol, which can stop your liver from
producing glucose
• any disorder that affects the liver, heart, or kidneys
• some eating disorders, such as anorexia
• pregnancy
 SYMPTOMS
• An irregular or fast heartbeat
• Fatigue
• Pale skin
• Shakiness
• Anxiety
• Sweating
• Hunger
• Irritability
• Tingling or numbness of the lips, tongue or cheek
• In severe cases:
• Confusion, abnormal behavior or both, such as the
inability to complete routine tasks
• Visual disturbances, such as blurred vision
• Seizures
• Loss of consciousness
 PREVENTION
• Follow the diabetes management plan you and your
doctor have developed. If you're taking new
medications, changing your eating or medication
schedules, or adding new exercise, talk to your doctor
about how these changes might affect your diabetes
management and your risk of low blood sugar.
• eating frequent small meals throughout the day is a
stopgap measure to help prevent your blood sugar
levels from getting too low
• (See book for hypoglycemia management)
 INTERVENTIONS
•Assess causative or contributing factors by
identifying the factors present.
•Assess the degree of impairment.
•Repeat the patient’s blood glucose level after 1 hour.
•Monitors patient’s vital signs.
•Draw blood for baseline electrolytes.
•Obtain a complete patient history including the last
alcohol intake and medications.
• Check the current blood glucose.
• For conscious patients with blood glucose is below 60mg/dl
give at least 10-15g of fast-acting simple carbohydrates such
as 1 tablespoon of honey, 6 pcs of crackers, half glass of
juice, or soda.
• For unconscious patients and patients unable to swallow
administer dextrose 50% 50ml bolus per IV as prescribed.
 HYPERGLYCEMIA
• Hyperglycemia means high blood sugar or glucose.
Glucose comes from the foods you eat. Insulin is a
hormone that moves glucose into your cells to give
them energy. Hyperglycemia happens when your body
doesn't make enough insulin or can't use it the right
way.
• Fasting hyperglycemia. This is blood sugar that's higher
than 130 mg/dL (milligrams per deciliter) after not eating or
drinking for at least 8 hours.

• Postprandial or after-meal hyperglycemia. This is blood

sugar that's higher than 180 mg/dL 2 hours after you eat.
People without diabetes rarely have blood sugar levels over
140 mg/dL after a meal, unless it’s really large.
 CAUSES
• Skip or forget your insulin or oral glucose-lowering
medicine
• Eat too many grams of carbohydrates for the amount of
insulin you took, or eat too many carbs in general
• Have an infection
• Are ill
• Are under stress
• Become inactive or exercise less than usual
• Take part in strenuous physical activity, especially
when your blood sugar levels are high and insulin
levels are low
 SYMPTOMS
• Increased thirst
• Headaches
• Trouble concentrating
• Blurred vision
• 3P- Polydipsia: increased thirst, Polyphagia:
increased eating, Polyuria: increased urination
• Frequent peeing
• Fatigue (weak, tired feeling)
• Weight loss
• Blood sugar more than 180 mg/dL
• Ongoing high blood sugar may cause:

• Vaginal and skin infections

• Slow-healing cuts and sores
• Worse vision
• Nerve damage causing painful cold or insensitive feet,
loss of hair on the lower extremities, or erectile
dysfunction
• Stomach and intestinal problems such as chronic
constipation or diarrhea
• Damage to your eyes, blood vessels, or kidneys
 INTERVENTIONS

• Check Vital Signs

• Assess the patient’s history
• Assess physical condition. Assess the patient’s blood
pressure while sitting and standing to detect orthostatic
changes.
• Assess the body mass index and visual acuity of the patient.
• Educate about home glucose monitoring
• Encourage client to read labels
**Give Candy wether hyper/hypoglycemic
*
 *3PS
• Polyphagia
• Polydipsia
• Polyuria
 GROUP QUIZ (KIDS)
S/SX, PREVENTION/CAREGIVER
INTERVENTIONS

• HIV/AIDS/STIs
• APPENDICITIS
• LEUKEMIA- ALL, AML
• HYPOGLYCEMIA AND HYPERGLYCEMIA
• EPILEPSY

• Make a pamphlets- for kids, simplified