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Whaley and Wong Chapters 35, 36
Components of the Blood
• water, albumin, electrolytes, clotting factors
– Cellular Components
• RBCs, WBCs, Platelets • All formed in the red bone marrow (after birth)
– In utero- spleen, thymus, liver
• lymphatic system regulates maturation
provides O2 to the tissues – life span 120 days – manufacture regulated by erythropoetin – Normal Hematocrit.12-16 grams .35-45% – Normal Hemoglobin.Erythrocytes RBCs – carry hemoglobin which is attached to oxygen.
Etiology/Pathophysiology – causes of RBC/Hgb depletion 2. shape.Problems of Erythrocyte Production Anemia – reduction of RBC volume or Hgb concentration below normal Classifications: 1. Morphology – changes in RBC size. and color .
hemophilia .Causes of Anemia Nutritional deficiency – iron. B12 Increased destruction of RBCs – sickle cell anemia Impaired or decreased rate of production – aplastic anemia Excessive blood loss . folate.
blood loss .inadequate supply of iron .Iron Deficiency Anemia Causes .inability for form Hgb .excessive demands for iron req’d for growth .impaired absorption .
dietary counseling .Iron Deficiency Anemia Signs and Symptoms: due to tissue hypoxia > lack of energy. red cell indices (MCV. MCH. pallor Diagnosis: CBC with diff. physical exam Medical Treatment: supplement with ferrous sulfate (dosages vary with age). easy fatigability. iron studies. MCHC).
Iron Deficiency Anemia Nursing Assessment and Interventions: . caution about high toxicity of iron .teach parents proper administration of iron preparations.educate parents about nutrition .explain laboratory testing .
Hgb S “sickles” . occ Hispanics Hgb A is partly or completely replaced by Hgb S With dehydration.Sickle Cell Anemia Causes: genetic transmission. and temp elevations. 2 parents with the trait have 25% chance of having child with SCD. found primarily in Blacks. hypoxia.acidosis.
vaso-occlusion from sickled RBCs .splenic congestion and enlargement . stroke .hepatomegaly. lordosis. heart failure. kyphosis .increased RBC destruction .cardiomegaly. liver failure .renal ischemia.Sickle Cell Anemia Pathophysiology: .osteoporosis. hematuria .
Sickle Cell Anemia Signs/Symptoms: Exercise intolerance Anorexia Jaundiced sclera Gallstones Chronic leg ulcers Growth retardation .
Sickledex .mild to severe bone pain .priapism .Hgb electrophoresis .arthralgia .acute abdominal pain .Stained blood smear Vaso-occlusive crisis .Sickle Cell Anemia Diagnosis .
analgesics for pain .electrolyte replacement .blood replacement .oxygen therapy .hydration .antibiotics .bed rest .Sickle Cell Anemia Medical management Supportive/symptomatic tx of crises .
Sickle Cell Anemia Nursing care: Minimize tissue deoxygenation Promote hydration Minimize crises Pain management Administering blood transfusions Encourage screening and genetic counseling Parent education .
Thalassemia Autosomal recessive disorder – Greeks. Syrians Signs/symptoms – microcytic anemia > splenomegaly.jaundice.epistaxis. chelation . Italians. gout Diagnosis – Hgb electrophoresis Medical Treatment – transfusions.
evidence of x-linked inheritence.Hemophilia Factor 8 or factor 9 deficiency – prolonged bleeding any where in the body! Cause: X-linked recessive disorder. labs Medical Management: Factor VIII concentrate. DDAVP (vasopressin) . defects in platelets and clotting factors Diagnosis: history of bleeding episodes.
Rest .Compression .Ice .Elevation Prevent crippling effects of bleeding Client education .Hemophilia Nursing care: Prevent bleeding Recognize and control bleeding (RICE) .
000.Idiopathic Thrombocytopenic Purpura Causes: acquired hemorrhagic disorder of unknown origin. splenectomy . Anti-D antibody. probably an autoimmune response to disease-related antigens Diagnosis: platelet count < 20. steroids. bleeding from mucous membranes. abnl bleeding time and clot retraction Signs and Symptoms: petechiae. prolonged bleeding from abrasions Medical management: supportive. bruising.
Idiopathic Thrombocytic Puerpera Nursing Considerations: Client/Parent teaching No contact sports No aspirin Prevent infection .
shaking.Blood Transfusion Complications: Hemolytic reactions .urticaria.chills.dyspnea . fever .wheezing Circulatory overload .progressive signs of shock Febrile reactions Allergic reactions . flushing .flank pain .
maintain patent IV line with NS. notify practitioner .Blood Transfusions Nursing Care Take VS BEFORE administering blood Check ID of recipient with donor’s blood type Administer 50 mL or 1/5 volume SLOWLY – STAY WITH THE CHILD Administer with NS on piggyback set-up Use appropriate filter Use within 30 mins – infuse within 4 hrs If reaction suspected: Stop the transfusion. take VS.