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Hypoproliferative anemia
- defect in production of RBCs
- bone marrow cannot produce adequate number of erythrocytes
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Hemolytic anemia
- excess destruction of RBCs ->
- release of hemoglobin from erythrocytes into plasma ->
- tissue hypoxia ->
- erythropoietin production ->
- hemoglobin broken down and excreted in bile as bilirubin
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Where is erythropoietin produced?
- The kidney
- (renal failure -> anemia)
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Megaloblastic anemia
- vitamin B12 deficiency or folic acid deficiency
- vitamin B12 deficiency is called pernicious anemia
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Myelodysplastic syndrome (MDS)
- abnormal development (dysplasia) of blood cells (usually erythrocytes)
- cells die while waiting to be released, so fewer cells in circulation
- cells are also not very functional
- increased risk for infection and bleeding
- neutropenic precautions
-
Sickle cell anemia
- treat with BMT
- Hydrea (increased hemoglobin)
- Arginine (antisickling)
- chronic RBC transfusions
- daily folic acid replacements
-
Thalassemia
hypochromia, microcytosis, hemolysis and anemia
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Osmolarity
- Amount of substance in a liter of solution
- plasma osmolarity is between 275-295 mOsm/L
-
Crystalloid vs. colloid
- crystalloid: fluids that are clear (hypo/hyper/iso)
- colloid: fluids with protiens or startch (blood products). Always hypertonic, plasma expander, watch for increased BP, dyspna, and bounding pulse
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Isotonic fluids
- use for volume expander
- watch for fluid overload in cardiac patients
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Hypotonic vs. hypertonic
- hypotonic: cells swell (O)
- hypertonic: cells shrink
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Normal saline uses
- shock
- blood transfusions
- *can lead to fluid overload in cardiac patients
-
Lactated Ringers uses
- dehydration
- burns
- fluid/acute blood loss
- *contains potassium and calcium
- *caution for liver and renal pts
-
0.45% Sodium Chloride uses
- cellular dehydration d/t diuresis
- hypertonic dehydration
- slow rehydration
- *electrolyte imbalance may occur
-
D5LR uses
- hypovolemic shock
- hemorrhagic shock
- *caution with renal or cardiac
- *monitor for fluid overload
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D5 1/2NS uses
- heat exhaustion
- diabetes
- TKO w/ renal and cardiac pts
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When to call the physician with a central catheter:
- temp of 100.5
- chills, dyspnea, dizziness
- site irritation (pain, leaking, bleeding)
- swelling in neck, face, chest or arm
- change in length of external cath
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Risks of supported nutrition (TPN, enteral)
- infection (TPN)
- aspiration (enteral)
- hyperglycemia
- electrolyte balance, diarrhea
- "refeeding syndrome": severe electrolyte imbalance when restarting nutrition after nearly starving. Manifested by hypophosphatemia
-
Care of a pt with enteral nutrition
- monitor for abdominal distention
- monitor for presence of BS
- >30 degrees during feeings and following feeding for at least 1 hour
- oral care
-
Packed red blood cell (PRBC) rationale for transfusion
- hypocolemia
- symptomatic anemia
- surgery
- *creates an increase in RBC mass
- *20 gauge needle or bigger
- *stay with pt for 15 min
-
Platelet rational for transfusion
- bleeding dur to a severe decrease in platelets
- *stay with pt for 15 min
-
Plasma rationale for transfusion
- administered in bleeding patients with coagulation deficiencies
- *includes coagulation factors
- *stay with pt for 15 min
-
Febrile nonhemolytic reaction of blood transfusion
- most common
- caused by antibodies to donor leukocytes
- chills, fever 2 hrs after start of transfusion
- use leukocyte filter, antipyretics
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Acute hymolytic reaction to blood transfusion
- PREVENTABLE d/t incompatible blood
- fever, chills, pain, nausea, chest discomfort, etc
- tx - d/c transfusion, maintain blood volume and renal prefusion, prevent DIC
-
Transfusion-related acute lung injury (TRALI) reaction to blood transfusion
- antibodies in donor plasma stimulate recipient's leukocytes, leukocytes aggregate and damage lungs
- pulmonary edema w/in 4 hours after transfusion
- fever, chills, acute respiratory distress, bilateral inflitrates
- tx - 02, intubation, diruetics
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Nursing management of blood transfusion reaction
- d/c transfusion
- IV NS in a new tubing
- assess vitals, resp, LOC
- notify MD, blood bank
- return bag to bank
- document
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Bone marrow biopsy pt care
- small area anesthetized, might feel sharp pain
- monitor for bleeding (BP, pulse, site, CBC)
- monitor for infection (WBC count, temp)
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Red blood cell structure
- erythrocyte
- responsible for carring oxygen
- hemoglobin attaches O2 to RBCs, aided by iron, vit B12, vit B6, and folic acid
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Hematocrit
% of blood occupied by RBCs
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Mean cell volume (MCV)
average cell size
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Mean cell hemoglobin (MCH)
average amount of hemoglobin
-
Mean cell hemoglobin concentration (MCHC)
average concentration of hemoglobin per unit volume of an average RBC
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RBCs normal range
4.2-6.2 million
-
-
Hematocrit normal range
42-48%
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Hemoglobin normal range
12-16.5g/dl
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Polycythemia
excessive circulating erythrocytes
-
Neutropenic precautions
- proper hygeine (cleaning)
- equipments stays in pt's room
- no live vaccines
- reverse precautions
- (p. 931)
- *neutropenia
-
Leukemia
- malignant proliferation of WBC (lymphocytes or myeloid)
- malignant cells found in peripheral blood
- anemia, infection, bleeding, weakness, and fatigue
- leukocyte count, ANC, hematocrit, platelets, electrolytes
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Lymphoma
- malignant neoplasm of lymphocytes in lymph nodes and organs that grow into nodular masses
- no malignant cells found in peripheral blood
- Hodgkin's (curable)
- Non-Hodgkin's (prognosis varies)
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Polycythemia vera
- chronic, overproduction of RBC, WBC, and platelets; spleenomegaly
- occurs in old, Jewish men
- increased blood volume and viscosity
- hypercoaguable
- *risk for thrombosis
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Thrombocytopenia
- platelet count less than 100,000/mm3
- significant hemorrhage possible at 50,000
- spontaneous bleeding possible at 10-15,000
- petechiae, ecchymosis, frank bleeding
- congenital or acquired
- cause: ASA, heparin, GPIIb/IIIa Inhibitors
- tx: Neumega
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Heparin induced thrombocytopenia (HIT)
- platelets aggretate 5-10 after treatment
- causes arterial and venous thrombosis
- tx - direct thrombin inhibitor and warfarin
- never give heparin ever again
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Disseminated intravascular coagulation (DIC)
- uncontrolled activation of clotting factors->
- lots of clots ->
- clotting factors depleted ->
- massive hemorrhage
- triggered by trauma, shock, burns, surgery
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Erythropoietin
- Epogen, Procrity, Aranesp
- stimulates production of RBCs and hemoglobin
- treats anemia
- monitor for seizures
- monitor BP; severe hypertension
-
Colony stimulating factos
(as a medication)
- Neupogen, Neulasta, Leukine
- stimulate production of WBCs
- reduce time pt is vulnerable for infection
- treats neutropenia
- immunocompromised d/t chemo, transplant
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Anticoagulation/Antiplatelets
- GPIIb/IIIa Inhibitors
- ADP blockers-theinopyridine
- warfarin [antagonist = vit. k]
- heparin
- fibrinolytics/thrombolytics (clot buster)
-
Haptoglobin
- protein that removes free hemoglobin from the blood
- (serum test for anemia)
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