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Nursing Management of the Patient with Hematologic and Immunologic Alterations

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Discuss IOM competencies: patient centered care, informatics, ... Oral supplement (ferrous sulfate) IV supplement (iron dextran) Nursing Diagnoses. Anemias ... – PowerPoint PPT presentation

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Title: Nursing Management of the Patient with Hematologic and Immunologic Alterations


1
Nursing Management of the Patient with
Hematologic and Immunologic Alterations
  • Janie Best, MSN, ACNS-BC
  • NURS 228 Spring 2009

2
Objectives
  • Discuss IOM competencies patient centered care,
    informatics, interdisciplinary team, evidenced
    based practice, and quality outcomes in the care
    of the patient with hematological and
    immunological conditions.

3
Objectives
  • Relate principles of anatomy and physiology to
    the nursing care of individuals with hematologic
    and immunologic health problems.
  • Integrate and relate the pathophysiologic changes
    of normal blood cells to common clinical
    assessments in the adult patient.

4
Objectives
  • Analyze the common health problems that accompany
    alterations in blood cells in the adult patient.
  • Apply the nursing process and holistic caring
    principles to address the needs of adult patients
    who have alterations in the hematologic and
    immunologic systems.

5
Objectives
  • Integrate restorative principles into a plan of
    care for adult patients who have alterations in
    the hematologic and immunologic systems.
  • Identify the various roles and contributions of
    the health care team in providing care for the
    adult with hematological, immunological, and
    oncological functions.

6
Objectives
  • Develop nursing interventions to assist adult
    patients with alterations in hematological and
    immunological function.
  • Discuss major care concerns for patients and
    families undergoing hematological and
    immunological treatments.

7
Objectives
  • Evaluate the effectiveness of nursing
    interventions appropriate to achieving optimal
    outcomes of planned care for the adult with
    hematologic and immunologic systems disorders.

8
Health Promotion Considerations
  • High Risk Populations
  • Gerontologic
  • Cultural / Ethnic

9
Health Assessment
  • Health History
  • Medications
  • Diet
  • Current Concerns
  • Physical Examination

10
Laboratory Tests
  • Complete Blood Count (CBC)
  • RBC
  • Hgb, Hct
  • WBC
  • Differential count
  • Shift to the left
  • Platelets

11
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12
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13
Laboratory Tests
  • ESR
  • Iron Metabolism
  • Reticulocyte
  • Ferritin
  • Transferrin
  • Transferrin saturation

14
Diagnostic Tests
  • Bone Marrow Aspiration and Biopsy
  • Indication
  • Procedure
  • Risks
  • Nursing Management

15
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16
Anemia
  • Overview
  • Etiologic Classifications
  • Decreased RBC production
  • Blood Loss
  • Increased RBC destruction

17
Clinical Manifestations
  • Physical Exam
  • Integumentary
  • Cardiopulmonary
  • Neurologic
  • GI
  • Musculoskeletal

18
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19
Decreased RBC Production
  • Altered Hemoglobin synthesis
  • Iron deficiency
  • Thalassemias
  • Chronic inflammation
  • Altered DNA synthesis
  • Vitamin B12 or folic acid malabsorption or
    deficiency
  • Bone marrow failure
  • Aplastic anemia
  • Myeloproliferative leukemias
  • Lymphoma
  • Chronic infection or inflammation

20
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21
Iron Deficiency Anemia
  • Most common type of anemia
  • Etiology

22
Iron Deficiency Anemia
  • Clinical Manifestations
  • Systemic
  • Severe Anemia
  • Cheilosis
  • Koilonychia

23
Iron Deficiency Anemia
  • Nursing Management
  • Preventive education
  • Nutritional counseling

24
Iron Deficiency Anemia
  • Nursing Management
  • Oral supplement (ferrous sulfate)
  • IV supplement (iron dextran)

25
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26
Nursing Diagnoses
Deficient Knowledge
27
Vitamin B12 Deficiency
  • Pernicious Anemia
  • Etiology
  • Clinical Manifestations
  • Diagnostic Studies
  • Interdisciplinary Care

28
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29
Vitamin B12 Deficiency Anemia
  • Schilling Test

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/9869.htm
30
Folic Acid (Folate) Deficiency
  • Etiology
  • Clinical Manifestations

31
Folic Acid (Folate) Deficiency
  • Interdisciplinary Care
  • Nursing Management
  • Ongoing Care

32
Hemolytic Anemias
  • Intrinsic
  • Within the RBC
  • RBC cell membrane defects
  • Sickle cell anemia, thalassemia
  • Inherited enzyme defects (G6PD deficiency)
  • Extrinsic
  • Originate outside the RBC
  • Drugs
  • Toxins and venoms
  • Infections
  • Trauma, burns
  • Mechanical damage (prosthetic heart valves,
    hemodialysis, radiation)

33
Sickle Cell Anemia
34
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35
Example
36
Thalassemia
  • Autosomal recessive
  • Found in
  • Treatment

37
Aplastic Anemia
  • Etiology
  • pancytopenia
  • Manifestations
  • Diagnostic Studies

38
Aplastic Anemia
  • Interdisciplinary Care
  • Dietary considerations
  • Nursing Management
  • Neutropenic precautions
  • Thrombocytopenic precautions
  • dephia Lippincott Williams Wilkins.
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