Blood and Lymph Disorders
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Hypovolemic Anemia (Blood Loss Anemia)
- Abnormally low circulating blood volume. Sudden reduction in total blood volume can lead to hypovolemic shock.
- S/S: weakness; stupor; irritability; pale, cool, and moist skin.
- subjective data: complains of thirst, weakness,irritability and restlessness.
- objective data: decreased BP, rapid, weak, and thready pulse; rapid resp. cold clammy skin w/ pallor.
- medical management: blood transfusion.
- nursing intervention: keep pt flat and warm. V/S should be taken frequently.
(vit B-12 deficiency)
- metabolic defect: the absence of a glycoprotein intrinsic factor. Intrinsic factor essential for absorption of Vit B12
- manifestation: extreme weakness; skin color pale lemon-yellow. edema in the legs.
- subjective data: complaints of palpitations, nausea, flatulence, and indigestion. *soreness and burning in the tongue.
- objective data: a smooth and erythematous tongue.
- Diagnostic test: Schilling test. erythrocytes appear large and have abnormal shapes.
- medical management: vit b-12 injections, transfusion packed RBC. usu vit b-12 injections monthly for life.
- nursing interventions: V/S checked q 4hrs, special mouth care performed several times daily, diet high in protein, vits, minerals. warm blankets.
(failure of normal process of cell generation and development)
congenital and acquired
- Congenital = 30% in childern is inherited.
- Acquired aplastic anemia r/t exposure viral invasion, meds, chemicals, radiation, or chemotherapy. 70% acquired is idiopathic.
- manifestations: weakness, general malaise, dyspnea, palpitations. petechiae, ecchymoses, bleeding gums, and epistaxis, GI bleeding.
- subjective data: hx of exposure to chemicals such as insecticides and drugs. hx of aplastic anemia
- objective data: pallor, signs of infection, bleeding tendencies. dyspnea and tachycardia.
- diagnostic tests: bone marrow study, increased yellow marrow.
- medical management: antineoplastic meds, radiation therapy, blood transfusion, bone marrow transplant, splenectomy
- nursing interventions: look for signs of bleeding, stool tobe monitored for occult blood. encourage activities on progressive basis.
Iron Deficiency Anemia
- RBC's have a decreased levels of hemoglobin. excessive iron loss is usu cause. chronic intestinal and uterine bleeding. subtotal gastrectomy.
- manifestations: pallor, glossitis (inflammation of the tongue). fatigue, weakness, and shortness of breath. s/s of angina.
- subjective data: glossitis, pagophagia (desire to eat ice, clays, or starches. complaints of headaches, paresthesia, burning sensation of tongue.
- objective data: pallor and tachycardia. fragile fingernails, mucuous membranes of the mouth are inflamed. cracks at side of mouth.
- diagnostic tests: peripheral blood counts that show RBC and hemoglobin levels and hematocrit are decreased.
- medial management: iron salts such as ferrous sulfate. 900mg daily.
- interventions: foods high in iron include leafy green vegtables, organ meats, white beans, dried fruits, egg yolk.
Sickle Cell Anemia
most common genetic disorder in US.
defective hemoglobin molecule.
1 in 500 African-Americans has sickle cell anemia
- abnormal, crescent-shaped RBC containing hemoglobin S which is a defective hemoglobin molecule.
- manifestation: pain brought on by events that cause dehydration or the oxygen tension in the body. abdominal enlargement due to pooling of blood.
- subjective data: sickling symptom is pain. aching of joints in hands and feet. deep, gnawing and throbbing pain.
- objective data: abdominal enlargement, jaundice, edema in extremities.
- diagnostic test: Hemoglobin S not Hemoglobin A. Low hemocratic and hemoglobin values.
- interventions: rest is encouraged, opioid analgesics are used to treat pain.
Polycythemia (Erythrocytosis) excessive bone marrow production
polycythemia vera - erythrocytosis - abnormal increase in the number of circulating red blood cells.
myeloproliferative disorder with hyperplasia
secondary polycythemia generated by any source of hypoxia.
- increase in erythrocytes, granulocytes, and platelets. elevated WBC with basophilia. predisposes to infarctions of vital organs.
- manifestations: venous distention and platelet dysfunction cause esophageal varices, epistaxis, GI bleeding. Hepatomegaly and splenomegaly.
- subjective data: complaints of sensitivity to hot can cold. generalized pruritus r/t histamine release from increased # of basophils.
- objective data: eczema and dermatologic changes. skin may develop erythemic appearance. elevated BP accompanies left ventricular hypertrophy.
- diagnostic test: plasma and RBC volume are increased. Hypercellularity of RBCs, WBCs, and platelets.
- medical management: repeated phlebotomy decreases blood viscosity: removal of 500-2000 mL until hemocratic 45%-48%. reduce blood vol.
severe reduction in granulocytes
neutrophil count < 200/mm. Normal 3000-7000
WBC count is extremely low (leukopenia)
- suppression of the bone marrow reduces the number and production of white blood cells.
- manifestations: fever, chills, headache, and fatigue. ulcerations of mucuous mambranes are also found. bronchial pneumonia
- subjective data: complaints of fever, extreme fatigue, and prostration.
- objective data: erythema and pain from ulcerations.
- diagnostic test: leukocytes w/ neutrophils differential will be below normal.
- medical management: alleviate the factors responible for bone marrow depression. prevent or treat infection.
- intervention: protect against infection. meticulous hand washing by medical and nursing personnel and strict asepsis are mandatory. frequent oral hygiene.
excess of leukocytes accumulates in the bone marrow and lymph nodes
ALL - acute lymphocytic leukemia
AML - acute myelogenous leukemia
CML - chronic myelogenous (granulocytic) leukemia
CLL - chronic lymphocytic leukemia
- manifestations: bone marrow overcrowding by abnormal cells. inadequate production of normal marrow elements.
- subjective data: pain in bones or joints is often noticed. fatigue, malaise, decreased activity tolerance, and irritability.
- objective data: infections are common. occult blood is detected. petechiae and ecchymoses.
- medical management: achieve remission or control the symptoms.
- intervention: thrombocytopenia-induced hemorrhage may be life threatening.
- manifestation: petechiae and ecchymoses. epistaxis and gingival bleeding are common. circulatory hypovolemia. cool clammy skin. GI tracr bleeding.
- subjective data: hx of bleeding after surgical, dental procedures. exposure to toxic or hazardous agents. complaints of headache, extemity pain, and numbness.
- objective data: pain on pressure to the abdomen. occasionally hematoma.
- diagnostic test: platelet count will be low.
- medial management: underlying cause is assessed and corrected. transfusion may be ordered. heprin may be the cause.
- intervention: monitir vitals, watch for hypovolemic shock.
number of platelets is fewer than 150,000 / mm
medical management: corticosteroid therapy
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