Nursing 210

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• Nursing 210
• Fluid and Cells

Nursing management of patients with hematologic
dysfunction
Laurie Brown RN, MSN, MPA-HA, CCRN
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Development of Blood Cells
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Hemoglobin and Hematacrit
Hb Women 12-16 Men 13.5-18
Hct Women 38-47 Men 40-54
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Complete Blood Count
White Blood Cells (WBC) 5,000-10,000
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WBCDifferential

• Neutrophil
• Eosinophil
• Basophil
• Lymphocyte
• Monocyte

• 50-70
• 2-5
• 0-2
• 20-40
• 4-8

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CBC

• Platelet Count
• 150,000-400,000

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Red Cells

• Mean Corpuscular Hemoglobin (MCH)
• Mean Corpuscular Volume (MCV)
• Mean Corpuscular Hemoglobin Concentration (MCHC)

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Clotting

• Extrinsic
• Intrinsic

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Heparin PTT
Coumadin PT or INR
Vitamin K
Protamine sulfate
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Drugs Impairing the Hematologic System

• Drugs causing bone marrow suppression
• Drugs causing hemolysis
• Drugs that disrupt platelet action
• Drugs that disrupt clotting action

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ANEMIAS

• Can Not Make
• Lost
• Destroyed

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ANEMIAS

• Iron Deficiency
• Pernicious Anemia
• Folic Acid Deficiency
• Trauma
• Chronic loss

• Sickle Cell
• Infectious Agents
• Antibodies
• Aplastic Anemia
• G6PD Deficiency

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Sickle Cell Anemia

• Pain Control
• Sickle cell crisis
• Rational for orders
• Nursing orders

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Pernicious Anemia

• Vitamin B 12
• Intrinsic Factor
• Cells mutate and become large
• Development of Neurological problems

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Clotting Problems

• Thrombocytopenia
• Hemophilia
• Von Willebrand
• Disseminated Intravascular Coagulation (DIC)

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DIC

• Imbalance between the process of coagulation and
  anticoagulation

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Treatment
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Heparin Administration

• Heparin loading dose
• Initial Maintenance Infusion
• Dosage calculation often by patients weight

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TransfusionAdministration

• Identification
• Lab values
• Drs order verify
• Pt assessment
• IV site assessment
• Documentation
• Verify with 2nd RN
• Monitor VS

• Remain with the patient

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• Automatic IV infuser pump
• Flow rate calculation
• Blood/Blood product w/tag
• 150 cc NS
• Blood Administration Set
• Gloves

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Blood Bank

• Patient name and I.D. number
• Unit number and ABO/Rh type on bag with blood bag
  compatibility tag bag unit/type
• Verify expiration date on blood bag

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Autologous Blood Transfusions

• Preoperative autologous blood donation
• Acute normovolemic hemodilution
• Intraoperative autologous transfusion
• Postoperative blood salvage

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Characteristics of Normal Cells

• Limited Cell Division
• Specific Morphology
• Small Nuclear-Cytoplasmic Ratio
• Perform Specific Differentiated Functions
• Adhere tightly together
• Are nonmigratory
• Grow in an orderly and well differentiated manner
• Are contact inhibited

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Characteristics of Malignant Cells

• Demonstrate rapid or continuous cellular
  division.
• Show anaplastic morphology
• Have a large nuclear-cytoplasmic ratio
• Lose some or all differentiated functions
• Adhere loosely together
• Are able to migrate
• Grow by invasion
• Are not contact-inhibited

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Leukemia

• AML - Acute Myelogenous
• ALL - Acute Lymphocytic
• CML - Chronic Myelogenous
• CLL - Chronic Lymphocytic

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FAB Leukemia Classification

• French American British Classification
• Historically distinguishing AML from ALL was a
  major clinical problem
• Chemotherapy dependent on tissue type

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Acute Leukemia NCCN Guidelines

• National Comprehensive Cancer Network (NCCN) has
  issued guidelines for treatment of many cancers
  including Leukemia as well as other hematological
  malignancies
• http//www.nccn.org/index.html

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Bone Marrow Aspiration

• Bone marrow biopsy
• Bone marrow aspiration

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Lymphoma

• Hodgkins lymphoma
• Non-Hodgkins lymphoma

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Multiple Myeloma

• Gammopathy
• M Protein
• called a tumor marker

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History of Myeloma

• Skeletal evidence of myeloma obtained from
  Egyptian mummies
• First case described in 1844
• 1845 Dr Henry Bence Jones detected heat
  properties of urinary light chains
• 1929 Bone marrow aspiration
• 1937 serum protein electrophoresis
• 1960 Alkeran and prednisone- first treatment

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What is Multiple Myeloma?

• A cancer of the bone marrow
• The location where cells are produced
• The affected cells are plasma cells
• Plasma cells produce antibodies (proteins that
  fight off infection)

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To Many Harmful Plasma Cells

• Abnormal Plasma Cells are called Myeloma Cells
  and develop without warning
• Myeloma cells collect in bones and cause soft
  spots where the cell is damaged

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Effects of the blood

• Normal cells are not being produced in the bone
  marrow
• Bones are damaged
• Bone demineralization (soft spots)

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Symptomatic Multiple Myeloma

• Calcium
• Renal
• Anemia
• Bone

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