Hema Diseases
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HEMATOLOGIC DISORDERS
BY: JOHN ARBIE T. TATTAO, RN
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ANEMIAA reduction in RBC that in turn ↓ the oxygen carrying capacity of the blood
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MAJOR CAUSES OF ANEMIA
Loss of RBC’sDeficiencies and abnormalities of erythrocyte production
Destruction of RBC
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MAJOR CLASSIFICATION OF ANEMIA
A. Hypoproliferative Anemia
Bone marrow cannot produce adequate number of RBC
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MAJOR CLASSIFICATION OF ANEMIA
B. Hemolytic AnemiaResults in premature destruction of RBC
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MAJOR CLASSIFICATION OF ANEMIA
C. Anemia resulting from loss of RBC
> ex: bleeding from GIT, trauma, menorrhagia, chronic epistaxis
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IRON- DEFICIENCY ANEMIA
PROBLEM: chronic, microcytic, hypochromic anemia resulting from inadequate absorption or excessive loss of iron leading to hypoxemic tissue injury
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IRON- DEFICIENCY ANEMIA
CAUSES:Predisposing FactorsA.Chronic blood loss 1. Trauma2. Menorrhagia3. GIT bleeding
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IRON- DEFICIENCY ANEMIAB. Inadequate intake of food rich in iron
1. Chronic diarrhea2. Malabsorption syndrome3. High cereal intake with low
animal protein ingestion4. Subtotal gastrectomy
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IRON- DEFICIENCY ANEMIAS/SX OR CLINICAL MANIFESTATIONS:
Plummer Vinsons SyndromeEarly Sx are nonspecific, includes fatigue, weakness, SOB, pale conjunctiva
KoilonychiaCheilosisPICA
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IRON- DEFICIENCY ANEMIA Peripheral blood smear reveals microcytic and hypochromic RBC
CBC reveals:↓ Hgb to as low as 6-9 g/dl↓ total RBC count↓ Hct levels in relation to ↓ HgbRBC indices reveals ↓ MCV, MCH, MCHC
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IRON- DEFICIENCY ANEMIA Serum iron reveals ↓ levels
IDA - ↓ 10mg/dl N: 50 – 150 mg/dl
Decreased serum ferritin levels
Complete absence of hemosiderin
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IRON- DEFICIENCY ANEMIAMANAGEMENT:Drugs/Pharmacology:Iron Supplementa. Oral (Ferrous sulfate, Ferrous
gluconate, Ferrous Fumarate)NURSING RESPONSIBILITY:1. Advice pt. to take supplement 1
hr. Before meal
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IRON- DEFICIENCY ANEMIA2. Administer iron supplement with meals if taking it on empty stomach causes gastric distress
3. Administer w/ straw if diluting in iron liquid prep.
4. Do not take antacids or dairy products w/ Fe
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IRON- DEFICIENCY ANEMIA5. ↑ intake of Fe: Take iron w/ orange juice
6. Monitor and inform patient for S/E
a. Melenab. Anorexiac. Diarrhea/Constipationd. N/Ve. Abdominal pain
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IRON- DEFICIENCY ANEMIAParenteral Iron TherapyAdministered to pt. Who:a. Have an intolerance to oral
preparationsb.Continue to suffer blood lossc. Habitually forgetting to take
their medication
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IRON- DEFICIENCY ANEMIANURSING RESPONSIBILITY1. Administer with the use of Z tract
method2. Don’t massage injection site3. Ambulate4. Monitor pt for S/E
a. Fever/chillsb. Lymphadenopathyc. Urticartia
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IRON- DEFICIENCY ANEMIAd. Pain at injury sitee. Localized abscessf. Hypotension sec. to anaphylactic shock
DIET: Iron rich foods (ex: egg yolk, legumes, raisins, beans, organ meat, GLV)
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IRON- DEFICIENCY ANEMIA
Monitor signs of bleeding
Advice pt. to have CBRProvide good oral care Instruct pt. to avoid taking tea/coffee
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IRON- DEFICIENCY ANEMIAEncourage intake of Fe rich foods
Encourage pts. to continue Fe therapy as long as it is prescribed even though patient may no longer feel fatigued
Inform pt. that iron causes the stool to become dark green or black in color
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IRON- DEFICIENCY ANEMIA
Administer meds as ordered
Blood transfusion as necessary
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MEGALOBLASTIC/MACROCYTIC ANEMIA Anemias caused by deficiencies of Vit. B12 and folic acid
Characterized by the appearance of megaloblasts (large, primitive RBC’s) in blood and bone marrow
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PERNICIOUS ANEMIA
PROBLEM: Chronic, macrocytic, hyperchromic anemia caused by failure of absorption of Vit. B12 due to deficiency of intrinsic factor leading to hypochlorhydria
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PERNICIOUS ANEMIACAUSES: Total gastrectomy/Ileal resection
Atrophy of gastric mucosa Imflammatory disease of ileum
Strict vegetarian diet Absence of intrinsic factor Heredity
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PERNICIOUS ANEMIAS/SX: Red beefy tongue Headache, dizziness, dyspnea, palpitations, generalized body malaise, pallor
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PERNICIOUS ANEMIAGIT changes – mild diarrheaDyspepsia Neurologic Manifestations:a. Peripheral Neuropathy and
loss of balanceb. Confusionc. Paresthesia in extremities
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PERNICIOUS ANEMIA Lack of balance, uncoordinated movement
Loss of proprioception Depression, psychosis Achlorhydria
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PERNICIOUS ANEMIALABS/DX EVALS: Schillings Test – measure the absorption of orally administered radioactive Vit B12 before and after parenteral administration of intrinsic factor
Purpose: Used to detect Vit B12 absorption
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PERNICIOUS ANEMIA Procedure:1.Administration of oral
radioactive vit B122.Administration of large,
nonradioactive parenteral dose of vit b12 followed in a few hrs.
Interpretation: Cause of deficiency
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PERNICIOUS ANEMIAProcedure:3. The same procedure is repeated, but this time intrinsic factor is added to the oral radioactive Vit b12
Interpretation: Absorption of Vit B12
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PERNICIOUS ANEMIANursing Responsibility:1. Collect 24 hour urine
specimen2. Keep pt NPO, except for H2O
8-12 hours before the test3. Promote pt understanding
on proc. And emphasize ability to comply with urine collection
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PERNICIOUS ANEMIAMANAGEMENT:Drug/Pharmacology:a. Vit B12 injectionsNx. Resp:1. Administer Vit B12 injections at
monthly intervals for lifetime as ordered.
2. Oral administration is used only in cases of nutritional deficiency
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PERNICIOUS ANEMIADiet:↑ calorie or CHO, ↑ CHON, iron and Vit. C
Nursing Intervention:1. Enforce CBR2. Administer medication as
ordered3. Avoid irritating mouthwash.
Use of soft bristled tb is encouraged
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PERNICIOUS ANEMIANursing Intervention:4. Avoid applying electric heating pads
5. Administer blood transfusion as needed
6. Physical examination q 6 months
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FOLIC ACID DEFICIENCY ANEMIAPROBLEM: malabsorption of dietary folic acid due to lack of intake or absorption
CAUSE:a. Poor dietary intakeb.Poor GI absorptionc. Folate antagonistsd. Increased req.
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FOLIC ACID DEFICIENCY ANEMIA
d. Increase requirementS/SX:Same to PA but w/o neurologic involvement
Signs of poor oxygenationa. Dizzinessb. Irritabilityc. dyspnea
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FOLIC ACID DEFICIENCY ANEMIA
d. Pallore. Headachef. Oral ulcersg. Tachycardia
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FOLIC ACID DEFICIENCY ANEMIALabs/Dx Evals:1. RBC indices reveals ↑ MCV and ↓MCHC2. Serum folate levels reveals less than 4
mg/ml (N: 7 to 20 mg/ml)3. Schilling test reveals normal finding4. Blood smear reveals large RBC5. Therapeutic trial reveals client
responding to 50 to 100mg folic acid administered IM for 10 days.
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FOLIC ACID DEFICIENCY ANEMIAMANAGEMENT:Drug/Pharma Therapy1.Administer oral doses of
folic acid 0.1 to 5.0 mg/day until the blood profile improves or until the cause of intestinal malabsorption is corrected
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FOLIC ACID DEFICIENCY ANEMIA2. Clients with malabsorption syndromes may need parenteral folic acid initially, followed by maintenance therapy with oral doses
Diet/Nutritional Therapy↑ foods high in FA (mostly plant sources)
Daily req: 100 to 200 mg/day
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FOLIC ACID DEFICIENCY ANEMIA
Nursing Intervention:1.Administer meds as
ordered2.Referral to AA for
alcoholic patients3.Proper food preparation