Immune & Immune & Haematologic DisordersHaematologic Disorders

NURS 2016NURS 2016

Chapters: 33, 51-54Chapters: 33, 51-54

AnemiaAnemia Anemia: lower than normal Anemia: lower than normal

hemoglobin (normal is 120-180g/dL)hemoglobin (normal is 120-180g/dL) 3 main categories:3 main categories:

– Loss of red cellsLoss of red cells– HypoproliferativeHypoproliferative– HemotyticHemotytic

Symptoms of anemia are more Symptoms of anemia are more apparent when onset is rapid. A apparent when onset is rapid. A person can tolerate a 50% decreased person can tolerate a 50% decreased in RBC gradually, but rapid 30% in RBC gradually, but rapid 30% decrease can cause vascular collapse.decrease can cause vascular collapse.

AssessmentAssessment

General: Weakness, fatigue, malaiseGeneral: Weakness, fatigue, malaise Appearance: Pallor of skill and mucous Appearance: Pallor of skill and mucous

membranes, tongue smooth red, membranes, tongue smooth red, beefy ulcerations at corner of mouthbeefy ulcerations at corner of mouth

Appetite: Crave ice, starchAppetite: Crave ice, starch Nutrition: lack of iron, B12, folic acid, Nutrition: lack of iron, B12, folic acid,

vegetarians need to supplement B12 vegetarians need to supplement B12 (comes from animal sources)(comes from animal sources)

Assessment Cont’Assessment Cont’

Cardiac Status: look for signs of Cardiac Status: look for signs of increased cardiac loadincreased cardiac load

GI: N&V, coffee grounds, melena, GI: N&V, coffee grounds, melena, diarrhea, anorexia, stool for OBdiarrhea, anorexia, stool for OB

Hx: menstrual cycle, alcohol and Hx: menstrual cycle, alcohol and family hxfamily hx

Neuro: peripheral numbness, poor Neuro: peripheral numbness, poor coordination, confusioncoordination, confusion

Dietary IronDietary Iron

Iron deficiency anemia most Iron deficiency anemia most commoncommon

Sources: organ meats, black, Sources: organ meats, black, pinto and garbonzo beans, leafy pinto and garbonzo beans, leafy greens, raisins & molassesgreens, raisins & molasses

Vitamin C enhances absorption of Vitamin C enhances absorption of iron from dietary sourcesiron from dietary sources

Iron SupplementsIron Supplements

Ferrous SulfateFerrous Sulfate Take 1 hour before or 2 hours Take 1 hour before or 2 hours

after meals (will not absorb with after meals (will not absorb with food)food)

Increase intake of vitamin CIncrease intake of vitamin C Increase intake of fiberIncrease intake of fiber Stool will be darkStool will be dark

Case StudyCase Study

Mark is 3 years old. His mother Mark is 3 years old. His mother brings him to the clinic after a brings him to the clinic after a diagnosis of iron deficiency diagnosis of iron deficiency anemia after a routine anemia after a routine examination by his family doctor. examination by his family doctor. He is a very picky eater. He is to He is a very picky eater. He is to start oral iron therapy.start oral iron therapy.

Rheumatoid ArthritisRheumatoid Arthritis

Inflammatory disorder that Inflammatory disorder that primarily involves the synovial primarily involves the synovial membrane of the jointsmembrane of the joints

Clinical Manifestations:Clinical Manifestations:– Joint painJoint pain– SwellingSwelling– WarmthWarmth– ErythemaErythema– Lack of functionLack of function

Nursing DiagnosisNursing Diagnosis

PainPain FatigueFatigue Impaired mobilityImpaired mobility Self-care deficitSelf-care deficit Disturbed sleeping patternDisturbed sleeping pattern Disturbed body imageDisturbed body image Ineffective copingIneffective coping

InterventionsInterventions

Relieving pain & discomfortRelieving pain & discomfort Reducing fatigueReducing fatigue Increasing mobilityIncreasing mobility Facilitating self-careFacilitating self-care Improving sleepImproving sleep Improving body imageImproving body image Monitoring & managing potential Monitoring & managing potential

complicationscomplications Increasing knowledge of disease Increasing knowledge of disease

managementmanagement

LeukemiaLeukemia

True cause is unknownTrue cause is unknown Unregulated proliferation or accumulation Unregulated proliferation or accumulation

of white blood cells (WBC)of white blood cells (WBC) In the bone marrow, replacing normal In the bone marrow, replacing normal

marrow elementsmarrow elements Classified as either lymphocytic or Classified as either lymphocytic or

mylocytic according to the stem cell mylocytic according to the stem cell involvedinvolved

Classified as acute (abrupt onset) or Classified as acute (abrupt onset) or chronic (evolves over months to years)chronic (evolves over months to years)

LeukemiaLeukemia Clinical Manifestations:Clinical Manifestations:

– WeaknessWeakness– FatigueFatigue– Bleeding tendenciesBleeding tendencies– PetechiaePetechiae– EcchymosisEcchymosis– VomitingVomiting– FeverFever– InfectionInfection– HeadacheHeadache– PainPain

Nursing DiagnosesNursing Diagnoses

Risk for infection & bleedingRisk for infection & bleeding Impaired mucous membrane Impaired mucous membrane Pain & discomfortPain & discomfort Imbalanced nutritionImbalanced nutrition Risk for diarrheaRisk for diarrhea Fluid imbalanceFluid imbalance Risk for excess fluid volume Risk for excess fluid volume Risk for yperthermiaRisk for yperthermia

Nursing Diagnoses Nursing Diagnoses Cont’Cont’ Fatigue & activity intolerance Fatigue & activity intolerance Impaired skin integrityImpaired skin integrity Grieving Grieving Disturbed body imageDisturbed body image Self-care deficit Self-care deficit Deficit knowledgeDeficit knowledge AnxietyAnxiety Impaired gas exchangeImpaired gas exchange

Nursing InterventionsNursing Interventions

Preventing BleedingPreventing Bleeding Preventing InfectionPreventing Infection Managing MucositisManaging Mucositis Easing Pain & DiscomfortEasing Pain & Discomfort Attaining & Maintaining Adequate NutritionAttaining & Maintaining Adequate Nutrition Management Fluid & Electrolyte balanceManagement Fluid & Electrolyte balance Decreasing Fatigue & DeconditioningDecreasing Fatigue & Deconditioning Improving Self CareImproving Self Care Managing Anxiety & GriefManaging Anxiety & Grief Promoting Positive Body ImagePromoting Positive Body Image Encouraging Spiritual Well-beingEncouraging Spiritual Well-being

Human Human Immunodefinciency VirusImmunodefinciency Virus(HIV)(HIV) HIV InfectionHIV Infection RetrovirusesRetroviruses

HIV asymptomaticHIV asymptomatic HIV symptomaticHIV symptomatic

Acquired Acquired Immunodeficiency Immunodeficiency Syndrome (AIDS)Syndrome (AIDS) Risk factors:Risk factors:

– Transmitted through bodily fluidsTransmitted through bodily fluids Sexual intercourse (heterosexual or Sexual intercourse (heterosexual or

homosexual)homosexual) Injection of IV drugsInjection of IV drugs TransfusionsTransfusions Childbirth/breastfedChildbirth/breastfed

Clinical ManifestationsClinical Manifestations

Respiratory:Respiratory:– SOB, dyspnea, cough, chest pain, fever SOB, dyspnea, cough, chest pain, fever

are characteristic of pneumoniaare characteristic of pneumonia G.I.:G.I.:

– Loss of appetite, N&V, oral candidiasis, Loss of appetite, N&V, oral candidiasis, diarrheadiarrhea

Neuro:Neuro:– Encephalopathy, peripheral neuropathyEncephalopathy, peripheral neuropathy

Clinical Manifestations Clinical Manifestations Cont’Cont’ Integumentary:Integumentary:

– Herpes simplex, flaking skin, skin cancersHerpes simplex, flaking skin, skin cancers Reproductive:Reproductive:

– Vaginal candidiasis, ulcerative sexually Vaginal candidiasis, ulcerative sexually transmitted diseases (syphilis, herpes), PID, transmitted diseases (syphilis, herpes), PID, amenorrheaamenorrhea

Other:Other:– Fatigue, headache, night sweats, weakness, Fatigue, headache, night sweats, weakness,

weight loss, dry cough, SOB, diarrhea, edema, weight loss, dry cough, SOB, diarrhea, edema, swallowing difficulties, dementia, depressionswallowing difficulties, dementia, depression

AssessmentAssessment

Dietary StatusDietary Status Skin & Mucous MembranesSkin & Mucous Membranes Respiratory StatusRespiratory Status Neurologic StatusNeurologic Status Fluid & Electrolytes StatusFluid & Electrolytes Status Level of KnowledgeLevel of Knowledge Use of Alternative TherapiesUse of Alternative Therapies

Nursing DiagnosisNursing Diagnosis Impaired skin integrityImpaired skin integrity Risk for infectionRisk for infection Activity intoleranceActivity intolerance Disturbed thought processesDisturbed thought processes Ineffective airway clearanceIneffective airway clearance Imbalanced nutritionImbalanced nutrition DiarrheaDiarrhea PainPain Social isolationSocial isolation Anticipatory griefAnticipatory grief Deficient knowledgeDeficient knowledge

Nursing InterventionsNursing Interventions Improving airway clearanceImproving airway clearance Promoting skin integrityPromoting skin integrity Maintaining perineal skin integrityMaintaining perineal skin integrity Prompting usual bowel habitsPrompting usual bowel habits Preventing infectionPreventing infection Relieving pain & discomfortRelieving pain & discomfort Improving nutritional statusImproving nutritional status Improving activity toleranceImproving activity tolerance Maintaining thought processesMaintaining thought processes Coping with griefCoping with grief Monitoring & managing complicationsMonitoring & managing complications