APLASTIC ANEMIA

Acquired (other cause: congenital, unknown) Autoimmune mechanism Direct injury to myelotoxin

Always cause

occasionally:

only few cases: when received -chorampenicol -streptomycin in large amounts: -sulfonapoides -tripelannamine -radiant energy -guinnacrine -DDT (xray) -phenyl butazone -meprobamate -benzene & de-anticonvulsants -carbon tetrachloride

rivatives -alkylating agents -antimetabolites to treat malignant tumor T-cells mediate an attack on bone marrow (immunosuppressant except costicosteroids)

Destroy stem cells & impair production of erythrocyte, leukocyte, platelets> biopsy

Bone aplasia (decrease hematopoiesis)

THROMBOCYTOPENIA

ERYTHROPENIA (decrease RBC level)

KIDNEY DISEASE

NEUTHROPENIA (decrease WBC level)

fewer platelets availale fr coagulation decrease phagocytosis decrease oxygen level in blood kidney will not release decrease adhesion,decrease aggregation erythropoietin capabilities to plug smallbreaks in small decrease immune response blood vessels decrease erythropoetin hormone decrease release of prothrombin decrease RBC production infection (fever) DIAGNOSTIC PROCEDURE:

prone to bleeding or hemorrhage decrease amount of matured RBC CBC: NORMAL RESULTS RBC : MALE= 5-6 Million cells/mcl FEMALE= 4-5 Million cells/mcl WBC: 4,500 10,000 cells/mcl PLATELETS: 140,000 450,000 cells/mcl HEMOGLOBIN: MALE= 14-17 gm/dl FEMALE= 1215 gm/dl MENATOCRIT: MALE= 41% - 50% FEMALE= 36% 44%

decrease oxygen utilization of cells

Bone marrow tests show whether your bone marrow is healthy and making enough blood cells. The two bone marrow tests are aspiration (as-piRA-shun) and biopsy.Bone marrow aspiration may be done to find out if and why your bone marrow isn't making enough blood cells. For this test, your doctor removes a small amount of bone marrow fluid through a needle. The sample is looked at under a microscope to check for faulty cells.A bone marrow biopsy may be done at the same time as an aspiration or afterward. For this test, your doctor removes a small amount of bone marrow tissue through a needle.

ANEMIA

PALLOR

DYSPNEA

FATIGUE

NURSING PROBLEMS INEFFECTIVE BREATHING PATTERN

y y

NURSING MANAGEMENT Assess respiratory rate, depth, effort, rhythm and breath sounds. Respiratory rate and rhythm changes are early warning signs of impending respiratory difficulties. Assess for the quality, duration, intensity, & distress associated with dyspnea. Inquire about precipitating and alleviating factors. Knowledge of these factors is useful in planning interventions to prevent or manage future episodes of dyspnea. Assess nutritional status (e.g., weight and albumin and electrolyte levels). Malnutrition may results in premature development of respiratory failure because it reduces respiratory mass and strength. It blunts ventilator responses to hypoxia & impairs pulmonary and systemic immunity. Overfeeding increases of CO?, which increases respiratory drive and respiratory muscle fatigue. Monitor breathing patterns:

FLUID VOLUME DEFICIT

y y

y y y FATIGUE
y

Obtain specimens for analysis of altered potassium levels (e.g., serum and urine potassium) as indicated. Monitor for neurologic and neuromuscular manifestations of hypokalemia (e.g., muscle weakness, lethargy, altered level of consciousness). Encourage increase of fluid intake Monitor vital signs as appropriate. Weigh daily and monitor trends Assess severity of fatigue on a scale of 0 to 10; assess frequency of fatigue, activities associated with increased fatigue, ability to perform activities of daily living (ADLs), times of increased energy, ability to concentrate, mood, and usual pattern of activity. Evaluate adequacy of nutrition and sleep. Encourage the client to get adequate rest. Refer to Imbalanced Nutrition: less than body requirements or Disturbed Sleep pattern if appropriate. Determine with help from the primary care practitioner whether there is a physiological or psychological cause of fatigue that could be treated, such as anemia, electrolyte imbalance, hypothyroidism, depression, or medication effect. Encourage client to express feelings about fatigue; use active listening techniques and help identify sources of hope.

RISK FOR INFECTION

y y y

Observe and report signs of Infection. Assess temperature, Use an electronic or mercury thermometer to assess temperature. Note and report laboratory values (e.g., white blood cell count and differential, serum protein, serum albumin, and cultures).

y y

Assess skin for colour, moisture, texture, and turgor of the skin. Encourage a balanced diet, emphasizing proteins to feed the immune system. Encourage fluid intake and adequate rest to bolster the immune system.

MEDICAL MANAGEMENT: DRUG Generic Name: cyclosporine Brand Names: Gengraf, Neoral, Sandimmune CLASSIFICATION MECHANISM OF AND INDICATION ACTION Oral dose in C:mmunosuppressive inhibit T-celladults or children agents mediated immunity with transplant by: rejection is I: the most based on the effective drugs for decreasing body weight. production of prevention and Initially start interleukin-2 by treatment of with 12 to 15 organ activated T-helper milligrams (mg) transplantation cells
per kilogram (kg) per day and after a period of time the dose may be reduced to 5 to 10 mg per kg per day. Parentral dose in adults or children with transplant rejection reactions. It is routinely used in patients with renal, hepatic or cardiac transplantation. It is started orally 12 hours before the

ROUTE, DOSE, FREQUENCY

CONTRAINDICATIONS
contraindicated during breast feeding and in patients with hypersensitivity.

SIDE EFFECTs
y y y y y y y y y

decreasing the number of interleukin receptors on cytotoxic T cells.

Acne Dizziness Headache Increased hair growth Nausea Runny nose Sleep disorders Stomach discomfort Vomiting

NURSING RESPONSIBILITIES Monitor cyclosporine blood levels at regular intervals. Monitor daily weights, fluid balance, and blood pressure response. Monitor blood urea nitrogen and serum creatinine levels, as ordered. Signs or symptoms of nephrotoxicity may develop 2 to 3 months after

rejection is based on the body weight and is 2 to 6 mg per kg per day.

transplant and continued for 6 or more months thereafter.When graft rejection has started, it is preferably given I.V because oral bio-availability is low.

transplant surgery. Monitor liver function tests, as ordered. Warn the patient not to stop therapy without the physician's supervision.