Professional Documents
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Hematologic Diseases
Andrew D. Beluso, RN
Care of Clients with Hematologic
Diseases
Blood – transports cellular requirements and
products from one part of the body to another;
composed of plasma (55%) and cellular
component (45%)
slightly alkaline (ph 7.35-7.4)
5-6 liters or 70-75 ml/kg BW (average volume)
Pulmonary circulation = 1300 cc
arterial (400cc) + capillary (60cc) + venous (840cc)
Systemic circulation = 3000 cc
arterial (550cc) + capillary (300cc) + venous (2150cc)
Care of Clients with
Hematologic Diseases
Hematopoiesis – blood cell production; done in
the bone marrow (red), pelvis, sternum, ribs,
epiphysis of long bones
Erythropoiesis – red blood cell production in the
liver in utero (2 to 5 months old) then in bone
marrow.
needs iron, protein, pyridoxine (B6), cyanocobalamine
(B12), folic acid, and copper
Reticuloendothilial System – mononuclear
phagocyte system or macrophage (spleen, liver,
lymphatic system, lungs)
The reticuloendothelial system (RES),
part of the immune system, consists of the
phagocytic cells located in
reticular connective tissue, primarily
monocytes and macrophages. These cells
accumulate in lymph nodes and the
spleen. The Kupffer cells of the liver and
tissue histiocytes are also part of the RES.
Care of Clients with Hematologic
Diseases
Nursing Assessment:
Pallor – conjunctiva
Jaundice (hemolytic) – sclera; palms of
hands; soles of feet
Signs of bleeding such as petechiae,
ecchymosis, hematoma, epistaxis
Lymph nodes enlargement
Limited joint range of motion
Splenomegaly or hepatomegaly
Care of Clients with Hematologic
Diseases
Physical Assessment:
• Auscultate – heart murmur, bruits
• Inspect – above assessment
• Palpate – lymph nodes, location, size, bone
tenderness
• Percuss for ling excursion, splenomegaly,
hepatomegaly
• Evaluate joint ROM asnd tenderness
Care of Clients with Hematologic
Diseases
Diagnostic Assessment:
Blood
CBC with differential
b. Creatinine – N=0.7-1.4mgs/dl
• direct (N=0.1-0.2mg/dl)
• indirect (N=0.1-0.8mg/dl)
Diagnostic Assessment
Miscellaneous
a. ESR – N=0 to 20 mm/hr
b. Coomb’s test – indirect blood from mom, direct
blood from baby’s cord
c. Schillings test – Vit.B12 in the gastro-intestinal
system
prep NPO x 8 hours
radioactive Vit.B12 given PO
Vit.B12 nonradioactive given IM
2 hours after urine collection for radioactive
Vit.B12; N = 15-40% of oral dose excreted
Diagnostic Assessment
Urine and Stool
Urinalysis
Hematest
Hemoccult – prep; -no dark colored food x 24 hours prior to
test
Radiologic
CXR
Scan
Lymphangiography
Bone Marrow aspiration and biopsy
Preferred site – iliac crest, sternum or tibia
Before: consent, position exposing the site
After: pressure to site x5miuntes
Erythrocyte Disorders
Anemia – reduction below normal level in
number of erythrocytes, quantity of hemoglobin
and volume of packed RBC’s.
Basic underlying – tissue hypoxia
Signs and Symptoms – depends upon severity and
chronicity and age.
• a. Mild – hemoglobin 10-14 gms; asymptomatic; palpitations,
dyspnea and diaphoresis following strenuous exertion.
• b. Moderate – increased palpitations, dyspnea, and
diaphoresis; fatigue at rest or during activity.
• c. Severe – pale and exhausted all the time, sever
palpitations, sensitivity to cold, loss of appetite, profound
weakness, angina.
ANEMIA
Three broad categories