RN Exam 3 Review: Hematological Problems

! RN Exam 3 Review: Hematological Problems " 1. Sickle Cell Anemia Etiology: Genetic disorder causing RBCs to sickle and block capillaries Signs & Symptoms: • Severe pain (esp. during crises) • Fatigue • Pallor, jaundice • Swollen hands/feet (dactylitis) • Frequent infections • Delayed growth Nursing Actions: • Hydration: IV fluids to reduce sickling • Pain management: Opioids during crises • Oxygen: For hypoxia • Avoid cold temps, stress, high altitudes • Administer hydroxyurea as ordered Patient Education: • Stay hydrated • Avoid known triggers (infection, stress, dehydration) • Vaccinations & regular medical follow-ups " 2. Pernicious Anemia (B12 Deficiency) Etiology: Lack of intrinsic factor → ↓ B12 absorption Signs & Symptoms: • Fatigue, pallor • Glossitis (smooth, red tongue) • Neurological: paresthesia, balance issues Nursing Actions: • Administer vitamin B12 (cyanocobalamin) IM monthly • Monitor neurological function Patient Education: • Lifelong B12 injections if intrinsic factor is absent • Eat B12-rich foods (meat, dairy, eggs) " 3. Aplastic Anemia Etiology: Bone marrow fails to produce sufficient blood cells Signs & Symptoms: • Pancytopenia (↓ RBCs, WBCs, platelets) • Fatigue, infections, bleeding/bruising Nursing Actions: • Infection prevention: neutropenic precautions • Bleeding precautions • Administer immunosuppressants, transfusions, stem cell transplant if needed Patient Education: • Report signs of infection or bleeding • Avoid crowds and injury " 4. Thalassemia Etiology: Genetic defect in hemoglobin production Signs & Symptoms: • Severe anemia • Bone deformities (face/skull) • Delayed growth • Hepatosplenomegaly Nursing Actions: • Administer regular blood transfusions • Chelation therapy to manage iron overload • Monitor for iron toxicity Patient Education: • Adhere to transfusion and chelation schedule • Genetic counseling recommended " 5. Chronic Myeloid Leukemia (CML) Etiology: Abnormal proliferation of granulocytes; associated with Philadelphia chromosome Signs & Symptoms: • Fatigue, weight loss • Splenomegaly • Night sweats Nursing Actions: • Administer tyrosine kinase inhibitors (imatinib) • Monitor WBCs • Prepare for possible bone marrow transplant " 6. Chronic Lymphocytic Leukemia (CLL) Etiology: Overproduction of incompetent lymphocytes Signs & Symptoms: • Asymptomatic early • Lymphadenopathy • Recurrent infections • Fatigue Nursing Actions: • Monitor CBCs • Treat infections promptly • Administer chemo, monoclonal antibodies " 7. Idiopathic Thrombocytopenic Purpura (ITP) Etiology: Autoimmune destruction of platelets Signs & Symptoms: • Petechiae, ecchymosis • Mucosal bleeding • Low platelet count Nursing Actions: • Corticosteroids, IVIG • Bleeding precautions • Possible splenectomy Patient Education: • Avoid contact sports • No aspirin/NSAIDs • Monitor for signs of bleeding " 8. Hemophilia (A/B) Etiology: Inherited deficiency in clotting factor VIII (A) or IX (B) Signs & Symptoms: • Excessive bleeding/bruising • Hemarthrosis (bleeding into joints) • Prolonged aPTT Nursing Actions: • Administer missing clotting factor • Apply cold packs to bleeding joints • Immobilize during active bleeding Patient Education: • Avoid NSAIDs • Wear medical alert bracelet • Learn self-infusion of factor " 9. Disseminated Intravascular Coagulation (DIC) Etiology: Widespread clotting → bleeding due to depletion of clotting factors Triggered by: sepsis, trauma, cancer, obstetric complications Signs & Symptoms: • Bleeding from IV sites, gums • Petechiae • Tachycardia, hypotension • Organ failure Nursing Actions: • Treat underlying cause • Administer blood products (platelets, FFP) • Monitor labs: PT, aPTT, fibrinogen, D-dimer " 10. Thrombocytopenia Etiology: ↓ Platelets from bone marrow failure, drugs, autoimmune disease Signs & Symptoms: • Bleeding, bruising • Petechiae • Low platelet count (<150,000/mm³) Nursing Actions: • Bleeding precautions • Avoid IM injections, rectal temps • Administer platelet transfusions as ordered " 11. Hemorrhage Etiology: Blood loss from trauma, surgery, or ruptured vessels Signs & Symptoms: • Tachycardia, hypotension • Cool, clammy skin • ↓ LOC • ↓ Hemoglobin/Hematocrit Nursing Actions: • Control bleeding • Administer IV fluids & blood products • Monitor VS, UOP " 12. Blood Transfusions Key Points: • Always verify patient & blood product with 2 RNs • Use 20G or larger IV • Stay with patient first 15 minutes • Start infusion slowly (≤ 120 mL/hr) Transfusion Reactions: • Febrile: Chills, fever • Hemolytic: Back pain, hypotension, tachycardia • Allergic: Rash, itching, anaphylaxis Nursing Actions: • Stop transfusion immediately • Maintain IV with NS using new tubing • Notify provider & blood bank • Monitor VS and send blood bag for analysis # STUDY TIPS: • Know normal lab values for: o Hemoglobin (M: 13–17 g/dL, F: 12–16 g/dL) o Platelets (150,000–400,000/mm³) WBCs (5,000–10,000/mm³) RBCs (M: 4.7–6.1, F: 4.2–5.4 million/µL) Memorize common precautions: bleeding, neutropenic, infection control Focus on safety and patient teaching in each condition Know drugs like hydroxyurea, imatinib, corticosteroids, IVIG, epoetin alfa o o • • •