Anemia
Deficiency in:
- number of RBCs
- quality/quantity of Hgb
- volume of packed RBCs (Hct)
Causes:
- decrease in RBC production
- blood loss
- increased RBC destruction
- hypoxia causes many of the S&S
- not a specific disease
- severity determined by Hb levels
Clinical Manifestations of Anemia
- Pale, rectal bleed, chest pain, tachycardia, HA, cold, anorexia, dyspnea at rest, weight loss, bone pain, depression, CHF, MI
Hemolysis cause: jaundice of skin, conjuctive and sclera pruritis
Iron-deficiency anemia
affects the young, picky eaters, and reproductive age women
S&S:
- pallor, inflammation of the tongue (glossitis) & lips (cheilitis), HA, tongue burning
Iron supplements:
- one hour before meals
- take with OJ
- avoid contact with teeth (stains)
- can cause: constipation, black tarry stools
Aplastic anemia
bone marrow doesn’t produce enough blood cells
- can have genetic component
S&S:
- fatigue, dyspnea, dizzy, HA, cold, pale, angina, flu-like, bruises, bleeding and heavy periods
Treatment:
- blood transfusions, stem cell transplants may offer a cure for some
Hemolytic anemia
premature destruction of RBCs
can affect people with heart valve replacement
S&S:
- jaundice, enlarged liver/spleen, dark urine, fatigue
Care:
- fluids r/t possible renal failure
- need to treat cause
- packed RBCs gives slowly to avoid cardiac problems
Pernicious anemia
Vitamin B12 deficiency
affects women 40-70 - northern european
S&S:
- anorexia, N/V, abd pain, weakness, paresthesias, confusion
Treatment:
- vitamin B12 shots until counts are WNL then will have life-long injections
Leukemia
Risk factors:
- genetics
- exposure
- radiation
- nuclear accidents
- chemicals
ALL, AML, CML, CLL
Medical Management for Leukemia
Destroy neoplastic cells
- chemotherapy
- radiation
- steroids
- targeted therapy
Minimize or control complications:
- total body radiation to prepare for BMT
- manage pancytopenia: bone marrow transplant
Nursing management for Leukemia
- emotional support
- neutropenia assessment and precautions
- skin assessment and care
- conserve energy
- alopecia (may be permanent with whole brain radiation)
- vaccines: flu and pneumovax
- can Surmount
Polycythemia Vera
- increase production of RBCs
- increase in blood viscosity
- increase in volume
- age: 60s, male, slow onset
- Treatment: phlebotomy: 300-500ml may be removed every other day until Hct is WNL.
- ASA 81 mg
Clinical Manifestations of Polycythemia Vera
Early stage:
- no symptoms
Moderate stage:
- headaches
- vertigo
- tinnitus
- blurred vision
Late stage:
- thromboses
- embolization
- nosebleeds
- ecchymoses
- GI bleed
Lupus (SLE)
chronic, autoimmune
Diagnosis:
- +ANA, high sed rate
- Low RBC, WBC, platelet
- IgE
S&S of Lupus (SLE)
- fever
- butterfly rash
- oral ulcers
- pericarditis
- hematuria
- anemia
- thrombocytopenia
- azotemia (high levels of nitrogen containing compounds – urea, creatinine)
Med/Nurse management for Lupus (SLE)
- NSAIDs
- Steroids
- Imuran
- treatment r/t organ system most involved
- fatigue control
- avoid triggers: light, stress, pregnancy
- nutrition
- emotional support
Fibromyalgia
- chronic widespread musculoskeletal pain with multiple tender points.
- fatigue (doesn’t go away with rest), sleeplessness, IBS, anxiety, memory problems, and HA
- disorder of central processing with neuroendocrine/neurotransmitter dysregulation
Diagnosis:
- difficult
- pain in 11 of 18 tender points for 3 months
Treatment for Fibromyalgia
- NSAIDs
- antidepressants
- Flexeril
- Ambien
- massage
- heat/cold
- avoid sugar, caffeine and ETOH
- stress management
Rheumatoid Arthiritis
- chronic progressive inflammation
- bilateral, symmetrical
- collagen breakdown
- synovial damage
- scar tissue
- permanent join deformity
Clinical manifestations of Rheumatoid Arthiritis
- fatigue
- diffuse joint pain
- fever
- anorexia and weight loss
- inactive stiffness
- PAIN IN THE AM
- muscular shortening
- nontender joint nodules
- +Rheumatoid factor
- increased sed rate
- +ANA
- thin synovial fluid
- high WBCs
Med/Nurse measures for Rheumatoid Arthiritis
- ASA/NSAIDs
- suppress immune (methotrexate)
- antimalarials
- gold therapy
- steroids
- surgery
- nutrition
- rest
- avoid increasing damage to joints
- support
MRSA
- both hospital or community acquired
- viable for days on surface and clothing
- patients at risk
- –immunosuppressed
- –invasive devises (caths)
- –break in skin barrier (surgery)
VRE
- hardier than MRSA
- viable on surface for weeks
- E.coli: 2nd most common cause of nosocomial infections
- responds ONLY to Synercid and Zyvox
Patient teaching for Antibiotic-resistant organisms
- do not take antibiotics to prevent illness
- handwashing
- take antibiotics as ordered
- no antibiotics for cold/flu
- do not take leftover antibiotics (there shouldn’t be any!)
C.difficile
- at risk: 65 year olds
- received large doses of antibiotics
- have been on antibiotics for >7 days
- Pts on: H2 blockers, preop bowel preps, chemo
- immunocompromised
- COPD, CRF, GI procedures
- ICU, ECF, semi-private rooms
- smells VERY bad
- most common cause of nosocomial infections esp in surgery patients
S&S:
- diarrhea, N/V/A, abd distention, hyperactive bowel sounds, fever
usually self-limiting (1-5 days)
