33
Lesson Plans for
Hematologic Disorders
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 33.1:
2. Identify data to be collected when assessing a patient with a disorder of the hematologic system.
3. Describe tests and procedures used to diagnose disorders of the hematologic system, and nursing
5. Describe the pathophysiology, signs and symptoms, medical diagnosis, and medical treatment for
selected disorders of the hematologic system.
6. Assist in planning nursing care for a patient with a disorder of the hematologic system.
CHAPTER TEACHING FOCUS
• In this chapter, students will be introduced to the components of the hematologic system, including its
role in oxygenation and hemostasis.
• Furthermore, students will have the opportunity to learn about the data that needs to be collected when
assessing a patient with such a disorder.
• Hematologic system tests and procedures, nursing considerations, and the nursing care for patients
undergoing common therapeutic measures will be discussed.
• Finally, students will have the opportunity to examine select disorders of the hematologic system, as
well as pathophysiology, signs and symptoms, medical diagnosis and treatment, and the development
of a nursing care plan for affected patients.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Homeostasis and Regulation
• Concept: Nutrition
• Exemplar: Iron Deficiency (Anemia), p. 635
• Table 33-5: Drug Therapy: Drugs Used to Treat Disorders of the Hematologic System, p. 634
• Coordinated Care: Helping the Certified Nursing Assistant Care for Patients with Blood Disorders,
p. 640
• Pharmacology Capsule, p. 635
THEME: Oxygenation and Hemostasis
• Concept: Clotting
• Exemplar: Thrombocytopenia, p. 638
• Box 33-4: Nursing Actions for the Patient at Risk for Injury from Bleeding, p. 630
• Box 33-6: Administration of a Platelet Transfusion, p. 632
• Exemplar: Disseminated Intravascular Coagulation, p. 639
• Box 33-4: Nursing Actions for the Patient at Risk for Injury from Bleeding, p. 630
2 Chapter 33Hematologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) The life of a red blood cell (RBC) is approximately __________.
a) 60 days
b) 90 days
c) 120 days
d) 150 days
2) The blood type A positive signifies the presence of the type A __________.
a) antigen
b) antibody
c) platelet
d) clotting factor
3) Plasma is composed primarily of __________.
a) bile
b) spinal fluid
c) joint synovium
d) water
4) Cryoprecipitate is administered primarily for __________.
a) a decreased hemoglobin and hematocrit
b) hemophilia A
c) an elevated white blood cell count
d) sickle cell anemia
5) Fresh frozen plasma (FFP) primarily contains __________.
a) factors I and III
b) factors II, IV, and IX
c) all factors except platelets
d) platelets
6) A blood transfusion reaction to donor leukocytes is what type of reaction?
a) Hemolytic
b) Anaphylactic
c) Febrile
d) Circulatory overload
7) The increased number of red blood cells associated with polycythemia vera causes the blood to
increase in __________.
a) plasma
b) viscosity
c) leukocytes
d) volume
8) Pernicious anemia is related to which vitamin deficiency?
a) A
b) B6
c) B12
d) C
9) The pain associated with a sickle cell crisis is caused by __________.
a) tissue hypoxia
b) bone marrow spasms
c) fever and dehydration
d) cardiomegaly
10) Hemorrhaging related to coagulation disorders is commonly due to abnormal clotting factors and
___________.
a) leukopenia
b) hemorrhagic fever
c) anaphylaxis
d) thrombocytopenia
___________________________________________________________ Chapter 33Hematologic Disorders 3
Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What is the role of red blood cells in oxygenation?
Question: What are the four main types of transfusion reactions?
4 Chapter 33Hematologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.1
Instructor Preparation
Textbook Objectives Covered
2. Identify data to be collected when assessing a patient with a disorder of the hematologic
system.
3. Describe tests and procedures used to diagnose disorders of the hematologic system, and
nursing considerations for each.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying hematologic disorders, including:
• Components and function of the hematologic system
• Nursing assessment of hematologic disorders
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• anemia (p. 632)
• purpura (p. 627)
Assignments 2 hours
1
READ – Textbook (pp. 622-624)
REVIEW
• Figure 33-1: Blood components (p. 623)
• Figure 33-2: Formation of a blood clot (p. 624)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1, 3 (p. 641)
ANSWER – Study Guide
• Part IA: 5, 9 (p. 199)
___________________________________________________________ Chapter 33Hematologic Disorders 5
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.1
2
READ – Textbook (pp. 624-627)
REVIEW
• Box 33-1: Assessment of Patients with Disorders of the Hematologic System (p. 625)
• Box 33-2: Assessing for Orthostatic Changes in Vital Signs (p. 626)
ANSWER – Text
ANSWER – Study Guide
• Part IA: 2, 4, 7, 8 (p. 199)
3
READ – Textbook (pp. 627-629)
REVIEW
• Table 33-1: Diagnostic Tests and Procedures Laboratory Tests (p. 628)
ANSWER – Study Guide
• Part IIIC: 20 (p. 201)
6 Chapter 33Hematologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.1
Lecture Outline 20 minutes
1
Slide 1
Chapter 33
Hematologic Disorders
Slide 2
Structures and Components of the Hematologic System
• Bone marrow
• Liver
• Spleen
• Blood
TALKING POINTS:
• Where are the majority of red blood cells and platelets produced?
• The bone marrow is the spongy center of the bones where the red blood cells and
platelets are made.
• The liver manufactures clotting factors.
• The spleen removes old red blood cells from circulation.
Slide 3
Physiologic Functions of the Hematologic System
• Oxygenation
• Red blood cells transport oxygen from the lungs to the tissues and carbon dioxide
from the tissues back to the lungs for excretion
• Hemoglobin in red blood cells combines with oxygen and carbon dioxide to
accomplish oxygenation
TALKING POINTS:
• What is the coagulation cascade?
Slide 4
Physiologic Functions of the Hematologic System (cont.)
• Hemostasis
• Control of bleeding
___________________________________________________________ Chapter 33Hematologic Disorders 7
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.1
Age-Related Changes
• Bone marrow becomes less productive
Slide 6
• May be the symptoms of an underlying hematologic disorder
Chief Complaint and History of Present Illness
Medical History
• Cancer or prior cancer treatment, human immunodeficiency virus (HIV) infection, liver
disease, kidney disease, malabsorption disease, prolonged bleeding or delayed healing
TALKING POINTS:
• Why is it important to find out what over-the-counter medications the patient is taking?
Slide 8
Family History
• Sickle cell disease or hemophilia
• Death of a family member at a young age for reasons other than trauma may indicate a
genetic hematologic disorder
Slide 9
Review of Systems
• Changes in skin color, skin dryness, pruritus (itching), and brittle fingernails or toenails
• Dizziness, vertigo, confusion, and pain
• Headaches
• Changes in vision
TALKING POINTS:
• What characteristics of a patient’s headache should be assessed?
Review of Systems (cont.)
• Bleeding or pain in the mouth, gums, or tongue
• Normal bowel function and recent changes
8 Chapter 33Hematologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.1
Slide 11
Functional Assessment
• Occupation and hobbies
• Self-concept
• Activity and exercise
TALKING POINTS:
• How can a patient’s occupation or hobbies affect the hematologic system?
Slide 12
Physical Examination
• Measure vital signs, height, and weight
• General survey
• Patient’s responsiveness, mood, expression, and posture
• Any reddened, swollen, or painful areas
• Skin
• Note general color
• Describe bruising
• Head and neck
• Signs of bleeding in eyes, ears, nose, mouth, throat
• Cracking at the corners of the mouth
TALKING POINTS:
• What variations in the vital signs may indicate a hematologic disorder?
• A patient with a low red blood cell count may appear pale.
• What are the differences between petechiae, purpura, and ecchymosis?
Slide 13
Physical Examination (cont.)
• Thorax
• Lungs
• Assess respiratory rate and effort
• Auscultate breath sounds
• Heart and vascular system
• Assess heart rate, resting blood pressure, and adaptation of blood pressure to
position changes
• Abdomen
TALKING POINTS:
• Patients with low red blood cell counts often are dyspneic, or short of breath, because
they do not have enough red blood cells to carry oxygen to all of their tissues.
• What causes the heart rate to increase in a patient with a low red blood cell count?
• The liver and spleen can become enlarged with blood cell disorders, causing abdominal
fullness and tenderness.
___________________________________________________________ Chapter 33Hematologic Disorders 9
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.1
3
Slide 14
Diagnostic Tests and Procedures
• Blood tests
• Red blood cell count
• Hemoglobin (Hb or Hgb)
• Hematocrit (Hct)
TALKING POINTS:
• The red blood cell count is the total number of red blood cells found in a cubic millimeter
(mm3) of blood.
• The hemoglobin indicates the oxygen-carrying capacity in the blood.
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
PRACTICE
• Divide the class into small groups. Have
each group identify the role of the following
hematologic system components in
oxygenation and hemostasis:
• Bone marrow
• Liver
• Spleen
• Blood fired blood cells, platelets, clotting
factors, plasma)
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
2
PRACTICE
• Online, ask the student to submit three to
five assessment questions appropriate to
ask a patient with fatigue, tarry stools, joint
3
DISCUSS
• Have student pairs take turns role-playing a
nurse-patient interaction in which the nurse
is explaining the purpose and preparation for
two of the laboratory tests from the
10 Chapter 33Hematologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.1
Critical Thinking Question
A 28-year-old African-American man with a history of sickle cell anemia is admitted in sickle
cell crisis. He is in extreme pain. During the admission assessment, a nurse documents the
patient has not had a bowel movement for 3 days and has been having difficulty voiding.
The nurse auscultated and documented occasional bowel sounds in the upper quadrants.
The nurse attempts to palpate the abdomen to assess for a fecal mass or distended bladder,
but the patient complains of severe pain. Should the nurse palpate the abdomen more gently
to complete the abdominal assessment? Why or why not?
Discussion Guidelines: No, the nurse should not continue to palpate the abdomen. The cells
characteristic of sickle cell anemia adhere to and block the larger blood vessels throughout the
and girth measurement.
Instructor Notes/Student Feedback
___________________________________________________________ Chapter 33Hematologic Disorders 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.2
Textbook Objectives Covered
5. Describe the pathophysiology, signs and symptoms, medical diagnosis, and medical treatment
for selected disorders of the hematologic system.
6. Assist in planning nursing care for a patient with a disorder of the hematologic system.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying hematologic disorders, including:
Materials and Supplies
• computer and PowerPoint
projector
• blood transfusion policy and
procedure
Key Terms
• anemia (p. 632)
• ecchymosis (p. 627)
• purpura (p. 627)
• universal donor (p. 629)
Assignments 2 hours
4
READ – Textbook (pp. 629-634)
REVIEW
• Box 33-3: Nursing Actions for the Patient at Risk for Injury from Insufficient Oxygenation
Related to Low Red Blood Cell Counts (Anemia) (p. 629)
• Box 33-4: Nursing Actions for the Patient at Risk for Injury from Bleeding (p. 630)
• Table 33-3: Commonly Transfused Blood Products (p. 631)
• Box 33-5: Administration of a Red Blood Cell Transfusion (p. 631)
ANSWER – Text
• Review Questions for the NCLEX Examination: 4, 5 (p. 641)
ANSWER – Study Guide
12 Chapter 33Hematologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.2
5
READ – Textbook (pp. 632-640)
REVIEW
• Figure 33-4: Comparison of normal red blood cells (A) and sickled cells (B) (p. 635)
ANSWER – Text
• Review Questions for the NCLEX Examination: 6-11 (p. 641)
ANSWER – Study Guide
• Part IA: 3 (p. 199)
• Part IB: 1-11 (p. 200)
• Part IIC: 1-4 12-15, 24, 25 (pp. 200-202)
6
READ – Textbook (pp. 632-640)
REVIEW
• Nursing Care Plan 33-1: Patient in Sickle Cell Crisis (p. 637)
ANSWER – Study Guide
50-Minute Lesson Plan
Lecture Outline 20 minutes
4
Slide 15
Therapeutic Action
• Nursing actions for the patient at Risk for injury from low red blood cell counts
• See Box 33-3
Slide 16
Therapeutic Action (cont.)
• Nursing actions for the patient at Risk for injury from bleeding
• See Box 33-4
Slide 17
Blood Product Transfusion
• Criteria for transfusion
• Typing for transfusions
• Sample sent for typing and crossmatching
• Type A, B, AB, or O; either Rh positive or Rh negative
• O negative: universal donors because their blood does not contain any of the A, B, or