___________________________________________________________ Chapter 33Hematologic Disorders 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.2
Slide 18
Blood Product Transfusion (cont.)
• Transfusions of packed red blood cells
• Consent signed before any blood transfusion
• Blood sample drawn; sent for type and crossmatch
• Policies for administering blood products vary; be familiar with and follow your
institution’s policies
TALKING POINTS:
• For each unit of packed red blood cells transfused, how much should the patient’s
hemoglobin and hematocrit increase approximately?
• One way to prevent the risks of infection and reactions with blood transfusions is to collect
the patient’s own blood before a planned procedure and then transfuse the patient’s own
blood back into the patient if needed as an autologous red blood cell transfusion.
Slide 19
Blood Product Transfusion (cont.)
• Platelet transfusion
• When platelet count falls <20,000 cells/mm3
• Patient must give signed consent
TALKING POINTS:
• Platelets are commonly ordered in four-packs or six-packs; each pack contains
approximately 60 mL.
• When should platelets be administered if they are being given to prevent bleeding during
a procedure?
Slide 20
Blood Product Transfusion (cont.)
• Fresh frozen plasma transfusions
• Plasma separated from whole blood by centrifugation and quickly frozen
• Contains all the clotting factors as well as the plasma proteins
Slide 21
Blood Product Transfusion (cont.)
• Reactions to blood transfusions
• Four main types
• Hemolytic
• Anaphylactic
• Febrile
• Circulatory overload
• Symptoms
• Back or chest pain, fever, chills, decreased blood pressure, urticaria, wheezing,
dyspnea, or coughing during the transfusion
14 Chapter 33Hematologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.2
Slide 22
Blood Product Transfusion (cont.)
• Reactions to blood transfusions
• Interventions
• Stop transfusion immediately; keep intravenous line open with normal saline
• Immediately notify provider, nursing supervisor, blood bank
• Be prepared to administer oxygen, epinephrine, Solu-Cortef, furosemide (Lasix),
antipyretics as prescribed by provider
• Save the unused portion of the blood bag for the blood bank
• Be prepared to collect blood and urine samples from the patient for evaluation
Slide 23
Colony-Stimulating Factors
• Naturally occurring hormones that stimulate the bone marrow to produce more blood cells
• Erythropoietin (Epogen)
• Stimulates bone marrow to produce more red blood cells
TALKING POINTS:
• Erythropoietin is predominantly used for what type of patient?
Slide 24
Polycythemia Vera
• Too many red blood cells are produced
• Increased cells make blood more viscous (thicker); doesn’t circulate freely throughout
body
• Symptoms: headache, dizziness, ringing in the ears, and blurred vision. Patients with this
disorder may have a ruddy (reddish) complexion
• Treatment is to have a unit of blood phlebotomized, or taken off, to keep the hematocrit
normal
5
Slide 25
Aplastic Anemia
• Complete failure of the bone marrow
• Extremely low red blood cell count, white blood cell counts, and platelet counts because
Slide 26
Aplastic Anemia (cont.)
• Signs and symptoms: pallor, extreme fatigue, tachycardia, shortness of breath,
hypotension, unusually prolonged or spontaneous bleeding, and frequent infections that
do not resolve
• Transfusion: replace red blood cells and platelets
• Antibiotics to prevent or treat infections; corticosteroids also may be given
• If bone marrow does not recover, a transplant may be considered if donor can be found
Slide 27
Autoimmune Hemolytic Anemia
• Bone marrow makes enough blood cells, but they are destroyed once released into
circulation
• Causes: certain infections, drug reactions, and certain cancers
___________________________________________________________ Chapter 33Hematologic Disorders 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.2
Slide 28
Autoimmune Hemolytic Anemia (cont.)
• Signs and symptoms: pallor, extreme fatigue, tachycardia, shortness of breath, and
hypotension
• Patients may appear jaundiced
• High bilirubin levels from all the red blood cells lysed (broken down)
• Patients have a positive Coombs’ antiglobulin blood test
• Medical treatment: identifying and treating the cause
• Blood transfusions may be needed to replace red blood cells
• Corticosteroids may be administered to the patient
• Patient usually recovers in a few days to weeks
Slide 29
Iron Deficiency Anemia
• From a diet too low in iron or from the body not absorbing enough iron from the
gastrointestinal tract
• Symptoms: fatigue and pallor
• Severe cases: orthostatic changes in heart rate and blood pressure
• A low red blood cell count, low hemoglobin value, low hematocrit; a low serum iron level,
TALKING POINTS:
• Older adults with poor eating habits frequently suffer from anemia.
• What foods are high in iron?
Slide 30
Pernicious Anemia (Vitamin B12 Anemia)
• Vitamin B12 not absorbed from stomach
• May lack intrinsic factor
• May have had a gastrectomy
• Symptoms: fatigue, pallor, weakness, a sore tongue, numbness of hands or feet
• Treatment: monthly intramuscular injection of vitamin B12 (cyanocobalamin)
TALKING POINTS:
Sickle Cell Anemia
• Disk-shaped red blood cells become sickle-shaped
• Misshapen cells more fragile than normal red blood cells; as a result, the sickled cells
16 Chapter 33Hematologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.2
Slide 32
Sickle Cell Anemia (cont.)
• Genetic disease: almost exclusively in African Americans
• Carried on a recessive gene; a person must inherit the gene from both the mother and the
father to actually have the disease
• Sickle cell crisis: the sickled cells become stuck in larger blood vessels of the body;
obstruct blood flow and cause severe pain
TALKING POINTS:
• How many African Americans carry the genetic trait for sickle cell anemia?
Slide 33
Sickle Cell Anemia (cont.)
• Various stressors can trigger a sickle cell crisis
• Dehydration, infection, overexertion, cold weather changes, excessive alcohol
consumption, smoking
• Symptoms vary: depend on where circulation is blocked by the sickled red blood cells
• Circulation to the chest, abdomen, bones, joints, bone marrow, brain, or penis may be
compromised
• Tissue hypoxia occurs, causing severe pain
Slide 34
Sickle Cell Anemia (cont.)
• Medical diagnosis of sickle cell disease
• Providers use clinical judgment
• Radiographs and scans of the painful area to evaluate for bleeding
• Medical treatment of sickle cell crisis
TALKING POINTS:
• Aggressive intravenous hydration helps the kidneys clear the metabolic wastes from
ruptured red blood cells.
• Intravenous morphine commonly is prescribed for pain relief.
• Will oxygen therapy help to reverse a sickle cell crisis?
Slide 35
Sickle Cell Anemia (cont.)
• Assessment
• Complete description of the pain
• Document location, intensity, duration, and precipitating events; vital signs every 4
hours
• Assess for fever
• Any symptoms of an infection, such as sore throat, cough, abnormal breath sounds,
dysuria, or diarrhea
• Monitor for signs and symptoms of dehydration
___________________________________________________________ Chapter 33Hematologic Disorders 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.2
Slide 36
Sickle Cell Anemia (cont.)
• Interventions
• Acute pain
• Anxiety
• Risk for injury
• Ineffective therapeutic regimen management
Thrombocytopenia
• Too few platelets circulating in the blood
• Not enough platelets being made in bone marrow or too many platelets are being
TALKING POINTS:
• Chemotherapy and radiation do not distinguish between rapidly dividing cancer cells and
rapidly dividing normal cells like those that produce platelets.
• When can thrombocytopenia be expected in a patient receiving chemotherapy or
radiation?
6
Thrombocytopenia (cont.)
• Examples of too many platelets being either destroyed or consumed are idiopathic
thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP)
Slide 39
Disseminated Intravascular Coagulation (DIC)
• A hypercoagulable state
• Overstimulation of normal coagulation cascade: simultaneous thrombosis and
hemorrhage
Disseminated Intravascular Coagulation (cont.)
• Always secondary to another pathologic process: overwhelming sepsis, shock, major
Disseminated Intravascular Coagulation (cont.)
• Blood tests that help diagnose DIC include prothrombin time, partial thromboplastin time,
fibrinogen, thrombin time, fibrin split products level, and D-dimers
18 Chapter 33Hematologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.2
Slide 42
Hemophilia
• Genetic disease: affected person lacks some blood clotting factors normally found in
plasma
• Signs and symptoms
• Uncontrollable bleeding is the hallmark of hemophilia
• Occurs after trauma; however, also spontaneously for no clear reason
TALKING POINTS:
• What is the incidence of hemophilia?
• In hemophilia A, factor VIII is missing, whereas in hemophilia B, factor IX is missing.
• Regardless of whether the trait is inherited or spontaneous, it is rare for women to have
this disease.
• Because any surgical procedure puts the patient at great risk for bleeding, a complete
preoperative evaluation must be done.
Slide 43
Hemophilia (cont.)
• Medical diagnosis
• Measuring factors VIII and IX in the blood
• Partial thromboplastin time
• Medical treatment
• No cure; treatment is symptomatic
Slide 44
Hemophilia (cont.)
• Assessment
• For bleeding and pain; note what measures have stopped the bleeding and relieved
pain in the past
• Monitor vital signs and urine output
• Interventions
• Risk for injury
• Acute pain
• Ineffective therapeutic regimen management
Slide 45
Question 1
• After about _____ days, the old red blood cells are filtered out of circulation by the liver
and spleen.
A. 30
B. 60
C. 90
D. 120
TALKING POINTS:
___________________________________________________________ Chapter 33Hematologic Disorders 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.2
Slide 46
Question 2
• A person with type O blood would have ______.
A. the A antigen
B. the B antigen
C. both the A and B antigens
D. neither the A nor the B antigen
TALKING POINTS:
Activities
Classroom Choose from below to make 30 minutes
Online
4
PRACTICE
• Obtain the written policy and procedure for a
blood transfusion from a local hospital. Include
any patient preparation materials as well as
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Assign
students to use the nursing diagnosis
20 Chapter 33Hematologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.2
5
PRACTICE
• Divide the class into several small groups.
Provide each group with blood pressure
cuffs and stethoscopes. Have each group
practice the assessment for orthostatic
hypotension and appropriately document
findings. After the practice, each group
should list two possible conditions that would
cause orthostatic hypotension. Using the
nursing diagnosis Risk for injury, each group
should write a goal, two nursing
interventions, and expected patient
outcomes. Call on the various groups to
share their work and discuss the rationale.
• Divide the class into four groups and assign
each group one of the following:
• An 84-year-old woman has a history of
hypertension and aplastic anemia. Two
•
• A 55-year-old man has recently
completed his second week of
chemotherapy and is receiving a blood
transfusion. He began to experience
itching and wheezing 20 minutes after his
infusion started.
• A 68-year-old woman with osteoarthritis
___________________________________________________________ Chapter 33Hematologic Disorders 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 33.2
6
PRACTICE
• Divide the class into small groups. Assign
each group one of the nursing diagnoses
below and have them create a nursing care
plan:
• Acute pain related to sickle cell crisis
• Anxiety
• Activity intolerance
• Risk for injury due to potential for
Critical Thinking Question
What key points should a nurse include in the teaching plan for a patient who has recently
been diagnosed with sickle cell anemia?
Instructor Notes/Student Feedback
22 Chapter 33Hematologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
33
Assessments for
Hematologic Disorders
CHAPTER 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
considerations for each.
Lesson 33.2:
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.
Assessments by Lesson & Objective
Lesson 33.1
1
Study Guide
• Part IA: 5, 9 (p. 199)
• Part IIC: 6, 18, 19, 21, 26 (pp. 200-202)
• Part IIID: 1 (p. 202)
• NCLEX Review: 10
2
Study Guide
• Part IA: 2, 4, 7, 8 (p. 199)
• Part IIID: 5, 6 (p. 203)
Evolve Instructor Resources
• Test Bank: 7
• Open Book Quiz: 2
Evolve Student Resources
• NCLEX Review: 2, 8
• Prioritization: 4
3
Study Guide
• Part IIIC: 20 (p. 201)
Evolve Instructor Resources
Evolve Student Resources
• Prioritization: 5
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
4
Study Guide
• Part IA: 6 (p. 199)
• Part IIC: 5, 7-11, 17, 22, 23, 27 (pp. 200-202)
• Part IIID: 7, 8 (p. 203)
Evolve Instructor Resources
Evolve Student Resources
• NCLEX Review: 3
• Prioritization: 1, 2
5
Study Guide
• Part IA: 3 (p. 199)
• Part IB: 1-11 (p. 200)
• Part IIC: 1-4 12-15, 24, 25 (pp. 200-202)
Evolve Instructor Resources
• Test Bank: 3, 6, 9, 17, 18, 20, 24
• Open Book Quiz: 7-10
Evolve Student Resources
• NCLEX Review: 6, 7
Study Guide
Evolve Instructor Resources
• Test Bank: 1, 8, 10, 11, 14, 21, 22, 26
Evolve Student Resources
• NCLEX Review: 1, 4, 5, 9
• Prioritization: 3
Instructor’s Notes/Student Feedback