4.
UP COLLEGE OF NURSING
MEDICAL-SURGICAL NURSING
Hematology, Oncology, Cardiology
Lecturer: Mr. Ferdinand B. Valdez
OVERVIEW OF THE STRUCTURE AND FUNCTION OF THE
HEMATOLOGIC SYSTEM
I.
Blood
A. 55% Plasma
1. Serum
2. Plasma Proteins all produced in the LIVER
Globulin
Alpha transports bilirubin, steroids and
hormones
Beta transports iron and copper
Gamma transports immunoglobulins
(GAMED)
B.
CELLULAR COMPONENTS
I.
MS4
Sickling Crisis
Vasoocclusive Crisis
2. Airway: avoid deoxygenating activities
1
Prostaglandin
Serotonin
Histamine
Bradykinin
For inflammation
KUPFFER kidneys
MICROGLIA CSF
MACROPHAGE - blood
2. Lymphocytes
T cells (Thymus)
For immunity
Target site of HIV
AZT ZIDOVUDINE or
RETROVIR : drug of choice for aids
UPM
NK cells
Natural killer cells
Anti-tumor and anti-viral properties
III. PLATELETS
A. N = 150-450 thousand mm3
B. Promotes hemostasis prevention of blood loss
promote clotting mechanisms
C. MEGAKARYOCYTES immature/baby platelets; target
site of DHF; target site of dengue virus causing petechiae
D. Normal lifespan: 9-12 days
E. Illness associated with Platelet dysfunction
Hemophilia
3.
4.
5.
C.
(+) petechiae
Petechiae
Purpura
Ecchymoses
D.
E.
BLOOD DISORDERS
I.
MS4
Trauma
Menstruation
GIT bleeding
Hematemesis
Melena (UGIB)
Hematochezia (LGIB) (d/t E. histolytica
DOC: metronidazole)
2. Inadequate intake of iron rich food
3. Inadequate absorption of iron due to
Chronic diarrhea
Malabsorption syndrome
NURSING MANAGEMENT
1.
Administer with meals to lessen GIT
irritation
2.
Use straw for liquid form
3.
Administer with orange juice or
vitamin C to facilitate absorption
4.
Inform client of SE/monitor for
a.
Anorexia
b.
Nausea and vomiting
c.
Abdominal pain
d.
Diarrhea/constipation
e.
Melena
NURSING MANAGEMENT
1.
Administer using z-tract method to
prevent discomfort, discoloration and
leakage
2.
Avoid massaging of injection site
instead encourage pt. to ambulate to
facilitate absorption
3.
Monitor SE
a.
Pain at injection site
UPM
b.
c.
d.
e.
Localized abscess
Lymphadenopathy
Fever and chills
Pruritus and urticaria
Hypotension anaphylactic
shock epinephrine; SE:SNS
Globin
Heme
A. Ferrous
1.
Bilirubin
2.
Biliverdin
B. Ferritin
Early sign of anaphylactic shock: dyspnea
B.
B.
C.
D.
C.
D.
B.
Chemotherapeutic Agents
Nitrogen Mustard (Anti-metabolite)
Vincristine (plant alkaloid)
Methotrexate (alkylating agent)
Phenylbutazones
SIGNS AND SYMPTOMS
1. Headache, dizziness, dyspnea, palpitations, pallor,
cold sensitivity, generalized body malaise r/t
decreased RBC
2. Leukopenia (increased susceptibility to infections)
3. Thrombocytopenia
Petechiae
Ecchymoses
PREDISPOSING FACTORS
1. Rapid BT or multiple BT
2. Massive Trauma
3. Massive Burns
4. Neoplasia
5. Anaphylaxis, septicemia
6. Hemolytic Reactions
7. Pregnancy
8. Septicemia
SIGNS AND SYMPTOMS
1. Petechiae (systemic and widespread) lungs and
retinal cells, lower and upper extremities
2. Ecchymoses
3. Oozing of blood
4. Hemoptysis
5. Hemorrhage
6. Oliguria (late sign) anuria
UPM
7.
C.
D.
Vitamin K
Heparin
K.
BLOOD TRANSFUSIONS
I.
OBJECTIVES
A. To replace circulating blood volume
B. Increase oxygen carrying capacity of the blood
C. Combat infections if decreased WBCs
D. Prevent bleeding if decreased PLT
II. NURSING MANAGEMENT/PRINCIPLES
A. Proper refrigeration
B. Proper blood typing and cross-matching
1. Type O universal donor
2. Type AB universal receipient
3. 85% of general population is Rh (+)
Blood expiration:
Platelets : 5 days
RBC: 5-7 days, 250 cc
C. Aseptically assemble all materials needed for BT
1. Filter set (BT set)
2. PNSS for flushing to prevent hemolysis
3. 18-19 gauge large bore needle to prevent hemolysis
D. Instruct another RN to re-check the following:
1. Name of patient
2. Proper typing and cross matching
3. Bt and ct
4. Expiration date
5. Serial number
E. Check blood unit for presence of bubbles, cloudiness,
sediments and dark color as it may indicate bacterial
contamination
F. NEVER WARM BLOOD PRODUCTS! ROOM
TEMPERATURE ONLY may destroy vital factors in
the blood
1. Warming only done if you have dewarming devise
2. Warming only done during emergency situations if there
is massive blood loss/order for rapid BT massive
transfusion
G.
MS4
Nursing Management
Stop BT, Notify MD, Flush with PNSS
Administer Isotonic Solution to counteract
shock and prevent acute tubular necrosis
Return blood unit to blood bank for reexamination
Obtain urine and blood sample of client for
re-examination and send to lab
Monitor VS and IO
2. Allergic reactions
Nursing Management
Stop BT, Notify MD, Flush with PNSS
Diphenhydramine administration as ordered
If (+) to hypotension, it indicates
anaphylactic shock administer Epinephrine
as ordered
Return blood unit to blood bank for reexamination
Obtain urine and blood sample of client for
re-examination
Monitor VS and IO
3. Pyrogenic reactions
Nursing Management
Stop BT
Notify MD
Flush with PNSS
Administer antipyretics and antibiotics as
ordered
Provide hypothermic blanket
Return blood unit to blood bank for reexamination
Obtain urine and blood sample of client for
re-examination
Monitor VS and IO
4. Circulatory overload
Orthopnea
Nursing Management
Stop BT
Notify MD
Administer loop diuretics as ordered
NO FLUSHING!
Monitor VS and IO
Air embolism
Thrombocytopenia
Citrate intoxication
Hyperkalemia arrhythmia
A.
B.
C.
D.
E.
F.
G.
5.
6.
7.
8.
Antimetabolites
Alkylating agents
Plant alkaloids
Antineoplastic antibiotics
I.
BENIGN (tumor)
Well differentiated
(+)
(-)
Good
Surgery/removal
MALIGNANT (Cancer)
Poorly differentiated
(-)
(+)
Poor
ChemoTx, RT, Surgery
commonly preferred, Bone
Marrow Transplantation
2.
Radiation
UV rays
Nuclear explosion
Chronic irritation
Urethane/hydrocarbons
Smoking
Hormones in females
NURSING MANAGEMENT
GIT
Nausea and vomiting
Oral care
Reproductive organs
Sterility
Genetic counseling
Renal System
Increased serum uric acid
UPM
B.
GIT
Nausea and vomiting
Diarrhea
Stomatitis
1.
2.
UPM
Stages:
I. Myocardial Injury Atherosclerosis
II. Myocardial Ischemia Angina Pectoris
III. Myocardial Necrosis Myocardial infarction
Atherosclerosis
Narrowing of artery
Lipid and fat deposits
Tunica intima
I.
B.
C.
II.
B.
MS4
PREDISPOSING FACTORS
1. Sex men
2. Race Blackto MI,Angina
3. Smokingpotent vasoconstrictor
4. Hyperlipidemiagenetic
5. Obesity
6. Prolonged use of OCPs
7. Sedentary lifestyle
8. Diet high in saturated fats
9. DM
10. Hypothyroidism
SIGNS AND SYMPTOMS
1. Chest pain
2. Dyspnea
3. Tachycardia
4. Palpitations
5. Diaphoresis
TREATMENT
1. Percutaneous Transluminal Coronary Angioplasty
(PTCA)
compress ateroma
Revascularize myocardium
Prevent angina
TYPES
1. Stable Anginathe cause is predictable
D.
E.
DIAGNOSTICS
1. History taking and PE
2. ECG ST segment depression, T wave inversion
3. Stress test (treadmill test) 30 minutes to measure
exertion; abnormal ECG
4. Elevated serum uric acid and cholesterol
F.
Nitroglycerin (NTG)
Sublingual
Inform the patient of burning sensation
Small doses (1st dose) venodilator
dilation of veins of lower extremities
Large doses (subsequent doses)
vasodilator increase venous pooling
decreased venous return rests the heart
GIVEN IN THREE DOSES WITH 3-5
Arteriosclerosis
Hardening of an artery
CHON and Ca deposits
Tunica media
ATHEROSCLEROSIS
A.
C.
MINUTES INTERVAL
PREDISPOSING FACTORS
1. Sex men
2. Race Black
3. Smoking
4. Hyperlipidemia
5. Obesity
6. Prolonged use of OCPs
7. Sedentary lifestyle
8. Diet high in saturated fats
9. DM
10. Hypothyroidism
NURSING MANAGEMENT
PRECIPTATING FACTORS
1. Excessive strenuous physical exertion
2. Extreme emotional response
3. Exposure to cold environment
4. Excessive intake of foods rich in saturated fats (whole
milk)
3.
4.
Beta-blockers propanolol
5.
6.
7.
8.
Prevent complications MI
10. Hypothyroidism
D.
split S1 and S2
Rales/crackles
S4 atrial gallop
E.
DIAGNOSTICS
1. CARDIAC ENZYMES
P atrial depolarization
QRS ventricular depolarization
T ventricular repolarization
U wave hypokalemia
Peaked T wave hyperkalemia
ST segment depression angina pectoris
ST segment elevation and T wave inversion MI
Widening of QRS - arrythmia
IMPORTANT
TYPES
1. Based on Location
F.
PERFORM CARDIOVERSION
B.
C.
MS4
ST segment elevation
Vasodilators
NTG SE: orthostatic hypotension, headache
and dizziness
ISDN
Ca-Antagonists
Beta-blockers
ACE inhibitors
PREDISPOSING FACTORS
1. Sex men
2. Race Black
3. Smoking
4. Hyperlipidemia
5. Obesity
6. Prolonged use of OCPs
7. Sedentary lifestyle
8. Diet high in saturated fats
9. DM
8
UPM
Anticoagulants
Heparin monitor PTT antidote:
protamine sulfate
Coumadin PT vitamin K
(Aquamephyton)
Given together. Coumadin takes effect
after 3 days
Prevent complications
ArrhythmiasPVCs
CARDIOGENIC SHOCK OLIGURIA AS
MS4
LATE SIGN
(L) CHF
Thrombophlebitis
Pericarditis
Rupture of myocardium r/t myocardial
aneurysm
DRESSLERS SYNDROME or post-MI
pericarditis syndrome severe dyspnea,
oliguria, headache/dizziness, PVCs
Non-resistance to pharmacological
agents
UPM