DISORDERS
By Tonie Metheny, MS, RN
ERYTHROPOIESIS
ERYTHROPOIESIS
Nutrient
Function in erythropoiesis
Cobalamin (B12)
RBC maturation
Folic Acid
RBC maturation
Iron
Hemoglobin synthesis
OVERVIEW OF ANEMIA
erythrocyte
Hemoglobin
Hematocrit
RBC/whole blood
OVERVIEW OF ANEMIA
RBC production
RBC destruction
http://www.youtube.com/watch?v=_ZV5140OykE
OVERVIEW OF ANEMIA
Common causes
Dietary
Bilirubin
Erythropoetin
Biopsy
CT/MRI
OVERVIEW OF ANEMIA
Clinical manifestations
Vague
Secondary
Fatigue
Pallor or jaundice
Increased HR and SV
SHOB
Palpitations
OVERVIEW OF ANEMIA
Nursing Management
Blood
Epo
transfusion
Vitamins
Iron supplement
O2
therapy
Volume replacement
Dietary teaching
IRON-DEFICIENCY ANEMIA
Look to your left and right
Chronic condition
Decreased
Causes
hemoglobin synthesis
Inadequate
intake
Malabsorption
Blood loss
Hemolysis
Alcoholism
Malnutrition
IRON-DEFICIENCY ANEMIA
Clinical Manifestations
Low
RBC
Pallor
Sensitivity to cold
Headache
Low
Iron
Glossitis
Cheilitis
Parethesia
IRON-DEFICIENCY ANEMIA
Diagnostics
Determine
Guaiac test
http://www.youtube.com/watch?v=W4NCWt0hQJM
Endoscopy
Colonoscopy
IRON-DEFICIENCY ANEMIA
Monitor
effectiveness of therapy
THALASSEMIA
hemolysis of RBCs
THALASSEMIA
of anemia
Physical and mental retardation
Splenomegaly and hepatomegaly
Jaundice
Bone marrow expansion and hyperplasia
Cranial & maxillary thickening
THALASSEMIA
asymptomatic
Microcytosis
Hypochromia
THALASSEMIA
major
in B12 uptake
Decreased intrinsic factor= decreased cobalamin
uptake
Causes
Anemia!
Pernicious
anemia
GI
PERNICIOUS ANEMIA
Clinical Manifestations
Secondary
to tissue hypoxia
Diagnositics
Macrocytic
RBC
Low serum cobalamin
Endoscopy
Shilling test
PERNICIOUS ANEMIA
good nutrition
Lifelong B12 injections
1000mg IM QD x 2 weeks
Weekly until H/H is normalized
Monthly for life
http://
www.youtube.com/watch?v=VkgE6X_NErM
APLASTIC ANEMIA
AKA pancytopenia
Decrease
Causes
Congential
vs Acquired
Clinical Manifestations
Minor
to severe
Secondary to pathophysiology
Anemia
Neutropenia
Thrombocytopenia
APLASTIC ANEMIA
AKA pancytopenia
Decrease
Causes
Congential
vs Acquired
Clinical Manifestations
Minor
to severe
Secondary to pathophysiology
Anemia
Neutropenia
Thrombocytopenia
APLASTIC ANEMIA
Diagnostics
Bone
http://www.youtube.com/watch?v=w8-jx1dtg0U
Prone to sickling
Cells
Occlusion occurs
Spleen
Manifestations
Extremely painful
Fever
Swelling
Tenderness
Hypertension
n/v
complications
Avoid triggers
High altitudes
Stay hydrated
Treat infection promptly
Immunizations
COAGULATION DISORDERS
Hemorrhagic disorders
Hemophilia
Deep
Vein Thrombosis
Pulmonary Embolism
Thrombocytopenia
Disseminated Intravascular Coagulation
PLATELET
BLOOD CLOTS
Four components
Vascular response
Platelet plug
Fibrin clot
Clot Lysis
BLOOD CLOTS
process
blood clotting
Four components
Vascular response
Platelet plug
Fibrin clot
Clot Lysis
Natural anticoagulants
Heparin, Protein S, Protein
C
Keeps blood in a fluid state
CLOTTING STUDIES
ACT
Activated
Clotting Time
70-120 seconds
PTT
Activated
INR
International
PT
Prothrombin
Normalized Ratio
Time
11-16 seconds
THROMBOCYTOPENIA
Inherited
vs acquired thrombocytopenia
IMMUNE THROMBOCYTOPENIC
PURPURA
Most common type of thrombocytopenia
Autoimmune disease
Lysis
Clinical Manifestations
Mucosal
or cutaneous bleeding
Petechiae, purpura, superficial ecchymoses
Prolonged bleeding after routine procedures
Manifestations of internal hemorrhage
IMMUNE THROMBOCYTOPENIC
PURPURA
Diagnostic Studies
CBC
H/H
Platelet count
PT/PTT
Antigen
assay
Bone Marrow Analysis
Flow Cytometry
IMMUNE THROMBOCYTOPENIC
PURPURA
Collaborative Care
Corticosteroids
(phagocytosis)
Prednisone
Solu-medrol
Splenectomy
Platelet
transfusions
THROMBOCYTOPENIA
Nursing Management
Teach
Monitor
HEMOPHILIA
factors
or deficient clotting
Three types
Hemophilia
A (Factor VIII)
Hemophilia B (Factor IX)
Von Willebrand disease (vWF,
VIII, and platelets)
HEMOPHILIA
Limited
HEMOPHILIA
Diagnostic studies
Platelet
PT/PTT
Factor
count
assays
Collaborative care
Prevent
Treatment
of complications
HEMOPHILA
Nursing Management
Stop
bleeding quickly
Joint
bleeds
Manage
life-threats
DISSEMINATED INTRAVASCULAR
COAGULATION
Thrombotic disorder
Abnormally initiated and accelerated clotting
Causes
Shock
Septicemia
Cardiac arrest
Snakebites
DIC
Clinical manifestations
Bleeding
Bleeding
Thrombotic
DIC
Diagnostic studies
PT/PTT,
Thrombin time
Fibrinogen & platelet counts
Factor assays
Collaborative Care
Stabilize
patient
O2
Volume replacement
Treat cause
Provide supportive care of manifestations
DIC
Nursing care
Early
detection of bleeding
Astute assessment
Administer
http://
www.npr.org/2011/06/28/137454415/the-child-cases-guilt
y-until-proven-innocent
Popliteal
Virchows triad
Venous
stasis
Endothelial damage
Hypercoagulation
Pathophysiology
Platelet
aggregation creates
entrapment of RBC, WBCs and
more platelets
Thrombus occurs usually at valve
because of stasis
Thrombus can resolve or may
eventually break off
Clinical Manifestations
Unilateral
Pain
Sensation
LE edema
Diagnostic studies
CBC,
clotting studies
Venous compression ultrasound
Duplex ultrasound
Collaborative care
Anticoagulation
treatment
Coumadin
Heparin
Unfractionated heparin
Heparin Sodium
LMWH
Lovenox
Thrombolytic
bleeding
Monitor CBC and coagulation test
Use electric razors- not straight
Soft toothbrushes
Administer stool softeners
Assess for mental status changes
PULMONARY EMBOLISM
plug
Clinical manifestations
Dyspnea
Chest
pain
Hemopytsis
May be sudden or develop slowly
PULMONARY EMBOLISM
Complications
Pulmonary
infarction
Pulmonary
hypertension
Dx Studies
X-ray,
PULMONARY EMBOLISM
Collaborative Care
Prevent
DVT!
Early
treatment of PE
Long
PULMONARY EMBOLISM
Nursing interventions
Semi-fowlers
position
Administer 02, fluids and medications as ordered
Monitor for complications
Emotional support
Education for long term anticoagulation therapy
COUMADIN
Used to prevent thrombosis
Has a delayed onset
Inhibits Vitamin K
Lots
Green
leafy veggies
Dried herbs
Broccoli, brussel sprouts
HEPARIN
Activation of antithrombin
Inactivates
clotting factors
Immediate effects
Protamine Sulfate is the antidote
Monitor PTT