HEMO Nursing Interventions

Safe and Effective Care Environment
Examine individual patient factors for safety, especially among older adults
Apply the principles of asepsis to protect immunocompromised patients
Modify the environment to protect patients who have thrombocytopenia
Identify appropriate resources for the patient with a serious hematologic problem or recovering from a stem cell transplant
Health Promotion and Maintenance
Teach pts ways to prevent leukemia or lymphoma by avoiding known environmental causative agents
Identify patients at risk for infection and hemorrhage
Assess the patient’s endurance in performing ADLs
Teach patients and family members how to avoid injury and infection when blood counts are low
Physiological Integrity
Identify the risk factors for development of leukemia, lymphoma, and myelodysplastic syndromes
Interpret laboratory data and assessment findings to determine the presence of infection in the patient with neutropenia
Prioritize nursing interventions for the patient with neutropenia
Prioritize nursing interventions for the patient with thrombocytopenia
Nursing Diagnosis
Risk for Infection
Risk for Injury
Fatigue related to decreased oxygenation & increased energy demands
MDS: Risk Factors
Exact cause unclear
Aging
Chemical exposure
Tobacco smoke
Exposure to radiation
Chemotherapy
Dx: Examination of chromosomes and genes
Thrombocytopenia Clinical Manifestations
Usually asymptomatic
Bleeding, either mucosal or cutaneous-most common
Epistaxis
Petechiae
Ecchymosis
Prolonged bleeding after procedures
Thrombocytopenia Nursing Interventions
Administration of corticosteroids if cause is unknown
Platelet transfusion
Administration of oprelvekin (Neumega)
Discourage use of OTC products (ASA)
Encourage complete health evaluation if there are signs of bleeding tendencies
Observe for signs in patients on chemo
Prevent/control hemorrhage
Teach self-care measures to avoid bleeding
when positioning in bed
Handle patient gently,
Use lift sheet when moving
Women should
Count sanitary napkins when menstruating
When injections/venipunctures are necessary
AVOID IM INJECTIONS! use smallest gauge needle for the task
Apply firm pressure to needlestick site for 10 minutes or oozing stops
Apply ice to
areas of trauma
Test all urine/stool
for occult blood
Observe IV sites
q2h for bleeding
how to Avoid trauma to rectal tissues
withhold enemas
Give well-lubricated suppositories with caution
Measure
abdominal girth daily
Advise using
electric shaver
Teach patient to avoid mouth trauma, use
Soft-bristled toothbrush or sponges
dont floss
Avoid dental work, especially extractions
Encourage patient not to
blow the nose or insert objects into the nose
Teach patient to wear firm shoes
when ambulating
platelets
150,000-400,000
WBC count
• 4000-10000/uL
• Elevations in WBC count over 11,000 uL are associated with infection, inflammation, tissue injury or death and malignancies (ex: leukemia, lymphoma)
• A total WBC count less than 4000 uL = LEUKOPENIA
NEUTROPENIA:
less than 1000 cells/uL;
severe neutropenia is less than 500 cells/uL
results from leukemia, bone marrow suppression, high risk of infection & death from sepsis. CHECK TEMP Q 4 HOURS
ANC
absolute neutrophil count
Leukopenia
a total WBC count less than 4000/uL
Hodgkins Nursing Plans and Interventions
• Protect client from infection; monitor temp carefully
• Observe for signs of anemia
• Provide adequate rest
• Provide preoperative and postoperative care for laparotomy and splenectomy
• Provide emotional support to client and family
• Hodgkins disease is one of the most curable of all adult malignancies. Emotional support is vital. Career is often interrupted for tx. Chemo renders many males sterile. May bank sperm before tx
Assessment of hodgkins
• Enlarged lymph nodes one or more
• Anemia, thrombocytopenia, elevated leukocytes, decreased platelets
• Fever, increased susceptibility to infections
• Anorexia, weight loss
• Malaise, bone pain
• Night sweats
• General pruritis without skin lesions may develop
• Cough, dyspnea, stridor and dsyphagia may all reflect mediastinal node involvement
General Nursing Management
Monitor patient for:
Infection – check cultures, x-ray
Anemia- check CBC
Thrombocytopenia – check Platelet Count.
Neutropenic precautions and Bleeding precautions: NCP 31-3
Teaching: Table 31-24
leukemia Nursing Management
Oral and GI mucosa – remove dentures, assess gums
Note color and moisture of membranes
Oral hygiene – soft bristle toothbrushes okay until – low plt count – sponges. Mouth care before and after meals.
Analgesics – before eating
Saline and baking soda rinses
Mycelex troche /Diflucan – fungal infections
Balance between activity and rest Safety! HEPA filter mask – ambulate outside room. Maintain fluid status/ electrolyte balance. I and O
Daily weights
Discuss end of life issues – Hospice
Discuss with patient / family complications of disease.
Hodgkin’s Lymphoma (Clinical Manifestations)
Painless, enlarged lymph node on one side of the neck.
Individual nodes are painless and firm. NOT HARD.
Cervical, supraclavicular and mediastinal nodes most common.
Pruritis – unknown cause??
Pain after consuming alcohol at node site.??

All organs can be involved. Symptoms develop as organ is
compressed. Cough Jaundice Abdominal pain Bone pain Herpes zoster infections are common

“B” Symptoms
Fever without chills Drenching sweat (HS) Unintentional weight loss Poorer prognosis if symptoms present
non hodgkins Clinical Manifestations
Lymphadenopathy Symptoms appear later in the disease Either “B” or “T” cell 1/3 have “B”symptoms
Symptoms dependent upon where lymphadenopathy is found.
non hodgkins Nursing Management
Monitor for side effects of treatment
Chemotherapy and Radiation side effects.
Risk for infection – related to chemotherapy treatment AND loss of effective immune response because of disease.
Teaching focuses on prevention of infection. Know tumor location – monitor for symptoms.
multiple myeloma clinical maifestations
Fatigue
Bone pain – back or ribs.
Increases with movement and decreases with rest.
Easy bruising
Osteoclast activating factor – made by plasma cells lead to bone breakdown osteoporosis on Xray
Bone destruction causes severe pain
Increased risk for pathologic fractures.
Hypercalcemia
Renal failure – due to increased myeloma protein. Check for elevated protein levels.
multiple myeloma Nursing Management
Pain management NSAIDS for mild pain Opioids for moderate to severe pain. Activity restrictions < 10 lbs lifting. S&S of hypercalcemia Maintaining mobility Hydration Monitor renal function Pneumovax and influenza vaccines.
DIC Nursing Interventions
Be alert to precipitating factors!
Management of underlying cause
Accurate, ongoing assessment
Early attention to manifestations
Institute appropriate measures
Early attention to bleeding: external and internal
Proper administration of blood products
DIC Nursing Diagnoses
Ineffective tissue perfusion related to bleeding or thrombosis
Acute pain related to bleeding into tissues and diagnostic procedures
Decreased cardiac output related to fluid volume deficit and hypotension
Anxiety related to fear of the unknown, disease process, diagnostic procedures, and therapy
DIC Management
Management
Diagnose quickly! Stabilize patient Treat the underlying cause Supportive care for manifestations Blood product support-with caution Possible anticoagulation