Hematology

Hello all, today we will review the the hematological system.

Pathophysiology/Etiology

-    Malignant disorder of the blood-forming tissues of the bone marrow, spleen, and lymph systems characterized by unregulated proliferation of WBC (Cancer of white blood cells (WBC)
-    Exact cause unknown; but factors involved in development include: radiation, certain chemicals and drugs (such as chemotherapy agents), genetic and immunologic factors
-    Two main types: acute lymphocytic leukemia (peak age incidence 2 – 4 years); Acute myelogenous leukemia (most common leukemia among adults and peaks at age 60)
-    Acute leukemia has a rapid onset, progresses rapidly; left untreated, death will result in days or months
Assessment
-    Immune function and bone marrow function assessments
-    Pay close attention to client’s skin: bruising, bleeding, painful lymph nodes); oral cavity; gastrointestinal status (rectal bleeding, pain, diarrhea); genitourinary system (dysuria, hematuria)

Signs and Symptoms

Associated with depressed bone marrow and infiltration of leukemic cells into other organ systems:
-    Bone pain
-    Joint swelling
-    Enlarged liver and spleen
-    Weight loss
-    Fever
-    Swollen lymph nodes
-    Signs of anemia (fatigue, pallor, tachycardia, dyspnea on exertion)
-    Signs of bleeding (ecchymoses, hematuria, bleeding gums)

Diagnostic

-    WBC count often elevated
-    Hemoglobin, hematocrit, and platelets decreased
-    Bleeding times increased
-    Bone marrow aspiration and biopsy – most definitive

Treatment

-    Chemotherapy standard treatment for leukemia
-    Other drugs used to control /prevent infection and nausea/vomiting
-    Chemotherapy drugs (vincristine, predisone, cyclophosphamide)
-    Side effects: bone marrow depression (causing increased risk of infection); stomatitis; alopecia; fatigue; GI effects (nausea, vomiting); monitor for extravasation
Immune globulin (to minimize infection)
-    Antiemetics: (zofran, compazine, raglan) given 30 minutes prior to therapy
-    Interferon alfa (minimize infection, slow growth of cancer cells)

Nursing Interventions

-    Skin and mouth care
-    Monitor lab results – CBC, bleeding times
-    Nutritional support
-    Pain management
-    IV site care
-    Infection control / Isolation requirements

The link below provides an array of nursing care plans.

http://www.rncentral.com/nursing-library/careplans

Reference

Brunner, L.S., Suddarth, D.S., & Smeltzer, S. C. O. (2008). Medical-Surgical Nursing (11th ed.). Philadelphia: Lippincott Williams & Wilkins.