NCM 112: MEDICAL SURGICAL NURSING

Lecture Notes| Midterms

HEMATOLOGIC PROBLEMS
COMPOSITION OF BLOOD PLATELETS (THROMBOCYTES)
Blood is a specialized body fluid. It has four
 For blood clotting (coagulation). When a
main components: plasma, red blood cells,
blood vessel is injured, platelets gather at the
white blood cells, and platelets. It has many site, adhere to the vessel's lining, and form a
functions, including delivering nutrients and plug to stop bleeding.
oxygen.  Found in the blood and spleen.
PLASMA
 The liquid component of blood, making up
about 55% of its total volume.
 Serves as a transport medium for nutrients,
hormones, waste products, and proteins.
 Helps maintain BP and volume.
 Maintains the body's pH balance and
electrolyte levels.
FUNCTIONS/USES
 Maintenance of pH, Fluid, and Electrolytes
 Temperature regulation (vasodilation:
Increased °C; vasoconstriction: decreased °C)
 Clotting process (Platelets)
 Immunologic protection (WBC)
 Transport (RBC)
 Waste removal

Normal Life
Cell Function
Limits Span
Carries
RBC 5 million 120 days oxygen,
WHITE BLOOD CELL (LEUKOCYTES)
blood types
 The immune system's primary defense Infection
4,500 to Hours to
mechanism against infections and foreign WBC and allergic
10,000 months
invaders. response
 They identify and destroy pathogens (like 150,00 to About 10
Platelets Clotting
450,000 days
bacteria, viruses, and fungi), remove dead or
damaged cells, and play a role in immune
responses. ANEMIA
 They help the body fight infection and other A condition in which the number of red blood
disease. cells or the hemoglobin concentration within them
 They are stored in your blood and lymph is lower than normal.
tissues.
RED BLOOD CELLS (ERYTHROCYTES)
 Responsible for transporting oxygen from the
lungs to the rest of the body and returning
carbon dioxide from the body to the lungs to be
exhaled.
 Made in the bone marrow and it contain a protein
called hemoglobin, which carries oxygen.

Romina Blaine Angelu L. Bascos – BSN 3D | benguet state university – college of nursing
 NCM 112: MEDICAL SURGICAL NURSING
Lecture Notes| Midterms
HEMATOLOGIC PROBLEMS
 Characterized by a deficiency in the number GENERAL SYMPTOMS
or quality of red blood cells (RBCs) or a
decrease in the hemoglobin content within  Feeling very tired or weak
those cells. (Hemoglobin – protein in RBC  Pale skin
responsible for carrying oxygen from the lungs  Shortness of breath
to the rest of the body).  Dizziness
 When someone has anemia, their body does  Fast or irregular heartbeats
not get enough oxygen-rich blood.
MANAGEMENT
 Basically: Decreased no. Of RBC or the ability
to carry O2  Folic Acid Supplementation
 Will eventually led to hypoxia – lack of  Diet – consume foods rich in folic acid such as
oxygen in tissues leafy green vegetables, legumes, nuts and
TYPES OF ANEMIA seed, liver, eggs, and citrus fruits.
 Avoid or limit alcohol consumption because it
1. Folic Acid Deficiency Anemia interferes with folic acid absorption.
2. Aplastic Anemia
APLASTIC ANEMIA
3. Iron Deficiency Anemia
Aplastic anemia is a rare but serious blood
FOLIC ACID DEFICIENCY ANEMIA condition that occurs when your bone marrow
 Folic acid is a B vitamin that helps your cannot make enough new blood cells.
body make red blood cells.
 Occurs when the body lacks enough folic
acid (also known as folate), a B9-vitamin that
is essential for the production and maturation
of RBCs. Without sufficient folic acid, RBCs
cannot develop properly, leading to a
decrease in their number and an impaired
ability to carry oxygen efficiently.
 Megaloblastic anemias result most often from
deficiencies of vitamin B12 and folate.
 Megaloblastic RBCs (abnormally large and
immature RBCs that are produced in the bone
marrow when there is a disruption in the  Bone marrow failure or problem with
normal process of RBC formation, known as production of cells.
erythropoiesis)
GENERAL SYMPTOMS

 Fatigue
 Shortness of breath
 Pale skin
 Frequent infections
 East bruising and bleeding
 Dizziness and headache
MANAGEMENT

 Blood transfusions
 Bone marrow transplant
 Lifestyle adjustment

Romina Blaine Angelu L. Bascos – BSN 3D | benguet state university – college of nursing
 NCM 112: MEDICAL SURGICAL NURSING
Lecture Notes| Midterms
HEMATOLOGIC PROBLEMS
IRON DEFICIENCY ANEMIA
 Iron deficiency anemia is the most common
cause of anemia worldwide.
 Low hemoglobin/ decreased RBCs.
 Iron deficiency anemia occurs when your
body does not have enough iron. Iron helps
make red blood cells.
 Normal Results: Male adult: 65 – 175
mcg/dL; Female adult: 50 – 170 mcg/dL.
GENERAL SYMPTOMS

 Fatigue
 Shortness of breath
 Pale skin
 Dizziness
 Cold hands and feet
 Brittle nail
MANAGEMENT
 A type of megaloblastic anemia.
 Iron supplements CAUSES
 Diet changes – Eat more iron-rich foods like
red meat, poultry, fish, beans, lentils, tofu,  Low B12 due to diet
spinach, and fortified cereals. Pair these foods  Gastric/Ileal surgeries
with vitamin C-rich foods (like oranges or  Malabsorption disease
tomatoes) to help your body absorb iron  Thyroid disease
better.  Hypothyroidism → Decreased Hydrochloric
 Avoid drinking alcohol Acid → Decreased Iron → Poor absorption of
B12
VITAMIN B12 ANEMIA/PERNICOUS  Age
ANEMIA  Drugs that block acid in the stomach
Occurs when a lack of vitamin B12 or folate  Chemotherapy and radiation
causes the body to produce abnormally large  Lacking intrinsic factor (autoimmune
red blood cells that cannot function properly. destruction of gastric parietal cells)
Note: Hyperthyroidism → Increased in blood
temperature → affects bone marrow production
(temperature sensitive)
SIGNS AND SYMPTOMS

 Weakness
 Sore tongue, no taste
 Numbness/tingling
 Pallor, jaundice
 Gi complaints
 Diplopia (Double-vision), hearing problems
 Impotence (helplessness), incontinence (lack
of control)
 CNS changes
 Irritability

Romina Blaine Angelu L. Bascos – BSN 3D | benguet state university – college of nursing
 NCM 112: MEDICAL SURGICAL NURSING
Lecture Notes| Midterms
HEMATOLOGIC PROBLEMS
 Cardiovascular changes  Pallor
 Low hgb/hct
 Schilling test (to evaluate vit. B12 absorption) SICKLE CELL CRISIS
– intrinsic factor Occurs when sickled red blood cells clump
together and block blood flow in small blood
TREATMENT vessels, causing extreme pain and other
symptoms.
 Vit. B12 intake
 Iron and folic acid intake
 Blood transfusion
 Bed rest

SICKLE CELL ANEMIA

Sickle cell disease is an inherited blood
disorder that affects hemoglobin, the protein
that carries oxygen through the body. It affects
red blood cells, changing them into stiff, sticky
sickle cells that block blood flow.

 Aplastic – Megaloblastic crisis, infection,

decrease in RBCs
 Will eventually led to heart failure
 8-24 months
 Sudden halt in the production of red blood
cells, usually triggered by a viral infection,
particularly parvovirus B19.
 Hemolytic – RBC destruction
 Vaso-Occlusive – occlusions can cause organ
 Defect in hemoglobin
failure, stroke or MI, pulmonary infarction
 RBC changes shape into sickle type:
 After 5 years
C-shaped
 S/S usually seen after 6 months DIAGNOSTICS
 Causes: Genetic (HbS instead to HbA)
 Electrophoresis – a technique used to
Note: Sickle cell disease is caused by a variant of
separate particles such as DNA, RNA,
the beta-globin gene called sickle hemoglobin
proteins, and carbohydrates based on their
(HbS). HbA is a healthy RBC (normal
charge.
hemoglobin).
 CBC
SIGNS AND SYMPTOMS  Presence of sickled cells
 X-ray
 ↑ HR
TRIGGERS
 SOB
 Enlarged heart
 Cold environment – constriction of blood
 Enlarged liver
vessels = ↓ Blood flow
 Enlarged spleen (splenomegaly)
 Physical exercise – ↑ Oxygen requirements
 Fatigue, lethargy
 Dehydration
 Jaundice, dark urine
 Acidosis
 Intense pruritus (itchiness)
 Stress
 Swelling joints
 Sleep
 Pain in joints, chest, abdomen, muscles
 Infection
 Low grade fever

Romina Blaine Angelu L. Bascos – BSN 3D | benguet state university – college of nursing
 NCM 112: MEDICAL SURGICAL NURSING
Lecture Notes| Midterms
HEMATOLOGIC PROBLEMS
 Unpressurized aircraft – risk for hypoxia immune system problem. Or it can be a side
effect of taking certain medications.
TREATMENT

 Pain
 Oral NSAID (analgesic, anti-inflammatory,
antipyretic)
 No Meperidine (Demerol) – potential to
cause seizure, give oral morphine or
opioids for crisis
 No IM injection since circulation is impaired
 Hydration
 No caffeine (avoid dehydration)
 Oxygen – monitor oxygen saturation
 Warm compress
 Blood Transfusion
 Bone marrow transplant
 No pressure behind the knees, hip
 Iron and folic acid if needed  Decreased in platelets: <100,000
 Antibiotics  Normal Range: 150,000 to 400,000
 Sterile technique cells/mm³
 Bed rest – raised height of bed
CAUSES
 Plasmapheresis – a method of removing
blood plasma from the body by withdrawing  Decreased production of platelets in the bone
blood, separating it into plasma and cells, and marrow due to certain conditions.
transfusing cells back into the bloodstream.  Decrease in lifespan
(Removal of Sickle Cell)  Blood pooling in the spleen
WATCH OUT FOR:  Dilution of the blood stream – ↑ Volume of
fluids or blood transfusion that don’t contain
 Retinopathy (poor vision) enough platelets.
 Nephropathy (kidney failure)
Note: The spleen normally stores some
 Brain infarction – ↓ Blood flow in the brain
platelets. However, if the spleen is enlarged (due
 Myocardial Infarction
to conditions like liver disease or certain cancers),
 Infection leading to gangrene (dead cells)
it can hold onto more platelets than usual,
 Splenic sequestration
reducing the number of platelets in the
 Aplastic crisis
bloodstream, leading to thrombocytopenia.
 Avascular necrosis (loss of blood supply to
the bone) SIGNS AND SYMPTOMS
 Priapism (prolonged erection of penis or
painful erection)  Petechiae
 Purpura (small blood vessels leak blood under
THROMBOCYTOPENIA the skin) – <1 cm
Thrombocytopenia is a condition in which you  Ecchymosis (small bruise) – >1cm
have a low blood platelet count. Platelets  Oral blood blisters
(thrombocytes) are colorless blood cells that help  Fatigue
blood clot. Platelets stop bleeding by clumping  Weakness
and forming plugs in blood vessel injuries.
Thrombocytopenia might occur as a result of a
bone marrow disorder such as leukemia or an

Romina Blaine Angelu L. Bascos – BSN 3D | benguet state university – college of nursing
 NCM 112: MEDICAL SURGICAL NURSING
Lecture Notes| Midterms
HEMATOLOGIC PROBLEMS

 A bleeding disorder
 The blood doesn't clot in the typical way
because it doesn't have enough blood-clotting
TREATMENT proteins (clotting factors).
 It can lead to excessive bleeding and
 Blood transfusion
hemorrhages and it is fatal in some cases.
 Splenectomy
 Lithium carbonate – a psych drug that treats CAUSES
bipolar syndrome; ↓ lethargy by improving
overall mood stability and reducing depressive  Clotting factors – caused by deficiencies or
symptoms. dysfunctions in specific clotting factors, such
 Education (Bleeding related – soft bristle as factor X, which impairs the conversion of
toothbrush, no blood thinner, wound care and fibrinogen to fibrin, a key step in blood clot
healing, proper hygiene, etc.) formation.
 Hemophilia A – low amount of functional
HEMOPHILIA factor VIII (a clotting protein necessary for
Hemophilia is a bleeding disorder that slows the effective blood clotting)
blood clotting process.  Hemophilia B – Christmas/Factor IX (results
from a deficiency or dysfunction of factor IX,
another crucial clotting factor, named after the
Christmas factor)
 Von Willebrand’s disease - lack of Von
Willebrand factor (essential for blood clotting
and stabilizes factor VIII), genetic (usually
female)
Note: VWF binds to factor VIII (8), another
clotting protein, and platelets in blood vessel

Romina Blaine Angelu L. Bascos – BSN 3D | benguet state university – college of nursing
 NCM 112: MEDICAL SURGICAL NURSING
Lecture Notes| Midterms
HEMATOLOGIC PROBLEMS
walls. This process will help form a platelet plug
during the clotting process.
SIGNS AND SYMPTOMS

 Hematuria (blood in urine)

 Hematemesis (vomiting blood)
 Epistaxis (nose bleeding)
 Internal bleeding
 Excessive bleeding
 Bleeding from gums
 Pain
 Shock
TREATMENT

 Blood transfusion
 Clotting factors
 Fresh Frozen Plasma/FFP
 Bleeding precautions
 Use a soft toothbrush and do not use
dental picks.
 Avoid forceful coughing, sneezing, or
blowing of the nose.
 Use caution with sharp objects.
Note: For patients on anticoagulants, reversal
agents may be ordered if there is a current
bleeding emergency.
 Protamine sulfate is the antidote
for heparin.
 Vitamin K is the antidote for warfarin.
Instruct them to avoid products that contain
aspirin or NSAIDs. These drugs reduce platelet
action and inhibit clotting.

Romina Blaine Angelu L. Bascos – BSN 3D | benguet state university – college of nursing