Nursing Practice III - V ●​ Pharynx – structure from nasal cavity to oral cavity to have

RESPI HEMA an access to larynx

Comprehensive Phase
Group of muscles with mucus linings:
Function of Respiratory System ●​ Tonsils
●​ Primary ●​ Adenoids
○​ Provides oxygen → cellular metabolism ●​ Lymphoid tissues (Lymphatic system)
○​ Removes waste products = Carbon dioxide ​ Functions of Lymphatic:
●​ Secondary ●​ Immunity
○​ Sense of smelling d/t olfactory receptors of respiratory ●​ Protection
tract ●​ Passageway
○​ Voice production
○​ Maintains acid base balance ⭐ ​ Chronological order of Pharynx: ‘NaOL’
●​ NAsopharynx – air passage
●​ Oropharynx – air + food passage
ANATOMY
●​ Laryngopharynx – air passage
UPPER AIRWAY
●​ Filters air
​ Respiratory procedures for Laryngopharynx:
●​ Humidifies air
1.​ Intubation
●​ Warmths air
2.​ Bronchoscopy
= PROTECTION
●​ Larynx
Structure of Upper Airways
-​ AKA voice box
●​ Nose – lining of ciliated mucosa divided by a septum making
-​ Group of muscles
right and left nostrils
○​ ⭐Olfactory receptors
-​ Terminal part of the upper airway
Medical dx for inflammation of voice box: LARYNGITIS ⭐
●​ Paranasal sinuses: ‘FEMS’
Structure of Larynx:
○​ Frontal sinus – biggest
●​ Thyroid cartilage – adam’s apple
○​ Ethmoid sinus
●​ Cricoid cartilage – signet ring cartilage
○​ Maxillary sinus – widest
●​ Epiglottis – lid or flap; changes in contraction of
○​ Sphenoid sinus
epiglottis may lead to alteration
Alteration: SINUSITIS – usually viral; does not usually need
​ ​ Normal: Opens as air enters to enter the lungs
medications
Alteration: Opens as food enters → lungs →
Best mngt: Proper hydration
⭐
​
ASPIRATION
​ ​ IV regulation; 6-8 glasses of fluid intake
​ ​ Normal: Closes as food enters to enter stomach

Airah B. Bolinbough, RN
​ ​ Alteration:Closes as air enters → stomach → flatulence If CO2 stays inside the lungs = COPD
​ ​ ​ If kumipot ang daan = ASTHMA
EPIGLOTTITIS If naging one way = BRONCHITIS
❌
​ ​ ​
1.​ Do not insert anything in the oral cavity
⭐ Tell the nurse whose about to insert tongue ●​ Accessory Muscles
depressor in px with epiglottitis that she have a -​ Utilization of these muscles means utilizing your energy
phone call to stop her – kahit anong ginagawa, u ○​ Scalene – elevates the first 2 ribs
should answer a phone call ○​ Trapezius – shoulder movement
2.​ Do not examine ○​ Pectoralis major – shoulder movement
○​ Sternocleidomastoid – raises sternum
●​ Vocal cords ○​ External intercostals – raises the entire ribs
⭐ What produces the voice? Larynx
⭐ What specific structure produces the voice? Voice cords ⭐Medulla – middle, respiratory center of Brain
⭐ What mechanism produces the voice? Vibrations ⭐Pons – controls and rate of rhythm
⭐ When is the voice produced? Vibration during expiration ⭐Brain stem – respiration regulator
LOWER AIRWAY – enables gas exchange NORMAL BREATH SOUNDS
Structures of Lower Airway Bronchial Bronchovesicular Vesicular
●​ Trachea
From larger airways From smaller From distal part of
-​ AKA windpipe
●​ Larynx airways the lungs
-​ Tube-like structures that are consist of group of smooth ●​ Bronchi ●​ Bronchioles ●​ Alveoli
muscles = C shaped rings ●​ Trachea ●​ Distal part of
-​ 10-12 cm long bronchi Sound: Low pitch
​ Function: Passageway of air into and from the lungs Sound: High pitch,

●​ Main stem bronchi – branch the trachea towards right and left
d/t⬆️
loud, harsh sound –
pressure from
larger airways
Sound: Moderate or
Breezy sound
Stethoscope: Bell

lung

●​ Bronchioles – smaller branches off the bronchi ABNORMAL/ADVENTITIOUS BREATH SOUNDS

○​ Primary bronchioles – smaller ●​ Fine crackles
○​ Secondary bronchioles – smallest -​ d/t fluid accumulation
-​ Short, high-pitch bubbling
●​ Alveolar ducts - door gates towards alveoli -​ Hair strand scratching-like sound

●​ Alveoli – where gas exchange takes place

Airah B. Bolinbough, RN
 ●​ Coarse crackles ●​ Occupation
-​ d/t cough → mucus accumulation -​ Sexual worker
-​ Short but low pitch breath sound
●​ MANTOUX TEST/PURIFIED PROTEIN DERIVATIVES (PPD)
●​ Wheezes -​ Screening test to know if there is TB exposure
-​ Present in asthma px during expiratory ​ Health Teaching:
-​ High pitch, musical, hissing, or whistle sound 1.​ When to come back? After 48-72 hours
💡Inspiratory wheezes – present in bronchitis px 2.​ Why to come back? Interpretation of result
⭐
​
RN may interpret result of PPD, too early or too late
●​ Pleural friction rubs may lead to false (+) or false (-) result
-​ Crackling, grating, squeaky sound
-​ Sounds like a scratch paper rubs against each other ⭐ A.​ Classify the patient
-​ Sandpaper/liha sound ●​ Normal individual
3 I’s of PFR ○​ Healthy
●​ Infection – PTB, pneumonia ○​ HTN
●​ Inflammation – pleuritis ○​ DM
●​ Infiltration – tumor, pleural effusion ○​ COPD
○​ Asthma
DIAGNOSTIC PROCEDURES ○​ CKD
●​ Immunocompromised
●​ CHEST X-RAY
○​ HIV
-​ Shows the anatomical and appearance of the lungs
○​ AIDS
Type of radiation: Low beam
○​ Cancer
-​ Pregnancy is not a contraindication provided that they will
wear lead apron
B.​ Duration of the wheel
Nsg R: Ask the following to ensure if lead apron is
Normal individuals
needed
●​ <10mm – negative
●​ LMP
●​ >10mm – positive
●​ Sexual history
​ ​ ​ Immunocompromised
-​ Male RN may ask about female sexual hx
●​ <5mm – negative
provided that they are with companion
●​ >5mm – positive
-​ If px is not comfortable, ask female RN to
do it
(+) PPD
PNLE: Sexual hx is still performed even to nuns
●​ CXR – to know the extent of lesion
PNLE: PCOS hx + Nun = perform sexual hx bc
●​ Confirmatory testing
there is possibility of pregnancy
○​ Sputum exam
●​ Marital status
Airah B. Bolinbough, RN
 ○​ TB Quantiferon Gold Test – blood is the ●​ Bronchodilators
specimen ●​ Steroids
(-) PPD ​
After
●​ Continue to monitor the s/sx
1.​ Assess for respiratory status
If s/sx progress → confirmatory testing

●​ SPUTUM EXAM
2.​ Position
●​ No complication: Semi-fowler’s – to
edema
⬇️ laryngeal

Before ●​ With complication: Side-lying – to prevent

1.​ Purpose aspiration
2.​ Time: Early in the morning, before breakfast (5-6am) 3.​ Assess the return of gag reflex
3.​ Amount: 10-15ml (1 spoonful)
4.​ Oral care is not allowed before the collection
⭐
-​ 2 hours after procedure

❌ STRICT NPO 2 hours after procedure

✔️
Rinse with water only
Tongue depressor to assess gag reflex → no gag

❌Gargle
→ aspiration
4.​ Complications
5.​ Viability – <30 minutes and must be properly stored ●​ Bleeding = bright red sputum
After ​ = Frequent swallowing
1.​ Do not resume diet right after ●​ Laryngospasm – most fatal complication as it
may cause complete obstruction of the airway
2.​ Ensure if the specimen is accepted by medical
technologists ●​ THORACENTESIS
-​ Removal of pleural fluid
●​ BRONCHOSCOPY -​ Orthopneic position – back is the puncture site
-​ Involves direct visualization of LBT ​
-​ Fiber optic bronchoscope Positions during
A.​ Straddling on chair with arms and shoulder rested
Purpose -​ Able to transfer + sit (bed → chair)
●​ Visualization
●​ Bronchial washing – ⬆️
H2O pressure towards mucus +
●​ Bronchial suctioning – removes the water
-​ No to mild symptoms
B.​ Sitting with arms and shoulder by a table at the bedside
-​ Able to sit + unable to transfer
●​ Collection of tissue sample -​ Mild to moderate symptoms
​ C.​ Place the px to unaffected side with HOB 30-45 degrees
Before -​ Unable to transfer + sit
1.​ Consent + money – it is an expensive procedure -​ Moderate to severe symptoms
2.​ Baseline VS – to compare after the procedure ​
3.​ NPO 4-6 hours Position after: Unaffected Side – promotes lung re-expansion
​
Emergency equipment: Tracheostomy set
​
●​ Epinephrine
●​ Muscle relaxant
⭐
Emergency medications:
RESPIRATORY DISORDERS
Airah B. Bolinbough, RN
 BRONCHIAL ASTHMA
Signs of Asthma
-​Chronic (innate, inborn) condition that causes inflammatory 1.​ Expiratory wheezes
disorder -​ Somehow a good sign because it indicates a slightly
-​ Exposure to allergens → inflammation → obstruction open airway
Cause: Unknown 2.​ SOB
Contributing factor: Allergens
3.​⬆️ -​ May lead to DOB = general tightness of airway
HR
-​ Compensatory mechanism
3 changes to airway
●​ Bronchoconstriction – narrowing of airway 4.​ Hyperventilation
●​ Airway inflammation – compression of goblet cells (produces Acid base imbalance: Respiratory Alkalosis if (+) wheezes

●​ ⬆️
mucus)
mucus production – d/t compressed goblet cells leading to ⭐
and hyperventilating
Respiratory Acidosis when there is a complete
obstruction of airway → CO2 retention → Respiratory
more obstruction
Acidosis
Different types of Contributing Factors 5.​ Signs of hypoxia
●​ Extrinsic – environmental problems -​ Same with signs of anemia at RBC carries the oxygen
○​ Dust
○​ Pollens Early signs: ALOC
○​ Fomites ●​ Mental confusion
●​ Irritability
⭐
Every when to change the linens?

⭐2x a month for a normal individual ●​ Restlessness

⭐Once a week
Warm water; 2 hours naka babad or shorter duration
if possible
Late signs: Color
●​ Cyanosis
●​ Clubbing of fingernails
⭐ CHN: Black, foldable, bank umbrella in community setting for
protection from stray dogs
●​ Brittleness of hair

Management
●​ Intrinsic 1.​ Position: High fowler's, semi-fowler's, upright – promotes
○​ Drugs lung expansion
○​ Food – do not eat foods where you are allergic 2.​ Oxygen
-​ Cetirizine will not always be effective, in the long -​ No need for MD order but only 1-2 lpm
run, body may be immune to cetirizine → 3.​ Suction
ineffective → severe allergy -​ There might be mucus d/t compression of goblet cells
○​ Stress -​ Suction is possible because airway is somehow open
○​ Extreme temperature -​ Contraindicated if there is generalized closure of airways
(no wheezing)
4.​ Call for emergency assistance
●​ Mixed type -​ Do not leave the px during asthma attack, you must
-​ Combination of extrinsic and intrinsic assess, observe, and intervene
-​ Buzzer to call for help
Airah B. Bolinbough, RN
 -​ Getting the medications is assigned to assistant/helper Priority: Safety
5.​ DOC:
●​ Bronchodilators 2. Non-pharmacological
○​ Beta 2 agonist “-terol” ●​ Avoidance of allergens
-​ Relaxes smooth muscle d/t dilating effect → ●​ Best exercise: Improves lung ventilation
opens the airway ○​ Swimming
○​ Spirometry
○​ Anticholinergic inhalation “-tropium” ●​ Best pet: Aquatic marine (gold fish)

S/E: ⬆️
-​ Decreases secretions
HR → Risk for Cardiac arrhythmia
WOF: Tachycardia & Extreme CHRONIC OBSTRUCTIVE PULMONARY
palpitation → REFER → Replacement of
medication order
DISEASE
-​ AKA Chronic Airway Limitation (CAL)
○​ Methylxanthine “-phylline”
Nursing Intervention
1.​ Monitor for therapeutic effect
​
​
-​
​
​
​
​
​
​
​ ​ ⬇️
Progressive disorder + Inflammatory disorder

Problem in structure
2.​ Contraindicated to chocolates, coffee, tea Cause
→ TOXICITY ●​ Smoking (lifestyle)
○​ Damages elastase – responsible for expansion of alveoli
Preventive Management ○​ Damages cilia – responsible for recoil alveoli
1.​ Pharmacological ●​ Self – allowing 2nd hand smoking despite knowing the risk
●​ Steroids
-​ Highly gastric irritants 2 TYPES OF COPD
-​ Prevent reoccurrence ●​ PULMONARY EMPHYSEMA
-​ Air trapping of carbon dioxide inside the alveoli
Tablet form Parenteral Inhalation -​ No oxygen will enter the lungs because the alveoli is not
emptied — fully occupied with carbon dioxide retention
Time: After For px with (+) Gargle after use -​ FIFO: First In, First Out
meals SOB d/t prone to oral
thrush SIGNS: COPD
Steroids +
antacids “-zole” ⬆️ ⭐
●​ Chronic non-productive cough (dry cough)
●​ Carbon dioxide level → hypercapnia or hypercarbia =

❗ ●​ Oxygen level ⬇️
RESPIRATORY ACIDOSIS
(chronic hypoxia) → stimulus for
✔️Never stop medications abruptly
Must be tapered gradual elimination → ADDISONIAN CRISIS
breathing (hypoxic drive)
●​ Over distention of alveoli → barrel chest

​ ​
●​ Leukotrienes modifiers “-kast”
Time: Bedtime
stimulated → Erythropoietin →
appearance → Pink puffers
⬆️
●​ Polycythemia vera secondary to chronic hypoxia → kidney
RBC → Pinkish

●​ Pursed-lip breathing – helps them ease DOB

Side effects: Drowsiness
Airah B. Bolinbough, RN
 Mngt: Teach proper PLB
●​ Distress
4.​ Diet
●​ ⬆️ Calorie – generally thin d/t anorexia (everything taste

●​ ⬆️Protein – improves the muscle to help in DOB

●​ DOB like phlegm)

●​ CHRONIC BRONCHITIS ❌
✔️ 2 cups & above – CHO byproduct is carbon dioxide

damaged goblet cells → ⬆️

-​ Chronic, recurrent + inflammation of the airway →
mucus production with or
without inflammation → accumulation → mucus plug →
⭐ SFF – prevent fully distended abdomen
Any food is possible, priority is SF
5.​ Medications – to control the s/sx of disorder
obstruction ●​ Bronchodilators
-​ Alveoli is not affected ●​ Corticosteroids
​ ●​ Antibiotics – infection (common to bronchitis)
​ Signs ●​ Mucolytic agent – given to bronchitis as expectorant

●​ Carbon dioxide level ⬆️

●​ Chronic productive cough
– airway is obstructed with mucus
plug → Oxygen has a greater pressure so it enters the Complications
and given to emphysema px as antitussive

continuously ⬆️
lungs → Carbon dioxide remains inside the airway →
, carbon dioxide remains at alveoli (which
1.​ Cardiac problems
2.​ Sepsis → antimicrobial resistance

●​ Oxygen level
⭐⬇️
is still normal) → barrel chest → RESPIRATORY
ACIDOSIS
(hypoxia) – unable to reach alveoli
Preventive Management
1.​ Vaccination – may have infection but lesser symptoms → lesser
because it is already occupied with high carbon dioxide → level of antibiotics
cyanosis → blue-bloaters
●​ Pulmonary hypertension – Carbon dioxide ⬆️ pressure →
Oxygenated blood from lungs return to pulmonary artery
2.​ Avoid crowded places
3.​ Avoid extreme temperature

(venous return; goes back to systemic circulation) → Best Past time: Gardening
abdominal area edema → ascites → bloatedness →
“bloaters”
RESTRICTIVE AIRWAY DISEASE (RAD)
Management
1.​ Cessation of smoking
2.​ Low oxygen concentration RIB FRACTURE SIMILARITIES FLAIL CHEST
●​ Venturi mask – 33% oxygen concentration
Only 1 affected rib Cause 2 or more rib
⭐ ●​ Nasal cannula – 45% oxygen concentration
Lungs cannot regenerate – irreversible damage
3.​ Pulmonary toileting (elimination) Signs
●​ Trauma
●​ Blunted injury
fracture

●​ Pursed-lip breathing – carbon dioxide elimination

●​ OFI for bronchitis unless contraindicated d/t ⬇️
●​ Chest pain –
oxygen
and referred
Hallmark:
Paradoxical
Contraindications
●​ CKD pain breathing
●​ Heart Failure ●​ Shallow ●​ Complete
●​ Chest Physiotherapy – 3-4x/day before meals breathing ●​ Incomplete

Airah B. Bolinbough, RN
 (fear of rib (wave-like ruptured bleb stay on the upper thoracentesis
puncturing the chest portion because it is ●​ Treatment
lungs) breathing) one 2. Open – opening in less dense → low or
normal, one the pleural wall absent breath Types
Management
1. Pain medications
abnormal

Priority: Gas
3. Tension – ⬆️
lung
pressure → tracheal
sound at the upper
lung segment d/t
inadequate lung
1. Hemothorax -blood

⭐
2. Pyothorax/
empyema – pus
exchange deviation towards the expansion 3. Hydrothorax – fluid

Management
1. Mechanical
heart → compression
of the heart → CO
→ heart failure
⬇️ Diagnostics
1. Lung ultrasound –
ventilator tells the location,

⭐ Sign of flail chest

improvement:
Diagnostics
1. CT scan septation ⭐
amount, and

(windowing of pleural
Breathing is not the fluid)
concern of px → ask
for pain (+) Septation →
medications chest tube
(Pain is recognized because
breathing problem is
(-) Septation →
corrected)
thoracentesis → Fail:
Chest tube
PNEUMO SIMILARITIES PLEURAL Chest tube
THORAX EFFUSION management
1st: Drainage
Air in the pleural
space ⭐
Signs
Fluid
accumulation –
Fluid in the pleural
space
N: 100cc/hr
A: >100cc/hr +
bright red (bleeding)
Cause lower segment of Cause
●​ Rib fracture
●​ Flail chest
the lungs because it
is more dense →
1. Primary: Unknown
– goal is to know the
⬇️ Output for 3 hours
→ assess the breath
●​ Stab wound low or absent reason of fluid in the sounds
●​ Gunshot breath sound at the lungs
wound lower segment d/t ●​ Diagnostic (+) Breath sounds:
inadequate lung thoracentesis Notify MD → CXR (to
Types expansion know re-expansion)
1. Spontaneous –
without obvious
cause secondary to
⭐ Air
accumulation –
2. Secondary: Existing
medical condition
●​ Therapeutic
●​ Fully
expanded:
Possible
Airah B. Bolinbough, RN
 removal of with sterile gauze in
chest tube 3 way method to
Mngt: Pain prevent tension
reliever 30 pneumothorax
mins prior
If disconnected:
●​ Not fully Submerged the chest
expanded: tube in sterile water
Continue chest at 2-3 cm
tube
Cut the tubing in 2-3
(-) Breath sounds: cm, save for
Possible tubing reconnection
problem → Notify MD performed by the MD

2nd: Water-seal
Bottle
N: Intermittent
A: Continuous –
air-leakage d/t tubing
problem → Notify MD

3rd: Suction Control

Bottle
N: Continuous +
gentle bubbling
A: Continuous +
vigorous bubbling –
suction machine
problem → secure
another suction
machine → MD
changes the suction
machine

Position:
Semi-fowler’s with HEMATOLOGICAL DISORDERS
chest tube below the
heart or chest level IRON DEFICIENCY ANEMIA
If dislodge: Cover -​ ⬇️Iron storage
Airah B. Bolinbough, RN
 -​ ⬇️Iron production Best absorbed: With meals
+​ Vitamin C or Vit C rich foods (better) = better
Risk Factor absorption
●​ Pregnant ​ Liquid prep: Use straw
●​ Children
●​ Parenteral Iron Supplement
Cause Best method: IM
●​ Inadequate iron intake Best technique: Z-track method
●​ Malabsorption syndrome 1.​ Prevents discoloration
●​ Blood loss 2.​ Prevents damage to subcutaneous tissue
○​ Trauma
○​ Menorrhagia ●​ Blood Transfusion
○​ Surgery -​ Last option treatment modality
-​ Life-threatening situations
Sign
●​ Pica
●​ Paleness PERNICIOUS ANEMIA
●​ Pallor
●​ Poor focus or attention -​ One of deadliest form of anemia because it attacks the CNS
●​ Signs of hypoxia
Problem: Lack of intrinsic factor
Management -​ Found in GI tract (stomach)
1. Complete Bed Rest – lessen oxygen demand -​ Produced by parietal cells
​ Risk for fall/injury Function of IF: Helps vitamin B12 re-absorption
​ Priority: Safety Function of B12: RBC maturation; Protects for myelin sheath
2. Increase iron diet: GLORY
●​ Green leafy vegetables Diagnostic Test
●​ Legumes ●​ Screening: CBC
●​ Organ meat ●​ Confirmatory: Schilling’s Test (24 hours urine test)
●​ Raisins
●​ Yolks 1.​
2.​
❌
Preparation

❌
NPO
Red meat for 3 days
Contraindications
●​ Tea
●​ Antacids
​
​
​
​
​
​
1st void: DISCARD
2nd void: COLLECT
⭐
Result: (+) B12 in urine → inabsorption
but DUE TIME

​ ✔️
●​ Milk
Fortified Signs
●​ Red beefy tongue – HALLMARK
Medications ●​ Mouth sores
●​ Oral iron supplement: FeSO4 ●​ S/sx of anemia
Best time: Without meals ●​ Paresthesia/Numbness → Mental retardation

Airah B. Bolinbough, RN
Management ❌
❌ Anything fresh
1.​ Anemia management (CBR, O2, BT)
2.​ Lifelong injection of B12 every 3 months (5-10ml) ✔️
✔️
Raw
Single private room + HEPA filter
Site:
●​ Dorsogluteal
●​ Ventrogluteal
✔️N95 mask (inside the room)
Ordinary surgical mask
Discard the used N95 mask → wear an ordinary
3.​ Oral care using soft bristle toothbrush surgical mask → transfer from 1 room to another
●​ Pricey → discard the surgical mask before entering the

4.​ ❌
❌
●​ Dentist recommendation
Heat application – risk for burn injury d/t numbness
new room → wear new N95 mask
3.​ Bleeding precautions

​ ❌Warm compress

✔️
Sauna ●​ ❌
●​ Non-contact sports: Chess with computer opponent
Swimming – exertion of energy
5.​
❌Extensive footwear

✔️
Barefoot
Buy late afternoon – foot is already expanded d/t activities
●​ Isometric exercise: YOGA
●​ Play: Solitary
○​ Playing cards (solitaire)

❌
done all day

✔️
Close shoes – causes foot compression
Open slippers/sandal (Rambo)
○​ Rubik's cube

POLYCYTHEMIA VERA
APLASTIC ANEMIA
-​ AKA Pancytopenia – all is ⬇️⬇️⬇️
-​
-​ ⬆️RBC → ⬆️
Hgb → ⬆️ blood viscosity → ⬆️
Overproduction or hyperplasia of bone marrow elements
Hct

-​ Sudden cessation of bone marrow elements → bone marrow Risk Factors

depression ●​ >60 y/o
-​ Element of bone marrow that are low: RBC (anemia), WBC ●​ COPD

⭐
(infection), Platelet (bleeding)
Earliest sign of infection: Sore throat followed by fever Diagnostic Test
1.​ Bone marrow Aspiration
Diagnostic Test 2.​ Laboratory test: CBC
●​ Screening: CBC a.​ Hgb >20 g/dl

⭐
●​ Confirmatory: Bone marrow aspiration (painless)
Painful d/t anesthesia induction
Common site: Posterior Iliac Crest
b.​ Hct >60%

2.​ Blood uric acid level → gouty arthritis

Management
1.​ Blood Transfusion Signs
●​ Fresh Whole Blood – more ideal; addresses the 3 ●​ Red → Purple → Blue discoloration
inadequate elements ●​ Painful fingers and toes
●​ Packed RBC – addresses the anemia ●​ Extreme pruritus
2.​ Infection Precaution: Reverse isolation (avoiding na
mahawa si patient) Management
Airah B. Bolinbough, RN
 1.​ Therapeutic phlebotomy (250-500ml to be extracted every 3 ●​ (-) Bleeding
months) 4.​ Platelet transfusion – last treatment option
2.​ DOC

⬇️
●​ Hydroxyurea – myelosuppression ✔️
5.​ Bleeding precautions

❌ Electric razor

​ ​
●​ Allopurinol – uric acid
Mngt: Monitor rashes
S/E: Steven Johnson Syndrome
✔️ Oral care

❌ ✔️
Rinse with water
Nasal packing during nose bleeding
●​ Antihistamines – avoid scratching → bleeding ​ Lean forward to prevent aspiration
●​ Hydralazine – for hypertension crisis

⭐
3.​ Cryotherapy – cold temperature exposure
4.​ Oat milk bath / oatmeal + water – lessen itchiness
5.​ Encourage strict rigorous follow up every 3 months +
HEMOPHILIA
phlebotomy Signs
❌
6.​ Avoid long period of rest

❌
Sales lady work
7.​ Diet: LSLF + Hot and spicy
●​ Earliest: Joint bleeding (Hemarthrosis)
●​ Late: Joint destruction (fracture) → shortened height
8.​ Encourage OFI for hemodilution Types
●​ Factor 8 deficiency – classic
-​ AKA “Von Willebrand Disease”
IDIOPATHIC THROMBOCYTOPENIA PURPURA Mngt: Factor 8 concentrate
Problem: Platelet (>100,000) ●​ Factor 9 deficiency
Cause: Autoimmune diseases -​ AKA “Christmas Disease”
Age: School age - Adolescent Mngt: Factor 10 concentrate
Priority Nsg Dx: Disturbed Body Image → Depression → Suicide -​ Replacement of clotting factor
Signs
●​ Petechiae
●​ Easy bruising
●​ Ecchymosis – large patches, circular in shape
●​ Active bleeding in mucous membrane

Management

⬆️
⬇️
Platelet – ✔️
1.​ Steroid – for 3 days then repeat platelet count
steroids
Platelet – Step 2
2.​ IV immunoglobulin – depends on patient’s weight
3.​ Anti D antibody – obsolete treatment
Requirements
●​ <19 y/o
●​ Normal Hgb
●​ Normal WBC
Airah B. Bolinbough, RN