ASSOCIATE DEGREE NURSING PROGRAM
NURS 201: ADULT HEALTH CARE II
Methodical Instruction N 2
4 hours
Theme: Interventions for Clients with red blood cell disorders.
Instructor:
Place of training: educational rooms, hospital wards.
Aim: Students must be able to use the basic nursing skills in the assessment of the clients with hematological problems
Professional orientation of students:
After completing this theme, you should be able to:
- Know the anatomy and physiology of the hematological system.
- Describe changes associated with aging.
- Identify factors that place clients at risk for hematological problems.
- Perform appropriate assessments for clients with these problems.
- Interpret diagnostic test findings for clients with suspected or actual hematological disease.
6. Explain the purpose of frequent monitoring.
Program of self training:
Interpret blood cell counts and clotting tests to assess the client’s hematologic status.
Chapter outline:
- Anatomy and physiology review
- Bone marrow
- Blood components
i. Red blood cells (erythrocytes)
ii. White blood cells (leukocytes)
iii. Platelets
- Accessory organs of hematopoiesis
i. Spleen
ii. Liver
- Hemostasis/blood clotting
i. Platelet aggregation
ii. The blood-clotting cascade
iii. Fibrin clot formation
iv. Fibrinolysis
- Hematologic changes associated with aging
- Anticoagulants and thrombolytics
i. Anticoagulants
ii. Thrombolytics
- Assessment techniques
- History
i. Demographic data
ii. Personal and family history
iii. Diet history
iv. Socioeconomic status
v. Current health problems
- Physical assessment
i. Skin assessment
ii. Head and neck assessment
iii. Respiratory assessment
iv. Cardiovascular assessment
v. Renal and urinary assessment
vi. Musculoskeletal assessment
vii. Abdominal assessment
viii. Central nervous system assessment
- Psychosocial assessment
- Diagnostic assessment
i. Tests of cell number and function
1. Complete blood count
2. Reticulocyte count
3. Hemoglobin electrophoresis
4. Leukocyte alkaline phosphatase
5. Coombs’ test
6. Serum ferritin, transferrin, and total iron-binding capacity
ii. Tests measuring bleeding and coagulation
a. Capillary fragility test
b. Bleeding time test
c. Prothrombin time
d. International normalized ratio
e. Partial thromboplastin time
f. Platelet agglutination/aggregation
2. Radiographic examinations
3. Bone marrow aspiration and biopsy
a. Client preparation
b. Procedure
c. Follow-up care
TESTS AND TASKS:
1. Which laboratory test result in a client with sickle cell disease in crisis indicates that the packed red blood transfusion should be discontinued?
|
a. |
Hct of 32% |
|
b. |
HgbS of 88% |
|
c. |
Serum iron level of 300 mcg/dL |
|
d. |
Total WBC count of 12,000/mm3 |
____ 2. Why is the client with polycythemia vera at an increased risk for a myocardial infarction?
|
a. |
The rapid synthesis of cells greatly increases metabolism. |
|
b. |
The abnormal hemoglobin in the erythrocytes inadequately oxygenates the myocardium. |
|
c. |
The increased number of erythrocytes increases blood viscosity and the workload of the heart. |
|
d. |
The disease is most prevalent among men in their 60s and 70s who have other conditions that damage the heart. |
Answers:1.c 2.c.
lITERATURE:
Ignatavicius, D. & Workman, L. (2006). Medical-surgical nursing: Critical thinking for collaborative care (5th ed.). Volume I & II.
