ASSOCIATE DEGREE NURSING PROGRAM
NURS 201: ADULT HEALTH CARE II
Methodical Instruction N 1
4 hours
Care of the Patient with Hematological Problems
Theme : Interventions for clients with hematological problems
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 assessment finding of the skin of an 82-year-old woman should be explored further?
|
a. |
Discolored fingernails |
|
b. |
Areas of petechiae on the trunk and arms |
|
c. |
Mottled pigmentation on the neck, cheeks, and forehead |
|
d. |
Numerous cherry hemangiomas scattered across the anterior and posterior trunk |
__ 2.A client’s warfarin (Coumadin) therapy was discontinued 3 weeks ago. Which laboratory test result indicates that all effects of the warfarin have been eliminated?
|
a. |
International normalized ratio (INR) of 0.9 |
|
b. |
Total white blood count of 9000/mm3 |
|
c. |
Serum ferritin level of 350 ng/mL |
|
d. |
Reticulocyte count of 1% |
____ 3.A client with a deep vein thrombosis is prescribed to be started on oral warfarin (Coumadin) while still receiving intravenous heparin. What is the nurse’s best action?
|
a. |
Administer the medications as prescribed. |
|
b. |
Remind the physician that two anticoagulants should not be administered concurrently. |
|
c. |
Hold the dose of warfarin until the client’s partial thromboplastin time is the same as the control value. |
|
d. |
Monitor the client for clinical manifestations of internal or external bleeding at least every two hours. |
Answers: 1 B. 2.a 3.A
lITERATURE:
- Ignatavicius, D. & Workman, L. (2006). Medical-surgical nursing: Critical thinking for collaborative care (5th ed.). Volume I & II.
Philadelphia
