Nursing Care of Hematologic Alterations

Prepare: The Nursing Care of Hematologic Alterations

Nursing Intervention – Taking Action

• A nurse develops a fever before she is scheduled to work. Which priority action is most appropriate?

Recognizing Cues – Altered Hematological Conditions

• In reviewing a client’s chart, the nurse notes a hemoglobin of 7 g/dL with a low hematocrit. Which symptoms are consistent with these lab values? Select all that apply.

Analyzing Cues – Altered Hematologic Conditions

• The nurse notes a client as having erythrocytosis. The nurse understands that this can be caused by which factors? Select all that apply.

Self-Check: Outcome – Nursing Evaluation

• The nurse is developing a discharge teaching plan including information on the client’s diagnosis of thrombocytopenia. The client’s seizure drug was discontinued. When can the nurse schedule the follow-up complete blood count (CBC) to ensure the platelet count returns to normal?

Self-Check: Nursing Diagnoses – Hematologic Alterations

• Review the altered hematologic problems below and drag the expected signs/symptoms to the correct box.

Self-Check: Nursing Actions – Hematologic Alterations

• Review the nursing actions below. Match the actions to the most appropriate hematologic alteration.

Self-Check: Hospital Acquired Infection

• The nurse is reviewing the hospital census list to identify those clients who are immunocompromised. Select which patients are at high risk for hospital acquired infection.

Self-Check: Nursing Evaluation – Transfusion Reaction

Julie had a hysterectomy. During the procedure she lost a significant amount of blood. She is anemic with a hemoglobin level of 7.2 g/dL (normal 10-15 g/dL). The surgeon has ordered 2 units of packed red blood cells to be given immediately. You started the blood at 13:00, and at 13:15 you note the following things: Fever, chills, headache, anxiety, and muscle pain.

• Which of the following reactions is she likely experiencing?
• Which is the best course of action to take?

Reflect: The Nursing Care of Hematologic Alterations

Recognizing Cues – Nursing Assessment

• Review the case below and select all assessment items that require priority follow-up (review the narrative and table).

Nursing Diagnoses – Developing a Hypothesis

• Janet is a 64-year-old patient admitted with shortness of breath and fatigue. Her vital signs: T=97.5, BP 118/77, P 110, R 20, oxygen saturation 91% on room air. Skin is pale, cool, and dry with normal turgor and capillary refill < 3. Lungs clear in all lobes. Heart is regular rate and rhythm with no murmur. No edema is present. Select the nursing diagnoses for the client with aplastic anemia. Select all that apply.

Prioritization – Nursing Intervention

• Janet is diagnosed aplastic anemia. You receive the following orders from the provider, prioritize them in the order that would treat the patient most effectively:

Provider Orders

• Oxygen at 4L/min per nasal cannula continuous oximetry. Monitor vital signs q4hours. Type and cross for 2 units PRBCs now. When ready give 2 units PRBCs over 4 hours. Fall precautions. Neutropenic precautions.

Evaluation – Nursing Outcomes

• Assessment of which system will give the most information as you evaluate the outcomes of the nursing care for Janet (diagnosed with aplastic anemia).
• Which of the following labs can you look at to best evaluate the outcomes of the nursing care for this patient?

Recognizing Cues

• You are asked to call the healthcare provider about Bill. Identify below the items that should be included to help the provider determine needed orders (review the narrative and table).

Prioritizing Care

• Prioritize the nursing diagnoses for the client with polycythemia and low oxygen saturation, and drag them to the correct prioritized order.

Nursing Actions – Polycythemia

• Bill was diagnosed with polycythemia. Further testing was ordered. The nurse is reviewing the provider orders. Match the rationale to the order:

Nursing Outcomes – Polycythemia

• The nurse is reviewing the completed orders. Which assessment items would indicate improvement in Bill’s condition? Select all that apply

Anemias

Prepare: Anemias

Recognizing Cues – Anemia

• Which options are laboratory markers for anemia? Select all that apply.

Recognizing Cues – Anemia

• Which nursing diagnosis is the same when comparing anemia to coronary artery disease?

Nursing intervention – Anemia

• A client was stabbed and lost a lot of blood. Given the cause, what would the nurse expect to do next?

Self-Check: Analyzing Cues – Anemia

• Review the following conditions and select the type of anemia they are most likely to be:

Self-Check: Recognizing Cues – Anemia

• Review the assessment findings below and select which are most likely caused by anemia.

Self-Check: Nursing Actions – Anemia

• Review the nursing actions below. Select the nursing diagnosis that best fits these actions.

Self-Check: Nursing Action – Anemia

• Review the following types of anemia, and identify the medication that is most appropriate:

Self-Check: Analyze Cues – Anemia

• The nurse is teaching a class and looks for some examples of different things that can affect treatment of anemia. Review the examples below and identify the barrier to each situation from the drop-down choices.

Reflect: Anemias

Recognizing Cues – Nursing Assessment

• Review the case below and select all assessment items that suggest the presence of anemia.

Analyzing Cues – Nursing Assessment

Review the case below and select all assessment items that are risk factors or require priority follow-up.

Alma is being seen in the emergency department with complaints of shortness of breath with activity. Select the assessment findings that suggest each of the potential conditions she could have.

Generating a Hypothesis – Nursing Diagnosis

• Alma is being seen in the emergency department with complaints of shortness of breath with activity. This has started progressively over several months. She denies orthopnea or dyspnea at rest. Her vital signs: T=97.9, Blood pressure is 110/70, pulse 90. Her skin is pale. Lungs are clear to auscultation; heart rate and rhythm is regular with no murmurs or extra heart sounds. There is no pedal edema. A complete blood count from today shows the following:
• In analyzing the patient record, which select the type of anemia you suspect:

Planning Care– Anemia

• Alma is being seen in the emergency department due to shortness of breath with activity that has developed progressively over several months. She denies orthopnea or dyspnea at rest. Her vital signs: T=97.9, Blood pressure is 110/70, pulse 90. Her skin is pale. Lungs are clear to auscultation; heart rate and rhythm are regular with no murmurs or extra heart sounds. There is no pedal edema. Select the intervention from the orders and match to the nursing diagnosis.

Nursing Diagnoses – Planning Interventions

• Review the admission information below and identify the pertinent findings.

Analyzing Cues – Anemia

• Review the following anemias, and select the expected findings for each.

Nursing Action – Anemia

Review the nursing progress note below and select the priority nursing assessment cues:

Dwayne is a 25-year-old male who presents to the emergency department with moderate joint pain for which he has not taken anything and refuses the offered non-steroidal anti-inflammatory medication. Dwayne states he has had mild shortness of breath for the past few days. Additionally, he recently lost his job and has been experiencing some financial stress. Vital signs: T = 99.2°F (37.3°C), BP = 155/90, Pulse = 110, oxygen saturation is 92% on room air. Skin is pale. Lungs are clear to auscultation; heart rate and rhythm are regular with no abnormal heart sounds. There is no edema.

• Based on the assessment, pick the appropriate nursing diagnoses.
• Based on the assessment, pick the suggested actions the nurse should take.

Nursing Outcomes - Sickle Cell Anemia

Nursing discharge note:

• Dwayne is being discharged from the hospital after experiencing sickle cell crisis. He denies shortness of breath currently. He states having no pain. He has met with the social worker, who will be working with him on his finances and programs available. Vital signs: T = 98.1, BP = 124/70, Pulse = 90, oxygen saturation is 97% on room air. Skin color is normal, mucous membranes are pink. Lungs are clear to auscultation; heart is regular rate and rhythm with no abnormal heart sounds. There is no edema. Review the nursing discharge note and check if the goal is being met at this time or check whether further follow-up is required before the transfer.