Cardiology and Hematology Ppt

OXYGENATION CARDIOVASCULAR AND HEMATOLOGIC SYSTEM

CARDIOVASCULAR SYSTEM

TERMINOLOGIES
VENTILATION – MOVEMENT OF AIR IN & OUT OF THE LUNGS
RESPIRATION – EXCHANGE OF GASES : EXTERNAL & INTERNAL
EXTERNAL – BET. ALVEOLI & PULMONARY CAPILLARIES
INTERNAL – BET. SYSTEMIC CAPILLARIES
PERFUSION – AVAILABILITY & MOVEMENT OF CAPILLARY BLOOD FOR EXCHANGE OF GASES

CASE STUDY
You are the Emergency Room nurse
A patient came in, 48 y.o., dyspneic , with the following vital signs : T= 38C, RR=50, CR=105, BP=160/110 mmHg

CASE STUDY
You noted that the patient is jaundiced, with bipedal edema, and prefer to sit than lie down.
What is your immediate nursing action even without the doctor’s order?

CASE STUDY
What nursing history would you ask ?
What other nursing assessment would you do?
What is your plan for the patient?

CARDIOVASCULAR SYSTEM
Review of Anatomy & Physiology
Assessment : History and Physical Assessment
Diagnostics
Planning

REVIEW OF ANATOMY AND PHYSIOLOGY- Heart
Structures
Blood Supply – LCA, RCA, veins
Conductive System –Sino-atrial node AV node Bundle of His Bundle branch Purkinje fibers

HEART RA RV LUNGS LA LV SYSTEMIC CIRCULATION SYSTEMIC CIRCULATION LUNGS SYSTEMIC CIRCULATION

CONDUCTION PATHWAY RA LA RV LV - SA NODE AV NODE- BUNDLE OF HIS BUNDLE BRANCH PURKINJE PURKINJE

Nervous System Control
SYMPATHETIC
PARASYMPATHETIC

Properties of the Heart:
All or None Principle
Rhythmicity
Excitability
Refractoriness
Conductivity
Automaticity
Extensibility

STROKE VOLUME (SV) - amount of blood pumped out with each contraction
HEART RATE (HR)
CARDIAC OUTPUT (CO)– volume of blood pumped out per minute
=SV x HR
PRELOAD
AFTERLOAD

REVIEW OF ANATOMY AND PHYSIOLOGY – Blood Vessels
Arteries
Microcirculation
Veins
Flow Regulation
Pressure gradient
Flow resistance
Role of Blood vessels
Layers of the Blood Vessels:
Intima
Media
Adventitia

REVIEW OF ANATOMY AND PHYSIOLOGY
CIRCULATION
SYSTEMIC
PULMONARY
PORTAL

PULMONARY CIRCULATION RA RV LUNGS LA LV SYSTEMIC CIRCULATION SYSTEMIC CIRCULATION LUNGS SYSTEMIC CIRCULATION

SYSTEMIC CIRCULATION RA RV LUNGS LA LV SYSTEMIC CIRCULATION SYSTEMIC CIRCULATION LUNGS SYSTEMIC CIRCULATION

HISTORY AND PHYSICAL EXAM
Check for:
dyspnea,
jaundice,
edema,
hemoptysis,
fatigue,
syncope and fainting,
cyanosis ,
abdominal pain and discomfort,
clubbing of fingers, chest pain,
palpitations

Heart –I P P A
aortic area,
pulmonic area,
tricuspid,
mitral
Heart Sounds
S1- AV valve closure
S2 semilunar v. closure
S3 vent. Gallop
S4 atrial gallop
Murmurs
rubs

Blood vessels
Inspection
color:pallor, rubor, cyanosis
circulation of extremities
Palpation
edema, pulses
Auscultation
bruit

Diagnostic Assessment
NonInvasive
ECG
Dynamic ECG Stress Test
Treadmill Vector
Cardiogram
Phonocardiogram
Echocardiogram
Chest Xray
Radionuclide Studies
Venography
UTZ – DOPPLER
Pletysmography

Invasive
Cardiac Catheterization
Arteriogram
Angiocardiogram
Venogram
Lymphogram
Bone Marrow Aspiration:
Sternum
iliac crest
tibia (infants )

Blood and Urine Studies
CBC
Hematocrit
Clotting time
PT
PTT
APTT
ESR
lipid profile
serum enzymes: SGOT, SGPT, LDH, CPK
VMA
Renin Test
Schilling’s Test

HEMODYNAMICS MONITORING
CVP n= 6 -12 cm water
Measures:
cardiac efficiency,
bld volume,
peripheral resistance,
right ventricular pressure
0-pt be at mid axillary line, 5 cm below the sternum
dc ventilator with reading
= fluid overload, = hypovolemia

HEMODYNAMICS MONITORING
Pulmonary Artery and Pulmonary Wedge Pressure
Swan Ganz catheter :
floated at the right heart,
measures left side of the heart
Intraarterial Blood Pressure :
Radial Artery,
Allen’s Test

Planning for Health Promotion
Modification of High Risk Factors
Promotion of Circulation
Prevention of Infection
syphillis,
staph, strep,
german measles
Genetic counselling
Role of nutrition

Modification of High Risk Factors
dyslipedemia
hypertension
smoking
sedentary lifestyle
obesity
stress
glucose intolerance,
alcohol abuse
caffeine
pollution

Planning for Health Maintenance & Restoration
Basic Life Support
Advanced Life Support
Client With Cardiac Surgery:
Closed Heart surgery
Open Heart Surgery
Heart Transpant

Closed Heart surgery
valvutomy
mitral commisurotomy

Open Heart surgery (CABG)
COMPLICATIONS :
DYSRHYTHMIAS
THROMBOSIS AND PULMONARY EMBOLISM
CARDIOGENIC SHOCK
BLEEDING
WOUND INFECTION
RENAL FAILURE
ELECTROLYTE IMBALANCE
POST-OP PSYCHOSIS

HEART TRANSPLANT
CRITERIA
1. End Stage of Disease
2. Freedom from Chronic Disease
3. Family Support
4. Age < 50 yo
5. No psychological problem
IMPORTANT
1. Immunosuppressant & Steroids – 4 hrs prior
2. Donor-Recipient Compatibility – size, crossmatching
3. Donor Heart – saline solution 4C up to 4 hrs

CARDIOVASCULAR DISTURBANCES
CORONARY / ISCHEMIC HEART DISEASE
Arteriosclerotic Heart Disease
Angina Pectoris
Coronary Insufficiency
Myocardial Infarction
CONGESTIVE HEART FAILURE
HYPERTENSION
PERIPHERAL VASCULAR DISEASE
DISORDERS OF THE BLOOD

ARTERIOSCLEROTIC HEART DISEASE
Plaque formation and internal thickening (intima) Fibrosis and calcification (media) Narrowing and constriction of coronary arteries S/sx of ISCHEMIA

ANGINA PECTORIS
1. STABLE
2. UNSTABLE
3. PRINZMETAL – coronary artery spasm
4. NOCTURNAL
5. DECUBITUS

ISCHEMIA VS INFARCTION NO STRESS/ EXERTION PRECIPITANTS PERMANENT NO PERMANENT CARDIAC TISSUE DAMAGE NOT RELIEVED RELIEVED REST NITROGLYCERINE > 5 MIN 3-5 MIN DURATION SUBSTERNAL CONSTRICTIVE (+ SX OF SHOCK) SUBSTERNAL PRESSURE/ HEAVINESS SQUEEZING PAIN INFARCTION ISCHEMIA

ANGINA PECTORIS
DIAGNOSIS:
Nitro Test 0.4mg
NURSING GOALS:
1. O2 to myocardium
2. O2 demand
3. Prevent future episodes of angina

O2 to Myocardium :
Antiplatelets
Calcium Blockers
Beta blockers
Whisky/Brandy
Nitrates :
RAPID-ACTING :
Nitroglycerine
Nitrostat
AmylNitrate
LONG-ACTING:
ISDN,ISMN, Nitroglycerine ointment, Transdermal,
IV

O2 Demand
Limit activities – CBR
Moderate Exercise
Sedatives
Warmth

Prevent Future Episodes
DIET – low calorie, low saturated fat
No tobacco
Stress Reduction (Anger Management)

Coronary Insufficiency
IMBALANCE BETWEEN :
OXYGEN SUPPLY
OXYGEN DEMAND

MYOCARDIAL INFARCTION
IRREVERSIBLE CARDIAC DAMAGE FROM OCCLUSION OF 1 OR MORE CORONARY ARTERY
REVIEW OF ANATOMY AND PHYSIOLOGY
E.C.G.
Recent M.I. – ST elevation (injury)
T wave inversion (ischemia)
Previous M.I. – Q wave (necrosis / old infarct)
BLOOD STUDIES
Troponin T & I
LDH
CPK MB

P Q R S T E.C.G.

P Q R S T E.C.G. ST SEGMENT ELEVATION

P Q R S T E.C.G. INVERTED T - WAVE

P Q R S T E.C.G. Q wave

MYOCARDIAL INFARCTION
NURSING CARE
1. Pain relief –
Morphine ( + preload & afterload)
Demerol causes vomiting
2. Oxygen
3. Inotropics
4. Beta Blockers
5. Antiarrhythmics
6. No ice or very hot drinks
7. Anticoagulants
8. ECG and CVP monitoring
9. Laxatives – Lactulose
10. PTCA
11. Thrombolytic Therapy
BEFORE CELLULAR DEATH, US. 6 HRS AFTER THE ATTACK

CARDIAC ARRHYTHMIA
Review Conduction Pathway
Review the Basics of Normal ECG

P Q R S T E.C.G.

CARDIAC ARRHYTHMIA
Sinus Tachycardia – P wave precede each QRS >100 bpm
Sinus Bradycardia – P wave precede each QRS <60 bpm
Atrial Fibrillation: P wave = f waves; QRS = normal

P Q R S T E.C.G.

CARDIAC ARRHYTHMIA
Premature Ventricular Contraction: P wave normal: early QRS
Ventricular Tachycardia : 3 or more PVCs
Asystole – no cardiac activity

P Q R S T E.C.G.

CARDIAC ARRHYTHMIA
Nursing Management
Oxygen
Complete Bed Rest
Cardioversion/ defibrillation
Administer antiarrhythmics as prescribed:
Atropine
Beta blocker- propanolol
Lidocaine
Epinephrine

Review of Anatomy and Physiology
Backward Failure
Forward Failure
Left-Sided
Right Sided
Hypermetabolic Failure
Clinical Manifestations according to:
Tissue Anoxia
Pulmonary Hypertension
Systemic congestion

C.H.F. RA RV LUNGS LA LV SYSTEMIC CIRCULATION SYSTEMIC CIRCULATION LUNGS SYSTEMIC CIRCULATION LV

Review of Anatomy and Physiology
Backward Failure
Forward Failure
Left-Sided
Right Sided
Hypermetabolic Failure
Clinical Manifestations according to:
Tissue Anoxia
Pulmonary Hypertension
Systemic congestion

Diagnostics
Nursing Management
Goals :
CARDIAC LOAD
REST AND SEDATION
2. CARDIAC CONTRACTILITY
CHRONOTROPICS – DIGITALIS
Increase in force of contraction
monitor serum K,
C/I if HR </= 60 bpm,
DIGITALIS TOXICITY

SODIUM REABSORPTION AND FLUID RETENTION
- DIURETICS ( Thiazide, Loop, K-sparing)
-measure UO
-weigh patient
-watch for s/sx of electrolyte imbalance
- DIET : Sodium Restricted (0.5gm/day)

4. PREVENTION OF COMPLICATIONS:
Intractable HF
Pulmonary edema
Pulmonary Infarction
Myocardial Infarction
Digitalis Toxicity
Cardiac Arrhythmia
Pneumonia

PULMONARY EDEMA
Emergency!
Fluid into the alveoli, bronchi & bronchioles
S/SX:
… of CHF
Dyspnea
Cough with pink frothy sputum

PULMONARY EDEMA
MANAGEMENT:
Oxygenation
Assist in Intubation
Rotating tourniquet
Phlebotomy
CVP monitoring

HYPERTENSION
IN SYSTOLIC PRESSURE >140
IN DIASTOLIC PRESSURE > 90
CLASSIFICATION :
PRIMARY
BENIGN- GRADUAL
MALIGNANT -ABRUPT ONSET ;SHORT COURSE
SECONDARY: Renal patho, Adrenal patho, Genetics

HYPERTENSION >=100 >=160 or HPN, Stage 2 90-99 140-159 or HPN, Stage 1 80-89 120-139 or PreHPN <180 <120 and Normal DBP mmHg SBP mmHg CATEGORY

HYPERTENSION
Assess for Major CVD Risk Factors
Assess for Identifiable Causes of Hypertension:
Sleep apnea
Drug-Induced related
Chronic Kidney Disease
Primary Aldosteronism
Renovascular Disease
Cushing’s Syndrome/steroid Therapy
Pheochromocytoma
Coarctation of the Aorta

HYPERTENSION
Diagnostics
Nursing Care :
Teach about: modification of Lifestyle, diet, avoidance of stimulants and coffee
Administer meds as prescribed: ANTIHYPERTENSIVES AND DIURETICS
Hypertensive Crisis : DIAZOXIDE (Hyperstat), NaNITROPRUSSIDE (Nipride)

PERIPHERAL VASCULAR DISEASE
ISCHEMIA OF THE PERIPHERAL VESSELS
Review of Peripheral Vascular Structures
Signs and Symptoms of Ischemia
Coldness
Pallor
Rubor
Cyanosis
Pain ( Intermittent Claudication)

ISCHEMIA OF THE PERIPHERAL VESSELS
Nursing Management
Increase Arterial Blood Flow or Venous return
Promote Vasodilation
Prevent and Treat Vascular Occlusion

Proper positioning
Exercise
Short walks
Buerger Allen Routine
Oscillating Bed
Circoelectric Bed

Buerger Allen Routine
1. FEET UP , 3 MIN
2. SIT ON BED & DO FOOT EXERCISE,3 MIN
3. LIE DOWN 5 MIN

Patient education
Decrease wieght
Avoid prolonged standing
Never wear constricting garments
Never cross legs

Promote Vasodilation
Warmth
No nicotine
Vasodilators : papaverine HCl, vasodilan
Moderate alcohol
sympathectomy

Prevent and Treat Vascular Occlusion
- avoid prolonged bedrest
-increase fluids
-proper positions
-anticoagulant therapy & fibrinolytics
Heparin - APTT- Protamine SO4
Dicumarol- PT - Vit K

ARTERIAL DISEASE
ARTERIOSCLEROSIS OBLITERANS – LATE STAGE OF ATHEROSCLEROSIS WITH PARTIAL OR COMPLETE OCCLUSION BY ATHEROMA WITH THROMBOSIS
RAYNAUD’S DISEASE – PERIODIC SPASM OF THE ARTERIES
ANEURYSMS – LOCALIZED OR DIFFUSED ARTERIAL DILATION
EMBOLUS/THROMBUS

VENOUS DISEASE
THROMBOPHLEBITIS –
INFLAMMATION OF THE VEIN WITH CLOT FORMATION
HOMAN’S SIGN
PHLEBOTHROMBOSIS
CLOTS WITHOUT INFLAMMATION
VARICOSE VEINS
TRENDELENBERG’S TEST – NORMAL VEIN FILLS FROM BELOW

DISEASE OF ARTERIES AND VEINS
BUERGER’S DSE / Thromboangitis Obliterans
RECURRING INFLAMMATION OF ARTERIES & VEINS
SMOKING
INTERMITTENT CLAUDICATION
A-V FISTULA
ABN COMMUNICATION BETWEEN A. & V.
TRAUMATIC/ CONGENITAL
BRUIT

NURSING CARE OF PATIENTS WITH AMPUTATION
Control Bleeding – Bandage
Prevent Edema – elevate 1 st 24 hrs
Relieving Phantom Limb Pain – hypnosis, destruction
Assume Body Alignment – Prone 30 min 2x a day to prevent flexion contracture ; AKA – HIP FLEXION AND ABDUCTION, EXTERNAL ROTATION BKA – KNEE FLEXION

NURSING CARE OF PATIENTS WITH AMPUTATION
Trochanter roll against the hip along the outer side to prevent outward rotation
Preparing for Locomotion
Stump care : wash with soap and water only
Exercise : quad setting, isometric
Crutch walking : weight- palms, stairs : GOOD LEG FIRST TO HEAVEN; BAD LEG FIRST TO HELL

The acute nursing management of a client with CHF will include all of the following goals except:
Increase in cardiac output
Elevation in renal blood flow
Reduction in the heart’s workload
Decrease in myocardial contractility

end of cardiovascular system

Hematologic System

REVIEW OF ANATOMY AND PHYSIOLOGY – Blood and Lymphatics
Composition of the blood
RBC, WBC, Platelets, Plasma
RBC
normal erythropoeisis requires : pyridoxine, Vit B12, folic acid, protein, copper, cobalt;
HEMOBGLOBIN : Iron; Oxygen transport; Acid-base buffer
WBC
granulocytes –neutrophils, eosinophils, basophils
agaranulocytes –lymphocytes (T,B), monocytes
Plasma
albumin, water, clotting factors, antibodies

REVIEW OF ANATOMY AND PHYSIOLOGY – Blood and Lymphatics
Role of the Bone Marrow
Production of all blood components
Major Roles of the Blood
homeostasis
transport of nutrients and electrolytes
distribute hormones and electrolytes
Major Role of Lymphatics
brings back blood to the circulation
immune antibody production

HEMATOLOGIC DISTURBANCES
DISORDERS OF THE BLOOD
RBC : IDA, PERNICIOUS ANEMIA, APLASTIC ANEMIA, HEMOLYTIC ANEMIA, POLYCYTHEMIA VERA
WBC and Plasma Cell : LEUKEMIA, MULTIPLE MYELOMA
Lymph Nodes and Spleen : LYMPHOMA, INFECTIOUS MONONUCLEOSIS, SPLENIC RUPTURE, HYPERSPLENISM
Hemorrhagic Disorders : PURPURA
Altered Coagulation : HEMOPHILIA, HYPOPROTHROMBINEMIA, D.I.C.

RBC :
IDA
PERNICIOUS ANEMIA
APLASTIC ANEMIA
HEMOLYTIC ANEMIA
POLYCYTHEMIA VERA

NUTRITIONAL ANEMIA
IRON DEFICIENCY ANEMIA
PERNICIOUS ANEMIA

RBC
normal erythropoeisis requires : pyridoxine, Vit B12, folic acid, protein, copper, cobalt;
HEMOBGLOBIN : IRON ; Oxygen transport; Acid-base buffer
WBC
Plasma

HEMOGLOBIN LEVEL FALLS BELOW NORMAL
CAUSES:
Poor intake if iron rich foods
Poor absorption & utilization of iron from foods
Acute / chronic blood loss

increased requirement :
infants after 6 mos,
children & adolescents
women of reproductive age
pregnant & nursing women
Erroneous food practices
Respiratory & GI conditions
Substandard living condition

CAUSES:
Acute / chronic blood loss

Form of Iron-
hemosiderin: from animal food
more readily absorbed than from plants (nonheme iron)
Effects of other foods
inhibit absorption of iron:
tea, unpolished rice, veges: bulaklak ng kalabasa, sampalok, mustasa

Host factors :
poor iron absorption in:
severe protein-energy malnutrition & repeated diarrhea
Infections
Delibitating disease

CAUSES:
Acute / Chronic blood loss

Acute / Chronic blood loss
Acute hemorrhage
Chronic or repeated Blood loss:
WHIPWORM
0.005 ML OF BLOOD PER WORM PER DAY
HOOKWORM
0.2 ML OF BLOOD PER WORM PER DAY
SCHISTOSOMIASIS
MALARIA
PEPTIC ULCER
EXCESSIVE MENSTRUAL FLOW

CLINICAL FEATURES:
Asymptomatic
inability to respond to increased iron demand
Normal Hgb levels but with s/sx :
lack of energy, fatiguability, reduced power and concentration
Severe anemia :
difficulty in breathing,
palpitation,
headache,
faintness
loss of appetite

ASSESSMENT:
Lab:
DECREASED HEMOGLOBIN & HEMATOCRIT LEVEL
MICROCYTIC, HYPOCHROMIC RBC
DECREASED RETICULOCYTE COUNT
Clinical Method
HISTORY
CLINICAL EXAMINATION - PALLOR

TREATMENT:
IRON ADMINISTRATION:
ORAL
ADULT : 100-120 mg/day
INFANTS AND CHILDREN : 3mg/kg/day
PARENTERAL IRON DEXTRAN
IM : 250 MG FOR EACH gm% LOWER THAN THE NORMAL VALUE
IV: 100-300 mg in 500ml SALINE SOLUTION

ORAL IRON ADMINISTRATION
ABSORPTION :
GREATEST DURING THE FIRST MONTH OF TX, AND DECREASES WHEN IRON STORES ARE INCREASING
EMPTY STOMACH: GOOD ABSORPTION, MORE G.I. S/E
ADMINISTER DURING OR PC
ASCORBIC ACID
BETTER ABSORBED IN FERROUS THAN IN FERRIC FORM
FERROUS SULFATE IS THE CHEAPEST AND READILY ABSORBABLE FORM
DOSE: CALCULATE THE ELEMENTAL IRON
FERROUS SULFATE HAS 36.74% ELEMENTAL IRON

ORAL IRON ADMINISTRATION
DURATION:
2 MOS, ANEMIA IS ALREADY ALLEVIATED
5 MOS, FOR IRON STORES
PREGNANT : 24 TH WK TO TERM
SIDE EFFECTS:
CONSTIPATION/DIARRHEA
NAUSEA
EPIGASTRIC PAIN / HEART BURN

PARENTERAL IRON ADMINISTRATION
INDICATIONS:
SEVERE DEFICIENCY
ORAL PREPARATIONS FAIL
CONDITION DO NOT PERMIT ORAL ADMINISTRATION
ABSORPTION:
RAPID
THERAPEUTIC RESPONSE
SAME WITH ORAL

ADVANTAGE:
S/E ARE AVOIDED
PROBLEMS WITH ABSORPTION IS AVOIDED
DISADVANTAGE:
COSTLY
TOXICITY IS POSSIBLE
ALLERGIC REACTION

PRECAUTION:
GIVEN UNDER CLOSE SUPERVISION BY PHYSICIAN
Z-TRACK METHOD
TISSUE STAINING & IRRITATION

IRON TOXICITY
VERY RARE IN ORAL
SIDEROSIS
HEMOSIDERIN IN TISSUES
HEMOCHROMATOSIS
END POINT OF SIDEROSIS,
DAMAGE TO LIVER AND PANCREAS
PREVENTION:
ADMIN IN DIVIDED DOSES
KEEP OUT OF CHILDREN’S REACH

MEASURES TO MINIMIZE IRON REQUIREMENTS
PARASITE CONTROL
ADMINISTER MEDS FOR PARASITISM
MINIMIZE RISK OF REINFESTATION:
REGULAR DEWORMING – EVERY 4-6 MOS
FOOTWEAR
PROPER USE OF LATRINE
FAMILY PLANNING
DECREASE THE # OF PREGNANCIES AND DELIVERIES
IUD – INCREASED MENSTRUAL LOSSES
POST-DELIVERY MEASURES
LATCH ON – OXYTOCIN RELEASE
CUT THE CORD AFTER PULSATION STOPS

MEASURES TO DIRECTLY AUGMENT IRON STORES
SUPLEMENTATION
PREGNANT 24 WKS TO TERM
NURSING MOTHERS
MALNOURISHED INFANTS & PRESCHOOLERS
PRETERM INFANTS
FORTIFICATION
EDUCATION

Burger King guest

PERNICIOUS ANEMIA
REVIEW OF ANATOMY & PHYSIOLOGY : STOMACH
Stores and mixes food with gastric juices & mucus producing chemical & mechanical changes in the bolus of food
Sphincters: cardiac and pyloric
Divisions: fundus, body, antrum
Secretions:
Pepsinogen : by chief cells
HCl: by parietal cells
Intrinsic factor : by parietal cells
mucoid

PERNICIOUS ANEMIA
RBC
normal erythropoeisis requires : pyridoxine, Vitamin B12 , folic acid, protein, copper, cobalt;
HEMOBGLOBIN : Iron; Oxygen transport; Acid-base buffer
WBC
Plasma

PERNICIOUS ANEMIA No INTRINSIC FACTOR VIT B 12 cannot be absorbed Alteration in DNA synthesis needed for cell division Delayed cellular division, altered nuclear pattern MEGALOBLAST Ineffective erythropoeisis : increased serum bilirubin & urobilinogen excretion

PERNICIOUS ANEMIA
OTHER TISSUES AFFECTED BY VIT B12 DEFICIENCY:
MOUTH
STOMACH
VAGINA
MYELIN SHEATH

PERNICIOUS ANEMIA
S/SX:
WEAKNESS, FATIGUE, PALLOR, JAUNDICE
SORE MOUTH, SMOOTH BEEFY TONGUE
ATROPHY OF THE GASTRIC MUCOSA
PERIPHERAL NERVE DEGENERATION : TINGLING, NUMBNESS OF HANDS AND FEET
LOSS OF COORDINATION, +ROMBERG’S

PERNICIOUS ANEMIA
DIAGNOSIS:
PERIPHERAL SMEAR : MACROCYTIC CELLS
(+) ROMBERG’S
GASTRIC ANALYSIS
(diagnex blue test) – ACHLORHYDRIA from thinning of mucosa – HCl is also produced by parietal cells of the stomach
SCHILLING’S TEST – B12 IN 24 HRS URINE SPEC

SCHILLING’S TEST
DEFINITIVE TEST FOR PERNICIOUS ANEMIA
DETECT LACK OF INTRINSIC FACTOR
MEASURES ABSORPTION OF RADIOACTIVE VIT B12 BOTH BEFORE & AFTER PARENTERAL ADMINISTRATION OF INTRINSIC FACTOR
FASTING CLIENT IS GIVEN RADIOACTIVE VIT B12 BY MOUTH AND NONRADIOACTIVE VIT B12 IM

SCHILLING’S TEST
24-48 HR URINE OBTAINED & TESTED FOR VIT B 12
AFTER 1 WK, FASTING CLIENT IS GIVEN RADIOACTIVE VIT B 12 ORALLY WITH PARENTERAL HUMAN INTRINSIC FACTOR
URINE TEST IS REPEATED

PERNICIOUS ANEMIA
MANAGEMENT:
NO CURE; VIT B12 IM FOR LIFE
DIET: MEAT & DAIRY
HCL :
1 ST WK;
DILUTE WITH WATER;
ADMINISTER WITH STRAW
AVOID SEASONED FOODS

PERNICIOUS ANEMIA
MANAGEMENT:
MOUTH CARE: SOFT TOOTHBRUSH
AVOID HEATING PADS – DECREASE IN SENSATION
AFTER 2-3 DAYS TX, INCREASE IN RETICULOCYTE COUNT
REHAB & PT FOR NEURODEFICITS

APLASTIC ANEMIA
DEPRESSION OF ALL BLOOD FORMING ELEMENTS FROM BONE MARROW DESTRUCTION
IDIOPATHIC
SECONDARY

APLASTIC ANEMIA
CAUSE:
ANTINEOPLASTIC DRUGS & RADIATION
IMMUNOSUPPRESIVE DRUGS
CHLORAMPHENICOL
SULFONAMIDES
TOXIC SUBSTANCES: BENZENE ,DDT, THIAZIDE, DIURETICS GOLD

APLASTIC ANEMIA
ASSESSMENT :
S/SX OF ANEMIA
INCREASED SUSCEPTIBILITY TO INFECTION
BLEEDING TENDENCIES & HEMORRHAGE

APLASTIC ANEMIA
LAB:
NORMOCYTIC ANEMIA
GRANULOCYTOPENIA
THROMBOCYTOPENIA
BONE MARROW BIOPSY:
FATTY
VERY FEW DEVELOPING CELLS

HEMOLYTIC ANEMIA EXCESSIVE RBC DESTRUCTION
CAUSES:
ACQUIRED
SNAKE VENOM
BURNS
BT INCOMPATIBILITY
MALARIA
TOXOPLASMOSIS
CONGENITAL
HEREDITARY SPHEROCYTOSIS
G6PD DEFICIENCY
THALASSEMIA
SICKLE CELL

POLYCYTHEMIA
INCREASE IN CIRCULATING BLOOD CELLS IN THE BLOOD DUE TO BONE MARROW OVERGROWTH
FORMS:
POLYCYTHEMIA VERA
SECONDARY POLYCYTHEMIA
RELATIVE POLYCYTHEMIA

POLYCYTHEMIA
ASSESSMENT :
RUDDY COMPLEXION
HYPERTENSION
SYMPTOMS OF CHF
THROMBUS FORMATION
BLEEDING
HEPATOSPLENOMEGALY
GOUT
PHLEBOTOMY

CLINICAL CARE OF PATIENTS WITH ANEMIA
REST
SKIN CARE
DECUBITUS ULCER FROM CELL HYPOXIA
DIET
6 SMALL EASILY DIGESTIBLE MEALS
NO HOT & SPICY FOODS
MOUTH CARE
TRANSFUSION NOT A ROUTINE
OXYGEN

CLINICAL CARE OF PATIENTS WITH ANEMIA
PROTECTION FROM INJURY
BURNS and CHILLING
ISLOLATION BY:
REVERSE ISOLATION
LIFE ISLAND- BED ENCLOSED IN PLASTIC CANOPY
LAMIANR AIRFLOW LIMIT – UNIT WITH MICROFILTER

Don’t look at me…

WBC and Plasma Cell :
LEUKEMIA
MULTIPLE MYELOMA

LEUKEMIA
FATAL NEOPLASTIC DISEASE THAT INVOLVES THE BLOOD FORMING TISSUES OF THE:
BONE MARROW
SPLEEN
LYMPH NODES
UNCONTROLLED & DESTRUCTIVE PROLIFERATION OF ONE TYPE OF WBC & ITS PRECURSORS

LEUKEMIA
INFILTRATE:
LIVER
SKIN
KIDNEYS
LYMPH TISSUES
TYPES:
MYELOGENOUS
LYMPHOCYTIC

LEUKEMIA
S/SX:
ANEMIA
THROMBOCYTOPENIA
INFECTION
PETECHIAE
HEPATOSPLENOMEGALY & LYMPH NODE ENLARGEMENT
ARTHRALGIA & BONE PAIN FROM EXPANSION OF BM

LEUKEMIA
LAB:
INCREASED WBC
ANEMIA
THROMBOCYTOPENIA
INCREASE ALKALINE PHOSPHATASE
OSTEOBLASTIC ACTIVITY
BONE MARROW BIOPSY

LEUKEMIA – NURSING CARE
PROVIDE ADEQUATE REST INCREASED METABOLIC RATE FROM OVERPRODUCTION OF LEUKOCYTES
PAIN CONTROL ASA, CODEINE, DEMEROL
ADEQUATE FOOD & FLUID INTAKE HIGH CALORIE DIET VITAMIN SUPPLEMENTS 3-4 L OF FLUID PER DAY

LEUKEMIA – NURSING CARE
MOUTH CARE H2O2 LEMON & GLYCERINE
PREVENT INFECTION PROTECT PATIENT FROM HIS OWN FLORA – NEOMYCIN
CHEMOTHERAPY
GOAL- INDUCTION OF COMPLETE REMISSION
TOLERABLE LEVEL OF TOXICITY – CRITERION FOR LIMITATION OF INDUCTION PHASE

MULTIPLE MYELOMA
MOST COMMON NEOPLASTIC DISORDER OF THE PLASMA CELL
BONE MARROW MALIGNANCY
REVIEW OF PLASMA CELL AND ITS PRODUCTS
S/SX:
BACK PAIN,
FATIGUE, WEIGHT LOSS,
OSTEOPOROSIS
HYPERCALCEMIA

MULTIPLE MYELOMA
LABS:
BLOOD: DECREASED WBC, HGB & PLATELET; INCREASED SERUM INMMUNEGLOBULINS
RADIOLOGY
DIFFUSE BONE LESIONS
DIAGNOSIS: BENCE-JONES PROTEIN GLOBULIN IN THE URINE

Lymph Nodes and Spleen :
LYMPHOMA
INFECTIOUS MONONUCLEOSIS
SPLENIC RUPTURE
HYPERSPLENISM

LYMPHOMA
HODGKIN’S & NON HODGKIN’S DISEASE
LYMPHOSARCOMA
BURKITT’S LYMPHOMA

HODGKIN’S DISEASE
MALIGNANT NEOPLASM OF THE LYMPHOID TISSUE
ENLARGEMENT OF THE LYMPH NODES
NIGHT SWEATS
BODY MALAISE
WEIGHT LOSS
REED-STERNBERG CELLS IN LYMPHNODE BIOPSY

NONHODGKIN’S DISEASE
MALIGNANT NEOPLASM OF THE LYMPHOID TISSUE
ENLARGEMENT OF THE LYMPH NODES
MORE FATAL & DIFFICULT TO CONTROL
UNDIFFERENTIATED CELLS IN LYMPH NODE BIOPSY

AKA : GLANDULAR / KISSING DSE
S/SX:
PAINFUL ENLARGEMENT - LYMPHNODES
LYMPHOCYTOSIS
FEVER

CAUSE: EPSTEIN-BARR VIRUS
CONTACT: KISSING
DIAGNOSIS : PAUL-BUNNEL HETEROPHIL TEST
COMPLICATION : SPLENIC RUPTURE

SPLENECTOMY
INDICATIONS:
RUPTURE OF THE SPLEEN FROM TRAUMA, INFECTIOUS MONONUCLEOSIS
HYPERSPLENISM – EXCESSIVE SPLENIC DAMAGE OF CELLULAR BLOOD COMPONENTS

SPLENECTOMY
NURSING CARE:
PREOP
PNEUMOCOCCAL VACCINE
POSTOP
MONITOR FOR BLEEDING & SHOCK
FEVER WITHOUT INFECTION IS COMMON
PROPHYLACTIC ANTIBIOTIC

Hemorrhagic Disorders : PURPURA
EXTRAVASATION OF SMALL AMTS OF BLOOD INTO THE TISSUES AND MUCUS MEMBRANE
VASCULAR PURPURA
CAUSES :
HEREDITY
ALLERGY (HENOCH-SCHONLEIN)
DRUGS (TOXIC PURPURA)
POOR NUTRITION
INFECTION
HPN
THROMBOCYTOPENIC PURPURA

Disorders of Altered Coagulation
HEMOPHILIA
HYPOPROTHROMBINEMIA
D.I.C.

HEMOPHILIA
Deficit in one of the clotting factors
A – Factor VIII
B - Factor IX
C- Factor XI

HEMOPHILIA
S/SX:
PROLONGED BLEEDING AFTER MINOR INJURY:
CUTTING OF CORD
CIRCUMCISION
IMMUNIZATION
HEMARTHROSIS
PERIPHERAL NEUROPATHY – BLEEDING NEAR PERIPHERAL NERVES
LAB:
PROLONGED PTT
NORMAL PLT CT
ANEMIA

HYPOPROTHROMBINEMIA
LIVER FAILURE
BLEEDING EPISODES
VITAMIN K

D.I.C.
2 CONFLICTING SETS OF MANIFESTATIONS:
DIFFUSE FIBRIN DEPOSITION WITHIN ARTERIOLES AND CAPILLARIES THROUGHOUT THE BODY
BLEEDING INTO THE KIDNEYS, BRAIN, ADRENAL, HEART AND OTHER ORGANS

D.I.C. DIFFUSE FIBRIN DEPOSITION WIHIN ARTERIOLES AND CAPILLARIES WIDESPREAD CLOTTING DEPLETION OF CLOTTING FACTORS

D.I.C.
CAUSE:
UNKNOWN
CRITICAL ILLNESS:
TOXEMIA OF PREGNANCY
CANCER
SURGICAL PROBLEMS
HEMOLYTIC DSE
ASSESMENT:
PETECHIAE, ECCHYMOSIS
PROLONGED BLEEDING
ARF
CONVULSIONS
COMA
LAB:
FIBRIN SPLIT PRODUCTS

A.I.D.S.
Severe deficit in cellular immune functions
HIV virus- infects T helper cells
Transmission
Antiretroviral drugs
Assessment:
Flulike s/sx
Hypoxemia from pulm infection
Progressive weight loss
Temp elevations; night sweats
Neurologic dyfxn
Opportunistic infections
Laboratory :
ELISA
Western Blot
Anemia
Leukopenia
thrombocytopenia

A.I.D.S.
NURSING INTERVENTION:
Administer meds
Monitor resp, neurologic, F & E balance
Monitor nutritional intake
Inspect oral cavity for ulcerations
Observe s/sx of infection
Severe leukopenia – neutropenic precaution
Blood & body fluid precaution
Emotional support

The nurse should understand that a heparin order for a client with DIC is given to:
Prevent clot formation
Increase blood flow to target organs
Increase clot formation
Decrease blood flow to target organs

GOD BLESS

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Cardiology and Hematology Ppt

by precyrose on Jul 15, 2008

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Cardiology and Hematology Ppt — Presentation Transcript