1. Identify priorities of care for the patient experiencing bone marrow suppression.
● Bone marrow suppression
○ Decreased RBCs (erythrocytes)
... [Show More] decreased WBCs (neutrophils) and decreased
Platelets (thrombocytes)
■ wbc 5-10k
■ platelets 150k-450k
● thrombocytopenia = decreased platelet count
○ petechiae and bruising
● Anemia
○ •Lower than normal hemoglobin and fewer than normal circulating erythrocytes
■ hg 12-16
○ •A sign of an underlying disorder
● Types
○ Hypoproliferative: defect in production of RBCs
■ –Caused by iron, vitamin B12, or folate deficiency, decreased
erythropoietin production, cancer
○ •Hemolytic: excess destruction of RBCs
■ –Caused by altered erythropoiesis, or other causes such as
hypersplenism, drug-induced or autoimmune processes, mechanical
heart valves
■ •May also be caused by blood loss
■ •Anemia of chronic illness
● Manifestations
○ •Depend on the rapidity of the development of the anemia, duration of the
anemia, metabolic requirements of the patient, concurrent problems, and
concomitant features
○ •Fatigue, weakness, malaise (most common!)
○ •Pallor or jaundice
○ •Cardiac and respiratory symptoms
○ •Tongue changes
○ •Nail changes
○ •Pica
● Medical Management
○ •Correct or control the cause
○ •Transfusion of packed RBCs if anemia severe
○ •Treatment specific to the type of anemia
■ –Dietary therapy
■ –Iron or vitamin supplementation: iron, folate, B12
■ –Transfusions
■ –Immunosuppressive therapy
■ –Other
● Nursing Process: The Care of the Patient With Anemia—Diagnoses
○ •Fatigue
○ •Altered nutrition
○ •Altered tissue perfusion
○ •Noncompliance with prescribed therapy
● Nursing Process: The Care of the Patient With Anemia—Interventions
○ •Decreased oxygen carrying capacity!
○ •Heart must try to compensate for low Hgb.
○ •Balance physical activity, exercise, and rest.
○ •Maintain adequate nutrition.
○ •Maintain adequate perfusion
○ •Patient education to promote compliance with medications and nutrition.
○ •Monitor VS and pulse oximetry; provide supplemental oxygen as needed.
○ •Monitor for potential complications-(heart failure is one)
● •Iron deficiency anemia
○ Etiology
■ •Deficient dietary intake
■ •Malabsorption
■ •Blood loss
■ –Bleeding ulcers
■ –Menorrhagia
■ –Chronic alcoholism with chronic blood loss from GI tract
○ Signs and Symptoms
■ •Mild anemia
● –Usually asymptomatic
■ •Severe anemia
● –Fatigue
● –Irritability
● –Dypsnea
● –Tachycardia
● –Smooth, sore tongue
● –Brittle, ridged nails
● –Eating nonnutrient substances (PICA)
○ Diagnosis
■ •Low Hgb
■ •Low Hct
■ •Low serum ferritin
■ •Low MCV (small RBC)
○ Treatment****
■ •Oral: (ferrous sulfate)Takes weeks to months to correct iron-deficiency
anemia with iron supplements.
■ •Best absorption on an empty stomach
● - Vitamin C increases absorption
● - Avoid taking with milk or other dairy products
■ •Side effects- GI upset, constipation
■ - Fiber helps counteract constipating effects
■ •Tell patient it may color stool dark green or black
○ Iron rich foods
■ meat, clams, potatoes with skin, broccoli, iron fortified cereal, raisins,
spinach
○ avoid dairy products when administering iron
● Parenteral ferric gluconate IV/IM
○ •Should give test dose due to risk of anaphylaxis
○ •Meticulous care of IV site to observe for infiltration.
○ •If IM- give Z-track method
● Vitamin B12 deficiency (Permicious anemia
○ One type of a megaloblastic anemia
○ •Pathophysiology: decreased gastric production of HCl, decreased intrinsic factor
○ •You need intrinsic factor to absorb Vit B 12
○ •Individuals at risk:
■ –Bariatric patients esp. with gastric and intestinal resection.
■ –Total gastrectomy
■ –Vegan diet
■ –Antibiotics (long-term)
■ –Chronic gastric inflammation
■ –Atrophic gastric mucosa
○ Manifestations:
■ –Red, beefy tongue, pale mucous membranes
■ –Neuro: confusion, paresthesias, numbness, tingling, ataxia, loss of
balance, loss of proprioception.
■ –Decreased Hgb
■ •Death due to heart failure if untreated
○ •Treatment- IV/IM Vit. B 12. If no problem with absorption, may be able to take
oral once stabilized.
● Anemia in renal disease
○ Occurs when creatinine > 3
○ •Multiple factors:
■ –Lack of erythropoeitin (hormone produced by kidney)
■ –RBCs shortened life span
■ –Lose RBCs in dialyzer (hemodialysis)
○ treatment: Epogen (synthetic EPO)
● Neutropenia
○ •Decreased production or increased destruction of neutrophils (<2,000/mm3)
■ decreased WBCs
○ •Increased risk for infection: monitor closely
○ •Absolute neutrophil count (ANC)<1,000.
○ •Medical management: treatment depends on the cause
○ •Nursing management: patient education [Show Less]