NR 324 Week 4 Hematologic Alterations
Student Name
Chamberlain University
NR-324 Adult Health I
Prof. Name
Date
Week 4: Hematologic Alterations Nursing Care
Prepare: The Nursing Care of Hematologic Alterations
Nursing Intervention – Taking Action
Question: A nurse develops a fever before she is scheduled to work. Which priority action is most appropriate?
Answer: The nurse should notify the supervisor that she is unable to work today. Working with a fever could place immunocompromised patients at risk. It is essential for healthcare professionals to recognize their own symptoms as part of infection prevention and control protocols (CDC, 2023).
Recognizing Cues – Altered Hematological Conditions
Question: 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)
Answer:
- Dyspnea
- Fatigue
- Abnormal skin color
These symptoms are classic indicators of anemia, particularly when hemoglobin is below normal range. Dyspnea and fatigue result from decreased oxygen delivery to tissues, while pale or abnormal skin color reflects hypoxia (Ignatavicius et al., 2021).
Analyzing Cues – Altered Hematologic Conditions
Question: The nurse notes a client as having erythrocytosis. The nurse understands that this can be caused by which factors? (Select all that apply)
Answer:
- Chronic smoking
- High altitude
Erythrocytosis refers to an elevated red blood cell count, often seen in response to hypoxic conditions such as high altitude or smoking-induced hypoxia (Huether & McCance, 2020).
Self-Check: Outcome – Nursing Evaluation
Question: When can the nurse schedule the follow-up complete blood count (CBC) to ensure the platelet count returns to normal after discontinuation of the seizure drug in a thrombocytopenia patient?
Answer: Two weeks will give sufficient time for the platelet count to improve.
Self-Check Tables
| Hematologic Problem | Expected Signs/Symptoms |
|---|---|
| Thrombocytopenia | Bruising, petechiae, bleeding gums |
| Anemia | Fatigue, pallor, dyspnea |
| Neutropenia | Fever, sore throat, signs of infection |
| Nursing Action | Most Appropriate Condition |
|---|---|
| Administer oxygen | Anemia |
| Apply bleeding precautions | Thrombocytopenia |
| Initiate neutropenic precautions | Neutropenia |
Self-Check: Hospital Acquired Infection
Question: Which patients are at high risk for hospital acquired infection? (Select all that apply)
Answer:
- An older adult with rheumatoid arthritis on adalimumab
- An adult with HIV and a low CD-4 count
- An adult with breast cancer taking tamoxifen
These individuals are immunocompromised due to underlying conditions or treatments that suppress immune function.
Self-Check: Nursing Evaluation – Transfusion Reaction
Scenario: Julie had a hysterectomy, became anemic (Hgb 7.2 g/dL), and received 2 units of PRBCs. Fifteen minutes into the transfusion, she experiences fever, chills, headache, anxiety, and muscle pain.
Question 1: Which of the following reactions is she likely experiencing?
Answer: Febrile non-hemolytic reaction.
Question 2: Which is the best course of action to take?
Answer: Stop the blood, change the tubing and bag to normal saline and start infusing. This step prevents further exposure and maintains IV access with non-reactive fluids (AABB, 2022).
Reflect: The Nursing Care of Hematologic Alterations
Recognizing Cues – Nursing Assessment
| Assessment Item | Requires Follow-Up |
|---|---|
| Pale, cool skin | Yes |
| Fatigue | Yes |
| Capillary refill < 3 sec | No |
Nursing Diagnoses – Developing a Hypothesis
Client: Janet, 64, admitted with SOB and fatigue.
Nursing Diagnoses for Aplastic Anemia:
- Fatigue
- Risk for bleeding
- Risk for infection
- Impaired gas exchange
Prioritization – Nursing Intervention
Provider Orders (prioritized):
- Neutropenic precautions and fall precautions
- Oxygen at 4L/min via nasal cannula
- Type and cross for 2 units PRBCs now
- Continuous oximetry
- Monitor vital signs q4hours
- When ready, give 2 units PRBCs over 4 hours
Evaluation – Nursing Outcomes
Question 1: Assessment of which system gives the most information?
Answer: Cardiovascular system
Question 2: Which lab best evaluates outcomes?
Answer: Complete blood count
Recognizing Cues
Scenario: You are calling the provider for Bill.
Include: Vital signs, recent labs (elevated Hct, low SpO2), respiratory symptoms, diagnosis of polycythemia.
Prioritizing Care – Polycythemia
Prioritized Diagnoses:
- Altered gas exchange
- Altered tissue perfusion
- Risk for thromboembolism
- Knowledge deficit
Nursing Actions – Polycythemia
| Provider Order | Rationale |
|---|---|
| Oxygen administration | Improve oxygen delivery |
| Encourage fluid intake | Prevent blood viscosity |
| Monitor for thrombotic events | Risk of clotting |
Nursing Outcomes – Polycythemia
Indications of Improvement (Select all that apply):
- Reduced shortness of breath
- Increased oxygen saturation
- Change in lung sounds
Anemias
Recognizing Cues – Anemia
Question: Which lab markers indicate anemia? (Select all that apply)
Answer:
- Hemoglobin
- Hematocrit
- Red blood cell count
- Red cell distribution width
Shared Nursing Diagnosis: Anemia & Coronary Artery Disease
Answer: Impaired gas exchange
Nursing Intervention – Anemia
Scenario: A client was stabbed and lost blood.
Answer: Transfuse ordered packed red blood cells
Analyzing Cues – Anemia
| Condition | Type of Anemia |
|---|---|
| Poor dietary iron intake | Iron deficiency anemia |
| Long-term gastritis | Pernicious anemia |
| Genetic hemoglobin disorder | Thalassemia |
Recognizing Cues – Anemia
Symptoms (Select all that apply):
- Shortness of breath with activity
- Low hemoglobin and hematocrit
- Abnormal skin assessment
- Orthopnea
Nursing Actions – Anemia
| Action | Related Diagnosis |
|---|---|
| Administer iron supplements | Iron deficiency anemia |
| Educate on B12 intake | Pernicious anemia |
| Monitor respiratory status | Impaired gas exchange |
Analyze Cues – Anemia
| Situation | Barrier |
|---|---|
| Low income preventing follow-up visits | Financial barrier |
| Language barrier during health education | Communication barrier |
Reflect: Anemias
Recognizing Cues – Nursing Assessment
| Findings Suggestive of Anemia |
|---|
| Pale skin |
| Fatigue |
| Shortness of breath with activity |
Analyzing Cues – Risk Factors
Case: Alma has SOB with activity.
- Risk factors include: gradual onset, pale skin, low hemoglobin, no edema.
Generating a Hypothesis – Nursing Diagnosis
Likely Type of Anemia: Iron deficiency anemia
Planning Care – Anemia
| Order | Nursing Diagnosis |
|---|---|
| Prescribed iron supplement | Imbalanced nutrition |
| Monitor oxygen saturation | Impaired gas exchange |
Analyzing Cues – Anemia Findings
| Type of Anemia | Expected Finding |
|---|---|
| Iron deficiency | Microcytic, hypochromic RBCs |
| Pernicious anemia | Glossitis, paresthesia |
| Thalassemia | Target cells on blood smear |
Nursing Action – Priority Cues
Case: Dwayne, 25, moderate joint pain, pale skin, financial stress.
Diagnoses (Select all that apply):
- Pain
- Fatigue
- Impaired gas exchange
- Stress overload
Actions (Select all that apply):
- Administer prescribed pain medication
- Supplemental oxygen
- Suggest dietary changes
- B12 and folate supplement
Nursing Outcomes – Sickle Cell Anemia
Discharge Note Summary:
Dwayne is stable post-crisis, denies SOB, no pain, normal VS, met with social worker.
Evaluation: Goals are currently being met.
References
AABB. (2022). Standards for blood banks and transfusion services.
Centers for Disease Control and Prevention. (2023). Infection prevention and control. https://www.cdc.gov/infectioncontrol/
NR 324 Week 4 Hematologic Alterations
Huether, S. E., & McCance, K. L. (2020). Understanding pathophysiology (7th ed.). Elsevier.
Ignatavicius, D. D., Workman, M. L., & Rebar, C. R. (2021). Medical-surgical nursing: Concepts for interprofessional collaborative care (10th ed.). Elsevier.