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This chapter is from the book

This chapter is from the book

Key Concepts

This chapter discussed the most common types of hematological disorders. The key concepts will help the nursing graduate on the NCLEX exam by focusing on the most commonly used key terms, diagnostic exams, and pharmacological agents used to treat these disorders. This section is covered on the NCLEX exam in the area of physiological integrity.

Key Terms

  • Dyspnea
  • Enuresis
  • Fatigue
  • Hemarthrosis
  • Hemolysis
  • Jaundice
  • Leukopenia
  • Otitis media
  • Pallor
  • Paresthesia
  • Priapism
  • Pruritus
  • Sequestration
  • Tachypnea
  • Thrombocytopenia
  • Tinnitus
  • Upper respiratory infections

Diagnostic Tests for Review

The diagnostic tests for a client with hematological disorders are the same as any other routine hospitalization of a client (CBC, urinalysis, and chest x-ray). Specific tests, such as the Schilling test for B12 deficiency, and sickledex and Hgb electrophoresis, are used to diagnose sickle cell anemia and thalassemia. Review these tests prior to taking an exam for a better understanding of the disease process:

  • Schilling test
  • CBC with differential
  • Hemoglobin electrophoresis

Pharmacological Agents Used in Hematological Disorders

A client with a hematological disorder will receive a number of medications to stimulate red blood cell production and replace needed vitamins or nutrients. Analgesics are also a requirement for the pain associated with some diseases. You'll need to review the drugs listed in Table 10.3 prior to an exam for knowledge of their effects, side effects, adverse reactions, and nursing implications. These medications are not inclusive of all the agents used to treat gastrointestinal disorders; therefore, you will want to keep a current pharmacology text handy for reference.

Table 10.3. Hematological Pharmacological Agents

Name

Action

Side Effects Include

Pertinent Nursing Implications

Vitamin B12 (cyanocobalamin)

Necessary for metabolic processes and required for RBC formation. Prevents B12 deficiency and treats pernicious anemia.

Diarrhea, itching, rash, hypokalemia, anaphylaxis, pain at IM site.

Available IM, subcutaneously, intra-nasal (useful by this route only if need is due to a nutritional deficiency). Teach foods high in vitamin B12: meats, seafood, egg yolk, and fermented cheese. PO can be administered with meals or mixed with fruit juice. Intranasal (use within an hour of hot food or liquid). Instruct of lifelong need after gastrectomy.

Ferrous sulfate (Femiron, Feostat) Imferon Tip: IM iron is Imferon

An essential mineral found in hemoglobin. Prevents and treats iron deficiency.

IM and IV: dizziness, seizures, tachycardia, hypotension. IM: skin staining, arthralgia, myalgia, anaphylaxis. PO: constipation, dark stools, diarrhea, pain in epigastric region, staining of teeth with liquid preparations.

Assess for signs of anaphylaxis (rash, itching, laryngeal edema with wheezing). Monitor Hgb and Hct levels. Monitor for overdose: stomach pain, fever, nausea and vomiting, bluish lips and fingernails, seizures, and tachycardia. Avoid antacids, coffee, tea, dairy products, or whole grain breads when on PO iron. Dilute liquid iron in water or fruit juice. Administer with a straw or place drops at back of throat. Give iron with citrus fruit or juice to enhance absorption (can also be taken with vitamin C pill).

Hydroxyurea (Droxia)

Reduces painful crises in sickle cell anemia. An anticancer agent.

Anorexia, nausea, vomiting, consti-pation, hepatitis, alopecia, rashes, pruritus, leukopenia, anemia, thrombocytopenia.

Monitor laboratory values for signs of leukopenia, anemia, and thrombocytopenia in the client. Assess for side and adverse effects.

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