Hematology System Problems

Worksheet

Short Answer Questions

1. Identify the general clinical manifestations and complications of anemias.

 Fatigue/weakness
 Pale/yellowish skin
 Arrhythmias
 Shortness of breath
 Dizziness or light-headedness
 Chest pain
 Cold hands and feet
 Headaches

2. Describe the etiologies of anemia.

 Anemia results from one or more of 3 basic mechanisms:
o Blood loss (acute or chronic)
o Deficient erythropoiesis
o Excessive hemolysis (RBC destruction)
3. Discuss the general nursing management of patients with anemia.
 Blood or blood product transfusions
 Drug therapy
 Volume replacement
 Dietary and lifestyle changes
 Oxygen therapy
 Client teaching regarding nutrition intake and compliance with safety
precautions to prevent falls and injury
4. Explain the pathophysiology,
5. Identify the clinical manifestations of thrombocytopenia.
 Bleeding in the skin
 Petechiae (tiny red dots on the skin)
 Minor injuries may cause bruises
 Blood in stool or urine
 Unusually heavy menstrual period

6. Discuss the general nursing management of patients with thrombocytopenia.

 Treatment of the cause of thrombocytopenia
 Thrombocytopenia caused by a drug is corrected by stopping the drug
 Encourage patient not to take drugs that impair platelet function (eg. Aspirin .
NSAID)
 When bleeding is severe, platelets may be transfused

7. Compare and contrast the major types of leukemia in terms of age of onset, clinical
manifestations and diagnostic findings.
TYPE AGE OF KEY CLINICAL KEY DIAGNOSTIC STUDIES
ONSET MANIFESTATIONS
Acute Increase in Fatigue & weakness Low RBC, Hb, Hct count
Myelogenou incidence Headache Low platelet count
s Leukemia with Mouth sores Low-high WBC count with
advancing Anemia myeloblasts
age; peak Bleeding High LDH
incidence Fever Greatly hypercellular bone
b/w 60 & 70 Infection marrow with myeloblasts
yrs Sternal tenderness
Gingival hyperplasia
Minimal hepatosplenomegaly
& lymphadenopathy
Acute Before age Fever; pallor; bleeding; Low RBC, Hb, Hct, platelet
Lymphocyti 14; peak anorexia; fatigue; bone, joint, count
c Leukemia incidence and abdominal pain; High LDH
between 2-9 generalized lymphadenopathy; Transverse lines of
years infections; weight loss; rarefaction at ends of
hepatosplenomegaly; metaphysis of long bones on
headache; mouth sores; radiograph
neurological manifestations; Hypercellular bone marrow
increased intracranial pressure; with lymphoblasts
secondary to meningeal Lymphoblasts also possible
infiltrations in cerebrospinal fluid
Presence of Philadelphia
chromosome in 20-25% of
patients
Chronic 50-70 years No symptoms frequently Mild anemia and
Lymphocyti of age; rare thrombocytopenia with
below 30 Detection of disease often disease progression
c Leukemia during exam for unrelated
years; Increase in peripheral
predominant condition lymphocytes
in males Increase in presence of
 Chronic fatigue
lymphocytes in bone marrow
 Anorexia Hypo-gammaglobulinemia
 Splenomegaly &
lymphadenopathy &
hepatomegaly
 May progress to fever,
night sweats, weight
loss, fatigue, & frequent
infections
Chronic 25-60 years; No symptoms early in the Low RBC, Hb, Hct count
Myelogenou peak disease, then: High platelet count early,
s Leukemia incidence  Fatigue & weakness lower count later
around 45  Fever Increase in
years  Sternal tenderness polymorphonuclear
 Weight loss neutrophils
 Joint & bone pain Normal number of
lymphocytes and normal or
  Massive splenomegaly low number of monocytes in
 Increase in sweating WBC differential
Low leukocyte alkaline
phosphatase
Presence of Philadelphia
chromosome in 90% of
patients

8 Identify the goals of care for patients with leukemia that would guide nursing care
interventions.
- Induction therapy
o Attempt to induce remission & seek to destroy leukemic cells in tissues,
peripheral blood, and bone marrow
o Nursing interventions focus on neutropenia, thrombocytopenia, and anemia
- Provide psychosocial support for the client and family
- Intensification therapy – high-dose therapy
- Consolidation therapy – after remission is achieved
o Eliminates remaining leukemic cells that may not be pathologically evident
- Maintenance therapy – lower doses of the same drug given every 3-4 weeks (goal is to
keep the body free of leukemic cells)

9. Compare Hodgkin’s lymphoma and non-Hodgkin’s lymphoma in terms of etiology,

clinical manifestations, nursing and collaborative management.

HODGKIN’S DISEASE NON-HODGKIN’S LYMPHOMA

Clinical - Enlarged lymph nodes (NOT - Painless lymph node enlargement
Manifestations PAINFUL) - Airway obstruction
- Tachycardia - Hyperuricemia
- Generalized pruritus without - Renal failure
skin lesions - Pericardial tamponade
- Fever - GI complaints
- Night sweats - Fever
- Weight loss - Night sweats
- Itching - Weight loss
- Fatigue
Pathophysiolog - Normal structure of lymph - The bodies continues to create
y nodes is destroyed by lymphocytes even though the old
hyperplasia of monocytes ones don’t die – this oversupply of
and macrophages lymphocytes crowds into your
- The disease arises in a single lymph nodes causing them to swell.
location and then spreads - Most often begins in the B cells
along adjacent lymphatics (lymphocyte that fights infection by
producing antibodies to neutralize
foreign invaders) or T cells
(lymphocyte that kill foreign
invaders directly)
Etiology - Infection with Epstein-Barr Cause usually unknown
virus
- Genetic predisposition
 - Exposure to occupational
toxins
Diagnostic & - Peripheral blood analysis - MRI / CT
Staging Studies - Excisional lymph node - Lymph node biopsy
biopsy And the others of Hodgkin’s Lymphoma
- Bone marrow exam
- Radiological evaluation
Collaborative
Management

Key Nursing
Roles

10. Multiple Myeloma has a known/unknown etiology?

Etiology is unknown but thought that chromosomal & genetic factors, radiation, and chemicals
may be a factor.

11. Briefly describe the pathophysiology of multiple myeloma.

Excessive production of plasma cells. Cancerous plasma cells accumulate in the bone marrow
and crowd out healthy blood cells. Rather than produce helpful antibodies, the cancer cells
produce abnormal proteins that can cause complications.

12. Identify the diagnostic studies used in the confirmation of multiple myeloma.
- Laboratory, radiological, & bone marrow exam
- Urinalysis (for M proteins)

13. Identify the key nursing management components when caring for patients with
multiple myeloma.
- Ensure adequate hydration
- Provide analgesic for any pain being experienced
- Prompt management of hypercalcaemia
- Dose adjustment of bisphosphonate therapy
Multiple Choice Questions

1. The practical nurse notes that a patient’s hemoglobin is 115mmol/L and her hematocrit is
30%. The practical nurse knows that these levels:

a. Are within normal limits for a woman

b. Will affect the patient’s ability to transport oxygen to her cells
c. Significantly increase the patient’s risk for abnormal clotting
d. Increase the patients risk for infection

2. A patient with kidney failure has low erythropoietin levels. As a result, the practical nurse
would expect which of the following in the CBC? Select all that apply.

a. A low RBC count

b. A high hemoglobin level
c. A high WBC count
d. Increased numbers of immature RBCs in the blood

3. On assuming care for a patient who was admitted after spleen was removed to stem
abdominal bleeding. The nurse understands that this will affect the patients:

a. Ability to metabolize drugs

b. Excretion of toxic waste products
c. Blood clotting
d. Immune function

4. The practical nurse caring for a patient with a diagnosis of thrombocytopenia knows that this
disorder will affect the patient’s:

a. Ability to form blood clots

b. Ability to fight infection
c. Energy level
d. Nutritional status

5. After a bone marrow aspiration, the practical nurse appropriately plans to:

a. Significantly increase the patient’s fluid intake to restore blood volume

b. Withhold all analgesics to allow accurate assessment of mental status
c. Carefully monitor the site for signs of excess bleeding
d. Warn the patient to remain on bed rest for 24 hours after the procedure
6. A 19 year old patient is admitted in sickle cell crisis. The FIRST nursing action would be to:

a. Administer pain medications

b. Obtain blood samples for analysis
c. Administer antibiotics
d. Insert a Foley catheter

7. An LPN is assigned to a patient with thrombocytopenia. A priority goal of nursing care is:

a. Prevention of infection
b. Prevention of injury
c. Prevention of dehydration
d. Prevention of nutritional deficit

8. A patient diagnosed with multiple myeloma asks the practical nurse what she should expect
when undergoing radiation therapy. The most appropriate response would be that:

a. The skin may look and feel sunburned over the radiated area
b. Radiation therapy is painless and has few side effects
c. Although radiation therapy is painful, it will help reduce the size of the tumor
d. The patient will need to be careful to avoid exposing the family to the radiation

9. A patient is evaluated for possible Hodgkin lymphoma. Which of the following assessment
findings would be expected?

a. Enlarged cervical lymph nodes

b. Absent Reed Sternberg cells
c. Negative Epstein-Barr virus
d. Immovable, painful inguinal lymph nodes

10. The practical nurse develops a nursing diagnosis of Risk for Infection for a patient with
leukemia. The best action by the practical nurse would be to:

a. Require visitors with colds to wear masks

b. Wash hands when leaving the room
c. Document signs of infection in the medical record
d. Maintain protective isolation protocols at all times
Complete the following table: Giving Medications Safely: Anemia

Drug Class Purpose Nursing Patient Teaching

Implications

Iron plays a key role Assess bowel Stool may appear

in making RBCs. function for black from the
Iron
constipation or supplements.
Prevention/treatment diarrhea
of iron-deficient Ensure that patient
anemia Monitor takes iron with food.
hemoglobin, and
hematocrit prior to
administration

Vitamin B12 Eat foods high in

deficiency - meat, seafood, egg
Vitamin B 12
pernicious anemia yolk, and cheese

The body needs B12

to make RBCs.

Megaloblastic anemia Eat foods high in

vegetables, fruit,
Folic Acid Macrocytic anemia and organ meats –
heat destroys folic
acid in food.

Folic acid may

make urine more
intensely yellow.