MEDICAL SURGICAL NURSING | YFB

HEMATOLOGICAL SYSTEM
OVERVIEW OF THE STRUCTURE AND FUNCTIONS
COMPONENTS thereby preventing
edema.
BLOOD FORMING ORGANS o FIBRINOGEN
1. Bone Marrow – produces 100% of RBC, ▪ Clotting factor that
60-70% of total WBC, and platelets prevents bleeding.
2. Liver o GLOBULINS
3. Thymus gland ▪ Alpha – transports
4. Spleen hormones, iron,
5. Tonsils steroids and ferritin
6. Lymph nodes ▪ Beta – same function
7. Lymphoid organs with alpha
• Payer’s Patches – located ▪ Gamma /
between the small and large Immunoglobulin on
intestine; target site of IG / Antibodies
salmonella typhi → THYPHOID ANTI-BODIES
FEVER → (+) ROSE SPOTS ON
Anti-
THE STOMACH → SE. Bone Description
bodies
marrow depression
IgG → The most abundant
BLOOD VESSELS
→ Involve in autoimmune
1. Veins – largest: SVC & IVC
disorder
2. Arteries – largest: aorta
→ The only antibody that
3. Capillaries
passes the placenta
IgA → Found in all bodily
BLOOD
secretions such as sweat,
• 8% of Total body weight
tears, saliva, colostrum
• Plasma – 55%
IgM → The largest antibody
• Blood elements / Formed Element – → Involve in short term
45% phagocytosis
PLASMA → Involve in acute
• Fluid portion inflammation
• Color – yellow IgE → Involve in allergic reactions
PLASMA CONSISTS OF: IgD → Long term phagocytosis
PLASMA CHONs (LIVER) → Chronic inflammation
→ TYPES
o ALBUMIN BLOOD CELLS
▪ Most abundant
RED BLOOD CELLS / ERYTHROCYTES
▪ It maintains osmotic
• Normal: 4-6/mm3
pressure or colloidal
• Contains hemoglobin
osmotic pressure
o Female: 12-14 gl/Dl (12-16)
o Male: 14-16 dl/Dl (14-18)
• Transports and carries 02
• Contains hematocrit
o The RBC percentage in whole
blood
o x3 hemoglobin
o Female: 36 – 42%
o Male: 42 – 48%
• Formation or maturation of RBC
o Iron
o Folic acid

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o Vitamin c o T-cell lymphocytes (cell-
o Vitamin B6 mediated immunity)
o Vitamin b12 ▪ Cytotoxic cells
o Intrinsic factor ▪ Memory cells
• RBC is destroyed by the liver and ▪ Suppressor cells –
spleen (red pulp) released whenever
there’s an antigen
Remember! (foreign body) →
Erythropoietin is the hormone for stimulating autoimmune in the
the bone marrow to produce RBC. body is producing
excessive suppressor
WHITE BLOOD CELLS / LEUKOCYTES T-cells that destroys
• Normal: 5,000 – 10,000 m/mm3 the normal cells or
• 2 types tissues of the body
o Granulocytes / Granular cells ▪ Helper cell – target
▪ Neutrophils site of HIV, prevents
• Segmenters major blood
(mature infections. NORMAL:
neutrophils) - 500 or more; if less
↑ed than 200 means (+)
• Bands AIDS
(immature ▪ Natural Killer Cells
neutrophils) (NK cells) – it has an
↓ed anti-viral and anti-
▪ Eosinophils tumor
▪ Basophils
Granulocytes Description OPPORTUNISTIC INFECTIONS
Neutrophils → Most abundant of → Pneumocystis carinii pneumonia
all the WBC → Kaposi’s sarcoma (skin cancer)
→ Average lifespan: 2- → Meningitis
4 hours
→ PTB
→ 60-70% of total WBC
→ Short term → Oral Thrush
phagocytosis → AIDS Dementia Complex
→ Involve in acute
inflammation PLATELETS
Eosinophils → Allergic reaction → Prevents bleeding by preventing
Basophils → Parasitic infection, homeostasis (prevention of blood loss)
ingest large fat → Normal Average life span: 9-12 days
particle
→ Megakaryocytes
o Target site of dengue virus
o Non-granular / Agranular cell
▪ Monocytes o Baby or immature platelets
▪ Lymphocytes
TYPES OF IMMUNITY
MONOCYTES Natural Artificial
• Largest WBC Active Expressed Received
• Macrophage of the blood → Longer and vaccines
• Involve in long-term phagocytosis to contracted
• Involve in chronic inflammation come, disease
longer
LYMPHOCYTES to go
Passive Received Received
• Integral part of the immune system → Easy maternal anti-serum
• Consists of: come, antibody with AB
o B-cells lymphocytes (humoral easy from performed
immunity) go from

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placenta or another
breastmilk host

HEMATOLOGICAL SYSTEM
HEMATOLOGICAL DISORDERS
9. Cold sensitivity
10. Brittleness of the hair
→ Most common type of anemia 11. Spoon shaped nails (Koilonychia)
→ Characterized by the deficiency of 12. Plummer Vinson syndrome
iron reading to a decreasing in ► Atrophic glossitis
hemoglobin ► Dysphagia
► Stomatitis
INCIDENCE RATE 13. Pica
1. Tropical Areas
2. Developing countries DIAGNOSTIC PROCEDURES
3. Common among women 1. Complete Blood Count (CBC) - ↓hgb,
4. Poor ↓hct, and ↓RBC
2. Serum iron and ferritin - ↓ed or low
PREDISPOSING FACTORS a. Normal Iron: 60-170 mg/dL
1. Chronic blood loss is due to: b. Ferritin
a. Trauma/accidents i. Male: 12-30 mg/dL
b. Heavy menstruation ii. Female: 12-15 mg/dL
c. Pregnancy 3. Bone Marrow Depression – most
d. G.I.T. bleeding definite test
i. Hematemesis –
vomiting of blood PRIORITY NURSING DIAGNOSIS
ii. Melena – passage 1. Fatigue
out of black tarry 2. Activity intolerance
stool 3. Knowledge deficit
1. Upper GIT
bleeding IMPLEMENTATION
2. Duodenal 1. Enforce complete bed rest with
ulcers bathroom privileges
iii. Hematochezia – 2. Monitor for signs of bleeding of all
passage of fresh hematology test including urine, stool,
blood for rectum etc.
1. Lower GIT 3. Foods rich in iron:
bleeding a. Organ liver meat
2. Amoebiasis b. Brown rice
2. Inadequate absorption of iron c. Egg yolk
3. Chronic diarrhea d. Beans
4. High cereal intake with low animal e. Raisins and molasses
CHON ingestion f. Dried fruits
5. Malabsorption syndrome g. Nuts
6. Alcoholism h. Dark green leafy vegetables
4. Administer medications as ordered:
SIGNS AND SYMPTOMS a. ORAL IRON SUPPLEMENTS
1. Unusually asymptomatic b. FERROUS SULFATE
2. Headache i. Melena
3. Dizziness 5. Adm. Parenteral iron preparation:
4. Dyspnea a. IRON DEXTRAN (IMFERON)
5. Tachycardia i. Given IM/IV
6. Palpitations b. SORBITEX
7. Pallor i. Given IM
8. Generalized body malaise c. FERROUS FUMARATE

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i. Melena 4. Autoimmune
d. FERROUS GLUCANATE 5. Strictly vegetarian diet
i. Green stool 6. Degenerative changes – elderly
PATHOPHYSIOLOGY
NURSING CARE WHEN GIVING ORAL IRON ► Stomach (wildest section of GIT) →
SUPPLEMENTS parietal cells / oxytocic / argentaffin →
1. Food decreases absorption of iron but it promotes B12 (responsible for
causes GIT irritation – best taken with maintaining integrity of myelin sheath)
food to lessen GIT irritation reabsorption CYANOCOBULAMIN → it
2. It is best administered with orange promotes maturation of RBC → it
juice or vitamin c to facilitate produces Hydrochloric acid → it aids in
absorption indigestion
3. When diluting it in liquid iron
preparation → administer with straw to SIGNS AND SYMPTOMS
prevent staining of the teeth 1. Anemia-like symptoms
4. Monitor and inform clients of the a. Headache
possible side effects b. Dizziness
a. Anorexia c. Dyspnea
b. Nausea and vomiting d. Tachycardia
c. Abdominal pain e. Palpitation
d. Constipation / diarrhea f. Body malaise
e. Melena (FeSO4) g. Pallor
f. Green stool (Fe Gluconate) h. Cold sensitivity
5. Administer using Z-track method 2. GIT Changes
(deep IM) to prevent discomfort a. Mouth sores
6. Encourage client to ambulate to b. Red beefy tongue / sore
facilitate absorption tongue
7. Monitor and inform client of the side c. Indigestion or dyspepsia
effects d. Wight loss
a. Pain at the injection section e. Jaundice
b. Localize abscess 3. CNS
c. Lymphadenopathy a. (+) tingling sensation
d. Pruritus b. Paresthesia
e. Fever and chills c. Numbness
f. If (+) hypotension, indicative d. Ataxia
of anaphylaxis → administer e. Psychoses
Epinephrine because of its
bronchodilator effect DIAGNOSTIC PROCEDURES
1. Schillings test – reveals inadequate
REMEMBER! absorption of B12 → urine sample is
If the client is non-compliant to oral iron collected → if (-) to Vit. B12 =
prep, administer parenteral iron preparation Pernicious Anemia
as ordered. a. Injection of non-radioactive

MEGALOBLASTIC ANEMIA B12

b. Oral ingestion of radioactive
B12
2. Peripheral blood smear: reveals giant
► Megaloblastic anemia resulting from a immature RBC with hyperpigmented
deficiency of intrinsic factor leading to nuclei
hypochlorhydria → decrease in Hcl 3. Intrinsic factor antibody test
secretion
PRIORITY NURSING DIAGNOSIS
PREDISPOSING FACTORS 1. Fatigue
1. Subtotal gastrectomy 2. Activity intolerance
2. Hereditary 3. Knowledge deficit
3. Inflammatory disorder of the ileum
(Crohn’s disease / regional enteritis)

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NURSING MANAGEMENT d. Retinal hemorrhage

1. Enforce CBR with bathroom privilege
2. Administer medications as ordered
a. FOLIC ACID DIAGNOSTIC PROCEDURES
i. 1 mg / day 1. CBC – Reveals pancytopenia
b. VITAMIN B12 2. BONE MARROW ASPIRATION –
i. IM injection confirmatory test; reveals hypoplastic
ii. Monthly intervals for or acellular marrow replaced by fats;
lifetime Site: posterior iliac crest (hip bone)
iii. Route: Dorsogluteal /
ventrogluteal NURSING DIAGNOSIS
iv. SE: Free of toxicity 1. Fatigue
3. Provide a dietary intake of HIGH 2. Activity intolerance
CALCIUM, CHON, CHO, IRON and 3. Knowledge deficit
VITAMIN C. 4. Infection
4. Avoid heat application 5. Bleeding tendencies
5. Instruct client to use soft bristled
toothbrush and avoid irritating NURSING MANAGEMENT
mouthwash 1. Removal of underlying cause
2. Institute blood transfusion as ordered
REMEMBER! (whole blood)
If the client with pernicious anemia is not 3. Impose CBR
given with Vit. B12 → the patient will die 4. Administer O2 inhalation
within 1-3 years. 5. Institute severe isolation
6. Monitor for signs of infections
7. Avoid any parenteral injection
8. Provide heparin lock
► Stem cell disorder characterized by 9. Administer medications as ordered:
bone marrow depression leading to a. IMMUNOSUPPRESANTS
pancytopenia i. Cyclosporine (sand
immune)
PREDISPOSING FACTORS ii. Anti-thymocyte
1. Environmental Factors globulin
a. Pesticides • MOA: it
b. Benzene and its derivatives suppresses
2. Exposure to radiation the activity of
3. Certain drugs immune cells
a. Broad spectrum antibiotics that are
i. Chloramphenicol damaging
ii. Sulfonamides the bone
b. Phenothiazines marrow
c. Chemotherapeutic agents thereby
i. Nitrogen mustard helping the
(anti-metabolic) bone marrow
ii. Methotrexate to repair and
generate
SIGNS AND SYMPTOMS new blood
1. Anemia like symptoms cells
2. Leukopenia: increase susceptibility to
develop infections b. BONE MARROW STIMULANTS
3. Thrombocytopenia i. Epogen (Epocrit) –
4. Signs of bleeding tendencies stimulates production
a. Petechiae – numerous: of RBC
purpura ii. Neurogen (Filgastrim)
b. Ecchymosis – stimulates
c. Oozing of blood from production of WBC
venipuncture sites

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i. Altered taste
sensitivity
ii. Avoid giving meat
→ Diarrhea
i. Adm. Anti-diarrheal
agents 30-45 mins
before start of chemo
4. Reproductive Organs
→ Infertility / sterility
i. Produce genetic
counselling before
start of
chemotherapy
ii. Encourage
male/female client to
do sperm or egg cell
REMEMBER!
banking
In anemia, avoid taking/drinking coffee
and tea – it contains TANNATES that impair
iron absorption.
1 unit of whole blood contains how many
mL of blood?
CHEMOTHERAPEUTIC DRUGS
450 mL + 50 mL (preservatives)
► Anti-neoplastic drugs
= 500 mL/ unit of FWB
► It kills or destroys cancer cell and
normal rapidly producing cells
1 unit of packed RBC contains how many
EPIDERMAL CELLS mL of blood?
1. Hair follicles – alopecia
→ Hair will grow back after 4-6 330 mL + 20 mL (preservatives)
months pot chemotherapy = 350 mL/ 1 packed of RBC
→ Encourage clients to use wigs
or turban
2. Bone marrow depression –
pancytopenia ► Increase in the volume of RBC
→ Anemia like symptoms
i. Alternate rest and PREDISPOSING FACTORS
activity CLASSIFICATION:
ii. Administer O2 1. Polycythemia Vera – a
→ Leukopenia myeloproliferative disorder where the
i. Reverse isolation etiology is unknown
(positive air pressure 2. Secondary polycythemia – develops
room) as a response to tissue hypoxia →
→ Thrombocytopenia, bleeding COPD
tendencies, petechiae,
ecchymosis LUNG DISORDERS
3. GIT Cells RESTRICTIVE LUNG DISORDERS
→ Stomatitis / mouth ulcer ► Limitations in lung expansion
i. Provide oral care ► Examples:
→ Nausea & vomiting o MSW
i. Adm. Anti-emetics 30- o GSW
45 mins before start of o Pleural Effusion
chemo o Pneumothorax – air
ii. Produce bland diet o Hemothorax – blood
iii. Avoid giving hot soup o Hydrothorax – fluid
→ Dysgeusia o Pyothorax – pus

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► Treatment: thoracentesis or chest tube Risk for thrombus formation due to ↑ed platelet
thoracotomy (CTT) aggregate
↓
Leading to embolus
SECONDARY POLYCYTHEMIA ↓
Embolus then travels to:
↓
► Blue bloaters BRAIN → cerebral arteries → stroke / CVA
► Inflammation of the bronchi Headache
dizziness
PREDISPOSING FACTORS numbness
1. Air pollutants tinnitus
2. Smoking – nicotine ↓
HEART → coronary arteries → myocardial
PATHOGNOMONIC SIGN: ischemia / angina pectoris → if prolonged,
Productive cough for 3 consecutive months leads to MYOCARDIAL NECROSIS /
for 2 successive years, also known as INFARCTION
smoker’s cough. ↓
LUNGS → pulmonary embolism
Dyspnea
PATHOPHYSIOLOGY
Chest pain
Basic pathogens:
Tachycardia
► Inflammation → swelling
Tachypnea
► Bronchospasm
Hemoptysis
► Increased mucous production
↓
↓
LOWER EXTREMITIES → peripheral tissue
Decreased 02 in the blood (hypoxemia)
ischemia → intermittent claudication (leg pain
↓
upon walking) → if prolonged, leads to
Decreased 02 in tissue (hypoxia)
GANGRENE FORMATION
↓
Clean with Packin’s Solution → 980 mL of PNSS
EARLY SIGNS LATE SIGNS
& 20 mL of K permanganate
Restlessness Bradycardia
↓
Agitation Extreme restless LIVER (hepatomegaly)
Tachycardia Dyspnea ↓
Cyanosis
SPLEEN (splenomegaly)
↓ ↓
The kidney will compensate, it will secrete a JOINTS (gouty arthritis)
hormone called ERYTHROPOETIN
↓
Decreased volume of RBC
↓ SIGNS AND SYMPTOMS
Secondary polycythemia 1. Skin is ruddy, dusky redness (plethora),
& pruritus due to histamine release
2. Hypertension, headache, dizziness,
tinnitus, and blurred vision
► Hyperplasia of the bone marrow 3. Hepatomegaly and splenomegaly
leading to 4. Angina, intermittent claudication,
o Erythrocytosis - ↑ed RBC dyspnea, and thrombophlebitis
o Leukocytosis - ↑ed RBC 5. CHF (orthopnea)
o Thrombocytosis - ↑ed platelets 6. Thrombus formation → MI, CVA,
gangrene
7. Gouty arthritis → ARTHRALGIA
PATHOPHYSIOLOGY
↑ed in blood viscosity (hemo-concentrated)
↓ DIAGNOSTIC PROCEDURES
Sluggish blood flow 1. CBC – reveals elevated RBC, WBC,
↓ platelets
2. Bone Marrow aspiration

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NURSING DIAGNOSIS
1. Impaired gas exchange TYPES OF LYMPHOMA
2. Altered tissue perfusion
3. Fatigue
4. Activity intolerance ► Easy to treat
5. Skin integrity ► Good prognosis
6. Comfort pain ► Common among young adult
► Proliferation of Sternberg cells in single
NURSING MANAGEMENT lymph nodes then travel to other
1. Treat the underlying cause if it is lymph nodes → affecting the B-Cells
secondary polycythemia ► REED STERNBERG CELLS – large,
2. Force fluids to promote good abnormal lymphocytes that releases
hydration and lessen hemo- cytokines which increases the
concentration production
3. Monitor for complications
a. Chest pain indicates coronary PREDISPOSING FACTORS
arterial / pulmonary occlusion 1. Idiopathic
4. Assist in weekly venesection 2. High risk groups – 20 to 25 years old
(phlebotomy) to reduce high blood 3. Hereditary
cell mass 4. Virus: Epstein Barr virus – cause of
a. Involves removing 500-2,000 kissing’s disease or mononucleosis →
mL of blood until hematocrit transmitted through saliva
returns to normal
5. Encourage ambulation to prevent PROGESSION (STAGES)
development of thrombus formation Stages Description
6. Administer meds as ordered: Stage 1 Single lymph node
a. ANALGESICS Stage 2 2 or more lymph nodes on the
b. MYELOSUPPRESIVE AGENTS same sides of diaphragm
i. Chlorambucil Stage 3 Both sides of diaphragm
c. ANTI-COAGULANTS Stage 4 Disease disseminates spread
i. Heparin / coumadin through other extra lymphatic
d. ANTI-GOUT organs like spleen
i. Allopurinol (Zyloprim) (splenomegaly) → poor
7. Instruct client to avoid intake of iron prognosis
8. Advice use of TSB or cool water to
lessen pruritus SIGNS AND SYMPTOMS
9. Assist in chemotherapy to suppress the EARLIEST SIGNS
bone marrow in producing more 1. Enlarged, painless, non-tender, firm,
blood cells movable lymph nodes
10. Instruct clients to avoid high altitude → 2. Bone pain, edema
decreased oxygen → stimulates 3. Cyanosis in the face and encl
kidney to produce erythropoietin 4. Night sweats

LYMPHOMA LATE SIGNS

1. Splenomegaly
► Cancer of the lymph nodes
2. Hepatomegaly
► Lymphadenopathy
3. Facial edema
4. Dyspnea
LYMPH NODES
5. Enlargement of lower extremities due
► It filtrates the blood and site of to blockage in the lymph nodes
phagocytosis therefore accumulates
► Location of lymph nodes (most
abundant) REMEMBER!
o Mandible It has increased curative rate of about 90-
o Axilla and breast 95% if detected and treated early.
o Groin or inguinal region
o GIT

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TREATMENT ↓
1. Chemotherapy Bone decalcification / demineralization
2. Radiation Therapy ↓
Pathologic fracture
CHEMOTHERAPEUTIC DRUGS ↓
1. Bleomycin Bone pain especially at the back
2. Adriamycin
3. Dacarbazine NADIR PERIOD
4. Vincristine The patient has less than 15,000 platelets
5. Prednisone
6. Adriamycin PREDISPOSING FACTORS
7. Cyclophosphamide onclovir 1. Idiopathic
2. Hereditary
3. Smoking

► Malignant SIGNS AND SYMPTOMS

► It affects both B & T-cells 1. Anemia
► Tumor geos throughout the lymph 2. Leukopenia
nodes and lymphatic organs in a very 3. Thrombocytopenia
unpredictable pattern 4. Hypercalcemia
► Prominent, painless, generalized 5. Multiple bone fractures
lymphadenopathy 6. Bone pain, especially at the back
► Most common among older adults 7. Hepatomegaly

TREATMENT DIAGNOSTIC PROCEDURES

1. Chemotherapy 1. (+) Bence Jones CHON is present in
2. Transfusion of packed RBC the urine: tumor marker released by
3. Administration of O2 inhalation tumor cells
2. BUN & Creatinine – elevated

NORMAL BUN
► Abnormal proliferation of the plasma 10-20 mg/dL
cells in the bone marrow
► Immature and malignant NORMAL CREATININE
► Invades other organs 0.6-1.2 mg/dL
o Bone marrow
o Spleen NORMAL SERUM CALCIUM
o Liver 8.5-10.5 mg/dL
o Kidney
TREATMENTS
PATHOPHYSIOLOGY 1. Chemotherapy
Multiple myeloma 2. Radiation Therapy
↓ 3. Dialysis
Increased proliferation of plasma cells → can
travel to liver, kidney, spleen, etc. →
overcrowding of plasma cells → suspension of
blood cells → PANCYTOPENIA ACUTE LEUKEMIA
► Rapidly progressive
MULTIPLE MYELOMA ► Fatal
↓
Release of Osteoclast Activating Factor (OAF) CHRONIC LEUKEMIA
↓ ► Gradual onset, less severe symptoms
Bone destruction ► Milder and have more normal cells /
↓ organomegaly
Hypercalcemia → kidney stones → KIDNEY
FAILURE (NEPHROPATHY)

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► Defect is hematopoietic stem cell that DIAGNOSTIC PROCEDURES
differentiates into monocytes, 1. CBC
granulocytes, and platelets. a. WBC is >200,000/mm3
► Types b. RBC and platelets are low
o Acute lymphocytic – young 2. Lumbar puncture – blasts in CSF
children 3. Bone X-ray – shows lesion
o Acute myelogenous – adult

NURSING MANAGEMENT
PREDISPOSING FACTORS 1. Monitor and prevent infection) major
► Idiopathic cause of death)
► G- genetic factors 2. reverse isolation, aseptic technique
► I -Immunologic factors (AIDS - Kaposi’s 3. avoid invasive procedures
sarcoma) 4. low bacteria diet
► V- viral factors a. raw foods / fresh fruits
► E- environmental factor b. vegetables – might be
► Physical factors: contaminated with pesticide
o Direct trauma 5. avoid live plants, fresh flowers →
o Explosion PSEDOMONAS INFECTIONS because of
o Air pollution stagnant waters
► Chemical factors: 6. Prevent bleeding and pain reliever
o Nicotine (smoking) 7. Avoid injections, rectal suppositories,
o Oral contraceptives blowing of nose, constrictive or tight
o Nitrates/Nitrites/Food clothing, avoid
additives 8. Use soft toothbrush or electric razon
▪ Free radicals 9. Manage anemia
PATHOPHYSIOLOGY a. Alternate activity and rest
LEUKEMIA → it can invade other organs such b. High caloric diet
as spleen, liver, joints 10. Provide info regarding treatment
↓ a. BONE MARROW TRANSPLANT
Prolonged proliferation of immature (blasts) – recommended treatment
WBC
↓ CHEMOTHERAPY SIDE EFFECTS
Overcrowding of immature WBC ► Induced infection
↓ ► Anemia
Suppression of other blood cells or formed ► Body image
elements ► Bleeding (hyperuricemia,
↓ hyperkalemia)
Anemia ► Sterility
↓
Neutropenia → decreased WBC → increased RADIATION THERAPY SIDE EFFECT
susceptibility to develop infection →
► Leukapheresis – filters WBC
PNEUMONIA
↓
BONE MARROW TRANSPLANT
Thrombocytopenia
During remission stage → undetectable
calcium cells → harvest to bone marrow and
SIGNS AND SYMPTOMS
then reinfuse it
1. Infection
1. AUTOLOGOUS BMT – person itself, the
2. Anemia
donor of the bone marrow is the pt.
3. Bleeding
himself. Patient is given higher dose of
4. Weakness and weight loss
chemo tx drugs; no graft rejection
5. Splenomegaly. Hepatomegaly,
2. SYNERGIC BMT – fraternal twin /
lymphadenopathy
identical twin; lesser graft rejection
6. Bone pain
3. ALLOGENIC BMT – another person,
7. Gout
general anesthesia, placed on prone
8. Renal stones
position (posterior iliac crest), a quart

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of bone marrow is extracted then CRYOPRECIPITATES
infuse immediately to medullary • 1 unit is 10-20 mL
cavity. • Clotting factor VIII and XIII and
Fibrinogen
BLOOD TRANSFUSION • To be transfused within 6hrs.

OBJECTIVES PRINCIPLES OF BLOOD TRANSFUSION

► To replace the circulating blood 1. Proper refrigeration
volume • Expiration of packed RBC is 3-
► To increase the oxygen carrying 6 days
capacity of the blood (decrease in • Expiration of platelet is 3-5
RBC) days
► To combat infections (decrease in 2. Proper typing and cross matching
WBC) • Type O - universal donor
► To prevent bleeding (decrease in • Type AB - universal recipient
platelets) • 85% of population is RH
positive
INDICATIONS 3. Aseptically assemble all materials
1. After surgery, trauma or needed for BT
hemorrhage/shock a. Filter set
2. Severe anemia b. Gauge 18-19 needle
3. Leukopenia c. Isotonic solution (0.9
4. Agranulocytosis (bone marrow does NaCl/plain NSS) to prevent
not produce enough or mature WBC) hemolysis
4. Instruct another RN to re check the
COMPONENTS following
1. Client name
WHOLE BLOOD 450 mL + 50 mL 2. Blood typing and cross
(preservatives) = 500 matching
mL/ unit of FWB 3. Expiration date
PACKED RBC 330 mL + 20 mL 4. Serial number
(preservatives) = 350
mL/ 1 packed of RBC ► Check the blood unit for bubbles
cloudiness, sediments and darkness in
WHOLE BLOOD color because it indicates bacterial
• No clotting factors contamination
• Unseparated blood containing a. Never warm blood as it may
anticoagulant – preservative destroy vital factors in blood.
solution b. Warming is only done during
• One unit contains emergency situation and if
o 450mL you have the warming device
o 50mL anticoagulant c. Emergency rapid BT is given
o HGB approximately 12g/dL after 30 minutes and let
o HCT 35-45% natural room temperature
PACKED RBC warm the blood.
• One unit is approximately 30mL and
► BT should be completed less than 4
has a hematocrit of 50-70%
hours because blood that is exposed
• One unit raises the HCT up to 2-3%
at room temperature more than 2
hours causes blood deterioration that
FRESH FROZEN PLASMA
can lead to BACTERIAL
• 200-300mL CONTAMINATION
• Rich clotting factor ► Avoid mixing or administering drugs at
• No RBC BT line to prevent HEMOLYSIS
• Raises levels of clotting factor 2-3% ► Regulate BT 10-15 gtts/min or KVO rate
or equivalent to 100 cc/hr to prevent
circulatory overload.

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► Monitor strictly vital signs before, 6. Obtain urine and blood sample and
during and after BT especially every 15 send to laboratory for reexamination
minutes for first hour because majority and output
of transfusion reaction occurs during
this period.

SIGNS AND SYMPTOMS

BT REACTIONS 1. Fever and chills
2. Headache
3. Tachycardia
SIGNS AND SYMPTOMS 4. Palpitations
1. Headache and dizziness 5. Diaphoresis
2. Dyspnea 6. Dyspnea
3. Diarrhea/Constipation
4. Hypotension NURSING MANAGEMENT
5. Flushed skin 1. Stop BT
6. Lumbar/sternal/ Flank pain. 2. Notify physician
7. Urine is color red/ port wine urine 3. Flush with plain NSS
4. Administer medications as ordered
NURSING MANAGEMENT a. Antipyretic
1. Stop BT b. Antibiotic
2. Notify physician 5. Send the blood unit to blood bank for
3. Flush with plain NSS re examination
4. Administer isotonic fluid solution to 7. Monitor vital signs and intake
prevent shock and acute tubular 8. Obtain urine and blood sample and
necrosis send to laboratory for reexamination
5. Send the blood unit to blood bank for 9. Monitor vital signs and intake and
re examination output
6. Obtain urine and blood sample and 10. Render TSB
send to laboratory for reexamination
7. Monitor vital signs and intake and
output
SIGNS AND SYMPTOMS
1. Orthopnea
2. Dyspnea
SIGNS AND SYMPTOMS 3. Rales/Crackles upon auscultation
1. Fever 4. Exertional discomfort
2. Dyspnea
3. Bronchial wheezing NURSING MANAGEMENT
4. Skin rashes 1. Stop BT
5. Urticaria 2. Notify physician
6. Laryngospasm and Bronchospasm 3. Administer medications as ordered
a. LOOP DIURETIC (LASIX)
NURSING MANAGEMENT
1. 1Stop BT
2. Notify physician
3. Flush with plain NSS
4. Administer medications as ordered
a. ANTI HISTAMINE (BENADRYL)
i. if positive to
hypotension,
anaphylactic shock,
treat with
EPINEPHRINE
5. Send the blood unit to blood bank for
reexamination

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