Lippincott Certification Review Medical-Surgical Nursing

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Disseminated Intravascular Coagulation

Box 8-1: Types of Anemia

This chart summarizes the etiology, signs and symptoms, medical management, and nursing interventions for each type of anemia, which is defined as a decreased number of red blood cells (RBCs). Description and Etiology Signs and Symptoms Medical Management Nursing Interventions

Anemia from blood loss Anemia resulting from the loss of more than 500 mL of blood • Acute blood loss, as in trauma or surgery • Chronic blood loss, as in menstrual or GI bleeding

• RBC count below normal on serum blood tests • Acute blood loss: sudden onset of symptoms, such as hypovolemia, hypotension, hypoxemia, irritability, stupor, weakness, tachycardia, and cool, moist skin • Chronic blood loss: gradual and vague symptoms, such as exertional dyspnea, increased fatigue, and pallor • Exertional dyspnea, fatigue, infections, pallor, and palpitations • Hemorrhage—bleeding (nasal, oral, rectal, or vaginal), ecchymosis, petechiae, or purpura • Low platelet, RBC, and WBC counts • Dry bone marrow—low number of stem cells found upon aspiration

• The source of the bleeding is identified and controlled through medical or surgical means. • Transfusion and iron supplementation may be needed. Packed RBCs are typically used if a blood transfusion is required. • Shock must be treated if it occurs. • Initial treatment involves removing the causative agent, if possible, and administering blood component transfusions. • Medications such as antithymocyte globulin (ATG), cyclosporine, granulocyte colony– stimulating factors, and granulocyte–monocyte colony–stimulating factor may be administered. • The idiopathic form of the disease is treated with steroids. • If the anemia cannot be reversed or if it results from an autoimmune disturbance, stem cell transplantation is recommended; this treatment is more effective if the patient does not receive blood products first and is younger than age 30.

• Monitor patient’s stool, urine, vomitus, or sputum for blood. • Control blood loss by applying pressure to obvious bleeding sites. • Preform dressing changes as needed to assess blood loss. • Utilize assessment skills to identify signs and symptom of internal bleeding. • Help identify the causative agent. • Assist a weak patient with daily activities. • If the patient has pancytopenia, take safety precautions and steps to control infection and bleeding because their ability to fight infection and sustain clotting is decreased. • Help the patient and family cope with the severity of the illness and its prognosis. (Death may result from infection or hemorrhage.) • If the patient is receiving ATG, perform skin testing, and monitor for allergic reaction.

Aplastic anemia Anemia that is caused by damage or suppression of the bone marrow leading to decreased blood cell production for all blood cell lines • Drug therapy with a chemotherapeutic drug, chloramphenicol, mephenytoin, phenylbutazone, or a sulfonamide • Exposure to environmental or occupational hazards, such as benzene, insecticides, or radiation • Infection, such as cytomegalovirus, Epstein– Barr virus, hepatitis, parvovirus B19, human immunodeficiency virus, or

miliary tuberculosis • Congenital causes

• Unknown etiology or an autoimmune disturbance (50% of cases)

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