Aplastic Anemia Case Study FINAL

18 ADAMSON UNVERSITY College of Nursing Patient A wa re$erred to a !ematolo%it w!o ordered a (one marrow e+amination) T!e a"irate o(tained wa inade?ate $or e&alation de to la#' o$ marrow) Only a in%le ite #old (e a"irated) Pre" made $rom t!e a"irate !owed a mar'edly !y"o#elllar marrow wit! &ery $ew !emato"oieti# #ell) 0ell "reent #onited #onited o$ lym"!o#yte, "lama #ell, #ell, and tromal #ell) T!ere were no mali%nant #ell "reent)

18 ADAMSON UNVERSITY College of Nursing Patient A wa re$erred to a !ematolo%it w!o ordered a (one marrow e+amination) T!e a"irate o(tained wa inade?ate $or e&alation de to la#' o$ marrow) Only a in%le ite #old (e a"irated) Pre" made $rom t!e a"irate !owed a mar'edly !y"o#elllar marrow wit! &ery $ew !emato"oieti# #ell) 0ell "reent #onited #onited o$ lym"!o#yte, "lama #ell, #ell, and tromal #ell) T!ere were no mali%nant #ell "reent)

18 ADAMSON UNVERSITY College of Nursing

OB&ECTIVES General O'(e#ti)e$ 

To (e a(le to a""ly w!at we !a&e learned t!eoreti#ally at t!e #ommnity and #lini#al ettin% and a$ter t!at tdy, we #an (e a(le to ndertand t!i dieae dee" er to%et!er wit! t!e !el" o$ or 0lini#al Intr#tor and #ommnity !ealt! "ro&ider and a(le to "ro&ide o"timm or tandard ?ality #are to t!e "atient t!ro%! ma'in% o$ t!e nrin% inter&ention and !ealt! ed#ation re%imen)

Se#ifi# O'(e#ti)e$ St%*ent+N%r$e Centere*: 

To %ain 'nowled%e a(ot t!e dieae "ro#e, "redi"oin% $a#tor, #lini#al man i$etation



and t!e dieae mana%ement To %ain 'ill and a""ro"riate attitde needed to $n#tion a a tdent-nre in t!e



#ommnity Identi$y "ro(lem@ De&elo" a tea#!in% "lan and trate%ie a""ro"riate $or t!e %oal

 

attainment To (e a(le to e t!e nrin% "ro#e a $ramewor' $or #are o$ t!e "atient To de&elo" and eta(li! inter"eronal relation!i" w!ile t!e #ae i on%oin%

Client Centere*:    

To mana%e !i dieae To 'now t!e im"ortan#e o$ !i #om"lian#e to !i dieae To "re&ent and mana%e t!e "otential #om"li#ation t!at mi%!t o##r Per$ormed em"!ai>ed !ealt! tea#!in% and $ollowin% dietary intr#tion and retri#tion a well a "er$ormin% a""ro"riate e+er#ie

INTRODUCTION


T!i i a #ae o$ a 14-year-old male "atient w!o wa dia%noed wit! A"lati# Anemia) A"lati# Anemia i a rare dieae #aed (y a de#reae in or dama%e to marrow tem #ell, dama%e to t!e mi#roen&ironment wit!in t!e marrow, and re"la#ement wit!in t!e marrow wit! $at) T!e "re#ie etiolo%y i n'nown, (t it i !y"ot!ei>ed t!at t!e (ody= T-#ell mediate ina""ro"riate atta#' a%aint t!e (one marrow, reltin% in (one marrow A"laia) T!ere$ore, in addition to e&ere anemia, i%ni$i#ant netro"enia and t!rom(o#yto"enia are alo een) T!e $ollowin% are t!e mot #ommon ym"tom o$ A"lati# anemia) *owe&er, ea#! #!ild may e+"erien#e ym"tom  ym"tom di$$erently Sym"tom may in#lde@ • • • • • • • • • • • • • •

*eada#!e Di>>ine Naea
In A"la "lati ti## Anemi nemia, a, t!e t!e "ati "atien entt !a !a "an# "an#yt yto" o"en enia ia Bi)e Bi)e)) anem anemia ia,, net netro ro"e "eni niaa and and t!rom(o#yto"eniaC reltin% in de#reae o$ all $ormed element) T!e dia%noi #an only (e #on$irmed on (one marrow e+amination) e$ore t!i "ro#edre i nderta'en, a "atient will %enerally !a&e !ad ot!er (lood e+am to $ind dia%noti# #le, +-ray, 0T-#an or ltraond ima%in% tet, and li&er tet) A"lati# anemia i a erio illne and treatment ally de"end on t!e nderlyin% #ae)
18 ADAMSON UNVERSITY College of Nursing S""orti&e t!era"y may in#lde@ • • • •

lood tran$ion B(ot! red (lood #ell and "lateletC Anti(ioti# t!era"y Medi#ation Immno""rei&e t!era"y

It i "remed "remed t!at t!e lym"!o#yte o$ "atient wit! A"lati# A"lati# anemia detroy t!e tem #ell and #one?ently im"air t!e "rod#tion o$ eryt!ro#yte, le'o#yte and "latelet) De"ite it e&erity, A"lati# Anemia #an (e treated in mot "eo"le) T!oe w!o are yon%er t!an 3 year, w!o are ot!erwie !ealt!y, and w!o !a&e a #om"ati(le donor #an (e #red o$ t!e dieae (y a (one marrow tran"lantBMTC or Peri"!eral lood Stem 0ell Tran"lantBPS0TC) Tran"lantBPS0TC) Internationally, t!e annal in#iden#e in Ero"e a detailed in lar%e, $ormal e"idemiolo%i# tdie i imilar wit! t!at in t!e United State, wit! two #ae "er million "o"lation) A"lati# anemia i t!o%!t to (e more #ommon in Aia t!an in t!e wet) T!e in#iden#e wa a##rately determined to (e $or #ae "er million in an%'o' (t it may (e #loer to i+ #ae "er million "o"lation in t!e rral area in T!ailand, t!en and a !i%! a 14 #ae " er million "o"lation in a"an (aed on "ro"e#ti&e tdie) T!e maor #ae o$ mor(idity and mortality $rom A"lati# anemia in#lde in$e#tion and (leedin%) No ra#ial "redi"oition re"orted in t!e US, !owe&er, t!e "re&alen#e i in#reaed in t!e
A#?ired Idio"at!i# B61:C

18 ADAMSON UNVERSITY College of Nursing E+"ore to #!emi#al and dr% B9:C Atoimmne B1:C Pre%nan#y B1:C *e"atiti B1:C

Etiology o Aplastic Anemia

Exposure to chemicals and drugs; 5%Autoimmune; 1%

0% ; 1% Pregnancy ; 1%HepatitisFanconi;

Idiopathic; 91%

0ontittional B
tili>in% t!e en&ironment o$ t!e "atient to ait !im in !i re#o&ery)H It in&ol&e t!e nre= initiati&e to #on$i%re en&ironmental ettin% a""ro"riate $or t!e %radal retoration o$ t!e "atient= !ealt!, and t!at e+ternal $a#tor ao#iated wit! t!e "atient= rrondin% a$$e#t li$e or (iolo%i# and "!yiolo%i# "ro#ee, and !i de&elo"ment)


I

#!oe

t!i

t!eory

(e#ae

T!e

En&ironmental

T!eory o$ Nrin% i a "atient-#are t!eory w!i#! i a "rimary %oal o$ "atient !a&in% APASTI0 ANEMIA) It $o#e in t!e alteration o$ t!e "atient= en&ironment in order to a$$e#t #!an%e in !i or !er !ealt!) 0arin% $or t!e "atient i o$ more im"ortan#e rat!er t!an t!e nrin% "ro#e, t!e relation!i" (etween "atient and nre, or t!e indi&idal nre) In t!i way, t!e model mt (e ada"ted to $it t!e need o$ indi&idal "atient) T!e en&ironmental $a#tor a$$e#t di$$erent "atient ni?e to t!eir itation and illnee, and t!e nre mt addre t!ee $a#tor on a #ae-(y-#ae (ai in order to ma'e re t!e $a#tor are altered in a way t!at (et #are $or an indi&idal "atient and !i or !er need)

PATIENT0S DATA Name: Patient A A**re$$:
18 ADAMSON UNVERSITY College of Nursing Gen*er: Male Ci)il Stat%$: Sin%le Date "f Birt!: May ., 2332 Pla#e "f Birt!: Parana?e 0ity E*%#ati"nal Attainment: Elementary Fradate Reli,i"n: Roman 0at!oli# Nati"nality:
NURSING HISTOR1 C!ief C"mlaint

Pro%rei&e wea'ne and !ortne o$ (reat! wit! minimal "!yi#al e$$ort)

18 ADAMSON UNVERSITY College of Nursing Pre$ent Hi$t"ry

at ly 13 231, !e !ad an e"iode o$ noe(leed "on %oin% !ome $rom #!ool) T!ey immediately went to Uni-*ealt! Medi#al 0enter $or #!e#'-") T!e "atient A nder%one a #om"lete (lood #ont) T!e do#tor w!om t!ey #onlted made a re$erral to Parana?e Do#tor in#e !e noti#ed t!at t!e "atient= (lood "ro$ile !a de#reaed $rom it normal &ale, (t (e#ae o$ many !oe!old #!ore and in#e t!ey are (y in t!eir wor' and alo de to la#' o$ $inan#e, t!ey de#ided not to %o to Parana?e Do#tor) at No&em(er 23, 231 "atient A wa admitted to t!e Parana?e Do#tor wit! #om"laint o$ "ro%rei&e wea'ne and !ortne o$ (reat! wit! minimal "!yi#al e$$ort) Many "ete#!ial !emorr!a%e #o&er !er #!et and le%) Se&eral (rie are $ond on !er le% and t!i%!) a(oratory tet were ordered on ad miion) T!e relt o$ !i (lood e+am i till low o !i mot!er de#ided to !a&e !im admitted at t!e Emer%en#y room $or o(er&ation) On No&em(er 21, 231, t!e "atient A wa admitted at "edia ward) A##ordin% to t!e "atient !e ometime $eel eay $ati%a(ility and e+"erien#ed di$$i#lty o$ (reat!in% t!en t!e do#tor ordered o+y%en t!era"y) *e wa %i&en t!e $irt "a#' o$ PR0) Patient A wa re$erred to a !ematolo%it w!o ordered a (one marrow e+amination)

Pa$t Hi$t"ry

yme le&el retrnin% to normal wit!in two mont!) *e !a no ot!er "at medi#al !itory) T!ere i no $amily !itory o$ !ematolo%i# diorder)

Per$"nal an* S"#ial Hi$t"ry

A##ordin% to "atient A, !e wa tron% and doen=t !a&e any #o m"lain o$ di$$i#ltie and "ain or any "ro(lem "!yi#ally or emotionally) In $a#t, !e i a mem(er o$ t!e tra#' and $ield in#e !e wa in %rade 9 and re#ei&ed di$$erent award) *e !ad a %ood relation!i" wit! !i "arent and i(lin%) *e i &ery a#ti&e in #!ool and #ommnity (y en%a%in% in di$$erent a#ti&itie)

18

lood Prere Ple Rate Re"iratory Rate Tem"eratre

ADAMSON UNVERSITY College of Nursing Vital Si,n$ 1135.3mm*% 113("m 26#"m .L0

De)el"mental Hi$t"ry

it! re%ard, to !i "y#!oo#ial de&elo"ment !e i nder identity &) Role #on $ion and in "y#!oe+al t!eory !e i nder t!e laten#y ta%e) In #o%niti&e de&elo"ment t!eory, !e i in $ormal ta%e, in w!i#! t!e #!ild learn to t!in' and reaon in a(tra#t term) A##ordin% to !i mot!er, t!e "atient doen=t want to (e ditr(ed w!en !e i doin% omet!in%) *e want to wor' wit! !i own) *e alway "ea' ot !i need w!ene&er !e a' $or omet!in%)

-ee*in, Hi$t"ry

Patient A !a a %ood a""etite in eatin%) *e i not #!ooy re%ardin% $ood and doen=t !a&e any $ood aller%ie) *e eat - time a day in#ldin% merienda and drin' .-6 %lae o$ water) *e i not ta'in% any $ood ""lement) *e i $ond o$ ea tin% treet $ood #! a
Imm%ni2ati"n Hi$t"ry

A##ordin% to !i Mot!er, "atient A re#ei&ed #om"lete immni>ation)

P!y$i#al E3aminati"n Hi$t"ry

Feneral Sr&ey@ ody (ilt i "ro"ortionate to it wei%!t and !ei%!t) Potre@ Rela+ed, ere#t "otre, #oordinated mo&ement O&erall !y%iene@ 0lean and neat ation@ Undertanda(le and e+!i(it t!ro%! ao#iation

ASSESSED

TECHNI4UE

NORMAL

ACTUAL

ANA1SIS

18 ADAMSON UNVERSITY College of Nursing AREA

0olor

USED

In"e#tion

-INDINGS S5IN i%!t to dee"

-INDINGS •

(rown •

rown 'in

Internal (leedin%

#olor "ete#!ial !emorr!a%e #o&er !er #!et and

•

le% e&eral (rie are $ond on !er le% and

Te+tre S'in tr%or

Pal"ation Pal"ation

Smoot! S'in "rin%

t!i%!) Smoot! S'in "rin%

Normal Normal

(a#'

(a#'

immediately

immediately

w!en "in#!ed Uni$orm wit!

w!en "in#!ed Uni$orm wit!

normal ran%e

!i%! ran%e o$

Pal"ation

No edema

tem"eratre No edema

In"e#tion in"e#tion

HAIR rown to (la#' E&enly

la#' E&enly

*air t!inne

In"e#tion

ditri(ted t!in or t!i#'

ditri(ted T!i#' !air

Normal

and t!i#'ne Te+tre

Pal"ation

Smoot! and

Smoot! and

Normal

il'y No li#e NAIL Pin'i!

il'y No li#e

normal

Pale

Poor (lood

Tem"eratre

Preen#e o$

Pal"ation

Normal

edema 0olor Ditri(tion

Preen#e o$ li#e

In"e#tion

0olor

In"e#tion

Normal Normal

#ir#lation

18 ADAMSON UNVERSITY College of Nursing S!a"e and

In"e#tion and

Smoot!, #on&e+

te+tre 0a"illary Re$ill

"al"ation Per$ormed

in #r&atre in #r&atre Prom"t retrn o$ Retrn wit!in 4

(lan#!ed tet

"in' or al

e#ond

In"e#tion

#olor B1-2 e#C HEAD Ronded

Ronded

Bnormo#e"!ali#C

Bnormo#e"!ali#C

ymmetri#, wit!

ymmetri#, wit!

$rontal, "arietal

$rontal, "arietal

and o##i"ital

and o##i"ital

Si>e, !a"e and ymmetry

Preen#e o$

In"e#tion

ma or nodle

Smoot!, #on&e+

Normal Poor #ir#lation

Normal

"rominen#e "rominen#e Smoot!, ni$orm Smoot!, ni$orm Normal in #oniten#y,

in #oniten#y,

a(en#e o$

a(en#e o$

nodle and

nodle and

ma) Symmetri# or

ma) Symmetri# $a#ial Normal

Bymmetry o$

li%!tly

$eatre

tr#treC

aymmetri#

In"e#tion

$a#ial $eatre *ead mo&ement

0an li$t !ead

0an li$t !ead

li%!tly and trn

li%!tly and trn

t!em $rom ide

t!em $rom ide

to ide E1ES *air e&enly

to ide

ditri(tion and

ditri(ted, 'in

ditri(ted, 'in

ali%nment

inta#t, eye(row

inta#t, eye(row

ymmetri#ally

ymmetri#ally

ali%ned E?ally

ali%ned E?ally

ditri(ted,

ditri(ted,

Eye(row@ !air

Eyela!e@ e&enne o$

In"e#tion

In"e#tion

in"e#tion

*air e&enly

Normal

Normal

Normal

18 ADAMSON UNVERSITY College of Nursing ditri(tion and

#rled li%!tly

#rled li%!tly

dire#tion o$ #rl

otward)

otward)

S'in inta#t, no

S'in inta#t, no

#!ara#teriti#

di#!ar%e, no

di#!ar%e, no

0onn#ti&a and

di#oloration l(ar

di#oloration l(ar

Poor (lood

#onn#ti&a i


#ir#lation

#lear wit! tiny

#lear wit! tiny

#a"illarie

#a"illarie

&ii(le,

&ii(le,

"al"e(ral

"al"e(ral



"in', no

"in', no

di#!ar%e, #lera

di#!ar%e, #lera i w!ite No edema, no

Eyelid@ r$a#e

In"e#tion

In"e#tion

#lera

a#rimal %land,

In"e#tion and

i w!ite No edema, no

naola#rimal

"al"ation

tenderne and

tenderne and

In"e#tion

no tearin% Rond, (la#',

no tearin% Rond, (la#',

e?al in i>e

e?al in i>e

Illminated

Illminated

li%!t

""il #ontri#t

""il #ontri#t

Symmetry,

NOSE Symmetri#al,

Symmetri#al,

!a"e and #olor

trai%!t and

trai%!t and

O##rren#e o$

ni$orm in #olor Pin' m#oa, no

ni$orm in #olor Pin' m#oa, no

redne,

di#!ar%e and

di#!ar%e and

wellin% and

wellin% $ree o$

wellin% $ree o$

di#!ar%e
leion No tenderne

leion No tenderne

d#t P"il@ #olor, !a"e and e?ality Re"one to

In"e#tion

In"e#tion

In"e#tion

Pal"ation

Normal

Normal

Normal

Normal

Normal

Normal

18 ADAMSON UNVERSITY College of Nursing i"@

In"e#tion

MOUTH Symmetry o$

Symmetry,

in"e#tion

#ontor ni$orm

#ontor,

ymmetry) Pale

0olor,

"al"ation

"in' #olor,

"ale

de Poor (lood

In"e#tion

No tenderne Pin',

no tenderne Pale,

#ir#lation Pale de to Poor

moit

moit

(lood

tenderne Fm@ 0olor

ymmetri#al

Normal in

moitre

#ir#lation) Normal moitre EARS 0olor i ame a

0olor i ame a

0olor, ymmetry

t!e #olor o$ t!e

t!e #olor o$ t!e

o$ i>e and

$a#e

$a#e

"oition

ymmetri#al

ymmetri#al

ari#le ali%n in

ari#le ali%n in

t!e oter #ant!

t!e oter #ant!

o$ t!e eye Mo(ile, $irm, no

o$ t!e eye Mo(ile, $irm, no

elati#ity and

tenderne,

tenderne,

area o$

"inna re#oil

"inna re#oil

tenderne Aditory

a$ter it i $olded A(le to trn

a$ter it i $olded A(le to trn

!ead and eye

!ead and eye

toward t!e

toward t!e

ond Normal &oi#e

ond Normal &oi#e

tone adi(le

tone adi(le

In"e#tion

A(le to re"eat

A(le to re"eat w!i"ered word

In"e#tion

w!i"ered word NEC5 Symmetri#al and

Preen#e o$

mo&e $reely no tenderne

mo&e $reely No tenderne

Ari#le@

Te+tre,

In"e#tion

Pal"ation

In"e#tion

$n#tion

Re"one to

In"e#tion

normal &oi#e tone Re"one to w!i"ered &oi#e A""earan#e and mo&ement Preen#e o$

Normal

Normal

Normal

Normal

Normal

Symmetri#al and Normal Normal

18 ADAMSON UNVERSITY College of Nursing tenderne,

tenderne,

leion

leion

0olor

In"e#tion

and no leion THORA6 i%!t to dee"

(rown

and no leion

• •

rown "ete#!ial

• •

Normal Internal

!emorr!a%e

leedin% Normal Dy"nea

0!et !a"e Re"iratory

In"e#tion In"e#tion

Ronded 1-23 #"m

#o&er !er #!et Ronded 26 #"m

"attern Poition o$

In"e#tion

midline

midline

Normal

ternm reat! ond

A#ltation

Vei#lar,

Vei#lar,

Normal

ron#!o-

ron#!o-

&ei#lar and

&ei#lar and

(ron#!ial HEART 3-133 ("m

(ron#!ial

0ardia# rate

A#ltation

113 ("m

0om"enatory me#!anim o$ t!e !eart de to in#reae need $or o+y%en

S'in #olor 0ontor owel ond

Si>e Stren%t! and

In"e#tion In"e#tion A#ltation

ABDOMEN i%!t to dee"

i%!t to dee"

Normal

(rown Ronded *i%! "it#!ed

(rown Ronded *y"oa#ti&e

Normal De#reae

irre%lar %r%le,

irre%lar %r%le

"eritali

!y"era#ti&e UPPER 7 LOWER E6TREMITIES In"e#tion E?al in i>e E?al in i>e In"e#tion 0an $le+ and 0an $le+ and

tone

e+tend arm and

e+tend arm and

Mo(ility Tem"eratre

le% Mo(ile Same wit! (ody

le% Mo(ile Uni$orm wit!

tem" wit!in

!i%! ran%e o$

In"e#tion Pal"ation

Normal Normal

Normal
18 ADAMSON UNVERSITY College of Nursing A""earan#e

In"e#tion

normal ran%e i%!t to dee" • •

tem"eratre "ete#!ial •

(rown No leion

!emorr!a%e

leedin%

"reent !er

and di#oloration

Internal

•

le% e&eral (rie are $ond on !er le% and t!i%!)

GENITALIA No leion,

No leion,

%lan "eni $or

nodle,

nodle,

leion, nodle,

wellin% or

wellin% or

wellin% and

in$lammation

in$lammation

No wellin%,

No wellin%,

$or wellin%,

in$lammation,

in$lammation,

in$lammation,

and di#!ar%e

and di#!ar%e

No tenderne,

No tenderne,

nodle,

t!i#'enin%,

t!i#'enin%,

t!i#'enin%

nodle are not

nodle are not

"al"a(le

"al"a(le

Penile !a$t,

in$lammation Uret!ral meat

and di#!ar%e Tenderne,

In"e#tion

In"e#tion

Pal"ation

COURSE IN THE WARD

Normal

Normal

Normal

18 ADAMSON UNVERSITY College of Nursing DOCTOR0S ORDER

RATIONALE

NURSING RESPONSIBILIT1

18 ADAMSON UNVERSITY College of Nursing 11-21-1



@9 PM

Pleae admit to



Admittin% a "t) in



et t!e "atient

Pedia ward nder

t!e ward i eential

i%n t!e in$ormed

t!e er&i#e o$ Dr)

$or #ontino

#onent) Ma'e a

0orte

monitorin%

#!art)

treatment5 mana%ement  e&alation) 

Se#re #onent $or admiion 





mana%ement

et t!e S)O) o$ t!e "atient i%n t!e in$ormed



Monitor Vital Si%n

#onent)

? !i$t  re#ord 



To !a&e a (aeline



data  monitor $or

t!e &ital i%n

ntoward 5+ t!at

#loely) Re#ord 

#an (e an indi#ation

"lot "ro"erly t!en

o$ "oi(le

re"ort any

#om"li#ation

a(normal $indin%

DAT

to t!e "!yi#ian  

To meet meta(oli#

Intr#t t!e "atient to eat well

demand 

To o(tain5monitor

(alan#ed diet

Dia%noti# E+am aC 00 

O(tain a (lood am"le $rom t!e



To determine t!e le&el o$ di$$erent (lood #om"onent a well a t!e de&iation $rom

"atient and end to t!e la(

18 ADAMSON UNVERSITY College of Nursing normal &ale (C MA  

o(tain in$ormed

To #!e#' i$ t!ere i$

#onent "re"are

t!ere i an

et  ait t!e

a(normality in t!e

"!yi#ian drin%

marrow t!at #an (e

t!e "ro#edre Pot MA- a""ly

an indi#ator o$ a



"rere to t!e

#ertain (lood

"n#tred ite

"ro(lem

note $or i%n o$ in$e#tion) #C lood Ty"in%  

O(tain (lood am"le t!en end

To determine (lood

to t!e la(

ty"e $or #om"ati(ility "rior to T 

Treatment aC *oo' PNSS 1 + JVO

 

Inert IV line  eta(li! #orre#t

Rote $or dr%

$low rate #!e#'

adminitration  to

IV $or "aten#y 

addre $lid 

i%n o$ in$e#tion

ntritional need (C Se#re 2 nit o$ PR0 "ro"erly ty"ed  #ro mat#!ed t!en tran$erred ea#! nit $or 2 !or,



To re"la#e $or t!e la#'in% "e#i$i# (lood #om"onent



Se#re #onent $or T "re"are et) Send re?et to t!e (lood (an')

18 ADAMSON UNVERSITY College of Nursing  !or a"art on#e a&aila(le  

PNSS i t!e only

IV< to JVO w!ile

iotoni# oltion

on T BPNSSC

#om"ati(le $or T)



Maintain "atent IV line and re%late "ro"erly note $or i%n o$

 

$or immediate

at#! ot $or T

inter&ention or

rea#tion

mana%ement

in$e#tion



monitor &5 #loely, i$ rea#tion o##r to" t!e tran$ion t!en o"en t!e mainline re"ort immediately to t!e "!yi#ian



<roemide



23m%5IV mid T

To "re&ent $lid o&erload5 #on%etion 

wit! P "re#ation

O(tain P "rior to adminitration, i$ le t!an 6353 do not adminiter

 

to eta(li! (aeline

monitor &5 ? 4

data and monitor

!or and re#ord

nde 5+ t!at may indi#ate ntoward 5+



monitor &5 tri#tly and re#ord

18 ADAMSON UNVERSITY College of Nursing  

"ro&ide im"ortant

monitor I  O ?

data on "t)= $lid

!i$t and re#ord

ele#trolyte (alan#e



o(tain t!e I  O o$ t!e "atient a##rately t!en

 

O2 in!alation  1-2

to meet O2 demand o$ t!e "t)

re#ord 

5min "er naal

"ro"erly re%late t!e O2 $low rate)

#annla

Intr#t SO not to mo'e, a&oid e o$ &olatile, $lamma(le material, oil, %reae, al#o!ol and a#etone) 



$or immediate

wat#! ot $or DO,

mana%ement and

&omitin% and

inter&ention



monitor t!e "atient #loely

ei>re

 

Diet a Tolerated

To meet meta(oli# demand



Intr#t t!e "atient to eat well (alan#ed diet

6@3 PM

 

#ont) PNSS + JVO

Rote $or dr% adminitration  to addre $lid 



Maintain "atent IV line and

18 ADAMSON UNVERSITY College of Nursing ntritional need

re%late "ro"erly note $or i%n o$ in$e#tion

 

maintain O2

to meet O2 demand o$ t!e "atient



"ro"erly re%late

in!alation  1-2

t!e O2 $low rate)

5min &ia naal

Intr#t SO not to

#annla

mo'e, a&oid e o$ &olatile, $lamma(le material, oil, %reae, al#o!ol 



re$er

and a#etone)

aement

 

$or $rt!er

re"la#e $or t!e

$a#ilitate T on#e

la#'in% "e#i$i#

a&aila(le

#om"onent o$ (lood



Se#re #onent $or T "re"are

13@43 PM

et, wat#! ot $or T rea#tion, monitor &5 tri#tly

 

$$) " ot!er la(

to det) Im"ro&ement $rom "re&io (lood "ro$ile

 

re$er

$or $rt!er aement



%et relt $rom t!e la(oratory


#ont) PNSS + JVO

Rote $or dr%



Maintain "atent

adminitration  to

IV line and

11-22-1

addre $lid 

re%late "ro"erly

4@3 AM

ntritional need

note $or i%n o$ in$e#tion

 

re"la#e $or t!e



Se#re #onent

$a#ilitate T on#e

la#'in% "e#i$i#

$or T "re"are

a&aila(le

#om"onent o$ (lood

et, wat#! ot $or T rea#tion, monitor &5 tri#tly) Send re?et to t!e (lood (an'

 

#ont) &5 monitorin%

to eta(li! (aeline



monitor &5

data and monitor

tri#tly and

nde 5+ t!at may

re#ord) Re"ort

indi#ate ntoward

any a(normal

5+ or "oi(le

$indin%

#om"li#ation

 

maintain O2

to meet O2 demand o$ t!e "atient



"ro"erly re%late t!e O2 $low rate)

in!alation  1-2

Intr#t SO not to

5min &ia naal

mo'e, a&oid e

#annla

o$ &olatile, $lamma(le material, oil, %reae, al#o!ol

18 ADAMSON UNVERSITY College of Nursing and a#etone)

 

re$er

aement

 

.@3 PM

$or $rt!er

re"la#e $or t!e



Se#re #onent

on#e PR0 i

la#'in% "e#i$i#

$or T "re"are

a&aila(le re&ie

#om"onent o$ (lood

et, wat#! ot $or

tran$ion to rn

T rea#tion,

ea#! nit $or  !or

monitor &5

e&ery  !or

tri#tly) Send

inter&al

re?et to t!e (lood (an')







$or $rt!er



aement re"la#e $or t!e

re$er

la#'in% "e#i$i#

e#re  nit o$

e#re #onent $or T, "re"are et)

#om"onent o$ (lood

"latelet #on#entrate 11-2-1



ty"e O "e#i$i# and

6@29 AM

tran$e a

to eta(li! (aeline data and monitor

#ont &5 monitorin%

nde 5+ t!at may indi#ate ntoward 5+ or "oi(le #om"li#ation

 

re$er






$or MA

To #!e#' i$ t!ere i$



o(tain in$ormed

t!ere i an

#onent "re"are

a(normality in t!e

et  ait t!e

11-24-1

marrow t!at #an (e

"!yi#ian drin%

13@33 AM

an indi#ator o$ a

t!e "ro#edre Pot MA- a""ly

#ertain (lood



"rere to t!e

"ro(lem

"n#tred ite note $or i%n o$ in$e#tion

 

re$er

aement

 

$or $rt!er

tart !ydro#ortione

$or



o(er&e 13 Ri%!t o$ medi#ation

immno""reion

.3m%5 IV ?  !or 9@33 PM  

ionia>id 433 m%5

"ro"!yla+i $or

ta( 1 ta( OD

$rt!er in$e#tion

 

Anti(ioti#

"romote #ell %rowt!

$oli#ard -#om"le+

and di&iion,

1 #a" OD

in#ldin% R0 t!at







!el" "re&ent anemia

 

#ont) &5 monitorin%

to eta(li! (aeline data and monitor nde 5+ t!at may indi#ate ntoward




18 ADAMSON UNVERSITY College of Nursing 5+ or "oi(le #om"li#ation

 

re$er


ANATOM1 AND PH1SIOLOG1 lood i a "e#iali>ed (odily $lid t!at deli&er ne#eary (tan#e to t!e (odyQ #ell 8 #! a ntrient and o+y%en 8 and tran"ort wate "rod#t away $rom t!oe ame #ell) In &erte(rate, it i #om"oed o$ (lood #ell "ended in a li?id #alled (lood "lama) Plama, w!i#! #om"rie 99: o$ (lood $lid, i motly water B63: (y &olmeC, and #ontain diol&ed "rotein, %l#oe, mineral ion, !ormone, #ar(on dio+ide B"lama (ein% t!e main medim $or

18 ADAMSON UNVERSITY College of Nursing e+#retory "rod#t tran"ortationC, "latelet and (lood #ell t!emel&e) T!e (lood #ell "reent in (lood are mainly red (lood #ell Balo #alled R0 or eryt!ro#yteC and w!ite (lood #ell, in#ldin% le'o#yte and "latelet) T!e mot a(ndant #ell in &erte(rate (lood are red (lood #ell) T!ee #ontain !emo%lo(in, an iron-#ontainin% "rotein, w!i#! $a#ilitate tran"ortation o$ o+y%en (y re&eri(ly (indin% to t!i re"iratory %a and %reatly in#reain% it ol(ility in (lood)

-%n#ti"n "f t!e 'l""* Tran$"rt$:



Diol&ed %ae Be)%) o+y%en, #ar(on dio+ideC



ate "rod#t o$ meta(olim Be)%) water, reaC



*ormone



En>yme



Ntrient B#! a %l#oe, amino a#id, mi#ro-ntrient B&itamin  mineralC, $atty a#id, %ly#erolC



Plama "rotein Bao#iated wit! de$ene, #! a (lood-#lottin% and anti-(odieC



lood #ell Bin#l) w!ite (lood #ell Qle#o#yteQ, and red (lood #ell Qeryt!ro#yteQC)

Maintain$ B"*y Temerat%re C"ntr"l$ H



T!e "* o$ (lood mt remain in t!e ran%e ). to 7)4, ot!erwie it (e%in to dama%e #ell)

Rem")e$ t"3in$ fr"m t!e '"*y



T!e 'idney $ilter all o$ t!e (lood in t!e (ody Ba""ro+) . "intC,  time e&ery 24 !or) To+in remo&ed $rom t!e (lood (y t!e 'idney lea&e t!e (ody in t!e rine) BTo+in alo lea&e t!e (ody in t!e $orm o$ weat)C

Re,%lati"n "f B"*y -l%i* Ele#tr"lyte$

18 ADAMSON UNVERSITY College of Nursing 

E+#e alt i remo&ed $rom t!e (ody in rine, w!i#! may #ontain arond 13% alt "er day B#! a in t!e #ae o$ "eo"le on wetern diet #ontainin% more alt t!an t!e (ody re?ireC)

C"m"$iti"n "f t!e Bl""* 89 RED BLOOD CELLS

Red (lood #ell are t!e mot #ommon #ell $ond in (lood) T!ere are a(ot 9 million red (lood #ell in ea#! #(i# millimeter o$ (lood or a""ro+imately 293 million red (lood #ell in e&ery dro" o$ (lood) T!i nm(er &arie wit! indi&idal in a##ordan#e to !eredity, %ender and tate o$ !ealt!) T!ee #ell are "rod#ed (y t!e (one marrow and !a&e a li$e"an o$ -4 mont!) !en t!ey die, t!ey are detroyed (y ma#ro"!a%e in t!e li&er and "leen) T!i "ro#e releae iron to (e tored in t!e li&er and (ile "i%ment to (e e+#reted) -%n#ti"n$:

Red (lood #ell are im"ortant in t!e "ro#e o$ re"iration) Fae in&ol&ed in re"iration are #arried arond t!e (ody t!ro%! t!ee #ell) O+y%en readily #om(ine wit! !emo%lo(in to $orm o+y-!emo%lo(in in t!e ln% w!ere t!ere i !i%! #on#entration o$ o+y%en) *owe&er, o+y!emo%lo(in i an nta(le #om"ond and will (rea' down to releae o+y%en w!en t!ere i low #on#entration o$ o+y%en in t!e rrondin%) *en#e t!ere will (e an e&en ditri(tion o$ o+y%en to all "art o$ t!e (ody) Red (lood #ell alo #arry "art o$ t!e #ar(on dio+ide wate $rom t!e #ell t!ro%! mot i tranmitted t!ro%! "lama a ol(le #ar(onate)

9 PLASMA

Plama i a "ale yellowi! $lid wit! a total &olme o$ 2- liter in a normal adlt) ;9 WHITE BLOOD CELLS

!ite (lood #ell are re"oni(le $or t!e de$ene ytem in t!e (ody) T!ere are a""ro+imately ,333 w!ite (lood #ell "er millimeter o$ (lood or  a million w!ite (lood #ell in

18 ADAMSON UNVERSITY College of Nursing e&ery dro" o$ !man (lood) !ite (lood #ell $i%!t in$e#tion and "rote#t or (ody $rom $orei%n "arti#le, w!i#! in#lde !arm$l %erm and (a#teria) !ite (lood #ell, t!e red (lood #ell are $ormed $rom t!e tem #ell o$ t!e (one marrow) It !a a li$e-"an o$ a #o"le o$ day) !en t!ey die, t!ey are detroyed (y rrondin% w!ite (lood #ell and re"la#ed wit! new one)

Tye$ "f WBC:

Ne%tr"!il$ ma'e " 99:-73: o$ t!e total w!ite (lood #ont in t!e (loodtream) T!ey

!a&e a e%mented n#le and it i aid to (e 0= !a"ed) Netro"!il #an (e mot #ommonly $ond near ite o$ in$e#tion or inry w!ere t!ey will ti#' to t!e wall o$ t!e (lood &eel and en%l$ any $orei%n "arti#le t!at try to enter t!e (loodtream) T!ey #an alo (e $ond in t!e " o$ wond) E"$in"!il$ ma'e " 2:-9: o$ t!e total (lood #ont and mainly atta#' "araite and

any anti%en #om"le+e) T!ee #ell are alo re"oni(le $or aller%i# re"one wit!in t!e (lood) Ba$"!il$ ma'e " le t!an 1: o$ t!e total w!ite (lood #ont) T!ey e#rete anti-

#oa%lant and anti(odie, w!i#! mediate !y"ereniti&ity rea#tion wit!in t!e (lood) T!ey are 'nown to !a&e "!a%o#ytory $eatre t!o%! t!ey are more o$ten related to immediate immne rea#tion a%aint e+ternal %erm and dieae) M"n"#yte$ , t!o%! !a&in% only 9:-.: in t!e total w!ite (lood #ont, are t!e lar%et o$

t!e 9 ty"e o$ w!ite (lood #ell) T!ey a#t a tie ma#ro"!a%e and remo&e $orei%n "arti#le and "re&ent t!e in&aion o$ %erm w!i#! #annot (e e$$e#ti&ely dealt wit! (y t!e netro"!il) T!ey !a&e (een 'nown to !a&e "!a%o#yti# $n#tion) Lym!"#yte$ "rod#e anti-(odie a%aint to+in e#reted (y (a#teria and in$e#tin%

%erm) T!ee anti(odie will (e e+#reted into t!e "lama to 'ill (a#teria in t!e (lood a well a a#t a anti-to+in) T!ee anti-(odie will #ae t!e $orei%n "arti#le to #lter to%et!er, renderin% t!em eaily en%l$ed (y t!e "!a%o#yte) *owe&er, t!e natre o$ lym"!o#yte i !i%!ly "e#i$i# and t!ey #an only re#o%ni>e #ertain anti%en)

<9 PLATELET

18 ADAMSON UNVERSITY College of Nursing Platelet are %ranlar non-n#leated $ra%ment o$ #yto"lam in t!e $orm o$ o&al di#) A "latelet #onit o$ two "art, a #lear oter %rond (tan#e o##"yin% t!e %reater "art o$ t!e "latelet and a #entral "art t!at #ontain %ranle) -%n#ti"n: T!ey e#rete a !ormone #alled erotonin w!i#! #ontri#t torn (lood &eel) T!ey alo !a&e a maor role in a##mlatin% at ite o$ inry ti#'in% to%et!er to "l% %a" in (ro'en (lood &eel) T!ey are ri#! in a #ertain a#ti&ator t!at a#ti&ate ome "rotein $ond in "lama) T!ee "rotein are t!rown ot in t!e $orm o$ $i(er a a networ') T!i networ' tra" t!e e#a"in% R0 and $orm a #lot t!at will eal t!e #t (lood &eel and o (leedin% i to""ed)

PATHOPH1SIOLOG1 !ormal Hypoxi

Erythropoietin is produced in the kidney and liver in response to

Erythropoie

Bone

18 ADAMSON UNVERSITY College of Nursing Hematopoietic Stem Cells

yeloid Stem

Lymphoid Stem

e"akaryoc

!eticulocyt

onocyt

#hrombocyt

Erythrocyt

acropha"

yelobla

Small

B$ %revent bleedin"

&ith hemo"lobi n that carries

Eosinoph

%lays a part in in+ammatory and aller"y

*i"ht parasitic inection

%lasma

,"/

,"-

,nvolved in memory response to anti"en already

,"

1st antibody synthesied in the primary immune

-nti"en receptors on lymphocyte surace

%ha"ocytosi

Basophils

eutroph

%ha"ocytosis o small patho"enic

#$

emory B

,"E

Humoral adaptive immunity

Cell$ mediated immunity

Helper # cells

%roduce cytokines Stimulates prolieration o cytotoxic #$cells and activate macropha"

,". ,nvolved primary response to a ne0ly sensed -ller"ic symptoms in immediate hypersensiti vity

Cytotoxic # Cells

-ttach 2iller to abnormal Cells cells and release chemicals called Lymphokine s 0hich helps to


Suppress or # Cells

,nvolved in 0indin" do0n a success ul

emory # Cells

%rovide rapid deense to any subse3u ent invasion by the

Exposure to viral inection

Humoral Immune $esponse

#ellular Immune $esponse

B$Lymphocytes binds 0ith the -nti"en74irus

'nce # helper cells detects a virus5 it activates and divides6 Some stays as a

%lasma cells releases antibodies

Cytokines

18 ADAMSON UNVERSITY College of Nursing Cytotoxic t$cells are activated to kill virus

4iral elimination

Some stays as a

acropha"es are stimulated

B cells are stimulated to produce antibodies 0hich binds to the Suppressor # cells are stimulated to slo0 do0n immune response once virus is

History" 4iral Hepatitis - (4iral ,nection) o amily history o hematolo"ic disorders a&oratory and 'iagnostic Exam $esults" #omplete (lood #ount" • •

• •

RESULTS NORMAL VALUES  Predisposing 2)42 + 13 5 4)3 + 13 5 toFactor" 4)6 + 13 5 7)1 %d5 12)3819)3 %5d • -"e 19 y7o (a:or peak in teens and 24: -44: t0enties) 6 6 1+ 13 5 133 ; 13 5 to 493 ; 13 65 1)2 + 13 65 4)2 ; 13 65 to 6)6 ; 13 65

RBC Precipitating Factor" HGB 4iral ,nection (Hepatitis -) HCT Lie st le Eatin street oods PLT WBC Differential: 94 - 2: Lym!"#yte$ <9: #hie #omplaint" M"n"#yte$ 19: 1.-44: 4: 9-12: Reti#%l"#yte$ %ro"ressive 0eakness and shortness o breath 0ith minimal

physical e;ort6 (one )arro* Examination" -spirate sho0ed a markedly hypocellular marro0 0ith very e0 hematopoietic cells6 Cells present consisted o lymphocytes5 plasma cells5 and stromal cells6 #here 0ere no mali"nant cells present6


Hypocellu

ormocellul

#linical +igni,cance"

#omplete (lood #ount" • • • •

-ll CBC parameters are lo06 .ecrease in !BC5 H/B5 and HC# su""est to -nemia .ecrease in &BC su""est to inection .ecrease in %latelet su""est to %etechial hemorrha"es and bruisin"

(one )arro* Examination" •

- markedly hypoplastic (4ery e0) bone marro0 is a con=rmatory test o aplastic anemia6

>neventul recovery to viral

4iral hepatitis - pro"resses


,ncrease number o #$

Severe ,mbalance in #$ C totoxic #$cells and Hel er #$Cells alteration Hel er #$cells releases -nti$Hemato oietic

Stimulates prolieration o Cytotoxic #$cells to the Hematopoietic Stem Cells and destroyin" it by producin" toxin causin" them to lyse6

-ctivate destruction o hematopoietic

*ailure o the bone marro0 to produce stem cells5 the initial orm o all blood Bone arro0 %ancytopenia

.ecrease !BC

.ecrease &BC

.ecrease

Lo0 H"b5 Lo0

Lo0er immune deenses

.ecrease clottin" ability

.ecrease '? supply to cells

&eakness *ever

%allor

Heart

*ati"ue

Heart increases cardiac output by pumpin" out more blood

Bruisin" %etechial hemorrha"

#emp


.yspnea

!! ?< cpm

compensatory tachycardia

!! 11@ bpm

#linical )aniestations - +igns and +ymptoms" Pancytopenia   

Anemia .o* $(#/" %allor5 *ati"ue5 .yspnea !eutropenia .o* (#/" *ever5 &eakness hrom&ocytopenia .lo* Platelet/" %etechial hemorrha es Bruisin

!ursing #are Plan" 16 !isk or inection r7t decreased resistance and increased susceptibility secondary to neutropenia ?6 !isk or bleedin" r7t decreased platelet count A6 ,ne;ective tissue perusion related to decrease


LABORATOR1 E6AMINATIONS C"mlete Bl""* C"%nt:

RBC HGB HCT PLT WBC Differential: Lym!"#yte$ M"n"#yte$ Reti#%l"#yte$

RESULTS 2)42 + 135 7)1 %d5 24: 1+ 1365 1)2 + 1365

NORMAL VALUES 4)3 + 135 to 4)6 + 135 12)3819)3 %5d -44: 6 133 ; 13 5 to 493 ; 1365 4)2 ; 1365 to 6)6 ; 1365

64: 19: 4:

94 - 2: 1.-44: 9-12:

Clini#al Si,nifi#an#e: • • • •

All 00 "arameter are low) De#reae in R0, *F, and *0T %%et to Anemia De#reae in 0 %%et to in$e#tion De#reae in Platelet %%et to Pete#!ial !emorr!a%e and (riin%

B"ne Marr". E3aminati"n: T!e a##om"anyin% a"irate mear i mar'edly !y"o#elllar, #om"oed motly o$ #attered myeloid and eryt!roid element)

18 ADAMSON UNVERSITY College of Nursing Clini#al Si,nifi#an#e: •

A mar'edly !y"o"lati# BVery $ewC (one marrow i #onitent wit! a dia%noi o$ a"lati#

•

anemia) I$ mali%nant #ell were "reent, a dia%noi o$ metatati# dieae or lym"!oma wold !a&e (een li'ely) one marrow o$ "atient wit! le'emia or myelody"lati# yndrome ty"i#ally are !y"er"lati# wit! in#reaed nm(er o$ !emato"oieti# (lat "reent)

Clini#al Manife$tati"n$: 

Anemia =L". RBC>: Pallor,
N%r$in, Re$"n$i'ilitie$:

1) 2) ) 4) 9) 

Retri#t $lid inta'e Adminiter O+y%en in!alation 2-PM a ordered Pla#e "atient in $owler= "oition En#ora%e dee" (reat!in% e+er#ie En#ora%e inta'e o$ $ood ri#! in Iron12

Ne%tr"enia =L". WBC>:

1) 2) ) 4) 9) )

Monitor &ital i%n "e#ially tem"eratre I$ $e&er i "reent "ro&ide TS En#ora%e $lid inta'e En#ora%e Iron S""lement Em"!ai>ed "eronal !y%iene, ade?ate ret and lee" "eriod In"e#t $or t!e "reen#e o$ wond, i$ "reent "ro&ide wond #are, a(raion, or l#er

o$ m#o mem(rane or 'in a a "otential ite o$ in$e#tion 7) ear ma' to er&e a "rote#tion



T!r"m'"#yt"enia =l". Platelet>: Pete#!iae, riin%, Ri' $or leedin%


1) Intr#t a(ot t!e a##om"anyin% ri' o$ !emorr!a%e and t!rom(oi

18 ADAMSON UNVERSITY College of Nursing 2) ) 4) 9)

Pre&ent $all (y am(latin% wit! t!e "atient a ne#eary En#ora%e e+er#ie re%larly 0!e#' $or any i%n o$ (leedin% Pla#e in (leedin% "re#ation "ro&ide meti#lo ite #are o$ intra&eno ite or

wond, and a&oid trama ) Intr#t a(ot in% o$ o$t toot!(r! and ra>or


DRUG STUD1 DRUG

Generi# Name: <roemide Generi# Name: ai+ Cla$$ifi#ati"n: oo" Direti#

DOSAGE

23m% 5 IV

ACTION

<roemide in!i(it rea(or"tion o$ Na and #!loride mainly in t!e medllary "ortion o$ t!e a#endin% oo" o$ *enle) E+#retion o$ "otaim and ammonia i alo in#reaed w!ile ri# a#id e+#retion i red#ed) It in#reae "lamarenin le&el and e#ondary !y"eraldoteroni m may relt) <roemide red#e P in !y"erteni&e a well a in normoteni&e) It alo red#e "lmonary edema (e$ore direi !a et in)

INDICATION

NURSING

RESPONSIBILITIES Oral, IV@ Edema  Red#e doa%e i$ %i&en ao#iated wit! wit! ot!er !eart $ailre, anti!y"erteni&e #irr!oi, Renal readt doa%e dieae) %radally a P re"ond) IV@  Adminiter wit! $ood or a#te Plmonary mil' to "re&ent FI Edema "et)  Fi&e early in t!e day o Oral@ t!at in#reaed rination *y"ertenion will not ditr( lee")  A&oid IV e i$ oral e lood tran$ion i at all "oi(le) are o$ten  ARNINF@ Do not mi+ #om"li#ated (y "arenteral oltion wit! water retention, !i%!ly a#idi# oltion w!i#! may wit! "* (elow )9) woren ln%  Do not e+"oe to li%!t, $n#tion, !eart may di#olor ta(let or $n#tion and5or oltion do not e 'idney $n#tion) di#olored dr% or oo" direti#, oltion) medi#ation t!at  Di#ard dilted oltion red#e (ody water a$ter 24 !r) (y ma'in% t!e  Re$ri%erate oral 'idney e+#rete oltion) more rine, are  Meare and re#ord t!o%!t to "re&ent wei%!t to monitor $lid

18 ADAMSON UNVERSITY College of Nursing water retention) 



DRUG

Generi# Name: *ydro#ortione Generi# Name: *ydro#ortione Sodim P!o"!ate Cla$$ifi#ati"n: Antiin$lammatory Synt!eti# *ormone Adrenal 0orti#oteroid Fl#o#orti#oid Mineralo#orti#oi d

DOSAGE

.3 m% 5 IV ?  !or

ACTION

S!ort-a#tin% ynt!eti# teroid wit! (ot! %l#o#orti#oid and mineralo#orti#oid "ro"ertie t!at a$$e#t nearly all ytem o$ t!e (ody) Antiinflammat"ry =,l%#"#"rti#"i*> a#ti"n: Sta(ili>e le'o#yte lyoomal mem(rane in!i(it "!a%o#ytoi and releae o$ aller%i# (tan#e ""ree $i(ro(lat $ormation and #olla%en de"oition red#e #a"illary dilation and "ermea(ility and in#reae re"oni&ene o$ #ardio&a#lar ytem to #ir#latin% #ate#!olamine) Imm%n"$%re$$i)

INDICATION

Re"la#ement t!era"y in adreno#orti#al in$$i#ien#y to red#e erm #al#im in !y"er#al#emia, to ""re ndeira(le in$lammatory or immne re"one, to "rod#e tem"orary remiion in nonadrenal dieae, and to (lo#' A0T* "rod#tion in dia%noti# tet) Ue a antiin$lammatory or immno""rei& e a%ent lar%ely re"la#ed (y ynt!eti# %l#o#orti#oid t!at !a&e minimal mineralo#orti#oid

#!an%e) Arran%e to monitor erm ele#trolyte, !ydration, li&er and renal $n#tion) Arran%e $or "otaimri#! diet or ""lemental "otaim a needed)

NURSING RESPONSIBILITIES  Eta(li! (aeline and #ontinin% data on P, wei%!t, $lid and ele#trolyte (alan#e, and (lood %l#oe)  a( tet@ Periodi# erm ele#trolyte (lood %l#oe, *#t and *%(, "latelet #ont, and 0 wit! di$$erential)  Monitor $or ad&ere e$$e#t) Older adlt and "atient wit! low erm al(min are e"e#ially #e"ti(le to ad&ere e$$e#t)  e alert to i%n o$ !y"o#al#emia Bee A""endi+
18 ADAMSON UNVERSITY College of Nursing e a#ti"n: Modi$ie immne re"one to &ario timli red#e anti(ody titer and ""ree #ell-mediated !y"ereniti&ity rea#tion) Mineral"#"rti#"i* a#ti"n: Promote odim retention, (t nder #ertain #ir#mtan#e Be)%), odim loadin%C, en!an#e odim e+#retion "romote "otaim e+#retion and in#reae %lomerlar $iltration rate BF
a#ti&ity)











Monitor $or "eritent (a#'a#!e or #!et "ain #om"reion and "ontaneo $ra#tre o$ lon% (one and &erte(rae "reent !a>ard) Monitor $or and re"ort #!an%e in mood and (e!a&ior, emotional inta(ility, or "y#!omotor a#ti&ity, e"e#ially wit! lon%term t!era"y) e alert to "oi(ility o$ ma'ed in$e#tion and delayed !ealin% Bantiin$lammatory and immno""rei&e a#tionC) Note@ Doe adtment may (e re?ired i$ "atient i (e#ted to e&ere tre Berio in$e#tion, r%ery, or inryC) Note@ Sin%le doe o$ #orti#oteroid or e $or a !ort "eriod B1 w'C do not "rod#e wit!drawal ym"tom w!en di#ontined, e&en wit!


DRUG

Generi# Name: Vitamin  0om"le+ 
DOSAGE

1#a" OD

ACTION

INDICATION

NURSING







RESPONSIBILITIES 'btain a careul history o dietary intake and dru" and alcohol usa"e prior to start o therapy6 .ru"s reported to cause olate de=ciency include oral contraceptives5 alcohol5 barbiturates5 methotrexate5 phenytoin5 primidone5 and trimethoprim6 *olate de=ciency may also result rom renal dialysis6 2eep physician inormed o patients response to therapy6 onitor patients on phenytoin or sub therapeutic plasma levels

18 ADAMSON UNVERSITY College of Nursing t!e man$a#tre o$ n#lei# a#id and t!ere$ore $or %rowt! and re"rod#tion, a well a t!e $ormation o$ red (lood #ell and t!e $n#tion o$ t!e #entral ner&o ytem)

NURSING CARE PLAN A$$e$$ment

Dia,n"$i$

Plannin,

Inter)enti"n

Rati"nale

E)al%ati"n

18 ADAMSON UNVERSITY College of Nursing S(e#ti&e@ Ine$$e#ti&e  0om"laint tie "er$ion o$ "ro%rei&e related to de#reae in wea'ne R0 #ont and !ortne o$ (reat! wit! minimal "!yi#al e$$ort O(e#ti&e@  Pallor 
A$ter 2 day o$ nrin% inter&ention , t!e "atient will (e a(le to ma+imi>e tie "er$ion



Monitored &5





Adminiter O+y%en in!alation 2- 5min a ordered



to meet O+y%en demand



Pla#e "atient in $owler= "oition



to in#reaed ln% e+"anion



En#ora%e dee" (reat!in% e+er#ie



To $a#ilitate %ood re"iration



En#ora%e inta'e o$ $ood ri#! in Iron12



"romote #ell %rowt! and di&iion, in#ldin% R0 t!at !el" "re&ent anemia



Promote ed ret



to de#reaed o+y%en demand



Pro&ided a #ond#i&e en&ironment



to allow t!e "atient $or eno%! ret



Adminiter Iron12 S""lement a ordered



"romote #ell %rowt! and di&iion, in#ldin% R0 t!at !el" "re&ent anemia

$or (aeline #om"arion  too' "rom"t inter&ention $or any de&iation

A$ter . !or o$ nrin% inter&ention, t!e "atient wa a(le to ma+imi>e tie "er$ion a e&iden#ed (y "in'i! #olored li", #onn#ti&a, nail (ed, and %m)

18 ADAMSON UNVERSITY College of Nursing A$$e$$ment S(e#ti&e@ 

O(e#ti&e@  De#reaed 0 #ont  Pallor 
Dia,n"$i$ Ri' $or in$e#tion r5t de#reaed reitan#e and in#reaed #e"ti(ility e#ondary to netro"enia

Plannin, A$ter . !or o$ nrin% inter&ention, t!e "atient will (e a(le to &er(ali>e ndertandin % and identi$y inter&ention to "re&ent or red#ed ri' o$ in$e#tion)











Inter)enti"n Monitor &ital i%n "e#ially tem"eratre

I$ $e&er i "reent "ro&ide TS

En#ora%e $lid inta'e

En#ora%e inta'e o$ "rotein- and #alorie-ri#! $ood) Ae ntritional tat, in#ldin% wei%!t, !itory o$ wei%!t lo, and erm al(min)



Rati"nale


To red#e (ody tem"eratre



To "ro&ide !ydration)


T!i maintain o"timal ntritional tat



Patient wit! "oor ntritional tat may (e aner%i#, or na(le to mter a #elllar immne re"one to "at!o%en and are t!ere$ore more #e"ti(le to in$e#tion)

E)al%ati"n A$ter . !or o$ nrin% inter&ention, t!e "atient wa a(le to &er(ali>e ndertandin% and identi$y inter&ention to "re&ent or red#ed ri' o$ in$e#tion)

18 ADAMSON UNVERSITY College of Nursing 

Streed "ro"er !and wa!in%



Em"!ai>ed "eronal !y%iene, ade?ate ret and lee" "eriod









to red#e t!e ri' o$ tranmittin% "at!o%en $rom t!e area o$ t!e (ody



To leen t!e ri' o$ a#?irin% in$e#tion



to red#e t!e tranmiion o$ "at!o%en to t!e "atient at ri' $or in$e#tion



to er&e a "rote#tion



Mot anti(ioti# wor' (et w!en a #ontant (lood le&el i maintained a #ontant (lood le&el i maintained w!en medi#ation are ta'en a "re#ri(ed) T!e a(or"tion o$ ome anti(ioti# i !indered (y #ertain $ood "atient !old (e intr#ted a##ordin%ly)

imit &iitor

ear ma'

Tea#! "atient to ta'e anti(ioti# a "re#ri(ed


A$$e$$ment S(e#ti&e@ 

O(e#ti&e@  "ete#!ial !emorr!a% e #o&er !er #!et and le%  e&eral (rie are $ond on !er le% and t!i%!)  ow "latelet  "allor

Dia,n"$i$ Ri' $or (leedin% r5t de#reaed "latelet #ont 5 t!rom(o#yto"eni a

Plannin, A$ter . !or o$ nrin% inter&ention , t!e "atient will (e a(le to identi$y ri' and en%a%e in a""ro"riate (e!a&ior or li$etyle #!an%e to "re&ent (leedin%

Inter)enti"n  Monitor "latelet #ont daily 

Ae 'in $or e&iden#e o$ "ete#!iae or (riin% and (leedin%



%revent alls by ambulatin" 0ith the patients as necessary



Encoura"e exercise re"ularly



Check or any si"ns o bleedin"



%lace in bleedin" precaution provide meticulous site care o intravenou





Rati"nale Si%ni$i#ant de#reae on "latelet #an a$$e#t (lood #lottin%)

E)al%ati"n A$ter . !or o$ nrin% inter&ention, t!e "atient wa a(le to identi$y ri' and en%a%e in Early dete#tion o$ (leedin% !el" a""ro"riate (e!a&ior or "re&ent i%ni$i#ant (lood li$etyle #!an%e to lo and "otential !o#' "re&ent (leedin%



To a&oid inry



To "romote "!yi#al !ealt!y (ein%






s sites or 0ounds5 and avoid trauma



,nstruct about usin" o sot toothbrush and raor



In#reae ri' in (leedin% $ollowin% e&en minor trama


DISCHARGE PLANNING Me*i#ati"n  

Intr#t #lient and !er i%ni$i#ant ot!er to #ontine ta'e !er "re#ri(ed medi#ation Orient t!e #lient to%et!er wit! !er i%ni$i#ant ot!er a(ot t!e name o$ dr%, t!eir



a#tion, t!e e+a#t doa%e, t!e $re?en#y and t!e rote o$ adminitration) Intr#t #lient and i%ni$i#ant ot!er to $ollow t!e intr#tion w!en adminiterin%



medi#ation) En#ora%e t!e i%ni$i#ant ot!er not to lea&e t!e #lient drin% medi#ation E+"lain to t!e #lient and i%ni$i#ant ot!er t!e ide e$$e#t and ad&ere e$$e#t o$ t!e



dr% !e ta'e (y "re#ri(in% it mani$etation) En#ora%e t!e #lient and i%ni$i#ant ot!er not to to" inta'e o$ "re#ri(ed medi#ation,



nle a""ro&ed (y t!e "!yi#ian) En#ora%e t!e #lient and i%ni$i#ant ot!er to re"ort to t!e "!yi#ian immediately i$ any



ad&ere e$$e#t or ide e$$e#t !ad o##rred) E3er#i$e$  

Intr#t #lient to (alan#e a#ti&itie wit! ade?ate ret "eriod) En#ora%e early am(lation, ait t!e #lient i$ needed)

Treatment  

Ed#ate #lient and i%ni$i#ant ot!er t!e im"ortan#e o$ dr% #om"lian#e) Di# to t!e #lient and i%ni$i#ant ot!er t!e #om"li#ation o$ t!e #ondition (e#ae 'nowled%e a(ot t!e #ondition ""ort learnin% t!at will de#reae de$i#it and an+iety)

Hy,iene  

En#ora%e #lient and i%ni$i#ant ot!er to do daily !y%iene) Di# to t!e #lient and i%ni$i#ant ot!er t!e im"ortan#e o$ "ro"er !y%iene to "romote



en!an#ement o$ 'nowled%e re%ardin% it im"ortan#e) En#ora%e #lient to a' aitan#e i$ needed)

18 ADAMSON UNVERSITY College of Nursing O%tatient "r*er$

0all t!e do#tor i$ any o$ t!e $ollowin% o##r@      

*a&e it#!y 'in and de&elo" 'in ra!e) E+"erien#e naea and &omitin%) Yo !eart i (eatin% $at or yo are (reat!in% $at) Yo !a&e a ei>re B#on&lionC) Yo !a&e #!et "ain or tro(le (reat!in% all o$ a dden) Yo !a&e ?etion or #on#ern a(ot yor #are, medi#ine, or treatment)

Diet  

To "romote wellne, eat a (alan#ed diet ri#! in $re! $rit and &e%eta(le) Eat !i%! #alori# $ood and ri#! in "rotein to maintain o"timal ntritional tat

Sirit%al  

Alway a' Fod $or %idan#e in e&eryt!in%, e"e#ially wit! !er #ondition) Prayin% alo $or all t!e "eo"le w!o are !el"in% !er wit! !er " and down)

IMPLICATIONS O- THE CASE STUD1 TO THE -OLLOWING AREAS: N%r$in, Re$ear#!

18 ADAMSON UNVERSITY College of Nursing T!i tdy #an (e ed a a re$eren#e "oint in$ormation $or $rt!er reear#! o$ t!e e+itin% mana%ement o$ "atient wit! A"lati# Anemia) T!ere mi%!t (e ome in$o in t!i tdy t!at #an e $or $tre reear#!) Aide $rom (ein% ad&anta%eo a a im"le a#ademi# ed#ational material, t!i tdy mi%!t er&e a a %ide $or orientin% "eo"le a(ot t!e element o$ t!e dieae, and !ow t!i dieae a$$e#t "eo"le)

N%r$in, E*%#ati"n T!i tdy #an (e ed a a re$eren#e to de&elo" ndertandin% o$ t!e nrin% #are and mana%ement $or "atient wit! A"lati# Anemia) T!i #ae tdy will ena(le t!e tdent to learn !ow to ae "atient wit! any i%n o$ A"lati# Anemia and (e a(le to "ro&ide a""ro"riate nrin% #are and mana%ement) Moreo&er, t!e tdent will learn a(ot t!e nrin% inter&ention and !a&e an 'nowled%e o$ t!e rationale (e!ind it a#tion) T!ey #an a""ly t!ee inter&ention in t!e real ettin% w!en t!ey en#onter t!e ame or imilar #ondition) In t!i manner, t!ey are %ettin% more 'nowled%e a(ot t!e dieae t!at t!ey #an e to $rt!er de&elo" t!eir 'ill a tdent nre and $tre nre) It may o"en a new door in t!e "ra#ti#e o$ %ettin% ?ality #are) T!i tdy mi%!t alo in"ire ot!er indi&idal to #ome " wit! t!eir own reear#! a(ot t!i diorder or any imilar #ondition)

N%r$in, Pra#ti#e T!i tdy will er&e a a %ide to !ealt! #are "ro&ider to 'now w!at are t!e "oi(le and a""ro"riate nrin% inter&ention $or a #lient !a&in% A"lati# Anemia) T!i tdy #an %i&e a %ood introd#tion to t!e diorder o t!at an eta(li!ed nrin% a#tion #an (e ?i#'ly tili>ed)

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Aplastic Anemia Case Study FINAL

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