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Hematology

RBC Disorders

WBC Disorders
Clotting Disorders

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Iron Deficiency Anemia Aplastic Anemia Vitamin B12/Pernicious Anemia Sickle Cell Anemia

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Inadequate amount of iron impairs formation of hemoglobin and RBCs and results in decreased ability of the blood to transport oxygen to the tissues. Results from blood loss, increased metabolism demands, syndromes of GI malabsorption, and dietary inadequacy.

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Risks Factors o Inadequate Diet o Gastrointestinal Bleeding o Menstruation o Pregnancy Assessment o Pica o Irritability o Widened Pulse Pressure o Brittle nails, Spoon shaped o Pearly white sclera Cracked painful corners of mouth (cracks in the corners of mouth, due to poor nutrition or vitamin deficit) o Weakness and fatigue o Restless Leg Syndrome
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Nursing Implementations Identify the cause Small easily digestible meals. Oral iron therapy (ferrous sulfate) IM therapy (Iron dextram) give via Z-track method. Give iron rich foods Exercise with planned rest periods Monitor for signs and symptoms of Iron Overdose o Side Effects: o Black stool o Constipation o Foul aftertaste
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Iron-Rich Foods
o o

o o o o o

o
o o

Breads and cereals and whole grains Dark green, leafy vegetables and legumes and potatoes Dried fruit, raisins, and prune juice Egg yolk Kidney beans Liver, meats Molasses Nuts and seeds Shellfish Tofu

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The nurse selects which of the following as the most appropriate dietary menu items for a client with irondeficiency anemia? 1. Salad with lettuce, fruit, and nuts 2. Roast beef and broccoli 3. Lasagna with tomato sauce and steamed carrots 4. Mixed green salads topped with tuna fish

An adult female client has been treated for iron deficiency anemia. To evaluate the effectiveness of the treatment, the nurse would assess for resolution of which of the following symptoms? 1. Dermatitis 2. Pale conjunctiva 3. Bleeding gums 4. Hair pigment changes

A client has been diagnosed with iron deficiency anemia (IDA), and wants to know what foods would help to maintain adequate iron levels in the body. Which of the following items regarding diet information would be beneficial for the nurse to include in a teaching plan for achieving the goal of increased iron levels? 1. Maintain a strict vegetarian diet. 2. Eat ice cubes that are present in beverages. 3. Increase tea and cereal in the diet. 4. Use adequate sources of vitamin C in the diet

Which of the following statements made by a client with iron-deficiency anemia indicates the need for further teaching? 1. "I should stop taking the medicine if my stools turn black." 2. "I should dilute the liquid iron preparation and use a straw when taking it." 3. "I can prevent the constipation by increasing the intake of fluids and fiber." 4. "I should return to the clinic if my stomach upset worsens with this medication."

A client with iron-deficiency anemia is scheduled for a complete blood count. The nurse anticipates that the report will show which characteristics of the red blood cells (RBCs)? 1. Normocytic, normochromic 2. Macrocytic, normochromic 3. Microcytic, hypochromic 4. Normocytic, hyperchromic

A client has an order for an iron preparation to be given by the parenteral route. The nurse plans to give the medication by which of the following routes? 1. Intermittent infusion 2. Deep gluteal intramuscular (IM) injection, using the Z-track method 3. Intramuscular in the deltoid to promote medication dissipation through muscle contraction 4. Subcutaneous injection with weekly site rotation

The nurse is preparing an IM injection of Iron Dextram (Dexferrum) that is especially irritating to subcutaneous tissue. To prevent "tracking" of the medication and irritation to the tissues, it is best to take which of the following actions? 1. Use a small-gauge needle 2. Administer at a 45-degree angle 3. Apply ice to the injection site 4. Use the z-track technique

Aplastic anemia happens when there has been an injury to stem cells, causing a decrease in all blood elements (pancytopenia); erythrocytes, leukocytes, and thrombocytes may all be depressed.
Sometimes called bone marrow failure

Can come on slowly or all of a sudden or at any age.

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Diagnosis
o

Bone Marrow Biopsy High doses of Radiation or Chemotherapy. Exposure to toxic chemicals (BENZENE, Chloramphenicol) Autoimmune disorder (Lupus) Deficiency in erythrocytes, leukocytes and thrombocytes Petechiae, purpura, bleeding, pallor, weakness, tachycardia and fatigue

Risk Factors
o o

Assessment:
o

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Intervention:
o o o o o

Stem Cell transplant Immunosuppressive medication Corticosteroids Blood transfusion Wear medical alert bracelet

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A nurse is admitting a client with a diagnosis of aplastic anemia. Which of the following is the best room for the nurse to assign this client? 1. A semi-private room with a client whose diagnosis is urosepsis. 2. A regular private room at the end of the hall. 3. A private isolation room equipped with a negative airflow. 4. A semi-private room with a client whose diagnosis is thrombophlebitis.

The nurse is obtaining a health history on a client who is admitted with a diagnosis of rule out aplastic anemia. Considering the diagnosis, which of the following data is most important for the nurse to elicit during the interview? 1. Recent travel outside the country 2. Exposure to chemicals and drugs 3. History of blood transfusion 4. Medication allergies

A nurse caring for a client who has experienced a bone marrow biopsy and aspiration should assess for which of the following as the most serious complication? 1. Hemorrhage 2. Infection 3. Shock 4. Splintering of bone marrow fragments

Lack of B12 results in defective maturation of RBCs When vitamin B12 deficiency anemia is caused by a lack of intrinsic factor, a substance normally secreted by the gastric mucosa, it is called pernicious anemia. Pernicious anemia is caused by a lack of intrinsic factor. Intrinsic factor is a protein produced by the stomach that binds to vitamin B12.
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Diagnosis o The Schillings test is a medical investigation used for patients with vitamin b12 deficiency. o The patient is given two doses of vitamin B-12 (cobalamin). o The first dose is radioactive and taken by mouth. o The second dose is not radioactive and is given as a shot 2-6 hours later. o Urine is then collected over the next 24 hours to measure whether vitamin B-12 is normally absorbed. o Excreting 8-40% of the radioactive vitamin B-12 within 24 hours is normal.

Vitamin B12/Pernicious Anemia o Risk Factors: o Partial or complete gastric resection o Veganism o Heredity o Assessment: o Tingling and numbness on hands and feet. o Difficulties in memory and balance. o Sore tongue o Irritability, mild depression.

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Assessment Cont:
o o o o o

Red swollen tongue Decrease sense of vibration in lower extremities. Babinski + Romberg test Decreased reflexes.

Nursing Implementations:
o o o

Vitamin B12 therapy for life (may be monthly injections) Rotate injection sites Six small feedings, soft pureed foods.
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A client diagnosed with anemia who is being treated with iron replacement therapy is not responding to clinical treatment and reports tingling and paresthesias of the extremities. The nurse questions the client to determine if the client: 1. Is compliant with iron replacement therapy 2. Has an underlying medical condition of diabetes that is complicating the course of treatment. 3. May also have a vitamin B12 deficiency that may account for presentation of neuropathy symptoms. 4. May be taking vitamin C supplements that may account for presentation of neuropathy symptoms.

When conducting discharge teaching for a client who is at risk for pernicious anemia because of gastrectomy, the nurse reinforces that the client will require which of the following for preventive treatment? 1. Niacin supplementation for lifetime 2. Vitamin B12 injections for lifetime 3. A single dose injection of ferrous sulfate to correct the condition 4. Riboflavin injections monthly for at least a year

The nurse would assess a client who has undergone a small bowel resection of the ileum for development of which type of anemia? 1. Iron-deficiency anemia 2. Pernicious Anemia 3. Anemia of chronic disease 4. Aplastic anemia

The client is given radioactive Vitamin B 12 in water for a Schilling test. The nurse instructs the client that the primary purpose of this test is to measure his body's ability to do which of the following? 1. Store Vitamin B12 2. Digest Vitamin B12 3. Absorb Vitamin B12 4. Produce Vitamin B12

Inherited hemoglobinopathies that cause abnormal sickle shaped hemoglobin to partially or totally replace normally shaped RBC. The Vaso-occlusive crisis, or sickle cell crisis, is a common painful complication of sickle cell disease in adolescents and adults. Conditions such as anxiety, dehydration, infection or trauma may trigger a sickling crisis. Difficulty breathing and excruciating pain are symptoms of a crisis. Common in people with African or Mediterranean descent.
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Sickle Cell Anemia

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Assessment:
o o o o o

Increased susceptibility to infection. Anemia Sickle cell Crisis Jaundice Irritability, lethargy, anorexia and malaise

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When caring for a client with sickle cell crisis, which dietary measures should the nurse emphasize?

1. 2. 3. 4.

High-protein supplements Limited intake of sodium-rich foods Six small meals eaten throughout the day High fluid intake

Which of the following nursing observations indicate that a positive outcome for a client with sickle cell crisis has been met? The client has an intake of 3,000 mL per day. The urinary output is 20 cc per hour. Client complains of persistent joint pain. The client has a temperature of 100 degrees F.

1. 2. 3.

4.

Which of the following nursing diagnoses should receive the highest priority in a client with sickle cell crisis? 1. Pain 2. Self-care deficit 3. Activity intolerance 4. Altered health maintenance

The nurse is preparing a teaching plan for a client with sickle cell disease about ways to prevent crisis episodes. Which of the following should be emphasized to prevent sickle cell crisis?</question> Eat nutritious foods that are high in iron. Seek treatment for infections as soon as possible. Take adequate amounts of supplemental vitamins and minerals. Avoid any type of physical activity.

1. 2.

3.

4.

A couple seeks genetic counseling for sickle cell. Both have sickle cell traits. The nurse understands that the chances of the couple's offspring developing sickle cell disease with each pregnancy is: 1. None of the offspring will develop sickle cell disease. 2. Twenty-five percent of their offspring will develop sickle cell disease. 3. Fifty percent of their offspring will develop sickle cell disease. 4. All their children will have sickle cell traits, but none will have the disease.

A 14-year-old boy with sickle cell anemia is admitted with severe pain in his abdomen and legs. He asks why the doctor ordered oxygen when he is not having any problems breathing. The nurse will be most accurate in stating that the main therapeutic benefit of oxygen is to: 1. Prevent further sickling. 2. Prevent respiratory complications. 3. Increase the oxygen-carrying capacity of red blood cells (RBCs). 4. Decrease the potential for infection during the crisis.

1.

2.

3.

4.

A 2-year-old has just been diagnosed with sickle cell anemia. The nurse has explained the diagnosis to the family as well as provided information about the treatment plan. The nurse will anticipate the need for additional teaching when the mother makes which statement? "My husband loves to fly his small plane. I guess we'll have to take a commercial plane for our trips from now on." "If my child gets the flu bug, she might develop a sickling crisis." "My child will need extra iron tablets because of her anemia." "During a sickling crisis, my child will probably be hospitalized for pain control and hydration therapy."

Intervention
o o o o o

o o o

Prevent Sickling Crisis Avoid anything that triggers hypoxia Increase Fluids Infection prevention Encourage diet of high calorie, high protein, with folic acid supplement Supportive therapy during crisis Avoid stress and fatigue Oxygen therapy and blood transfusion (as prescribed) to increase tissue oxygenation
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Bone marrow disorder characterized by an abnormal increase in RBC's (erythrocytosis) often accompanied by leukocytosis. Untreated survival time is 12 years; with treatment, 715 years.

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Assessment:
o o o o o o

Ringing in the ears. Feeling of abdominal fullness. Pruritus after bathing Pain Ruddy complexion Gum bleeding Enlarged spleen

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Nursing Implementation
o

o o

o
o

Observe signs of bleeding, thrombosis, stools, urine, gums, skin, ecchymosis. Avoid prolonged sitting, knee gatch and pillow under the knees. Cool water baths to decrease pruritus Force fluids to reduce blood viscosity Avoid foods high in iron Avoid falls and bumps

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The nurse is preparing a teaching plan for a client with polycythemia vera on ways to maintain nutrition. The nurse should include in the plan which of the following? 1. Increase intake of foods high in iron.</choice_1> 2. Encourage small, frequent meals rather than three big meals. 3. Increase the amount of red meats and organ meats in the diet. 4. Encourage the use of hot spices in foods to stimulate appetite

Autosomal recessive disorder characterized by the reduced production of one of the globin chains in the synthesis of hemoglobin. Most common in descents such as Italians, Greeks, Syrians or their offsprings.

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Assessment:
o o o o o o

Frontal bossing Maxillary prominence Wide-set eyes with a flattened nose Greenish-yellow skin tone Hepatosplenomegaly Sever Anemia Microcytic; hypochronic red blood cells

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Treatment/Nursing Implementation Treatment is supportive; the goal of therapy is to maintain normal hemoglobin levels by the administration of blood transfusions. Bone marrow transplantation may be offered as an alternative therapy. o Monitor for Iron overload (iron-chelating agent Desferal) o Splenectomy o Genetic counseling

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The nurse has completed some child and family education for a child diagnosed with thalassemia. The medical plan of treatment includes blood transfusions when the anemia reaches a severe point. Which statement by the parents indicates a need for further education? 1. Because of the anemia, my child will need extra rest periods. 2. My child inherited this disorder from both of us. 3. We should be alert to periods when our child seems paler than usual. 4. My child needs an iron supplement.

The nurse is caring for a child diagnosed with thalassemia major who is receiving her first chelation therapy. The nurse reinforces teaching about chelation therapy with the parents by stating that it is done to: 1. Decrease the risk of hypoxia. 2. Decrease the risk of bleeding. 3. Eliminate excess iron. 4. Prevent further sickling of red blood cells (RBCs).

The elementary school nurse is called to the gym when a child with a history of thalassemia complains of dizziness during physical education class. The priority action of the nurse should be to: 1. Assist the child to the nurse's office to lie down until the dizziness passes. 2. Assist the child to sit in the gym until the dizziness passes. 3. Utilize an ammonia ampoule to prevent loss of consciousness. 4. Assess the child's blood pressure and pulse.

The nurse is caring for a child with beta-thalassemia who has received many blood transfusions. The nurse assesses for which of the following as a priority at this time? 1. Neutropenia 2. Petechiae 3. Hemosiderosis 4. Hemoglobin S formation

In Hodgkin's lymphoma, cells in the lymphatic system grow abnormally and may spread beyond the lymphatic system. As Hodgkin's lymphoma progresses, it compromises your body's ability to fight infection.
When B cells develop into large abnormal cells, these abnormal, cancerous cells are called Reed-Sternberg cells. Instead of undergoing the normal cell cycle of life and death, Reed-Sternberg cells don't die, and they continue to produce abnormal B cells in a malignant process.

Signs and Symptoms

o o o o o

o o o

Painless swelling of lymph nodes in your neck, armpits or groin. Persistent fatigue Fever and chills Night sweats Unexplained weight loss as much as 10 percent or more of your body weight Coughing, trouble breathing or chest pain Loss of appetite Itching

Nursing Intervention
o

o o o

For stages I and II without mediastinal node involvement, the treatment of choice is extensive external radiation of the involved lymph node regions. With more extensive disease, radiation and multidrug chemotherapy are used. Monitor for drug-induced pancytopenia, an abnormal depression of all the cellular components of the blood, which increases the risk for infection, bleeding, and anemia. Monitor for signs of infection and bleeding. Protect the child from infection. Monitor for side effects related to chemotherapy or radiation; the most common side effect of extensive irradiation is malaise, which can be difficult for older children and adolescents to tolerate both physically and psychologically.

A client is scheduled for biopsy to rule out lymphoma. The nurse understands that a biopsy finding suggestive of a lymphoma is the presence of: 1. Reed-Sternberg cells. 2. Philadelphia chromosome. 3. Epstein Barr virus. 4. Herpes simplex virus.

A client has just been diagnosed with Hodgkin's disease. Several hours after she returns to the room after having a lymphangiogram, she tells the nurse her urine is blue. The nurse's best response is: 1. "That's OK. It will go away on its own." 2. "I'll call the doctor, and he can explain the cause of the urine discoloration." 3. "This is a predictable response to the test and shows you are adequately excreting the dye." 4. "This is an expected side effect of the test. It will go away by itself in a few hours."

The nurse monitors a client with Hodgkin's disease for which of the following complications that could be fatal? 1. Spinal cord compression 2. Superior vena cava obstruction 3. Kidney and/or liver failure 4. Infection and/or hemorrhage

A client with suspected Hodgkin's disease wants to know why a lymph node biopsy is necessary. The best response by the nurse is that the biopsy is: 1. The easiest test to confirm the diagnosis. 2. The most definitive test to confirm the diagnosis 3. Less likely to cause major complications. 4. The quickest way to find the correct answer.

Cancer of blood forming organs causing an uncontrolled production of white blood cells (leukocytes, myelocytes, and their precursors) by the bone marrow. Four primary categories of leukemia according to the type of WBC involved and the rate of cell growth.
o
o o o

Acute Lymphoblastic Leukemia (ALL) Acute Myelogenous Leukemia (AML) Chronic Lymphoblastic Leukemia (CLL) Chronic Myelogenous Leukemia (CML)
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Acute Lymphoblastic Leukemia (ALL) o Most common type of leukemia in young children o This disease also affects adults, especially those age 65 and older o Standard treatments involve chemotherapy and radiation o The survival rates vary by age: 85% in children and 50% in adults Acute Myelogenous Leukemia (AML) o Occurs more commonly in adults than in children o More commonly in men than women o AML is treated with chemotherapy o The five-year survival rate is 40%
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Chronic Lymphocytic Leukemia (CLL)

o

o o

Most often affects adults over the age of 55. It sometimes occurs in younger adults, but it almost never affects children. Two-thirds of affected people are men. The five-year survival rate is 75%. It is incurable, but there are many effective treatments. Occurs mainly in adults. A very small number of children also develop this disease. Treatment is with imatinib (Gleevec) or other drugs. The five-year survival rate is 90%
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Chronic Myelogenous Leukemia (CML)

o

o o

Risk Factors:
o o o

Exposure to chemicals Radiation Treatment of other types of cancer

Diagnosis
o

Bone Marrow Biopsy

o
o o o

Assessment:
Fatigue Weakness Pain (joints) Night Sweats
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Assessment Cont:
o o o o o o

Petichiae, Echymosis Spleenomegaly Hepatomegaly Enlarged lymph nodes. Low WBC/Extremely High Low RBC Low Platelets

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Nursing Implementations:
o o o o o o

o
o o

Observe for early signs of infection Mouth Care q2 Assess and control Bleeding, anemia Provide Rest, Comfort, Nutrition Nausea, antiemetics, usually Reduce side effects from therapeutic regimen Provide emotional/spiritual support Let the patient participate in treatment Maintain strong support system
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The nurse would teach a client with sickle cell trait that he or she: 1. Should avoid fluid loss and dehydration. 2. Can expect to experience hemolytic jaundice. 3. Can expect to experience chronic anemia. 4. Is protected from sickle cell crises under normal circumstances

A client has an order for a test to determine if pernicious anemia is present. For which of the following tests should the nurse schedule the client? 1. Serum folate level 2. Schilling test 3. Serum iron and total iron-binding capacity (TIBC) 4. Bone marrow aspiration

An adolescent receiving cyclophosphamide (Cytoxan) for acute lymphocytic leukemia (ALL) asks the nurse to come quickly to evaluate blood in my urine. The most important action by the nurse would be to: 1. Explain this is normal for these drugs. 2. Measure intake and output. 3. Force fluids to improve the hematuria. 4. Recognize that this is untoward and report the event

A child with leukemia has developed pancytopenia. The nurse would institute which measures designed to reduce stomatitis in this child during the course of chemotherapy? (Select all that apply.) 1. Using alcohol-based mouthwash to reduce oral organisms 2. Administering pain medications as ordered 3. Increasing intake of citrus juices, such as orange juice, that contain Vitamin C 4. Rinsing the mouth several times a day with plain water 5. Brushing the teeth twice a day with a firm-bristled toothbrush

A client with leukemia is receiving chemotherapy. The client is immunosuppressed, with a low absolute neutrophil count. The nurse anticipates that which of the following medications would be used in the treatment of the client? 1. Zidovudine (AZT) 2. G-CSF (Neupogen) 3. Raloxifene (Evista) 4. Toremifene (Fareston)

A 3-month-old infant is diagnosed with leukemia. Which of the following does the nurse anticipate will be part of the plan of care for this infant? 1. The baby will be placed in isolation. 2. Leukemia is familial, and other children should be assessed. 3. All immunizations will be withheld during exacerbations. 4. The baby will be NPO during chemotherapy.

Which of the following characteristics is associated with chronic leukemia? 1. Immature lymphocytes proliferate the marrow 2. Gradual onset of the disease 3. Rapid disease progression 4. Primarily affects younger adults

The common feature of leukemia is which of the following? 1. A compensatory polycythemia stimulated by thrombocytopenia. 2. An unregulated accumulation of white blood cells in the bone marrow. 3. Increased blood viscosity resulting from an overproduction of white cells. 4. Reduced plasma volume in response to a reduced production of cellular components.

A 40-year-old client is referred to a hematologist with a tentative diagnosis of acute myelogenous leukemia (AML). The client's only complaint is fatigue. Which of the following diagnostic tests would the nurse expect to be ordered first? 1. Liver function studies 2. Uric acid 3. Lumbar puncture 4. Bone marrow biopsy

A 3-month-old infant is diagnosed with leukemia. Which of the following does the nurse anticipate will be part of the plan of care for this infant? 1. The baby will be placed in isolation. 2. Leukemia is familial and other children should be assessed. 3. All immunizations will be withheld during exacerbations. 4. The baby will be NPO during chemotherapy.

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Refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Inherited as a (sex-linked) recessive trait. Occurs in men but is transmitted by women carriers who are symptom free. There are two main types of hemophilia.
o

Hemophilia A, you have little to no clotting factor VIII (8). About 9 out of 10 people with hemophilia have type A. Hemophilia B, youre missing or have low levels of clotting factor IX (9).
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Assessment:
o
o o o o o

Abnormal bleeding from Umbilical cord Prolonged bleeding from cuts Epistaxis Joint pain, tenderness, swelling and limited ROM Tendency to bruise easily Normal platelet count but clotting time may be abnormal.

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Nursing Interventions
o o o o o o

Prevent injury and Bleeding as Much as possible Provide an environment as safe as possible Control bleeding episodes when they occur Avoid IM/IV administration of drug No aspirin and NSAID's Give Antihemophillic factor via IV Advice child to wear medic alert bracelet

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Which of the following blood products does the nurse anticipate the physician will order for a client diagnosed with hemophilia? Whole blood Packed red blood cells (PRBCs) Fresh frozen plasma (FFP) Albumin

1. 2. 3.

4.

The nurse would explain to a client newly diagnosed with hemophilia that it is a hereditary bleeding disorder that: 1. Has a higher incidence in females. 2. Is associated with joint bleeding, swelling, and damage. 3. Is related to genetic deficiency of the von Willebrand factor 4. Can be caused by lack of Vitamin B12

The nurse is administering factor VIII to a child with hemophilia. The nurse should observe for which potential complication during the infusion? Fluid overload Transfusion reaction Emboli formation Contracting AIDS

1. 2. 3.

4.

At a hemophilia camp, several children with injuries arrive at the clinic at the same time. When prioritizing care for the children, the child who requires the most immediate care from the nurse is the child with: 1. A swollen knee. 2. Abrasions on both arms. 3. A slight head injury 4. A puncture wound in the foot.

A 2-year-old with hemophilia is being discharged, and the nurse is completing discharge teaching with his parents. Which of the following statements by the parents indicates they require further teaching regarding hemophilia? 1. It is good to know that his sister will not get hemophilia also. 2. If our son has a temperature, we will not give aspirin or ibuprofen, only acetaminophen. 3. We will get a Medic-Alert bracelet for our son as soon as we get home. 4. We will be sure to watch our son very closely to make sure he does not have another episode of bleeding.

Idiopathic Thrombocytopenic Purpura (ITP) Is a bleeding condition in which the blood doesnt clot as it should. This is due to a low platelets count. Acute ITP: self limiting with a duration of less than 6 months; typically follows a viral disease. Chronic ITP: Autoimmune disease of young adulthood

Secondary Thrombocytopenia: (thiazides, aspirin, nonsteroidals, sulfonamides, Tagamet, Lanoxin, Lasix, heparin, morphine, Tegretol)

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Idiopathic Thrombocytopenic Purpura (ITP) o Nursing Considerations: o Bleeding Precautions o Avoid aspirin containing products and any other medications or herbs with an anticoagulant effect o Put firm, consistent pressure on any bleeding area for 510 minutes. o Do not use dental floss. o Shave with an electric razor to decrease the risk of accidental cuts.

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Idiopathic Thrombocytopenic Purpura (ITP)

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The nurse instructs the client receiving chemotherapy that which of the following should be avoided to reduce the risks associated with thrombocytopenia? 1. Being near individuals with upper respiratory infection 2. Keeping fresh flowers and plants in the home 3. Shaving with an electric razor 4. Trimming nails with a nail clipper

A child diagnosed with Sarcoma is being treated with chemotherapy. The results of a complete blood count (CBC) indicate severe thrombocytopenia. Nursing interventions related to this finding would include: (Select all that apply) 1. Encouraging foods high in iron. 2. Limiting physical contact with the child. 3. Removing fresh flowers from the childs room. 4. Clearing the floor of the childs room to prevent falls and bruises. 5. Minimizing needle sticks and intrusive procedures.

The nurse assesses for petechiae and ecchymosis as the most common signs in a client diagnosed with which of the following disorders? 1. Iron-deficiency anemia 2. Pernicious anemia 3. Vitamin K deficiency 4. Thrombocytopenia

The nursing care plan for a client diagnosed with idiopathic thrombocytopenia purpura (ITP) takes into account which of the following therapies for this disorder? 1. Alkylating chemotherapy 2. Platelet transfusions 3. Corticosteroid therapy 4. Bone marrow transplant

A hereditary bleeding disorder characterized by a deficiency of or a defect in a protein term Von Willebrand factor (vWF)
Disorder causes platelets to adhere to damage endothelium

Tendency to bleed from mucous membranes

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Von Willebrand Disease (vWF) o Assessment: o Epistaxis o Gum Bleeding o Easy bruising o Excessive menstrual bleeding o Intervention: o The administration of clotting factors o Provide emotional support

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A client with von Willebrand's disease presents to the hospital with prolonged bleeding following a dental procedure. The nurse is aware that the client might need to be transfused with which of the following products? 1. Cryoprecipitate 2. PRBCs 3. Granulocytes 4. Platelets

Questions?

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