Complex Nursing

Topics: Blood, Coagulation, Haemophilia A Pages: 9 (2412 words) Published: April 14, 2013
Anaemia – a condition where there is a reduction in the number of red blood cells and a deficiency of haemoglobin in the blood.

Possible Causes of Anaemia – severe blood loss, failure of the bone marrow to produce red blood cells, genetic inability of red blood cells to carry oxygen adequately, destruction of red blood cells by the body or foreign substances, dietary (problems with child growth).

Common types of Anaemia – Iron deficiency – lack of iron which is the main constitute of Hb, pernicious – lack of intrinsic factor necessary to absorb Vitamin B12, others (sickle cell – presence of varying proportions of Hb) (bean like shape)

Presenting problems of Anaemia – pallor, susceptibility to fatigue/lethargy, shortness of breath, headache, dizziness, fainting, lack of concentration, loss of appetite, rapid pulse, bruising, bleeding, dysphagia, sore mouth, oedema of ankles, increased susceptibility to infection, palpitations, angina in elderly, delayed healing, sensitivity to cold, cheilosis (dry scaling of the lips and angles of the mouth caused by riboflavin deficiency).

Specific nursing Actions for Anaemic patients – briefly review relevant diagnostic assessment, explain the condition, relating it to the cause of the patient’s problem eg. Fatigue, assist and support the patient during diagnostic procedures, implement measures to increase oxygen to cell by positioning to promote ventilation, encourage periods of rest to minimise over activity, avoid overheating, encourage to provide a well balanced diet with necessary supplements for the type of anaemia, iron plus foods high in vitamin C to enhance absorption, high B12 foods, folic acid and Vitamin B12 supplements, high fibre to counteract iron induced constipation, oral care according to appetite, monitor vital signs for blood transfusion, instruct patient to sit or lie down when dizzy, assist with initial ambulation, frequent turnings and repositioning to prevent skin break down, observe, record vital signs and skin colour, observe for reactions to drugs eg. Iron supplements.

Thrombocytopenia – condition characterised by a reduction in the number of platelets – may be inherited or acquired

Possible causes of Thrombocytopenia – Drugs, chemical agents (chemo or radiation therapy), autoimmune, aplastic anaemia (the body doesn’t produce enough white and red blood cells or platelets due to the stem cells in the bone marrow being damaged), Vitamin B12 or Folate deficiency.

Presenting problems of Thrombocytopenia - External bleeding usually is the first sign of a low platelet count. External bleeding may cause purpura or petechiae. Purpura are purple, brown, and red bruises. This bruising may happen easily and often. Petechiae are small red or purple dots on your skin. Prolonged bleeding from small cuts, bleeding or oozing from the mouth or nose, especially when having brushed your teeth or nosebleeds, abnormal vaginal flow (especially heavy menstrual flow).

Specific Nursing Actions for Thrombocytopenia patients – briefly review relevant diagnostic assessment, control superficial bleeding (external pressure), monitor patient for signs of internal bleeding (pulse rate) – not BP as this can cause bruising, inspect skin for petechiae, purpura, regular testing of urine, stools, vomit for occult blood, monitor for headaches/drowsiness (cerebral bleeding), care with dizziness – risk of falls, avoid aspirin medications/intramuscular injections, carry Med alert card, avoid contact sports, minimize potential for soft tissue injury.

Nursing a patient that has chemotherapy – Encourage nutritional supplements as eating, swallowing and talking may be difficult, diet modification may be necessary (limit spicy or acidic foods), encourage regular mouth cleans with saline due to dry mouth (radiation), discourage the use of smoking and alcohol, apply topical anaesthetics, educate pt to eat and drink when not nauseated, administer antiemetics prior to chemotherapy and...
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