NR 324 Week 4 Hematologic Alterations

Student Name

Chamberlain University

NR-324 Adult Health I

Prof. Name:

Date

Hematologic Alterations

Nursing care of hematologic alterations

When caring for patients with hematologic conditions, nurses must adhere to safety protocols and practice self-awareness regarding their health. If a nurse experiences symptoms such as fever before a shift, the appropriate course of action is to inform their supervisor and refrain from attending work. This precaution minimizes the risk of spreading infection to immunocompromised patients. Although personal protective equipment (PPE) plays a vital role in preventing infection transmission, avoiding patient interaction when symptomatic is a more effective first step. Symptom management, such as taking acetaminophen, may help reduce discomfort but should not replace professional responsibility and communication.

Recognizing and Analyzing Cues in Hematologic Conditions

Recognizing cues – altered hematologic conditions

A nurse identifying a hemoglobin level of 7 g/dL along with a low hematocrit must assess for common symptoms, such as shortness of breath, fatigue, and pallor. These clinical signs reflect reduced oxygen-carrying capacity and require prompt evaluation to inform appropriate interventions.

Analyzing cues – altered hematologic conditions

In cases of erythrocytosis, nurses must assess contributing factors like folate deficiency, chronic smoking, or living at high altitudes. Unlike iron deficiency and heavy menstrual bleeding, which typically result in anemia, erythrocytosis stems from different physiological triggers. Accurately identifying these causes allows for targeted care and proper patient education.

Nursing Intervention and Evaluation

Nursing intervention table

Nursing Intervention	Details
Self-check: Outcome – Nursing Evaluation	Develop discharge teaching for a patient with thrombocytopenia. After stopping seizure medication, schedule a CBC in two weeks to monitor platelets.
Self-check: Nursing Diagnoses	Link symptoms of hematologic alterations with accurate nursing diagnoses to build a patient-centered care plan.
Self-check: Hospital-Acquired Infection	Identify at-risk patients (e.g., elderly or immunosuppressed) from the hospital census and prioritize them for preventative interventions.

Nursing evaluation – transfusion reaction

If a patient like Julie develops symptoms such as chills and fever after receiving packed red blood cells post-surgery, a febrile non-hemolytic transfusion reaction should be suspected. Immediate nursing actions include stopping the transfusion and starting a normal saline infusion to mitigate adverse effects and prevent further complications.

Reflecting on Nursing Care of Hematologic Alterations

Aplastic anemia – patient evaluation

In a patient presenting with fatigue and shortness of breath due to aplastic anemia, monitoring vital signs—including blood pressure, temperature, and respiratory rate—is essential. Observing skin conditions such as pallor and coolness helps identify complications like poor perfusion or impending hypoxia, necessitating prompt intervention.

Developing a hypothesis – nursing diagnosis

For a patient named Janet with aplastic anemia, nursing diagnoses may include fatigue, risk for bleeding, and impaired gas exchange. The sequence of care should involve initiating neutropenic precautions, administering oxygen therapy, arranging for PRBC transfusion, and consistent monitoring of vital signs to ensure stabilization.

Evaluation – nursing outcomes

Successful patient outcomes depend on consistent assessment of respiratory function and laboratory values such as CBC. Monitoring heart rate and oxygen saturation is critical in evaluating the effectiveness of interventions and guiding further care planning.

Hematologic Conditions: Polycythemia and Anemia

Recognizing cues – polycythemia

When contacting a provider about Bill, a polycythemia patient with low oxygen saturation, the nurse should communicate vital signs and lab results to support clinical decision-making. This ensures timely and accurate treatment strategies.

Prioritizing care – polycythemia

The following nursing diagnoses should be prioritized in polycythemia cases: impaired gas exchange, altered tissue perfusion, risk of thromboembolism, and lack of disease-specific knowledge. Appropriate interventions should be tailored to address these concerns in order of clinical urgency.

Nursing actions – polycythemia

Further diagnostic testing will refine nursing actions. Clinical improvement in patients like Bill may be observed through higher oxygen saturation, decreased respiratory distress, and stabilization of vital parameters.

Anemia: Assessment, Planning, and Action

Recognizing cues – anemia

Key laboratory markers used to diagnose anemia include hemoglobin, hematocrit, red blood cell count, and red cell distribution width. Monitoring these values helps determine the type and severity of anemia, guiding treatment.

Nursing intervention – anemia

In cases of acute blood loss, such as from a stab wound, the immediate nursing priority is administering prescribed packed red blood cells to restore circulatory volume and oxygen-carrying capacity.

Self-check: Analyzing cues – anemia

Nurses must associate clinical presentations with appropriate anemia types. Common symptoms may include exertional dyspnea, pallor, and reduced hemoglobin or hematocrit levels. This understanding is vital for accurate diagnosis and care planning.

Reflect – anemias

In evaluating Alma, a patient presenting with shortness of breath and pallor, the nurse should suspect anemia. Reviewing Alma’s vital signs and laboratory data will guide accurate diagnosis and appropriate interventions.

Generating a hypothesis – nursing diagnosis

Alma’s symptoms may suggest iron deficiency anemia or thalassemia. Nursing interventions should be designed to address fatigue, enhance oxygenation, and monitor lab trends for progression or improvement.

Nursing diagnoses – planning interventions

Based on Alma’s admission findings, interventions should include monitoring hemoglobin levels, advising on iron-rich nutrition, and administering supplements as prescribed. Ongoing assessment will help evaluate therapeutic success.

Nursing action – anemia

In Dwayne’s case, who reports moderate joint pain and slight shortness of breath, vital sign changes and symptom review point to potential anemia. Nursing care should focus on medication administration, lifestyle counseling, and dietary modifications.

Nursing outcomes – sickle cell anemia

Dwayne’s discharge plan should confirm stabilization post sickle cell crisis. Documented improvements in vital signs and reduced symptoms confirm that nursing goals have been met, supporting long-term recovery planning.

References

American Association of Colleges of Nursing. (2020). Nursing care of hematologic alterations: Nursing interventions. Retrieved from https://www.aacnnursing.org/

Centers for Disease Control and Prevention. (2022). Transfusion reactions: A nurse’s guide to management. Retrieved from https://www.cdc.gov/

National Heart, Lung, and Blood Institute. (2023). Anemia: Causes and risk factors. Retrieved from https://www.nhlbi.nih.gov/