Things you See Over And Over Again Part III

Study Guides

Blood Dyscrasias

Agranulocytosis

What it is—lowering of the white blood cells called granulocytes

Signs and symptoms—infections, fever, rigors, sore throat, septicemia, gingival bleeding

Possible drugs that cause it—indomethacin, NSAIDs, cephalosporins, chemo drugs, penicillins, propylthiouracil, sulfasalazine

Possible medical causes—bone marrow diseases, autoimmune diseases, leukemia, bacterial infections, poisoning

What are you going to do about it--   

                                            

Protect the patient from infection

• Meticulous hand washing
• Strict asepsis
• Patient Teaching
• Discuss frequent, thorough oral hygiene
• Treat or prevent mouth and pharyngeal infection
• Explain need for soft, bland diet high in protein, vitamins and calories
• Balanced rest and activity to prevent fatigue and malaise
• Avoid crowds, people with infectious diseases
• Teach S/Sx of infection and its intervention

Neutropenia

What it is—decrease in the number of white blood cells called neutrophils

Signs and symptoms—infection, sepsis, sore throat, fever, mouth ulcers

Drugs that may cause it—Dilantin, chemo drugs, indomethacin, propylthiouracil, clozapine, Tegretol

Possible medical causes—cancer, hepatitis, HIV/AIDS, leukemia, lupus, radiation

What are you going to do about it—

• Check skin integrity
• Check breath sounds
• Temp q4h- report over 101F
• CBC
• Monitor S&S infection
• Hand hygiene
• No fresh flowers
• No standing water
• Low microbial diet
• TCDB
• Meticulous body hygiene
• Inspect IV sites
• Keep visitors with respiratory infections away

Thrombocytopenia

What is it—a reduction in the number of platelets (< 150,000)

Signs and symptoms—bruising, purpura, Petechiae, nosebleeds, bleeding gums, ecchymosis, fatigue, blood in stools and urine, prolonged bleeding during surgery

Drugs that may cause it—valproic acid, methotrexate, chemo drugs, interferon, Singulair, heparin, isoniazid, tamoxifen, dantrolene, clopidogrel (Plavix), chemo drugs, Tagamet, Tegretol, cephalosporins

Possible medical causes—leukemia, bacterial infection, liver failure, heparin therapy, lupus, DIC, HELLP, aplastic anemia

What are you going to do about it—

• If medication toxicity is the cause then D/C meds
• Meticulous asepsis and gentle handling of patient
• Monitor plasma and platelet infusion and whole blood transfusion for reaction and effects on condition
• Avoid trauma, use stool softeners, high fiber diet, check for presence of blood, use soft tooth brush, gently blow nose
• Notify physician for signs and symptoms of bleeding
• Avoiding contact sports or other activities in which head injury might occur

AVOID BLEEDING:

•Avoiding accidental cuts by using an electric razor and taking care when using sharp tools or kitchen implements 

•Avoiding intramuscular injections 

•Brushing teeth with a soft toothbrush to decrease gum bleeding  

•Headache or changes in neurological status can indicate intracranial bleeding. 

•Vomiting frank blood or coffee ground material 

•A backache or flank pain may indicate internal bleeding 

•Urine that appears dark or smoky looking may indicate bleeding in the urinary tract 

•Unexplained increase in pulse rate and decrease in blood pressure 

•Joint pain may indicate bleeding into a joint

Leukopenia

What it is—destruction of the WBCs called leukocytes

Sign and symptoms—anemia, pneumonia, fever, headache, mouth ulcers, dysmenorrhea

Drugs that can cause it—Depakote, Lamictal, Wellbutrin, interferon, chemotherapy

Medical causes—viruses, radiation, aplastic anemia, lupus, cancer, Hodgkin’s, TB, HIV/AIDS