Page 420 - Critical Care Nursing Demystified

Chapter 9 CARE OF THE PATIENT WITH CRITICAL HEMATOLOGIC NEEDS 405

History

The patient’s age and cultural background are important as hematologic system
functioning decreases with age, and some types of anemias are more frequent
in cultural/ethnic groups. For example, sickle cell anemia is frequent in African-
Americans.
Check to see if the patient is in pain. If so, perform a complete pain assess-
ment. It is common for patients to say they have achy joints or pain upon move-
ment if they are having a sickle cell crisis. (See OPQRST method in Chapter 3,
Table 3–2.)
A functional history should be performed with special attention to any com-
ments regarding fatigue, weakness, or inability to perform previous activities.
The lack of RBCs and increase in WBCs can cause fatigue and an inability to
perform life roles. Ask the patient if he or she has a history of headache, bleed-
ing, or dyspnea. Does the patient have a loss of appetite?
What is the chief problem stated by the family or significant other? Many
times hematological problems are chronic and much valuable information regard-
ing care can be elicited. Does the patient have a past medical history (PMH) of
anemia, leukemia, trauma, or clotting disorders such as PE and DVT?
What medications are taken regularly by the patient? Do they include anti- Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
coagulants, chemotherapeutic agents, or iron?
Do they describe any numbness and tingling in the extremities? If they can
walk, do they have a sense of balance? Neurological signs of anemia can include
these along with apathy and irritability.

NURSING ALERT
The patient’s medications should be assessed as many can cause myelosuppression,
which is a decrease in all three cell lines. Common medications that can cause
myleosuppression include Dilantin (phenytoin), some antibiotics, and chemothera-
peutic alkalyating agents. Medications like aspirin, clopidogrel (Plavix), and ibuprofen
(Advil) can decrease platelet function.

Inspection

First, a generalized inspection of the skin is needed. An overall pale color can
signify loss of hemoglobin. Jaundice of the skin and eyes can signify an inability
of the liver to reuse bilirubin from older, spent RBCs. Does the patient have
petechiae—small, pinpoint hemorrhages seen in platelet dysfunction? Are there
bruises or hematoma formations? These would indicate bleeding into larger areas.