Hematologic Disorders for Certified Emergency Nursing (CEN)
Included In This Lesson
Study Tools For Hematologic Disorders for Certified Emergency Nursing (CEN)
Outline
Hematologic Disorders:
Definition/Etiology:
- Anemia: Low red blood cells
- Sickle Cell Disease: defective hemoglobin molecules cause the RBCs to assume a “sickled shape”. Because of the shape these cells tend to clump together and cause an increased viscosity of the blood resulting in capillary obstruction.
- Hemophilia: Clotting disorder identified by a deficiency in factor VIII and factor IX.
Pathophysiology:
There are several pathos on several different disorders. I recommend you seek out the information on your own if you are interested. Some of the major ones you will see are congenital, like hemophilia and sickle cell disease, but something like anemia can be caused by a variety of factors including blood loss, or destruction of RBCs
Clinical Presentation:
Anemia:
- Fatigue
- DOE
- Dizziness
- Pallor
- Feeling cold
Sickle Cell Disease:
- Acute, severe pain – most common reason for ED visits
- Weakness due to anemia
- Pallor
- Jaundice from rapid breakdown of RBC
- Infections from splenic damage
Hemophilia:
- Brusing with minor injuries
- Bleeding into soft tissues, muscles, or joints with pain and swelling
- Paresthesia that progresses to nerve injury following a compressing hematoma
- Epistaxis
- Hematuria
- AMS from intracranial bleeding
- Shock from blood loss
Collaborative Management:
With anemia, our primary goal is to identify the cause and then treat it. We need a full panel of labs including a type and cross. We should anticipate fluids and possible blood transfusions. As there is a drop in HgB, which carries O2, you might want to think of giving them some.
In sickle cell crises, pain management is usually the first thing they need. It’s important to assess where their pain is. Is this simple joint pain, or is this acute chest syndrome. The complications from SCD are numerous and include chronic anemia, aplastic crisis, frequent infections, renal failure, pulmonary embolism, jaundice, blindness, and chronic skin ulcers. So yea…a pretty thorough assessment is necessary with these patients as well as a full panel of labs which would include a reticulocyte count. In treating, we want to rehydrate, treat infections, maintain a warm environment, and give blood if anemic.
With hemophilia, we want to delay the blood draw until IV factor replacement has been initiated. Then get a CBC, platelets, fibrinogen level and factor levels. We do not want to delay treatment as they can bleed out pretty easily. Remember to initiate factor VIII replacement even before diagnostics in known hemophiliacs. Once you perform a venipuncture, we want to apply pressure to the area for 3-5 minutes.
Evaluation | Patient Monitoring | Education:
- Anemia – well…the evaluation is simply if they are no longer anemic. So serial blood work is necessary, especially after treatment.
- In the sickle cell patient, continuous monitoring of their pain level will help to determine the extent of their crisis.
- With hemophilia, well…. Are they still bleeding? And while that may seem like a simple statement, thorough assessment is necessary. It’s not enough that we don’t see external bleeding, but we need to assess for signs of internal bleeding as well.
Linchpins: (Key Points)
- Blood work
- Hold on Hemo
- Treat underlying cause
Transcript
For more great CEN prep, got to the link below to purchase the “Emergency Nursing Examination Review” book by Dr. Laura Gasparis Vonfrolio RN, PHD
https://greatnurses.com/
References:
- Emergency Nurses Association. (2022). Emergency Nursing Orientation 3.0. Cambridge, MA: Elsevier, Inc.
- Sheehy, S. B., Hammond, B. B., & Zimmerman, P. G. (2013). Sheehy’s manual of emergency care (Vol. 7th Edition). St. Louis, MO: Elsevier/Mosby.
Tiona RN
Concepts Covered:
- Studying
- Medication Administration
- Adult
- Emergency Care of the Cardiac Patient
- Intraoperative Nursing
- Microbiology
- Cardiac Disorders
- Vascular Disorders
- Nervous System
- Upper GI Disorders
- Central Nervous System Disorders – Brain
- Immunological Disorders
- Fundamentals of Emergency Nursing
- Dosage Calculations
- Understanding Society
- Circulatory System
- Concepts of Pharmacology
- Hematologic Disorders
- Newborn Care
- Adulthood Growth and Development
- Disorders of Pancreas
- Postoperative Nursing
- Pregnancy Risks
- Neurological
- Postpartum Complications
- Noninfectious Respiratory Disorder
- Peripheral Nervous System Disorders
- Learning Pharmacology
- Prenatal Concepts
- Tissues and Glands
- Developmental Considerations
- Factors Influencing Community Health
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Developmental Theories
- Basic
- Neonatal
- Pediatric
- Gastrointestinal
- Newborn Complications
- Labor Complications
- Fetal Development
- Terminology
- Labor and Delivery
- Postpartum Care
- Communication
- Basics of Mathematics
- Statistics
- Basics of Sociology
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of the Thyroid & Parathyroid Glands
- Liver & Gallbladder Disorders
- Lower GI Disorders
- Respiratory
- Delegation
- Perioperative Nursing Roles
- Acute & Chronic Renal Disorders
- Respiratory Emergencies
- Disorders of the Adrenal Gland
- Documentation and Communication
- Preoperative Nursing
- Legal and Ethical Issues
- Oncology Disorders
- Female Reproductive Disorders
- Musculoskeletal Trauma
- Renal Disorders
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Integumentary Disorders
- Emergency Care of the Trauma Patient
- Urinary Disorders
- Musculoskeletal Disorders
- EENT Disorders
- Neurological Emergencies
- Disorders of Thermoregulation
- Neurological Trauma
- Basics of NCLEX
- Integumentary Important Points
- Multisystem
- Test Taking Strategies
- Urinary System
- Emergency Care of the Neurological Patient
- Central Nervous System Disorders – Spinal Cord
- Respiratory System
- Emergency Care of the Respiratory Patient
- Cognitive Disorders
- Anxiety Disorders
- Depressive Disorders
- Trauma-Stress Disorders
- Substance Abuse Disorders
- Bipolar Disorders
- Psychotic Disorders
- Concepts of Mental Health
- Eating Disorders
- Personality Disorders
- Health & Stress
- Psychological Emergencies
- Somatoform Disorders
- Prioritization
- Community Health Overview
- Gastrointestinal Disorders
- Integumentary Disorders
- Respiratory Disorders
- Neurologic and Cognitive Disorders
- Renal and Urinary Disorders
- Infectious Disease Disorders
- EENT Disorders
- Hematologic Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Endocrine and Metabolic Disorders
- Oncologic Disorders
- Behavior
- Emotions and Motivation
- Growth & Development
- Intelligence and Language
- Psychological Disorders
- State of Consciousness
- Note Taking
- Concepts of Population Health
- Basics of Human Biology