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.
NCLEX
Concepts Covered:
- Cardiovascular
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Circulatory System
- Nervous System
- Skeletal System
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System