Nursing 211

N211: Health Differences Across the Lifespan I of 148 Supplemental iron is not given to clients with sickle cell anemia. The anemia is not caused by iron deficiency. Folic acid is given orally to stimulate red blood cell synthesis. 1.30 Polycythemia Polycythemia is a chronic myeloproliferative disorder characterized by increased red blood cells, leukocytosis, thrombocytosis and increased hemoglobin concentration. Polycythemia occurs between the ages of 40-60 to males of Jewish ancestry. The mortality is high if untreated. Nursing Assessments Includes: clubbing of the digits (cystic fibrosis), dizziness, headache, hypertension, ruddy cyanosis of the nose, thrombosis of smaller vessels, visual disturbances (blurring, diplopia, engorged veins of fundus and retina.) Medical treatment is phlebotomy (350-500ml removed every other day until the patient’s hematocrit is reduced to low-normal) or plasmapheresis. Drug treatment includes chemotherapy and myelosuppressive drugs and anti-gout agents (Allopurinol). Interventions include administering juice or water to replace fluid volume lost during procedure. 1.31 Disseminated Intravascular Coagulation (DIC) Disseminated Intravascular Coagulation (DIC) is a coagulation disorder with thrombosis and hemorrhage. DIC is an acute complication of diseases and conditions, such as hypertension and septicemia that accelerate clotting. DIC is suspected there is blood oozing from two or more unexpected sites. Accelerated clotting process caused depletion of circulating clotting factors and platelets which can provoke severe hemorrhage. The first phase involves abnormal clotting in the microcirculation, which uses up clotting factors and results in the inability to form clots, so hemorrhage occurs. Diagnostics Prolonged Prothrombin time (PT), greater than 15 seconds; prolonged partial Prothrombin time (PTT), greater than 60-80 seconds; decreased fibrinogen, less than 150mg/dl; decreased platelet count, less than 100,000 ul and increased fibrin degradation products (FDP), and a positive D-dimer test specific for DIC. Nursing Assessments Shows abnormal bleeding without history of serious hemorrhagic disorder, petecchiae, purpura, hematomas, oliguria, shock, oozing from IV sites, drains, gums and wounds; gastrointestinal and genitourinary bleeding, hemoptysis, mental status change, hypotension, tachycardia and severe muscle, back and abdominal pain. ©2012 Achieve Page 41