nurse's notes

CHRONIC GRANULOCYTIC LEUKEMIA - characterized by white cell count rangin from 100,000- 1,000,000 per cu. mm. High percentage of this leukocytes are immature cells and associated with enlargement of the spleen and the liver but little swelling of the lymph nodes. Occur in the ages between 25 and 40 years old.

SIGNS AND SYMPTOMS:

• complain of the dragging sensation of the weight of the organ due to tumor of the spleen in the abdomen.
• painful and tender on pressure of long bones ( tibia, ribs, sternum)

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CHRONIC LYMPHATIC LEUKEMIA-

• characterized by by a greatky increased leukocytes count, over 90 percent of cells being mature lymphocytes.
• occur between ages 45-60 years old

SIGNS AND SYMPTOMS:

• generalyzed lymph nodes enlargement
• development of anemia, fever,cachexia
• hemorrhagic features

NURSING MANAGEMENT:

• assist the patient to accept and participate in the therapeutic regimen as effectively as possible
• control pain (sedatives as needed)
• nausea and vomitting- offer ice chips, anti-emetic drug-(per doctor's order) be given half hour before meal , small bland feeding
  
• oral fluid intake to prevent precipitation of uric acid and crystals in the kidney
• combat infection
• frequent mouth care- to remove old dried blood and combat mouth odor
• use cotton applicator instead of toothbrush to prevent gum irritation or trauma
• gentle cleaning of nostrils
• application of petroleum jelly on the lips to prevent from drying and cracking
• diet should be soft to reduce mechanical irritation of the gums
• evidence of infection ( fever-chills , skin lesions) should be promptly reported
• handle patient gently to prevent trauma
• close observation of the body orifice and skin for signs of bleeding
• place patient in bed when administering transfusion and steroids
• observed proper technique of administering blood transfusion
• demonstration of the nurse's concern for the welfare, does much to comfort the patient
  

APLASTIC ANEMIA- disorder characterized by hyperplasia or aplasia (failure) resulting of bone marrow depression or destruction

CAUSES:

• drug or chemical or the result of radiation damaged
• caused by agents produced by marrow aplasia such as benzene derivatives, anti tumor agents
• agents responsible for aplasia such as anti-convulsant, anti microbials, anti thyroids, antidiabetic, anti histamine, analgesics, sedatives, insecticides or heavy metal
• toxic materials such as inorganic arsenic
• viral infections especially hepatitis
  

SIGNS AND SYMPTOMS:
1. abnormal bleeding resulting from thrombocytopenia

• bleeding from gums, nose, gastrointestinal tract and genitourinary tract
• purpura, petechiae, ecchymoses

2. anemia- resulting from depression of hemoglobin

• pallor, weakness
• exertional dyspnea, palpitations

3. infection with high fever- resulting from granulocytopenia

• pharyngitis and oropharyngeal mucositis
• sepsis via gastrointestinal tract or genitourinary tract

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ANEMIA OF CHRONIC DISEASE (RELATIVE MARROW FAILURE)-

• an aregenerative anemia of intrinsic origin occurs in patient with chronic infection
• an anemia with inflammatory states such as rheumatoid arthritis and with neoplastic disease of all types.
• failure of red blood cell production and medication of all types are ineffective in correcting anemia until the infection or inflammatory process has been controlled or the tumor eradicated
  

AREGENERATIVE ANEMIA- failure by the bone marrow to release new red cells at a rate sufficient to maintain the red cell count and hemoglobin concentration at normal levels


PREDISPOSING FACTORS that causes:

• result from physical injury to the bone marrow such as occationally occurs in chronic exposure to x-ray or radioactive materials
• caused by mechanical interference with blood formation encountered in leukemia, plasmona, myeloma, hodgekin disease of bone marrow
• physical injury to the bone marrow- occurs in chronic exposure to x ray or radioactive materials
• bone marrow fibrosis -unknown cause
  

FOLATE DEFICIENCY- nutritional macrocytic anemia caused by folate deficiency


CAUSES:

• inadequate food intake
• surgery
• pregnancy
• lactation
• chronic liver disease
• long term use of anti-convulsion drugs which interfere folate absorption

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IRON DEFICIENCY ANEMIA- iron deficit in which the blood hemoglobin and the red blood cell count are below normal level



CAUSES:

• failure of the patient to ingest or absorb sufficient dietary iron to compensate for the iron requirement
• loss of iron due to bleeding such as gastrointestinal bleeding, excessive menstrual flow
• due to increase of iron requirement during pregnancy and menstruation

SYMPTOMS:
for mild anemia-

• limited pallor
• fatigue
• dyspnea- difficulty of bleeding

for severe anemia-

• hemoglobin count result is below 8 gm. per 100 ml (12 gm. normal hemoglobin count)
  
• weakness
• fatigability
• breathlessness
• cardiac palpitation
• sore of the tongue
• nail brittle-spoon shaped

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PERNICIOUS ANEMIA - vitamin B 12 deficiency

CAUSE : when there is defect in the gastric secretory function responsible for vitamin B 12 absorption

SIGNS AND SYMPTOMS:
1. physical weakness

• pallor
  
• dyspnea- difficulty of breathing
• orthopnea- ability to breath only when in upright position like sitting or standing
• palpitation
• edema of the legs- (edema- presence of excess fluid )

2. Gastrointestinal Symptom:

• sore in the mouth with smooth red beefy tongue (glossitis)
  
• loss of appetite
• indigestion
• abdominal pain
• recurring diarrhea and constipation

3. neurologic symptoms if untreated:

• tingling
• numbness or burning pains
• loss of position sense leading to disturbance of gait
  

4.psychiatric symptoms:

• depression
• paranoea
• delirium
• anorexia
• weight loss

PULMONARY TUBERCULOSIS-

• an infectious disease caused by mycobacterium tubercolosis
• caused by bacteria that spread from person to person through air
• an airborne disease transmitted by droplet secretion from the respiratory tract of an infected person during coughing, sneezing, talking, or singing
• acquired by a person who is in close contact with someone who has infectious tuberculosis
• acquired by a person with declining immunity such as HIV positive
• persons prone are those homeless , or on poverty
  

SIGNS AND SYMPTOMS:

• losing weight
• fatigue in the afternoon
• pale
• cough
• anorexia- (lack of appetite)
• indigestion
• abdominal pain
• vomiting
• sputum increases
• afternoon fever
• night sweats
• if progresses-rapid loss of weight and strength
• hemoptysis- ( presence of blood in the sputum due to hemorrhage from lung )

MANAGEMENT:

• physical, mental, emotional rest
• anti-tuberculous therapy
• proper nutrition
  

RESPIRATORY FAILURE - exist whenever the exchange of oxygen and carbon dioxide in the lungs accommodate with the body tissue metabolic rate of the oxygen consumption and carbon dioxide production.

HYPOXEMIA-lack of oxygen in the blood

HYPERCAPNEA- - accumulation of carbon dioxide in the blood


SIGNS AND SYMPTOMS:

• cyanosis-bluish discoloration of the skin, nail beds and mucous membrane caused by reduce oxygen in the blood
  
• tachycardia- abnormally rapid pulse rate, more than 1oo beats per minute
  
• bradycardia-abnormally slow pulse rate, lees than 60 beats per minute
• hypotension- low blood pressure
• dyspnea- difficulty of breathing or labored breathing
  
• restlessness
• irritable
• coma

PREVENTION:

• pre-oprerative preventive measure as the administration of aerosol, intermittent positive pressure breathing
• prequent repositioning of patient when he is in prolonged stay in bed
• respiratory therapy: maintaining clear airway, humidity and nebulization therapy, oxygen therapy
  

LUNG CANCER- tumors of the lung arising within the walls or epithelial lining of the bronchus


PRE-DISPOSING CAUSES:

• excessive smoking
• occupational exposure to asbestos, arsenic, chromium, nickle, iron, radioactive substances, coal tar products, petroleum oil mist,
  

SIGNS AND SYMPTOMS:

• hacking non-productive cough
• wheezing in the chest noted
• spitting of blood or blood streaks in the sputum
• fever due to infection like pneumonitis
• malaise
• weight loss
• fatigue
• anorexia
• chest pain
• dyspnea (difficulty of breathing)-due to partial bronchial obstruction
• symptoms of metastases like bone pain, abdominal discomfort, nausea and vomiting from liver involvement

• lobectomy-removal of one lobe
• pneumonectomy-removal of entire lung

NURSING MANAGEMENT:

• assist patient to undergo diagnostic procedure
• prevention of further extension to upper respiratory tract infection
• physical and emotional support
• teach patient the advantage of frequent exercises after operation
• providing supportive and rehabilitative measures
  

BRONCHIOGENIC CARCINOMA -

• malignant carcinoma of the bronchiols
• causing bleeding and bronchial obstruction
• spreads to involves other tissue of the lungs
• notably lymph nodes in the neck, liver,adrenal glands and the bones
  

POLMUNARY EMBOLISM -

• refers to lodgement in one or more polmunary arteries of a thrombus or thrombi from venous system or in the heart
• presence of thrombus will interrupt blood supply so, it may cause infarction of lung tissue

SIGNS AND SYMPTOMS: of Polmunary emboli

• sudden substernal pain
• dyspnea (difficulty of breathing)
  
• rapid and weak pulse shock
• syncope
• sudden death
  

SIGNS of Polmunary arteries are obstructed:

• dyspnea (difficulty of breathing)
  
• mild substernal pain
• weakness
  
• tachycardia ( abnormal rapid pulse rate)
  
• fever
  
• cough
• hemoptysis (presence of blood in the sputum)
  

PREDISPOSING CAUSES:

Immobilization- produces slowing of blood flow can produce a thrombus . Thus polmunary embolism is always a danger in :

• patient after surgery
• obstetrical delivery
• prolonged bedrest
• aged individual who are inactive
• patient with congestive heart failure or with atrial fibrillation

MANAGEMENT:
1. prevent venous stagnation -

• patient on bed should be encourage an early ambulation or ambulate if possible according to his condition
• passive leg exercises
• deep breathing exercises

2. If large obstructing embolus should always ready for emergency therapy to combat shock, hypoxia and heart failure

3. patient be guarded for symptoms of cardiac arrest





my nursing notes
reference: medical-surgical nursing book

BRONCHIECTASIS -

• permanent dilatation of one or more several bronchi
• due to weakening of the bronchial walls by chronic infection

SIGNS AND SYMPTOMS:

• chronic cough with foul sputum
• clubbing of fingers
• loss weight
• hemoptysis (presence of blood in the sputum)
  

'PREVENTION :

• avoidance of pertussis and be accomplished by prophylactic immunization in childhood
• treatment of chronic bronchitis because progression of this disease will cause bronchiectasis
  
• successful treatment of pneumonia

my nursing notes
reference: medical-surgical nursing book

LUNG ABSCESS -localized necrotic lesion characterized by cavity formation

ETIOLOGY:

• aspiration of foreign body into lung
• bacterial pneumonia
• tuberculosis

SIGNS AND SYMPTOMS:

• fever
• malaise
  
• cough
• if severe - productive cough with sputum both purulent and foul
  
• clubbing of the finger

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PLEURAL EFFUSION - collection of fluid in the pleural space

Signs and Symptoms of tuberculous pleurisy or due to infections by other organisms

• pale
  
• shortness of breath
• loss of weight
• body weakness
  
• easily fatigue
• slight dry cough
• fever
• dyspnea

Diagnostic Test:

• X ray
• Thoracentesis- aspiration of fluid for culture and bacteriologic media an for carcinoma study

Nursing Care:

• keep bed rest
• Encouraged highly nutritious foods
  
• prepare patient mentally and physically for thoracentesis
• assist physician for the procedure

Reference: Medical-Surgical Nursing Book and My nursing notes

PLEURISY -is the inflammation of the pleura

Condition in which Pleurisy develop at the onset or during :

• pneumonia
• tuberculosis
• after trauma to the chest
• pulmonary infarction, embolism

Diagnostic Test:

• X ray
• sputum exam
• pleural biopsy
• examination of fluid from thoracentesis for culture and smear

Signs and Symptoms:

• chest pain- sharp and knife like pain on inspiration
• fever-
  
• malaise

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Nursing Measures:

• Bed rest
• implement nursing measures for the underlying cause of pleurisy
• instruct to lie on the affected side to support the chest wall
• analgesic as per doctors order for pain
  
• watch for the signs of development of pleural effusion
  

VIRAL PNEUMONIA - acquired through the spread of infected respiratory droplet from person to person contact

SIGNS AND SYMPTOMS:

• harassing non-productive cough
• mucoid or mucopurulent sputum expectorated
• headache
• malaise
• chilliness
• fatigue

Nursing Cares:

• promotes rest and comfort
• same as bacterial pneumonia

reference: medical-surgical nursing book and my nursing notes