Competency
Describe nursing care interventions for clients with hematological disorders.
Instructions
Read the following Scenarios and answer the questions that follow. Make sure you cite any sources using APA format.
Scenario # 1
You are sent to the medical ICU to help out because there were several sick calls. You are instructed by the charge nurse to take vital signs on all of the clients in the 12-bed unit. You are just completing your rounds when a call bell goes off in room three. The client in room three is recovering from septic shock but has been stable for the past 48 hours. The client is awake and requesting ice chips. As you lean over to grab his pitcher, you notice blood oozing from two IV sites on his left arm. The Foley catheter has tea-colored urine, and the client’s central line in his chest has blood oozing from the site.
Question # 1: What in the data collection should be reported to the RN immediately? Why? (5-10 sentences)
Question # 2: What items in the client’s history are risk factors for DIC? (2-3 sentences)
Scenario # 2
You are working in the genetics clinic of a large medical center. Your first client of the day has a history of hemophilia A (factor VIII deficiency). The client came to the clinic for evaluation of right knee pain. He denies any history of trauma and states the pain began last night, worsening ever since. His pain is a 7/10.
Question # 3: Should the nurse be concerned about the client’s knee pain? Why or why not? (5-10 sentences)
Question # 4: Why are the vast majority of clients with hemophilia male? (5-10 sentences)
Scenario # 3
You are working in a small community emergency room when you receive a client complaining of severe pain (10/10) to her arms and chest. The pain began one hour ago. The client is known to have sickle cell disease.
Question # 5: What is the priority nursing intervention for this client? Explain your answer. (3-5 sentences)
Format
- Standard American English (correct grammar, punctuation, etc.)
- Logical, original and insightful
- Professional organization, style, and mechanics in APA format
- Submit document through Grammarly to correct errors before submission.
Resources
APA Online Guide
Question #1: In the given scenario, several concerning signs indicate a potential deterioration in the client’s condition, warranting immediate reporting to the RN. Firstly, blood oozing from the IV sites suggests possible clotting issues or compromised vascular integrity, which could lead to further complications such as infection or hemorrhage. Secondly, tea-colored urine in the Foley catheter indicates potential renal impairment or hematuria, which could be indicative of disseminated intravascular coagulation (DIC), a serious complication of sepsis. Lastly, blood oozing from the central line site raises concerns about central line-associated bloodstream infections (CLABSI) or vascular damage, requiring prompt assessment and intervention to prevent septicemia or further complications. Timely reporting of these findings is crucial to ensure prompt intervention and prevent deterioration of the client’s condition.
Question #2: Several items in the client’s history are potential risk factors for DIC, including the presence of septic shock, which can trigger systemic inflammatory responses leading to coagulopathy. Additionally, the client’s need for invasive interventions such as IV lines and Foley catheter increases the risk of infection and subsequent DIC development. Other factors such as underlying comorbidities, history of recent surgery, or trauma may also contribute to DIC risk by further exacerbating the inflammatory response and disrupting hemostasis.
Question #3: The nurse should be highly concerned about the client’s knee pain, considering his history of hemophilia A. Hemophilia A is characterized by deficient or defective factor VIII, a crucial clotting factor necessary for hemostasis. Even minor trauma or stress to the joints can result in bleeding episodes, leading to hemarthrosis, which presents as acute joint pain and swelling. In this case, the sudden onset and worsening of knee pain without a history of trauma strongly suggest a potential bleeding episode, requiring immediate assessment and intervention to prevent further joint damage and alleviate pain.
Question #4: The vast majority of clients with hemophilia are male due to the X-linked recessive pattern of inheritance associated with the disorder. Hemophilia is caused by mutations in genes located on the X chromosome, and males have only one X chromosome. Therefore, if a male inherits a defective X chromosome from his mother, he will develop hemophilia, as he lacks a second X chromosome to compensate for the defective gene. In contrast, females have two X chromosomes, providing a protective effect, as the normal gene on one X chromosome can compensate for the defective gene on the other, resulting in milder symptoms or carrier status.
Question #5: The priority nursing intervention for a client with sickle cell disease experiencing severe pain (10/10) to her arms and chest is to assess and manage pain effectively. Sickle cell disease is characterized by vaso-occlusive crises, during which sickle-shaped red blood cells obstruct blood flow, leading to tissue ischemia and severe pain. Prompt pain assessment using validated tools, administration of analgesics as prescribed, and non-pharmacological pain management strategies such as heat therapy or positioning to enhance comfort are essential interventions. Additionally, close monitoring for complications such as acute chest syndrome or respiratory distress is warranted, requiring collaborative care and timely interventions to optimize outcomes and alleviate suffering.
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