Unit 2: Hematology, Immunology, and Oncology Health Alterations

2.1. Overview | 2.2. Video | 2.3. Unit Learning Outcomes | 2.4 Oncology | 2.5. Hematologic Disorders | 2.6 Mr. Elektrolite | 2.7 Immunodeficiency | 2.8 Allergic Disorders | 2.9. References

2.1 Overview

The focus of this unit is alterations in hematopoietic and immune system function. In part, this includes hematologic disorders and treatments, administration of blood products, immune system alterations, and oncologic nursing. Priorities for nursing care in this population include the lack of oxygenated blood flow, risk of hemorrhage, and hypersensitivity and allergic reactions.

The hematology system is different from other body system because "it encompasses the entire human body" (Paul et al., 2016). Blood disorders may be life-threatening with some having few or no symptoms. The nurse's knowledge of pathophysiology and laboratory value interpretation is important in the care of such patients. Generally, the nursing management of patients with hematologic and immune system disorders is focused on activity intolerance, ineffective tissue perfusion, and effective or ineffective patient therapeutic regime management. In addition, it is imperative that nurses understand procedures for safe administration of blood and blood products.

The immune system defends the body against invading microorganisms, parasites, cancer cells and transplanted tissues (Delves, 2017). Foreign substances the body considers harmful are called antigens and stimulate an immune response (Delves, 2017). An allergy (or hypersensitivity) occurs when the immune system generates an exaggerated response to a foreign substance that for a non-allergic person the body considers harmless (Paul et al., 2016). These allergy-producing substances are allergens such as dust, mould, foods or medications. Responses to allergens range from minor irritations such as rhinitis to anaphylactic reactions (World Allergy Organization, 2018). Nursing care focuses on assisting patients to live with the allergy including managing exposure and planning treatment.

Cancer affects many people of all ages. There are various factors associated with cancer as well as a multitude of treatments and prognoses. The scope of practice of cancer nursing practice or oncology nursing is far-reaching and complex. Oncology nurses need to face their own values and beliefs regarding the nursing management of cancer as well as help patients, families and communities deal with the various stages and situations in cancer care.

On Being a Cancer Nurse

Every day you fight a battle against
physical, emotional, and spiritual collapse
yours and your patients.
Each day is infused with an intensity,
A sense of urgency.
Waves of emotion wash over you
as you move from situation to situation.
At first you are never sure if
the next experience might be the big one,
the one that overwhelms you.
Eventually you find that from each
encounter you emerge stronger,
more sure of your abilities,
confident enough to carry on for the next day,
and probably the day after that.
(Perry, 2009, p. 200)

2.2 A Personal Story Video

2.3 Unit Learning Outcomes

After completing Unit 2, you will be able to

2.4 Oncology: Nursing Management in Cancer Care

Ensure at a minimum you understand

Learning Activities

  1. Review the chapter in the course textbook about nursing management in cancer care including predisposing factors, causes, and treatments for cancer. 
  2. Review the various Student Resources related to the text book in thePoint®
  3. Reflection Moment: Reflect on the role of an RN when caring for a newly diagnosed cancer patient. How do you think your care could be different? Write your reflections in a journal or post a narrative/video to the Unit 2 Forum.
  4. Focus on Nursing Interventions: Review your knowledge related to Central Venous Access Devices (CVADs). What have you learned from your work experience? Review the CVAD’s in the course textbook, and your agency's clinical practice guidelines about the management of various CVADs.

Supplemental Learning Activities

2.5 Assessment and Management of Patients with Hematologic Disorders

Ensure at a minimum you understand:

Learning Activities

  1. Review the chapter in the course textbook on the assessment and management of patients with hematologic disorders.
  2. Focus on Nursing Interventions: Review and complete the Alberta Health Services Professional Development Resource on Transfusion of Blood and Blood Products. For additional information on use of blood products review the current Blood Transfusion Policy and Procedure Manual of the agency where you work.
  3. Play the Blood Typing Game here!
  4. Reflection Moment: What are the different ways an RN can function as part of the health care team in the care of patients with hematological disorders? Write your reflections in a journal, post in the Unit 2 Forum, or share a clinical story with your peers. 
  5. Medication Math Moments: Work through the following case scenario of Mr. Elektrolite. You are his nurse.

Supplemental Learning Activities

2.6 Mr. Elektrolite

Refer to the Alberta Health Services Professional Development Resource on Transfusion of Blood Components and Blood Products to help you answer some of the questions.

Mr. Elektrolite is a 67 year old male admitted to your unit with congestive heart failure. Relevant past medical history includes anterior ST-segment elevation myocardial infarction (STEMI) two years ago, gastro esophageal reflux disease (GERD), and gout in his right toe. Today, Mr. Elektrolite will receive 2 units of packed red blood cells (PRBC) with an IV furosemide 40 mg in between the units. You are going to initiate the 1st packed red blood cell infusion as soon as your colleague brings it to the unit.

Complete the following questions. Include the units of measurement in your answers. You may use a basic calculator only.
*Review the Medication Safety and Calculation Module if you are unsure how to answer the math questions. To see the answer, drag your cursor between the arrows.

What are some initial checks and assessments prior to the start of the infusion?

Informed consent signed, baseline vital signs, baseline physical assessment, patient wearing Transfusion Service Identification Number (TSIN), prescriber's order, confirm patient teaching completed, previous patient adverse effects, ensure the patient has appropriate IV access

The 1st unit of packed red blood cells has arrived. How do you proceed with the safety checks prior to the initiation of the blood product?

Ensure you have an IV pump and accurate blood tubing, have a second health care professional with you, check the blood product against the prescriber's order, go to the patient bedside, identify the patient using at least 2 identifiers, with your colleague check the bag label against the bag ensuring all components match, then check the label against the patient ID band and TSIN band, both health care professionals sign the label

You are ready to initiate the transfusion. The packed red blood cell unit has a total volume of 350 mL. How much maximum time do you have from the time of pick-up of the PRBCs to the end of the infusion?

4 hours

You decide to begin the infusion at a slower rate of 50 mL/hr via the IV infusion pump for the first 15 minutes of the infusion. How much volume (mL) is left in the bag at the end of the 15 minutes?

337.5 mL The total volume is 350 mL, and in 15 minutes (at a flow rate of 50 mL/hr) 12.5 mL will have infused.  this leaves 337.5 mL remaining in the bag.
50mL  = x mL       = 50 mL x 15 mins = x mL x 60 mins
60 mins  15 mins
X = 750 mL.mins    = 12.5 mL will be infused in 15 mins
60 mL.mins
Volume left in bag = 350 mL – 12.5 mL = 337.5 mL

You only have 3 hours left to complete the infusion of the first unit of blood cells. What will be the flow rate (mL/hr) that you will program into the IV pump (use the volume remaining in question 4). Round to the nearest whole number.

113 mL/hr   337.5 mL divided by 3 hours = 113 mL/hr
337.5 mL/3hrs = 112.5 mL/hr = 113mL/hr

After the initiation of the PRBC unit, when will you check the patient's vital signs? You have already completed the baseline vital signs.

After 15 minutes of the infusion, every hour during the infusion, at the end of the infusion and as needed

What is most important nursing action when a patient begins experiencing some form of adverse effects during the infusion?

Stop the infusion!

The 1st unit of PRBCs has infused. You plan to infuse the IV furosemide over 30 minutes. You have prepared the furosemide in a 50 mL mini-bag. What flow rate (mL/hr) would you program into the IV pump?

100 mL/hr To infuse 50 mL of fluid in half hour, the rate is 100 mL/hour.
50 mL = 1 hr   = 3000 mins.mL = 30mins.hr =>  100mL/hr
30mins  60 mins

 

Learning Activities

Supplemental Learning Activities

  1. View the following video about the Coagulation Cascade.
  2. Think about the various anticoagulant drug therapies and where they would act on the coagulation cascade (ex: low molecular weight heparins; warfarin sodium; antiplatelet aggregators etc.) Write your reflections in a journal or post in the Unit 2 Forum.

2.7 Assessment of Immune Function & Management of Patients with Immunodeficiency

Ensure at a minimum you understand:

Learning Activities

Supplemental Learning Activities

2.8 Assessment and Management of Patients with Allergic Disorders

Ensure at a minimum you understand

Learning Activities

Supplemental Learning Activities

2.9 References

Alberta Health Services. (2017, January). Professional development: Transfusion of blood components and products. https://www.albertahealthservices.ca/assets/wf/lab/wf-lab-clin-tm-manual-lm.pdf

Alberta Health Services. (2022, February). Policy: Transfusion of blood components and products. https://extranet.ahsnet.ca/teams/policydocuments/1/clp-prov-transfusion-blood-product-policy-ps-59.pdf

Carson, V. [Vicena19]. (2013, February). Nursing care of patients with altered immunity. Quizlet. https://quizlet.com/20154388/nursing-care-of-patients-with-altered-immunity-flash-cards/

Delves, P. (2021, September). Overview of the immune system. Merk Manual Professional Version. https://www.merckmanuals.com/professional/immunology-allergic-disorders/biology-of-the-immune-system/overview-of-the-immune-system

Mannarino, I. (n.d.). Anaphylactic shock. [Video]. Khan Academy. https://www.khanacademy.org/science/health-and-medicine/circulatory-system-diseases/shock/v/anaphylactic-shock

Mannarino, I. (n.d.). What is shock? [Video]. Khan Academy. https://www.khanacademy.org/science/health-and-medicine/circulatory-system-diseases/shock/v/what-is-shock

Merck Manual Consumer Version. (n.d.). Cancer. https://www.merckmanuals.com/home/cancer

The Nobel Prize. (2022) The blood typing game. https://www.nobelprize.org/educational/medicine/bloodtypinggame/index.html

Paul, P., Day, R.A., & Williams, B. (2016). Brunner and Suddarth's Canadian textbook of medical-surgical nursing (3rd ed.). Philadelphia, PA: Wolters Kluwer.

Shanejpb. (2015, June 8). AIDS and the human immunodeficiency virus (HIV). Study Stack. https://www.studystack.com/flashcard-848597

Shanejpb. (2015, May 26). Immune system. Study Stack. https://www.studystack.com/flashcard-Car845365

Van Nieuwehuizen, P. (n.d.). Coagulation cascade. [Video]. Khan Academy. https://www.khanacademy.org/science/health-and-medicine/advanced-hematologic-system/hematologic-system-introduction/v/coagulation-cascade

World Allergy Organization. (2023). Allergic Disease Resource Center. http://www.worldallergy.org/adrc/

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