Editing Medical-Surgical Nursing (section)

== Hematologic and Immune Disorders ==

=== Anemias ===

Iron deficiency anemia produces fatigue, pallor, and a microcytic hypochromic picture. Teach that oral iron is best absorbed on an empty stomach and with a source of vitamin C, that it causes dark stools and constipation, and that liquid forms are taken through a straw to protect the teeth.

Pernicious anemia results from lack of intrinsic factor with vitamin B12 malabsorption and adds neurologic findings such as paresthesia, ataxia, and impaired proprioception. It requires lifelong parenteral or high-dose supplementation, because oral standard replacement alone does not correct the absorption defect.

Sickle cell disease causes red cells to sickle under hypoxia, dehydration, infection, cold exposure, acidosis, and stress, occluding vessels and causing vaso-occlusive crisis with severe pain, swelling, and organ ischemia. Nursing care in crisis is hydration, oxygen, aggressive analgesia including opioids, warmth, and rest. Never apply cold, which promotes further sickling, and avoid constrictive measures.

=== Neutropenia and Bleeding Precautions ===

Neutropenic precautions apply when the absolute neutrophil count is low. Practice strict hand hygiene, screen visitors for illness, avoid fresh flowers and standing water, avoid raw or undercooked foods per facility policy, avoid invasive procedures including rectal temperatures and suppositories, and treat fever as an emergency, because it may be the only sign of infection when the inflammatory response is blunted.

Bleeding precautions for thrombocytopenia include a soft toothbrush, an electric razor, no rectal procedures, no intramuscular injections when avoidable, prolonged pressure after venipuncture, fall prevention, and avoidance of aspirin and nonsteroidal anti-inflammatory drugs.

=== Transfusion Reactions ===

Verify the blood product and the patient with two qualified individuals per policy, use normal saline only as the compatible solution, use appropriate filtered tubing, start slowly, and remain with the patient for the first fifteen minutes, when most severe reactions occur. Take a baseline set of vital signs and repeat per policy.

If any reaction is suspected, stop the transfusion immediately, keep the line open with normal saline using new tubing, take vital signs, and notify the provider and the blood bank. Acute hemolytic reaction presents with fever, chills, low back or flank pain, hypotension, dark urine, and a sense of doom. Febrile nonhemolytic reaction presents with fever and chills. Allergic reaction presents with hives and itching, and anaphylaxis adds wheezing and hypotension. Transfusion-associated circulatory overload presents with dyspnea, crackles, hypertension, and distended neck veins.

=== Human Immunodeficiency Virus ===

Progressive depletion of CD4 T lymphocytes produces immunodeficiency and opportunistic infection. Antiretroviral therapy adherence is critical, because inconsistent dosing promotes resistance. Standard precautions protect the nurse; the patient may need protective measures against infection depending on the CD4 count. Report fever, new cough, oral lesions, changes in vision, headache, or unexplained weight loss.