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According to DeWit and Kumagai (2013), patients with hematological disorders are given wide spectrum of treatment while the most common hematological disorder is anemia. Nevertheless, ferrous sulfate that is given to address iron deficiency anemia can cause gastrointestinal disturbance like nausea and nurses should keep a check on constipation. According to Adams and Urban (2013), ferrous sulfate should be given in empty stomach. This drug can turn the stool color to black and nurses should make sure that the drug is not taken with milk because it reduces absorption from gut. Sustained release or enteric coated pellets should not be crushed and if intramuscular injection is chosen, septic technique should be preferred. Similarly for folic acid, nurses should keep in mind that it can potentiate effects of anti-convulsants while chloramphenicol can alter absorption of folic acid. Also, patients should be given foods rich in folic acid.
Vitamin B12 is also given in hematological disorders and its injection should be given subcutaneous or intramuscularly. If it is given through intravenous route, it can cause anaphylaxis. It should be kept in mind that its deficiency is more prevalent in strict vegetarians.
Hydroxyurea is given in sickling of red blood cells and it should be discontinued if white cell count is below 2500 per cubic millimeter or when platelet is below 100,000 per cubic millimeter. It can cause gastrointestinal upset like vomiting and diarrhea.
Biological erythropoietin analogues are also used in patients having anemia secondary to chemotherapy or in chronic systemic diseases. It can be used to increase red cell count as preparation to autologous blood transfusion prior to a surgery. According to LeMone, Burke and Bauldoff (2011), patinets receiving erythropoietin should have sufficient iron stores therefore nurses should evaluate iron levels and initiate iron administration if necessary. Filgrastim is neutrophil growth enhancer is also used but prior to its administration, a complete blood count with differentiated leukocyte count should be ordered and shall be repeated two times per week till therapy lasts. Constant monitoring of blood pressure should also be done because it can cause a transient increase. Pegfilgrastim is also a neutrophil enhancer within bone marrow and it also increases bone marrow activity.
References
Adams, M., & Urban, C. (2013). Pharmacology; Connections to Nursing Practice (2nd Edition). Boston: Pearson.
DeWit, S., & Kumagai, C. (2013). Medical-surgical nursing(2nd Edition). St. Louis, Missouri: Elsevier.
LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-surgical nursing. Upper Saddle River, N.J.: Pearson.
