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U MODES PEU Find Im Case Study, Chapter 32 Assessment of Hematologic Function and Treatment Modalities 1. William Smith, a 76-year-old man, was admitted to the hospital with anemia. The physician informs Mr. Smith that it is necessary to perform a bone marrow aspiration to assess the formation of the blood cells. The physician explains the procedure to the patient, including the risks, benefits, and alternatives. An informed consentis obtained. (Learning Objective 4) a. How should the nurse prepare the patient for the procedure? b. What instructions should the nurse provide to the patient after the procedure? 2. Cindy Johnston, 65 years of age, is scheduled to have a right total knee replacement next week. She is at the pretesting clinic having the preoperative testing completed. The orders include: CBC, comprehensive metabolic panel, urinalysis, type and cross match for 2 units of PRBCs, chest X-ray, and ECG. Mrs. Johnston asks if she can donate her own blood for the procedure. (Leaming Objective 5) GIVE FEEDBACK TO MICROSOFT Announcements

Answer 1

BONE MARROW ASPIRATION

Definition:

Is a procedure performed by the doctor where a special needle is inserted into the bone marrow to obtain bone marrow tissue specimen  

Site: soft tissue from the medullary canal of long bone (femur, tibia, and humerus) and interstices of cancellous bone (sternum, rib, pelvis)

Purposes

ü To diagnosis/ staging of diseases like Leukemia, Multiple myeloma , Lymphoma , Anemia Thrombocytopenia, Pancytopenia

ü To monitor the development of hemolytic disease and respond towards the treatment given.

ü To obtain more information on hematopoiesis.

NURSES ROLE IN BONE MARROW ASPIRATION

• ASSESSMENT
• Check doctor’s order in progress note:
• Right client , Selected site for procedure Any pre-medication order ,Check for consent form is sign by doctor and client.
• Assess client’s: Lever of consciousness or restless, Ability to assume position required for procedure. Skin of procedure site , Vital sign .
• POSITION
• Iliac Crest ( posterial and superior part, client lie on lateral or prone position)
•  Sternum (2nd space of sternum)

PREPARE ENVIRONMENT

• Carbolised tray : Big tray with: • Disposable dressing set • Extra cotton balls and gauzes • 1 pair of sterile gloves • Face mask • 1 Fenestrated towel • Bone marrow aspiration needle with inner stylet •Cleansing solution (surgiacal spirit 70% and Povidone. • Lignocaine 1% or 2% • Syringes: 3ml×2, 5ml×2 and 20ml×2 • Needles: 18G×2 and 23G×2 • Heparin saline 5ml×2 • Elastoplast •
• Medication tray with prepared pre-medication drugs.
• Laboratory form according to type of test.

PRE-PROCEDURE

• Wash hand.
• Greet client and check ID tag.
• Explain procedure.
• Provide privacy.
• Adjust bed.
• Second nurse position client according to doctor’s chosen site for procedure.
• Expose insertion site and place sterilepad underneath.

open dressing set follow by all sterile items as per requirement needs. •

· Pour solution •

· Give assistant to doctor when necessary

· 2nd nurse observe client’s condition for difficulty in breathing or unbearable pain throughout the procedure.

· Maintain client in supine position and check client’s vital sign hourly for 4 hours.

· Make client comfortable

· Put up both cot side and place call bell within the client’s reach.

· Cleat trolley and wash hands.

· Document in nursing care plan.

Physical preparation •

· Make sure the doctor have obtain consent from client

• Provide clear explanation

• Make sure the puncture site has been cleaned

• check vital sign.

• Prepare equipments

· •Prepare trolley aseptically

· •Make sure equipments are complete

· Make sure laboratory technicians has been inform more earlier.( Technician must be present during procedure because aspirated bone marrow is smeared immediately on a glass slide.)

· Help client to remain in the right position

· ( Prepare the equipments and hold the client)

· Monitor vital signs during procedure to dectect complication.

POST PROCEDURE

· Monitor vital Signs

· Place the client in supine position and apply sandbag at the puncture site at least for 6 hours to prevent bleeding complication.

· Observe the pressure dressing is tight, clean and no signs of bleeding to prevent infection.

· Observe the client until their condition stable and recover.

· Keep the patient on bed rest for 30 to 60 minutes after the test.

· The patient to be NPO for several hours after the test to avoid nausea and vomiting.

· . Be aware that the complications to watch for from this procedure are hemorrhage, infection, symptoms of accidental puncture of the mediastinum and fracture and inadvertent puncture of the heart or any of the great vessels if the test was done on the sternum.