NCLEX-PN · Physiological Adaptation · 8 min read
Sepsis, Shock, Anaphylaxis and Blood Disorders
- Differentiate the clinical findings and nursing actions for common red blood cell, white blood cell, and coagulation disorders within the practical nursing scope of practice.
- Recognize the early signs of systemic infection, sepsis, and various shock states to support prompt data collection, hemodynamic monitoring, and urgent reporting to the registered nurse.
- Identify life-threatening manifestations of acute anaphylaxis and describe the practical nurse's role in immediate emergency response, medication reinforcement, and client safety.
Hematologic Disorders: Anemias and Bone Marrow Failure
Anemia is an alteration characterized by a reduction in red blood cells, hemoglobin, or hematocrit. Because red blood cells transport oxygen throughout the body, any significant drop in these components leads to a decreased oxygen-carrying capacity of the blood. Think of red blood cells as delivery vehicles; when the fleet is reduced, vital tissues receive less oxygen. As a result, the practical nurse collecting clinical data commonly identifies findings such as fatigue, pallor, tachycardia, tachypnea, and exertional dyspnea as the body works harder to circulate available oxygen.
When oral iron supplements are prescribed to address deficiency, the practical nurse reinforces key teaching points to ensure proper absorption and minimize discomfort. Clients should be taught that oral iron is best absorbed on an empty stomach and when taken with vitamin C. Liquid oral iron preparations can cause extrinsic staining of the teeth, so the practical nurse reinforces taking the liquid through a straw and rinsing the mouth immediately afterward. The practical nurse reinforces that oral iron commonly darkens stools, but black, tarry stools or other signs of gastrointestinal bleeding must be reported because taking iron does not rule out bleeding.
Specific forms of anemia arise from distinct underlying causes. Pernicious anemia results from a deficiency of intrinsic factor, which is normally secreted by gastric parietal cells; without intrinsic factor, the intestinal absorption of vitamin B12 is severely impaired. The practical nurse watches for characteristic manifestations of vitamin B12 deficiency, which include a beefy red tongue, peripheral paresthesias, and an unsteady gait. In contrast, aplastic anemia involves bone marrow failure that produces pancytopenia: a simultaneous reduction in red blood cells, white blood cells, and platelets. The practical nurse performs focused checks for fatigue, infection risks, and bleeding tendencies associated with this marrow suppression and reports all findings to the registered nurse.
Common mistakes
- Assuming antihistamines or corticosteroids can be given in place of epinephrine during anaphylaxis, whereas intramuscular epinephrine into the anterolateral mid-thigh is the sole first-line medication.
- Delaying broad-spectrum antibiotic administration significantly while waiting to obtain prescribed blood cultures, or administering antibiotics before collecting cultures when collection could have been performed promptly.
- Giving an unindicated rapid intravenous fluid bolus in cardiogenic shock can worsen pulmonary congestion; selected clients may need cautiously administered fluids under a specific order and close monitoring.
- Assuming that clinical signs of petechiae, purpura, or ecchymoses identify a specific numerical platelet count rather than serving as general physical indicators of bleeding risk that must be reported to the RN.
Key points
- Anemia decreases oxygen-carrying capacity; practical nurses reinforce taking oral iron on an empty stomach with vitamin C, using a straw for liquid iron to prevent tooth staining, and expecting dark green or black stools.
- Pernicious anemia stems from gastric parietal cell intrinsic factor deficiency causing vitamin B12 malabsorption (beefy red tongue, paresthesias, unsteady gait), while aplastic anemia involves bone marrow failure causing pancytopenia.
- Bleeding precautions for thrombocytopenia include soft toothbrushes, electric razors, avoiding rectal thermometers, and avoiding intramuscular injections due to hematoma risks; clients with hemophilia must avoid aspirin and NSAIDs.
- Sepsis involves life-threatening organ dysfunction from a dysregulated response to infection; prescribed blood cultures should be collected before antibiotics if this does not substantially delay treatment, and septic shock may present with warm or cold peripheral findings.
- Shock types differ in hemodynamic presentation: hypovolemic shock presents with hypotension and tachycardia, cardiogenic shock presents with pump failure and crackles where rapid fluid boluses must be avoided, and neurogenic shock features hypotension with bradycardia.
- Acute anaphylaxis requires immediate cessation of triggering IV infusions, emergency notification, and first-line treatment with intramuscular epinephrine in the anterolateral mid-thigh, followed by extended observation for biphasic reactions.
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