Haematological disorders involve pathologies of blood components, including red blood cells, white blood cells, platelets, and plasma proteins. The nursing process provides a systematic framework to address these complex conditions, moving from initial assessment to evaluation. In Nigerian clinical practice, nurses frequently encounter conditions like sickle cell anaemia, iron deficiency anaemia, and bleeding disorders due to infections or nutritional deficits. Applying the nursing process ensures individualized, structured care that reduces mortality and hospital stay duration.
Assessment forms the bedrock of haematological nursing. It begins with a thorough health history focusing on fatigue, bleeding tendencies, pain patterns, and dietary habits. Physical examination reveals subtle clinical indicators:
Accurate nursing diagnoses direct the path of haematological care. Common NANDA diagnoses for patients with blood disorders include:
Care planning requires SMART goals formulated alongside the patient and family. In resource-limited settings, realistic goal setting is vital. For instance, a goal for an anaemic patient might state that the patient will report a decrease in fatigue levels from severe to mild within 72 hours of receiving treatment. Goals must prioritize life-threatening risks, such as active bleeding or severe hypoxia, before addressing comfort measures.
Interventions must target the specific pathophysiological deficits identified during assessment. For anemia, nurses administer prescribed iron supplements, blood products, and encourage energy conservation by scheduling rest periods between activities. For bleeding disorders, nursing actions focus on trauma prevention: using soft toothbrushes, avoiding intramuscular injections, applying pressure to puncture sites for extended periods, and monitoring vital signs for early signs of hypovolemic shock.
Blood transfusions are common in haematology but carry serious risks. Nurses must verify patient identity, blood compatibility, and expiry dates with a second clinician before administration. Vital signs are recorded before starting, 15 minutes into the transfusion, and regularly thereafter. Common transfusion reactions include febrile non-haemolytic reactions, allergic responses, and life-threatening acute hemolytic reactions.
| Reaction Type | Key Symptoms | Immediate Nursing Action |
|---|---|---|
| Hemolytic | Back pain, fever, dark urine, hypotension | Stop transfusion, infuse normal saline, notify doctor |
| Allergic | Urticaria, pruritus, flushing | Slow transfusion, administer antihistamines as ordered |
| Circulatory Overload | Dyspnea, orthopnea, hypertension | Stop or slow transfusion, elevate head of bed, give diuretics |
Living with chronic blood disorders like sickle cell disease or hemophilia exacts a heavy psychological toll on patients and their families. Nurses provide education on recognizing warning signs such as sudden severe pain, fever, or uncontrolled bleeding. Psychosocial support involves linking patients with support groups, counseling families on coping mechanisms, and addressing social stigmas often attached to chronic illnesses in Nigerian communities.
Evaluation is the final step of the nursing process, where outcomes are compared against the goals set during the planning phase. The nurse assesses if haemoglobin levels have risen, if bleeding has ceased, or if the patient reports better pain control. If goals are unmet, the care plan is revised. For instance, if oral iron fails to raise haemoglobin due to malabsorption, the team may pivot to parenteral iron therapy.