Altered Tissue Perfusion related to Pancytopenia

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Nursing Care Plan for Pancytopenia

Aplastic anemia is a hematological disorder characterized by a decrease in peripheral blood cellular components caused by the failure of production in the bone marrow. In this situation the number of blood cells produced inadequate. Patients experiencing pancytopenia, ie a situation where there is a shortage of red blood cells, white blood cells, and platelets.

Aplastic anemia is a bone marrow failure syndrome that is characterized by peripheral pancytopenia and bone marrow hypoplasia. In aplastic anemia decreased production of blood cells from the bone marrow, causing reticulocytopenia, anemia, granulocytopenia, monocyitopenia, and thrombocytopenia. The term aplastic anemia is often also used to describe or even pancytopenia refractory anemia from any cause.

Nursing Diagnosis and Interventions for Pancytopenia

Altered Tissue Perfusion related to a decrease in cellular components required for the delivery of oxygen / nutrients to the cells.

Goal: indicates adequate perfusion

Expected outcomes:
  • Vital signs are stable.
  • Pink mucous membranes.
  • Capillary refill.
  • Adequate urine output.
Intervention and Rationale :

1) Measure vital signs, observation capillary refill, color of skin / mucous membranes, nail beds.
R /: Provides information about the adequacy of tissue perfusion and help needs intervention.

2) Auscultation of breath sounds.
R /: Dyspnea, gurgling shows CHF as long heart strain / compensatory increase in cardiac output.

3) Observation complaints of chest pain, palpitations.
R /: Ischemia cell, affecting myocardial tissue / potential risk of infarction.

4) Evaluation slowed verbal response, agitation, memory impairment, confusion.
R /: May indicate cerebral perfusion disturbances due to hypoxia

5) Evaluation of complaints of cold, keep the ambient temperature and the body to keep warm.
R /: vasoconstriction (to vital organs) lowers peripheral circulation.

Collaboration
6) Observation results of laboratory tests Complete blood.
R /: Identify deficiencies and needs treatment / response to therapy.

7) Provide a complete blood transfusion / packed as indicated.
R /: Increase the number of oxygen-carrying cells, improve the deficiency to reduce the risk of bleeding.

8) Give oxygen as indicated.
R /: Maximizing oxygen transport to the tissues.

9) Prepare the surgical intervention as indicated.
R /: Bone marrow transplant performed on bone marrow failure / aplastic anemia.

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