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Assessment of Hematologic Disorders - Physical Assessment
Assessment of Hematologic Disorders - Physical Assessment
Physical Assessment
Assess the whole body
Look for problems with tissue perfusion and oxygenation
Some assessment findings are less reliable when seen in an older adult
Need – Stethoscope, BP Cuff, Penlight
Skin Pallor or Jaundice in mucous membranes an nail beds
Pallor or cyanosis of the gums, conjunctivae, and
palmar creases indicates decreased Hgb levels and poor
tissue oxygenation
Gums – Assess for active bleeding in response to light
pressure, or brushing teeth, any lesions or draining
areas
Petechiae (pinpoint hemorrhagin lesions) & echymoses
(bruises) – bruises may cluster together
Bleeding from NG tubes, endotracheal tubes, central
lines, peripheral IVs or Foleys
Skin turgor
Itching? – can indicate hematologic dz
Culture – easier to see in dark skinned
-Pallor and cyanosis – oral mucous membranes,
conjunctiva of the eye
-Jaundice – roof of the mouth
-Petechiae – palms of the hands/soles of the feet
-Bruises – seen as darker areas of skin and palpated
as slight swellings or irregular skin surfaces, ask about
pain when palpating
Head & Neck Check for pallor and ulceration of mouth mucosa
Tongue – completely smooth (pernicious anemia), beefy
red (nutritional deficiencies)
Assess for sclera jaundice
Inspect and palpate all lymph nodes (does it remove or
remain fixed in position?, enlarged? pain?)
Respiratory Blood problems reduce oxygen delivery so they lungs
work harder to maintain tissue perfusion
Assess rate and depth of respirations – while pt is at
rest, doing mild physical activity (10 word sentence
without stopping for a breath, fatigued easily, sob on
rest or exertion, need extra pillow at night?
Cardiovascular Blood problems cause the heart to work harder to
maintain tissue perfusion
Look for chest heaves, distended neck veins, edema,
signs of phlebitis
Listen for murmurs, gallops, irregular rhythms,
abnormal blood pressure (systolic is lower than normal
= anemia, excess RBCs = higher BP)
In severe anemias the heart tries to compensate for a
continuous reduction in oxygen delivery (enlargement
of R ventricle, heart dz)
Renal and Urinary Bleeding may present as gross or occult hematuria
(blood in urine)
Voided sample: color (may be grossly bloody red or
dark brownish gold urine) and proteins (urine dipstick,
increases protein content if there is protein and blood
in urine)
Musculoskeletal Rib or sternal tenderness (sign of leukemia – cancer of
the blood) – occurs when the bone marrow greatly
overproduces cells therefore increasing the pressure in
the bones
Look at skin over superficial bones (ribs and sternum)
by applying firm pressure with the fingertips
Assess Range of Motion for joints
Document any swelling, joint pain, or motion limitation
Abdominal Spleen – usually not palpable (lies just beneath the
abdominal wall, under the ribs on the left side)
Enlarged spleen – occurs with many hematologic
problems and is detected by percussion but palpation is
more reliable, can be IDed by its movement during
respiration.
Spleen palpation – have the patient lie relaxed, supine
position while you stand on the patient’s right and
palpate the ULQ (gentle and caution, could be tender
and rupture easily)
Liver – palpate liver’s edge in RUQ of abdomen
Hepatic enlargement – often occurs with hematologic
problems, may be palpable as much as 4-5 cm below the
R costal margin, usually not palpable in the epigastrium
Chronic bleeding GI ulcer or polyp – if under stomach or
the small intestine then blood may not be visible in the
stool, OR such a small amount is passed each day that
the patient is not aware (so OBTAIN A STOOL
SPECIMEN for occult testing)
CNS Examine cranial nerves and test neurological function
Vitamin B12 def – impairs cerebral, olfactory, spinal
cord and peripheral nerve function (severe chronic def
can cause permanent neuro degeneration)
Many neuro problems in pts with leukemia – r/t
bleeding, infection, tumor spread
Head trauma in hematologic disorder pt – expand to
include frequent neuro checks and mental status exams
Other Fever
Chills
Night sweats