Assessment of Hematologic Disorders

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