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Adult Hlth 2 Test 3

Care of the Client with Hematological Alterations

Question	Answer
What are normal levels for RBC’s FOR FEMALES AGES 18-64?	4.2-5.4
What are normal levels for RBC’s for MALES ages 18-64?	4.7-6.1
What are normal levels for RBC’s for FEMALES ages >64?	3.8-5.2
What are normal levels for RBC’s for MALES ages > 64?	3.8-5.8
A decreased level of RBCs could indicate possible ___ or ____?	anemia or hemorrhage
An increased level of RBCs could indicated possible ____ or ____ (a chronic life-shortening myeloproliferative disorder resulting from the reproduction of a single clone-Tabers)?	An increased level could indicate possible chronic hypoxia or polycythemia vera
What is the normal HgB for FEMALE ages 18-64?	12-16
What is the normal HgB for MALE ages 18-64?	14-18
What is the normal HgB for FEMALE ages >64?	11.7-16.1
What is the normal HgB for MALE ages 64?	12.6-17.4
A decreased level of HgB could indicate possible ___ or ___?	anemia or hemorrhage
An increased level of HgB could indicate possible ___ or ___ (a chronic life-shortening myeloproliferative disorder resulting from the reproduction of a single cell clone-Tabers)	An increased level could indicate possible chronic hypoxia or polycythemia vera (a chronic life-shortening myeloproliferative disorder resulting from the reproduction of a single cell clone-Tabers)
What is the normal Hct for FEMALE ages 18-64?	37-47%
What is the normal Hct for MALE ages 18-64?	42-52%
What is the normal Hct for FEMALE ages >64?	35-37%
What is the normal Hct for MALE ages >64?	37%-51%
A decreased level of Hct could indicate possible?	A decreased level could indicate possible anemia or hemorrhage
An increased level of Hct could indicate possible?	An increased level could indicate possible chronic hypoxia or polycythemia vera (a chronic life-shortening myeloproliferative disorder resulting from the reproduction of a single cell clone—Tabers).
What is the normal WBC for both males and females of all ages?	5000-10,000
Increased levels of WBC are associated with__,___,___ & ___?	Increased levels are associated with infection, inflammation, autoimmune disorders and leukemia
Decreased WBC levels may indicate ___ or ___?	Decreased levels may indicate prolonged infection or bone marrow suppression.
What is the normal platelet (PLT) count for men and women of all ages?	150,000-400,000 mm3
Increased PLT levels may indicate __ or ___?	Increased levels may indicate polycythemia vera or malignancy.
Decreased PLT levels may indicated ___, ___, or ____?	Decreased levels may indicate bone marrow suppression, autoimmune dissease, or hypersplenism
What is a common name for Microcytic Anemia?	Iron deficiency anemia
What is the common name for Macrocytic Anemia?	Vitamin B12 deficiency anemia
With ____ the iron stores are depleted first, followed by the hemoglobin stores?	With iron deficiency, the iron stores are depleted first, followed by the hemoglobin stores.
What happens as a result of iron deficiency to RBCs?	As a result, RBCs are small (microcytic), and the client has mild manifestations of anemia, including weakness and pallor.
In iron deficiency anemia, serum ferritin values are less than ____?	12 g/L
______ is a common type of anemia and can result from blood loss, poor intestinal absorption, and an inadequate diet?	Iron deficiency anemia
What is the basic problem of Iron deficiency anemia?	The basic problem is a decreased iron supply for the developing RBC.
Iron deficiency anemia can occur at any age but is more frequent in who?	women, older adults, and people with poor diets.
______ causes anemia by inhibiting folic acid transport and reducing DNA synthesis in precursor cells. These precursor cells then undergo improper DNA synthesis and increase in size. Only a few are released from the bone marrow	Vitamin B12 deficiency
____anemia is called megaloblastic (macrocytic) because of the large size of these abnormal cells?	Vitamin B12 deficiency
______results result from poor intake of foods containing vitamin B12?	Vitamin B12 deficiency
______ can occur with vegetarian diets or diets lacking dairy products?	Vitamin B12 deficiency
Conditions such as small bowel resection, diverticula, tapeworm, or overgrowth of intestinal bacteria can lead to poor absorption of ____?	vitamin B12.
Anemia caused by failure to absorb vitamin B12 (pernicious anemia) is caused by a deficiency of intrinsic factor (a substance normally secreted by the gastric mucosa), which is needed for intestinal absorption of vitamin B12?	(pernicious anemia)
Folic acid deficiency can also cause ____?	megaloblastic anemia.
Manifestations of ____ are similar to those of vitamin B12 deficiency but nervous system functions remain normal, because folic acid does not affect nerve function?	Folic acid deficiency
What helps distinguish folic acid deficiency from vitamin B12 deficiency?	The absence of neurologic problems helps distinguish folic acid deficiency from vitamin B12 deficiency.
T/F Folic acid deficiency develops slowly, and symptoms may be attributed to other problems or diseases?	True
The three common causes of folic acid deficiency are?	poor nutrition, malabsorption, and drugs.
What is the most common cause of folic acid deficiency?	Poor nutrition, especially a diet lacking green leafy vegetables, liver, yeast, citrus fruits, dried beans, and nuts, is the most common cause.
What are the second most of folic acid deficiency?	Malabsorption syndromes, such as Crohn's disease, are the second most common cause.
Chronic alcohol abuse with malnutrition is another cause of?	folic acid deficiency Anticonvulsants and oral contraceptives slow or prevent the absorption and conversion of ___ leading to? Anticonvulsants and oral contraceptives slow or prevent the absorption and conversion of folic acid to its active form, leading
What manifestations might you see in a cl with Vitamin B12 Deficiency Anemia?	Severe pallor; Slight jaundice; Smooth, beefy red tongue (glossitis); Fatigue; Wt loss; Paresthesias of the hands and feet; Difficulty with gait
Folic acid deficiency anemia can be distinguished from B12 anemia how?	by the lack of neurological problems; folic acid deficiency retains neurological functions.
What common food sources would you suggest for a client who has Iron deficiency?	liver (especially pork & lamb); Red meat; organ meats; kidney beans; Whole-wheat breads & cereals; leafy green veggies; carrots; egg yolks; & raisins
What common food sources would you suggest for a cl who has Vit B12 deficiency?	Liver; organ meats; dried beans; nuts; green leafy veggies; citrus fruit; & brewer’s yeast
What common food sources would you suggest for a cl who has folic acid deficiency?	Liver; organ meats; eggs; cabbage; broccoli; & Brussels sprouts
Most often Aplastic Anemia is accompanied by a decrease in circulating RBC, leukopenia and thrombocytopenia. This is called___?	Pancytopenia (a deficiency of all three types).
____ is a disease with sustained increase in hemoglobin levels to 18g/dL; RBC count of 6 million/mm3 or hematocrit 55% or higher?	Polycythemia Vera (PV)
Persistently elevated Hct value (>55%); HTN; Dark, flushed appearance of hands & face; Distented superficial veins; Wt loss; Fatigue; intense itching; Enlarged hemorrhoids; Swollen, painful joints; Enlarged, firm spleen; Infarctions of heart; chest pain;	Polycythemia Vera (PV)
Strokes and bleeding tendency are also SS of ___?	polycythemia vera (PV)
What electrolyte imbalance might you see in polycythemia vera (PV) condition?	Gout & hyperkalemia-because the actual number of cells in the blood is greatly increased & the cells are not completely normal, cell life spans are shorter. Causing increased cell debris that includes uric acid and potassium.
What is the primary treatment for PV?	Monitor the CBC to assess response to treatment. Conservative treatment of repeated phlebotomies (2-5x per week) can prolong life for 10 to 20 yrs. Increasing hydration & promoting venous return help prevent clot formation, including prevention.
_______ is the blood drawing with removal of the client's RBCs to decrease the number of RBCs and reduce blood viscosity?	Phlebotomy
What patient education would you conduct with a patient with PV?	Drink at least 3 L of liquids each day; Avoid tight or constrictive clothing, especially garters or girdles.
T/F Pt with PV should wear gloves when outdoors in temperatures lower than 50° F (10° C)?	True
T/F It is not important for a pt with PV to keep all health care—related appointments?	False it is important
When should a pt with PV contact their dr?	Contact your physician at the first sign of infection.
T/F A pt with PV should take anticoagulants as prescribed; Wear support hose or stockings while you are awake and up; Elevate your feet whenever you are seated; Exercise slowly and only on the advice of your physician?	True
When performing activities or exercise when you have PV you should stop at the first sign of?	Stop activity at the first sign of chest pain
T/F it is not important for a pt with PV to use an electric shaver?	False it is
What type of toothbrush should a person with PV use and should they floss?	Use a soft-bristled toothbrush to brush your teeth and Do not floss between your teeth.
What is given to replace cells lost as a result of trauma or surgery?	RBC transfusion
Who else besides trauma and surgery pts might benefit from a RBC transfusion?	Clients with problems that destroy RBCs or impair RBC maturation also may benefit from RBC transfusions.
______, supplied in 250-mL bags, are a concentrated source of RBCs and are the most common component given to RBC-deficient clients?	Packed RBCs
What is given to clients with a hemoglobin level less than 6 g/dL (or a hemoglobin value of 6 to 10 g/dL if manifestations are present)?	Packed RBCs
______ are given to clients with platelet counts below 20,000 mm3 and to clients with thrombocytopenia who are actively bleeding or are scheduled for an invasive procedure?	Platelets
T/F Platelet transfusions are usually pooled from as many as 10 donors and do not have to be of the same blood type as the client?	True
For clients who are going to receive a bone marrow transplant (BMT) or who need multiple platelet transfusion, what might need to be prescribed?	single-donor platelets may be prescribed
_____ are taken from just one donor and decrease the amount of antigen exposure to the recipient, helping to prevent the formation of platelet antibodies?	Single-donor platelets
With ___the chances of allergic reactions to future platelet transfusions are thus reduced?	Single-donor platelets
____ may be given fresh to replace blood volume?	Plasma infusions
More commonly, plasma is frozen immediately after donation, forming____?	fresh frozen plasma (FFP)
What does freezing do for plasma?	Freezing preserves the clotting factors, and the plasma can then be used for clients with clotting disorders
When should you infuse FFP?	Infuse FFP immediately after thawing while the clotting factors are still active.
What pts are candidates for an FFP infusion?	Clients who are actively bleeding with a prothrombin time (PT) or partial thromboplastin time (PTT) greater than 1.5 times normal are candidates for an FFP infusion
____ is a product derived from plasma?	Cryoprecipitate
Clotting factors VIII and XIII, von Willebrand's factor, and fibrinogen are precipitated from pooled plasma to produce ____?	cryoprecipitate
Clients with a fibrinogen level of less than 100 mg/dL are candidates for a ____?	cryoprecipitate infusion
How should Cryoprecipitate transfusions be given?	Give this highly concentrated blood product to clients with clotting factor disorders at a volume of 10 to 15 mL/unit. Although cryoprecipitate can be infused, it is usually given by IV push within 3 minutes.
Dosages of ____are individualized, and it is best if the ____is ABO compatible?	Cryoprecipitate; Cryoprecipitate
WBC Transfusion is also called?	Granulocyte (White Cell) Transfusion
What types of pts receive granulocyte (white cell) transfusions?	At some centers, neutropenic clients with infections receive white blood cell (WBC) replacement transfusions.
What practice is controversial because the potential benefit to the client must be weighed against the potential severe reactions that often occur with ___ transfusions?	granulocyte (white cell transfusions; WBC transfusions
The surfaces of ____ contain many antigens that can cause severe reactions when infused into a client whose immune system recognizes these antigens as non-self. In addition, transfused ___have a short life span and provide minimal protection?	WBCs, WBCs
Assess lab values; verify medical prescription; assess cls VS, urine output, skin color, & Hx of transfusion reactions; Obtain venous access. Use central catheter/19-gauge needle if possible; obtain blood products from a blood bank. Transfuse immediately;	Nursing interventions for BEFORE blood infusions
Administer the blodd product using the appropriate filtered tubing; if blood prdt needs to be dilutes, use only normal saline solution; remain w/ pt during the 1st 15-30 min of infusion; infuse the blood prdt at the prescribed rate and monitor VS are all	Nursing interventions for during blood infusions
What do you do after a blood infusion?	when the transfusion is completed, discontinue infusion & dispose of the bag and tubing properly & DOCUMENT
How soon after you get a blood bag from the refrigerator should it be given?	IMEDIATELY; once a blood prdt has been released from the blood bank, the prdt should be transfused as soon as possible (e.g. RBCs should be completed w/in 4 hours of removal from the refrigerator)
Hemolytic reactions occur most often with in the first ___ mL of infusion?	50 mL
___ is a potential complication of rapid infusion?	fluid overload
Sepsis leading to _____ shock occurs when organisms are present in the blood?	distributive
Distributive shock is most commonly called ____?	septic shock
____often occurs with disseminated intravascular coagulation (DIC)?	sepsis
_____ occurs most often with bacterial infection and has also been reported among clients with viral and yeast sepsis?	Septic shock (sepsis-induced distributive shock)
T/F Distributive shock caused by sepsis does not resemble other types of shock in that it has two distinctive phases (Figure 40-2)?	True
The first phase of ____can be long, often lasting from hours to a day or longer?	Distributive shock/ septic shock
Manifestations during phase 1 of distributive/septic shock are ____ and the chance for recovery is ____ when the cl is recognized being in the first phase?	subtle. The chance for recovery is good when the client is recognized as being in the first phase of septic shock and appropriate interventions are started.
The second phase of ____ has a sudden onset and a rapid downhill course?	septic shock
If septic shock progresses to the second phase, chances for recovery are ____?	poor.
T/F Identifying clients in the first phase of septic shock can make the greatest difference in survival?	True
___ increases during the first phase of septic shock?	cardiac output
The first phase of septic shock is hyperdynamic and also may be called the ___ or ___?	high-output or warm-shock phase.
Increased cardiac output is reflected by ….?	increased cardiac output is reflected by tachycardia, increased stroke volume, a normal-to-elevated systolic blood pressure, and a normal CVP.
Increased cardiac output and vasodilation make the skin color appear____ with ___ mucous membranes and may feel __ to touch?	normal with pink mucous membranes and may feel warm to the touch.
T/F Phase 1 of septic shock is temporary and eventually the cardiac output is greatly reduced?	True
What marks the beginning of the second phase of septic shock.?	In the hyperdynamic phase of septic shock, respiratory rate and depth are increased, leading to respiratory alkalosis.
Lab assessment of a client with septic shock would include specimens of?	The presence of bacteria in the blood supports the diagnosis of sepsis. Obtain specimens of urine, blood, sputum, and any drainage for culture to identify the causative organisms.
A reduction of what protein might indicate sepsis?	Another indicator of sepsis and septic shock is a reduction in the blood levels of activated protein C
What does activated protein C do?	This protein is an enzyme that helps prevent inappropriate clot formation.
___ is activated when it binds to healthy endothelial cells of blood vessels?	protein C
In septic shock, the endothelial cells injured by endotoxins cannot activate protein C and thousands of small ____ form in the capillaries of vascular organs?	clots
Decreasing levels of ____ indicate the beginning of septic shock even before other manifestations are evident?	activated protein C
Drug therapy in septic shock includes ___ and ___ to enhance cardiac output & restore blood volume?	antibiotics and drugs used to enhance cardiac output and restore blood volume.
The same drugs used to enhance cardiac output and restore vascular volume in hypovolemic shock are used for ____?	septic shock
A major focus of drug therapy is antibiotics to combat ___?	sepsis
T/F In addition to antibiotics for sepsis, drugs to counteract disseminated intravascular coagulation (DIC) are not needed?	False they may be needed
Septic shock and DIC have two distinctly different phases, and the drugs for each phase of ____are different?	septic shock
Drug therapy in the first phase of septic shock and disseminated intravascular coagulation (DIC) is aimed at preventing coagulation by administering ____?	heparin
Drug therapy in the second, late phase of septic shock & DIC is aimed at increasing the blood's ability to clot. This therapy consists of what?	clotting factors, plasma, platelets, or other blood products.
Although septic shock can be caused by any organism, the most common agents are ____?	gram-negative bacteria.
When blood cultures have identified specific bacteria, IV ____ with known activity against the bacteria are given?	antibiotics
Multiple drugs with wide activity are prescribed when the causative organism of septic shock is ____?	not known
Drugs and drug categories commonly used for septic shock include…?	vancomycin, aminoglycosides, systemic penicillin or cephalosporins, macrolides, and quinolones
When clients are in the early phase of septic shock and are beginning to form many small clots, ____ may be given to limit unneeded clotting and to prevent the consumption of clotting factors?	heparin
When septic shock progresses to the late phase and small clots have formed to such an extent that the client no longer has enough clotting factors to prevent hemorrhage, ____ are infused?	clotting factors
Clotting factors (cryoprecipitate) are obtained from __?	pooled human serum
Infusing ____ also helps to replace clotting factors?	fresh frozen plasma (FFP)
T/F Platelets or other blood products may also be needed to replace clotting factors?	True
______ has been shown to stop the inflammatory responses and small clot formation of septic shock (Kleinpell, 2003a)?	Synthetic activated protein C
Name a type of synthetic activated protein C drug that is given as a continuous infusion over 4 days?	drotrecogin alpha (Xigris), is given as a continuous infusion over 4 days.
T/F Antibodies against the body's mediators for inflammation are being tested for their effectiveness in septic shock?	True
T/F Antibodies have been developed against the some proinflammatory cytokines, particularly interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor (TNF). This experimental therapy shows promise in reducing the extensive mortality associated	True

Created by: cgwayland

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