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Hematological
| Question | Answer |
|---|---|
| What is Anemia | Deficiency in the number of erythrocytes (red blood cells) Quantity or quality of hemoglobin Volume of packed RBCs (hematocrit) Combination of these |
| If RBCs transports oxygen, what can erythrocyte disorders lead to | Tissue Hypoxia |
| How can you Diagnose Anemia | Based on CBC, reticulocyte count and peripheral blood smear |
| Clinical Manifestations of anemia are caused by? | The body's response to Tissue Hypoxia |
| How do manifestations vary? | rate the anemia evolved, severity, and presence of a coexisting disease |
| What are the levels of Hgb and symptoms | Mild (Hgb 100-120 g/L) - may not produce symptoms Moderate (Hgb 60-100 g/L) - causes cardiopulmonary symptoms to increase in order to compensate Severe (Hgb <60 g/L) - many clinical manifestations involving multiple body systems |
| What are some acute Interventions? | Blood or blood product transfusion Medication therapy Volume replacement Oxygen therapy Dietary and lifestyle changes |
| What is erythropoiesis in equilibrium with? | RBC destruction and loss. |
| What is the normal lifespan of RBC? | 120 days |
| What are 3 alterations in erythropoiesis that may occur to decrease RBC Production? | Decreased Hgb synthesis may lead to iron-deficiency anemia, thalassemia and sideroblastic anemia Defective deoxyribonucleic acid (DNA) synthesis in RBCs (ex.cobalamin or folic acid deficiency) may lead to megaloblastic anemias Diminished availability of |
| Iron-Deficiency Anemia | Most Common nutritional disorder in the World. Decreased RBC production due to inadequate supplies of iron needed to synthesize Hgb |
| What are general Manifestations of Anemia | Glossitis Pallor and most common Cheilitis Lack of iron in the tissues can lead to headache, paresthesia, burning sensation in tongue |
| Treatments for iron anemia? | Medication Therapy – oral iron for 2-3 months to replenish body’s iron stores |
| Diagnostic tests for iron Deficiency Anemia | Lab/blood work (Table 33.6) Stool occult blood Endoscopy/colonoscopy Bone marrow biopsy |
| What is Thalessemia? | group of diseases involving inadequate production of normal Hgb and decreased RBC production. Genetic basis |
| What are some clinical Manifestation of Thalassemia | Frequently asymptomatic Splenomegaly, jaundice, hepatomegaly & cardiomyopathy |
| What are some inter-professional care for Thalassemia | Lab tests Genetic counselling Blood transfusion & chelating agents Hematopoietic stem cell transplantation (HSCT) |
| What is Megaloblastic Anemia | Megaloblastic anemias are a group of disorders caused by impaired DNA synthesis and characterized by the presence of large RBCs. |
| What is Pernicious Anemia | is caused by an absence of IF and IF is required for cobalamin absorption |
| What are some clinical Manifestation for pernicious anemia | Insidious onset Sore & shiny red tongue, anorexia, nausea/vomiting, abdominal pain Weakness, paresthesia, ataxia, impaired thought process |
| What are some Inter-professional and Diagnostic test | Lab tests Gastroscopy & biopsy Parenteral or intranasal cobalamin Ensure protection against injuries - falls, burns and trauma |
| What is Folic Acid Deficiency? | Required for DNA synthesis leading to RBC formation and maturation |
| What are some Clinical Manifestation for FAD | Insidious onset May be attributed to coexisting conditions Absence of neurological issues helps differentiate from cobalamin deficiency |
| What are some Diagnostic tests and Inter-professional care for FAD | Lab tests Replacement therapy – oral Eat foods with high amounts of folic acid |
| What is Aplastic Anemia | Aplastic anemia is a disease in which the patient has peripheral blood pancytopenia (decrease of all blood cell types—RBCs, white blood cells [WBCs], and platelets) and hypocellular bone marrow. |
| What are some clinical Manifestation for Aplastic Anemia | Can manifest acutely or insidiously Mild to severe fatigue, dyspnea & cardiovascular responses Neutropenia - infection, septic shock, low-grade fever Thrombocytopenia - predisposition to bleeding (e.g., petechiae, ecchymosis, epistaxis) |
| What are some diagnostic studies and inter-professional care for Aplastic Anemia? | Lab tests/iron studies Bone marrow biopsy/aspiration Hematopoietic stem cell transplantation (HSCT) |
| What is Anemia caused by Blood loss | Anemia resulting from blood loss may be caused by either acute or chronic problems |
| What is Gradual Acute blood loss? | Body maintains blood volume by slowly increasing the plasma volume Circulating fluid volume preserved Number of RBCs available to carry O2 is significantly diminished |
| What are some nursing and inter-professional management for anemia caused by blood loss? | Replace blood volume to prevent shock Identify source of hemorrhage & stop the blood loss IV fluids including crystalloid (LR or NS) Once volume replacement established, focus on correcting RBC loss Blood transfusion (packed RBCs) may be needed |
| Chronic Blood Loss | Similar etiology to those of iron-deficiency anemia: Bleeding ulcer Hemorrhoids Menstrual and postmenopausal blood loss |
| What is Hemolytic anemia? | – a condition caused by the destruction or hemolysis of RBCs at a rate that exceeds production |
| What is Intrinsic hemolytic anemias? | result from defects in the RBCs themselves |
| What is Extrinsic acquired hemolytic anemia? | patient’s RBCs are normal but external factors are causing damage Manifestations are the same as general anemia symptoms |
| What is sickle cell disease? | group of inherited autosomal recessive disorders characterized by the presence of an abnormal form of Hgb in the RBC |
| What is acquired hemolytic anemia? | – results from hemolysis of RBCs from extrinsic factors Physical destruction, immune reactions and infectious agents/toxins |
| What is Hemochromatosis? | Hemochromatosis is an iron overload disorder. Although it is primarily caused by a genetic defect, hemochromatosis occurs secondary to diseases such as sideroblastic anemia |
| What is polycythemia? | Polycythemia is an abnormal condition characterized by increased RBCs. This increase in RBCs can be so great that blood circulation is impaired as a result of the increased blood viscosity and volume |
| Conditions of hemostasis | Hemostasis involves the vascular endothelium, platelets and coagulation factors. Normally function together to stop hemorrhage and repair vascular injury. Impairment in any of these components may result in bleeding or thrombotic disorders |
| What is Thrombocytopenia? | Reduction of platelets to an amount below 150 x 109/L Acute, severe, prolonged decreases can result in abnormal hemostasis = prolonged bleeding |
| What is Heparin-induced Thrombocytopenia? | thrombocytopenia develops 5-10 days after onset of heparin therapy (platelet count falls by more than 50% or falls below 150 x 109/L) |
| Clinical Manifestation of Thrombocytopenia | Many patients are asymptomatic Most common symptom is bleeding : Epistaxis, gingival bleeding Bleeding into the skin Prolonged bleeding does not usually occur until platelet counts are less than 50 x 109/L |
| Patient Teaching Guide for Thrombocytopenia | -Notify your hcp of any manifestation of bleeding. Ask HCP about restrictions in your normal activities, such as vigorous exercise or lifting weights. Do not blow your nose forcefully; Do not bend down with your head lower than your waist. |
| Patient teaching guide continuation | Prevent constipation by drinking plenty of fluids, and do not strain when having a bowel movement. Shave only with an electric razor; do not use blades. Do not pluck your eyebrows or other body hair. |
| ptg continuation | Do not puncture your skin, such as by getting tattoos or body piercing. Avoid using any medication (e.g., ASA [Aspirin]) or herbal product that can prolong clotting time. |
| What is Neutropenia | reduction in neutrophils Less than 1-1.5 x 109/L <0.5 x 109/L – severe neutropenia |
| What are patients with neutropenia predisposed to | Patients with neutropenia are predisposed to infection with nonpathogenic organisms of normal body flora & opportunistic pathogens |
| Low WBC counts= | normal phagocytic mechanisms are impaired |
| What are classic signs of inflammation | – redness, heat and swelling – may not occur |
| Neutropenic Precautions | The patient’s normal flora is the most common source of microbial colonization & infection Transmission of organisms from humans most commonly occurs by direct contact with hands |
| Neutropenic Precautions 2 | Air, food, water, and equipment provide additional opportunities for infection transmission HCPs with transmissible illnesses and other patients with infections can be sources of infection Hand hygiene and private room. |
| Neutropenic Precautions 3 | High-efficiency particulate air (HEPA) filtration to eliminate aerosolized pathogens Monitor temperature frequently T > 38 + neutropenia – medical emergency No flowers/plant |
| Leukemia | Group of malignant diseases that affect blood and blood-forming tissues of the bone marrow, lymph system, and spleen |
| Lymphoma | Cancers originating in the bone marrow and lymph nodes |
| Multiple Myeloma | Cancerous plasma cells infiltrate the bone marrow & destroy bone Cause is unknown Develops slowly and insidiously |
| What is Blood Component Therapy | Blood component therapy is frequently used in managing hematological diseases. However, blood component therapy supports the patient only temporarily so is used in the interim until the underlying problem is resolved |
| What does Blood Transfusion encompass | Packed red blood cells (RBCs) Platelets Fresh frozen plasma (FFP) Cryoprecipitates |
Created by:
21sanni
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