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68WM6 Phs 2 Test 14
68WM6 Phase 2 test 14 blood, lymph, & immune
| Question | Answer |
|---|---|
| anemia | Blood disorder characterized by red blood cell, hemoglobin, and hematocrit levels below normal range |
| aplasia | (Aplastic Anemia) failure of the normal process of cell generation and development |
| Disseminated Intravascular Coagulation | Acquired hemorrhage syndrome of clotting, cascade overstimulation, and anti-clotting processes |
| Erythrocytosis | abnormal increase in the number of circulating red blood cells |
| Hemarthrosis | bleeding into a joint space |
| Hemophilia A | hereditary coagulation disorder; caused by lack of antihemophilic factor VIII, which is needed to convert prothrombin into thrombin through thromboplastin component |
| Heterozygous | having two different genes |
| Homozygous | having two identical genes inherited from each parent for a given hereditary characteristic |
| Idiopathic | cause unknown |
| Leukemia | malignant disorder of the hematopoietic system in which an excess of leukocytes accumulates in the bone marrow and lymph nodes |
| Lymphangitis | inflammation of one or more lymphatic vessels or channels that usually results from an acute streptococcal or staphylococcal infection in an extremity |
| Lymphedema | primary or secondary disorder characterized by the accumulation of lymph fluid in soft tissue, resulting in edema |
| Multiple Myeloma | malignant neoplastic immunodeficiency disease of the bone marrow |
| Myeloproliferative | excessive bone marrow production |
| Pancytopenic | deficient condition of all three major blood elements (red cells, white cells and platelets) results from bone marrow being reduced or absent |
| Pernicious | capable of causing great injury or destruction; deadly fatal |
| Reed-Sternberg cell | Atypical histiocytes; large abnormal, multinucleated cells in the lymphatic system, found in Hodgkin’s disease |
| Thrombocytopenia | An abnormal hematologic condition in which the number of platelets is reduced to fewer than 100,000/mm3 |
| make up 70% of WBC. The initial responder to any invasion | Neutrophils |
| key in the inflammatory response | Basophils |
| key in allergic responses | Eosinophils |
| Monocytes | phagocytes that circulate in the blood stream and work similarly to neutrophils |
| Macrophages | mature monocytes that live in tissue (i.e., alveolar macrophages in the lung and Kupffer cells in the liver |
| Lymphocytes | T cells and B cells that directly kill invaders and produce antibodies, respectively. (Lymphoid cells) |
| what is the function of the Lymphatic system? | Maintain fluid balance Produce (mature) lymphocytes WBC produced in the bone marrow but matured in lymph tissue Absorption and transportation of lipids from the intestine to the stream |
| lymph tissues | Lymph nodes Tonsils Spleen Thymus |
| where is the spleen located? | Located in left upper quadrant, just below the diaphragm |
| what is the function of the spleen? | Stores approximately 500ml Matures lymphocytes, monocytes and plasma cells (B cells) Destroys worn out RBCs Removes bacteria by phagocytosis (macrophages) Produce RBCs before birth |
| where is the Thymus located? | Located between the lungs in the mediastinum |
| what is a function of the Thymus? | to develop the immune system, matures T cells |
| Measurements of the size and hemoglobin content of erythrocytes. These include | Mean corpuscular volume (MCV) Mean corpuscular hemoglobin (MCH) Mean corpuscular hemoglobin concentration (MCHC) |
| The average amount of (weight) hemoglobin within an RBC | Mean Corpuscular Hemoglobin (MCH |
| The average concentration or he percentage of hemoglobin within an RBC | Mean Corpuscular Hemoglobin Concentration (MCHC |
| Often accompanies the differential WBC count and permits examination of the size, shape, and structure of individual RBCs, WBCs and platelets | Peripheral Smear |
| Most informative of all hematologic tests | Peripheral Smear |
| Adaptive Immunity | provides a specific reaction to each invading antigen and has the unique ability to remember the antigen that caused the attack |
| Allergen | a substance that can produce a hypersensitive reaction in the body |
| Antigen | a substance recognized by the body as foreign that can trigger an immune response |
| Attenuated | the process of weakening the degree of virulence of a disease organism |
| Autoimmune | pertains to the development of an immune response to one's own tissue |
| Autologous | something that has it's origin within an individual |
| the mechanism of acquired immunity characterized by the dominant role of small T cells | Cellular immunity |
| one of the two forms of immunity that responds to antigens; it is mediated by B cells | Humoral immunity |
| an abnormal condition characterized by an excessive reaction to a particular stimulus | Hypersensitivity |
| Immunity | the quality of being insusceptible to or unaffected by a particular disease or condition |
| Immunization | a process by which resistance to an infectious disease is induced or increased |
| Immunocompetence | the ability of an immune system to mobilize and deploy its antibodies and other responses to stimulation by an antigen |
| Immunodeficiency | an abnormal condition of the immune system in which cellular or humoral immunity is inadequate and resistance to infection is decreased |
| Immunogen | any agent or substance capable of provoking an immune response or producing immunity |
| Immunology | the study of the immune system |
| Immunosuppressive | the administration of agents that significantly interfere with the ability of the immune system to respond to antigenic stimulation by inhibiting cellular and humoral immunity |
| Immunotherapy | a special treatment of allergic responses; involves the administration of increasingly larger doses of the offending allergens to gradually develop immunity |
| Innate immunity | the body's first line of defense; provides physical and chemical barriers to invading pathogens and protects the body against the external environment |
| Lymphokine | one of the chemical factors produced and released by T cells that attract macrophages to the site of infection or inflammation and prepare them for attack |
| Plasmapheresis | removal of plasma that contains components causing or thought to cause disease |
| Proliferation | reproduction or multiplication of similar forms |
| three functions of the Immune system | protect the body against invaders, maintain homeostasis, surveillance network for recognizing and guarding against the development and growth of abnormal cells |
| natural immunity includes | Composed of skin and mucous membranes, cilia, stomach acid, tears, saliva, sebaceous glands and secretions and flora of the intestine and vagina |
| what is the body's 2nd line of defense? | acquired/adapted immunity - Composed of highly specialized cells and tissues, including the thymus, spleen, bone marrow, blood, and lymph |
| Provides specific immunity Results from production of antibodies in the cells Natural - after infection | acquired/adapted immunity |
| Unique ability to remember the antigen that caused attack and Consists of humoral immunity and cellular immunity | acquired/adapted immunity |
| an acquired condition that impairs the body's ability to fight disease; it is the end stage of a continuum of HIV infection | AIDS |
| CD4+Lymphocyte | these cells play a pivotal role in the ability of the immune system to recognize and defend against foreign invaders |
| Enzyme-Linked Immunoabsorbent Assay (ELISA | - a rapid enzyme immunochemical assay method to detect certain bacterial antigens and antibodies; the first test for HIV/AIDS |
| is a broad diagnostic terms that includes the pathology and clinical illness caused by HIV infection | HIV disease |
| Human Immunodeficiency Virus (HIV) | a retrovirus that causes HIV infection and HIV disease |
| HIV infection | the state in which HIV enters the body under favorable conditions and multiplies, producing injurious effects |
| a rare cancer of the skin and mucous membranes characterized by blue red or purple raised lesions | Kaposi's sarcoma |
| Pneumocystis Carinii Pneumonia (PCP) | an unusual pulmonary disease caused by a fungus and primarily associated with people who have suppressed immune systems |
| a virus that carries its genetic material in RNA rather than DNA, and it replicates by converting RNA into DNA | Retrovirus |
| Seroconversion | a person is said to have seroconverted when there is development of a detectable level of HIV antibodies found in the blood |
| Seronegative | means there is not a detectable level of HIV antibodies found in the blood |
| Vertical transmission | can occur during pregnancy, delivery or through postpartum breastfeeding |
| amount of measurable HIV virions | Viral Load |
| Western Blot- | Technique for analyzing small amounts of antibodies; the 2nd test for HIV/AIDS |
| Define the difference between HIV an AIDS | AIDS is defined as an acquired condition that impairs the body's ability to fight disease. It is the end stage of a continuum of HIV infection |
| Found worldwide but more prevalent in the US and Europe | HIV 1 |
| HIV 2 | Is prevalent in Western Africa and countries with historical and commercial ties to that region. It appears to be less virulent |
| Seroconversion takes place ___ days to ___ months after exposure, generally within one to three weeks. Process is accompanied by flu like or mononucleosis-like syndromes | 5 ; 3 |
| s/s of HIV/AIDS | mononucleosis or flu like symptoms. Some patients may experience vague symptoms indicative of a viral infection |
| is the median time between HIV infection and the development of end-stage HIV disease or AIDS in an untreated individual is anywhere from 10 to 14 years | Symptomatic infection, Early infection; |
| A physical exam may reveal persistent generalized lymphadenopathy (PGL); recurrent or localized infections; and neurological manifestations, such as numbness and tingling or weakness in the extremities | This phase is called AIDS-related complex |
| what are some ways that HIV is spread? | sexual practices, IV drug use/sharing needles, infected blood, vaginal secretions, breast milk |
| HIV is NOT transmitted by: | Hugging, dry kissing, shaking hands, food utensils, animals, insects, cough, sneezing |
| The three most common modes of transmission are: | Anal or vaginal intercourse Using contaminated drug-injecting equipment Transmission from mother to child |
| s/s of HIV Disease.... | Persistent unexplained fever, night sweets, weight loss, fatigue, and lymphadenopathy: S&S may not occur until 10-14 years after initial infection |
| How long does it take after exposure to detect HIV antibodies? | 1-12 weeks; detected with ELSA or Western Blot |
| Blood and plasma: CD4+ count _____ as disease progresses | decreases |
| Gastrointestinal System manifestations r/t HIV | Watery diarrhea, abdominal pain, weight loss, nausea, stomatitis, esophagitis, gastritis, yellow patches in the GI tract |
| Neurologic System manifestations r/t HIV | Cognitive dysfunction, motor impairment, decreased LOC, hemiparesis, mental and motor declines with progressive miltifocal leukoencephalopathy |
| what are the 4 steps of hemostasis | vessel spasm, platelet plug, clotting cascade, fibrinolysis |
| describe vessel spasm | contraction of blood vessel immediately after damage to control the loss of blood |
| describe platelet plug | platelets become activated, controls loss if vessel break is small |
| general description of clotting cascade | damage-prothrombin~thrombin~fibrinogen~fibrin =meshes w/ platelet plug/entraps RBCs&WBCs = serum released and clot is stable |
| describe fibrinolysis | process which breaks down a clot. Plasmin dissolves fibrin & dissolves the clot |
| Condition in which a component that is necessary to control bleeding is missing or inadequate | Coagulopathies |
| three examples of coagulopathies | thrombocytopenia, hemophilia, DIC(Disseminated Intravascular Coagulation) |
| Platelet disorder exhibiting a deficiency of the number of circulating platelets or change in the function of platelets | Thrombocytopenia |
| what are three causes of thrombocytopenia | aplastic anemia, leukemia, tumors and chemotherapy |
| Platelet sequestration can occur in the ____ | spleen |
| Most common cause for platelet destruction is | thrombocytopenia purpura |
| Significant bleeding can occur with platelet count of _____ | < 20,000/mm3 |
| Spontaneous bleeding can occur with platelet count of____ | < 5,000/mm3 |
| what are some examples of subjective info r/t Thrombocytopenia | Recent viral infection Current use of medications Extent of alcohol ingestion History of bleeding tendencies |
| objective examples r/t Thrombocytopenia | Melena, hematuria Petechiae and ecchymosis Epistaxis and gingival bleeding Signs of increased intracranial pressure caused by cerebral hemorrhage Any bleeding tendencies |
| diagnostic tests r/t Thrombocytopenia | Complete blood count- shows decreased platelets Peripheral blood smear- to identify abnormalities in all cell lines Bleeding time Bone marrow aspiration |
| examples of medical tx r/t thrombocytopenia | Corticosteroid therapy, Intravenous gamma globulin or immunosuppressive drugs Transfusion of platelets, Plasmapheresis Splenectomy |
| what is one unique nursing intervention r/t thrombocytopenia that we should teach pts to avoid? | Avoiding trauma (avoid sports with high risk of injury |
| recommended diet r/t thrombocytopenia | use of stool softners & high fiber diet |
| Hemophilia B (Christmas Disease) is caused by a deficiency of factor | IX |
| Hemophilia A is the most common type (85% of cases)- Antihemophilic factor ___ is absent | VIII |
| A decrease in the formation of prothrombin activators occurs as a result of decreased clotting factors | hemophilia |
| there are several clinical manifestations r/t hemophilia.....ready GO! | Internal or external hemorrhage with large ecchymosis into tissues Muscles show deformity and joints become ankylosed (immobile) Hemarthrosis- ankles, knees, and elbows  Pain, erythema and fever with hemarthrosis |
| Hemarthrosis | bleeding into the joints |
| diagnostic tests r/t hemophilia | serum blood tests, PT, INR, PTT, Hgb, Hct |
| medical tx r/t hemophilia | minimize bleeding, relieve pain, transfusion, admin factor VIII & IX |
| Teach/assess understanding of emergency care r/t hemophilia | Immobilize/Pressure Ice Contract physician Obtain medical alert tag and wear constantly |
| AGRANULOCYTOSIS | A severe reduction in the number of granulocytes (basophils, eosinophils, and neutrophils |
| common causes of agranulocytosis | Adverse medication reaction or toxicity Neoplastic disease Chemotherapy and radiation therapy Viral and bacterial infections Heredity |
| clinical manifestations of agranulocytosis | fever, chills, headache, fatigue, ulcerations of the mucous membranes, bronchial pneumonia and urinary tract infections in later stages |
| objective findings during an assessment r/t agranulocytosis | Fever over 100.6 F Erythema and pain from ulcerations Crackles and rhonchi due to exudates |
| diagnostic tests r/t agranulocytosis | WBC w/differential- decreased WBC Bone marrow biopsy – suppressed activity Cultures to identify possible infective organism |
| neutropenic diet - avoid what? | fresh fruits and veges, uncooked items, flowers, plants, bugs... UNCOOKED items. |
| name ways to protect against infection r/t agranulocytosis | Monitor pt closely Handwashing and strict asepsis Observe for s/s of infection Enforce neutropenic precautions Prevent infected visitors from contact w/pt Monitor mucous membranes for ulcerations |
| A malignant disorder of the hematopoietic system in which an EXCESS of leukocytes accumulates in the bone marrow and lymph nodes | Leukemia |
| r/t leukemia, cells infiltrate | lymph nodes, spleen, and liver and cause damage |
| 3 things that leukemia is attributed to | genetics, viruses, exposure to radiation / chemotherapeutic agents |
| clinical manifestations of Leukemia | anemia, thrombocytopenia, Leukopenia, enlarged lymph nodes and painless splenomegaly may be first sign |
| diagnostic tests r/t Leukemia | CBC, bone marrow biopsy, CXR, peripheral smear, CT/Lumbar puncture |
| subjective assessment findings r/t Leukemia | Pain in bones or joints Fatigue, malaise, and irritability Bleeding abnormalities |
| objecive assessment findings r/t Leukemia | Infection Occult blood in stools and urine Petechiae, ecchymoses, bleeding of mucous CBC |
| what are three types of Drugs that could be used r/t Leukemia | Chlorambucil, Hydroxyurea, Corticosteroids |
| tx r/t Leukemia is aimed at eradicating the Leukemia w/ ______ and ______ | chemotherapy and bone marrow transplant |
| Nursing interventions r/t Leukemia | Prevent infection, NEUTROPENIC PRECAUTIONS, avoid infectious agents, observe for s/s of infections, monitor graft vs host complications |
| r/t Leukemia, name pt teaching topics | S/S of infection Avoiding infected persons Contact physician for s/s of infection Medication/dietary All procedures and interventions to patient and family |
| these meds are used to tx Leukemia and can significantly increase survival rate | vincristine/prednisone and daunorubicin or doxorubicin |
| ALL | Acute lymphocytic leukemia |
| Malignant neoplastic immunodeficiency disease of the bone marrow | MULTIPLE MYELOMA |
| bone pain increasing with movement; ribs, spine, & pelvis is r/t ?? | multiple myeloma |
| clinical manifestations of multiple myeloma | bone destruction, pathological fractures, panytopenia, hypercalcemia, bence jones protein |
| objective assessment findings r/t multiple myeloma | expression of pain, able to form ADLs, fever, s/s of infection esp resp & urinary, monitor for bleeding |
| diagnostics r/t multiple myeloma | CBC, radiography, bone marrow biopsy(large amount of immature plasma), blood and urine(monoclonal protein is marker) Protein electrophoresis (bence jones protein) |
| medical management r/t multiple myeloma | Treatment is symptomatic; disease is incurable Radiation and chemotherapy Antineoplastic drugs Monitor CBC Treat hypercalcemia and pain |
| diet r/t a pt with d/o of Leukocytes or Plasma | depressed WBC production, Maintain neutropenic precautions/clean patient environment, Monitor CBC and report abnomal values, Administer antibiotics, as ordered |
| diet r/t Disorders of Leukocytes or Plasma | Provide high protien, high calorie, high vitamin diet |
| Inflammation of one or more lymphatic vessels or channels caused by an acute streptococcal or staphylococcal infection in an extremity | LYMPHANGITIS |
| Fine red streaks from the affected area in the groin or axilla Usually not localized, and edema is diffuse Chills, fever, and local pain accompany headache and myalgia | clinical manifestations of lymphangitis |
| how would you medically manage lymphangitis? | penicillin or other antimicrobial drugs to control infection, hot / moist heat-soaks or packs for comfort, elevate extremity |
| Primary or secondary disorder characterized by the accumulation of lymph in soft tissue and edema | lymphedema |
| causes for lymphedema | obstruction, removal of the lymph channels and nodes, hereditary, disturbed lymphy drainage |
| someone w/ lymphedema may complain of | pain & pressure, medical hx of varicosities, pregnancy, or modified radical mastectomy is impt |
| ______ is used to differentiate lymphedema from venous disorder | lymphangiography |
| what type of diet would you expect r/t managing lymphedema? | limit Na+ & avoid spicy foods which trigger thirst |
| nursing interventions r/t lymphatic drainage | elevate extremeties while sleeping and periodically during day, massage toward trunk, avoid constrictive clothing |
| T/F: There is a cure for lymphedema. | False. No cure just manage symptoms |
| More common in men older than 60 years of age, whites and those of Jewish ancestry | MALIGNANT LYMPHOMA |
| r/t malignant lymphoma, Tumors usually start in lymph nodes and spread to lymphoid tissue in the: | spleen, liver, GI tract, and bone marrow |
| s/s of malignant lymphoma | Painless lymphadenopathy in the cervical area Fever Weight loss Anemia Pruritus,GI malabsorption Bone lesions, bone fractures |
| diagnostic tests r/t malignant lyphoma | bone scan, CBC(increased RBCs, WBCs, platelets, ESR and anemia), chem 10, Coomb's test(+ result for antiglobulin), |
| what is crucial to determine the tx regimen r/t malignant lyphoma? | accurate staging |
| types of tx r/t malignant lyphoma | Chemotherapy and radiation. Immunotherapy with monoclonal antibodies Bone marrow transplant |
| pt teaching r/t malignant lymphoma | Frequently reassess knowledge Explanations of the extensive diagnostic workup and its importance of staging the disease for determining the treatment plan are an important focus of patient teaching during the diagnostic period |
| Chemotherapy agents used are | cyclophosphamide (Cytoxan) vincristine (Oncovin) Prednisone doxorubicin (Adriamycin) Bleomycin methotrexate |
| where is radiation commonly given r/t lymphomas tx | Commonly receive radiation to the chest wall, mediastinum, axillae, and neck |
| MONOCLONAL ANTIBODY THERAPY- RITUXIMAB (RITUXAN) is what? | Immunotherapy to eliminate malignant cells and induce remission Human cancer cells are injected into laboratory mice |
| T/F: Autologous grafts have a higher incidence of recurrence than allogenic | True |
| List three treatments of lymphomas | radiation, monoclonal antibody therapy, bone marrow transplant |
| Malignant disorder characterized by painless, progressive enlargement of lymphoid tissue Affects males twice as frequently as females | HODGKIN’S DISEASE |
| Lymphoid tissue enlargement is first noticed in the | cervical nodes and spleen |
| r/t hodgkin's disease, Characterized by abnormal or atypical cells called | Reed-Sternberg cells |
| s/s of hodgkin's disease | Anorexia Weight loss Malaise Extreme pruritus Low-grade fever Night sweats Anemia, leukocytosis followed by respiratory infections |
| subjective findings in an assessment r/t hodgkin's disease | Malaise Appetite loss Pruritus is often severe Bone pain occurs later in the disease’s course |
| objective findings in an assessment r/t Hodgkin's Disease | Cervical and supraclavicular lymphadenopathy Splenomegaly, hepatomegaly, and abdominal tenderness Excoriation of skin and evidence of scratching from pruritus Edema of the face and neck may be noticed Weight and nutritional status are recorded |
| diagnostic tests r/t Hodgkin's Disease | CBC-shows anemia, increased WBCs, increased ESR (shows an inflammatory process |
| hallmark sign for Hodgkin's Disease | presence of Reed-Sternberg Cells |
| what is the tx for stage I & II r/t Hodgkin's Disease | radiation |
| what is the tx for stage III & IV r/t Hodgkin's Disease | chemo & radiation |
| reduction of RBCs, a deficiency in hemoglobin and hematocrit, or an increased destruction of RBCs | Anemia |
| medical management of anemia | Depends on cause Bone marrow transplant Avoid blood transfusions if possible Splenectomy Drug therapy Treatment is often specific to the particular anemia |
| r/t hypovolemic anemia, what are the critical blood loss amounts? | Blood loss of 1000 ml or more in adult can be severe Blood loss < 500ml can be tolerated |
| s/s of hypovolemic anemia | Poor peripheral pulses Hypotension with increased capillary refill time Tachycardia Hypothermia Decreased hemoglobin and hematocrit |
| how long will it take for a pt to show signs of hypovolemic anemia? | Caution: lab results may not be accurate indicators until hours after injury |
| methods to control hemorrhage/medical management r/t hypovolemic anemia | Blood transfusion Plasma Dextran or other volume expanders Crystalloids |
| what would you teach a pt r/t hypovolemic anemia? | Signs/symptoms of bleeding Bleeding occasions Home management When to contact physician |
| Autoimmune disorder resulting from the destruction of parietal cell and eventual gastric mucosa atrophy | pernicious anemia |
| what is the Vit associated w/ pernicious anemia? | Vit B12 |
| what is the etiology of pernicious anemia? | Parietal cell damage Intrinsic factor not available to combine with Vitamin B12, systemic absorption in the ileum is prevented Vitamin B 12 is needed for growth and maturation of all body cells |
| r/t pernicious anemia, The bone marrow produces large, abnormal red blood cells called | megaloblasts |
| clinical manifestations r/t pernicious anemia | Fever Extreme weakness Dyspnea Hypoxia Slight jaundiced Edema of legs Constipation or diarrhea |
| Characteristic lemon-yellow–tinged pallor with "raw-beef" tongue | Pernicious anemia |
| what is the drug therapy for Pernicious anemia | Vit B12, folic acid, iron supplements |
| nursing interventions for pernicious anemia | Systematic approach Monitor vital signs every 4 hours Keep patient warm Oral care several times day High protein, vitamin, and mineral diet |
| T/F: Pt must understand the need for life-long replacement of Vit B12. | True - LIFE-LONG |
| failure of the normal process of generation and growth; not enough RBCs,Usually pancytopenic (low RBCs, platelets and WBCs) | aplasia |
| what are some causes of aplastic anemia | Causes Viral infections Medications Chemicals Radiation Chemotherapy |
| clinical manifestations r/t aplastic anemia | repeated infections, fatigue, palpations, dyspnea, bleeding tendencies, high mortality r/t high infections & hemorrhage, tachycardia |
| If you do a bone marrow biopsy on an aplastic anemia, what may be the results? | "dry tap", decreased cellular elements, decreased hematopoietic activity, may not show RBC irregularities |
| medical management r/t aplastic anemia | Blood transfusions are avoided, if possible Splenectomy may be required if that is the cause of thrombocytopenia Drug therapy Bone marrow transplant |
| what is one nursing diagnosis r/t aplastic anemia | Activity intolerance, related to inadequate tissue oxygenation |
| Why are blood transfusions avoided in patients with aplastic anemia? | Prevention of iron overloading, prevention of antibody development for transplant candidates, platelet transfusion, as needed – must be HLA typed |
| RBCs contain decreased levels of hemoglobin Causes Excessive iron loss Chronic bleeding of GI or genitourinary tract | iron deficiency anemia |
| occurs when an individual is given a killed or weakened antigen, which stimulates the formation of antibodies against the antigen | Artificially Acquired Active Immunity: |
| result of the activity of many leukocyte actions, reactions, and interactions that range from simple to complex | Cell-Mediated Immunity (CMI): |
| Humoral Immunity | antibody-antigen response. B lymphocytes produce circulating antibodies to act against a foreign substance |
| Antibody is a globulin (protein) produced by the ___ lymphocytes as a defense against an antigen | B |
| occurs when the person is expose to a disease, experiences the disease, and the body manufactures antibodies to provide future immunity to the disease | Naturally Acquired Active Immunity |
| is provided to the person by ready-made antibodies from another human or from an animal source. Immediate immunity to the invading antigen, but only last a short time | Passive Immunity |
| Products providing passive immunity | Hepatitis B immune globulin. Palivizumab. Rabies immune globulin. Cell-mediated defenses |
| Humoral immunity is mediated by | B cells |
| DTap vaccine is used for: | prevent diphtheria, tetanus, and pertusis |
| DTap vaccine is used for: | prevent diphtheria, tetanus, and pertusis |
| Immunity from immune globulins is rapid, but short-lived, up to ___ months | 3 |
| r/t contraindications: Anaphylactic allergy to yeast | Hep B Vaccine |
| r/t contraindications: Hypersensitivity to eggs/egg products | Flu vaccine |
| r/t contraindications: Avoid becoming pregnant 4 wks after immunization, Allergy to egg, gelatin or neomycin | measles, mumps, rubella vaccine (MMR II): |
| what is a nursing diagnosis r/t Leukemia or plasma d/o? | Hemorrhage, related to decreased physiologic clotting capabilities secondary to thrombocytopenia |
| Chills, fever, and local pain accompany headache and myalgia, Fine red streaks from the affected area in the groin or axilla,Lymphadenopathy (swollen lymph nodes | LYMPHANGITIS |
| what is the medical management for lymphangitis? | penicillin or other antimicrobial drugs for infection and hot moist heat-soaks or packs for comfort |
| what is the tx for Hodgkin's disease depend on? | staging process |
| what is the tx for stages I and II r/t hodgkin's disease? | Radiation therapy |
| what is the tx for stages III & IV r/t Hodgkin's disease | chemo and radiation |
| what type of meds could you see r/t chemo r/t Hodgkin's disease? (ABVD) | doxorubicin (Adriamycin) bleomycin (Blenoxane) vinblastine (Velban) dacarbazine (DTIC-DOME) |
| what is Neupogen used for? r/t Hodgkin's disease | Stimulates proliferation and differentiation of neutrophils Used to decrease infection in patients receiving antineoplastics that suppress neutrophil production |
| What cells are hallmark to Hodgkin’s Disease? | Reed-Sternberg cells |
| stage I Hodgkin's disease | abnormal single lymph nodes, regional or single extranodal site |
| Stage II Hodgkin's disease | Two or more lymph nodes on the same side of the diaphragm Localized involvement of extranodal site and one or more lymph node regions of the same side of diaphragm |
| Stage III Hodgkin's disease | Abnormal lymph node regions on both sides of diaphragm May be accompanied by spleen involvement subdivided into lymphatic involvement of the upper abdomen in the spleen (Splenic, celiac, and protal nodes |
| Stage IV Hodgkin's disease | Diffuse and disseminated involvement of one or more extralymphatic tissues and/or organs-with or without lymph node involvement; the extranodal site is identified as H, Hepatic; L. lung; P, pleural; M, marrow; D, dermal; O, osseous |
| Ingestion of large amounts of _____ and other _________ medications commonly taken by older adults increase risk of GI bleeding and can lead to alteration in clotting | aspirin; anti-inflammatory |
| Oral administration of ____ preparations increase the risk of GI bleeding and can lead to alteration in clotting | iron |
| Blood products should be administered with caution, since older adults are at increased risk of developing | congestive heart failure |
| cause of thrombocytopenia | usually idiopathic |
| cause of hemophilia | X-linked hereditary trait |
| cause of DIC | secondary process with massive over stimulation of the clotting cascade |
| is an inherited bleeding disorder characterized by abnormally slow coagulation of blood and spontaneous episodes of GI bleeding, epistaxis, and gingival bleeding caused by a mild deficiency of factor VIII | Von Willibrand's disease |
| when is Von Willibrand's disease commonly found? | post partum periods, menorrahgia, post surgery/trauma |
| tx for Von Willibrand' disease | cryoprecipitate transfusion w/factor VIII, fibrinogen and/or plasma, and DDVAP |
| Name two nursing diagnosis associated with a patient with a coagulation disorder | Altered tissue perfusion, related to hemorrhage Fluid volume deficit, related to hemorrhage Pain, related to thrombosis |
| Disseminated Intravascular Coagulation (DIC) | Grave coagulopathy resulting from the over stimulation of clotting and anticlotting processes in response to disease or injury |
| Massive stimulation of the clotting cascade results in the formation of clots in the microvasculature; Secondary process resulting in the over stimulation of normal clotting and anticlotting processes due to a primary medical process | DIC |
| When thrombosis is stimulated, fibrinolysis is also stimulated | DIC |
| Microvascular clotting causes decreased perfusion in organs and can lead to end organ damage | DIC |
| manifestations r/t DIC | noted bleeding from 3 unrelated sites: mucous membranes, IV, GI, GU tract, orifices, lungs, Diaphoresis with cold and mottled digits |
| diagnostic tests r/t DIC | DIC panel- shows prolonged PT/PTT, positive D-dimer (reveals elevated levels of fibrin breakdown products- indicates fibrinolysis |
| examples of fluid replacement r/t DIC | Crystalloids Transfusion (PRBCs, platelets, FFP) and cryoprecipitate (concentrated fibrinogen) Vitamin K Heparin therapy Aminocaproic acid- fibrinolysis inhibitor Anti-thrombin III- thrombosis inhibitor |
| Medications that may have a Thrombocytopenic Effect | Aspirin Digitalis derivatives Furosemide Nonsteroidal anti-inflammatory agents Oral hypoglycemics Penicillins Quinidine Rifampicin Sulfonamides Thiazides Rantitidine |
| Laboratory test that identifies the etiology of pernicious anemia May involve multiple stages of testing to determine whether B12 intake is low, or B12 absorption is altered | Schilling Test and Megaloblastic Anemia Profile |
| r/t schilling test, normal findings are excretion of 8% to 40% of radioactive Vit B12 within ____ hours | 24 |
| Evaluates presence of intrinsic factor | Gastric Analysis |
| In pernicious anemia the gastric secretions are _____ and the pH remains ____, after injection of histamine. | minimal; elevated |
| A radiological examination used to detect metastatic involvement of the lymph nodes | Lymphangiography |
| explain the process of a lymphangiography | Contrast medium is injected into a lymphatic vessel of the foot or hand, followed by radiological visualization of the lymphatic system |
| Bone marrow aspiration is most commonly performed in persons with: | marked anemia, neutropenia, acute leukemia, and thrombocytopenia |
| ____ ____ must be assessed prior to procedure, as contrast may severely damage poorly functioning ______. r/t lymphangiography | renal function; kidneys |
| r/t bone marrow aspiration, limit the client's activity for approx ____ minutes after procedure | 30 |
| RBCs contain decreased levels of hemoglobin | Iron Deficiency Anemia |
| Iron Deficiency Anemia is common in who? | infants, adolescents, prego women |
| Glossitis | inflammation and soreness of the tongue |
| Glossitis and pagophagia (desire to eat ice, clays, or starches) Headache, paresthesias, burning sensation of tongue and the most common objective sign is Pallor. All this is r/t what? | Iron Deficiency Anemia |
| objective signs r/t iron deficiency anemia | Tachycardia Finger nail fragility with spoon shape and raised border Stomatitis Lips are erythemic with cracking at the angles |
| what would you expect to see in the results from a CBC r/t iron deficiency anemia | decreased RBC, Hgb, Hct, decreased serum levels |
| drug therapy r/t iron deficiency | ferrous sulfate, Vit C, food high in iron |
| foods high in iron include: | organ meats, white beans, leafy veges, raisins, molasses, dry fruits and egg nog...well egg yolk |
| What is the most common clinical manifestation of iron deficiency anemia? | pallor |
| what are some things that can precipitate sickle cell anemia | dehydration, infection, overexertion, weather changes(cold), ingestion of alcohol & smoking, emotional stress |
| clinical manifestations of sickle cell anemia | abd enlargement w/ pooling of blood in liver, spleen, other organs. Jaundice, joint/back pain, edema, infarcts, hemorrhage, retinal damage, blindness, multisystem failure |
| r/t sickle cell anemia, CBC results=?? and WBC results=?? | CBC=decreased Hct & Hgb; WBC=increased |
| r/t sickle cell anemia, what would you tell your pt to get every year? | pneumovax and flu vaccine |
| What are the two priorities in treating patients with a Sickle Cell Crisis? | Fluid management and pain control |
| Myeloproliferative disorder with hyperplasia of bone marrow causing increased circulating erythrocytes, granulocytes and platelets | Polycythemia Vera (primary polycythemia) |
| Secondary polycythemia | Caused by hypoxia rather than a defect in the evolution of the RBC Hypoxia stimulates erythropoietein in the kidneys which stimulates erythrocyte production |
| Secondary polycythemia may result from: | May result from high altitude, pulmonary disease, cardiovascular disease, or tissue hypoxia Physiologic response to hypoxia, not pathologic |
| Clinical Manifestations of polycythemia | Venous distention and platelet dysfunction cause esophageal varices, epistaxis, GI bleeding, and petechiae Hepatomegaly and splenomegaly from organ engorgement |
| s/s of polycythemia | Sensitivity to hot and cold Pruritus Headaches, vertigo, tinnitus and blurred vision are often present, Eczema and dermatological changes, including erythema Hypertension with ventricular hypertrophy and angina |
| diagnostic tests r/t polycythemia | Arterial blood gases CBC Bone marrow examination BMR (Basic Metabolic Rate-increased) |
| what is the medical management for polycythemia | decreasing blood volume and viscosity and bone marrow activity. Drugs: all decrease bone marrow response |
| r/t secondary polycythemia, you want to avoid what? | high altitudes - airplanes |
| What is the major complication of polycythemia vera? | Thrombosis due to the abnormal increased number of circulating RBCs and platelets |
| Jehovah's Witnesses may accept what types of blood products? | Autologous transfusions and certain volume expanders |
| HIV cannot replicate unless it has a host; it attaches itself to: | CD4+ molecules; T-helper lymphocytes, monocytes and macrophages |
| diagnostic tests for HIV / AIDS | ELISA Enzyme Immunoassay (EIA) Viral Load CD4+ count CBC |
| two diff test methods r/t HIV / AIDS | confidential and anonymous |
| barriers to prevention r/t HIV/AIDS | denial, stereotyping, fear, cultural and community attitudes, education is a long term process |
| innate barriers r/t immunity | skin, mucous membranes, cilia, tears, flora of intestine & vagina |
| innate response is nonspecific, inflammatory response | adaptive response is specific immune response humoral immunity/cellular immunity |
| Innate - phagocytes, natural killer cells | adaptive - T lymphocytes, B lymphocytes |
| Specificity and Memory: Innate - NONE | Adaptive - Present |
| the basics of Humoral Immunity | mediated by B Cells, B cells produce antibodies, first response is slow compared to subsequent exposure, |
| Cell-Mediated Immunity | characterized by the dominant role of small T cells, Primary defense against intracellular organisms |
| Mechanism of action r/t Cell-Mediated Immunity | T cells produce lymphokines Lymphokines attract macrophages and neutrophils to the site for phagocytosis, or cytotoxic killer T cells can respond directly |
| what are some things we have to look forward to r/t getting older r/t our immune system? | High incidence of tumors, Greater susceptibility to infections, Delayed hypersensitivity response is decreased, decreased movement of respiratory secretions |
| what are some things we have to look forward to r/t getting older r/t our immune system?...as if that wasn't enough... | Decreased production of saliva and gastric secretions Decreased tear production increases risk of eye inflammation and infection Structural changes in urinary system leads to urinary retention or stasis s/s of infection are more subtle |
Created by:
jrstrader
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