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Hematology-med/surg
| Question | Answer |
|---|---|
| What is hematopoiesis? | The manufacture and development of blood cells |
| What are the two branches of the hematopoietic system? | Lymphatic system and bone marrow |
| What are the two branches of the lymphatic system? | Thymus gland and spleen |
| What are the two types of bone marrow? | Red marrow and yellow marrow |
| Where is red marrow found? | Long bones, pelvis, sternum |
| Blood cells are produced from: | Pluripotential stem cells |
| What are myeloid stem cells converted to? | Erythrocytes (RBC), several types of leukocytes (WBC), and platelets (for clotting) |
| What are lymphoid stem cells converted to? | Lymphocytes |
| What does myeloid mean? | Pertaining to the bone marrow |
| What are lymphocytes? | White blood cells with immune functions |
| What is the function of erythrocytes? | Transport oxygen and remove carbon dioxide |
| What is the production of erythrocytes called? | Erythropoiesis |
| What hormone is released by the kidneys and regulates the rate of erythrocyte production? | Erythropoietin |
| What minerals do erythrocytes require for maturity? | Iron and b vitamins |
| What is the normal number of erythrocytes and what factors affect them? | Between 3.6 and 5.4 million micro liters; varies with age, gender, and altitude |
| What does hemoglobin do to oxygenate the body? | Carries oxygen to the cells of the body |
| What is the normal amount of hemoglobin? | 12 to 17.4 g/dl |
| What is needed to make hemoglobin? | Iron |
| Hemoglobin binds with ____________ to form ________________. | Oxygen; oxyhemoglobin |
| What do leukocytes do? | Protect from infection |
| Normal count of leukocytes is: | 5,000 to 10,000/mm3 |
| What is leukocytosis? | Too many leukocytes |
| What is leukopenia? | Not enough leukocytes |
| Where are platelets (Thrombocytes) manufactured? | In red bone marrow |
| How long to platelets live? | ~7 days |
| Serum plasma is made up of what? | 90% water, 10% proteins |
| Plasma contains and transports what? | Blood cells, proteins, clotting factors |
| Glycoprotein llb/llla helps in ____________________. | Blood clotting |
| Plasma protein albumin maintains_____________. | Oncotic pressure |
| Three types of globulin: | Alpha, beta, gamma |
| Gamma globulins are also know as: | Immonuglobulins |
| What does fibrinogen do? | Helps in blood clotting |
| What does fibrinogen transform into? | Fibrin |
| What are the four blood types? | A; B; AB; O |
| How is blood type determined? | By heredity |
| What reacts with incompatible RBC antigens? | Antibodies |
| Who is the universal blood donor? | O |
| Who is the universal recipient? | AB |
| What is Rh factor? | Specific protein on the RBC membrane |
| What type of blood can Rh+ receive? | Either + or – |
| What type of blood can Rh- receive? | Only – blood |
| When you go to the blood bank to obtain a unit of RBC’s for a patient with B+ blood, you are given a unit of O- blood. Is this compatible? | Yes (O=universal donor, -=universal donor) |
| Where is the thymus gland located? | In the upper chest |
| What is the largest lymphatic structure? | The spleen |
| Undifferentiated stem cells released from bone marrow develop into what? | T lymphocytes |
| How are lymph nodes connected? | By lymph ducts |
| Lymph fluid is interstitial fluid that moves into they lymph system, passes through the nodes, and is cleansed by what? | Macrophages |
| Eventually lymph fluid returns where? | Vena cava |
| Lymph nodes are clustered where? | Axilla, groin, neck, and large vessels of the thorax and abdomen |
| What kinds of lymphocytes are contained in the lymph nodes? | T and B lymphocytes |
| Lymph fluid is propelled through ducts by contraction of: | Skeletal muscles |
| The lymph filters out _________ that gain entry to the body. | Bacteria |
| A 36-year-old African American,has a history of sickle cell anemia with several sickle cell crises over the past 10 years. While it is a genetic disorder, it is found primarily in African Americans. How many African Americans does it affect in the U.S.? | 1 in 600 (This common genetic disorder, found primarily in African Americans but also in people from Mediterranean and Middle Eastern countries, currently affects 1 in every 600 African Americans in the U.S.) |
| 57-year-old presents with weeping, lower extremity edema, and his skin is thickened and brawny. This condition has been present for 4 weeks, and he is seeking treatment. What treatment would you expect the physician to order? | Symptomatic treatment – in lymphedema, the treatment is usually symptomatic. |
| Margie Thurmon, a 57-year-old breast cancer survivor, is battling secondary lymphedema. How many women are affected by secondary lymphedema after cancer treatment? | More than ¼ - lymphedema affects more than ¼ of women who have received treatment for breast cancer; this accounts for an appreciable number of the 2 to 3 million Americans affected by this condition |
| Which cells are called white blood cells? | Leukocytes |
| Which cells are converted to red blood cells, white blood cells, and platelets? | Myeloid stem cells |
| Kevin Henderson, a 37-year-old male who has Hodgkin’s Disease, is a client on the oncology unit. Why would you instruct healthcare personnel to leave Kevin’s bed in the high-Fowler’s position whenever practical? | To increase the lung expansion – those who have Hodgkin’s Disease are at risk for an ineffective airway clearance and a impaired gas exchange. You, as Kevin’s nurse, would keep his bed in high-Fowler’s position to promote lung expansion |
| Which cells have the life span of 1 to 2 days and perform phagocytosis? | Leukocytes (the life span is only 1 to 2 days; consequently, the demand for the production of WBCs is continuous. They circulate in blood but also migrate from the blood into body tissues to search for and destroy potentially harmful substances.) |
| Which cells are also known as thrombocytes? | Platelets – because they help control bleeding by forming a clot |
| A client has been studying up on blood cell production since the development of his blood disorder. He tries to fool you, his nurse, with blood cell trivia. His question, “Which cell types are produced from pluripotential stem cells?” | lymphocytes, platelets, and erythrocytes as well as leukocytes |
| A 16-year-old high school student, is presenting at the primary care group with severe fatigue, sore throat, headache, oozing tonsils, and cervical lymph node enlargement. Which of the accessory lymphatic structures could enlarge? | Spleen – the tonsils, thymus gland, and spleen are accessory lymphatic structures. Infectious mononucleosis results in the production of B-cell lymphocytes and antibodies which infiltrate tissue, particularly the spleen, causing it to enlarge. |
| Where are lymph nodes primarily located? Select all that apply: neck, axilla, groin, arms. | Neck Axilla Groin |
| Ryan Stanford, an 18-year-old college student, was diagnosed with leukemia 4 years ago. In your nursing practice within the oncology unit at the hospital, what should you do to manage Ryan’s delayed clotting process? | Apply prolonged pressure to needle sites or other sources of external bleeding (Reduced platelet production results in a delayed clotting process and increases the potential for hemorrhage.) |
| Rick Ellerston, a 42-year-old ironworker, is a client in the diagnostic center. In your education regarding his upcoming testing, you discuss the role of lymphatic fluid and its circulation. What is the primary mechanism of lymphatic fluid circulation? | Skeletal muscle contraction – most lymphatic fluid circulates with the help of skeletal muscle contraction and is returned to venous circulation through one of two ducts. |
| Ralph Meander, an 80-year-old retired chemist, has been diagnosed with Cooley’s anemia, a severe form of beta-thalassemia. Which of the following is a symptom of Cooley’s anemia? | Bronzing of the skin – clients with Cooley’s anemia exhibit symptoms of severe anemia and a bronzing of the skin which is caused by hemolysis of erythrocytes. |
| Which cells have the major function of transporting O2 to and removing CO2 from tissues? | Erythrocytes |
| Wilkins Booth, a 70-year-old male, is a client in the long-term care facility. Mr. Booth has a history of lymphedema. What is an important part of your assessment as a result of impaired nutrition to his tissues? | Ulcers and infection in the edematous area – the tissue nutrition is impaired from the stagnation of lymphatic fluid leading to ulcers and infection in the edematous area. |
| When assessing they lymphatic system, what history, signs, and symptoms should you look for? | bleeding; fatigue; chills; infections; discomfort in axilla, groin, or neck; dysphagia; lymph node removal or splenectomy; tx for cancer/renal failure; all meds; dietary hx; foreign travel; exposure to industrial of environmental toxins |
| Physical exam of lymphatic system includes inspection for: | skin color, vital signs |
| Physical exam of lymphatic system of lymph nodes includes: | enlargement, redness, streaking; tonsils size and appearance; extremities should be equal in size |
| Diagnostic tests of they lymphatic system include: | lab tests (CBC, coagulation tests), bone marrow aspiration, schilling test, lymph node bx, radiography (ultrasound, CT, bone scan, MRI) |
| Schilling test distinguishes between __________________&________________. | folic acid deficiency & pernicious anemia |
| What does bone marrow aspiration evaluate? | blood cell formation |
| Role of the nurse includes prompt reporting of: | changes in clients condition and test results |
| The nurse monitors the client for adverse effects during and after diagnostic procedures. What adverse effect does the nurse especially monitor for? | bleeding |
| Nutritional considerations, iron is an essential component of: | hemoglobin |
| Nutritional considerations, vitamin c enhances: | folic acid and iron absorption |
| Nutritional considerations, vitamin B6 is needed for: | hemoglobin formation |
| Nutritional considerations, copper transfers: | iron from storage to plasma |
| Nutritional considerations, protein is a component of: | hemoglobin and enzymes. |
| Nutritional considerations, protein is involved in: | RBC production |
| With age RBCs: | become fewer in number and less flexible |
| Schilling test may not be possible in the elderly for what reason and how do you achieve the test anyway? | due to cognitive problems and urinary incontinence; insert a foley and put the foley bag in a bucket of ice |
| epoetin alpha (Epogen, Procrit) stilumates: | the production of RBCs |
| filgrastim (Neupogen) promotes | production of neutrophils |
| oprelvekin (Neumega) stimulates: | platelet production |
| Anemia causes reduction in amount: | of O2 carried to cells |
| Anemia is a deficiency of: | erythrocytes or hemoglobin |
| Causes of anemia: | blood loss; inadequate or abnormal erythrocyte production; desctruction of normally formed RBCs |
| Hypovolemic anemia assessment findings include: | pallor, tachycardia, hypotension, reduced UO, altered consciousness, fatigue, chills, diagnosed per CBC |
| What is the medical management for hypovolemic anemia? | bloodtransfusions, treatment of underlying cause |
| In hypovolemic anemia there is __________cellular function.: | compromised |
| Assessment of hypovolemic anemia: | history, vital signs, lab results, physical exam |
| Goals for outcome in patients with hypovolemic anemia are: | minimize blood loss, have normal RBC count and hematocrit level, normal BP, normal heart rate, normal body temperature, and 90% or greater O2 sat(most important) |
| Nursing interventions for hypovolemia are: | monitor vital signs, labs, I&O, guiac stools, put client in Trendelenburg position, infuse fluids |
| Nursing interventions for hypoxemia are: | monitor O2 sat and administer O2 |
| Nursing interventions for imbalanced body temperature are: | prevent drafts, provide blankets and warm fluids |
| Nursing interventions for activity intolerance are: | provide rest and limit nonessential activities |
| Iron deficiency anemia is: | insufficient iron for hemoglobin production |
| Assessment findings for iron deficiency anemia: | reduced energy, fatige, dyspnea; rapid heart rate; laboratory blood tests |
| Medical management for Iron deficiency anemia includes: | iron (oral or parenteral), blood transfusion |
| Nursing management of Iron deficiency anemia includes: | diet history, physical assessment, IM Z-track, teaching (treatment and medications) |
| Basic features of Z-track injection technique are: | pull tissue laterally ~1 inch, insert at 90 degree angle, wait 10 seconds w/needle in place & skin held taut, do not rub (don’t want it to ooze back out, very irritating) |
| Sickle cell anemia affects people of: | African, Mediterranean, or Middle Eastern descent |
| If client has one gene present of the sickle cell trait, they will have: | some abnormal hemoglobin |
| If client has two genes present of the sickle cell trait, they will have: | sickle cell disease |
| Clients with sickle cell anemia must have one gene from: | each parent |
| The sickle cell gene makes abnormal hemoglobin called: | hemoglobin S |
| During sickle cell crisis, abnormal shaped cells occlude vessels which leads to: | hypoxia which leads to severe pain |
| Sickle cell crisis occurs: | rapidly r/t hypoxia or other stressors. |
| What is a common effect of sickle cell crisis? | CVA |
| Why does sickle cell anemia contribute to hemolytic anemia? | abnormal shape leads to a shorter life span of the RBCs |
| What happens if the spleen becomes obstructed due to sickle cell anemia? | It contributes to the development of pneumonia (presses on lung). |
| Chronic anemia can lead to: | cardiomegaly, dysrhythmias, tachycardia, dyspnea |
| The impaired circulation caused by sickle cell anemia can lead to: | CVA, severe pain, chronic leg ulcers, priapism, pulmonary infarction, shock,renal failure |
| Assess the client with sickle cell anemia for: | tachydardia, dyspnea, jaundice (r/t rapid breakdown of hemoglobin), cardiomegaly, acute chest syndrome (triggered by dec Hbg & lung infiltrates) |
| How is sickle cell anemia diagnosed?: | sickledex test done on newborns, hemoglobin electrophoresis to determine if a person has the trait or the disease |
| Supportive treatment of sickle cell anemia includes: | regular blood transfusions and hydroxyurea (Hydrea) (drug) |
| Antibiotic treatment for sickle cell anemia: | treat even minor infections to prevent fever and sickling |
| A temperature change on a patient with sickle cell anemia can trigger: | a crisis |
| Medical treatment of sickle crisis: | Pain control (PCA), oxygenation, hydrate, transfusions |
| How do you remove excess iron during transfusions on a patient in a sickle crisis? | chelation |
| Diminished lung sounds for a person with sickle cell anemia can indicate: | blood not circulating through or spleen pushing on lungs |
| Nursing care for the patient with sickle cell anemia who is having pain: | analgesics, O2, handle patient carefully, elevate swollen joints, provide hydration and warmth, distraction and other nonpharmacologic pain relief techniques |
| Nursing intervention related to patient with sickle cell anemia’s increase risk of infection | prevent exposure to pathogens, immunizations, pt teaching r/t hygiene and skin care |
| Expected outcomes of treatment for patients with sickle cell anemia: | absence of pain, cough, respiratory distress, and purulent drainage from skin lesion; WBC count; temperature |
| Patient education regarding sickle cell is about prevention. Teach patient to: | keep medical appointments, do not exceed dosage of analgesics, do not smoke, do not travel to high altitudes, avoid vigorous activity, avoid constrictive clothing, pregnancy may be very complicated |
| A 19 year old client is admitted in sickle cell crisis. The priority nursing interventions would be to: administer pain meds, obtain blood for lab, administer antibiotics, insert a foley catheter | administer pain meds |
| Hemolytic anemia is: | chronic premature erythrocyte destruction |
| Assessment findings for patients with hemolytic anemia: | jaundice, enlarged spleen, shock, microscopic examination, Coombs test |
| Medical management of hemolytic anemia: | removing the cause, corticosteroids, blood transfusion, splenectomy |
| Nursing management of hemolytic anemia: | health history, supportive care, medication, client teaching self care |
| Thalassemia medical management: | symptomatic, frequent transfusions, Cooley’s |
| Thalassemia nursing management: | maintain bed rest, protect from infection, monitor blood transfusion |
| Pernicious anemia is a lack of intrinsic factor necessary for what? | absorption of vitamin B12 |
| With pernicious anemia there is a degeneration in what system? | nervous system |
| Assessment of pernicious anemia: | stomatitis, glossitis, diarrhea, digestive disturbances |
| Diagnostic assessment of pernicious anemia: | history, symptoms, blood and bone marrow studies, Schilling test, blood smear |
| Medical management of pernicious anemia: | IM vitamin B12 (continued for life), physical therapy for neurologic defects |
| Nursing management of pernicious anemia: | Client teaching regarding diet, oral care, and B12 administration and side effecrs; assist with ambulation; encourage mobility |
| In which deficiency will you find immature erythrocytes? | folic acid deficiency anemia |
| Assessment findings in the patient with folic acid deficiency anemia: | fatigue, sore and red beefy tongue, dyspnea, nausea, anorexia, HA, weakness, lightheadedness |
| Medical management of folic acid deficiency anemia: | folic acid supplements, balanced diet |
| Nursing management of folic acid deficiency anemia: | client education regarding diet, oral hygiene, and rest |
| What is polycythemia vera? | rapid proliferation of all types of blood cells produced by the bone marrow |
| Red blood cells for patients with polycythemia vera have: | a shorter life span (the quality of them is not as good) |
| Red blood cells for patients with polycythemia vera release: | potassium and uric acid |
| Patient’s with polycythemia vera have risk of what complications? | HTN, CVA, CHF, infarction and hemorrhage |
| Assessment, signs and symptoms for polycythemia vera: | reddish-purple face and lips, fatigue, headache, prurits, exertional dyspnea, excessive bleeding, hemorrhoids, splenomegaly, swollen and painful joints |
| Laboratory test for polycythemia vera: | hyperkalemis, high uric acid |
| Which lab abnormality could explain the joint pain for patients with polycythemia vera? | high uric acid |
| Medical management of polycythemia: | phlebotomy, anticoagulants, radiophosphorus and radiation therapy, antineoplastic drugs (chemo drugs) |
| Nursing management of polycythemia: | observe client for complications, provide information about drug therapy, reduce potential for thrombi formation |
| What actions will promote circulation for patients with polycythemia? | increase fluid intake, avoid crossing legs and wearing constrictive clothing, encourage physical activities (isometric exercises), anti-embolism stockings |
| What should patients with polycythemia do if they experience chest pain? | rest immediately and seek care |
| What are the four types of leukemia? | acute lumphocytic (ALL), chronic lymphocytic (CLL), acute myelogenous (AML), chronic myelogenous (CML) |
| At what age does acute lymphocytic leukemia occur? | onset <5 yr, rare after age 15 |
| At what age does chronic lymphocytic leukemia occur? | >40 years |
| At what age does acute meylogenous occur? | occurs at any age |
| At what age does chronic myelogenous occur? | occurs after age 20 |
| What is the most common type of leukemia? | chronic lymphocytic |
| Which type of leukemia has a genetic link? | chronic myelogenous |
| Why do patients with leukemia have severe anemia? | the body is making so many white blood cells it can’t make enough red blood cells |
| Assessment findings of leukemia: | severe anemia, bleeding, infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes |
| Medical management of leukemia: | antineoplastic drugs, transfusions, transplantation of bone marrow and stem cell |
| Most types of leukemia respond to what treatment? | antineoplastic drugs |
| Assessment of the patient with leukemia: | history, physical assessment, symptoms, lab results |
| Patients with leukemia are at risk for what? | infection, hemorrhage, activity intolerance, disturbed body image, anxiety and fear |
| Neutropenic precautions include: | private room (negative air flow if possible), handwashing, pt wears mask when out of the room, avoid crowded areas, no raw food, no cut flowers, minimize invasive procedures |
| Expected outcomes for the patient with leukemia: | no infection or blood loss, adapts to changes in body image, copes with anxiety and fears, tolerates activity between periods of rest |
| An 89-year-old female, is a client of the primary care group. In your client education before she leaves the office, you discuss with her some strategies for ingesting iron to combat her iron deficiency anemia. What strategies would you discuss? | * Drink liquid iron preparations with a straw – dilute liquid preparations of iron with another liquid such as juice and drink with a straw to avoid staining the teeth. |
| A 15-year-old is suffering from infectious mononucleosis and has developed significant ulcerations of the oral mucosa. What should you offer him in regards to his oral ulcerations? hard candy, soft, bland food, carbonated beverages, cool liquids | Soft, bland foods;Cool liquids |
| 21. Richard Brooks, a 36-year-old African American, is a client at the primary care group. Mr. Brooks has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia? | Hemoglobin S – replaces HbF. HbS causes RBCs to assume a sickled shape under hypoxic conditions. |
| In the surgical group, knowledge regarding hematopoiesis is used frequently in regards to clients in postsurgical care. Which of the following is true for the variation in the normal number of erythrocytes? | * People who engage in strenuous activity have an increased number of erythrocytes – they have an increased number of erythrocytes to maximize the transport of oxygen and carbon dioxide. |
| A patient seeks treamtne due to her increased fatigue, pruritis, and dizziness. Most disturbingly, her face and lips have taken on a reddish-purple tone. What could she do to decrease the potential for complications? | Consume 3L of water per day – the plan of care includes drinking 3 quarts (or liters) of fluid per day. Adequate hydration promotes venous return and ensures sufficient urine production. |
| A 36-year old African American has a history of sickle cell anemia with several sickle cell crises over the past 10 years. As a result of the disease process, he is currently experiencing acute chest syndrome. What is acute chest syndrome? | Pneumonia – acute chest syndrome is characterized by respiratory symptoms such as coughing, wheezing , tachypnea, and chest pain |
| A 16-year-old high school student is presenting with severe fatigue, sore throat, headache, oozing tonsils, and cervical lymph node enlargement. Considering the incubation period for Epstein-Barr virus, when would you estimate her exposure | 30-50 days ago – the incubation period for the Epstein-Barr virus can be as long as 30-50 days. |
| Which cells are white blood cells with immune functions? | Lymphocytes – lymphoid stem cells are converted to lymphocytes, WBCs with immune functions |
| A a 17-year-old high school senior has just recovered from infectious mononucleosis and is getting ready to return to school. Which of the following is appropriate client education as a result of her infection? | Avoid donating blood – in a client with infectious mononucleosis, the nurse instructs the client to avoid donating blood for at least 6mo after recovering from the infection |
| A 34-year-old boilermaker reports feeling tired, cold, short of breath at times, and intermittent chills. Your assessment reveals tachycardia and reduced energy. What would you expect the physician to order? | CBC |
| 12. Gloria Donaldson, a 34-year-old mother of four, presents at the ED with an elevated temperature and red-swollen, painful left axillary lymph nodes with visible red streaks. What would you expect the physician to diagnose? | * Lymphadenitis – when such inflammation affects the lymph nodes near the lymphatics, the condition is called lymphadenitis |
| Which cells have a lifespan of approximately 7.5 days and one-third of their population remains in the spleen unless needed to fight significant bleeding? | * Platelets – have a lifespan of approximately 7.5 days. 2/3 circulate in the blood and contribute to homeostasis. The remaining 1/3 is stored in the spleen, where they remain unless needed in cases of severe bleeding. |
| Clancy McMaster, a 79-year-old retired bartender, has been diagnosed with pernicious anemia. In your client education, as his nurse, you emphasize the importance of lifelong intramuscular administration which of the following? | * Vitamin B12 – for a client with pernicious anemia, the nurse emphasizes the importance of lifelong administration of vitamin B12. He or she teaches the client or a family member of the proper method to administer B12 injections. |
| 9. Laura Ferns, an 82-year-old retired school teacher, is a client at the primary care group. She has pernicious anemia and has been receiving treatment for several years. What is she lacking that results in pernicious anemia? | Intrinsic factor |
| What is the function of fibrogen? | It plays a key role in forming blood clots – fibrinogen, the largest share of plasma protein, plays a key role in forming blood clots. It can be transformed from a liquid to fibrin, a sold that controls bleeding. |
| 7. Your cousin from Denver seeks treatment due to her increased fatigue, pruritis, and dizziness. Most disturbingly, her face and lips have taken on a reddish-purple tone. What could have contributed to her condition? | Where she lives – for people who live at high altitudes, erythrocytosis is a normal phenomenon and usually requires no treatment. |
| There are several structures in the hematopoietic and lymphatic systems that contribute to the manufacture of blood cells. Which of the following structures does not participate in blood cell production? | Yellow bone marrow – consists primarily of fat cells and connective tissue. It does not participate in the manufacture of blood cells |
| Laura Ferns, an 82-year-old retired school teacher, is a client at the primary care group. She has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults? | Dementia – pernicious anemia may be accompanied by a dementia with symptoms similar to Alzheimer’s disease Clients experiencing cognitive changes should be screened, as early detection of pernicious anemia is critical to prevent neurological damage. |
| 4. Robert Muldoon, a 43-year-old police officer, is reporting for his appointment with the hematologist. He is being treated for chronic anemia and has questions about the condition. Which of his statements indicate the need for further client teaching? | “Red blood cells are found primarily in the distal end of my long bones.” |
| What is multiple myeloma? | malignancy involving plasma cells |
| In multiple myeloma, osetoclasts: | are overactively breaking down bone cells |
| Multiple myeloma increases: | blood calcium (pathologic fracture due to weakening bone) |
| Assessment findings of multiple myeloma: | pain, infection, symptoms of anemia, bruising, nosebleeds, renal calculi |
| Diagnostic findings for multiple myeloma: | skeletal radiographic studies (little dark spots like swiss cheese), serum calcium levels, bone marrow aspiration |
| Medical management of multiple myeloma: | steroids, anticancer drugs, antibiotics, analgesics, blood transfusions, back braces, body casts, bone marrow and stem cell transplants |
| Nursing management of multiple myeloma: | assess pain and signs of infection, fatigue, bleeding, thrombus formation, urine output, medication, ambulations, maintain safety, fluid intake (help flush calcium out of system), infection prevention |
| What are the two causes of agranulocytosis? | toxicity from drugs, idiopathic |
| Assessment findings of agranulocytosis: | fatigue, fever & chills, headache, opportunistic infections (mouth, throat, nose, rectum, and vagina) |
| Medical management of agranulocytosis: | removal of the cause, drug therapy |
| Nursing management of agranulocytosis: | history (esp medications), client teaching regarding infection prevention |
| Cause of aplastic anemia: | exposure to toxic chemicals, radiation, and drug therapy |
| What happens to cells in aplastic anemia? | they fail to develop |
| Aplastic anemia is what kind of disease? | autoimmune |
| Assessment findings for aplastic anemia: | weakness, fatigue, opportunistic infections, splenomegaly, unusual bleeding (Petechiae, ecchymoses, enlarged spleen) blood cell count, bone marrow aspiration |
| What is the difference between agranulocytosis and aplastic anemia? | aplastic anemia affects all cells, agranulocytosis affects granulocytes |
| Medical management of pancytopenia: aplastic anemia: | withdrawal of causative agent, transfusions, antibiotics, corticosteroids, bone marrow and autologous stem cell transplantation |
| Nursing management of pacytopenia: aplastic anemia: | history, physical assessment, symptoms, infection prevention measures, blood transfusion monitoring for reactions, nutrition (soft foods) |
| What is thrombocytopenia? | too few platelets (decreased manufacture or increased destruction) |
| What causes thromobytopenia? | drug induced, idiopathic |
| Assessment findings of thrombocytopenia: | purpura, bleeding from body parts, diagnosis low platelet count, abn bleeding and clotting times |
| Medical and surgical management of thrombocytopenia: | transfusions, splenectomy |
| Nursing management of thrombocytopenia: | minimize bleeding and hemorrhage, hold prolonged pressure after injections |
| What is hemophilia? | a genetic disorder causing blood clotting issues |
| How is hemophilia passed down? | sex linked recessive gene, usually passed mother to son |
| Assessment findings hemophilia: | oozing, bleeding, history of symptoms, laboratory tests |
| Medical management of heophilia: | transfusions (testing of donated blood is important), thrombin application |
| Nursing management of heophilia: | health history, physical assessment/vital signs, preventing bleeding, client teaching |
| Goals of nursing care for a client with hemophilia: | prevent trauma, minimize bleeding, pain control (bleeding into joints can cause extreme pain and disability), energy conservation |
| Education for patients with hemophilia: | eliminate ASA & NSAIDS, medic alert jewelry, inform all HCP (even dentist), soft tooth brush, contact physician promptly of pain or obvious bleeding |
| A 18 yo client with hemophilia wants to join an athletic team in college. Which of the following would be most appropriate? Hocky, golf, basketball, baseball | golf |
| What are the nutritional considerations for a client with hemophilia? | sources of heme iron and nonheme iron, consumptions of tea and coffee hinder absorption of iron, vitamin c intake enhances absorption of iron, foods rich in folic acid (ie, milk, eggs) |
| How does consumption of tea and coffee affect the absorption of iron? | hinders it |
| How does vitamin C intake affect absorption of iron? | enhances it |
| What pain medication do you want to avoid in patients with sickle cell crisis? | Demerol |
| Why should you assess older adults with neurologic decline or dementia for pernicious anemia? | could be caused by not enough oxygen to the brain |
| Lymphedemia happens because: | impaired lymph circulations |
| What are the two types of lymphedemia? | primary (congenital) secondary (acquired) |
| Assessment findings lymphedema: | skin swollen, pitted, thickened, rough, discolored; infection; ulcers; lymphangiography |
| Medical and surgical management of lymphedema: | symptomatic, complex decongestive physiotherapy, surgery |
| Nursing management of lymphedema: | assessment affected area, skin, measure limb; client teaching treatment, exercises, elevation, elastic garments, mechanical devices; emotional support |
| Lymphangitis and lymphadenitis are usually: | streptococcal microorganisms |
| Assessment finding of lymphangitis and lymphadenitis: | inflammation, red streaks, fever, tender & enlarged lymph nodes, visual inspection and palpations |
| Medical management of lymphangitis and lymphadenitis: | antibiotic therapy (IV) |
| Nursing management of lymphangitis and lymphadenitis: | med adm, assess response to medication, assess skin, monitor temp and swelling, promote comfort, enhance ADL’s, client teaching regarding elastic sleeve and stocking application (don’t want fluid pooling) |
| A client develops lymphedema of her left arm following a radical mastectomy. Discharge teaching would include: removing antiembolic stockings every day; elevating arm when seated or in bed, inspecting skin every other day, add low K foods to diet | elevating the left arm when seated or in bed |
| What causes mononucleosis? | Epstein-Barr virus (direct contact with oral secretions) |
| Signs and symptoms of mono: | fatigue, fever, sore throat, headache, cervical lymph node enlargement, splenomegaly, oozing tonsils, pharyngeal swelling |
| Diagnostic findings of mono: | positive slide agglutination test, Epstiein-Barr virus antibody titer, heterophil agglutination |
| Medical management of mono: | bed rest, analgesic and antipyretic therapy, increased fluid intake, corticosteroids, antibiotics |
| Nursing management of mono: | throat inspection, lymph node palpation, client teaching (rest, avoid blood donation), emotional support |
| What are the two types of lymphoma? | Hodgkins and non hodgkins |
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