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ch33 blood
hematological
| Question | Answer |
|---|---|
| CBC consists of/identifies: | total # blood cells hemoglobin/hematocrit % RBC indices (shape/size) |
| bone marrow aspiration/biopsy | assess formation of blood cells, quantity/quality of each type. Used to confirm marrow infection/tumor. |
| bone marrow aspiration/biopsy hazards | bleeding- apply pressure infection- aseptic technique acetaminophen/Tylenol for pain avoid NSAID's (risk of bleeding) |
| ANEMIA | < normal hemoglobin/RBC's = < normal oxygen delivery |
| types of anemia | Hypoproliferation= defective RBC production) Bleeding = RBC loss Hemolytic = RBC destruction |
| complications (s/s) of severe anemia: | heart failure paresthesias delirium/confusion (angina if heart disease) |
| treatment of anemia | correcting / controlling cause if severe: packed red blood cell (PRBC) transfusion |
| pica | craving of ice, starch, or dirt found in those with iron deficient anemia |
| subjective s/s anemia objective s/s anemia | S: weakness, fatigue, malaise, palor, pica O: jaundice, palor, tongue = red/sore (smooth), angular cheilosis, brittle rigid nails |
| possible RN Dx @ anemia | fatigue r/t < Hgb & < O2 carrying of blood altered nutrition < body required altered tissue perfusion r/t < Hgb/Hct |
| RN anemia interventions | -manage fatigue -adequate diet (iron,B12,Folic Acid,protein) -FVD = IV fluids and/or transfusion |
| most common anemia= | iron deficient anemia cause should be thought BLEEDING until proven otherwise |
| anemia labs (iron deficiency) | -low serum Fe = low Hbg -MCV decreases -Low Hct / RBC related to Hgb -elevated TIBC |
| Iron IV/IM | -parenteral test dose (anaphylaxis) -staining / Z-track |
| oral iron supplements | -best empty stomach, with orange juice (Vit C) -w. food ok, if GI upset -avoid dairy and antacids (1h a.c. / 2h p.c.) -liquid stains teeth = use straw & rinse mouth |
| foods high in iron | organ meats, meats, beans, leafy greens, raisins, molasses |
| foods high in Vit C | citrus juices, orange, strawberry, tomato, broccoli |
| manage constipation w/ iron supplements by... | -stool softeners -high fiber diets |
| end stage renal / hemodialysis anemia.. | -monitor for folate and iron deficiency -maintain Hgb 11-12g/dL DO NOT EXCEED 13 -CK Hgb FREQUENTLY |
| APLASTIC ANEMIA | (rare)decreased-damaged marrow stem cells. -marrow aplasia -neutorpenia / thrombocytopenia also occur |
| s/s aplastic anemia | -complications of marrow failure -infections / anemia -purpura -retinal hemorrhages common |
| treatment of aplastic anemia | -bone marrow transplant (BMT) -periph. blood stem cell Xplant (PBSCT) -immunosuppresive therapy |
| MEGALOBLASTIC anemia | anemia caused by Vit B12 or folic acid deficiency |
| Folate / Folic Acid foods | liver green veggies |
| megaloblastic (folate) anemia more common in .. | alcoholism poor diet (few/no veggies) pregnancy hemolytic anemias GI malabsorptive diseases |
| megaloblastic (B12) anemia more common in .. | strict vegetarians (no meat/dairy) Crohn's disease Pernicious anemia gastric cancers |
| schilling test | used to determine B12 vs. Folate deficient megaloblastic anemia. oral B12, raidoactive B12, intrinsic factor admin, then urinalysis. |
| intrinsic factor antibody test | used to confirm / rule out pernicious anemia along side other tests |
| hemolytic anemia | rbc shortened lifespan = <RBC, hypoxia |
| hemolytic anemia labs | elevated reticulocytes increased indirect bilirubin less haptoglobin more hemoglobin |
| Hemolytic & Cycle Cell anemias treatment | mainly transfusions |
| transfusion complications include: | iron overload, poor venous access, infections, alloimmunization, increased blood viscosity |
| Sickle Cell management includes | -daily folic acid -strict infection monitoring -pneumococcal & flue vaccines -careful hydration -pain management (ASA, NSAID, morphine PCA) |
| thalassemia 2 types alpha / beta | hereditary anemias associated with defective synthesis of hemaglobin..more often mediterranean, african, asian |
| glucose-6-phosphate dehydrogenase deficiency G6PD deficiency | inherited enzyme deficiency african american, greek, italian, mediterranean, asian, jewish, more MEN. |
| G6PD deficiency events caused by... | fever, specific meds, fava beans |
| immune hemolytic anemia caused by.. | antibodies, results in hemolytic transfusion reaction |
| most hemolytic amemias are which type? | WARM |
| immune hemolytic anemia manifestations | mild - life threatening fatigue / dizziness splenomegally hepatomegally lymphadenopathy / jaundice |
| immune hemolytic anemia mgt | -stop offending Rx -high doses corticosteroid -blood Xfusions possible -splenectomy possible (=lifelong risk for infection, need flu/pneu vaccines -immunosuppressive agents |
| hereditary hemochromatosis | excess iron absorbed from GI > 1-2mg daily excess iron deposited into various organs which become dysfxnal |
| leukopenia | < normal lymphocytes / neutrophils |
| Neutropenia | < 2000/mm squared neutrophil count increased risk for bacterial infection exogenous & opportunistic |
| ANC readings & risk for infection.. | significant if <1000 high if < 500 almost certain if <100 |
| patient with neutropenia often do not present signs of ___. Therefore... | patient with neutropenia often do not present signs of INFECTION. Therefore, FEVER, may not occur (especially if corticosteroids) |
| thrombocytopenia risk for infection values | not significant until <20,000 or if invasive procedure <50,000 (Plt) |
| Acute Myeloid Leukemia (AML) | most common non-lymphocytic leukemia |
| most common complications and/or causes of death in AML-acute myeloid leukemia | major hemorrhages (thrombocytopenic) and infections (neutropenic) |
| RN DX related to Leukemia | risk for: infection,bleeding,impaired skin integrity, imbalanced nutrition, mobility, fatigue, acute pain, EFV / FVD, diarrhea, impaired mucus membranes, etc |
| RN interventions for Leukemia | prevent/mgt infections-bleeding mgt mucositis improve nutrition ease pain decrease fatigue maintain fluid-electrolytes improve self care mgt anxiety/grief spiritual well being promote self/home/community care |
| MYELOMA | -2nd most common hematologic cancer -back or rib pain -elevated total protein levels -hypercalcemia -dehydration, thirst, constipation, confusion, (coma) |
| primary thrombocythemia essential thrombocthemia | -bone marrow/stem cell disorder -increased platelet production - >600,000/mm(cubed) (normal 150-450 X 10(cubed)) |
| thrombocythemia s/s | -painful burning, warmth, redness in localized distal area of extremity -hemorrhage / occlusion -DVT / pulmonary embolism -headacheds, diplopia |
| secondary thrombocytosis | increased number of platelets can be caused by many other Dx: infections, chronic inflammation, iron deficiency, cancers, hemorrhage, splenectomy |
| thrombocytopenia | decreased platelet counts normal = ? |
| causes of thrombocytopenia | < production (LEUKEMIA..) > destruction (LUPUS/LYMPHOMA..) > consumption (DIC) |
| treatment of 2ndary thrombocytopenia | platelet transfusion thrombocytopenia bleeding precautions p. 938 |
| idiopathic thrombocytopenic purpura ITP | more common women/young children acute or chronic (2 forms) macrophages ingest platelets marrow increases platelet production |
| s/s of ITP idiopathic thrombocytopenic purpura | -easy bruising -heavy menses -petechiae -GI bleeding and/or hemoptosis |
| thrombocytopenia platelet count #'s | 30,000-50,000 = carefully observed 20,000/bleeding = improve count 10,000 = increased risk of bleeding 5,000 = spontaneous/fatal CNS or GI hemorrhage may occur |
| hemophelia A hemophelia B/ Christmas disease | -inherited, X-linked = males -hemorrhages into body parts (mostly joints) -poor clotting/ poor healing |
| treatment of hemophelia A/B | -factor VIII or IX transfusion (-recombinant factor VIIa for those with VIII, IX antibodies) -Aminocaproic Acid helps stabilize clots |
| hemophalia teachings | -avoid alcohol, nsaids, aspirin, -good dental hygeine -avoid injections/invasive procedures -id bracelets -prophylactic factor Xfusions -genetic testing |
| disseminated intravascular coagulation (DIC) | sign of underlying other condition variable severity, potentially life threatening massive amounts tiny clots form in microcirculation / excessive clotting = bleeding |
| DIC can be triggered by... | sepsis, trauma, cancer, shock, toxins, allergic response |
| s/s of DIC | p. 956 per system bleeding multiple organ dysfxn syndrome (MODS) renal failure |
| treatment of DIC | -O2, fluids, electrolytes, vasopressor, cryoprecipitate, fresh-frozen plasma, HEPARIN, aminocaproic acid |
| most common causes of DIC | SEPSIS & ACUTE PROMYELOCYTIC LEUKEMIA |
| THROMBOTIC DISORDERS | hyperhomocysteinemia antithrombin deficiency protein C deficiency protein S deficiency activated protein C resistance Factor V Leiden Mutation acquired thrombophilia |
| various types of ANEMIAS | iron defifiency anemia renal disease anemia aplastic anemia megaloblastic anemia sickle cell anemia thalassemias |
| conditions resulting from thrombosis include: | MI, CVA, periph. arterial occlusive disease, DVT, pulmonary embolism -ANTICOAGULATION THERAPY NECESSARY- |
| hyperhomocysteinemia | -elderly, renal failure, smokers -deficient folic acid, B6, B12 test = admin methionine, measure serum homocysteine in 4 hours |
| antithrombin deficiency | -hereditary -later in life >50yrs -DVT, and other thrombi -heparin resistance |
| protein C deficiency | -hereditary -thrombotic events 30-45yrs of age -warfarin induced skin necrosis** **antidote = Vitamin K **infuse heparin & fresh frozen plasma, purified protein C concentrate |
| protein S deficiency | -spontaneous recurrent venous thrombi -as early as 15 years of age -axillary, mesenteric, cerebral **warfarin induced skin necrosis possible |
| factor V Leiden Mutation | most common cause of inherited hypercoagulability in caucasians -homozygous=anticoag Rx for life -heterozygous=anticoag Rx few months |
| heparin induced thrombocytopenia (HIT) | -complication of heparin therapy -formation of antibodies against heparin-platelet complex s/s = decreased platelet count 4-14 days after starting therapy MONITOR PLATELET COUNTS IF HEPARIN THERAPY |
| HEPARIN INDUCED THROMBOCYTOPENIA / HIT increases risk of ... | MI, CVA, DVT, ischemic damage to extremity necessitating amputation. fatal thrombosis risk 20-30% |
| LMWH LOW MOLECULAR WEIGHT HEPARINS | dalteparin/Fragmin enoxaparin/Lovenox -have more selective effects on coagulation- lower incidence of HIT but also CONTRAINDICATED IN HIT!! |
| WARFARIN/COUMADIN | -anticoagulation therapy -Vit K is antidote -avoid Vit K foods (spinach, broccoli, lettuce) -monitor INR (standard reporting of PT) |
| nursing mgt of thrombotic disorders | -avoid circulatory stasis -ambulate -anti embolism stockings -low dose aspirin therapy -avoid tabacco/nicotine use -avoid crossing legs -Rx-Rx considerations (warfarin) |
| therapies for blood disorders | splenectomy therapeutic apheresis blood component therapy special preparatoins |
| splenectomy complications, etc | -pneumonia (vaccine prior if able) -abdominal distention -abscess formation -lethal infections **see care if minor signs of infections **predisposed to serious thrombotic/hemorrhagic problems |
| apheresis | -blood is passed thru centrifuge -components separated -platelets / leukocytes / stem cells |
| diseases transmitted by blood transfusion | -Hep B/C (viral) -AIDS / HIV -Cytomegalovirus (CMV) -Graft vs. Host disease -Creutzfeldt-Jacob disease (CJD) |
| blood donor qualifications = | -health history screening -50kg/110lbs (450mL donation) -oral temp >99.6 -pulse reg, 50-100 -BP: 90/50-180/100 -Hgb: men 13.5 / women 12.5 |
| autologous donation | -patients own blood is collected for possible future use -4-6 weeks preop -iron supplements NEVER PLACED IN GEN DONOR SUPPLY CAN BE FROZEN UP TO 10 YRS |
| MOST COMMON TRANSFUSION REACTION? | febrile nonhemolytic reaction fever / chills antipyretics ok |
| most dangerous transfusion reaction? | ACUTE HEMOLYTIC REACTION -life threatening -ABO mis-match |
Created by:
rtcdavis
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