Care of the Client with Hematological Alterations
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| What are normal levels for RBC’s FOR FEMALES AGES 18-64? | show 🗑
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| show | 4.7-6.1
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| What are normal levels for RBC’s for FEMALES ages >64? | show 🗑
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| show | 3.8-5.8
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| A decreased level of RBCs could indicate possible ___ or ____? | show 🗑
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| An increased level of RBCs could indicated possible ____ or ____ (a chronic life-shortening myeloproliferative disorder resulting from the reproduction of a single clone-Tabers)? | show 🗑
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| show | 12-16
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| show | 14-18
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| show | 11.7-16.1
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| What is the normal HgB for MALE ages 64? | show 🗑
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| A decreased level of HgB could indicate possible ___ or ___? | show 🗑
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| show | An increased level could indicate possible chronic hypoxia or polycythemia vera (a chronic life-shortening myeloproliferative disorder resulting from the reproduction of a single cell clone-Tabers)
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| show | 37-47%
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| What is the normal Hct for MALE ages 18-64? | show 🗑
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| show | 35-37%
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| show | 37%-51%
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| A decreased level of Hct could indicate possible? | show 🗑
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| show | An increased level could indicate possible chronic hypoxia or polycythemia vera (a chronic life-shortening myeloproliferative disorder resulting from the reproduction of a single cell clone—Tabers).
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| What is the normal WBC for both males and females of all ages? | show 🗑
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| show | Increased levels are associated with infection, inflammation, autoimmune disorders and leukemia
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| Decreased WBC levels may indicate ___ or ___? | show 🗑
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| show | 150,000-400,000 mm3
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| show | Increased levels may indicate polycythemia vera or malignancy.
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| show | Decreased levels may indicate bone marrow suppression, autoimmune dissease, or hypersplenism
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| show | Iron deficiency anemia
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| What is the common name for Macrocytic Anemia? | show 🗑
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| With ____ the iron stores are depleted first, followed by the hemoglobin stores? | show 🗑
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| What happens as a result of iron deficiency to RBCs? | show 🗑
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| In iron deficiency anemia, serum ferritin values are less than ____? | show 🗑
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| ______ is a common type of anemia and can result from blood loss, poor intestinal absorption, and an inadequate diet? | show 🗑
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| show | The basic problem is a decreased iron supply for the developing RBC.
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| show | women, older adults, and people with poor diets.
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| ______ causes anemia by inhibiting folic acid transport and reducing DNA synthesis in precursor cells. These precursor cells then undergo improper DNA synthesis and increase in size. Only a few are released from the bone marrow | show 🗑
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| ____anemia is called megaloblastic (macrocytic) because of the large size of these abnormal cells? | show 🗑
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| ______results result from poor intake of foods containing vitamin B12? | show 🗑
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| show | Vitamin B12 deficiency
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| Conditions such as small bowel resection, diverticula, tapeworm, or overgrowth of intestinal bacteria can lead to poor absorption of ____? | show 🗑
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| show | (pernicious anemia)
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| Folic acid deficiency can also cause ____? | show 🗑
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| show | Folic acid deficiency
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| What helps distinguish folic acid deficiency from vitamin B12 deficiency? | show 🗑
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| show | True
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| The three common causes of folic acid deficiency are? | show 🗑
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| show | Poor nutrition, especially a diet lacking green leafy vegetables, liver, yeast, citrus fruits, dried beans, and nuts, is the most common cause.
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| show | Malabsorption syndromes, such as Crohn's disease, are the second most common cause.
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| Chronic alcohol abuse with malnutrition is another cause of? | show 🗑
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| show | Severe pallor; Slight jaundice; Smooth, beefy red tongue (glossitis); Fatigue; Wt loss; Paresthesias of the hands and feet; Difficulty with gait
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| Folic acid deficiency anemia can be distinguished from B12 anemia how? | show 🗑
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| What common food sources would you suggest for a client who has Iron deficiency? | show 🗑
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| What common food sources would you suggest for a cl who has Vit B12 deficiency? | show 🗑
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| show | Liver; organ meats; eggs; cabbage; broccoli; & Brussels sprouts
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| Most often Aplastic Anemia is accompanied by a decrease in circulating RBC, leukopenia and thrombocytopenia. This is called___? | show 🗑
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| ____ is a disease with sustained increase in hemoglobin levels to 18g/dL; RBC count of 6 million/mm3 or hematocrit 55% or higher? | show 🗑
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| show | Polycythemia Vera (PV)
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| Strokes and bleeding tendency are also SS of ___? | show 🗑
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| show | Gout & hyperkalemia-because the actual number of cells in the blood is greatly increased & the cells are not completely normal, cell life spans are shorter. Causing increased cell debris that includes uric acid and potassium.
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| show | Monitor the CBC to assess response to treatment. Conservative treatment of repeated phlebotomies (2-5x per week) can prolong life for 10 to 20 yrs. Increasing hydration & promoting venous return help prevent clot formation, including prevention.
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| show | Phlebotomy
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| What patient education would you conduct with a patient with PV? | show 🗑
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| T/F Pt with PV should wear gloves when outdoors in temperatures lower than 50° F (10° C)? | show 🗑
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| T/F It is not important for a pt with PV to keep all health care—related appointments? | show 🗑
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| show | Contact your physician at the first sign of infection.
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| show | True
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| When performing activities or exercise when you have PV you should stop at the first sign of? | show 🗑
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| T/F it is not important for a pt with PV to use an electric shaver? | show 🗑
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| What type of toothbrush should a person with PV use and should they floss? | show 🗑
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| What is given to replace cells lost as a result of trauma or surgery? | show 🗑
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| show | Clients with problems that destroy RBCs or impair RBC maturation also may benefit from RBC transfusions.
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| ______, supplied in 250-mL bags, are a concentrated source of RBCs and are the most common component given to RBC-deficient clients? | show 🗑
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| What is given to clients with a hemoglobin level less than 6 g/dL (or a hemoglobin value of 6 to 10 g/dL if manifestations are present)? | show 🗑
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| show | Platelets
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| T/F Platelet transfusions are usually pooled from as many as 10 donors and do not have to be of the same blood type as the client? | show 🗑
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| For clients who are going to receive a bone marrow transplant (BMT) or who need multiple platelet transfusion, what might need to be prescribed? | show 🗑
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| show | Single-donor platelets
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| show | Single-donor platelets
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| ____ may be given fresh to replace blood volume? | show 🗑
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| show | fresh frozen plasma (FFP)
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| show | Freezing preserves the clotting factors, and the plasma can then be used for clients with clotting disorders
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| show | Infuse FFP immediately after thawing while the clotting factors are still active.
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| show | Clients who are actively bleeding with a prothrombin time (PT) or partial thromboplastin time (PTT) greater than 1.5 times normal are candidates for an FFP infusion
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| ____ is a product derived from plasma? | show 🗑
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| Clotting factors VIII and XIII, von Willebrand's factor, and fibrinogen are precipitated from pooled plasma to produce ____? | show 🗑
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| Clients with a fibrinogen level of less than 100 mg/dL are candidates for a ____? | show 🗑
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| show | Give this highly concentrated blood product to clients with clotting factor disorders at a volume of 10 to 15 mL/unit. Although cryoprecipitate can be infused, it is usually given by IV push within 3 minutes.
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| Dosages of ____are individualized, and it is best if the ____is ABO compatible? | show 🗑
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| WBC Transfusion is also called? | show 🗑
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| What types of pts receive granulocyte (white cell) transfusions? | show 🗑
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| What practice is controversial because the potential benefit to the client must be weighed against the potential severe reactions that often occur with ___ transfusions? | show 🗑
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| The surfaces of ____ contain many antigens that can cause severe reactions when infused into a client whose immune system recognizes these antigens as non-self. In addition, transfused ___have a short life span and provide minimal protection? | show 🗑
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| Assess lab values; verify medical prescription; assess cls VS, urine output, skin color, & Hx of transfusion reactions; Obtain venous access. Use central catheter/19-gauge needle if possible; obtain blood products from a blood bank. Transfuse immediately; | show 🗑
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| Administer the blodd product using the appropriate filtered tubing; if blood prdt needs to be dilutes, use only normal saline solution; remain w/ pt during the 1st 15-30 min of infusion; infuse the blood prdt at the prescribed rate and monitor VS are all | show 🗑
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| show | when the transfusion is completed, discontinue infusion & dispose of the bag and tubing properly & DOCUMENT
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| How soon after you get a blood bag from the refrigerator should it be given? | show 🗑
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| show | 50 mL
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| ___ is a potential complication of rapid infusion? | show 🗑
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| show | distributive
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| Distributive shock is most commonly called ____? | show 🗑
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| show | sepsis
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| show | Septic shock (sepsis-induced distributive shock)
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| show | True
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| The first phase of ____can be long, often lasting from hours to a day or longer? | show 🗑
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| Manifestations during phase 1 of distributive/septic shock are ____ and the chance for recovery is ____ when the cl is recognized being in the first phase? | show 🗑
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| show | septic shock
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| If septic shock progresses to the second phase, chances for recovery are ____? | show 🗑
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| show | True
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| ___ increases during the first phase of septic shock? | show 🗑
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| show | high-output or warm-shock phase.
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| show | increased cardiac output is reflected by tachycardia, increased stroke volume, a normal-to-elevated systolic blood pressure, and a normal CVP.
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| show | normal with pink mucous membranes and may feel warm to the touch.
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| show | True
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| What marks the beginning of the second phase of septic shock.? | show 🗑
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| Lab assessment of a client with septic shock would include specimens of? | show 🗑
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| show | Another indicator of sepsis and septic shock is a reduction in the blood levels of activated protein C
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| What does activated protein C do? | show 🗑
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| show | protein C
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| In septic shock, the endothelial cells injured by endotoxins cannot activate protein C and thousands of small ____ form in the capillaries of vascular organs? | show 🗑
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| show | activated protein C
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| Drug therapy in septic shock includes ___ and ___ to enhance cardiac output & restore blood volume? | show 🗑
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| The same drugs used to enhance cardiac output and restore vascular volume in hypovolemic shock are used for ____? | show 🗑
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| A major focus of drug therapy is antibiotics to combat ___? | show 🗑
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| show | False they may be needed
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| show | septic shock
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| Drug therapy in the first phase of septic shock and disseminated intravascular coagulation (DIC) is aimed at preventing coagulation by administering ____? | show 🗑
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| show | clotting factors, plasma, platelets, or other blood products.
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| show | gram-negative bacteria.
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| When blood cultures have identified specific bacteria, IV ____ with known activity against the bacteria are given? | show 🗑
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| Multiple drugs with wide activity are prescribed when the causative organism of septic shock is ____? | show 🗑
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| show | vancomycin, aminoglycosides, systemic penicillin or cephalosporins, macrolides, and quinolones
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| show | heparin
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| When septic shock progresses to the late phase and small clots have formed to such an extent that the client no longer has enough clotting factors to prevent hemorrhage, ____ are infused? | show 🗑
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| show | pooled human serum
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| Infusing ____ also helps to replace clotting factors? | show 🗑
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| show | True
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| ______ has been shown to stop the inflammatory responses and small clot formation of septic shock (Kleinpell, 2003a)? | show 🗑
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| show | drotrecogin alpha (Xigris), is given as a continuous infusion over 4 days.
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| T/F Antibodies against the body's mediators for inflammation are being tested for their effectiveness in septic shock? | show 🗑
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| T/F Antibodies have been developed against the some proinflammatory cytokines, particularly interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor (TNF). This experimental therapy shows promise in reducing the extensive mortality associated | show 🗑
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