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  1. lymphocyte
    T and B cells
  2. monocytes
  3. Eosinophils
  4. Basophils
  5. Neutrophils
    inflammation/first responders
  6. WBC
  7. RBC
  8. Spleen
    helps destroy/breakdown old platelets, organ involved with infection control.
  9. Polycythemia Vera
    The primary cause of this disorder is to many RBCs. It is a cancerous condition! Looks at the Philadelphia chromosome.

    Secondary form: living in altitude/copd/blood doping (olympics)
  10. Macrocytic-normochromic
    large RBC that have a normal color=vit. B12 deficiency, folic acid
  11. Microcytic-hypochromic
    -low color=iron deficiency anemia, cell is smaller and has less color
  12. Normocytic normochromic
    normal color=usually from acute blo0d loss
  13. Most common type of anemia-in third world countries, -may cause mental issues
    -cells will look like pale, microcymic hypochromic, heme is missingFatigue, SOB, HR up, pale skin, look at mucuous membrane around the eyeballs, pale tongue
    Iron Deficiency Anemia
  14. cracked fissures around the mouth
  15. CLASSIC SIGN, spoon-shaped nails
  16. Preventive education
    Nutritional counseling
    Oral supplement (ferrous sulfate)
    Understand difference between pill form and IM
    Pill-can stain teeth=use straw or drop it at the back of the throat,
    take on empty stomach,
    follow up with OJ or vitamin C which will increase absorption
    For Ims use a Z-track
    Expect stool to be black and tarryIf stool is green= too much iron!
    Anemia management
  17. It is genetic among african american women, also with gastric bypass pts.
    -A form of Vitamin B12 Deficiency(treated by diet and supplements)-Large Cell Anemias
    Pernicious anemia
  18. Lack of Intrinsic factor which is required for absorption of B12 Diet
    Pernicious anemia
  19. Diagnosed by the Schilling Test
    Pernicious Anemia
  20. Gastric issues/pancrease

    Red beefy tongue & neuro=CLASSIC SIGN
    pernicious anemia
  21. Drug to give for this disorder is Cyanocobalamin
    Pernicious Anemia
  22. Tell your pt. with Pernicious Anemia that they will have to receive treatment _____
    for life.
  23. THIS PT will usually receive an IM injection for the rest of their lives. Not PO because they cannot process it.
    pernicious anemia
  24. (same signs and symptoms w/o nerve tissues problems), it is RARE, give supplements
    folate deficiency
  25. Folate essential for formation and maturation of RBC’s
    Folate orally (vitamin B9)
    Common in bread
    folate deficiency
  26. pt. Not forming Red blood cells, usually caused by renal failure or cancer
    aplastic anemia
  27. common with patients who have undergone chemo, also with autoimmune disorder, also renal failure where kidneys are not forming erythropoeitin (lack of signal to produce RBC)
    aplastic anemia
  28. drug to give: Epogen=given to make bone marrow produce RBC
    aplastic anemia
  29. Side effect of this drug: too much RBC or polycythemia=high BP, clotting (due to vascular damage, because blood is to thick!), bone marrow suppresion (myelosuppresion)
  30. blood cell is lysed/ or broken=they release bilirubin: jaundince color-yellow sclera
    hemolytic anemia
  31. Blood Transfusion Reaction, Infection, Drugs, Sickle Cell, G6PD enzyme deficiencyJaundice/ecteric (same meaning)-Not because of liver failure but because of high bilirubin level
    hemolytic anemia
  32. Hemorrhage
    Trauma, Complications of surgery, Disruption vascular integrityStop / replace blood loss
    causes of hemolytic anemia
  33. Erythropoietin (EPO) ↑ Number of stem cells committed to RBC productionShortens the time to mature RBCs
    drug therapy for aplastic anemia
  34. what is HOP treatment
    • Hydration
    • Oxygenation
    • Pain relief
  35. symptoms; pain
    abdominal and long bones
    hand foot syndrome
    joint pain
    sickle cell anemia
  36. complications:
    leg ulcers
    sickle cell anemia
  37. proliferative disorder in which myeloid stem cells escape normal control mechanisms
    polycythemia vera
  38. caused by excessive production of erythropoietin from chronic hypoxia
    secondary polycythemia vera
  39. Medical management is removal of cause or therapeutic phlebotomy

    Manifestations: Thick, sticky blood which causes tissue ischemia and infarction, Increased BP and angina

    Treatment: Remove cause (tumor), Phlebotomy, Hydration to minimize complications
    polycythemia vera
  40. excess RBC
    polycythemia vera
  41. Platelet count < 150,000
  42. severe bledding platelet count
    Platelet count < 100,000
  43. Can result from: Decreased production of platelets within the bone marrow
    Increased destruction of platelets
    Increased consumption of platelets
  44. thrombocytopenic purpura (rare), chronic, takes time
  45. more common among women
    Autoimmune or idiopathic thrombocytopenic purpura
  46. acquired from chemo or radiation
    Acquired thrombocytopenia
  47. increased level of WBCs
  48. uncontrolled neoplastic proliferation of leukocytes
  49. lots of baby WBC that dont work right

    Bone marrow is highjacked; will have many many babies of one kind only-that doesnt work right.
    Early arrest of cell maturationBlock of cell production precursor
    Many blast cells
    Acute leukemia
  50. Mature or near-mature cells that dont work right
    chronic leukemia
  51. No single causative agent
    Combination of genetic and environmental influences
    Chemical agentsChemotherapeutic agents
    VirusesRadiation Immunologic deficiencies
  52. Symptoms include:
    Anemia, Bleeding, Infection, Weight Loss, Bone pain, Liver/ Spleen enlargement, Elevated Uric Acid (by-product of protein metabolism)
  53. Bone marrow overproduces ONE type of WBC that doesnt work. Will also not produce platelets which makes pt. At risk for bleeding.=pt. Will complain of bone pain
  54. DX:
    Blood tests, Bone Marrow Biopsy
    Very deficeint reds and platelets
    Infection or bleeding problem
  55. Treatment:
    Bone Marrow Transplantation-wipe out existing one that makes dysfunctional WBCsStem cell transplantCombination Chemotherapy
  56. This cancer stays in the bone marrowMature B-cells produce abnormal antibodies (called M-protein, found in the bloodstream)=forms tumorsCytokines and IL-6 help sick cells to survive
    Tumor masses of plasma cells form in the skeletal and soft tissues
    multiple myeloma
  57. Diffuse Bone Lesions
    multiple myeloma
  58. Diffuse bone lesions, Pain, bone is very porous or brittle.
    multiple myeloma
  59. Pathological Fractures (they didnt trip or fall, they just snapped and fell)-this is when doctors find out what the problem is., Hypercalcemia=bone destruction=
    multiple myeloma
  60. M-proteins, Bence Jones proteins.Common in african american males
    multiple myeloma
  61. Treatment:
    Plasmapheresis, chemotherapy, pain, biphosphonate
    multiple myeloma
  62. Types:
    malignant lymphoma
  63. Malignancies characterized by a proliferation of committed lymphocytes rather than stem cell precursors

    Solid tumors- particularly affecting lymph nodes and spleen
    malignant lymphoma
  64. Presence of Reed-Sternberg (RS) cellsarises from a single node and spreads (definitive diagnosis)
    hogdkins disease
  65. Lymphadenopathy (enlargement), Night Sweats, swelling of extremities? Genetic (maybe). younger people
    hodgkins disease
  66. Early Dx (Fever of unknown origin) is important.CXR, Lymphagiography, Biopsy75% cure, 20 year survival
    hodkins disease
  67. Wide spectrum of disordersvariety of causes ( exposure to infection, immune, genetic, environmental, H. Pylori (bacteria common in ulcer disease)
  68. No RS cells presentS/S: Similar to HD. generalized Lymphadenopathy
    non hodgkins
  69. Patient ages 50+ more common
  70. Many physical and psychological needs:Evokes great fear
    Equated with death
    Family may need help
    Patient empowered by knowledge of disease and treatment can have a more positive outlook and improved quality of life
    lymphoma management
  71. anemia caused by deficiency in intrinsic factor
    Pernicious anemia
  72. patients with sickle cell has periodic episodes of extensive cellular sickling, called:
  73. most common symptom of sickle cell crisis
  74. jaundice often causes intense
  75. drug used to reduce number of sickling and pain episodes
  76. Drugs given for pain management of sickle cell pain
  77. lack of ___ is the main cause of sickling cells
  78. teaching pts to avoid activities that lead to hypoxia and hypoxemia, stress, are ways to avoid ______
    a sickle cell crisis
  79. anemia that requires IM using Z track method
    iron deficiency anemia
  80. Vegan diets and poor intake of foods containg B12 leads to
    B12 Deficiency
  81. Glossitis is__
    smooth, beefy, red tongue-- common for B12 Deficiency
  82. B12 is need for normal ____ function
  83. Test given to diagnose pernicious anemia:
    Schilling Test, which measures B12 in urine
  84. Folic acid deficiency may present same symptom as B12 deficiency but the difference is it does not affect ____ function
  85. poor nutrition
    3 most common cause of folic acid anemia
  86. Deficiency of circulating RBCs becaue of failure of bone marrow to produce these cells:
    Aplastic anemia
  87. ______ is common in Aplastic anemia, where all three cell types are deficient.
  88. Mainstay management for patiets with aplastic anemia:q
    blood tranfusions
  89. long term exposure to toxic agents, drugs, infection
    Common causes of ACQUIRED aplastic anemia
  90. removal of the spleen
  91. hyperviscous
    thicker than normal blood
  92. cancer of RBC that has these three major hallmarks:
    1. massive production of RBCs
    2. Excessive leukocyte production
    3. Excessive production of platelets
    Polycythemia Vera
  93. this disorder presents the ff symptoms:
    1. mucous membranes have dark flushed cyanotic appearance
    2. intense itching caused by dilated blood vessels and poor tissue oxygenation.
    3. thrombosis (clot formation)
    4. sludging of the blood
    5. results in increased uric acid and potassium which leads to gout and hyperkalemia
    6. patients have poor oxygenation with severe hypoxia
    Polycythemia Vera
  94. Phlebotomy or blood drawing is a treatment used in pts. with
    Polycythemia Vera
  95. hydration
    increasing venus return, and
    using anticoagulants are treatments used for:
    Polycythemia Vera
  96. Type of cancer with uncontrolled production of immature WBCs in the bone marrow
  97. WBC disorder that makes excessive abnormal WBCs. Also leads to anemia, thrombocytopenia, and leukopenia.
  98. Cause of Leukemia is:
  99. The heart makes adjustments when tissue perfusion with oxygen is reduced because of Leukemia. Because of this, expect, the heart rate to be _________, and the blood pressure ___________.
    • Increased
    • decreased
  100. Because of the anemia that results from Leukemia, expect the respiration to be:
    increased. Pt. may be coughing with SOB.
  101. Intestinal changes from Leukemia include increased bleeding tendency and fatigue. Expect patient to also have engorgement of the ____ and ____
    liver and spleen
  102. lab results show: decreased Hgb and Hct levels, low platelet count, abnormal WBC count. WBC may be low, normal, or elevated. Which disorder is this?
    Acute Leukemia
  103. 2 definitive tests for diagnosing Leukemia:
    • 1. bone marrow aspiration
    • 2. Biopsy
  104. ____ is the major cause of death among pts. with Leukemia
  105. Actions for this type of disorder includes:
    monitoritng pts. daily CBC with differential WBC count and absolute neutrophil count. Inspect mouth for lesions and mucosa breakdown. Assess lungs q8hrs for crackels, wheezes, and reduces breath sounds.
  106. the standards treatment for pts. with Leukemia
    bone marrow transplant
  107. patient care for those with Thrombocytopenia ultimately involves minimizing the risk for :
    • bleeding
    • (thrombo is platelets)
  108. Patient care for those with Leukemia ultimately involves minimizing the risk for:
  109. This is a cancer of the lymphoid tissues. they are the abnormal growth of one type of leukocyte, the lymphocytes. Affected organs are usually the liver and spleen. They are also solid tumors.
  110. Hodgkin Lymphoma affects two age groups:
    • 1. teens
    • 2. adults in their 50s and 60s
  111. Hodgkins Lymphoma has nodes that contain a specific cancer cell type: a marker called ___
    Reed Sternberg cell
  112. this type of lymphoma generally spreads in an orderly fashion: from one group of lymph node to the next.
    Hodgkins Lymphoma
  113. B symptoms that occur with HL
    • 1. fevers
    • 2. night sweats
    • 3. unexplained weight loss
  114. In HL, the affected lymph nodes are enlarged but ___
  115. Hodgkins Lymphoma is one of the most treatable types of cancer. true or false?
  116. Infections from H. Pylori, Epstein Barr viral infection, and Burkitts lymphoma has been associated to cause:
    Non Hodgkins Lymphoma
  117. This WBC cancer involves overpduction of antibodies and thus making fewer functioning RBCs, WBCs, and platelets. It also produces excess cytokenes that increase the cancer cell growth and destroy bone.
    Multiple Myeloma
  118. The pt. with _____ presents the following symptoms:
    bone fracture
    presence of Bence Jones Protein
    Multiple Myeloma
  119. Protein found in Multiple Myeloma
    Bence Jones Protein
  120. A rare platelet disorder in which platelets clump together abnormally in the capillaries and too few platelets remain in circulation.
    Thrombotic Thrombocytopenia Purpura
  121. An autoimmune disorder where the total number of circulating platelets is greatly decreased, even though platelet production in the bone marrow is normal.
    Autoimmune thrombocytopenic purpura
  122. a nurse taking care of a client with DIC (Disseminated Intravascular Coagulation) has which priority nursing diagnosis?
    • Ineffective tissue perfusion: cardiopulmonary
    • (In DIC, both abnormal clotting and hemorrage reduce circulation. Oxygenation to organs and tissues decrease
  123. A pt. is getting blood transfusion to treat severe anemia. he suddenly develops chills and low back pain. What shoudl the nurse do first?
    A. slow transfusion and monitor pt. closely
    B. Administer Benadryl
    C. Take vitals
    D. stop transfusion and call Dr. immediately
    D. Chills and low back pain suggest an acute hemolytic reaction.
    (this multiple choice question has been scrambled)
  124. The earliest symptom of Hodgkins disease is usually:
    a painless enlargement of the lymph nodess.
  125. Name this drug:

    Toxicity:green, then tarry stools
    do not give with antacids or milk
    avoid reclining for 15-30 mins to avoid esophageal erosion
    Ferrous fumarate
  126. Ferrous Fumarate does what?
    replaces iron
  127. Name this drug:
    Common side effects: hypertension, long
    bone pain, cough
    Seizure, CHF, DVT
  128. Name this drug:
    used to prevent low platelet counts
    side effects: pain, red
    eyes, dizziness, bone pain, HTN, vision changes
    Oprelvekin (Neumega)
  129. name this drug:
    -stimulates proliferation and differentiation of neutrophils
    side effects:
    Nausea, alopecia
    thrombocytopenia, ARDS, wheezing

    -give mild analgesia for bone pain
  130. Name this drug:
    Vit B12 replacement-needed for nerve functioning
    Side effects: Diarrhea, optic nerve atrophy,CHF, pvd, pulmonary edema, anaphylactic shock

    -tell pts. Treatment
    for life for pernicious anemia
  131. name this drug:
    -needed for erythropoesis, increase, RBC, WBC, platelets

    side effect: flushing and bronchospasm
    urine will turn bright yellow
    Folate (Vit. B9)
  132. Platelet count
  133. What does creatinine measure?
    give the normal value:
    • Muscle breakdown
    • 0.8-1.4
  134. This genetic disorder results in chronic anemia, pain, organ damage, increased risk for infection, and early death.The main problem is the formation of abnormal hemoglobin chains where SICKLED RBCs form masses that block blood flow and further leads to HYPOXIA
    Sickle Cell Disease
  135. Hydroxyurea works by stimulating fetal hemoglobin which does not sickle. It is the treatment of choice for:
    Sickle cell disease
  136. The problem of this disorder is decreased iron supply for the developing RBC
    Iron Deficiency Anemia
  137. Type of anemia that result from failure to absorb Vit. B12 and is caused by a deficieny of Intrinsic Factor
    Pernicious anemia
  138. Substance normally secreted by the gastric mucosa and is needed for intestinal absorption of vit. B12
    Intrinsic Factor
  139. Anemia that is a deficiency of circulating RBCs because of failure of the bone marrow to produce these cells
    Aplastic Anemia
  140. symptoms of gout and hyperkalemia are present in:
    Polycythemia Vera
  141. Cancer that involves uncontrolled production of immature WBCs in the bone marrow.
  142. WBC cancer that involves a more mature lymphocyte called a plasma cell. B-lymphocyte plasma cells (needed to make antibodies) overproduce, and when this happens, it produces excess cytokenes and destroys bone.
    Multiple Myeloma
  143. Epogen is a subq injection used to treat______ and people with ____ _____ _______.
    • Anemia
    • Chronic Kidney Failure
  144. Drug used for low platelet counts (thrombocytopenia). It helps your body may more platelets. Used mostly by chemo patients.
    Oprelvekin (Neumega)
  145. This drug is used to prevent infectious complications associated with a decrease in the number of neutrophils in the body (neutropenia). Neutropenia may develop in cancer patients receivingchemotherapy or undergoing bone marrow transplantation
  146. _______, one of the B vitamins that is a key factor in the synthesis (the making) of nucleic acid (DNA and RNA).
    Folic Acid
  147. Caused by an out of control inflammatory response like sepsis, major trauma, and bleeding.
    -clotting and bleeding at the same time.
    -so look for symptoms of bleeding (petechiae), and symptoms of clotting (MI, CVA, stroke, ischemia)
    -look at platelet count, D-Dimer
  148. Treatment for DIC
    • replace blood products
    • Heparin (this is the confusing part, "why give heparin if pt. is already bleeding? because this treats the initial clotting)
  149. An RN from pediatrics has floated to the medical-surgical unit. Which of these patients is best to assign to the float nurse?

    A) a. A 42-year-old with sickle cell disease who is receiving a transfusion of packed red blood cells

    B) b. A 50-year-old with pancytopenia who needs assessment of risk factors for aplastic anemia

    C) c. A 55-year-old with folic acid deficiency anemia caused by alcohol abuse who needs counseling

    D) d. A 60-year-old with newly diagnosed polycythemia vera who needs teaching about the disease
    A. Because sickle cell disease is commonly diagnosed during childhood, the pediatric nurse will be familiar with the disease and with red blood cell transfusion. The other patients have problems more commonly seen in adult patients and should be cared for by nurses who are more experienced in caring for adults.
  150. An increase in abdominal girth in a thrombocytic patient indicates possible _____.
  151. the only proven lifestyle-related risk factor for leukemia is ______.
  152. name some Vit. B12-rich foods
    Dairy products such as milk, cheese, and eggs will provide the necessary vitamin B12 that the client needs.
  153. Induction Therapy is not a cure for Leukemia. It is a _____.
  154. An elevated temperature would indicate an infection, not ______.
  155. The nurse is providing genetic counseling to the client with sickle cell disease and the client's healthy spouse. Which information does the
    nurse include?
    ''The sickle cell trait will be inherited by your children.''
  156. _____ and ________ in the neutropenic client may be the first symptom of infection.
    wheezes and crackles
  157. The nurse is caring for the client with neutropenia with a suspected infection. Which intervention does the nurse implement first?
    Obtains ordered cultures
  158. Red blood cell (RBC) indices are part of the complete blood count (CBC) test. They are used to help diagnose the cause of anemia, a
    condition in which there are too few red blood cells.
    RBC Indices
  159. adverse side effect of anti-platelet meds:
  160. The nurse is caring for a 32-year-old client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?

    1Pallor, bradycardia, and reduced pulse pressure

    2. Pallor, tachycardia, and a sore tongue

    3. Sore tongue, dyspnea, and weight gain

    4. Angina, double vision, and anorexia
    2. Pallor, tachycardia, and a sore tongue are all characteristic findings in pernicious anemia. Other clinical manifestations include anorexia; weight loss; a smooth, beefy red tongue; a wide pulse pressure; palpitations; angina; weakness; fatigue; and paresthesia of the hands and feet.
  161. A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to:.
    sit upright, leaning slightly forward.
  162. signs of ___ ____ include:
    abnormal bleeding
    easy bruising
    Acute Leukemia
  163. Care for pts. with ___ includes the ff:
    1. placing the pt. in a private room and imposing reverse isolation if necessary
    2. avoid using indwelling catheters and giving IM injections
    3. screening visitors and staff for contagious diseases
  164. do not give aspirins, taking rectal temps, or performing digital rectal temps for pts. with
  165. large nucleated rbcs found in Pernicious Anemias and Vit. B12 Deficiencies:
  166. most serious hazard of bone marrow aspiration and biopsy
  167. ferrous fumarate must be taken _____ to _____ months for iron replenishment to occur?
    6-12 months
  168. Absence of Intrinsic factor is associated with B12 Deficiency, because the vitamin cannot bind to be transported for absorption in the :
  169. a patient with sickle cell trait would have:
    chronic anemia
  170. bone pain in the back of the ribs is a classic symptom of
    multiple myeloma
  171. petechiae and bruising are common early signs of:
  172. Decreasing intake of fresh fruits and vegetables is recommended for patients who have:
    WBC problems such as leukemia, or those with Myelosuppresion because fresh fruits and veggies may contain a lot of bacteria.
  173. petechia, purpura, epistaxis (nose bleeds), and bleeding gums are common signs of:
  174. Should you give aspiring to a a pt. with thrombocytopenia?
    No! because this will increase his risk for bleeding.
  175. A neutropenic patient is admitted with a diagnosis of possible sepsis (infection).Which one should the nurse accomplish first?
    Antibiotics should be started as quickly as possible for a patient with possible sepsis, but specimens for cultures are needed before starting the antibiotics to obtain accurate culture results.
  176. Which assessment information about a patient who is receiving oprelvekin (Neumega) requires immediate action by the nurse?
    The patient's respiratory rate indicates that pulmonary edema, a possible adverse effect of Neumega, may be occurring. The nurse should immediately perform assessments such as breath sounds and oxygen saturation and then notify the physician. Because Neumega is used to treat thrombocytopenia, a low platelet count and bruising would not be unusual.
Card Set:
2011-10-18 23:46:45
Hematology Nursing

nursing hematological system
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