LPN 41

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LPN 41
2012-03-06 19:55:29
Hematologic HIV Immunologic Disorders

chapter 32 33 34
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  1. What are the two components Ige work with?
    Basophils and mast cells to release histamine
  2. Anatomic structures and components:
    • - Spleen
    • - Thymus
    • - Stem cells
    • - WBC (leukocytes)
    • - Neutrophils
    • - basophils have to do with the blood
    • - mast cells have to do with tissue
  3. What does histamine call upon?
  4. What does Basophil Ige release?
  5. The bone produce WBC's. Five major types of WBC's exist:
    • neutrophils
    • basophils
    • eosinophils
    • neutrophils
    • monocytes
  6. Function of Eosinophils;
    • To combat parasitic infections
    • They are also associated with allergic reactions and other inflammatory processes.
  7. Function of Basophils;
    Can initiate a massive inflammation response that quickly brings other WBC's to the site of the infection.
  8. Multistep of inflammation:
    • Rubor (redness)
    • Tumor (swelling)
    • Calor (heat)
  9. When does Active acquired immunity occur?
    when a person synthesizes his or her own antibodies in response to a pathogen.
  10. A shift to the left on a CBC indicates:
    The percentage of WBC's that are neutrophils is greater than 60%.
  11. A shift to right on a CBC indicates:
    Only a small percentage of the WBC's are neutrophils.

    • Occurs when:
    • - the body is overwhelmed with infection
    • - bone marrow not producing neutrophils
    • (less than 60%)
  12. Neutropenia is caused by:
    • decreased bone marrow production
    • chemotherapy
    • radiation therapy
    • certain drugs
    • autoimmune reaction
  13. Skin test serve as a barometer of:
    Immune system functioning
  14. What does the skin test point out?
    Hyposensitivities or hypersensitivities to a particular antigen.
  15. Some examples of allergens used in skin testing include:
    • dust
    • pollen
    • animal dander
    • purified protein derivative
    • tuberculin bacillus
    • candida albicans
  16. Thrombocytopenia
    Low platelet count
  17. Regarding infection, patients with leukemia are at great risk for bleeding r/t:
  18. Intervention: risk for injury; Infection: for the patient with acute leukemia includes;
    Uncooked foods because naturally they contain the bacteria Escherichia coli, Pseudomonas aeruginosa and Klebsiella spp.
  19. Assessment for Leukemia:
    • Assess for any evidence of bleeding;
    • the lower the platelet count the greater the risk for bleeding

    • platelet count <50,000 cell per/mm3
    • causes patient to continue bleeding
  20. Hypersensitivity Reaction Type IV
    Delayed hypersensitivity reactions result from immune cells migrating to the sit of exposure days after the exposure to the antigen

    • Can occur with;
    • contact dermatitis
    • measles rash
    • tuberculin skin testing
    • various drugs
    • drug allergies
  21. What is ITP?
    Idiopathic thrombocytopenia purpura
  22. Drugs that induce ITP;
    • sulfonamides
    • thiazide diuretics
    • chlorpropamide
    • quinidine
    • gold
  23. Why don't thrombocytopenia get platelet transfusions?
    because they are destroyed.
  24. Function of the spleen;
    filters microorganisms from the blood.
  25. What is TTP?
    Thrombotic Thrombocytopenia Purpura
  26. Main treatment for TTP;
  27. Transfusions are contraindicated for TTP;
    because platelets cause extreme clotting and makes the disease worse.
  28. 90% of Lupus patients are;
    women of child bearing age
  29. Signs and symptoms of Systemic Lupus Erythematosus;
    • Musculoskeletal symptoms:
    • -Arthralgias
    • -Myalgias
    • Rash and photsensitivity:
    • -butterfly shaped rash across the bridge of nose and cheeks.
  30. Medical treatment for Lupus;
    No treatment
  31. SLE (systemic lupus erythematosus) intervention;
    Disturbed body image: rash, avoid sun; use sun block SPF >15
  32. Musculoskeletal symptoms of SLE;
    • are experienced by 95% of patients at some time during the course of their disease, includes;
    • athralgias (joint pain)
    • myalgias (muscle pain)
  33. Drugs used to prevent rejection of a transplant organ:
    • Steroid agents; Decadron
    • use/action: to prevent rejection of a transplant organ b/c glucocorticoid agents interfere with eicosanoid production.

    Also used to treat acute hypersensitivity reaction type I (anaphylaxis)

    • Nursing intervention:
    • Give these drugs with meals.
  34. Bone marrow Transplant and Peripheral Blood Stem cell Transplant:
    Restore hematologic and immunologic systems
  35. Three main types of transplants are:
    • (1) allogenic bone marrow transplant
    • (2) autogolus bone marrow transplant
    • (3) peripheral blood stem cell transplant
  36. (2)Autogulous bone marrow transplant;
    patients own bone marrow is harvested then re-infused

    used in solid tumor
  37. (1)Allogenic bone marrow transplant;
    bone marrow from a human leukocyte antigen matched donor is infuse into the patient
  38. (3)Peripheral blood stem cell transplant;
    similar to hemodialysis; stem cells are harvested, which are later returned to the patient.
  39. Red blood cells have proteins called;
    Antigens ( A and B)
  40. What is the primary function of the hematologic system?
    oxygenation and hemostasis (control of bleeding)
  41. The liver performs many functions for different parts of the body systems. As part of the hematologic system the liver;
    manufactures clotting factors
  42. Function of the spleen;
    removes old RBC's from circulation
  43. Clotting factors:
    • Fibrinogen (factor I)
    • Thrombin (factor II)
  44. Age-Related changes in hematology;
    bone marrow becomes less productive

    • hematologic function not affected unless a person is:
    • a person is unusually stressed
    • a chronic illness
    • treatment for cancer

    In conditions necessitating a higher production of blood cells, bone marrow usually responds to the increased demand, given time.
  45. Family history of hematologic disorders include;
    • Sickle cell
    • Hemophilia
  46. Death of a family member at a young age for reasons other than trauma may indicate;
    A genetic hematologic disorder
  47. What is Epistaxis?
    unexplained nose bleeds
  48. Epistaxis is an example of a;
    clotting factor disorder
  49. Orthostatic changes in b/p and pulse are;
    • B/P decreases 15 to 20 points
    • Pulse increases 15 to 20 points
  50. Most common site for a bone marrow biopsy is;
    • posterior iliac crest
    • anterior iliac crest
    • sternum
    • tibia
  51. After a bone marrow biopsy, the nurse should;
    • check the site for bleeding
    • apply pressure dressing
  52. In a physical assessment: what would cracking at the corners of the mouth indicate?
    decrease amount of vitamin D
  53. Blood test:RBC, Hct, Hgb, platelet count for both men and women
    • RBC male=4.6-6.2/female= 4.2-5.4 million
    • Hgb male= 13-18 female= 12-16
    • Hct male= 40-54% female= 37-47%
    • platelet count- 140,000 to 400,000
    • Iron- measures the patients ability to produce RBC's
  54. Hematocrit is usually;
    3x the hemoglobin
  55. A reduction in the number of rbc's or in the quatitiy of hgb in the blood is ;
  56. universal donor;
    type O
  57. universal recipeint;
    type AB
  58. small 1-3 mm red or reddish purple spots on the skin resulting from capillaries breaking and leaking small amounts of blood into the tissues are:
  59. Polycythemia;
    too many RBC's
  60. What activates the blood clotting system?
    Platelets or Thrombocytes
  61. Therapeutic Action:Nursing actions for the patient at Risk for Injury from low red blood cell counts:
    • Oxygen as ordered
    • Blood products (erythropoietin)
    • Allow for rest periods
    • Elevate patients head with a pillow
    • Keep warm (blankets)
    • teaching
  62. Therapeutic Action: Nursing action for the patient at Risk for Injury from bleeding:
    • Blood transfusions
    • Avoid prolonged tourniquet use, IM's, suppositories enemas
    • Prevent constipation
    • BP
    • Hygiene (for everyone)
  63. Common blood products:
    • RBC
    • Platelets
    • FFP (fresh frozen Plasma)
    • Cryoprecipatate (used for hemophilia)
  64. What is needed prior to a patient receiving a blood transfusion?
    Signed consent
  65. Autogulous transfusion:
    Using the patients own blood
  66. Proper order of administration of blood;
    • *Consent form
    • *Sample of blood is drawn and sent to blood
    • blood bank to be crossmatched
    • *IV line of NS with 18 or 20gauge (16gauge)
    • *Check by 2 people
    • *Start within 30 mins
    • *Take vitals
    • *Give blood over 2-4 hrs
    • *Stay with patient 5-10 minutes after
    • starting blood
    • * Check for reaction: such as; back pain,
    • fever, chills or decrease b/p and elevated
    • temperature
    • * Monitor vitals per protocol.
  67. With a platelet transfusion, each platelet pack should;
    Increase platelet count to 5,000-10,000
  68. What blood product used for transfusion does not contain platelets?
    FFP (fresh frozen plasma)
  69. Name for the four main types of reactions to blood transfusions;
    • Hemolytic
    • Anaphylactic
    • Febrile
    • Circulatory overload

    Some s/s of a reaction are: chest pain, fever, chills, decreased blood pressure, wheezing, coughing. Occurs during the transfusion
  70. If a patient has a reaction to a blood transfusion, what should be done?
    After stopping the transfusion, the nurse must immediately notify the physician, nurse supervisor and the blood bank.

    The blood product should be returned to the blood bank.
  71. Naturally occurring hormones that stimulate the bone marrow to produce more blood cells:
    • Erythropoietin (Epogen)
    • Stimulates the bone marrow to produce more
    • red blood cells.
    • Effects on the hematocrit not apparent for
    • several days.
  72. Drugs commonly used to treat hematologic system disorders include;
    • Epogen: stimulates bone marrow to produce
    • RBC's
    • Neumega:stimulate bone marrow to produce
    • platelets
    • Ferrous sulfate:iron replacement (causes
    • constipation).
    • Iron Dextran:iron replacement; administer
    • by IM/ Z-track
    • Vitamin B12:Replacement; IM injection
    • Hydroxyurea:Prevention of sickle cell crisis
  73. RBC disorders:
    • May have too many or too few rbc's
    • May be due to acute or chronic blood loss
    • Having too few is seen more commonly
  74. In acute or chronic blood disorders the body compensates in 3 ways:
    • 1. By increasing heart rate and respiratory
    • rate.
    • 2. Redistribution of blood away from the skin.
    • 3. Produces more erythropoietin to produce
    • produce new RBC's.
  75. What is Polycythemia Vera?
    • a condition where too many RBC's are produced.
    • Treatment: is to have a unit of blood phlebo-
    • tomized, or taken off, to keep the hematocrit normal.
  76. What is aplastic anemia a result of?
    • A complete failure of the bone marrow
    • Extremely low RBC count
    • Caused by: certain drugs, and exposure to toxic chemicals and radiation.
  77. Signs and symptoms of Aplastic Anemia include;
    • pallor
    • extreme fatigue
    • tachycardia
    • shortness of breath
    • hypotension
    • unusually prolonged or spontaneous excessive bleeding.
  78. Autoimmune Hemolytic Anemia;
    • Seen in newborns, can occur after delivery if the mom has Rh-negative blood and the baby has Rh-positive blood.
    • Can cause problems to the baby
    • Are usually given Rogam
  79. Signs and symptoms of Autoimmune Hemolytic Anemia:
    • Pallor
    • Extreme fatigue
    • Tachycardia
    • Shortness of breath
    • Hypotension
    • Patients may appear Jaundice due to low RBC/Bilirubin.
    • Patients have a positive Coombs' antiglubulin blood test, it is common.
    • Medical Treatment: Identifying & treating the cause.
  80. What would cause a person to suffer from pernicious anemia?
    • Lack of intrinsic factor
    • Gastrectomy/no stomach
    • Alcoholic
  81. Signs & symptoms of pernicious anemia:
    • fatigue
    • pallor
    • weakness
    • a sore tongue
    • numbness of hands or feet
    • Treatment include: Monthly injections of vitamin B12 for life for gastrectomy patient.
  82. Sickle Cell Anemia:
    • A disease which disk shaped rbc's become sickle shape.
    • Misshapen cells more fragile than normal rbc's.
    • Sickled cells easily rupture as they pass thru small capillaries;they also get stuck in capillaries causing an obstruction of blood flow
  83. What kind of a disease is sickle cell disease?
    • Genetic disease; recessive gene from mom or dad.
    • Signs and symptoms:
    • low red blood cell count
    • fatigue
    • jaundice
    • cardiomegaly
    • elevated respiratory rate
  84. Sickle cell crisis: triggers are;
    • dehydration
    • infection
    • smoking
    • cold weather changes
    • over exertion
    • excessive alcohol consumption
  85. How is sickle cell crisis determined?
    there is no test to determine sickle cell crisis
  86. Medical treatment for sickle cell crisis
    Hydroxyurea- commonly used to treat leukemia; prevents sickle cell crisis.
  87. Thrombocytopenia
    • too few platelets circulating in the blood; issues is bleeding
    • Classic symptoms:petechiae and purpura, gingival bleeding,epistaxis, or unusual bleeding.
  88. Examples of thrombocytopenia:
    • ITP; idiopathic thrombocytopenic purpura
    • TTP; thrombotic thrombocytopenic purpura
  89. DIC: dissimenated intravascular coagulation
    • A hypercoagulable state
    • Over stimulation of normal coagulation cascade; sinultaneous thrombosis and hemorrage.
    • Always secondary to another pathologic process; sepsi, shock, major trauma, crush injuries, burns, cancer, acut tumor lysis symdrome or obstetrics complications.
  90. Hemophilia
    • Uncontrollable bleeding is the hallmark of hemophilia. Occurs after trauma, however, also spontaneously for no reason.
    • More common in type A blood
    • Factors VIII and IX are missing
    • Women who carry the trait pass it to their sons.
  91. Interventions for Hemophilia:
    • Risk for injury
    • Acute pain
    • Ineffective therapeutic Regimen management.
  92. Hemophilia patient teaching:
    • Protect from injury
    • First Aid.