Cardiovascular (Part 2) and Hematologic Disorders

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BCnurses2014
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203337
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Cardiovascular (Part 2) and Hematologic Disorders
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2013-02-25 17:53:05
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MedSurg
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MedSurg test
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  1. Characteristics of Arteriosclerosis
    • Thickening of arterial wall
    • Loss of elasticity
    • Hardening of artery walls (calcification)
  2. Atherosclerosis
    • A type of arteriosclerosis
    • Lipoprotein and fibrous tissue accumulate in the arterial wall
  3. Pathophysiology of Atherosclerosis
    Vessel damage > vessel inflammation > fatty streak appears on inner lining of artery
  4. Increased risk of Atherosclerosis
    • High levels of lipoproteins¬†
    • Low density lipoprotein (LDL) too high
    • High density lipoprotein (HDL) too low
  5. LDL/HDL normal levels
    • LDL - Want lower than 100
    • HDL - Want higher than 40
  6. Treatment of Arteriosclerosis/Atherosclerosis
    • Diet therapy - Fat content <30%, LDL low, HDL high, homocysteine levels low
    • Stop smoking
    • Exercise
    • Drug therapy
  7. Peripheral Venous Disease disorders
    • DVT
    • PE
  8. Causes of DVT
    • Endothelial injury
    • Venous stasis
    • Hypercoagulability
  9. Greatest risk of DVT
    Lead to PE
  10. DVT risk factors
    • Hip surgery
    • Knee surgery
    • Open prostate surgery
    • Immobility
    • Phlebitis (vein inflammation)
    • Pregnancy
    • Heart failure
  11. Signs of DVT
    • Groin tenderness and pain
    • Sudden onset of unilateral swelling of leg
    • Homan's sign only accurate 10%
    • Diagnostic tests - Doppler studies, venogram, ultrasonography
  12. DVT nursing diagnoses
    • Risk for ineffective tissue perfusion r/t interruption for venous blood flow
    • Acute pain r/t physical injury agent (thrombus)
  13. DVT nursing interventions
    • Prevention:
    • -Client edu
    • -Leg exercises
    • -Early ambulation
    • -Adequate hydration
    • -SCDs or TED hose
    • Rest and extremity evaluation
    • Observe for signs and symptoms of PE
  14. Signs and symptoms of PE
    • SOB
    • Chest pain
    • Panic
  15. Drug therapy for DVT
    • Anticoagulants (Heparin, Warfarin)
    • Thrombolytic Therapy to dissolve clot
  16. Function of hematologic system
    • Transportation of:
    • - Oxygen to cells
    • - CO2 from cells
    • - Hormones, electrolytes, and nutrients to cells
    • - Waste products to the liver and kidneys
    • Coagulation and clotting of blood
    • Immune response
  17. Erythrocytes
    • Concave disc
    • Carry hemoglobin that transports O2 to body tissues
    • Production in bone marrow = erythropoiesis
    • Circulates 120 days
    • Eliminated in liver and spleen
  18. Whole blood contains ___ grams of Hgb / 100 mls of blood
    14-15
  19. Normal WBC count
    5,000-10,000 / ml
  20. Platelets
    • Primary function = Aid the body in clot formation
    • Thrombocytes derived from megakarocytes in the bone marrow
    • Life span in 8-12 days
    • Stored in spleen and destroyed by phagocytosis
  21. Normal platelet count range
    150,000 - 450,000
  22. Thrombin converts...
    fibrinogen to fibrin for clotting
  23. Normal RBC range
    • Men: 4.5-5.3 million/mm
    • Women: 4.1-5.1 million/mm
  24. Normal Hct range
    • Men: 37-49%
    • Women: 36-46%

    Hct is generally three times Hbg
  25. Normal Hbg range
    • Men: 13-18g/100ml
    • Women: 12-16g/100ml
  26. Erythropoiesis
    • RBC production
    • Begins in bone marrow of vertebrae, sternum, ribs, and pelvis
    • Completed in the blood or spleen
    • Stimulus for RBC production = hypoxia
  27. Required components for proper development of RBCs
    • Iron necessary for hemoglobin synthesis
    • Protein
    • Vitamins b, b12, c, e
    • Folate
  28. RBC destruction
    • Life span of 120 days
    • Old or damaged RBCs are lysed by phagocytes in the spleen, liver, bone marrow, lymph nodes
    • Process of RBC destruction = hemolysis
    • Phagocytes save and reuse amino acids and iron from the heme units of lysed RBCs
  29. Anemia results from:
    • Decreased erythrocyte production
    • Increased erythrocyte production
    • Acute or chronic blood loss
  30. Causes of decreased erythrocyte production
    • Altered hemoglobin synthesis
    • Altered DNA synthesis
    • Bone marrow failure
  31. Acute blood loss anemia
    • All blood components are lost and nothing is recycled
    • Loss can be any source: trauma, GI, surgical procedure, clotting disorder
    • Blood may need to be replaced via transfusion
    • Fluid shifts from interstitial to vascular to maintain BP
  32. Chronic blood loss anemia
    • May be secondary to chronic GI bleeding or heavy menses
    • As blood is lost the body's supply of iron that is normally recycled when old RBCs are destroyed is lost.¬†
    • Result = depletes iron stores as RBC production attempts to maintain supplies
  33. Nutritional anemias
    • Iron Deficiency Anemia
    • Vitamin B12 Deficiency Anemia
    • Folic Acid Deficiency Anemia
  34. Iron deficiency anemia
    • Caused by inadequate supply of iron
    • Normally recycled, but need to renew with diet
    • Can lose iron when blood is lost
    • Most common type of anemia
  35. Vitamin B12 deficiency anemia
    • Needed for DNA synthesis (result = large abnormal cells)
    • Malabsorption of B12 secondary to many things (gastritis, partial/total gastrectomy, loss of pancreatic secretions)
    • When loss is specifically due to loss of intrinsic factor, its called pernicious anemia
  36. Folic acid deficiency anemia
    • Needed for DNA synthesis
    • (result = large abnormal cells)
    • Usually due to inadequate intake (alcoholics, elderly, drug addicted)
  37. Dietary sources of iron
    • Beef
    • Chicken
    • Egg yolk
    • Clams, oysters
    • Pork loin
    • Turkey
    • Veal
    • Bran flakes
    • Brown rice
    • Whole grain breads
    • Dried beans
    • Dried fruit
    • Greens
    • Oatmeal
  38. Dietary sources of folic acid
    • Green leafy vegetables
    • Broccoli
    • Organ meats
    • Eggs
    • Wheat germ
    • Asparagus
    • Liver
    • Milk
    • Yeast
    • Kidney beans
  39. Dietary sources of B12
    • Liver
    • Fresh shrimp and oysters
    • Eggs
    • Milk
    • Kidney
    • Meats (muscle)
    • Cheese
  40. Hemolytic anemias
    • Sickle cell
    • Thalassemia
    • Acquired hemolytic anemia
    • Glucose-6-phosphate dehydrogenase (G6PD) anemia
  41. Sickle cell anemia
    • Hereditary
    • Primarily in african americans
    • Result = an abnormal synthesis of hemoglobin that causes sickle-like appearance of RBCs
  42. Thalassemia
    • Hereditary disorder
    • Result = deficient production of hemoglobin and fragile RBCs
  43. Acquired Hemolytic anemia
    • hemolysis occurs secondary to something outside the cell itself
    • Trauma to cell from many factors including: prosthetic heart valves, severe burns, hemodialysis, radiation, certain infections, immune-mediated responses (transfusion reactions), drugs, venom
  44. Glucose-6-phosphate dehydrogenase (G6PD) anemia
    • Hereditary disorder in RBC metabolism
    • Result = direct oxidation of the Hgb which damages the RBC
  45. Aplastic anemia
    • AKA Bone marrow failure
    • Bone marrow fails to produce all three types of blood cells
    • Leads to panocytopenia - everything is low
    • Rare and cause is unknown in 50% of cases
    • Can occur from exposure to certain chemicals, toxins, and infections

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