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What % of WBC are Polymorphonuclear neutrophils?
What % of WBC are Bands?
What % of WBC are Lymphocytes?
What % of WBC are Monocytes?
What % of WBC are Eosinophils?
What % of WBC are Basophils?
What is the normal WBC?
5000-10000 is normal WBC count.
What are Bands?
What does it mean if you see a LEFT shift?
- If you start to see increase # of neutrophils (bands)
- Shift to Left, usually d/t infection, to try and fight infection BM is releasing younger WBC
When would you see an increase in Eosinophils?
up in patient w/allergies or parasitic infections.
What is the basic problem in Leukemia and what are the two types?
- Uncontrolled WBC production
- 1) Myelogenous
- 2) Lymphogenous
What happens in the BM in leukemia?
Only real difference from normal stem cells is that the cancer cells divide rapidly, and the expanding mass of cancer cells will squeeze out normal from BM and tissues
What causes anemia in leukemia?
they don’t have enough of the good cells so they can have a significant anemia.
What are the major causes of death in bone marrow failure in leukemia?
BM failure can result in infections which is often the cause of death in patient w/these disorders or hemorrhage from not enough platelets
Why are people w/leukemia easily fatigued?
Patients are really fatigued because all these rapidly dividing cells are using up nutrition and regular cells aren’t getting any nutrients.
Where else can leukemia cells infiltrate (besides the Bone Marrow)?
Leukemia cells can also infiltrate the liver or the spleen.
What is the treatment for leukemia?
- Chemotherapy (Doxorubicin, Bleomycin, & Vinca alkaloids)
- Bone marrow transplant
Drugs used to treat leukemia will suppress the bone marrow, what can this cause??
Bleeding and infection
What can chemotherapy cause as it destructs the tumor?
- tumor destruction will cause a uric acid load.
- Can cause a nephropathy or also arthritis.
- And immunosuppression.
What are our concerns w/Doxorubicin?
- Cardiac toxicity.
- Can appear up to 5 yrs. later.
What are our concerns with Bleomycin?
- Pulmonary fibrosis, in the setting of high concentration O2 will cause worsening.
- Need to be careful to dilute FiO2 w/room air. Keep FiO2 less than 30%
What are our concerns with Vinca Alkaloids?
- Can cause SIADH and peripheral neuropathy.
- Can also cause paresthesias in hands.
- Positioning is critical for patient who have had some of these drugs.
In a bone marrow transplant, the recipient gets the BM cells via a CVL which goes into their circulation, how long does time to engraftment take?
Time to engraftment (cells to take hold in BM) 10-28days and during that time the patient is isolation.
For anyone s/p chemo what are our concerns (Things we ask about?)
- check volume status
- history of N/V is common
- Check for coagulopathies.
What is AIDS? (pathophys)
- Viral infection kills helper T cells
- HIV uses those cells (CD4) to get entry into the T cells.
When was AIDS first discovered?
1st described in 1981 in US
CD4 T cell count less than____ cells/ml associated with significant morbidity
- Pneumocystis carina (type of pneumonia) doesn’t occur unless CD4 is less than 200cells/ml so signficant morbidity at that mark.
What are the cardiac consequences of AIDS?
- Up to 50 % of patients with HIV have abnormal cardiac ECHO
- 25% have pericardial effusions
What is HAART??? (HIV/AIDS tx)
- highly active antiretroviral therapy
- 3 agents
- Goal to achieve undetectable viral load by 24 weeks
What are s/s and complications of HIV/AIDS?
- S/S: night sweats. Weight loss. SOB. Complications: resp. failure. Pneumothorax. Pulmonary TB. Fungal infections. Carposi sarcoma. Lymphoma.
- Neuro complications can also occur: dementia, infections, neoplasms.
- CV and Vascular disease can occur too. Both as a result of infection and as a result of the antiviral treatment.
- Advanced disease adrenal insufficiency can occur.
When did the CDC start universal precautions?
Where can HIV be found??
Virus can be found in blood, saliva, tears, semen, CSF, cervical secretions, urine and Breast milk.
What will inactivate HIV?
Can be inactivated by dilute bleach solution (1:10 solution) along w/usual autoclave procedures.
How long can HIV live outside it's host?
Can live 7-10days outside of the host.
GA can cause immunosuppression. When does this start and how long does it last?
- Occurs within 15 min of induction
- May persist for 3 – 11 days
How does HIV effect the Neuro/muscular System?
- HIV associated with autonomic neuropathy
- Myopathy & peripheral neuropathy
- Avoid succinylcholine
What should you do after exposure to HIV?
- Hollow needle stick post exposure prophylaxis is recommended.
- Start 1-2hrs but can do up to 1-2 weeks following the injury.
- Very high risk exposures might consider beyond that time frame. But treating beyond that time frame is reducing the severity rather than preventing infection.
- Recommended prophylaxis is 4 weeks.
- Consists of AZT, Lamivudine, & Indinavir
If unresponsive hypotension in an HIV pt, what would you consider?
Persistent hypotension unresponsive then consider steroid supplementation as well.