adults exan 1 set 3

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kbryant86
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260014
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adults exan 1 set 3
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2014-02-04 08:10:19
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hematology
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adults exam 1 set 3
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  1. 4 structures of hematology system
    • lymph nodes
    • b. marrow
    • spleen
    • liver
  2. ns dx for RBC dysfunctions

    assessment
    Dec. in tissue perfusion

    assess= skin pallor, confusion, vertigo, HA
  3. what is included in the CBC
    • hgb
    • hct
    • RNC
    • Red cell indicies
    • WBC count
    • platelets
  4. abnl WBC counts:

    Luekopenia
    leukocytosis
    • penia= <4000
    • cytosis= >10,000
  5. "shift to the left"
    inc in band neutrophils signal acute infection
  6. aboslute neutro count formula?
    WBC(bands% + segs%) / 100
  7. WBC count 10,000, bands 2%, Segs 48%.

    what is pt's ANC?
    10,000(2+48) / 100

    = 5000
  8. ANV level:
    high risk
    mod risk
    nl risk
    h= <500 protective isolation

    m= 500-1000

    nl= 2800-7500
  9. rules of protective envirnment
    • No fresh ftuir/veggies (NCLEX)
    • no standing water or plants
    • reverse isolation
  10. causes of hemorrhagic tendenies
    low platelets of clotting fx's
  11. PT:
    nl
    used with what med?
    goal?
    how many times nl?
    • 12-15 sec
    • Coumadin

    • goal=18-37
    • 1.5-2.5 times nl
  12. INR:
    nl
    what med?
    goal?
    how many times nl?
    • 1.0
    • Coumadin

    • 2.0-3.0
    • 2-3 times nl
  13. PTT/APTT:
    nl?
    med?
    goal?
    how many times nl?
    • 23-34 sec
    • Heparin

    • goal= 46-80 sec
    • 1.5-2.5 times nl
  14. homologous blood
    autologous blood
    designated/directed blood
    autotransfusion
    • homo= from donor
    • atuo= from pt
    • desig= from family
    • autotrans= pt own blood removed and reinfused
  15. whole blood
    generall given over 4 hours
  16. Packed RBCS
    • RBC ONLY
    • cheaper
    • over 2-3 hours
  17. Leukocyte-poor RBC's
    prevents febrile, nonhemolytic rxns
  18. Irradiated RBC's
    deactivates transfused leukocytes from attacking hosts antigens 

    pt with depressed immune sys
  19. Frozen PRBC
    • awesome for Hx of trans rxns
    • costly
  20. fresh frozen plasma
    • plasma expander
    • has clotting factors
  21. Albumin
    • volume expander
    • pulls fluid back into vasc
  22. cryoprecipitate
    given to hemophiliacs
  23. acute hemolytic trans rxn
    • antibodies of recipient combine with antigen of donor blood
    • ABO icompatibility is most common
    • RBC's are destroyed
  24. Sx of acute hemolytic trans rxn
    • Immediate w/n 1st 100mL of blood
    • Chest and flank pain
    • fever
    • chills
    • tachycardia
    • tachypnea
  25. Febrile non hemolytic trans rxn

    sx's
    antibodies to donor leukocytes

    • sx= fever 1 degree C above baseline
    •  = chills
    •  = HA
    •  = malaise
  26. Allergic trans rxn
    sensitivity rxn to plamsa proteins in donor blood
  27. Sx to allergic rxn
    • uticaria
    • resp distress
    • itching (can give benadryl)
    • flushing

    can cause anaphlaxtic shock
  28. 3 types of cells in anemia
    nl= normo-

    small/pale= mirco /hypochromic

    large= macro
  29. ns interventions for anemia r/t blood loss
    • O2
    • blood
    • rest
    • nutrition
    • Fe supps
  30. MCV

    RDW
    mean corpuscular volume

    variation in rbc volume distribution width
  31. Fe deficiency anemia

    bllod test:
    MCV
    RDW
    diet, bleeding, malabsorption

    • m=low
    • R=high
  32. Fe deficiency anemia ns interventions
    • high Fe diet
    • black stool from Fe
    • fluids and roughage
    • Fe supps
  33. Pernicious anemia

    blood test:
    MCV
    RDW
    failure to absorb B12 due to lack of intrinsic factor

    • m=High
    • r=High
  34. pern. anemia interventions
    Vit B12
  35. Follic Acid Defect

    blood test:
    size?
    MCV
    RDW
    diet, alcohol, meds

    • large, immature RBC
    • m=High
    • R=High
  36. follic interventions
    • folate
    • no alcohol
    • Inc folic acid in diet
  37. aplastic anemia:
    patho=

    interventions
    patho= low RBC's, WBC's, plateletes (pancytopenia)

    • transfusions, epogen, nuepogen
    • drug hx and allergy
    • bone marrow transplant care
  38. sickle cell interventions
    • push fluid
    • pain
    • o2
    • skin care
    • antibiotics/transfusion
    • priapsim
  39. priapsim
    • male complication of sickle cell
    • continual erection
    • emergency
  40. polycythemia vera

    sx
    overproduction of rbc,wbc, and platetlets

    • sx=
    • fluid overload
    • HA, tinnitus
    • INc BP, HR, RR
    • red skin
    • thrombosis
    • Gi hemorrhage
  41. polycy vera interventions
    • no tight clothing
    • o2, rest
    • legs up
    • lox Na diet
    • diuretics
  42. leukemia
    • replacement of b.marrow by malignant immature WBC's
    • abnl immature WBC's in circulation
    • --> inflitrate liver, spleen, and lymph nodes
    • supress nl cells
    • low rbc, platelet, other granulocytes
    • high risk for infection, anemia, bleeding
  43. 4 major types of leukemia
    • ALL= acute lymphocytotic leukemia
    • CLL= chronic LL

    • AML= acute myeloid leukemia
    • CML= chronic ML
  44. acute lymphocytic leukemia
    primarily children and young adults

    Sx= infections, bleeding anemia

    Tx= chemo, BMT, SCT (stem cell trans)
  45. Chronic LL
    older adults

    Sx= fatigue, infections, lymphadenopathy

    Tx= may not treat or chemo, BMT
  46. Acute Myeloid Leukemia
    most acute leukemias in adults

    Sx= infections and abnl bleeding

    Tx= Chemo, SCT
  47. Chronic ML
    adults b/w 30-50 yrs

    • Sx= EARLY=asymptomatic (fatigue, DOE)
    •  = LATE= fever, night sweats

    Tx= interferon, chemo, sct

    progressive disease
  48. nursing care for leukemia
    • transfusions
    • chemo/radiation
    • spleenectomy for CLL
    • b.marrow/stem cell transplant
  49. b.marrow transplant
    • hard to find donor
    • marrow contains stem cells
    • high risk for infections
    • GVHD
  50. GVHD= graft versus host disease
    donor marrow attacks recipient
  51. where is bone marrow harvested from?
    where is it infused in the recipient?
    harvested from illiac crest

    infused via central line
  52. stem cell donor receives what before donating?
    where is the blood drawn?
    what is done to the blood?
    how is it administered to recipient?
    • hematopoetic growth factor 4-5 days prior
    • peripheral line to draw
    • WBC;s are seperated
    • given via centeral catheter
  53. Reed Sternborg cell
    • found in lymph nodes
    • differ b/w Hodgekins and non hodge
    • Hodge has it
  54. Hodgkins lymphoma
    • has reed sternberg cell
    • 15-35, over 50 yrs
    • Sx= swollen lymph node

    4 stages w/ A or B stages as well

    Tx= radiation and Chemo
  55. stages 1-4

    A vs B
    • 1 single lymph node region or structure
    • 2 two or more lymph node regions on the SAME side of the daiphragm
    • 3 involvment on BOTH sides of diaphragm and possibly spleen
    • 4 Disseminated involvement of distant extralymphatic organs or tissues

    • A= NO systemic involvement
    • B= fever, night sweats, wght loss
  56. nursing care of Hodgkins lymphoma
    • infection conrtol
    • emotional support
    • childbearing age may want to save sperm or eggs
  57. Non-Hodgkins lymphoma
    lymphoid malignany, spreads to other tissues

    Sx= painless swollen peripheral node NO STERNBERG CELLS on biopsy

    Tx= radiation and chemo
  58. multiple myeloma
    • B-cell plasma cells multiply & infiltrate b.marrow
    • bone is destroyed

    • Sx=bone pian, hyperCalemia
    • Has renal involvement

    Tx= chemo and radi of affected bones, SCT
  59. platelet count for Thrombocytopenia
    <100,000
  60. Disseminated Intravascular coagulation
    • high fatality rate
    • caused by snake bites, burns, and trauma

    widespread clotting, depletion of clotting factors, leading to complete hemorrhage and death
  61. DIC labs:

    PT/PTT
    FSP (fibrin split Products)
    PT= Increase

    • **FSP= Increase
    • **This is the key lab work for DIC

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