Card Set Information
3 general s/s of anemia?
2. dyspnea on exertion
S/S of anemia with HgB <6?
Protein made in the liver that carries Fe?
What does its level show?
Fe carrying capacity of the blood
Where does Fe absorption occur?
4 S/S that occur with Fe deficiency anemia besides regular anemia s/s?
1. glossitis - red tongue
2. cheilitis - lips
Labs with Fe-deficiency anemia?
decreased H&H & Fe
Considerations with Fe admin?
1. tk with OJ if possible
2. can stain skin & cause dark stools
How to admin IM Fe?
use Z track & leave 0.5 mL of air behind it
change needle before admin
How is it admin & what rate?
give small test dose then 1mL/min
abnormal HgB produced r/t abnormal globin protein
Who usually gets thalassemia?
Asians & Africans
S/S of thalassemia minor?
may be asymptomatic
may have chronic mild anemia
S/S of thalassemia major?
develops in childhood
1. s/s of anemia
2. splenomegaly & hepatomegaly
3. facial/head - down syndrome appearance
4. pronouced jaundice
5. mental & physical growth affected
Thalassemia major treatment?
1. blood transfusions to keep HgB at 10
2. chelation therapy
Why should thalassemia pt HgB be kept around 10?
low enough to stimulate erythroppoesis
What causes most deaths r/t thalassemia major?
cardiac complications due to Fe overload
2 types of megaloblastic anemias?
B12 deficiency & folic acid deficiency
What are RBC like with megaloblastic anemias?
large & fragile
5 causes of cobalamin deficiency?
1. inadequate diet
2. lack of intrinsic factor
Tx of lack of intrinsic factor?
B12 deficiency anemia
S/S of cobalamin deficiency anemia?
1. s/s of anemia
2. sore tongue
4. NV & abd pain
5. neuromuscular s/s
Neuromuscular s/s that occur with cobolamin deficiency anemia?
3. reduced vibratory & position sense
4. impaired thought processes
Dx of cobolamin deficiency?
1. lg RBC with decreased HgB/Hct
2. decreased cobolamin
Dx of deficient intrinsic factor?
1. positive schilling test
2. gastric acid negative for HCL acid
Difference b/t cobolamin & folic acid deficiency?
folic acid has no neuro s/s
S/S of folic acid deficiency anemia?
similar to cobolamin deficiency but no neuro s/s
Causes of folic acid deficiency anemia?
1. poor nutrition
Meds that can decrease folic acid?
methotrexate, antiseizure drugs, bactrim, sulfa drugs
ESRD effect on blood?
inadequate nutrition & reduction in erythropoiesis
Chronic inflammation effect?
increased RBC destruction
Care of aplastic anemia?
1. figure out cause
2. supportive care
3. possible stem cell transplantation
4. immunosuppresive therapy with transplants
When may lab data show severity of blood loss?
2 to 3 days
IV fluids given for blood loss?
NS or LR
no LR with liver disease
2 major causes of death in sickle cell anemia?
renal and pulmonary failure
9 s/s of SCA?
1. chronic pain
3. retinal vessel obstruction
4. kidney failure
5. spleen disorder & increased infections
7. chronic leg ulcers
Physical exam with SCA?
1. jaundice & increased bilirubin
2. bone & joint deformities on Xray
Dx of SCA?
sickledex -exposes RBC to deoxygenating agent
S/S of sickle cell crisis?
1. vaso-occlusion anywhere
2. pain, esp chest pain
6 precipitating factors for SCA?
3. physical & emotional stress
4. extreme cold
5. surgery & blood loss
6. high altitudes
Nursing actions for sickle cell crisis in order of priority?
3. pain mgmt
4. bed rest
5. blood transfusions
Use of hydroxyurea?
Teaching for SCA?
1. avoid precipitating factors
2. get vaccines r/t spleen issues
3 causes of acquired hemolytic anemias?
2. immune disorders
Infections/toxins that may cause hemolytic anemia?
snake bitesm, arsenic or lead poisoning
What problem of blood may be caused by snake venom?
Main priority in Tx of hemolytic anemia?
1. eliminate cause
2. blood products
3. removing spleen
Cause of hemachromatosis?
Who usually gets it?
Normal total body Fe level?
2 - 6 g
When do s/s of hemochromatosis develop?
b/t 40 & 60
Patho of hemachromatosis?
Fe accumulates in liver and other organs/skin
1. liver enlargement/cirrhosis
2. bronzing of skin
3. heart prob
5. testicular atrophy
3 elevated labs with hemochromatosis?
Dx of hemochromatosis?
1. molecular testing
2. liver biopsy
Hemachromatosis main goal of care?
How is this done?
remove excessive Fe
cannot remove all at once - will remove 500mL of blood q week X 2to 3 years
Main probs caused by hemachromatosis?
liver & CV probs
Primary polycythemia cause?
What other issues are involved?
chromosomal mutation - also affects platelets & WBC
Effects of primary polycythemia?
causes congestion of organs - splenomegaly & liver probs are common
Cause of secondary polycythemia?
hypoxia r/t altitude, pulmonary disease, CV disease, alveolar hypoventilation, defective O2 transport or hypoxia
15 s/s of polycythemia?
3. dizziness & vertigo
4. visual probs
7. increased uric acid/gout
9. hemorrhage due to vessel rupture
10. CV probs
CV probs that occur with polycythemia?
3. intermittent cluadication
5. risk for embolization
Care of polycythemia?
reduce blood volume
3. myelosuppressive to decrease RBC production
4. allopurinol for gout
Nursing care of polycythemia?
3. active or passive ROM to prevent thrombi
Immune thrombocytopenic purpura cause?
Who usually gets it?
platelets don't survive as long - normal is 8-10 days & ITP is 1to 3 days
1. immunosuppressant drugs: corticosteroids, imuran, cytoxan
3. IV immunoglobulin (band-aid)
4. danazol - androgen given with corticosteroids
When may platelet transfusion be given?
Thrombotic thrombocytopenia purpura?
similar to DIC - platlets are normal - clotting then bleeding occurs
S/S of TTP?
1. hemolytic anemia
3. neuro abnormalities
4. fever in absence of infection
5. renal abnormalities
Causes of TTP?
1. drug toxicity
4. autoimmune disease like lupus
What will occur if TTP goes untreated?
renal failure and death
Tx of TTP?
1. Tx underlying cause
Heparin induced thrombocytopenia & thrombosis syndrome (HITTS)?
platelet destruction & formation of thrombi
Onset time of HITTS?
4 to 14 days
HITTS causes high risk for what complication?
When should HITTS be suspected?
1. pt on heparin whose platelets drop 50%
2. unexplained bleeding
3. PTTs start to DECREASE & will require more heparin to be therapeutic
1. Do not infuse platelets
2. stop heparin & replace with different blood thiner
3. If severe clotting: plasmapheresis and/or protamine sulfate
S/S of all types of thrombocytopenia?
all s/s of bleeding
may be internal
may occur in retina, joints, brain
platelet growth factor to stimulate platelet production
2 indications of neuro bleeding?
HA or visual changes
Tx of hemophia A/B & von Willebrand's?
replacing missing factors is primary Tx
S/S of hemophilia & Von Willebrands?
any s/s of bleeding
Dx test results for hemophilia A/B & Von Willebrand's?
1. PT, Thrombin time, & platelet count are not affected
2. PTT prolonged
3. bleeding time prolonged in vW
Medical Tx of hemophilias and Von Willebrands?
1. prevent bleeding
2. replace deficient clotting factors
3. DDAVP (A & vW)
4. gene therapy
Effect of DDAVP in hemophilia and vW?
causes vasoconstriction & pushes blood to brain and heart in emergencies
What is essential in Tx of DIC?
find and Tx cause
Causes of DIC?
3. hemolytic processes - bleeding
4. obstetric conditions - ectopic pregnancy
5. tissue damage
injury occurs and causes clotting -> hyper clotting can cause ischemia & necrosis -> all clotting factors are used so bleeding occurs in other areas
S/S of DIC?
1. any organ can have infarct: MI, PE, CVA, bowel, kidney
2. bleeding - seen & unseen
Labs for DIC?
1. D-dimeer shows excess fibinolysis
2. thrombocytopenia & decreased fibrinogen
3. PT, PTT prolonged
4. high levels of fibrin degradation split products
Priorities with DIC?
1. tk to surgery
2. blood replacement
3. may tx thrombosis with heparin
Myelodysplastic syndrome (MDS)?
change in quatity & quality of bone marrow elements
MDS may progress to ____.
acute myelogenous leukemia (AML)
Dx of MDS?
bone marrow biopsy
Patho of MDS?
abnormal cells take over the bone marrow & cause pancytopenia
Care of MDS?
2. intesive chemo & stem cell transplants
4. Vidaza - first effective d4rug for MDS
Nursing care of MDS?
prevent infection & bleeding & deal with anemia s.s
S/S of leukemia?
1. too tired to play
2. bleeding probs
3. very high or low WBCs
4. high blasts - immature WBC released from marrow too early
What CBC result is specific to leukemia?
Difference b/t acute & chronic leukemia?
acute has more blasts & chronic has more mature WBCs
Acute myelogenous leukemia (AML) S/S?
1. immature nonfunctioning overloaded blasts
2. abrupt dramatic onset of infections/bleeding
3. hyperplasia of bone marrow & spleen
Acute lymphocytic leukemia (ALL) patho?
immature lymphocytes proliferate in bone marrow
fever & bleeding
s/s appear abruptly with progressive weakness & fatigue before
What s/s are particular to ALL?
Chronic myelogenous leukemia (CML)?
excessive mature neoplastic granulocytes in bone marrow & infiltrate liver & spleen
Genetic marker particular to CML?
Progression of CML?
chronic stable phase that can last years then acute aggressive phase
Chronic lymphocytic leukemia (CLL)?
production & accumulation of inactive long-lived mature-appearing lymphocytes
B cell involvement r/t immune response
S/S of CLL?
1. lymph node enlargement
2. increased infections
3. pain & paralysis from pressure of enlarge lymph nodes
What can CLL transform into?
Hairy cell leukemia?
B lmphocytes infiltrate bone marrow & liver
S/S of hairy cell leukemia?
Fever to be concerned with in leukemia?
7 effects of leukemic cells?
4. bone pain
5. meningeal irritation
6. oral lesions
7. solid masses
2 types of lymphomas?
Hodgkins & nonHodgkins
proliferTRION OF ABNORMAL GIANT MULTINUCLEATED CELLS
Hallmark sign of Hodgkins lymphoma?
Reed-Sternberg cells in lymph nodes
S/S of hodgkins lymphoma?
4. bone pain
5. ETOH induced pain
6. B symptoms: fever night sweats, weight loss
7. hepatomegaly & splenomegaly
Complications of hodgkins lymphoma?
intrathoracic involvement can cause superior vena cava syndrome, SC compression
Non Hodgkins lymphoma?
lymphoctes are arrested in various stages of development
What is commonly first complaint of nonhodgkins lymphoma?
painless lymph node enlargement
What organs/other areas may nonhodgkins lymphoma spread to?
renal/liver, airway obstruction, cardiac tamponade, nuro s/s
neoplastic plasma cells infiltrate BM & destroy bone
S/S of multiple myeloma?
1. skeletal pain triggered by movement
2. diffuse osteoporosis
3. spinal cord compression
4. [patholigic fractures
6. elevated protein levels
Dx of multiple myeloma?
1. monoclonal antibody in blodd or urine
3. elevated creatinine
4. positive urine bence jones protein
5. Xrays show bone erosion, thinning, fractures
6. bone marrow
Multiple myeloma Tx?
Tx cancer & Tx osteoporosis
Nursing care of multiple myeloma?
1. weight bearing as tolerated helps bones
2. adequate hydration up to 3-4 L per day
3. prevent fractures
4. braces prn
5. pain mgmmt
When may TRALI occur?
What is it?
up to 48 h post transfusion
noncardiogenic pulmonbary edema