hemo

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mthompson17
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271300
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hemo
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2014-04-21 02:19:27
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hemo nursing
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hemo nursing
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  1. 3 general s/s of anemia?
    • 1. palpitations
    • 2. dyspnea on exertion
    • 3. fatigue
  2. S/S of anemia with HgB <6?
    • 1. palpitations
    • 2. tachycardia
    • 3. CHF
    • 4. MI
  3. Protein made in the liver that carries Fe?

    What does its level show?
    transferrin

    Fe carrying capacity of the blood
  4. Where does Fe absorption occur?
    duodenum
  5. 4 S/S that occur with Fe deficiency anemia besides regular anemia s/s?
    • 1. glossitis - red tongue
    • 2. cheilitis - lips
    • 3. HA
    • 4. paresthesias
  6. Labs with Fe-deficiency anemia?
    decreased H&H & Fe
  7. Considerations with Fe admin?
    • 1. tk with OJ if possible
    • 2. can stain skin & cause dark stools
  8. How to admin IM Fe?
    use Z track & leave 0.5 mL of air behind it

    change needle before admin
  9. IV Fe?

    How is it admin & what rate?
    dextran

    give small test dose then 1mL/min
  10. Thalassemia?
    abnormal HgB produced r/t abnormal globin protein
  11. Who usually gets thalassemia?
    Asians & Africans
  12. S/S of thalassemia minor?
    may be asymptomatic

    may have chronic mild anemia
  13. 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
  14. Thalassemia major treatment?
    • 1. blood transfusions to keep HgB at 10
    • 2. chelation therapy
    • 3. zinc
    • 4. splenectomy
  15. Why should thalassemia pt HgB be kept around 10?
    low enough to stimulate erythroppoesis
  16. What causes most deaths r/t thalassemia major?
    cardiac complications due to Fe overload
  17. 2 types of megaloblastic anemias?
    B12 deficiency & folic acid deficiency
  18. What are RBC like with megaloblastic anemias?
    large & fragile
  19. 5 causes of cobalamin deficiency?
    • 1. inadequate diet
    • 2. lack of intrinsic factor
    • 3. malabsorption
    • 4. alcoholism
  20. Tx of lack of intrinsic factor?
    B12 injections
  21. Pernicious anemia?
    B12 deficiency anemia
  22. S/S of cobalamin deficiency anemia?
    • 1. s/s of anemia
    • 2. sore tongue
    • 3. anorexia
    • 4. NV & abd pain
    • 5. neuromuscular s/s
  23. Neuromuscular s/s that occur with cobolamin deficiency anemia?
    • 1. weakness
    • 2. paresthesias
    • 3. reduced vibratory & position sense
    • 4. impaired thought processes
  24. Dx of cobolamin deficiency?
    • 1. lg RBC with decreased HgB/Hct
    • 2. decreased cobolamin
  25. Dx of deficient intrinsic factor?
    • 1. positive schilling test
    • 2. gastric acid negative for HCL acid
  26. Difference b/t cobolamin & folic acid deficiency?
    folic acid has no neuro s/s
  27. S/S of folic acid deficiency anemia?
    similar to cobolamin deficiency but no neuro s/s
  28. Causes of folic acid deficiency anemia?
    • 1. poor nutrition
    • 2. ETOH
    • 3. meds
    • 4. hemodialysis
  29. Meds that can decrease folic acid?
    methotrexate, antiseizure drugs, bactrim, sulfa drugs
  30. ESRD effect on blood?
    decreased erythropoietin
  31. ETOH effect?
    inadequate nutrition & reduction in erythropoiesis
  32. Chronic inflammation effect?
    increased RBC destruction
  33. Care of aplastic anemia?
    • 1. figure out cause
    • 2. supportive care
    • 3. possible stem cell transplantation
    • 4. immunosuppresive therapy with transplants
  34. When may lab data show severity of blood loss?
    2 to 3 days
  35. IV fluids given for blood loss?
    NS or LR

    no LR with liver disease
  36. 2 major causes of death in sickle cell anemia?
    renal and pulmonary failure
  37. 9 s/s of SCA?
    • 1. chronic pain
    • 2. jaundice/gray
    • 3. retinal vessel obstruction
    • 4. kidney failure
    • 5. spleen disorder & increased infections
    • 6. hepatomegaly
    • 7. chronic leg ulcers
    • 8. priapism
    • 9. fatigue
  38. Physical exam with SCA?
    • 1. jaundice & increased bilirubin
    • 2. bone & joint deformities on Xray
  39. Dx of SCA?
    sickledex -exposes RBC to deoxygenating agent
  40. S/S of sickle cell crisis?
    • 1. vaso-occlusion anywhere
    • 2. pain, esp chest pain
    • 3. shock
    • 4. fever
    • 5. tachypnea
    • 6. HTN
    • 7. NV
    • 8. swelling
  41. 6 precipitating factors for SCA?
    • 1. infection
    • 2. dehydration
    • 3. physical & emotional stress
    • 4. extreme cold
    • 5. surgery & blood loss
    • 6. high altitudes
  42. Nursing actions for sickle cell crisis in order of priority?
    • 1. O2
    • 2. fluids
    • 3. pain mgmt
    • 4. bed rest
    • 5. blood transfusions
    • 6. hydroxyurea
  43. Use of hydroxyurea?
    decreases sickling
  44. Teaching for SCA?
    • 1. avoid precipitating factors
    • 2. get vaccines r/t spleen issues
  45. 3 causes of acquired hemolytic anemias?
    • 1. trauma
    • 2. immune disorders
    • 3. infections/toxins
  46. Infections/toxins that may cause hemolytic anemia?
    snake bitesm, arsenic or lead poisoning
  47. What problem of blood may be caused by snake  venom?
    DIC
  48. Main priority in Tx of hemolytic anemia?

    Other Tx?
    1. eliminate cause

    • 1. corticosteroids
    • 2. blood products
    • 3. removing spleen
  49. Cause of hemachromatosis?

    Who usually gets it?
    `hereditary

    European ppl
  50. Normal total body Fe level?
    2 - 6 g
  51. When do s/s of hemochromatosis develop?
    b/t 40 & 60
  52. Patho of hemachromatosis?

    S/S?
    Fe accumulates in liver and other organs/skin

    • 1. liver enlargement/cirrhosis
    • 2. bronzing of skin
    • 3. heart prob
    • 4. arthritis
    • 5. testicular atrophy
  53. 3 elevated labs with hemochromatosis?
    • 1. Fe
    • 2. ferritin
    • 3. TIBC
  54. Dx of hemochromatosis?
    • 1. molecular testing
    • 2. liver biopsy
  55. 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

    chelation therapy
  56. Main probs caused by hemachromatosis?
    liver & CV probs
  57. Primary polycythemia cause?

    What other issues are involved?
    chromosomal mutation - also affects platelets & WBC
  58. Effects of primary polycythemia?
    causes congestion of organs - splenomegaly & liver probs are common
  59. Cause of secondary polycythemia?
    hypoxia r/t altitude, pulmonary disease, CV disease, alveolar hypoventilation, defective O2 transport or hypoxia
  60. 15 s/s of polycythemia?
    • 1. HTN
    • 2. HA
    • 3. dizziness & vertigo
    • 4. visual probs
    • 5. tinnitus
    • 6. puritis
    • 7. increased uric acid/gout
    • 8. splenomegaly/hepatomegaly
    • 9. hemorrhage due to vessel rupture
    • 10. CV probs
  61. CV probs that occur with polycythemia?
    • 1. angina
    • 2. CHF
    • 3. intermittent cluadication
    • 4. thrombophlebitis
    • 5. risk for embolization
  62. Care of polycythemia?
    • reduce blood volume
    • 1. phlebotomy
    • 2. fluids
    • 3. myelosuppressive to decrease RBC production
    • 4. allopurinol for gout
  63. Nursing care of polycythemia?
    • 1. fluids
    • 2. oxygenation
    • 3. active or passive ROM to prevent thrombi
  64. Immune thrombocytopenic purpura cause?

    Patho?

    Who usually gets it?
    autoimmune disease

    platelets don't survive as long - normal is 8-10 days & ITP is 1to 3 days

    women 20-40
  65. ITP Tx?
    • 1. immunosuppressant drugs:  corticosteroids, imuran, cytoxan
    • 2. splenectomy
    • 3. IV immunoglobulin (band-aid)
    • 4. danazol - androgen given with corticosteroids
  66. When may platelet transfusion be given?
    platelets <10000
  67. Thrombotic thrombocytopenia purpura?
    similar to DIC - platlets are normal - clotting then bleeding occurs
  68. S/S of TTP?
    • 1. hemolytic anemia
    • 2. thrombocytopenia
    • 3. neuro abnormalities

    • 4. fever in absence of infection
    • 5. renal abnormalities
  69. Causes of TTP?
    • 1. drug toxicity
    • 2. pregnancy
    • 3. infection
    • 4. autoimmune disease like lupus
    • 5. scleroderma
  70. What will occur if TTP goes untreated?
    renal failure and death
  71. Tx of TTP?
    • 1. Tx underlying cause
    • 2. corticosteroids/immunosuppresants
    • 3. plasmapheresis
    • 4. splenectomy
  72. Heparin induced thrombocytopenia & thrombosis syndrome (HITTS)?
    platelet destruction & formation of thrombi
  73. Onset time of HITTS?
    4 to 14 days
  74. HITTS causes high risk for what complication?
    venous/arterial thrombi
  75. 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
  76. HITTS Tx?
    • 1. Do not infuse platelets
    • 2. stop heparin & replace with different blood thiner
    • 3. If severe clotting:  plasmapheresis and/or protamine sulfate
  77. S/S of all types of thrombocytopenia?
    all s/s of bleeding

    may be internal

    may occur in retina, joints, brain
  78. Neumega?
    platelet growth factor to stimulate platelet production
  79. 2 indications of neuro bleeding?
    HA or visual changes
  80. Tx of hemophia A/B & von Willebrand's?
    replacing missing factors is primary Tx
  81. S/S of hemophilia & Von Willebrands?
    any s/s of bleeding
  82. 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
  83. Medical Tx of hemophilias and Von Willebrands?
    • 1. prevent bleeding
    • 2. replace deficient clotting factors
    • 3. DDAVP (A & vW)
    • 4. gene therapy
  84. Effect of DDAVP in hemophilia and vW?
    causes vasoconstriction & pushes blood to brain and heart in emergencies
  85. What is essential in Tx of DIC?
    find and Tx cause
  86. Causes of DIC?
    • 1. shock
    • 2. septicemia
    • 3. hemolytic processes - bleeding
    • 4. obstetric conditions - ectopic pregnancy
    • 5. tissue damage
  87. DIC patho?
    injury occurs and causes clotting -> hyper clotting can cause ischemia & necrosis -> all clotting factors are used so bleeding occurs in other areas
  88. S/S of DIC?
    • 1. any organ can have infarct:  MI, PE, CVA, bowel, kidney
    • 2. bleeding - seen & unseen
  89. 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
  90. Priorities with DIC?
    • 1. tk to surgery
    • 2. blood replacement
    • 3. may tx thrombosis with heparin
  91. Myelodysplastic syndrome (MDS)?
    change in quatity & quality of bone marrow elements
  92. MDS may progress to ____.
    acute myelogenous leukemia (AML)
  93. Dx of MDS?
    bone marrow biopsy
  94. Patho of MDS?
    abnormal cells take over the bone marrow & cause pancytopenia
  95. Care of MDS?
    • supportive
    • 1. procrit
    • 2. intesive chemo & stem cell transplants
    • 3. ABX
    • 4. Vidaza - first effective d4rug for MDS
  96. Nursing care of MDS?
    prevent infection & bleeding & deal with anemia s.s
  97. 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
  98. What CBC result is specific to leukemia?
    increased blasts
  99. Difference b/t acute & chronic leukemia?
    acute has more blasts & chronic has more mature WBCs
  100. Acute myelogenous leukemia (AML) S/S?
    • 1. immature nonfunctioning overloaded blasts
    • 2. abrupt dramatic onset of infections/bleeding
    • 3. hyperplasia of bone marrow & spleen
  101. Acute lymphocytic leukemia (ALL) patho?

    S/S?

    ONset?
    immature lymphocytes proliferate in bone marrow

    fever & bleeding

    s/s appear abruptly with progressive weakness & fatigue before
  102. What s/s are particular to ALL?
    CNS s/s
  103. Chronic myelogenous leukemia (CML)?
    excessive mature neoplastic granulocytes in bone marrow & infiltrate liver & spleen
  104. Genetic marker particular to CML?
    philadelphia chromosome
  105. Progression of CML?
    chronic stable phase that can last years then acute aggressive phase
  106. Chronic lymphocytic leukemia (CLL)?
    production & accumulation of inactive long-lived mature-appearing lymphocytes

    B cell involvement r/t immune response
  107. S/S of CLL?
    • 1. lymph node enlargement
    • 2. increased infections
    • 3. pain & paralysis from pressure of enlarge lymph nodes
  108. What can CLL transform into?
    non-Hodgkins lymphoma
  109. Hairy cell leukemia?
    B lmphocytes infiltrate bone marrow & liver
  110. S/S of hairy cell leukemia?
    • 1. splenomegaly
    • 2. pancytopenia
    • 3. infection
    • 4. vasculitis
  111. Fever to be concerned with in leukemia?
    >99
  112. 7 effects of leukemic cells?
    • 1. splenomegaly
    • 2. hepatomegaly
    • 3. lymphadenopathy
    • 4. bone pain
    • 5. meningeal irritation
    • 6. oral lesions
    • 7. solid masses
  113. 2 types of lymphomas?
    Hodgkins & nonHodgkins
  114. Hodgkins's lymphoma?
    proliferTRION OF ABNORMAL GIANT MULTINUCLEATED CELLS
  115. Hallmark sign of Hodgkins lymphoma?
    Reed-Sternberg cells in lymph nodes
  116. S/S of hodgkins lymphoma?
    • 1. lymphadenopathy
    • 2. fatigue/weakness
    • 3. tacycardia
    • 4. bone pain
    • 5. ETOH induced pain
    • 6. B symptoms:  fever night sweats, weight loss
    • 7. hepatomegaly & splenomegaly
  117. Complications of hodgkins lymphoma?
    intrathoracic involvement can cause superior vena cava syndrome, SC compression
  118. Non Hodgkins lymphoma?
    lymphoctes are arrested in various stages of development
  119. What is commonly first complaint of nonhodgkins lymphoma?
    painless lymph node enlargement
  120. What organs/other areas may nonhodgkins lymphoma spread to?
    renal/liver, airway obstruction, cardiac tamponade, nuro s/s
  121. Multiple myeloma?
    neoplastic plasma cells infiltrate BM & destroy bone
  122. S/S of multiple myeloma?
    • 1. skeletal pain triggered by movement
    • 2. diffuse osteoporosis
    • 3. spinal cord compression
    • 4. [patholigic fractures
    • 5. hypercalcemia
    • 6. elevated protein levels
    • 7. pancytopenia
  123. Dx of multiple myeloma?
    • 1. monoclonal antibody in blodd or urine
    • 2. pancytopenia
    • 3. elevated creatinine
    • 4. positive urine bence jones protein
    • 5. Xrays show bone erosion, thinning, fractures
    • 6. bone marrow
  124. Multiple myeloma Tx?
    Tx cancer & Tx osteoporosis
  125. 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
  126. When may TRALI occur?


    What is it?
    up to 48 h post transfusion


    noncardiogenic pulmonbary edema

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