Hematology Med Surg

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Hematology Med Surg
2014-04-21 21:26:56
LCCC Nursing Hematology MedSurg

For Exam 3
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  1. What is the definition of Anemia?
    • Reduction of either Hemoglobin or Hematocrit
    • Anemia is more like a syndrome than a specific disease and may have many different causes
  2. What are the normal values for Hemoglobin and Hematocrit?
    • Hemoglobin:
    • Male-13.5-17.5 g/dL
    • Female- 12-16 g/dL

    • Hematocrit:
    • Male: 41-53%
    • Female: 36-46%
  3. What is the normal value for RBCs, platelets and WBCs?
    • RBCs:4-5 million/mm3
    • Platelets:150,000-400,000/mm3
    • WBCs: 5,000-10,000
  4. What are some different types of anemia?
    • Sickle Cell Disease
    • G6PD Deficient Anemia
    • Iron Deficient Anemia
    • Vitamin B12 Deficiency Anemia
    • Aplastic Anemia
  5. What is sickle cell disease?
    • A problem with the formation of hemoglobin chain. ¬†
    • It is genetic, autosomal recessive
    • Most common in African Americans
    • 40% of total hemoglobin is HbS
    • When exposed to decreased oxygen, these cells sickle and clump together, leading to a VOE (vaso-occlusive event)
  6. What are some things that cause sickling of the RBCs?
    • Hypoxia
    • dehydratoin
    • infection
    • venous stasis
    • pregnancy
    • alchohol
    • high altitudes
    • extreme temp changes
    • acidosis
    • strenuous exercise
    • emotional stress
    • anesthesia
  7. How are Sickled RBCs different from normal RBCs?
    • Sickled RBCs will go back to normal when oxygenated, but they are fragile and break easily
    • Average lifespan of a Sickled RBC is 12-15 days where a normal RBC is 120 days
    • -hemolytic anemia
  8. Name organ tissues often involved in sickle cell damage
    • Spleen
    • Liver
    • Kidneys
    • Heart
    • Brain
    • Bones
    • Joints
    • Retina
  9. How is sickle cell disease diagnosed?
    • Electrophoresis of blood sample:
    • -Sickle cell trait (AS) will show <40% HbS
    • Sickle cell disease (SCD) will show 80-100% HbS
    • -It will also show the number of sickled cells
    • -Other tests deal with the complications of the disease
  10. What are the S/S of a Sickle Cell Crisis?
    • Pain-EXTREME
    • Risk for high output HF due to increased blood viscosity (JVD, S3 heart sound)
    • Skin changes- may show pallor, jaundice or ulcers
    • Distended abdoment
    • Kidney failure
    • Behavioral changes
    • Pronator Drift
    • Priaprism- ¬†excessive vascular engorgement of the penic
  11. What is the nursing care for SCD?
    • Pain medication- around the clock, not PRN
    • Oxygen
    • PO/IV intake (increase fluids)
    • Keep extremities straight and HOB not greater than 30 degrees-promotes circulation
    • Keep room warm-vasodilation
    • Avoid manual BP if possible
    • No tight clothing
    • Circ checks q1hr
    • Patient education
  12. How is SCD pharmacologically managed?
    • Pain medications
    • Hydroxyurea (Droxia):
    • -Stimulates fetal Hb (HbF)
    • -Long term use has high risk of leukemia
    • -suppresses bone marrow function
  13. What is Iron deficiency anemia?
    • Serum ferritin < 10ng/mL (Normal: 12-300 ng/dL)
    • *Most common anemia, more common in women, elderly and poor nutrition
    • May Result from blood loss, poor Gi absorption of iron and inadequate diet
  14. What are the s/s of Iron deficient Anemia?
    • Weakness
    • Pallor
    • Dizziness
    • Fatigue
    • Exercise Intolerance
    • Fissures at the corner of mouth
    • Brittle, spoon nails
  15. Where is iron normally stored in the body?
    • 2/3 of the iron is stored in the hemoglobin
    • 1/3 stored in bone marrow, spleen, liver and muscles (these are usually depleted first)
  16. What is the treatment for iron deficient anemia?
    • Mild: Oral iron supplements (ferrous sulfate(Feosol))
    • -Take between meals
    • -Drink with straw as not to stain teeth
    • Severe: IV or IM iron
    • -Z track method to prevent skin staining
  17. What is the importance of B12?
    • Vitamin B12 activates the enzyme that moves folic acid into the ell so that DNA synthesis can occur
    • Usually absorbed in GI tract with instrinsic factor
  18. What is Vitamin B12 Deficiency Anemia?
    • Vitamin B12 deficiency leads to anemia by inhibiting folic acid transport and reducing DNA synthesis in precursor cells
    • -this improper DNA leads to increased size of RBCs and macrolytic RBCs
  19. What is pernicious anemia?
    • Failure to absorb B12 caused by deficiency of intrinsic factor which is needed for GI absorption.
    • Causes: Small bowel obstruction, chronic diarrhea and diverticulitis, low intake of B12 (such as vegetarianism)
  20. What are the S/S of B12 Deficiency Anemia?
    • Pallor, Jaundice, fatigue, weight loss
    • Glossitis- beefy, smooth tongue
  21. How is B12 Deficiency diagnosed?
    • Shilling test: multilevel test for instrinsic factor
    • Radioactive B12 PO and IM to saturate liver
    • Assess in 24 hours
    • If B12 is not absorbed, it will spill into the urine
  22. What is the treatment for B12 Deficient Anemia?
    • B12 injections for pernicious anemia
    • May use CaloMist nasal spray
    • *lifelong therapy
  23. What is Aplastic Anema?
    • Deficiency of circulating RBCs due to decreased RBC production in the bone marrow
    • S/S of poor oxygenation
    • Treated with a bone marrow transplant
  24. What is G6PD Deficient Anemia?
    • This is a genetic condition
    • Hemolysis of the RBCs due to a lack of glucose 6 phosphate dehydrogenase (G6PD)
  25. What is Polycythemia Vera?
    • Hypervicious blood due to increase in RBC production
    • Polycythemia Vera may be a cancer of the RBCs
  26. What is Primary Thrombasthenia?
    • Glanzman' Thrombasthenia
    • Autosomal recessive gene where clotting factors do not exist
    • May be treated with platelet precautions
  27. What is the distinct characteristic for Hemophilia?
    • They do not bleed more, they simply bleed longer due to lack of clotting factors
    • Genetic Cause
  28. What is Idiopathic thrombocytopenia Purpura?
    • Autoimmune response coats platelets so macrophages destroy them
    • There is a low number of circulating platelets even though production is normal
    • These mangles platelets block up the spleen and a spleenectomy may be necessary
  29. What is DIC?
    • Disseminating Intervascular Coagulation: clotting at the beginning uses up all of the clotting factors, putting the person into a hemophilic state (thrombocytopenia)
    • This person is first at risk of embolism, then at risk for hemorrage
    • This person is also at risk for sepsis and septic shock
  30. What is the normal PT/INR for coumadin?
    • PT: Normal- 11-12.5 sec
    • Anticoag therapy- 1.5-2.5x normal

    • INR: Normal-0.7-1.8
    • Anticoag therapy-2-3
  31. What is a normal PTT and aPTT for heparin therapy?
    • PTT: normal-60-70 sec
    • aPTT:normal-30-45 sec

    Therapy:1.5-2x normal