Hematology Med Surg
Card Set Information
Hematology Med Surg
LCCC Nursing Hematology MedSurg
For Exam 3
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
What are the normal values for Hemoglobin and Hematocrit?
Female- 12-16 g/dL
What is the normal value for RBCs, platelets and WBCs?
What are some different types of anemia?
Sickle Cell Disease
G6PD Deficient Anemia
Iron Deficient Anemia
Vitamin B12 Deficiency Anemia
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)
THIS CAN CAUSE ORGAN DAMAGE
What are some things that cause sickling of the RBCs?
extreme temp changes
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
Name organ tissues often involved in sickle cell damage
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
What are the S/S of a Sickle Cell Crisis?
Risk for high output HF due to increased blood viscosity (JVD, S3 heart sound)
Skin changes- may show pallor, jaundice or ulcers
Priaprism- excessive vascular engorgement of the penic
What is the nursing care for SCD?
Pain medication- around the clock, not PRN
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
How is SCD pharmacologically managed?
-Stimulates fetal Hb (HbF)
-Long term use has high risk of leukemia
-suppresses bone marrow function
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
What are the s/s of Iron deficient Anemia?
Fissures at the corner of mouth
Brittle, spoon nails
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)
What is the treatment for iron deficient anemia?
: Oral iron supplements (ferrous sulfate(Feosol))
-Take between meals
-Drink with straw as not to stain teeth
: IV or IM iron
-Z track method to prevent skin staining
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
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
What is pernicious anemia?
Failure to absorb B12 caused by deficiency of intrinsic factor which is needed for GI absorption.
: Small bowel obstruction, chronic diarrhea and diverticulitis, low intake of B12 (such as vegetarianism)
What are the S/S of B12 Deficiency Anemia?
Pallor, Jaundice, fatigue, weight loss
Glossitis- beefy, smooth tongue
How is B12 Deficiency diagnosed?
: 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
What is the treatment for B12 Deficient Anemia?
B12 injections for pernicious anemia
May use CaloMist nasal spray
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
What is G6PD Deficient Anemia?
This is a genetic condition
Hemolysis of the RBCs due to a lack of glucose 6 phosphate dehydrogenase (G6PD)
What is Polycythemia Vera?
Hypervicious blood due to increase in RBC production
Polycythemia Vera may be a cancer of the RBCs
What is Primary Thrombasthenia?
Autosomal recessive gene where clotting factors do not exist
May be treated with platelet precautions
What is the distinct characteristic for Hemophilia?
They do not bleed more, they simply bleed longer due to lack of clotting factors
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
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
What is the normal PT/INR for coumadin?
: Normal- 11-12.5 sec
Anticoag therapy- 1.5-2.5x normal
What is a normal PTT and aPTT for heparin therapy?
: normal-60-70 sec