exam 3 - blood and immune

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exam 3 - blood and immune
2011-04-02 23:05:20

blood and immune
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  1. anemia is a disease. t or f

    anemia is a clinical manifestation of a disease
  2. what can cause anemia
    • impaired function
    • decreased production
    • increased destruction

    • dietary probs
    • genetics
    • excess bleeding
    • bone marrow disease
  3. how will anemia manifest in the integumentary system?
    pallor, concave brittle nails, etc
  4. anemia:
    manifestations in cardiovascular?
    increase HR
  5. anemia:
    manifestations respiratory?
    • sob
    • dyspnea
  6. anemia:
    manifestations neurological
    • confusion
    • HA
  7. #1 NDx for sickle cell anemia
  8. early dx for sickle cell is critical. what supports this?
    all states mandate newborn screening
  9. is there a cure for sickle cell?
    no cure

    *bone marrow transplants
  10. what's the main goal for sickle cell?
    • manage pain
    • relieve sx
    • prevent/treat complications
  11. what is the hemoglobin that is abnormal w/ sickle cell anemia
    hbg S
  12. what does hgb S do to blood cells?
    cells sickle when under stress, causing them to tangle --> vaso-occlusion = pain
  13. sickle cell:
    patho of a vaso-occlusive crisis?
    decrease in o2 --> rbcs sickle --> occludes --> compromises cirulation --> pain --> edema --> tissue ischemia --> infarction
  14. sickle cell anemia:
    what can cause a vaso-occlusive crisis?
    • cold
    • dehydration
    • late pregnancy
    • physical exertion
    • mental/emotional stress
    • unknown
    • decreased o2
  15. top 2 NDx for sickle cell anemia?
    • pain
    • risk for infection (splenomegaly)
  16. sickle cell:
    what can cause ACUTE CHEST SYNDROME?
    fat emboli

    fat embolism (stroke in long bone d/t sticky sickle cell) --> decrease perfusion --> fat emboli to let loose--> severe occlusive crisis / PE
  17. sickle cell:
    s/s of acute chest syndrome
    • increase T
    • CP
    • cough
    • wheezing
    • tachypnea
  18. dc teaching for sickle cell:
    • rcv year flu vaccine
    • abd pain - splenomegaly
  19. sickle cell:
    acute chest syndrome caused by......
    • infection
    • atelectasis (IS, cough, deep breathe)
    • fat embolism
  20. sickle cell:
    treatment for severe pain?
    • morphine - vessel dilation
    • hydration - d5w
  21. sickle cell crisis tx
    • HYDRATE!
    • pain management
    • keep warm
    • o2

    ****TEDS, BP cuff, bed position can impede blood flow
  22. what increases the viscosity of blood in sickle cell anemia?
    clumping of cells together

    *the clumping also causes occlusion

    *organs may be occluded (spleen, liver)

    *when the spleen is ischemic = decreased immunity
  23. what causes pain in sickle cell anemia?
  24. this is a complication of vaso-occlusive crisis w/c can lead to resp failure and death
  25. sickle cell:
    acute chest syndrome diagnosis?
    • chest xray may initially be normal but may have new pulmonary infiltrate
    • hgb - 7.5-8
    • wbc - 20,000/mm3
    • spo3 - <93%
  26. What kind of anemai would you have to evaluate for bleeding, esp GI bleeding?
    iron deficiency anemia
  27. what can cause iron deficiency anemia?
    • blood loss
    • decrease GI absorption
    • inadequate diet

    *iron stores depleted first, followed by hemoglobin stores, RBCs (microcytic)
  28. how is iron deficiency anemia managed?
    • increase dietary intake
    • oral suppls
    • parenteral meds

    *meats, beans, green leafies
  29. iron deficiency anemia:
    • easy fatigue
    • pallor
    • palpitation
    • dyspnea
    • hair loss
    • malaise
    • muscle weakness
    • altered oral mucosa
    • irritability
    • mental status change
    • tingling of extremities
  30. the difference between chronic and acute anemia
    chronic - adjusts to low o2 levels and the individual may not feel different unless the anemia becomes severe

    acute - pt may experience significat sx relatively quickly

    *some pts with anemia have no sx
  31. vitamin b12 deficiency aka
    pernicious anemia
  32. manifestation of pernicious anemia (B12)
    • jaundice
    • pallor
    • NEUROFUNCTION - numbness, tingling (paresthesia), difficulty with gait, memory
  33. pernicious anemia is an issue with what?
  34. cause of pernicious anemia
    inhibits folic acid transport, reduces DNA synthesis


    *failure to absorb b12 d/t deficient intrinsic factor in gut => decrease absorption

    *result - precursor cells increase in size = macrocytic anemia
  35. what test is done for pernicious anemia (b12)
    shilling test - take b12

    * if they pee it out - b12 can be absorbed

    *if they don't pee it out - b12 cannot be absorbed = pernicious anemia
  36. the difference between folic acid anemia and other anemias?
    folic acid anemia has no nervous function involvement
  37. what causes folic acid anemia
    poor nutrition
  38. what foods are rich in folic acid
    grains, dairy, lentils, citrus, green leafies
  39. who's at risk for folic acid anemia
    chronic alcoholic

    etoh causes malabsorption
  40. deficiency in circulation RBC

    failure of bone marrow to produce d/t injury to precursor cells for RBC
    aplastic anemia
  41. what can cause destruction of RBC (aplastic anemia)
    LT meds
  42. aplastic anemia can cause decrease in w/c type of cells?

    • leukopenia - wbc
    • thrombocytopenia - platelets
    • pancytopenia - all cells
  43. what is the most common type of aplastic anemia?
    acquired aplastic anemia

    *caused by LT exposure to drugs/toxins
  44. leukemia is present with what complaints?
    pneumonia, anorexia, fatigue

    *dx with leukemia when the CBC report is examined
  45. sx of leukemia (r/t to anemia)
    • anemia
    • frequent infections (decrease in mature wbcs)
    • bruise easy
    • bleed easy
    • abd pain (splenomegaly)
    • bone pain
  46. causes of leukemia

    *environmental, genetic
  47. NDx for leukemia
    • risk for injury
    • risk for infection
  48. autoimmune thrombocytopenic purpura aka
    ITP - idiopathic thrombocytophenic purpura
  49. cause of ATP (ITP)
    platelets are attacked by our antibodies --> decreases platelets --> decreases clotting --> increases risk for bleeding

    (destruction exceeds production)
  50. manifestations of ITP
    bleeding, intracranial bleed, ecchymosis, petechiae
  51. treatments of ITP
    • IVig
    • plasmapheresis
    • splenectomy
    • platelet transfusion
  52. how does HIV attack the immune system
    hi jacks the cell - take over cell function and replicates

    destroys T cells and CD4 cells
  53. what is the CD4
    immun cell
  54. what is the dx for aids in relation to CD4 cells and infections?
    AIDS if:

    • CD4 <200 or
    • opportunistic infections (thrush)
  55. whats the normal range of CD4
  56. where is HIV or AIDS found (bodily fluids)
    • blood
    • semen
    • vaginal fluid
  57. how can HIV/AIDS be transmitted
    • sex
    • sharing needles
    • expousre to fetus or infant
  58. how is HIV/AIDS dx
    • lymphocyte count
    • antibody test
    • ELISA
  59. ELISA and WESTERN BLOT: how are they done
    • ELISA done first - serum test
    • WESTERN done to confirm
  60. what does the western blot look for? antibodies or the virus?
  61. patient education (HIV/AIDS) re: meds
    • lifelong meds
    • expensive
    • se: nvd, fatigue, anorexia
  62. NDX for HIV/AIDS
    • risk for infection
    • decreased self esteem
    • isolation