exam 3 - blood and immune
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anemia is a disease. t or f
anemia is a clinical manifestation of a disease
what can cause anemia
- impaired function
- decreased production
- increased destruction
- dietary probs
- excess bleeding
- bone marrow disease
how will anemia manifest in the integumentary system?
pallor, concave brittle nails, etc
manifestations in cardiovascular?
#1 NDx for sickle cell anemia
early dx for sickle cell is critical. what supports this?
all states mandate newborn screening
is there a cure for sickle cell?
*bone marrow transplants
what's the main goal for sickle cell?
- manage pain
- relieve sx
- prevent/treat complications
what is the hemoglobin that is abnormal w/ sickle cell anemia
what does hgb S do to blood cells?
cells sickle when under stress, causing them to tangle --> vaso-occlusion = pain
patho of a vaso-occlusive crisis?
decrease in o2 --> rbcs sickle --> occludes --> compromises cirulation --> pain --> edema --> tissue ischemia --> infarction
sickle cell anemia:
what can cause a vaso-occlusive crisis?
- late pregnancy
- physical exertion
- mental/emotional stress
- decreased o2
top 2 NDx for sickle cell anemia?
- risk for infection (splenomegaly)
what can cause ACUTE CHEST SYNDROME?
fat embolism (stroke in long bone d/t sticky sickle cell) --> decrease perfusion --> fat emboli to let loose--> severe occlusive crisis / PE
s/s of acute chest syndrome
- increase T
dc teaching for sickle cell:
- rcv year flu vaccine
- abd pain - splenomegaly
acute chest syndrome caused by......
- atelectasis (IS, cough, deep breathe)
- fat embolism
treatment for severe pain?
- morphine - vessel dilation
- hydration - d5w
sickle cell crisis tx
- pain management
- keep warm
****TEDS, BP cuff, bed position can impede blood flow
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
what causes pain in sickle cell anemia?
this is a complication of vaso-occlusive crisis w/c can lead to resp failure and death
ACUTE CHEST SYNDROME
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%
What kind of anemai would you have to evaluate for bleeding, esp GI bleeding?
iron deficiency anemia
what can cause iron deficiency anemia?
- blood loss
- decrease GI absorption
- inadequate diet
*iron stores depleted first, followed by hemoglobin stores, RBCs (microcytic)
how is iron deficiency anemia managed?
- increase dietary intake
- oral suppls
- parenteral meds
*meats, beans, green leafies
iron deficiency anemia:
- easy fatigue
- hair loss
- muscle weakness
- altered oral mucosa
- mental status change
- tingling of extremities
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
vitamin b12 deficiency aka
manifestation of pernicious anemia (B12)
- NEUROFUNCTION - numbness, tingling (paresthesia), difficulty with gait, memory
pernicious anemia is an issue with what?
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
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
the difference between folic acid anemia and other anemias?
folic acid anemia has no nervous function involvement
what causes folic acid anemia
what foods are rich in folic acid
grains, dairy, lentils, citrus, green leafies
who's at risk for folic acid anemia
etoh causes malabsorption
deficiency in circulation RBC
failure of bone marrow to produce d/t injury to precursor cells for RBC
what can cause destruction of RBC (aplastic anemia)
aplastic anemia can cause decrease in w/c type of cells?
- leukopenia - wbc
- thrombocytopenia - platelets
- pancytopenia - all cells
what is the most common type of aplastic anemia?
acquired aplastic anemia
*caused by LT exposure to drugs/toxins
leukemia is present with what complaints?
pneumonia, anorexia, fatigue
*dx with leukemia when the CBC report is examined
sx of leukemia (r/t to anemia)
- frequent infections (decrease in mature wbcs)
- bruise easy
- bleed easy
- abd pain (splenomegaly)
- bone pain
causes of leukemia
NDx for leukemia
- risk for injury
- risk for infection
autoimmune thrombocytopenic purpura aka
ITP - idiopathic thrombocytophenic purpura
cause of ATP (ITP)
platelets are attacked by our antibodies --> decreases platelets --> decreases clotting --> increases risk for bleeding
(destruction exceeds production)
manifestations of ITP
bleeding, intracranial bleed, ecchymosis, petechiae
treatments of ITP
- platelet transfusion
how does HIV attack the immune system
hi jacks the cell - take over cell function and replicates
destroys T cells and CD4 cells
what is the CD4
what is the dx for aids in relation to CD4 cells and infections?
- CD4 <200 or
- opportunistic infections (thrush)
whats the normal range of CD4
where is HIV or AIDS found (bodily fluids)
how can HIV/AIDS be transmitted
- sharing needles
- expousre to fetus or infant
how is HIV/AIDS dx
- lymphocyte count
- antibody test
- WESTERN BLOT
ELISA and WESTERN BLOT: how are they done
- ELISA done first - serum test
- WESTERN done to confirm
what does the western blot look for? antibodies or the virus?
patient education (HIV/AIDS) re: meds
- lifelong meds
- se: nvd, fatigue, anorexia
NDX for HIV/AIDS
- risk for infection
- decreased self esteem
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