BlLymDis

• Not known; but maybe genetics or hx chemo or radiation
• too many leukocytes in bone marrow and LNs
• immature cells go into bloodstream, infiltrate and damage bone marrow, lymph, spleen, CNS, organs, everywhere

• 4.
• Acute: lymphocytic (ALL), Myelogenous (AML)
• Chronic (CLL), (CML)
• Myleogenous- refers to nonlymphocytic groups of WBCells, granulocytes, monocytes, platelets

• -Overcrowding of weird cells and not enough normal ones/abnormal WBC production
• -splenomegaly, lymphadenopathy, hepatomegaly, bone pain, meningeal irritation, oral lesions, bleeding, petechiae
• -Predisposed to anemia, thrombocytopenia

• WBCs- low, high or way high
• anemia, thrombocytopenia,
• biopsy of bone marrow (immature leukocytes)
• CXR- may show nodal involvement, bone and lung changes
• lymph node biopsy- immature cells in excess

• Eradication- chemo, radiation, marrow xplant
• Prev of inf- watch for sx- neutropenic prec (leukopenia can be fatal)
• Thrombocytopenia- prev, watch for bleeding

• 4-6 months
• chemo helps kids
• - ALymphocyticL 5 year survival rate 50%
• -AMyelogenousL remission can be 75%
• -CLymphocyticL is variable early stages 10-12 years, late stages 18 months
• Adults w AML, 5 year remission in 25%

• trauma,
• vessel damage or inedequacy
• platelet or clotting factor malfunction
• liver disease (impairs clotting mechs)

itching, petechiae, epistaxis, gingival bleeding, hypovolemia, tension (and bleeding), pale, cold clammy skin, tachycardis, GI bleed, ABD pain, internal bleeding, CNS affected due to hypotension, H&P including recent trauma, exposure to tox, meds, radiation

• CBC (spec platelet count, Hgb, HCT), coag profile, liver profile, BMarrow studied
• Try and treat underlying cause (med induced?), xfusion of blood or blood products, treat stuff like hypotension, prevent trauma

low # circ platelets or a change in their function. Less than floor; 150,000 mm3

• ITP- most common cause of acquired- autoimmune.
• plts coated in antibodies, function normally. ABs make plts look foreign to spleen, macrophages destroy them

Heparin, penicillins, aspirin, oral hypglycemics, digoxin, sulfonamides, furosemide, thiazide, NSAIDS

CBC (platelet), peripheral blood smear, bleeding time, bone marrow biopsy to rule out anemia

recent viral infections may cause it petechiae and bruising, bleeding risk, mucous membranes, old puncture sites, less than 5000 mm3 can cause spontaneous bleed

ITP: IV Ig; corticosteroid and or immunosuppressants, splenectomy (80% benefit), xfusion of platelets if active bleeding (otherwise if platelets less than 20,000), plasmapheresis, be careful, limit sticks

• genetic
• male
• 85% of H/factor 8 missing (prothrombin to thrombin)
• Factor 9 is missing (plasma protein)

Internal, external bleeding. Larger ecchymotic areas, bleeding into joint space- hallmark of the disease, knees, ankles, elbow, painful, edema, fever

coag times, abnormal PTT, check for factor 8 and 9 def

• prev bleeding, pain relief, admin of factor 8 and 9, cryoprecipitate (8), factors pooled from 1000s of donors, now engineered factors avail. No ASA or aspirin at home, transfuse prior to surgery.
• Other than HIV, prognosis good

• genetic, men and women
• mild factor 8 def, slow coag time. Common post partum, menorrhagia, post surg, trauma

spontaneous GI bleeds

• Cryo, FFP, Factor 8
• DDAVP-desmopressin (vasopressin) release factor 8

very bad. overstim of clotting process, xfusion reactions, shock, septicemia, desease or injury, obstetric complications

widespread clots for within them

clotting factors are depleted- bleeding, clotting, bleeding

bleeding- anywhere, dyspnea, diaphoresis, mottled extremities

elevated D-Dimer (reveals the breakdown of fibrin, degree of fibrinolysis), coag profile, platelets, factor profile

• fix underlying cause, admin blood products and factors
• maybe heparin- stops form of microemboli, inhibits thrombin act, still controversial
• protect pt from potential (even oral care)
• prognosis varies

Review on own: clin manifestations, assessment, dx tests, mgmt, interventions, prog, drugs

inadequate tissue perfusion

dec in fluid volume shock

pump failure

hypersensitivity reaction shock

infection shock

restlessness, anxiety, disorientation, syncope, often dec urine output,

cool and clammy skin, thready pulse + tach combined w reduced bp, cold, moist, pale, or cyanotic skin

O2, raise pt legs above h level, increase IV fl unless contra, notify anesthesia person and surgeion, provide meds as ordered, continue to assess pt and respond to interventions

• ABCs
• modified trendelenburg
• warm and dry
• IV fluids
• blood/blood products
• NPO
• no pain meds

Q 1-2h

• 4h q15, 4h q30, 4h q1h, then q4h etc
• fully conscious
• on side, 45deg angle
• red or coffee ground

cover wound w warm sterile moistened sterile towel. Place in fowler's pos w knees slightly flexed, reassure, tell her surg will be req, prep pt for surgery, sterile tech precedures

• Untreated less than 5 years
• Stage I-II is 90% curable

• Peripheral blood studies – anemia
• Bone scan
• Increased WBC
• Abnormal ESR (Erythrocyte Sedimentation rate)
• CXR reveal a mediastinal mass
• CT scan & biopsy – organ & nodal involvement
• Bone marrow biopsy stages
• Presence of Reed-Sternberg cells!