Hematology (Anemia etc)

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LaurenFleming
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Hematology (Anemia etc)
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2011-08-27 12:14:22
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  1. What does bone marrow produce
    • WBC
    • RBC
    • Platelets
  2. ESR- erythrocyte sedimentation rate
    test the measures the settling of the rbcs in a test tube

    When it is settling it means that that pt may have an acute infection
  3. Complete Blood Count consists of
    Hemoglobin and Hematocrit
  4. Normal # for RBCs
    4,200,000 to 6,100,000/mm3
  5. Normal # for WBCs
    (5,000-10,000/mm3)
  6. Normal # for Platelets
    150,000-400,000/mm3
  7. Clotting Studies
    • PT
    • PTT
    • INR
  8. PT
    Prothrombin Time 11-12.5 sec

    test to evaluate hemostasis
  9. PTT
    Partial Thromboplatin Time 30-45 sec

    The PTT evaluates thecoagulation factors
  10. INR
    International normalized ratio

    normal range 0.7-1.8

    - when on warfarin – range 2-3

    - desired levels may vary according to patient condition
  11. Bleeding Time
    1- 9 mins

    They slit your arm and put gauze on it, then time how long it takes for you to stop bleeding

    Drugs like aspirin and Motrin will effect the bleeding time
  12. Radiologic Studies (diagnostic studies hemolytic system)
    CT and MRI
  13. Biopsies used in
    – Bone marrow, Lymph Node
  14. What would be primary nursing concerns for a patient post-procedure bone marrow biopsy?
    • Pain
    • Infection
    • Bleeding
  15. What Position is the pt in for a Bone Marrow biopsy
    prone or side lying
  16. What should you educate the pt with when the are getting a bone marrow biopsy
    Educate them on what to expect and feel

    Some patients say they can feel the pressure of the needle going into their hip

    Tell them they are conscious for sedation (local anesthetic)
  17. What kind of technique is used for Bone marrow biopsy
    Sterile

    because you are going right into the bone
  18. What kind of Post Care do you want to do for your pt after a Bone Marrow biopsy
    •Prevent bleeding (may have to put pressure on site)

    •Check for infection

    •Pain relief

    •Ice packs- vasoconstrict, stop bleeding

    •Avoid contact sports
  19. Anemia
    • Deficieny of RBCs
    • Low Hgb and Hct

    •Not a specific disease but rather a manifestation of a pathologic process
  20. Main Manifestation of Anemia
    tissue Hypoxia
  21. Integumentary Manifestations of Anemia
    • Pallor, especially of the ears, the nail beds, the palmar creases, the conjunctivae, and around the mouth
    • •Cool to the touch
    • •Intolerance of cold temperatures
    • •Nails become brittle and may lose the normal convex shape; over time, nails become concave and fingers assume clublike appearance
  22. Cardio Manifestations of Anemia
    Tachycardia at basal activity levels, increasing with activity and during and immediately after meals

    •Murmurs and gallops heard on auscultation when anemia is severe

    •Orthostatic hypotension
  23. Respiratory Manifestations of Anemia
    • Dyspnea on exertion
    • Decreased oxygen saturation levels
  24. Neurologic Manifestations of Anemia
    • Increased somnolence and fatigue
    • Headache
  25. What are the 3 Anemias Caused by Decreased Erythrocyte Production
    •Decreased Hb synthesis (Fe+ deficiency)

    •Defective DNA synthesis (Folic acid deficiency)

    •Decreased availability of erythrocyte precursors (Aplastic anemia)
  26. Iron-Defficiency Anemia is from
    •inadequate diet malabsorption, blood loss, hemolysis
  27. Clinical Manifestations of Iron-Defficiency Anemia
    •headache, inflammation of tongue and cheilitis (inflammation of lips),
  28. Cheilitis
    Inflammation of lips
  29. Diagnostic studies found in Iron-Defficiency Anemia
    • increase TIBC,
    • low serum iron,
    • H/H low
  30. How do you know its iron deficiency
    Take a blood test

    We need iron for the hgb to attach to the rbc


    ron will be low

    Hgb/Hct low

    Classic for iron deficiency- TIBC (total iron binding capacity) will increase
  31. TIBC is performed to rule out
    Iron-Deficiency Anemia


    IF you have iron deficiency this test will be increased

    If the rbcs are not holding onto the iron- then they have a greater capacity to hold onto iron
  32. Drug Therapy for Iron-Deficiency Anemia
    •GI side effects esp. constipation

    • •Take between meals to reduce GI distress and
    • improve absorption

    •Liquid take with straw

    side effects: black stool, constipation
  33. Assess pt with Iron-Deficiency Anemia for
    Hypoxemia
  34. Nursing Management: Iron-Deficiency Anemia
    •Administer O2 as ordered

    •Alternate rest/activity

    •Monitor VS, hgb/hct


    •Teach about meds

    •Transfuse with blood products if needed- pRBC’s
  35. Teach pt with Iron Deficiency Anemia about a Diet
    •Increase protein and iron (b/c hemoglobin is made of protein)

    •Small, frequent meals

    •Increase iron-rich foods (red meat, kidney beans, green leafy vegetables etc)
  36. Megaloblastic Anemias
    Cobalamin Deficiency

    Folic Acid Deficiency
  37. Cobalamin Deficiency is
    Vit B12 deficiency

    Lack of Intrinsic Factor (IF)
  38. Clinical Manifestations of Cobalamin Deficiency
    sore tongue, N/V, weakness, paresthesia of feet and hands, ataxia, confusion, pallor
  39. Diagnostic studies for Cobalamin Deficiency
    • macrocytic RBC’s,
    • decreased cobalamin,
    • Schilling test for IF absorption
  40. Nuero Signs are classic in what Anemia
    Cobalamin

    Confusion and Ataxia
  41. Ataxia
    Lack of muscle coordination
  42. Why is the intrinsic factor important
    it allows the absorption of Vit. B12

    if you are lacking IF than you are not able to absorb B12 causing Cobalamin anemia
  43. What does Shillings test test for
    used to determine whether the body absorbs vitamin B12 normally
  44. Collabrative care for a pt with Cobalamin Anemia
    •supplemental Vit. B12 IM for pernicious anemia,

    •Increase dietary B12 (not for pernicious anemia)

    •CaloMist – B12 nasal spray – maintain vitamin levels
  45. Pernicious Anemia is the Lack of
    Intrinsic Factor which causes Vit. B12 Not to be aborbed

    supplemental Vit. B12 has to be given IM
  46. Cobalamin Anemia is the lack of
    B12 but the Intrinsic Factor is still working properly

    Supplemental Vit B12 can be given by Diet
  47. Folic Acid Deficiency Anemia causes
    poor nutrition, malabsorption, drugs, alcohol abuse,
  48. What is Folic Acid needed for
    needed for DNA synthesis leading to RBC formation
  49. Folic Acid Deficiency Anemia Clincal Manifestations
    sore tongue, N/V, weakness, paresthesia of feet and hands, pallor

    No changes in Neuro signs
  50. Folic Acid Deficiency Anemia Treatment
    Folic acid replacement (1mg), diet high in folic acid
  51. Aplastic Anemia
    deficiency of RBC

    •Congenital due to chromosomal alterations

    •Acquired due to exposure to chemicals, radiation, medications, bacteria, viruses
  52. Pancytopenia
    deficiency of RBC, WBC and platelets
  53. What would the nurse expect to assess in the patient with Aplastic Anemia
    Signs of infection- increased WBC, fever, depressed

    First clue may be a sore throat
  54. Diagnostic studies for pts with Aplastic Anemia
    RBC, WBC and platelet counts, TIBC, bone marrow study
  55. Nursing and Collaborative Management for a pt with Aplastic Anemia
    •Bone marrow transplant

    •Immunosuppression with cyclosporin, etc.

    •Prevent complications from infection and hemorrhage
  56. Because Immunosuppresion is a treatment for Aplastic Anemia how can we prevent further infections
    Wear Gloves and Wash Hands
  57. What assessment do you want to narrow in on for Aplastic Anemia
    NEURO assessment

    Can be a sign of hypoxia

    For bleeding or infection

    Bleeding may occur first in the brain- confusion, change in mental status, stroke like symptoms, septic
  58. What is a Caution for visitors visiting Aplastic Anemia
    Screen visitors

    Anyone with a cold or infection should not be in there

    Children may not be sick but may be carrying an infection- so some kids may not be aloud in

    Avoid invasive Procedures
  59. What kind of room do you want for a pt with Aplastic Anemia
    Private room and possible isolation

    private room if their WBC is really low
  60. Acute Anemia caused by blood loss
    sudden blood loss due to trauma or surgery
  61. Chronic Anemia caused by blood loss
    • gradual blood loss where body adapts but there is insufficient RBC’s – GI bleeding, excessive
    • menstruation
  62. Collaborative care for Acute Anemia blood loss
    •replacing volume, prevent shock, blood transfusions, iron supplements etc
  63. What are the steps to stop Acute Anemia blood loss
    • replace blood volume,
    • ID source of hemorrhage and stop bleeding,
    • administer dextran,
    • Hetastarch, a
    • lbumin,
    • lactated
    • Ringer’s,
    • supplemental iron.
  64. Nurse Management for Acute blood loss
    •Post OP – monitor incision sites, drainage tubes, and dressings for blood loss.

    •Administer O2 therapy – monitor O2 saturation

    •Administer fluids, electrolytes, blood transfusions

    •Administer meds to increase production of RBC’s
  65. Nurse Management for Chronic Blood loss
    •ID source of bleeding and stop bleeding

    •Nursing management is same as for iron-deficiency anemia
  66. Polycythemia
    •Increased production of RBC’s causing impaired circulation due to increased blood viscosity
  67. What is the Nursing Priority for Polycythemia
    Hydration for fluid balance because blood is very viscous
  68. Primary - Polycythemia vera
    – form of cancer in which there is an increase in RBC, WBC and platelets (cells are often impaired)
  69. Secondary (Polycythemia)
    •hypoxia stimulates erythropoietin in kidneys which increase production of RBCs


    •Hepatomegaly, spleenomegaly, intermittent claudication, pain,
  70. Diagnostic studies for Polycythemia
    •Hb, rbc, wbc, platelets, (frequent)

    • bone marrow examination

    at some time the dr. takes blood out of body and puts some back in
  71. Collabrative care for Polycythemia
    • Hydration
    • frequent small meals
    • Avoid iron supplements
    • Avoid Citrus with meals
  72. Why wont Aspirin work for Polycythemia
    Because this is a clumping problem not a clotting problem that has to do with platelets

    So aspiriin will not help
  73. Why do we want to avoid Citrus foods with meals with Polycythemia
    citrus increases absorption of iron
  74. What can we look for on the pt with Polycythemia ??
    Bruises on places that are not normal for day to day activities and play
  75. myelosuppressant agents
    Reduce bone marrow activity

    used in pts with Polycythemia
  76. What are pts at risk for if they have Polycythemia
    Hyperkalemia: becuase Once the cells die they are going to release potassium

    Stroke: because blood is viscous and moves slower
  77. Thrombocytopenia
    Low platelet count

    Which means patient has problems with clotting
  78. •Immune Thrombocytopenic Purpura –
    (idiopathic thrombocytopenic Purpura)

    autoimmune disease that causes abnormal platelet destruction
  79. Thrombotic Thrombocytopenic Purpura
    –formation of micro-thrombi/platelets that deposit in arterioles and capillaries resulting in few platelets in circulation
  80. Thrombocytopnia Clinical Manifestations
    •Petechiae, ecchymoses, prolonged bleeding after routine procedures, major complication is hemorrhage
  81. Diagnostic Studies for Thrombocytopenia
    •Platelet count (decreased), bleeding time (prolonged), bone marrow, Hb/Hct
  82. •Collaborative Care

    Immune Thrombocytopenic Purpura
    corticosteroids, IV immunoglobulin,, splenectomy, platelet transfusion
  83. Collaborative Care

    Thrombotic Thrombocytopenic Purpura
    •corticosteroids, plasma exchange, anti-platelet agents
  84. Leukopenia
    –is a reduction in the total number of WBC
  85. Neutropenia
    reduction in number of neutrophils (granulocytopenia)

    •Syndrome that occurs with a variety of illness

    •Classic signs of infection or inflammation may not occur
  86. Neutropenia Diagnostic studies
    • Low Neutrophil Count 1000-1500, peripheral
    • blood smear to assess for immature cells, bone marrow aspirations

    may not have typical signs of infection

    Patients may not have the fever

    So you have to look outside the box to figure it out
  87. Collabrative Care for Neutropenia
    •Alert for minor complaints (sore throat, diarrhea, low grade fever etc)

    •Antibiotics

    •Screened visitors

    •Strict handwashing- MUST

    • •Private room (Laminar air flow rooms if needed)- protective isolation (you are protecting the
    • patient, not yourself)

    •Avoidance of fresh fruits and vegetables (severely compromised)- because of the bacteria on the outside of them
  88. Leukemia
    •A group of malignant disorders affecting the blood and blood-forming tissues of

    •Bone marrow

    •Lymph system

    •Spleen

    •Accumulation of dysfunctional cells due to loss of regulation in cell division
  89. Patient can have Leukemia in responce to what
    Chemotherapy
  90. Hemostasis
    the process that the body uses to form blood clots to help stop bleeding.
  91. Prolonged PT but normal PTT
    liver disease
  92. the PTT and PT tests are sometimes selectively performed as pre
    Pre-surgical procedures to screen for potential bleeding tendencies.
  93. Acute Leukemia
    symptom occur rapidly and without intervention will progress to death
  94. Leukemia Cells cause
    •Splenomegaly


    •Hepatomegaly


    •Lymphadenopathy


    • •Bone pain- immature
    • cells
  95. Leukemia Cells invade
    •Meningeal irritation

    •Oral lesions

    •Solid masses
  96. Hodgkins Disease
    a malignant condition caused by proliferation of abnormal, giant, multinucleated cells called Reed-Steinberg cells located in the lymph nodes

    • enlarged cervical, axillary or inguinal nodes, fever,
    • fatigue, night sweats
  97. Non- Hodgkins Disease
    malignant neoplasms of the immune system (lymphoid cancers that do not include Reed-Steinburg Cells)

    painless lymph node enlargement

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