33 Flashcards
_______ _____ is a complex system of cells throughout the body that are capable of phagocytosis
reticuloendothelial system
known as the fluid portion of blood, ______ contains albumin, globulin, fibrinogen. other clotting factors, electrolytes, waste products, and nurtrients
plasma
____ fight infections
Leukocytes (WBC)
______ carries hemoglobin to provide O2 to tissues
eryrhrocyte (RBC)
_____ prevents or limits bacterial infection via phagocytosis
neutrophil
_____ enters tissue as macrophage, highly phagocytic esp. against fungus
monocyte
____ involved in allergic reactions (neutrolizes histamine), digests foreign proteins
eosinophil
____ contains histamine, part of hypersensitivity reactions
basophil
____ component of immune system
lymphocyte
________ is responsible for cell mediated immunity, recognized material as foreign
T lymphocyte
______ responsible for humoral immunity, many mature into plasma cells to form antibodies
B lymphocytes
____ ____ secrete immunoglobulin (Ig, antibody), mature form of B lymphocyte
plasma cell
____provide basis for coagulation to occur, maintains hemostasis
Thrombocyte (platelet)
_____ the need for blood to continuously replenish its supply of cells
hematopoiesis
stem cells have the ability to replicate and can begin a process known as _______
differentiation
differentiation results in ____ or ____ stem cells
myeloid, lymphoid
lymphoid stem cells produce __ or __ lymphocytes
T or B
myeloid stem cells produce ____, ____, and ____
erythrocytes, leukocytes and platelets
mature erythrocytes consists primarily of _____, which contains iron and makes up 95% of the cell mass
hemoglobin
the process of preventing blood loss from intact vessels and stopping bleeding from (severed) cut off vessels is known as ________
hemostasis
primary hemostasis
severed blood vessel constricts > platelets aggregate to the site of injury> platelet plug is formed > coagulation factors become active
secondary hemostasis
intrinsic or extrinsic pathway is activated > prothrombin converts to thrombin > which converts fibrinogen to fribrin
steps after injury repair
plasminogen breaks down fibrin > plasmin is formed > plasmin digest fribrinogen and fibrin
_____ is a decreased number of circulating leukocytes which is common in the elderly due to decreased activity of the bone marrow
leukopenia
how are hematologic disordered identified?
by a CBC or peripheral blood smear which allows the shape and size of the erythrocytes and platelets to be determined by looking at a smear of blood under the microscope
hemoglobin concentration lower than normal result in ______. there are fewer than normal RBC and decreased amounts of O2 is delivered to the tissues
anemia
classifications of anemia
hypoperliferative (RBC deficiency) hemolytic (premature destruction of RBC) bleeding
_____ anemia is d/t vitamin B12 or folate deficiency, decreased erythropoietin production, and cancer
hypoproliferative
____ anemia is d/t altered erythythropoiesis, hypersplenism, drug induced or autoimmune processes, mechanical heart valves
hemolytic
manifestations of anemia
fatigue weakness pallor jaundice cardiac/respiratory symptoms tongue changes nail changes cracks on side of mouth (angular cheilosis pica
what is pica?
when people eat unedible items ex. chalk or nail polish *think of the TV show my strange addiction on TLC
General anemia assessment
H & P labs fatigue weakness, malaise, pain nutrition (may indicate vitamin deficiencies) meds cardiac and GI assessment (heart works harder to pump blood to hypoxic tissues) blood loss (menstrual flow, pregnancy, stools) neurologic assessment
what is the most common symptom of anemia?
fatigue
significant complication of anemia?
heart failure
_____ _____ ___ results when the intake of dietary iron is inadequate for hemoglobin synthesis. it is the most common type of anemia
iron deficiency anemia
what is the most common cause of iron deficiency anemia?
blood loss
what is the most common cause of iron deficiency in men and postmenopausal women?
bleeding from ulcers, gastritis, inflammatory bowel disease, GI tumors
what is the most common cause of iron deficiency anemia in premenopausal women?
menorrhagia ( excessive menstrual bleeding and pregnancy with inadequate iron supplementation
what causes iron deficiency anemia in pts who suffer from alcoholism?
chronic blood loss from the GI tract
clinical manifestations of iron deficiency anemia
smooth sore tongue, brittle and rigid nails, angular cheilosis
what is angular cheilosis?
dry (inflammed) corners of the mouth
how is the diagnosis of iron deficiency anemia sometimes established?
by bone marrow aspiration, the aspirate is stained to detect low levels of iron
what labs help establish the diagnosis of iron deficiency anemia?
ferritin levels HG levels hematocrit levels RBC levels transferrin (TIBC) level
medical management for iron deficiency anemia
stool specimens tested for occult blood iron supplements
what tests should pts 50 or older have in re. to iron deficiency anemia?
periodic colonoscopy, endoscopy, x ray exam of GI tract to detect ulcerations/gastritis/polyp/cancer
iron preparations for treating iron deficiency anemia
FErrous sulfate FErrous gluconate FErrous fumarate
how long should pts take iron supplements to help with the deficiency?
6-12 months b/c replenishment of iron takes long
before a full does of iron supplements parenterally what should be done?
small test dose should be administered to avoid risk of anaphylaxis
food high in iron?
meats (beef/calf/chicken liver) black/pinto/garbanzo beans leafy green vegetables raisins molasses
taking iron rich foods with a source of ______ __ (orange juice) enhances the absorption of iron
Vitamin C
which diets contain inadequate amounts of iron?
fad diets vegetarian diets
t/f: iron therapy should be continued as long as prescribed?
true, even if patient no longer feels fatigue
iron is best absorbed on a ____ stomach
empty but if it causes GI distress pt may take w/ meals
when should iron supplements be taken?
an hour before meals
taking iron with meals diminishes absorption by __ %
50
iron should not be taken w/ ____ or ___ ___ because they diminish absorpbtion
antacids or dairy products
pt. teaching for liquid forms or iron?
they can stain teeth so take the med through a straw, rinse mouth w/ water, oral hygiene after the med
pt teaching: iron salts may color the stool ___ ___ or ____
dark green or black
w/ IM injection of iron it may cause pain or staining of the skin. Which method should be used with this injection?
Z track method, DO NOT RUB THE SITE AFTER
anemias in renal disease are caused by a mild shortening of _______ lifespan and a deficiency or ________
erythrocyte (RBC) and erythropoietin (necessary for erythropoiesis)
anemia of chronic disease can only be caused by chronic diseases of ____, _____, and _____
inflammation infection malignancy
____ ____is rare and caused by decrease in or damage to marrow stem cells and the microenvironment w/in the marrow, and replacement on marrow w/ fat
aplastic anemia
in aplastic anemia it is hypothesized that the bodys ____ ___ attack the _____ _____ resulting in bone marrow aplasia
T cells, Bone marrow
___ and ___ occurs in addition to aplastic anemia
neutropenia and thrombocytopenia (deficiency of platelets)
what can aplastic anemia be caused by?
pregnancy infection meds chemicals radiation
what can produce bone marrow aplasia?
airplane glue paint remover dry cleaning solutions
clinical manifestations of aplastic anemia
are insidious (appear slowly) bone marrow failure fatigue pallor dyspnea bruising throat infections enlarged cervical lymph nodes enlarged spleen retinal hemorrhage
medical management of aplastic anemia
bone marrow transplant peripheral blood stem transplant immunosuppressive therapy (which prevents the pts. lymphocytes from destroying stem cells)
ATG (antihymocyte globulin)
purified gamma globulin obtained from horses and rabbits immunized with human T lymphocytes
lymphocytes of pts which aplastic anemia destroy ____ ___ and impair production of _____, _____, and _____
stem cells erythrocytes, leukocytes, platelets
nursing management of aplastic anemia
assess signs of infection and bleeding monitor for hypersensitivity reaction while administering ATG assess for drug-drug interactions monitor liver and renal dysfunction hypertension
what happens in anemias caused by vitamin B12 and folic acid deficiency?
identical bone marrow and peripheral blood changes occur b/c both vitamins are essential for normal DNA synthesis
____ is a decrease in all myeloid derived cells
pancytopenia
what foods are folate (folic acid) found in
green vegetables and liver
when does folic acid deficiency occurs?
limited intake of uncooked veggies alcohol pregnancy chronic hemolytic anemias
when does vitamin B12 deficiency occur?
chrons disease ileal resection or gastrectomy absence of intrinsic factor
____ ___ tends to run in families and occurs when there is an absent intrinsic factor and vitamin B12 deficiency
pernicious anemia
___ ___ is required for absorption of vitamin B12
intrinsic factor
Factors that decrease intrinsic factor
chronic gastritis, heavy alcohol use, cigarette smoking, complete or partial gastrectomy, gastric bypass
s/s Pernicious Anemia
red, sore and shiny tongue, GI discomfort (diarrhea, nausea), numbness, tingling, paresthesias of extremities, loss of coordination (ataxia), fatigue, pale mucous membranes , confusion
pts w/ pernicious anemia should have _______ every 1-2 yrs to screen for early gastric cancer
endoscopies
treatment of pernicious anemia
Treatment: B-12 containing foods (meats, dairy, eggs), B-12 supplements or injections
____ ____ and ____ ___ ___ ____detects deficiency of vitamin B12
schilling test and intrinsic factor antibody test
Schilling test
-Stage 1: give B12 only, measure urine for absorption. if no radioactivity is present in urine then its GI malabsorption and if it is present in urine its not ileal disease or pernicious anemia -Stage 2: give B12 and Intrinsic factor. if radioactivity is present in urine it is diagnoses as pernicious anemia
intrinsic factor antibody test
positive test = presence of antibodies that bind to B12 intrinsic factor complex >no binding to receptors of ileum > no absorption
how is folic acid deficiency treated?
increasing folic acid in diet and 1mg of folic acid daily
treatment of vitamin B 12 deficiency
B12 replacements (2mg/day) monthly IM injections if intrinsic factor absent treatment must continue for life
assessment for B12 and folic acid anemia
inspect skin mucous membranes and tongue gait stability ADLs may have jaundice in sclera vitiligo (patchy loss of skin pigmentation) may be present greying of hair tests of position and vibration sense neurologic assessment
pt teaching re. vitamin B12 and folic acid
eat small amounts of soft bland foods avoid excessive heat and cold if sensation is altered
the HbS gene is common in people of ____ descent
African
clinical manifestation of sickle cell anemia
jaundice sickle cell crisis acute chest syndrome pulmonary hypertension bones marrow expands in childhood leading to enlarged bones of face and skull tachycardia murmurs enlarged heart dysrhythmia and HF in adults susceptibility to infection
sickle cell crisis
sickle crisis: tissue hypoxia and necrosis d/t inadequate blood flow to tissue or organs aplastic crisis: infection w/ human parvovirus sequestration crisis: other organs pool the sickled cells
how is sickle cell anemia diagnosed
HG electrophoresis there will be low hematocrit and sickled cells on the smear pt usually diagnosed in childhood
treatment of sickle cell anemia
peripheral blood stem cell transplant hydroxyurea (chemotherapy to increase fetal HG) arginine RB transfusion support
what is the most common symptom w/ sickle cell anemia
PAIN, pts have acute and chronic pain that may affect daily living and may need a PCA. pts with minimal supports systems may have difficulty coping with the pain
____ anemias result from the exposure of an erythrocyte to antibodies
hemolytic
hemolytic anemia
inadequate number of circulating RBCs due to the premature destruction of RBCs by spleen
autoimmune hemolytic anemia
the immune system misidentifies red blood cells (RBCs) as foreign and creates autoantibodies that attack them
clinical manifestations of autoimmune anemia
asymptomatic fatigue dizziness splenomegaly (enlarged spleen) he[atomegaliy lymphadenopathy
autoimmune hemolytic anemia is classified by ___ ___ involved when antibodies react w/ RBC antigen
body temperature warm body antibodies bind to RBC in warm conditions (37 C or 98.6 F), most common cold body antibodies bind to RBC in cold conditions (0 C or 32 F)
assessment and diagnostic findings of autoimmune hemolytic anemia
low HG and Hct high reticulocyte count abnromal RBC sypherocytes are common high serum bilirubin level absent or low haptoglobin level posititve Coombs test
___ ___ (DAT) detects antibodies on the surface of the erythrocytes
Coombs test
medical management for autoimmune hemolytic anemia
dicontinue contributing meds high doses of corticosteroids (must taper) until hemolysis decrease decrease macrophage ability to clear RBC blood transfusion splenectomy if corticosteroids dont work immunosuppressive agents administered if corticosteroids or splenectomy dont work (must tapper) cold body no treatment, advised to stay warm
nursing management for autoimmune hemolytic anemia
vaccine of pneumovax if have splenectomy monitor pts taking corticosteroids (dont abruptly discontinue, taper, set schedule)
____ is a genetic condition and excess iron is absorbed from GI tract into organs causing them to become dysfunctional
hemochromatosis
clinical manifestation of hemochromatosis
no evidence of tissue damage till middle age b/c it take iron time to accumulate weakness lethargy arthralgia weight loss loss of libido hyperpigmented or bronze skin
assessment and diagnostic findings for hemochromatosis
high serum iron level and transferrin saturation normal CBC values test for the genetic mutation (C282Y hemozygosity)
medical management of hemochromatosis
removal of iron via phlebotomy to reduce serum ferritin to les than 50 ug/L and transferrin sat to 30% or less
nursing management for hemochromatosis
avoid alcohol abuse screening test for hepatoma assess signs of organ dysfunction
____ is increased volume of erythrocytes and high Hct. can be primary or secondary
polycythemia
_____ ___ is proliferative disorder of the myeloid stem cells. results in hypercellular bone marrow, and elevated RBC, WBC and platelet counts
polycythemia vera (primary polycythemia)
_____ ______ i caused by excessive production of erythropoietin. this can occur in response to rduced amount of O2 resulting in hypoxia
secondary polycythemia
_____ is a condition where there are fewere leukocutes than normal and results from neutropenia or lymphopenia
leukopenia
______ (neutrophil count
neutropenia
neutropenia causes a pt. to be at increased risk of infection. what can cause neutropenia?
aplastic anemia metastatic cancer, lymphoma, leukemia, chemo radiation therapy magaloblastic anemia immunologic disorders bacterial infections
clinical manifestations of neutropenia
no symptoms until pt infected CBC w/ differential can reveal neutropenia before onset of infection
medical management of neutropenia
if med induced, meds are stopped corticosteroids if cause immunologic G-CSF or GM-CSF if decreased production withholding chemo or radiation
____ refers to an increased level of leukocytes in the circulation
leukocytosis
what is a significant cause of leukocytosis?
hematologic malignancy
____ is characterized by a rapid continuous turnver of cells
hematopoiesis
___ is uncontrolled proliferation of WBC that are often immature
leukemia
