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Med Surg 1 > 33 > Flashcards

33 Flashcards

1
Q

_______ _____ is a complex system of cells throughout the body that are capable of phagocytosis

A

reticuloendothelial system

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2
Q

known as the fluid portion of blood, ______ contains albumin, globulin, fibrinogen. other clotting factors, electrolytes, waste products, and nurtrients

A

plasma

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3
Q

____ fight infections

A

Leukocytes (WBC)

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4
Q

______ carries hemoglobin to provide O2 to tissues

A

eryrhrocyte (RBC)

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5
Q

_____ prevents or limits bacterial infection via phagocytosis

A

neutrophil

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6
Q

_____ enters tissue as macrophage, highly phagocytic esp. against fungus

A

monocyte

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7
Q

____ involved in allergic reactions (neutrolizes histamine), digests foreign proteins

A

eosinophil

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8
Q

____ contains histamine, part of hypersensitivity reactions

A

basophil

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9
Q

____ component of immune system

A

lymphocyte

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10
Q

________ is responsible for cell mediated immunity, recognized material as foreign

A

T lymphocyte

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11
Q

______ responsible for humoral immunity, many mature into plasma cells to form antibodies

A

B lymphocytes

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12
Q

____ ____ secrete immunoglobulin (Ig, antibody), mature form of B lymphocyte

A

plasma cell

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13
Q

____provide basis for coagulation to occur, maintains hemostasis

A

Thrombocyte (platelet)

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14
Q

_____ the need for blood to continuously replenish its supply of cells

A

hematopoiesis

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15
Q

stem cells have the ability to replicate and can begin a process known as _______

A

differentiation

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16
Q

differentiation results in ____ or ____ stem cells

A

myeloid, lymphoid

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17
Q

lymphoid stem cells produce __ or __ lymphocytes

A

T or B

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18
Q

myeloid stem cells produce ____, ____, and ____

A

erythrocytes, leukocytes and platelets

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19
Q

mature erythrocytes consists primarily of _____, which contains iron and makes up 95% of the cell mass

A

hemoglobin

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20
Q

the process of preventing blood loss from intact vessels and stopping bleeding from (severed) cut off vessels is known as ________

A

hemostasis

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21
Q

primary hemostasis

A

severed blood vessel constricts > platelets aggregate to the site of injury> platelet plug is formed > coagulation factors become active

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22
Q

secondary hemostasis

A

intrinsic or extrinsic pathway is activated > prothrombin converts to thrombin > which converts fibrinogen to fribrin

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23
Q

steps after injury repair

A

plasminogen breaks down fibrin > plasmin is formed > plasmin digest fribrinogen and fibrin

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24
Q

_____ is a decreased number of circulating leukocytes which is common in the elderly due to decreased activity of the bone marrow

A

leukopenia

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25
Q

how are hematologic disordered identified?

A

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

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26
Q

hemoglobin concentration lower than normal result in ______. there are fewer than normal RBC and decreased amounts of O2 is delivered to the tissues

A

anemia

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27
Q

classifications of anemia

A

hypoperliferative (RBC deficiency) hemolytic (premature destruction of RBC) bleeding

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28
Q

_____ anemia is d/t vitamin B12 or folate deficiency, decreased erythropoietin production, and cancer

A

hypoproliferative

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29
Q

____ anemia is d/t altered erythythropoiesis, hypersplenism, drug induced or autoimmune processes, mechanical heart valves

A

hemolytic

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30
Q

manifestations of anemia

A

fatigue weakness pallor jaundice cardiac/respiratory symptoms tongue changes nail changes cracks on side of mouth (angular cheilosis pica

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31
Q

what is pica?

A

when people eat unedible items ex. chalk or nail polish *think of the TV show my strange addiction on TLC

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32
Q

General anemia assessment

A

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

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33
Q

what is the most common symptom of anemia?

A

fatigue

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34
Q

significant complication of anemia?

A

heart failure

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35
Q

_____ _____ ___ results when the intake of dietary iron is inadequate for hemoglobin synthesis. it is the most common type of anemia

A

iron deficiency anemia

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36
Q

what is the most common cause of iron deficiency anemia?

A

blood loss

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37
Q

what is the most common cause of iron deficiency in men and postmenopausal women?

A

bleeding from ulcers, gastritis, inflammatory bowel disease, GI tumors

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38
Q

what is the most common cause of iron deficiency anemia in premenopausal women?

A

menorrhagia ( excessive menstrual bleeding and pregnancy with inadequate iron supplementation

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39
Q

what causes iron deficiency anemia in pts who suffer from alcoholism?

A

chronic blood loss from the GI tract

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40
Q

clinical manifestations of iron deficiency anemia

A

smooth sore tongue, brittle and rigid nails, angular cheilosis

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41
Q

what is angular cheilosis?

A

dry (inflammed) corners of the mouth

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42
Q

how is the diagnosis of iron deficiency anemia sometimes established?

A

by bone marrow aspiration, the aspirate is stained to detect low levels of iron

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43
Q

what labs help establish the diagnosis of iron deficiency anemia?

A

ferritin levels HG levels hematocrit levels RBC levels transferrin (TIBC) level

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44
Q

medical management for iron deficiency anemia

A

stool specimens tested for occult blood iron supplements

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45
Q

what tests should pts 50 or older have in re. to iron deficiency anemia?

A

periodic colonoscopy, endoscopy, x ray exam of GI tract to detect ulcerations/gastritis/polyp/cancer

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46
Q

iron preparations for treating iron deficiency anemia

A

FErrous sulfate FErrous gluconate FErrous fumarate

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47
Q

how long should pts take iron supplements to help with the deficiency?

A

6-12 months b/c replenishment of iron takes long

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48
Q

before a full does of iron supplements parenterally what should be done?

A

small test dose should be administered to avoid risk of anaphylaxis

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49
Q

food high in iron?

A

meats (beef/calf/chicken liver) black/pinto/garbanzo beans leafy green vegetables raisins molasses

50
Q

taking iron rich foods with a source of ______ __ (orange juice) enhances the absorption of iron

A

Vitamin C

51
Q

which diets contain inadequate amounts of iron?

A

fad diets vegetarian diets

52
Q

t/f: iron therapy should be continued as long as prescribed?

A

true, even if patient no longer feels fatigue

53
Q

iron is best absorbed on a ____ stomach

A

empty but if it causes GI distress pt may take w/ meals

54
Q

when should iron supplements be taken?

A

an hour before meals

55
Q

taking iron with meals diminishes absorption by __ %

A

50

56
Q

iron should not be taken w/ ____ or ___ ___ because they diminish absorpbtion

A

antacids or dairy products

57
Q

pt. teaching for liquid forms or iron?

A

they can stain teeth so take the med through a straw, rinse mouth w/ water, oral hygiene after the med

58
Q

pt teaching: iron salts may color the stool ___ ___ or ____

A

dark green or black

59
Q

w/ IM injection of iron it may cause pain or staining of the skin. Which method should be used with this injection?

A

Z track method, DO NOT RUB THE SITE AFTER

60
Q

anemias in renal disease are caused by a mild shortening of _______ lifespan and a deficiency or ________

A

erythrocyte (RBC) and erythropoietin (necessary for erythropoiesis)

61
Q

anemia of chronic disease can only be caused by chronic diseases of ____, _____, and _____

A

inflammation infection malignancy

62
Q

____ ____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

A

aplastic anemia

63
Q

in aplastic anemia it is hypothesized that the bodys ____ ___ attack the _____ _____ resulting in bone marrow aplasia

A

T cells, Bone marrow

64
Q

___ and ___ occurs in addition to aplastic anemia

A

neutropenia and thrombocytopenia (deficiency of platelets)

65
Q

what can aplastic anemia be caused by?

A

pregnancy infection meds chemicals radiation

66
Q

what can produce bone marrow aplasia?

A

airplane glue paint remover dry cleaning solutions

67
Q

clinical manifestations of aplastic anemia

A

are insidious (appear slowly) bone marrow failure fatigue pallor dyspnea bruising throat infections enlarged cervical lymph nodes enlarged spleen retinal hemorrhage

68
Q

medical management of aplastic anemia

A

bone marrow transplant peripheral blood stem transplant immunosuppressive therapy (which prevents the pts. lymphocytes from destroying stem cells)

69
Q

ATG (antihymocyte globulin)

A

purified gamma globulin obtained from horses and rabbits immunized with human T lymphocytes

70
Q

lymphocytes of pts which aplastic anemia destroy ____ ___ and impair production of _____, _____, and _____

A

stem cells erythrocytes, leukocytes, platelets

71
Q

nursing management of aplastic anemia

A

assess signs of infection and bleeding monitor for hypersensitivity reaction while administering ATG assess for drug-drug interactions monitor liver and renal dysfunction hypertension

72
Q

what happens in anemias caused by vitamin B12 and folic acid deficiency?

A

identical bone marrow and peripheral blood changes occur b/c both vitamins are essential for normal DNA synthesis

73
Q

____ is a decrease in all myeloid derived cells

A

pancytopenia

74
Q

what foods are folate (folic acid) found in

A

green vegetables and liver

75
Q

when does folic acid deficiency occurs?

A

limited intake of uncooked veggies alcohol pregnancy chronic hemolytic anemias

76
Q

when does vitamin B12 deficiency occur?

A

chrons disease ileal resection or gastrectomy absence of intrinsic factor

77
Q

____ ___ tends to run in families and occurs when there is an absent intrinsic factor and vitamin B12 deficiency

A

pernicious anemia

78
Q

___ ___ is required for absorption of vitamin B12

A

intrinsic factor

79
Q

Factors that decrease intrinsic factor

A

chronic gastritis, heavy alcohol use, cigarette smoking, complete or partial gastrectomy, gastric bypass

80
Q

s/s Pernicious Anemia

A

red, sore and shiny tongue, GI discomfort (diarrhea, nausea), numbness, tingling, paresthesias of extremities, loss of coordination (ataxia), fatigue, pale mucous membranes , confusion

81
Q

pts w/ pernicious anemia should have _______ every 1-2 yrs to screen for early gastric cancer

A

endoscopies

82
Q

treatment of pernicious anemia

A

Treatment: B-12 containing foods (meats, dairy, eggs), B-12 supplements or injections

83
Q

____ ____ and ____ ___ ___ ____detects deficiency of vitamin B12

A

schilling test and intrinsic factor antibody test

84
Q

Schilling test

A

-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

85
Q

intrinsic factor antibody test

A

positive test = presence of antibodies that bind to B12 intrinsic factor complex >no binding to receptors of ileum > no absorption

86
Q

how is folic acid deficiency treated?

A

increasing folic acid in diet and 1mg of folic acid daily

87
Q

treatment of vitamin B 12 deficiency

A

B12 replacements (2mg/day) monthly IM injections if intrinsic factor absent treatment must continue for life

88
Q

assessment for B12 and folic acid anemia

A

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

89
Q

pt teaching re. vitamin B12 and folic acid

A

eat small amounts of soft bland foods avoid excessive heat and cold if sensation is altered

90
Q

the HbS gene is common in people of ____ descent

A

African

91
Q

clinical manifestation of sickle cell anemia

A

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

92
Q

sickle cell crisis

A

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

93
Q

how is sickle cell anemia diagnosed

A

HG electrophoresis there will be low hematocrit and sickled cells on the smear pt usually diagnosed in childhood

94
Q

treatment of sickle cell anemia

A

peripheral blood stem cell transplant hydroxyurea (chemotherapy to increase fetal HG) arginine RB transfusion support

95
Q

what is the most common symptom w/ sickle cell anemia

A

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

96
Q

____ anemias result from the exposure of an erythrocyte to antibodies

A

hemolytic

97
Q

hemolytic anemia

A

inadequate number of circulating RBCs due to the premature destruction of RBCs by spleen

98
Q

autoimmune hemolytic anemia

A

the immune system misidentifies red blood cells (RBCs) as foreign and creates autoantibodies that attack them

99
Q

clinical manifestations of autoimmune anemia

A

asymptomatic fatigue dizziness splenomegaly (enlarged spleen) he[atomegaliy lymphadenopathy

100
Q

autoimmune hemolytic anemia is classified by ___ ___ involved when antibodies react w/ RBC antigen

A

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)

101
Q

assessment and diagnostic findings of autoimmune hemolytic anemia

A

low HG and Hct high reticulocyte count abnromal RBC sypherocytes are common high serum bilirubin level absent or low haptoglobin level posititve Coombs test

102
Q

___ ___ (DAT) detects antibodies on the surface of the erythrocytes

A

Coombs test

103
Q

medical management for autoimmune hemolytic anemia

A

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

104
Q

nursing management for autoimmune hemolytic anemia

A

vaccine of pneumovax if have splenectomy monitor pts taking corticosteroids (dont abruptly discontinue, taper, set schedule)

105
Q

____ is a genetic condition and excess iron is absorbed from GI tract into organs causing them to become dysfunctional

A

hemochromatosis

106
Q

clinical manifestation of hemochromatosis

A

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

107
Q

assessment and diagnostic findings for hemochromatosis

A

high serum iron level and transferrin saturation normal CBC values test for the genetic mutation (C282Y hemozygosity)

108
Q

medical management of hemochromatosis

A

removal of iron via phlebotomy to reduce serum ferritin to les than 50 ug/L and transferrin sat to 30% or less

109
Q

nursing management for hemochromatosis

A

avoid alcohol abuse screening test for hepatoma assess signs of organ dysfunction

110
Q

____ is increased volume of erythrocytes and high Hct. can be primary or secondary

A

polycythemia

111
Q

_____ ___ is proliferative disorder of the myeloid stem cells. results in hypercellular bone marrow, and elevated RBC, WBC and platelet counts

A

polycythemia vera (primary polycythemia)

112
Q

_____ ______ i caused by excessive production of erythropoietin. this can occur in response to rduced amount of O2 resulting in hypoxia

A

secondary polycythemia

113
Q

_____ is a condition where there are fewere leukocutes than normal and results from neutropenia or lymphopenia

A

leukopenia

114
Q

______ (neutrophil count

A

neutropenia

115
Q

neutropenia causes a pt. to be at increased risk of infection. what can cause neutropenia?

A

aplastic anemia metastatic cancer, lymphoma, leukemia, chemo radiation therapy magaloblastic anemia immunologic disorders bacterial infections

116
Q

clinical manifestations of neutropenia

A

no symptoms until pt infected CBC w/ differential can reveal neutropenia before onset of infection

117
Q

medical management of neutropenia

A

if med induced, meds are stopped corticosteroids if cause immunologic G-CSF or GM-CSF if decreased production withholding chemo or radiation

118
Q

____ refers to an increased level of leukocytes in the circulation

A

leukocytosis

119
Q

what is a significant cause of leukocytosis?

A

hematologic malignancy

120
Q

____ is characterized by a rapid continuous turnver of cells

A

hematopoiesis

121
Q

___ is uncontrolled proliferation of WBC that are often immature

A

leukemia

Med Surg 1 (5 decks)

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