Anemia/Cancers/Lymph System Flashcards
1
Q
Anemia
A
- low RBCs produced, hemolysis, blood loss
- microcytic– sm. RBCs, iron deficiency—most common, less RBCs from low hgb lvl, comes from red meat
- macrocyctic—lg RBCs, folic acid/B12 deficiency, most common macro anemia, pernicious: B12 (DNA synethesis) loss results in intrinsic factor loss= no B12 absorption, unhealthy RBCs from O2 lack
- hereditary, hemolysis
2
Q
Anemia S/S
A
- pallor, fatigue, Dyspnea, tachy (common signs from O2 & hemoglobin loss in RBCs)
- pernicious— hand/feet numb from disease nerve damage & O2 loss, glossitis, these take longer to see, B12 IM shots not PO because of absorption issue
- iron deficient— glossitis, spoon nails/oral fissures, pica, take Fe supplements PO w OJ NO MILK. Until 2 hrs after can also be IV, use straw with oral ..can stain teeth
3
Q
Anemia Labs
A
- CBC— RBC shape/sz, hgb & hct lvls(range: 12-18)
- iron profile— pherotyn, total fe capacity, will see if PT fe deficient
- marrow biopsy— posterior iliac crest
- find blood loss source—sigmoidoscopy, colonoscopy, occult tests of stool/urine
4
Q
Anemia Therapy
A
- treat causes, maybe blood transfusions, iron foods (spinach, lentils)
- correct chronic blood loss
- oral/PN (Z-track)fe therapy—increased absorption from OJ/vit. C, take when hungry, no milk or antacid until 2 hrs prior to med, oral stains teeth so use straw
- fe therapy may cause nausea , vomiting, constipation, dark/tarry stools diarrhea
5
Q
Aplastic anemia
A
- bone marrow loses clotting factors (pancytopenia), turns yellow, fatty, fibrous
- fatal if untreated
- differs from other anemias
6
Q
Anemia Nursing
A
- watch V.S., —pulse/RR increases >20%, limit activity
- conserve energy
- O2 PRN
- safety risk for falls from weakness/dizzy
- oral hygiene
7
Q
Aplastic anemia S/S
A
- varies with bone failure
- early: weakness, fatigue, pallor, SOB, headaches
- later: pancytopenia get worse from marrow cell loss, tachy (H.F.), ecchymosis/petechiae, bloody mm/injection sites, bleeding into organs, death/infection from WBC loss
8
Q
Aplastic anemia labs
A
- starts with CBC— low values: pancytopenia, WBC range 4500-11000
- RBCs may be normal from 120 day life span
- marrow biopsy—definitive, dry tap, finds fatty/yellow tissue
- iron binding capacity tests
- serum iron level test
9
Q
Aplastic anemia nursing
A
- Similar to general anemia
- low platelets= risk for bleeding: thrombocytopenia, bleeding precautions, no aspirin, no NSAIDs, low WBCs=infection risk: leukopenia, infection protection
10
Q
Sickle cell anemia
A
- recessive & from parent
- RBCs sickle-shaped, rigid/crack easily, clumps & congests vessels and organs, painful, shape change from hgb/hct body change
- normal hgb, abnormal hgs from O2 changes
- found mostly in African/asian/ Mediterranean PTs
11
Q
Sickle Cell Pathology
A
- bilirubin rises
- jaundice, gallstones, splenomegaly/hepatomegaly
- increased bile pigment
- RBC lifespan reduced from 10-20 days to
12
Q
Sickle cell S/S
A
- starts after 6 mos old
- sickling constant— cells can rt to normal if O2 improves
- can Turn into sickle cell crisis aka vasocclusive disorder
13
Q
Sickle cell crisis
A
- any O2 decreases can cause it I.e. pneumonia, cold, dehydration infection
- sickling» thick blood in capillaries/chest & abdomen veins, joints/bones
- infarction, necrosis»pain/fever/swelling
14
Q
Sickle Cell Crisis s/s
A
- severe back & joint pain, joints/elbows/knee swelling
- abdominal pain from splenomegaly
- hand-foot syndrome (toe growth), life quality impaired
- death from infection, strokes, organ failure
- O2 need»avoid exertion ..sickling
15
Q
SCC labs
A
- blood smear
- low hgb
- low cbc
- high WBCs
16
Q
SCC therapy
A
- no cure, PT education: crisis prevention
- low dose antibiotic
- acute: opioids—pain management, transfusions—replaces some RBCs, O2 therapy—help resp. Status Po fluids/IVF—flush debris from sickle cells
- WARM Compress, no tight clothes, bedrest
17
Q
Polycythemia
A
- too many RBCs
- cancer
- makes blood thick like sludge
- hgb >18 mg (12-18 is normal), hct >55%
- primary is vera…rare, genetic, secondary is from hypoxia
18
Q
Polycythemia Vera
A
- From pulmonary issue: COPD, HF, smoking, high altitude living
- not disease but compensation mechanism
- body makes more RBCs
19
Q
Polycythemia S/S
A
- HTN, vision change, headache , dizzy, vertigo, tinnitus, itching, exertional dyspnea,
- bleeding gums/nose from dysfunctional/overproduced platelets
20
Q
Polycythemia therapy
A
- pt can hemorrhage/clot to death ..incurable but manageable
- stage 1: phlebotomy, baby aspirin, hct 45%, decrease hyperviscosity tissue, stage 2: chemo/radiation for blood cell suppression, leukemia side effect
21
Q
Polycythemia nursing/ PT teaching
A
- 3 L of H2O/day, phlebotomy’s like blood donation, monitor PT for bleeding/ hypovolemia
- splenomegaly/hepatomegaly: small meals, meds: monitor CBC, platelets
- report s/s if bleeding/iron deficiency, elevate legs, bleeding precautions
22
Q
D.I.C.
A
- bleeding syndrome not disease
- vessel clotting, rapid»high mortality so prognosis dependent on condition, organ/ limb necrosis, kidneys/brain affected
23
Q
D.I.C. Bleeding S/S & Regular s/s
A
- bleeding: bruising, petechiae, Iv/venipuncture site bleed, tarry stool, hematuria, nose/gums bloody, painful joints
- regular: bleeding w/o disorder history, joint pain/enlargement, massive bleed»>muscle/back pain, organ failure, shock/coma, death
24
Q
DIC labs
A
- long PT PTT, low platelets, low hgb, high BUN and creatinine, high fibrin
25
Q
DIC Tx and Care
A
- tx: varies conditionally, fix cause, hydration, FFP for factors, platelets, cyroprecipitate mainly used
- report/recognize bleeding, avoid trauma and roughness, ICU, inform family, use IDT
26
Q
Leukemia
A
- WBC Cancer/disorder
- dysfunctional, immature WBCs—can’t fight infection
- acute (85% of PTs) or chronic
- myeloid (monos, erythros), lymphoid (lymphos..CLL&CML)
- anemic and bleeding happen
*MMs at risk/infection - genetic or radiation/toxin exposure
- childhood cured with chemo 75%, adults 30-40%
27
Q
Leukemia AML/ALL
A
- affect blasts (immature), ALL—kids <15, abnormal lymphos growth, AML— >20 YO, bad prognosis
- S/S: sudden, illness, high fever, MM bleeding, petechiae, thrombocytopenia, death, pallor, malaise
28
Q
Chronic Lymphatic/Myelogenous Leikemia
A
- CLL—affects B/T lymphos, >40 YO
- CML— Philly chromosome, 40-45 YO
- stages— insidious—mild bleeds, PT feels fine, accelerated/acute: takes yrs, fatal: 3-4 post onset, 3-6 mos post acute stage
- S/S: low fever, pallor, weakness, SOB, malaise, fatigue, tachy, abd. Pain»organ megaly, sternal pain/tender ribs, confusion, personality change
- labs: marrow aspiration/biopsy, cbc, node biopsy, spinal tap, gene analysis
- interventions: radiation, chemo, marrow transplant: autograft/autologous
29
Q
Múltiple Myeloma
A
- plasma cell cancer in bone marrow …they reproduce fast
- with MM . Antibodies are useless
- incurable, treatable
*life expected 3-7 years - produces tissue eating tumors
- with organ failure, prognosis poor
30
Q
Múltiple myeloma S/S
A
- bone pain mainly, actué/chronic renal failure, stones, anemia, fatigue/pallor, peripheral neuropathy
31
Q
Multiple Myeloma Labs
A
- CBC
- MRI
- 24 he urine study/Iv pyelogram
- blood chemistries for Ca
- marrow biopsy
32
Q
Multiple myeloma therapy and Nursing
A
- long term pain/disease management
- corticos (-SONE drugs), chemo, monitor hypercalcemia, laminectomy/kidney treatment , stem cell transplant
- neuro—spine compression, back pain leg weak, sensory/bladder control loss
33
Q
MM diagnosed
A
- risk of infection r/t immune function
- risk for injury: fractures weak bones; immobility issues; hypercalcemia
34
Q
Hodgkin’s lymphoma
A
- lymph cancer, most curable type, enlarged nodes (cervical, inguinal etc)
- AIDS, immune therapy, organ transplant PTs at risk
- Begins as single malignant node
- reed-stenberg cells present
35
Q
Hodgkins lymphoma S/S
A
- itching, night sweats, wt. loss , fever, cough, fatigue, malaise
- late: no big nodes except retro peritoneal, jaundice, liver/spleen/ bones infiltration, nerve pain
36
Q
Hodgkins labs
A
- bone biopsy
- marrow biopsy/aspiration
- xray for cough/dysphagia
- liver/spleen biopsies
37
Q
Hodgkins Tx
A
- radiation, chemo, symptom management —fatigue, infection risk, coping PT teaching
- complications of chemo/radiation—bleeding
38
Q
Non Hodgkin’s lymphoma
A
- comprises all lymphomas
- in lymphoid tissue
- genetic
- no reed stenberg cells
- unclear cause
- usually older PTs
39
Q
Non Hodgkins s/s
A
- big rubbery nodes, night sweats/fever not likely, wt loss, malaise, big tonsils
- more rapid than Hodgkins
40
Q
Non Hodgkins labs
A
- lymph node/tonsil biopsy
- marrow biopsy
- xray
- lymphangiography
- pyelogram, CHV, serum level
41
Q
Non Hodgkins therapy & nursing. Care
A
- chemo/radiation
- marrow transplant
- Stem cell transplant
- nutrition important
- manage symptoms
42
Q
Hemophilia
A
