Blood Disorders - EXAM 5 Flashcards
What is sickle cell disease?
A group of inherited disorders characterized by the presence of abnormal sickle hemoglobin (Hbs) in the erythrocyte. The abnormal hemoglobin (HbS) causes the erythrocyte to stiffen and elongate taking on a sickle shape in response to low oxygen level.
What are sickling episodes?
Common triggers, low O2 tension in blood, most commonly due to infection. Sickled cells cannot pass through capillaries causing vascular occlusion and tissue injury, abnormal cells are hemolyzed, causing anemia
What is a sickle cell crisis?
A severe, painful, acute exacerbation of RBC sickling causing a vasoclusive crisis, leading to tissue ischemia, infection, and necrosis.
What are the clinical manifestations of sickle cell disease?
Varies greatly. Typically anemic, but asymptomatic except during crisis. Primary symptom associated with sickling is pain.
- Thrombosis or hemorrhage causing paralysis, sensory deficits, death
- Acute chest syndrome, pulmonary hypertension, pneumonia
- Hematuria, renal failure
- Hand-foot syndrome, osteonecrosis
- Hepatomegaly, gallstones
- Priapism
- Stasis ulcers of hands, ankles, and feet
- Splenic atrophy (autosplenectomy)
- Heart failure
- Hemorrhage, retinal detachment, blindness, retinopathy
What is the nursing and collaboartive management of sickle cell disease?
- Prevention: avoid high altitude, maintain fluid intake and prevent infection
- Sickle Cell Crises: oxygen, rest, and F+E, treat pain adequately, treat infections
- Hematopoietic Stem Cell Transplant (HSCTs): replace bone marrow
- Long term follow up required
What is hemophilia A?
A sex-linked recessive genetic disorder caused by a defective deficiency of coagulation factor VIII or less often, factor IX
What is the pathophysiology of hemophilia A?
The basic defect of hemophilia A is a deficiency of factor VIII (antihemophilic factor AHF). AHF is produced by the liver and is necessary for the formation of thromboplastin in phase I of blood coagulation. The less AHF found in the blood, the more severe the disease.
What are the risk factors for hemophilia A?
Recessive X-linked (transmitted by female carriers, displayed almost exclusively in men)
What are the clinical manifestations of hemophilia A?
- Slow, persistent, prolonged bleeding for minor trauma and small cuts
- Delayed bleeding after minor injuries (hours or days)
- Uncontrollable hemorrhage after dental extractions
- Epistaxis
- GI bleeding
- Hematuria
- Ecchymoses and hematomas
- Neurological signs and symptoms
- Hemarthrosis (bleeding into the joint)
What is the collaboartive care for hemophilia A?
- Prevent and treat bleeding VIA replacement therapy
- Treatment of complications of the disease and its treatment
What is the nursing management of hemophilia A?
Assessment of clinical manifestations, determine blood levels of factor VIII, and administration of factor VIII. Assess for allergic reactions to AHF. During acute bleeding:
- Direct pressure, ice, packing (gelfoam, fibrin foam)
- Administer factor VIII intravenously
- Immoblize joint and give analgesics
- Manage life-threatening problems from hemorrhage (airway, intracranial bleeding)
What are the causes of anemia?
- Decreased RBC Production
- Blood Loss
- Increased RBC destruction
What is the alteration/etiology for anemia caused by decreased erythrocyte production?
Ingredients for bone marrow recipe for RBCs are lacking.
- Fe
- Folic acid
- Cobalamin B12
- Erythropoietin
OR the bone marrow is not working
What are examples of situations that would cause anemia related to decreased RBC production?
- Fe deficiency
- Folic acid deficiency
- Cobalamin deficiency
- Pernicious anemia
- Aplastic anemia
- Anemia of chronic disease
What are the alteration/etiology for anemia caused by blood loss?
- Acute blood loss
- Chronic blood loss