CEN 1 Hematology Flashcards
Decreased cellular perfusion secondary to lack of circulating volume
Hypovolemic shock
Decreased cellular perfusion secondary to failure of the central pump
Cardiogenic shock
Decreased cellular perfusion secondary to maldistribution of the oxygen to the periphery
Distributive shock
Decreased cellular perfusion secondary to obstruction of blood into or out of the ventricles (e.g.
pulmonary embolism, pericardial tamponade, tension pneumothorax)
Obstructive shock
name 7 different types of obstructive shock
Pregnancy, tension pneumothorax, cardiac tamponade, pulmonary embolism, aortic aneurysm, aortic stenosis, excessive positive end expiratory pressure or PEEP
what is the mnemonic for remembering what receptors affect what part of the body
- We have ONE heart and Beta-ONE receptors mainly affect the heart
(contractility, automaticity, heart rate, etc.). We have TWO lungs and Beta-TWO receptors
affect mainly the lungs (bronchodilation, respiratory rate, etc.)
this Stimulates a system
agonist
this Diminishes the response of a system
antagonist
How would an alpha-adrenergic agonist affect the blood pressure?
answer needed
How would an anticholinergic affect the pulse rate?
answer needed
How would a beta-blocker affect the respiratory rate?
answer needed
Inflammatory mediators are released in response to either foreign invasion of tissue or tissue damage. They
have three main courses of action: what are they
Vasodilation, Increased capillary permeability, Increased coagulation
name two isotonic solutions used to treat hypovolemic shock
normal saline, lactated ringer solution
what blood type is considered the universal donor?
O negative
what blood product does not have to be ABO compatible
platelets
Give three examples of distributive shock
Neurogenic shock, septic shock, anaphylactic shock
name 7 causes of neurogenic shock
Spinal cord injuries above T4 - T6, Brain injury, Spinal or general anesthesia, CNS depressants, Hypoxia, Lack of glucose or excessive insulin (insulin shock), Vasovagal syncope
name 7 symptoms of neurogenic shock
Vasodilation, Gluconeogenesis, Dry skin, Bradycardia, Decreased contractility, Decreased, automaticity, Bradypnea, Bronchoconstriction
what are some treatments of neurogenic shock
1 - 2 Liter fluid bolus for hypovolemia, consider, vasoconstrictor such as phenylephrine if boluses ineffective, Atropine for low heart rate, Assist respirations as needed
what is the difference between hyperdynamic and hypodynamic sepsis
answer needed
what are 7 symptoms of hyperdynamic shock
- Malaise, not feeling well, tiredness, restlessness.
- Warm, flushed, dry skin
- Tachycardia, full bounding pulses
- RR of more then 20
- decreased urine output
- respiratory alkalosis
- fever/ chills
what are 7 symptoms of hypodynamic sepsis
- decreased LOC, stupor and coma
- cold, clammy, pale, mottled skin
- Tachycardia, weak, thread pulse
- fast, shallow respirations
- combined metabolic and respiratory acidosis
- decreased urine output or anuria
- hypothermia and mottled
A patient sustaining multiple traumatic injuries presents with a BP of 50/32 mm Hg, a pulse of 146/minute, a capillary refill of 4 seconds, and no urinary output. Appropriate volume resuscitation is:
a) D5W at a rate of 3 mL for every 1 mL of blood loss
b) Hetastarch at a rate of 3 mL for every 1 mL of blood loss
c) Blood replacement at a rate of 1 mL for every 1 mL of blood loss
d) Lactated Ringers solution at a rate of 1 mL for every 1 mL of blood loss
C
An overdose which results in profound central nervous system depression may result in:
a. Distributive shock
b. Obstructive shock
c. Cardiogenic shock
d. Hypovolemic shock
a. Distributive shock
Which of the following assessment parameters is most consistent with early compensated hypovolemic shock?
a) Respiratory alkalosis and cool clammy skin
b) Hypoglycemia and decreased urinary output
c) Deep, rapid respirations and hyperactive bowel sounds
d) Near-normal systolic blood pressure and abnormally low diastolic blood pressure
a) Respiratory alkalosis and cool clammy skin
Which of the following parameters indicates that fluid resuscitation for hypovolemia has been effective in a 200 (90 kg) pound patient?
a) A declining serum pH
b) A narrowing pulse pressure
c) A declining serum lactate level
d) A urinary output of 30 milliliters per hour
c) A declining serum lactate level
what is Polycythemia and what are the causes
Living or visiting a high altitude
Prolonged physical activity associated with hypoxia (e.g. - running a marathon)
Erythrocytosis - polycythemia secondary to hypoxic diseases such as COPD
what is polycynthemia vera
A condition with an overactive bone marrow resulting in high red blood cell, high white blood cell and high platelet counts. Is a genetic disease which typically affects middle-aged Jewish men. May cause heart failure and hypoxia.
what are some factors that may precipitate the sickling of red blood cells
Low oxygen concentrations Infection Acidosis Dehydration Exposure to cold
what are some clinical manifestations of sickle cell anemia
Sudden explosive abdominal, chest, back and joint pain
Splenic ischemia can lead to increased susceptibility to infection
Heart ischemia can lead to acute coronary syndromes
Priapism
Ulcers of the lower extremities and long thin extremities
what are some treatments for sickle cell anemia
Treat the underlying cause (IV fluids for dehydration, sodium bicarbonate for acidosis, antibiotics for infection, etc.)
High flow oxygen (may reverse as many as 80% of sickled cells)
Pain control
Support extremities on pillows
Oral hydroxyurea
what is neutropenia
A decrease in the white blood cells responsible for protecting the body from bacteria
what are some common causes of neutropenia
Cancer treatment such as chemotherapy or radiation
Immunosuppressive therapy after organ transplantation
Immunosuppressive diseases such as acquired immune deficiency syndrome
(AIDS)
Nutritional deficits
what are some clinical manifestations of neutropenia
Increased susceptibility to infection especially gram-negative bacteria
Blunted responses to infection, decreased redness, swelling, edema and pus formation.
what are some treatment considerations for neutropenia
Reverse Isolation
Avoid the use of indwelling catheters
Dilute IV medications, administer slowly
Culture all potentially infected sites
Early initiation of antibiotics
Acetaminophen (Tylenol) alternated with ibuprofen (Motrin, Advil) every 2 - 3 hours to decrease fever and drug toxicity.
Administer drugs to stimulate neutrophil production:
Granulocyte colony-stimulating factor (Neupogen)
Granulocyte-macrophage colony-stimulating factor (Leukine, Prokine)
what are the tests used to diagnose HIV
ELISA test, Western Blot test
what is Leukemia
Excessive production of abnormal, immature white blood cells.
Although the number of white blood cells increases, they do not function
normally and protection from infection diminishes.
what are some signs and symptoms of leukemia
Fatigue Fever Weight loss Bone pain Elevated uric acid levels Lymph node enlargement Hepatomegaly, and splenomegaly The same precautions that were introduced for neutropenia should be maintained for leukemia.
what is Idiopathic thrombocytopenia purpura, ITP
An autoimmune disorder that occurs most commonly in children between the ages of 2 to 4 resulting in a decreased platelet count. The disease often occurs several weeks after a viral infection or immunizations.)
what are some signs and symptoms of ITP
Signs and symptoms: Indications of bleeding such as bruising, petechiae, purpura, epistaxis, bleeding gums, gastrointestinal bleeding, and hematuria.
what is Thrombocytosis
abnormally elevated platelet count which leads to an increased risk of spontaneous clot formation
what is Disseminated intravascular coagulation (DIC)
DIC is not a disease, but rather an abnormal activation of the body’s clotting system that signals severe underlying problems. It involves both abnormal clotting and abnormal bleeding.
Which of the following patients is at highest risk for developing idiopathic thrombocytopenia purpura (ITP)?
a) A 3-year-old whose last chicken pox has just disappeared
b) A 52-year-old patient who is on daily aspirin for heart disease
c) A 17-year-old with an infected laceration to the dorsum of the right hand
d) An 80-year-old with a fractured humerus after falling down a flight of stairs
a) A 3-year-old whose last chicken pox has just disappeared
Which of the following statements, made by a patient being discharged home with leukemia, indicates they have understood their
discharge instructions?
a) “I will avoid exercising to decrease stress on my body.”
b) “I will change my tampons at least hourly to prevent infection.”
c) “I will call the doctor if my temperature exceeds 100°F (38°C).”
d) “I will avoid taking aspirin or nonsteroidal anti-inflammatory drugs to decrease the risk of bleeding.”
c) “I will call the doctor if my temperature exceeds 100°F (38°C).”
