Ch 30, 31 Flashcards
0
Q
In an older adult, what change would be seen in the MCV count?
A
May be slightly increased
1
Q
In an older adult, what change would be seen in the hemoglobin count?
A
normal, possibly slight decrease in men
2
Q
In an older adult, what change would be seen in the MCHC count?
A
may be slightly decreased
3
Q
In an older adult, what change would be seen in the WBC count?
A
diminished response to infection
4
Q
In an older adult, what change would be seen in the platelet count?
A
unchanged
5
Q
In an older adult, what change would be seen in the Partial thromboplastin time count?
A
decreased
6
Q
In an older adult, what change would be seen in the fibrinogin count?
A
may be elevated
7
Q
In an older adult, what change would be seen in the Factor V, VII, VIII, IX count?
A
may be elevated
8
Q
In an older adult, what change would be seen in the ESR count?
A
increased significantly
9
Q
In an older adult, what change would be seen in the serum iron count?
A
decreased
10
Q
In an older adult, what change would be seen in the total iron-binding capacity?
A
decreased
11
Q
In an older adult, what change would be seen in the ferritin count?
A
increased
12
Q
In an older adult, what change would be seen in the erythropoietin count?
A
may be decreased
13
Q
The measurement of gas-carrying capacity of RBC. Normal range?
A
Hemoglobin (Hb)
Female: 11.7-16.0 g/dL
Male: 13.2-17.3 g/dL
14
Q
Measure of packed cell volume of RBC’s expressed as a percentage of the total blood volume. Normal range?
A
Hematocrit (Hct)
Female: 35-47%
Male: 39-50%
15
Q
Count of number of circulating RBCs. Normal range?
A
Total RBC count.
Female: 3.8-5.1
Male: 4.3-5.7
16
Q
Determination of relative size of RBCs; low reflects microcytosis, high reflects macrocytosis. Normal range?
A
MCV
80-100 fL
17
Q
Measurement of average weight of Hb/RBCs; low indicates microcytosis or hypochromia, high indicates macrocytosis. Normal range?
A
MCH
27-34 pg
18
Q
Evaluation of RBC saturation with Hb; low indicates hypochromia, high is seen in spherocytosis. Normal range?
A
MCHC
32-37%
19
Q
Examination of the shape and size of RBCs. Normal finding?
A
RBC morphology
no variation
20
Q
Measurement of total number of leukocytes. Normal range?
A
WBC count
4,000-11,000
21
Q
Determination of whether each kind of WBC is present in proper proportion. Absolute value of each type of WBC can be determined by multiplying the percentage of cell type by total WBC count and dividing by 100.
A
WBC differential
22
Q
Neutrophil normal range
A
50-70%
23
Q
Eosinophil normal range
A
0-4%
24
Basophil normal range
0-2%
25
Lymphocyte normal range
20-40%
26
Monocyte normal range
4-8%
27
Normal range of platelets
150,000-400,000 uL
28
Evaluation of intrinsic coagulation status; more accurate than aPTT, used duringdialysis, coronary artery bypass procedure, arteriograms. Normal range?
Activated clotting time (ACT)
| 70-120 seconds
29
Assessment of intrinsic coagulation by measuring factors I, II, V, VIII, IX, X, XI, XII; longer with use of heparin. Normal range?
Activated partial thromboplastin time (aPTT)
| 25-35 seconds
30
Naturally occurring protein synthesized by liver that inhibits coagulation through inactivation of thrombin and other factors; is depleted in DIC. Normal range?
Antithrombin
| 21-30 mg/dL
31
Measurement of timed, small skin incision bleeds; reflection of ability of small blood vessels to constrict. Normal range?
Bleeding time
| 2-7 minutes
32
Reflection of capillary integrity when positive or negative pressure is applied to various areas of the body; positive test indication of thrombocytopenia, toxic vascular reactions. Normal finding?
Capillary fragility test (tourniquet test, Rumpel-Leede test)
No petechiae or negative
33
Reflection of clot shrinkage or retraction from sides of test tube after 24 hours; used to confirm a platelet problem. Normal finding?
Clot retraction
| Begins in 1 hour, maximum by 24 hours
34
Assay to measure a fragment of fibrin that is formed as a result of fibrin degradation and clot lysis; used in diagnosis of hyper-coagulable conditions (e.g. DIC, pulmonary embolism)
D-dimer
| <250 ng/mL
35
Reflection of degree of fibrinolysis and predisposition to bleed (if present); screening test for DIC; elevated levels associated with DIC, advanced malignancy, severe inflammation. Normal range?
Fibrin split products
| <10 mcg/mL
36
Increase in this is a possible indication of enhancement of fibrin formaion, making patient hypercoagulable, decrease in this indicates predisposition to bleeding. Normal range?
Fibrinogen
| 200-400 mg/dL
37
Standardized system of reporting PT based on a reference calibration model and calculated by comparing the patient's PT with a control value. Normal range?
INR
| 2-3
38
Normal range of platelets?
150,000-400,000 uL
39
Assessment of extrinsic coagulation by measurement of factors I, II, V, VII, X. Normal range?
```
Prothrombin time (PT)
11-16 seconds
```
40
Reflection of adequacy of thrombin; prolonged value indicates that coagulation is inadequate secondary to decreased thrombin activity
thrombin time
| 17-23 sec
41
Measurement of degree of RBC hemolysis or liver's inability to excrete normal quantities of bilirubin; increase in level with hemolytic problems. Normal range?
Bilirubin
Total: 0.2-1.2 mg/dL
Direct: 0.1-0.3 mg/dL
Indirect: 0.1-1.0 mg/dL
42
Differentiation among types of hemolytic anemias; detection of immune antibodies, detection of Rh factor
Direct: detection of antibodies that are attached to RBCs
Indirect: detection of antibodies in serum
Normal range?
Coombs test
| negative
43
Level available for production of new RBCs. Normal range?
Cobalamin (vit B12)
| 200-835 pg/mL
44
Measurement of degree of hormonal stimulation to the bone marrow to stimulate the release of RBCs. Normal range?
Erythropoietin
| 5-30 mU/mL
45
Measurement of settling of RBCs in 1 hr; inflammatory process causes an alteration in plasma proteins, resulting in aggregation of RBCs and making them heavier; the faster the rate, the higher the value. Normal range?
Erythrocyte sedimentation rate (ESR)
46
Major iron storage protein; is normally present in blood in concentrations directly related to iron storage. Normal range?
Ferritin
| 10-250 ng/mL
47
Normal range of folic acid?
3-16 ng/mL
48
An amino acid formed from methoionine; rapidly metabolized through pathways that require cobalamin (vit b12) and folic acid; increased in cobalamin and folic acid deficiency. Normal range?
homocysteine
Male: 5.2-12.9
Female: 3.7-10.4
49
Reflection of amount of iron combined with proteins in serum; accurate indication of status of iron storage and use. Normal range?
Serum iron
| 50-175 mcg/dL
50
Measurement of all proteins available for binding iron; transferrin represents the largest quantity of iron-binding proteins; therefore this is an indirect measure of transferrin; evaluation of amount of extra iron that can be carried. Normal range?
Total iron-binding capacity (TIBC)
| 250-425 mcg/dL
51
Indirect test for cobalamin. Metabolism of this requires cobalamin; helps differentiate cobalamin deficiency from folic acid deficiency.
methylmalonic acid (MMA)
52
Measurement of immature RBCs; reflection of bone marrow activity in producing RBCs. Normal range?
Reticulocyte count
| 0.5-1.5% of RBC count
53
The largest of proteins that bind to iron; increased in majority of people with iron-deficiency anemia. Normal range?
Transferrin
| 190-380 mg/dL
54
Decreased in iron-deficiency anemia and increased in hemolytic and megaloblastic anemia.
transferrin saturation
55
An electrophoretic measurement is used to detect the presence of this protein, which is found in most cases of multiple myeloma. Negative finding is considered normal. What are the nursing responsibilities?
Bence Jones protein urine study
| Acquire random urine specimen
56
Liver/spleen radioisotope study
Radioactive isotope is injected intravenously. Images from the radioactive emissions are used to evaluate the structure of the spleen and liver. Patient is not a source of radioacivity.
No specific nursing responsibilities
57
Bone scan radioisotope study and nursing responsibilities
Radioactive isotope is injected intravenously. Images from the radioactive emissions are used to evaluate the structure of the bone. Patient is not a source of radioactivity.
Patient will need to lie still during the imaging. Patient may be asked to drink 4-6 glasses of water and then void before the imaging to see the pelvic bones.
58
Skeletal x-ray
X-rays done as a bone survey to determine the presence of lytic lesions associated with multiple myeloma. Bone scans do not identify lesions in this condition because there is no uptake of radioactive isotopes due to lack of blood supply. No specific nursing considerations.
59
Liver, spleen, or abdominal ultrasound and nursing considerations
Used to detect the density and borders of abdominal organs. Irregular borders, masses, vascular structure, and biliary tree can be detected. Patients must be comfortable lying flat and having the probe compress the abdomen.
60
Positron emission tomography and nursing considerations
a nuclear tracer substance is injected and taken up by metabolically active cells. The follow-up scan shows different-colored tissues based on the metabolic rate. "Hot spots" reflect increased glucose consumption that is typical of tumors. IV access is required. Patient should be NPO except water and meds for at least 4 hours before this test. No IV solutions with glucose. Pts with diabetes may need adjustment on their meds. Bowel prep may be needed.
61
CT and nursing considerations
Radiologic examination and computer-assisted x-ray evaluates the lymph nodes. Contrast medium is often used in abdominal studies of the liver or spleen. Spiral (helical) CT scans are used to evaluate lymph nodes. Check for iodine sensitivity
62
MRI and nursing considerations
Sensitive images of soft tissue without using contrast media. No ionizing radiation required. Technique is used to evaluate spleen, liver, and lymph nodes. Have pt remove all metal objects and ask bout any history of surgical insertion of stapes, plates, or other metal appliances. Inform pt of need to lie still in small chamber.
63
Bone marrow biopsy and nursing considerations
Removal of bone marrow through a locally anesthetized site to evaluate the status of the blood-forming tissue. Used to diagnose multiple myeloma, all types of leukemia, and some lymphomas and to stage some solid tumors (e.g. breast cancer). It is also done to assess the efficacy of leukemia therapy. Obtain signed consent form. Consider preprocedure analgesic adminstration to enhance patient comfort and cooperation. Apply pressure dressing after procedure. Assess biopsy site for bleeding.
64
Lymph node biopsy (open) and nursing considerations
Performed in OR or procedure area using either local or general anesthesia. An incision is made, and the lymph node and surrounding tissue are dissected (excised) whenever possible. Signed consent, sterile technique to change dressings. Apply direct pressure to the area after the biopsy procedure. Monitor VS especially if platelet count is low. Sterile dressing is changed as ordered.
65
Lymph node biopsy (needle or fine needle)
Performed by physician at bedside or in an outpatient area. Extremely small needle is used to reduce the risk of tracking malignant cells through normal SQ tissue. Same nursing considerations as open procedure.
66
Tests are performed on malignant cells, either peripheral blood (e.g. leukemia) or biopsy specimen (bone marrow, lymph node) to assess genetic or chromosomal abnormalities of cancer cells. May be useful in confirming diagnosis and determining treatment modalities and prognosis.
Fluorescent in situ hybridization (FISH)
Comparative genomic hybridization (CGH)
Spectral karyotyping (SKY)
67
Surgical excision of the duodenum effects iron levels because?
This is where iron absorption occurs
68
A partial or total gastrectomy effects Cobalamin levels because?
removes parietal cells, thus reducing intrinsic factor needed for the absorption of cobalamin (Vitamin B12)
69
Gastric bypass effects Cobalamin levels how?
the duodenum may be bypassed and parietal cell surface area decreased, thus reducing intrinsic factor needed for the absorption of cobalamin (Vitamin B12)
70
How does ileal resection effect cobalamin levels?
This is where cobalamin absorption takes place
71
A blood type A person would have what antibody? Antigen?
| Would be compatible to receive blood and give blood to whom?
Anti-B antibodies; A antigens
Can receive blood from A, O
Could give blood to A, AB
72
A blood type B person would have what antibody? Antigen?
| Would be compatible to receive blood and give blood to whom?
Anti-A antibodies; B antigens
Can receive blood from B, O
Could give blood to B, AB
73
A blood type AB person would have what antibody? Antigen?
| Would be compatible to receive blood and give blood to whom?
Neither anti-A nor anti-B antibodies; A and B antigens
Can receive blood from AB, O
Can donate blood to AB
74
A blood type O person would have what antibody? Antigen?
| Would be compatible to receive blood and give blood to whom?
Anti-A and anti-B antibodies; no antigens
Can receive blood from O
Can donate blood to A, B, AB, O
75
Cobalamin (Vitamin B12) has what role? What are good food sources?
RBC maturation
| Red meats, especially liver, eggs, enriched grains
76
Folic Acid has what role? What are good food sources?
RBC maturation
| Green leafy vegetables, liver, meat, fish, legumes, whole grains
77
Iron has what role? What are good food sources?
Hemoglobin synthesis
Liver and muscle meats, eggs, dried fruits, legumes, dark green leafy vegetables, whole-grain and enriched bread and cereals, potatoes
78
Pyridoxine (Vitamin B6) has what role? What are good food sources?
Hemoglobin synthesis
| Meats, wheat germ, legumes, potatoes, cornmeal, bananas
79
Ascorbic Acid (Vitamin C) has what role? What are good food sources?
Conversion of folic acid to its active forms, aids in iron absorption
Citrus fruits, green leafy vegetables, strawberries, cantaloupe
80
How is deferoxamine (Desferal) administered and why is it given
IV or SQ
| to reduce iron overloading (hemochromatosis)
81
Erythrocytes (RBCs) function
Oxygen transportation
82
Leukocytes (WBCs) function
protection from infection
83
Thrombocytes (platelets) function
Initiate the clotting process
84
Neutrophils structure and function
granulocyte
| phagocytosis, early phase of inflammation (first at site of infection)
85
Eosinophil structure and function
granulocyte
| phagocytosis, parasitic infections, allergic response
86
basophil structure and function
granulocyte
| inflammatory response, allergic response
87
Lymphocyte structure and function
agranulocyte - two types B and T cells
| cellular, humoral immune response
88
monocytes structure and function
agranulocytes
| phagocytosis, cellular immune response, second at site of injury. Become macrophages when in tissue
89
An increase in the percentage of bands is called
a shift to the left
90
The spleen's functions are:
hematopoietic- able to produce RBCs during fetal development
filtration- removes old and damaged RBCs from circulation, removes hemoglobin from RBCs and returns iron component to the bone marrow for reuse, filters out bacteria, especially encapsulated organisms
Immunologic- contains a rich supply of lymphocytes, monocytes, and stored immune globulins
Storage: stores RBCs and approximately 30% of total mass of platelets
91
GI and main neuro symptoms of a cobalamin deficiency include
sore/red/beefy tongue, anorexia, nausea, vomiting, abdominal pain
impaired thought processes
92
Calcineurin Inhibitor drug and side effects
```
Cyclosporin
Hepatotoxicity
Hirsutism
Hypertension
Leukopenia
Lymphoma
Tremors
Nephrotoxicity
Increased risk for infection
Neurotoxicity (tremors, seizures)
Gingival Hyperplasia
```
93
Nonnucleoside reverse transcriptase inhibitor (NNRTI); how it works and drug alerts
Efavirenz (Sustiva), inhibits the action of reverse transcriptase
Do not use in pregnancy as large doses could cause fetal anomalies.
Once-a-day dose should be taken before bed (at least initially) to help patient cope with side effects of dizziness and confusion
94
Etravirine (Intelence) is used for what?
Etravirine (Intelence) used to inhibit reverse transcriptase
95
Neupogen is what type of drug and used for what?
G-CSF
Can be used to reduce the severity and/or duration of neutropenia. Should be considered for pts after chemotherapy based on their risk factors for neutropenia. Not as effective once neutropenia has occurred. Stimulates the production and function of neutrophils. Can be given IV or SQ
96
Nebupent is used for what? What are the S/S?
used for opportunistic infection Pneumocystis jiroveci pneumonia.
S/S include Pneumonia, nonproductive cough, hypoxemia, progressive shortness of breath, fever, night sweats, fatigue
97
Acute Leukemia
Clonal proliferation of immature hematopoietic cells
98
Chronic Leukemia
Mature forms of WBC and onset is more gradual
99
The standard for chemotherapy is what regimen?
```
ABVD regimen:
Adriamycin
Bleomycin
Vinblastine
Dacarbazine
```
100
Drug alert for Rituxan (NHL drug)
Monitor for signs of severe hypersensitivity infusion reactions, especially with first infusion.
Manifestations may include hypotension, bronchospasm, dysrhythmias, angioedema, and cardiogenic shock.
Screen for history of hepatitis as drug may reactivate hepatitis
101
Bisphosphonate (chemotherapy) administration and drug alert
Zometa
Given monthly by IV infusion
Patient should be adequately rehydrated before administering drug.
Renal toxicity may occur if IV infusion of drug is administered in less than 15 minutes.
102
HIT is identified by what change in platelet count?
50% decrease from baseline
103
Hodgkin's Lymphoma manifests as:
```
painless lymphedema (unless it presses on nerves)
Weight loss
Fatigue/weakness
Fever/chills
Tachycardia
Night sweats
```
104
Non-hodgkin's lymphoma manifests as:
Painless lymph node enlargement
FEver
Weight loss
Night sweats
