Chapter 31 exam 1 (b) Flashcards
What are 3 ways to have anemia?
- Deficient nutrients; Iron, Cobalamin (B12), Folic Acid
- Decreased erythropoietin (kidneys)
- Decreased iron deficiency (liver)
If you have decreased iron deficiency (liver), you have ____?
Anemia
If you have decreased erythropoietin (kidneys) you have ____?
Anemia
if you have deficient nutrients; Iron, Cobalamin (B12), Folic acid you have ____?
Anemia
What is the meaning of CYTIC? Example, Microcytic and Macrocytic.
SIZE
What is the meaning of CHROMIC?
COLOR
What morphologic change has an etiology caused by Acute Blood Loss, Hemolysis, Chronic Kidney Disease, Aplastic Anemia, Sickle Cell Anemia?
Normocytic & normochromic
What morphologic change has an etiology caused by IRON DEFICIENCY?
Microcytic (small) & hypochromic (pale color)
What morphologic change has an etiology caused by COBALAMIN (B12) DEFECIENCY, FOLIC ACID DEFICIENCY
Macrocytic/ Megaloblastic (big) & normochromic
What is an example of a condition that causes NORMOCYTIC & NORMCHROMIC morphologic change?
Sickle Cell Anemia, Acute blood loss, hemolysis, Aplastic Anemia
What is an example of a condition that causes MICROCYTIC (small) & HYPOCHROMIC morphologic change?
Iron Deficiency
What is an example of a condition/conditions that cause Macrocytic (megaloblastic) & Normochromic. *Pregnant can have this.
B12 & Folic Acid Deficiency
What is another name for MICROCYTIC?
MEGALOBLASTIC meaning large in size.
A DECREASE in Hemoglobin synthesis is caused by?
IRON DEFICIENCY
This causes ________?
- Decreased Hemoglobin Synthesis
- Defective DNA Synthesis
- Decreased # of RBC precursors (think pieces to help build RBC)
Decreased RBC production
Defective DNA Synthesis is affected by what TWO deficiency’s. *Think pregnant woman
Cobalamin (Vitamin B12) deficiency & Folic acid deficiency
Blood Loss Anemia can be split into what TWO categories?
Acute and Chronic
ACUTE blood loss anemia is caused by what?
TRAUMA & Blood vessel RUPTURE
Chronic blood loss anemia is caused by what?
- Gastritis (inflammation)
- Menstrual flow
- Hemorrhoids
Trauma & Blood vessel rupture are considered ACUTE or CHRONIC blood loss anemia?
ACUTE
-Gastritis (inflammation)
-Menstrual flow
-Hemorrhoids
are considered ACUTE or CHRONIC blood loss anemia?
CHRONIC
Increased RBC destruction hemolytic anemias can be broken down into what TWO type of Hemolytic anemias?
INTRINSIC & EXTRINSIC (Aquired Hemolytic anemia)
- Abnormal hemoglobin (Hb S–sickle cell anemia)
- Enzyme deficiency (G6PD: glucose-6-phosphate dehydrogenase)
- Membrane abnormalities (paroxysmal nocturnal hemoglobinuria, hereditary spherocytosis
this is INTRINSIC or EXTRINSIC (Acquired Hemolytic Anemia)
INTRINSIC
- Physical trauma (prosthetic heart valves, extracorporeal circulation)
- Antibodies (isoimmune and autoimmune)
- Infectious agents and toxins
this is INTRINSIC or EXTRINSIC (Acquired Hemolytic Anemia)
EXTRINSIC
Clinical Anemia Manifestations of the INTEGUMENT
Pallor and Jaundice
Clinical Anemia Manifestations of the EYES
Blurred Vision, Rectinal hemorrhage
Clinical Anemia Manifestations of the MOUTH
Glossitis (inflammation), smooth tongue
Clinical Anemia Manifestations of the CV
- Palpatations
- BOUNDING pulse
- Increased HR, Increased pulse pressure, MURMURS & BRUITS, Angina (chest pain), MI
Clinical Anemia Manifestations of the PULMONARY
Increased HR, orthopnea (problems laying supine breathing), dyspnea @ rest
Clinical Anemia Manifestations of the Neurologic
Vertigo, irritability, depression. Imparied thought process
Clinical Anemia Manifestations of the GI
Anorexia, difficulty swallowing, sore mouth, hepatomegaly, splenomagaly
Clinicall Anemia Manifestations of the Musculoskeletal
Bone Pain
What is a GENERAL clinical manifestation of overall ANEMIA?
FATIGUE
How do you calculate MEAN CORPUSCULAR VOLUME (MCV)?
(Total Hematocrit + Total # RBCs) X 10
I am a immature erythrocyte (makes RBCs) and I have nucleus.
Reticulocytes
I am a MATURE erythrocyte and I have (no nucleus or i have a nucleus)
no nucleus
Definition of _______
iron-bindingblood plasmaglycoproteinsthat control the level of freeironin biologic fluids; needed to transport iron in the formation of hemoglobin
Transferrin
Measures the body’s capacity to bind iron with transferrin
TIBC
This deficiency develops from; Inadequate dietary intake, Malabsorption (GI issues), Blood loss, Hemolysis
Iron-deficiency
This is One of the most common chronic hematologic disorders. What is Fe?
Iron-deficiency
What deficiency am I?
- Pallow, Glossitis (inflamed tongue), Chelitis (inflamed lips), HA (headache), paresthesias (tingling sensation), burning sensation on Tongue
Iron-deficiency
I am best absorbed in the duodenum and proximal jejunum.
Iron
What is the daily dosage of Iron for treatment?
150-200 mg of elemental iron
When is the best time to take Iron before meals?
1 hour before meals.
Taking Iron with (what vitamin) and (what juice) ENHANCES iron absorption.
Vitamin C & Orange Juice
Why would you have to INGEST iron with meals?
Gastric side effects caused from orange juice and vitamin C. (The absorption through fluid is faster than digesting)
The patient’s teeth is STAINED from drinking (Undiluted liquid iron, or diluted iron through a straw)?
Diluted Iron through a straw
GI side effects of Iron (3)
heartburn, constipation, and diarrhea
heartburn, constipation, and diarrhea are GI side effects of ________
Iron
Iron Deficiency Anemia: INTERVENTION
After teaching the patient about Iron supplements how long should they patient continue it after hemoglobin has returned to normal?
2-3 months
INTERVENTIONS for what ______ DEFECIENCY?
-Teaching: compliance with supplements and diet
-Supplements need to be continued for 2-3 months after hgb has returned to normal
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Iron Deficiency Anemia
What NURSING DIAGNOSES can be made for IRON DEIFICIENCY ANEMIA?
- Fatigue
- Altered Nutrition: Less than body requirements
- Ineffective self-health management
What TWO types of Megaloblastic/ Macrocytic (Big RBC) Anemias are there?
Cobalamin (B12) Deficiency & Folic Acid (Folate) Deficiency
What is Cobalamin?
Vitamin B12 Deficiency
What is another name for Cobalamin (B12) Deficiency
Pernicious anemia
What is another name for Pernicious Anemia and what is it?
It is Cobalamin (Vitamin B12) Deficiency in which there is LOW VITAMIN B12
What is the cause/etiology of Cobalamin (B12) Deficiency?
Lack of adequate intrinsic factor (this helps with absorption)
WHAT MEGALOBLASTIC ANEMIA IS THIS?
Clinical Manifestations: tissue hypoxia, shiny/beefy tongue, N/V, anorexia, ABD pain; NEUROLOGIC PROBLEMS <– (extremely important to remember)
Cobalamin (B12) Deficiency aka Pernicious Anemia
- This deficiency has neurologic problems Folic Acid Deficiency does not!!!
WHAT MEGALOBLASTIC ANEMIA IS THIS?
Diagnostic Studies: Serum folate levels, SCHILLING TEST (ingestion of radioactive cobalamin), endoscopy
Cobalamin (B12) Deficiency aka Pernicious Anemia
WHAT MEGALOBLASTIC ANEMIA IS THIS?
Collaborative Care: IM (injection) or IHN (inhalation) cobalamin (daily for 2wks, wkly until hct is normal, monthly for life)
Cobalamin (B12) Deficiency aka Pernicious Anemia
Without Cobalamin how long will the patient live?
1-3 years
Why is Folate important?
Required for DNA synthesis
WHAT MEGALOBLASTIC ANEMIA IS THIS? Clinical Manifestations: similar to cobalamin deficiency; NO NEUROLOGIC SYMPTOMS
Folic Acid (Folate) Deficiency
What is the etiology for Folic Acid (Folate) Deficiency
Lack of adequate intrinsic factor
Whats is the ETIOLOGY of B12 Deficiency and Folate Deficiency?
Lack of adequate intrinsic factor
What is the DIAGNOSTIC TEST for Folic Acid (Folate) Deficiency?
Low serum folate levels
WHAT ANEMIA IS THIS?
By performing Collaborative Care: Replacement therapy
- Encourage patient to eat foods high in folate: Green leafy vegetables, liver, meat, fish, legumes, whole grains
Folic Acid (Folate) Deficiency
The most COMMON type of Megaloblastic anemia is?
PERNICIOUS ANEMIA aka Cobalamin deficiency
What disease development cannot be prevented? Cobalamin and Folic Acid Deficiency’s are what?
Megaloblastic Anemias
What TWO things can you do to have symptom reversal in Megaloblastic anemias?
Early detection and treatment
What do you want to ENSURE/PROTECT for a patient who has Meagloblastic anemia?
-Ensure that injuries are not sustained because of the diminished sensations to heat and pain resulting from the neurologic impairment
-Protect patient from falling, burns, and trauma.
What kind of appropriate SCREENINGS do you perform in a patient with Megaloblastic anemia?
Screen for Gastric Cancer (remember B12 and Folic Acid Deficiency are related to absorption problems)
What do you CAREFULLY ASSESS for in patients with Megaloblastic Anemia?
Neurological difficulties
What is “not enough blood being produced” Anemia.
Aplastic
Decrease of all blood cell types RBCs, WBCs, and Platelets and hypocellular bone marrow?
Pancytopenia
If a patient is Aplastic what signs and symptoms do they have?
S/S: Range from chronic condition managed with erythropoietin or blood transfusions to a critical condition with hemorrhage and sepsis
Range from chronic condition managed with erythropoietin is signs and symptoms of what?
Aplastic Anemia
blood transfusions to a critical condition with hemorrhage and sepsis signs and symptoms of what?
Aplastic Anemia
What are the TWO type of Aplastic Anemia (how can you get it?
Congenital (born with it) and acquired
MANIFESTATIONS of what type of Anemia?
-can manifest abruptly (over days) or insidiously over weeks to months
-can vary from mild to severe
-Symptoms caused by suppression of any or
all bone marrow element fatigue and dyspnea (SOB)
Aplastic Anemia
MANIFESTATIONS of what type of Anemia?
- cardiovascular and cerebral responses
- neutropenia (low neutrophil count) - risk for infection & septic shock and death
- Even a low-grade fever (above 100.4° F [38° C]) should be considered a medical emergency
- Thrombocytopenia is manifested by a predisposition to bleeding (e.g., petechiae, ecchymosis, epistaxis)
Aplastic Anemia
What type of DIAGNOSTIC test/ LABS can you do to check for APLASTIC ANEMIA?
CBC, diff/plt, retic count, PT/PTT/INR, Fe, TIBC
Idiopathic/ autoimmune, chemical agents and toxins, durgs, radiation, viral & bacterial infection are CAUSES of what type of APLASTIC ANEMIA?
Acquired
Fanconi syndrome, thrombocytopenia, Schwachman-Diamond Syndrome are CAUSES of what type of APLASTIC ANEMIA?
Congenital
In NSG & collaborative management what type of IMMUNOSUPRRESSIVE THERAPY can you give the Patient?
Cytoxan
What are Aplastic Anemia: NSG & Collaborative Management?
- Immunosuppressive therapy: cytoxan
- Antithymocyte globulin
- Hematopoietic stem cell transplant: Need
- HLA-matched donor
- Supportive blood transfusions
What are CAUSES of Anemia of Chronic DIsease?
Causes: inflammatory, autoimmune, infectious, malignant disease processes
What is the meaning of “Anemia of inflammation”?
underproduction of RBCs & shorter RBC lifespan
What is “underproduction of RBCs & shorter RBC lifespan
Anemia of inflammation
What are the SIZE & COLOR of Chronic Disease?
Normocytic, normochromic, hypoproiferative (don’t make enough)
What are manifestations of Anemia of Chronic Disease?
Manifestation: fatigue, pallor; ferritin & Fe stores, NL folate & cobalamin
What are interventions that treat Anemia of Chronic Disease?
(treat cause (pRBCs, epogen subcut)
This is an Anemia cause by erythrocyte destruction: Autosomal, recessive, SINGLE POINT MUTATION on beta-hgb chain
Sickle Cell Anemia
What are the 4 types of Sickle Cell Anemia?
- Sickle Cell Anemia (most SEVERE)
- Sickle Cell-THALLASSEMIA (inherits two anemias one from each parent - less common and less severe)
- Sickle cell Hgb C disease - inherits two anemias – one from each parent (less common and less severe)
- Sickle cell trait – very mild to asymptomatic (carrier)
I am very mild to asymptomatic (carrier). What Sickle Cell am I?
Sickle cell trait
What type of Sickle cell is…. it inherits two anemias – one from each parent (less common and less severe)
Sickle cell Hgb C disease
What type of Sickle cell is… – inherits two anemias – one from each parent (less common and less severe)
Sickle cell THALLASSEMIA
What is the MOST SEVERE type of Sickle Cell?
SICKLE CELL ANEMIA
Sickle Cell Anemia causes pain where?
ALL OVER YOUR BODY
What happens to the Brain, Eye, Lung, Heart, and Kidney in Sickle Cell Anemia?
Brain-Thrombosis or Hemorrhage
Eye-Hemorrhage, Retinopathy, BLINDNESS
Lung- Acute chest syndrome, pulmonary embolism, pneumonia
Heart - Heart failure
Kidney - Hematuria (blood in urine) & Renal Failure
What happens to the Spleen, Bones & Joints, Liver-gallbladder, Penis, and Skin in Sickle Cell Anemia?
Spleen-Splenic Atrophy
Bones & Joints- Hand and food Syndrome OSTEONECROSIS
Liver & Gallbladder - Hepatomegaly, Gallstones
Penis- priapism (cant get erect)
Skin - Stasis ulcers of hands, ankles, and feet
THIS IS WHAT?
Increased # of RBCs
Increased Blood Viscosity (hyperviscosity)
Increased Volume (hypervolemia)
Polycythemia
What is Polycythemia (3)
Increased # of RBCs
Increased Blood Viscosity (hyperviscosity)
Increased Volume (hypervolemia)
Primary polycythemia is __ ________
not preventable
In Polycythemia what is SECONDARY (treat what?)
hypoxemia
What are manifestations of Polycythemia?
INCREASED blood viscosity, organ congestion, enlarged spleen & liver, hypercoagulopathies, clotting
INCREASED blood viscosity, organ congestion, enlarged spleen & liver, hypercoagulopathies, clotting. This is what anemia?
Polycythemia
What NURSING INTERVENTIONS for Polycythemia?
- Adequate oxygenation
- Control COPD symptoms
- Teach patient to stop smoking
- Avoid high altitudes
- Perform phlebotomy
- Myelosuppressive drugs used: monitor S/Es, ensure compliance. Suppress production of RBC’s
What are the NURSING MANAGEMENT for Thrombocytopenia?
- Diagnoses: Risk for bleeding, deficient knowledge
- Administer appropriate ordered medications
- Observe and document patient response
- Teaching: avoid heparin, medication management, when to call MD
What are the 3 types of Thrombocytopenia?
- Immune Thrombocytopenic purpura (ITP): ABNL PLT destruction
- Thrombotic Thrombocytopenic Purpura (TTP): ABNL agglutination of PLTs
- Heparin-Induced Thrombocytopenia (HIT): Immune response to heparin
Immune response to Heparin is what ANEMIA?
Heparin-Induced Thrombocytopenia (HIT)
ABNL agglutination of PLTs is what ANEMIA?
Thrombotic Thrombocytopenic Purpura (TTP)
ABNL PLT destruction is what ANEMIA?
Immune Thrombocytopenic purpura (ITP)
CAUSES/ MANIFESTATIONS of Thrombocytopenia
decreased Platelets (<150000/mcL)
Treatment: ITP
steriods, immunosuppressives, PLT transfusion, splenectomy
Treatment:TTP
Plasmaphoresis, steriods, dextran, chemotherapy, splenectomy
Treatment: HIT
Lepirudin, protamine sulfate (antidote for heparin), warfarin, thrombolytics
Etiology (the cause) & Pathophysiology of Leukemia is?
no single causative agent, combo environmental & genetic influences
What are the 4 types of Leukemia?
- AML: Acute myelogenous leukemia – 85% of acute leukemias
- ALL: Acute lymphocytic leukemia – 15%
- CML: Chronic myelogenous leukemia – Philadelphia chromosome, eventually ends in a “blastic phase”
- CLL: Chronic lymphocytic leukemia – most common in adults
Collaborative Care for Leukemia is?
- Drug therapy
- Hematopoietic stem cell transplantation
What is makes up 85% of acute leukemia?
AML - Acute myelogenous leukemia
What makes up of 15%, type of leukemia?
ALL - Acute lymphocytic leukemia
What is Philedelphia chromosome
CML - Chronic myelogenous leukemia
What is the most COMMON type of Leukemia in ADULTS?
CLL - Chronic lymphocytic leukemia
AML - Acute myelogenous leukemia other types of treatment are?
Autologus or altogenic HEMATOPOIETIC STEM CELL TRANSPLANT
ALL - Acute lymphocytic leukemia other types of treatment are?
Cranial radiation therapy, Hematopoietic stem cell transplant,
CML - Chronic myelogenous leukemia other types of treatment are?
Radiation, Hematopoietic stem cell tranplant, e-interferon, leukapharesis
CLL - Chronic lymphocytic leukemia other types of treatment are?
Radiation, SPENECTOMY, colony-stimulating factors, Hematopoietic stem cell tranplant,
What are the 2 type of Acute Leukemias?
AML - Acute myelogenous leukemia,ALL - Acute lymphocytic leukemia
What are the 2 type of Chronic Leukemias?
CML - Chronic myelogenous leukemia,CLL - Chronic lymphocytic leukemia
What is the Onset of AML?
Increase in incidence with advancing age, peak incidence betwee 60-70 yr of age
What is the Onset of ALL?
Before 14 yr of age, peak incidence b/w 2-9 yr of age and older adults
What is the Onset of CML?
25-60 yr of age peak incidence around 45 yr of age
What is the Onset of CLL (most common in adults)
50-70 yr of age rare below 30 yr of age, PREDOMINANCE IN MEN
What is the Manifestations of AML?
FATIGUE, WEAKNESS, HEADING, MOUTH SORES, BLEEDING, FEVER
What is the Manifestations of ALL?
FEVER, PALLOR, WEAKNESS, BONE JOINT, GENERALIZED LYMPHADENOPATHY, INTRACRANIAL PRESSURE, SECONDARY TO MENINGEAL INFILTRATION, NERVE DYSFUNCTION
What is the Manifestations of CML?
NO SYMPTOMS IN EARLY DISEASE, weakness fever, sternal tenderness, increase in sweating
What is the Manifestations of CLL (most common in adults)
NO SYMPTOMS FREQUENTLY, detection often during examination, fatigue, SPLENOMEGALY AND LYMPHADENOPATHY, HEPATOMEGALY
What is the Diagnostic Findings of AML?
Low RBC, Hb, Hct, low platelet, low to high WBC count
What is the Diagnostic Findings of ALL?
presence of Philedelphia chromosome 20-25%
What is the Diagnostic Findings of CML?
presence of Philedelphia chromosome is 90% in patient
What is the Diagnostic Findings of CLL (most common in adults)?
Mild anemia and Thrombocytopenia with disease progression
Nursing Management: Leukemia - Nursing Assessment?
Subjective: Health Hx, Medications, Surgical Hx
Objective: General, ROS, possible diagnostic findings REVIEW OF SYMPTOMS
Nursing Management: Leukemia - Nursing Diagnoses?
- Fatigue
- Altered nutrition: Less than body requirements
- Ineffective self-health management
- Risk for infection
- Pain
Nursing Management: Leukemia - Planning?
what kind of nursing interventions will you anticipate performing due to the problems you identified the patient as having?
Nursing Management: Leukemia - Nursing implementation
What specific actions did you take to assist the patient with coping with the problems you identified from your assessment data?
Acute intervention – things you can do now (or soon)
Ambulatory and home care (discharge planning)
Nursing Management: Leukemia - Evaluation
how well did your interventions work for this patient? Is the patient satisfied with the response? Are you satisfied with the response? Why or why not?
What are Blood Transfusion Reactions?
- Acute transfusion reactions
- Acute hemolytic reactions (body is reactions to antibody)
- Febrile reactions
- Allergic reactions (itching/ rash)
- Circulatory overload (too much blood too fast)
- Sepsis
- Transfusion-related lung injury (TRALI)
- Massive blood transfusion reaction
