Chapter 5 Flashcards
Primary hematologic diseases are _____ but hematologic manifestations secondary to other diseases are _____
Uncommon, common
Blood consists of what two things
Plasma and formed elements (rbc, wbc, platelet)
Som of the most important indicators of dysfunction in the hematologic system include problems associated with
Exertion
The signs and symptoms associated with exertions include
Dyspnea, chest pain, palpitations, severe weakness, and fatigue
Neurological symptoms associated with hematologic problems
Headache, drowsiness, dizziness, syncope or poly neuropathy
Symptoms of the skin and fingernail beds with hematologic problems
Pallor of the face, hands, nail beds and leaps, cyanosis, clubbing of the fingernail beds and wounds, easy bruising or bleeding
What are the critical possible life threatening indicators of hematologic disorder
Blood in stool or emesis, or severe pain and swelling in joints and muscles
Many hematologic induced signs and symptoms seen in the PT clinic are side effects of
Medication
Chronic use of steroids and NSAIDs can lead to
Gastritis, peptic ulcer causing gastrointestinal bleeding and iron deficiency anemia
Leukopenia is a common problem after
Chemotherapy
Leukopenia can present as signs of
Infection
What is thrombocytopenia
Low platelet count
Thrombocytopenia can be a result of medications from
RA and cancer
Erythrocytes consist of
Hemoglobin and support framework
Erythrocytes number is dependent on
Gender, elevation, physical activity
What is anemia
Too few erythrocytes
What is polycythemia
Too many erythrocytes
What is poikilocytosis
Abnormally shaped erythrocytes
Anisocytosis is
Abnormal variations in size of erythrocytes
What is hypochromia
Erythrocytes deficient in hemoglobin
In anemia which blood pressure value may be lower
Diastolic
In those with anemia there may be an increase in
Resting pulse rate
Resting cardiac output is effected by anemia true or false
False
Cardiac output_____ more than it does in people without anemia
Increases
If there is severe anemia usually rating cardiac output ____
Increases
What is primary polycythemia
Uncommon neoplasticism disease of the bone marrow of unknowns etiology
What is secondary polycythemia
Physiologic condition resulting from a decreased oxygen supply to the tissues
Symptoms of polycythemia progress insidiously or quickly
Insidiously
Most common first signs of polycythemia are
Shortness of breath and fatigue
Skin color and BP change in those with polycythemia
Increased skin coloration and increased BP
_____ can sometimes be the first symptom of polycythemia
Gout
Clinical signs and symptoms of polycythemia - from box
General malaise and fatigue, shortness of breath, intolerable pruritus, headache, dizziness, irritability, blurred vision, fainting, decreased mental acuity, feeling of fullness in head, disturbances of sensation in hands And feet, weight loss, easy bruising, cyanosis, clubbing of the fingers, splenomegaly, gout, hypertension
What is intolerable pruritus
Skin itching - indicative of primary polycythemia
What is sickle cell anemia
Generic term for a group of inherited, autosomal recessive disorders characterized by the presence of an abnormal form of hemoglobin
Mechanism of sickle cell anemia
Genetic mutation results in single amino acid substitution of hemoglobin, changes its shape causing it to lose the ability to deform and squeeze through tiny blood vessels
The two main features of sickle cell anemia
Chronic hemolytic anemia and vaso occlusion
Most common symptom of sickle cell anemia
Pain caused by blockage of sickle cells in an organ, bone or joint
Pain in sickle cell can last
Hours to 5 or 6 days and subsides gradually
Hand foot syndrome associated with sickle cell is associated with
Fever, pain and dactylitis
Leukocytosis is recognized by a count of more than
10,000 leakocytes/mm^3
The three clinical signs and symptoms associated with leukocytosis
Fever, infection, inflammation or trauma
What is leukopenia
Reduction in leukocytes below 5000 per microliter
Explain Nadir
The lowest point the white blood cell count reaches, 7-14 days after Chemotherapy or radiation therapy - must be most careful here with hygiene
Clinical signs and symptoms of leukopenia
Sore throat, cough, fever,,chills, sweating, persistent infections, frequent and painful urination, ulcerations of mucous membranes
Define leukemia
Uncontrolled growth of immature or dysfunctional white blood cells
Platelets survive _____ in circulation
8-10 days
Platelets are most effected by
Anticoagulant drugs, diet (lecithin and vitamin K) , exercise, liver disease, radiation
Thrombocytosis is associated with the tendency to
Clot
Clinical signs and symptoms of thrombocytosis
Thrombosis, splenomegaly, easy bruising
Most common cause of thrombocytopenia seen by pt’s
Cancer related
Severe thrombocytopenia results in
Petechiae most commonly on the lower legs
Clinical signs and symptoms of thrombocytopenia
Bleeding after minor trauma, spontaneous bleeding (petechiae, ecchymoses, purpura spots, epistaxis), menorrhagiA, gingival bleeding, Melena( black tarry stools)
What is hemophilia
A hereditary blood clotting disorder caused by an abnormality of functional plasma clotting proteins known as factors VIII and IX
___ is one of the most common manifestations of hemophilia
Hemarthrosis
______ is the second most common site of bleeding in those with hemophilia
Bleeding into the muscles
Bleeding into muscles is most common in
Flexors
When there is bleeding in psoas or iliacus ____
Compression of femoral artery may occur causing decreased sensation and referred pain to abdomen - they will have a position of flexion to reduce pain
Clinical signs and symptoms of acute hemarthrosis
Aura, tingling or prickling sensation, stiffening into position of comfort, decreased range of motion, pain, swelling,,tenderness and heat
Signs and symptoms of muscle hemorrhage
Gradually intensifying pain, protective spasm of the muscle, limitation of movement at the surrounding joints, muscle assumes position of comfort and loss of sensation
Clinical signs and symptoms of gastrointestinal involvement
Abdominal pain and distention, Melena ( blood in stool), hematemesis (vomiting blood), fever, lower abdominal or groin pain, flexion contracture of the hip due to spasm of the iliopsoas muscle secondary to retro peritoneal hemorrhage
How do you distinguish an iliopsoas bleed from a hip bleed
Flexion of the truck would cause severe pain if it was iliopsoas and just mild pain if it was hip whereas there would be severe pain with ER and IR if it was hip bleeding and just mild pain if iliopsoas
Exercise for those with anemia must be
Approved by physician
Clients with undiagnosed thrombocytopenia need
Immediate physician referral
Avoid this maneuver in those with thrombocytopenia
Valsalva maneuver
If rapid onset of anemia were to occur after major surgery what might you see
Exertional dyspnea and fatigue with increased heart rate
Chronic GI blood loss sometimes associated with use of NSAIDS can result in
Iron deficiency
Preoperatively clients cannot take aspirin or anti inflammatories because these
Decrease platelets
Bleeding under the skin, nosebleeds, bleeding gums and black stools require medical evaluation as these may be indicative of
Thrombocytopenia
