Disorders Of The Hematopoietic System

Question 1

It is used to treat or prevent folate deficiency anemia. Helps the body make healthy red blood cells and is found in certain foods.

Answer 1

Folic Acid

Question 2

Pernicious anemia is low in what vitamin?

Answer 2

Vitamin B12

Question 3

Helps keep your body’s and nerve cells healthy and helps make DNA

Answer 3

Vitamin B12

Question 4

Helps to turns food into energy and to keep the nervous system healthy. Your body can’t make it itself, normally get it from food

Answer 4

Thiamine

Question 5

Helps to prevent blood clots from forming

Answer 5

Warfarin

Question 6

Prevent and treat harmful blood clots. Helps keep blood flowing smoothly by lowering the activity of clotting protein in the blood

Answer 6

Enoxaparin

Question 7

Decreases the clotting ability of the blood and helps prevent harmful clots from forming in the blood vessels

Answer 7

Apixaban

Question 8

Decreases the clotting ability of the blood and help prevent harmful clots from forming in the blood vessels

Answer 8

Rivaroxaban

Question 9

-Patho: Deficiency of erythrocytes or hemoglobin
-Causes: Blood loss, inadequate RBC production/volume, destruction of RBCs

Answer 9

Anemia

Question 10

-Patho/Causes: sudden loss or chronic loss of small amounts of blood
-Signs and Symptoms: extreme pallor, tachycardia, hypotension, reduced urine output, altered consciousness, fatigue, chills, rapid respiratory rate (INSERT TABLE 31-2)
-Medical Management:
-Blood transfusions: treating underlying condition or chronic blood loss
- Administration of oral, IV, or IM iron: to restore hemoglobin
- Assessment: History, vital signs (how’s the HR, RR, CBC results) laboratory test results, physical examination, intake and output
-Nursing Diagnosis: Imbalanced body temperature; Activity Intolerance
-Interventions:
-Monitor results of CBC (how high or low hemoglobin and hematocrit)
-Assess vital signs; hypotension, tachycardia
-Monitor intake and output
-small frequent meals

Answer 10

Hypovolemic Anemia

Question 11

Hemolytic Anemia

Answer 11

-Patho: Malaria, sickle cell; chronic premature erythrocyte destruction
-Signs and Symptoms: Jaundice, enlarged spleen, shock
-Microscopic examination; Coombs’ test (direct antiglobulin test)
-Medical Management: removing the cause; corticosteroids; blood transfusions
-Surgical Management: Splenectomy
-Nursing Management: Health history, supportive care, medication, teaching measures of self care, arrange follow up evaluations/care (making appointments or transportation to appointments)

Question 12

-Patho: hereditary hemolytic anemia
-Types: alpha-thalassemias- (Southeast Asia/Africa), Beta-thalassemias- (mediterranean)
-Signs and Symptoms: Cooley’s anemia (beta): bronzing of the skin (from hemolysis)
-Medical Management: Symptomatic, frequent transfusions, iron chelation therapy (removing iron/heavy metals from the body)
Nursing Management: Bed rest, protect from infection, closely monitor before, during and after blood transfusion (LPN WONT ADMIN BLOOD TRANSFUSIONS)

Answer 12

Thalassemia’s

Question 13

-Patho: lack of intrinsic factor (glycoprotein made by parietal cells) necessary for absorption of vitamin B12
-Degenerative changed on nervous system
-Secondary to surgical removal of stomach or small bowel resection (illium is where vitamin B12 is absorbed)
-Signs and Symptoms: Stomatitis (inflammation of mouth), glossitis (inflammation of tongue), digestive disturbances; diarrhea; dyspnea with minimal exertion, jaundice, irritability, confusion, depression, numbness and tingling in the arms and legs, ataxia
-Diagnostics: Blood and bone marrow studies; Schilling Test (confirms diagnosis-rare), blood smear (assess maturity of erythrocytes)
-Medical Management: IM vitamin B12; physical therapy for permanent neurologic deficits
Nursing Management:
-Stomatitis and Glossitis: soft, bland diet; small, frequent meals (to help with fatigue); oral care
-Permanent neurologic deficit: encourage and assist with ambulation, supervision
-Teaching: administration of vitamin B12, diet

Answer 13

Pernicious Anemia

Question 14

-Signs and Symptoms: reddish-purple face and lips, fatigue, weakness, exertional dyspnea
-Diagnostics: elevated blood cell count, platelets and WBC counts elevated, abnormal serum K+ and uric acid
-Medical Management: phlebotomy (drain), radio phosphorus, and radiation therapy

Answer 14

Exocytosis

Question 15

increase in circulating erythrocytes, leukocytes & platelets; Rapid proliferation of blood cells produced by the bone marrow; cause is unknown

Answer 15

Polycythemia vera

Question 16

-Patho: proliferation of leukocytes, usually in immature form
-Four types according to dysfunctional bone marrow stem cell line (Acute and Chronic forms of lymphocytic and myelogenous leukemia)
-Precipitating factors: genetic correlation
-Signs and Symptoms: Severe anemia (rapid leukocyte proliferation causes a decrease in RBC & Plt), infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes, internal or external bleeding
-Medical Management: Antineoplastic drugs, transfusions, Transplantation: bone marrow; stem cell
-Nursing Process: The client with Leukemia
-Assessment: history of symptoms; physical assessment, laboratory results; assess neutrophil
-Diagnosis and Planning: Risks: infection, hemorrhage, activity intolerance, disturbed body image, anxiety, and fear
-Interventions: Monitor platelet counts; Assess for signs of bruising and petechiae(unknown bruises or are they getting bigger); report hematuria or epistaxis; Acknowledge client’s anxieties and fears; Educate patient regarding bleeding risk: electric razors, avoid cuts, prolonged pressure to needle sticks, etc Neutropenic Precautions (If low we are putting the neutropenic precautions in place; no visitors, wash hands, mask up if they are leaving the room)

Answer 16

Leukocytosis: Leukemia

Question 17

-Patho: malignancy involving plasma cells; Osteoclasts break down bone cells, resulting in increased blood calcium and pathologic fractures (calcium is going into blood)
-Osteolytic tumors: “punched-out” or “honeycomb” appearance in bones
-Signs and Symptoms: Pain, infection, symptoms of anemia, bruising, nosebleeds, renal calculi
-Diagnostics: skeletal radiographic studies: bone lesions (looking for that honeycomb appearance); elevated serum calcium levels, bone marrow aspiration
-Medical Management: Steroids, anticancer drugs, antibiotics, Analgesics, blood transfusions, Back braces, body casts (for support of the bones)
-Surgical Management: transplantation: bone marrow; stem cell (see Table 31-4)
-Nursing Management: Assess pain, signs of infection (fever, fatigue), fatigue, bleeding, thrombus formation, urine; Analgesics, ambulation (maybe need a walker), fluid intake, safety paramount (fall risk as their bones are breaking down), Prevent infection (hand washing, wearing a mask)

Answer 17

Multiple Myeloma

Question 19

-Patho: decreased production of granulocytes, Neutrophils, basophils, eosinophils (types of lymphocytes). Sulfonamides, antineoplastics, psychotropics are at a great risk for decreased granulocytes which can cause infection like fungal, yeast, bacterial
-Decreased granulocytes place the client at risk for infection
-Signs and Symptoms: Fatigue, fever, chills, headache, opportunistic infections
-Medical Management: remove cause; drugs: human granulocyte colony-stimulating factor (peg/Filgatrim)
-Nursing Management: drug assessment(what drugs are they taking; is that what is the cause), protective isolation (neutropenic); visitor restriction

Answer 19

Agranulocytosis

Question 20

-Patho: pancytopenia: numbers of all cells reduced. Aplasia: failure to develop
-Causes: unknown, autoimmune, exposure to toxic chemicals, radiation, drug therapy
-Signs and Symptoms: Weakness, fatigue, opportunistic infections, Unusual bleeding, petechiae, ecchymosis, Enlarged spleen/abdominal pain
-Diagnostics: blood cell count (CBC; H/H); bone marrow aspiration
-Medical Management: Withdrawal of causative agent, Transfusions, antibiotics, corticosteroids, Transplantations: bone marrow; autologous stem cell (Own stem cells)
-Nursing Management: History, physical assessment(look at skin, diet), symptoms, Infection prevention measures/isolation, Nutrition; modify oral hygiene (use soft toothbrush and not brush too hard to avoid a cut in mouth to prevent bleeding/infection), Monitoring of blood transfusion (frequent transfusions increase risk for reaction

Answer 20

Pancytopenia: Aplastic Anemia

Question 21

-Patho: platelet manufacture by bone marrow is decreased or platelet destruction by the spleen is increased
-Causes: leukemia; malignant blood diseases, severe infection
-Signs and Symptoms: purpura, bleeding, internal hemorrhage
-Medical Management: identify and treat cause; corticosteroids, transfusions
-Surgical Management: splenectomy
-Nursing Management: Manage/minimize bleeding(avoid falling); Adverse drug reactions; taper corticosteroid dosage and frequency

Answer 21

Thrombocytopenia

Question 22

-Patho: absence or reduction in clotting factor; inherited: mother to son
-Signs and Symptoms: oozing; severe bleeding, bleeding in joints
-Diagnostics: coagulant factor assay; shows deficiency in factor
-Medical Management: transfusions, thrombin/fibrin application to blood, fresh frozen plasma, direct pressure, factor concentrats
-Nursing Management: health history; physical assessment; vital signs, prevent trauma, minimize bleeding; reduce pain or discomfort
-Teaching: conserve energy; ways to prevent further episodes, blood transfusion monitoring for blood

Answer 22

Hemophilia

Question 23

A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from?

Answer 23

Blood loss; Abnormal erythrocyte production; Destruction of normally formed red blood cells

Question 24

A client who has undergone a hemigastrectomy has been diagnosed with pernicious anemia. The client asks the nurse what might have caused her problem. Which of the following is the nurse’s best response?

Answer 24

“You are no longer able to absorb vitamin B12 because of your surgery.”