exam 2 Flashcards
causes of thrombocytopenia
Commonly from ingestion of high doses of certain drugs
Autoimmune diseases
Increased platelet consumption Splenomegaly
Bone marrow suppression/failure
can be caused from heparin , quinine, sulfa abx
Diagnostic studies for COPD
H&P, spirometry, CXR, 6-min walk test, COPD assessment test, Clinical COPD questionnaire, ABGs
what is neutropenia
ANC < 1000
severe neutropenia <500
Patient has little or no ability to fight infection
moderate anemia
Hgb: 6-10
Cardiopulmonary s/sx at rest
what is sickle cell anemia
autosomal recessive disorder
abnormal hgb = Hgb S
Hgb S causes erythrocyte to stiffen and elongate taking on sickle shape in response to low O2 levels
Thrombocytopenia diagnostics
↓ Platelet count
Prolonged bleeding < 50,000
Hemorrhage < 20,000
Peripheral blood smear
Medical history
Clinical examination
Lab parameter comparisons
increased LDH
PT, INR
An autosomal recessive, disorder
altered transport of sodium and chloride ions in and out of epithelial cells
Affects primarily lungs, skin, GI tract (pancreas/biliary tract) , repro tract.
Cystic fibrosis
what is Hodgkins lymphoma
malignant neoplasm that originates in bone marrow , goes to lymphatic structures resulting in proliferation of lymphocytes
what does a peripheral blood smear show in sickle cell disease
may reveal sickled cells and increased abnormal reticulocytes
iron rich foods
liver, dried fruits, legumes, dark greens, whole grains, beans, cereals
acute asthma exacerbation symptoms
tripod position, prominent wheezing, RR >30, pulse > 120, accessory muscles to the neck, agitation
What education should be provided for patients with sickle cell disease
- Avoiding exposure to crowds to prevent infection
- severe exercise could cause hypoxia and causes changes in permeability
- Remove any constrictive clothes
- avoid anything that can trigger crisis
symptoms of DIC
bleeding from venipuncture sites, hemoptysis, hypotension, tachycardia, bloody stools, hematuria
shape of RBCs in sickle cell
rigid, elongated, crescent shape
asthma drug triggers
beta blockers: propranolol, metoprolol, timolol
Ace inhibitors: lisinopril, trigger dry cough
How is sickle cell disease diagnosed
Peripheral blood smear
Sickling test
Electrophoresis of hemoglobin
Skeletal x-rays
Magnetic resonance imaging (MRI)
Doppler studies
X-rays
Defective DNA synthesis in RBCs
Megaloblastic Anemia
progressive disease associated with an enhanced chronic inflammatory response in the airways and lungs, primarily caused by cigarette smoking that results in persistent airflow limitation. .
COPD
PEFR yellow zone
50-80% of personal best
indicates caution, something triggering asthma
asthma exacerbation assessment
RR/HR, accessory muscle use, lung auscultation, PEFR to monitor airflow obstruction, pulse ox, ABGs
purpose of peak expiratory flow rate
measures the maximum speed of expiration, can help predict an asthma attack or monitor severity of disease, measures degree of obstruction
stages of Hodgkins lymphoma
Stage 1 is one lymphnodes
2 – is two or more
3 – lymph nodes affected above and below diaphragm
4 – even on sides of diaphragm
COPD patho
Chronic inflammation of airways, lung parenchyma (bronchioles and alveoli), and pulmonary blood vessels
Airflow limitation, air trapping, gas exchange is abnormal, mucous hypersecretion
mild anemia
Hgb: 10-12
Palpitations, dypnea, fatigue
3rd leading cause of death in US
COPD
what other symptoms accompany pain during sickle cell crisis
Fever , swelling , tenderness, tachypnea, HTN, N/V
severe anemia
Hgb: <6
Pallor, Jaundice, Pruritus
Elevated HR, systolic murmurs, angina pectoris, MI, HF, cardiomegaly, congestion, ascites, edema
Peak flow results: green zone
80-100% , remain on meds
what is polycythemia
increased number of RBCs, causes hyperviscosity and hypervolemia
Diminished availability of erythrocyte precursors
Aplastic Anemia
what is an immunologic transfusion reaction
reaction when donor blood and recipient blood weren’t compatible
drug/food additive triggers of asthma
aspirin, NSAIDs, salicylic acid,
chronic long-term condition, intermittent inflammation that narrows airways in lungs, causes limitations of bronchiole responsiveness
asthma
abnormal lymph node assessment
tender = inflammation
enlarged > 1 cm
hard/fixed = malignancy
what meds can be used to treat neutropenia
Neupogen and filgastrim
Treatment for DIC
stabilize pt, oxygen, volume replacement , control bleeding, might need blood, vitamin k
COPD symptoms
chronic intermittent cough/sputum production
dyspnea
difficulty breathing
wheezing/chest tightness
underweight with anorexia
chronic fatigue
paroxysmal nocturnal dyspnea
How is polycythemia diagnosed
lab and bone marrow aspiration
Inadequate production of Hgb.
Autosomal recessive genetic disorder
Thalassemia
what is thrombocytopenia
reduction of platelets < 100, results in prolonged or spontaneous bleeding
COPD risk factors
Cigarette smoking
occupation chemicals and dusts
air pollution
infection
genetics
aging
asthma
gender
mild allergic transfusion reaction
hives
pruritis
facial flushing
Symptoms of Cobalamin deficiency (pernicious anemia)
palpations
fatigue
dyspnea
pallor
sore red, beefy, shiny tongue
anorexia
N/V
abdominal pain
weakness, paresthesias
decreased senses
ataxia, muscle weakness
impaire thoughts
Treatment of pernicious anemia
parenteral or intranasal admin of cobalamin
most common is 1000 mg of B12 IM , everyday for 2 weeks, then once a week until Hgb is normal , then once a month for life
management o f neutropenia
Put pt in isolation to protect pt.
remove fresh plants
monitor labs
any s/s of infection (fever = early sign)
keep eye on IV for infection
teach personal hygiene
instruct to take all meds especially antibiotics
check temp q4h
what is an acute transfusion reaction
reaction occurs during the transfusion
extra info about Hodgkins lymphoma
If begins above diaphragm,it will have slow progress, if below diaphragm itll spread quick
A is for pts with no symptoms
B is for pts with symptoms
causes of aplastic anemia
can be autoimmune but also caused by alcohol , radiation, viral or bacterial infection
symptoms of Hodgkins lymphoma
Enlargement of cervical, axillary, or inguinal lymph nodes, mediastinal nodes
Painless unless: Exert pressure on nerves, Alcohol
what is aplastic anemia (idiopathic)
pancytopenia with hypo cellular bone marrow
low bc, low rbc, low platelets
triggers of sickle cell
low o2 in blood
hypoxia or low oxygen in blood can be cause by infection, high altitude , stress, surgery, blood loss, dehydration, acidosis, lowered body temp
thalassemia major treatment
blood transfusions with chelating agents
meds
splenectomy
monitor hepatic, cardiac, pulmonary function
hematopoietic stem cell transplant
asthma triad
nasal polyps, asthma, sensitivity to aspirin and NSAIDs
anemia due to Decreased Hgb synthesis
Iron-Deficiency Anemia
Thalassemia
how does aging cause COPD
lung loses recoil or stiffness of chest wall causing alteration in gas exchange, lungs become rounder and smaller, decreased number of alveoli and happens due to loss of tissue in airway
what causes polycythemia
due to gene mutation but not inherited
can be caused by radiation or exposure to toxic substances
what causes an increase in Hgb
polycythemia and dehydration
What is DIC
Serious bleeding and thrombotic disorder that results from abnormally initiated and accelerated clotting
DIC is not a disease, abnormal response of normal clotting cascade caused by a disease process or disorder
COPD patient presentation
prolonged expiratory phase
wheezes
decreased breath sounds
barrel chest
tripod position
pursed lip breathing
Megaloblastic anemias
folic acid and cobalamin (vitamin b12) anemias
asthma risk factors
genetic factors
environmental factors
male gender before puberty
obesity
Late COPD manifestations?
polycythemia and cyanosis
hypoxemia
increased production of RBCs
bluish-red color of skin
Hgb concentration may reach 20 g/dL or more
hemolytic transfusion reaction
low back pain
hypotension
tachycardia
fever and chills
chest pain
tachypnea
hemoglobinuria
causes of pernicious anemia
absence of intrinsic factor
GI surgery (small bowel resection )
chronic GI disease (celiac or crohns)
excessive alcohol or hot tea ingestion (decreases acidity)
smoking
long term use of H2 blockers and PPIs
strict vegetarians
Treatment for transfusion reactions
antihistamines
antipyretics
stop transfusion
keep iv line open with normal salin e
monitor VS q15 min
post transfusion blood sample
treat s/sx
symptoms of aplastic anemia
fatigue
dypsnea
will have neutropenia (infection risk)
will have thrombocytopenia (bleeding risk)
the presence of cough and sputum production for at least 3 months in each of 2 consecutive years, is an independent disease that may precede or follow the development of airflow limitation.
Chronic Bronchitis
why are iron and TIBC elevated in aplastic anemia
iron is floating in blood
asthma diagnostic studies
history and physical, spirometry, peak expiratory flow rate, chest x-ray, oximetry, allergy testing, blood levels of eosinophils
Symptoms of polycythemia
headache, vertigo, dizziness, tinnitus, visual disturbances, pruritis, paresthesias, erythromyalgia, angina, intermittent claudication , thrombophlebitis
cystic fibrosis treatment
antibiotics for infections
pulmozyme, inhaled hypertonic saline, and CPT to clear secretions
digestive enzymes replacement to provide adequate nutrition
high calorie, high fat, high protein diet
supplemental fat soluble vitamins (A, d, e, K)
what causes pain in sickle cell
pain from vessel occlusion (tissue ischemia)
RBCs have hard time passing cuz of shape
what is a delayed transfusion reaction
reaction can happen days or weeks after transfusion
symptoms of salicylic/NSAID use
wheezing in 2 hrs, rhinorrhea, congestion, tearing, angioedema
treatment of intermittent and persistent asthma
avoid triggers of acute attacks
pre-mediate befor exercising
short medication (rescue med)
long term or controller med
Iron deficiency Anemia: S/sx
pallor
glossitis
cheilitis
headache
paresthesias
burning sensation
Cystic fibrosis symptoms
fatigue
chronic cough w/ thick/sticky mucus
recurrent URIs
chronic hypoxia
clubbing, barrel chest
decreased absorption of vitamins and enzymes
abdominal distention
decreased digestive enzymes
greasy, smelly stools (steatorrhea)
meconium ileus in newborn
rectal prolapse
How does electrophoresis of hgb diagnose sickle cell disease
determines amount of hgb s and scd from other variants
what does a “shift to the left” indicate
bone marrow releases more immature neutrophils during an infection when the body cannot keep up with WBC production , levels being to normalize when infection is gettin better or body can keep up
what are indications for a bone marrow biopsy
Used to diagnose disease
determine stage of progression of disease
check iron levels
monitor treatment of disease
check for anemia
check for cancer such as leukemia, lymphoma, multiple myeloma
sometimes to investigate fevers
symptoms of thrombocytopenia
Patients are often asymptomatic
Mucosal bleeding (nose or gingival bleeding)
Petechiae
Purpura
Ecchymoses
heavy menstrual flow in women
LOC changes
internal bleeding signs
asthma symptoms
prolonged expiration, expiratory wheezing, air trapping, lung hyperinflation, chest tightness, dyspnea, cough, accessory muscle use
spirometry use
assess lung function, measures how much air pt can inhale/exhale, diagnoses asthma and COPD, can be used to monitor treatment for chronic lung disease
Nursing interventions for bone marrow biopsy
apply pressure with sterile dressing
assess for bleeding and lay on site for 30-60 min
monitor VS
educate that area will be sore for 3 days
anaphylactic transfusion reaction
SOB
bronchospasm
anxiety
hives
pruritis
diagnosis of Hodgkins lymphoma
Peripheral blood analysis
CBC abnormalities are variable and not diagnostic
Excisional lymph node biopsy
Bone marrow examination
Radiologic evaluation
Thalassemia major
Thalassemia major = life threatening
Physical and mental delay
Jaundice
Splenomegaly
Hepatomegaly
Cardiomyopathy
Bone marrow hyperplasia
Treatment of thrombocytopenia
Prevent or control hemorrhage
Any bleeding needs evaluation and treatment
Watch for bleeding that can be difficult to detect
Avoid IM injections
Closely monitor platelet count, coagulation studies, Hgb, and Hct
Platelet Transfusions
Manage blood loss from excessive menstrual bleeding
Avoid SQ injections if possible , apply pressure and ice packs right after if given
soft toothbrush
febrile reaction symptoms
chills
fever
headache
flushing
tachycardia
anxiety
asthma triggers
cockroaches, furry animals, fungi, pollen, molds, cigarette or wood smoke, vehicle exhaust, concentrated pollution, physical exertion
why are fluids given during a sickle cell crisis
to reduce blood viscosity and prevent dehydration , maintain kidney function
Symptoms of sickle cell disease
asymptomatic except during sicking episodes
Symptoms:
pain from tissue hypoxia and damage
pallor of mucus membranes
jaundice from hemolysis
prone to gallstones
skin may have gray cast
systematic symptoms of lymphoma
Weight loss, fatigue/weakness, fever/chills, tachycardia, night sweats, itching
Advanced pts: hepatomegaly, splenomegaly, anemia
how do you treat an exacerbation of polycythemia
aspirin, ambulation, lukewarm bath
which pts may have high risk of acquiring DIC
pts with sepsis, notify HCP if septic and starts bleeding
complications of polycythemia
scurrying of bone marrow cuz it is overworked and can lead to leukemia, feeling full due to splenomegaly, splenectomy may be needed
COPD treatment
smoking cessation
evaluate for environmental or occupational irritants
breathing retraining (pursed lip, diaphragmatic breathing)
airway clearance
CPT
vaccines
drug therapy similar to asthma
what is nonimmunologic reaction
due to blood being damaged during transportation
what is included in a CBC with differential
Neutrophils, lymphocytes, eosinophils, basophils, monocytes
what is the treatment for polycythemia
reduce blood volume and viscosity by removing blood through phlebotomy
causes of Hodgkins lymphoma
Epstein Barr Virus (EPV)
Genetic predisposition,
Occupational toxins
HIV
treatment of aplastic anemia
hematopoietic stem cell transplant and immunosuppressive therapy with cyclosporine
will have ongoing blood transfusion , iron binding agent to prevent iron overload
iron deficiency anemia diagnostics
CBC
Low Hgb/Hct
Low serum iron
High TIBC
Low ferritin
Stool Occult blood test
Endoscopy/Colonoscopy
Bone Marrow Biopsy
the destruction of the alveoli and is a pathologic term that explains only one of several structural abnormalities in COPD patients
emphysema
diagnosis of aplastic anemia
Low Hgb, WBC, and platelet values
Low reticulocyte count
Elevated serum iron and TIBC
Hypocellular bone marrow with increased fat content (yellow marrow)
PEFR red zone
50% or less of personal best
indicates serious problem, action must be taken with HCP
Normal lymph node assessment
not palpable, < 1 cm, firm, contender
