Exam 2 - Heme Flashcards
Major clinical manifestations of anemia
- Fatigue
- Weakness
- Dyspnea
- Pallor
- Due to hypoxemia & tissue hypoxia
Pernicious anemia – Basic pathophysiology. What causes this specific type of anemia?
- Lack of intrinsic factor from gastric parietal cells
- Intrinsic factor required for vitamin B12 absorption – results in B12 deficiency
Iron deficiency anemia – Clinical manifestations/physical assessment findings
- Brittle, thin, coarsely ridged, spoon-shaped nails
- Red, sore, painful tongue
- Hgh 7-8
Infectious mononucleosis – Clinical manifestations
- “Classic triad”:
o Fever
o Sore throat
o Swollen cervical (neck) lymph nodes - Lab values > 50% lymphocytes and at least >10% atypical (activated) lymphocytes
- The increase in lymphocytes/atypical lymphocytes may affect multiple systems
- Serious complications are infrequent (<5%)
- Splenic rupture is most common cause of death
Hodgkin disease/Hodgkin lymphoma – Cause of lymphadenopathy
- Pressure and obstruction of the lymph nodes leads to lymphadenopathy in Hodgkin disease
Heparin-induced thrombocytopenia (HIT) – (Very) basic pathophysiology
- Complications occur 5 days after start of heparin treatment & result from heparin-dependent antiplatelet antibodies that cause aggregation of platelets and their removal from circulation
(Immune reaction, IgG antibodies, leads to increased platelet consumption & decrease in platelet counts.) - Antibodies bind to vessel walls, causing complications such as DVT, pulmonary embolism, stroke
- Normal platelet count is 150-450,000 (>100,000 for chemo patients)
Shift to the left – What does this mean in relation to neutrophils & infection?
- Body sends out neutrophils (immature) because the infection is so severe and the mature neutrophils have been used up
- An increased neutrophil count with a left shift is typically associated with bacterial infection, and may be increased in other inflammatory conditions or post-surgically.
Disseminated intravascular coagulation (DIC) – Common causes of DIC, Very basic pathophysiology.
DIC leads to ___________ and _____________ at the same time.
- Complex, acquired disorder: clotting and hemorrhage occur simultaneously
- Result of increased protease activity in the blood caused by unregulated release of thrombin with subsequent fibrin formation and accelerated fibrinolysis
- Endothelial damage is primary initiator
Multiple myeloma (MM)
What is the most common electrolyte imbalance caused by MM?
What happens in MM to cause this electrolyte imbalance?
- Hypercalcemia is most common electrolyte imbalance caused by MM (13%)
- Proliferation of osteoclasts –> too much bone broken down –> too much calcium in the blood
Acute leukemias – Clinical manifestations seen in early stages
- Anemia
- Bleeding purpura
- Petechiae
- Ecchymosis
- Thrombosis
- Hemorrhage
- DIC
- Infection
- Weight loss
- Bone pain
- Elevated uric acid
- Liver, spleen, and lymph node enlargement
Burkitt lymphoma – Virus associated with Burkitt lymphoma
Epstein-Barr Virus
Most common type of non-Hodgkin lymphoma in children
Which client is most likely to have iron deficiency anemia?
- A client with cancer receiving radiation therapy twice a week
- A toddler whose primary nutritional intake is milk
- A client with a peptic ulcer who had surgery 6 weeks ago
- A 15-year-old client in sickle cell crisis
2
The toddler will need to eat a balanced diet and may require an iron supplement. A diet based primarily on milk products will not cover the iron needs of a toddler. A client in sickle cell crisis may experience anemia, but it is due to the increased destruction of red blood cells, not poor iron intake. The client receiving radiation therapy may also develop anemia, but it is not due to poor nutritional intake, but bone marrow suppression. The client who has had gastric surgery may develop anemia as a result of lack of adequate utilization of vitamin B12.
(Illustrated, p 301)
A client has been diagnosed with pernicious anemia. What will the nurse teach this client regarding the medication he will need to take after he goes home?
- Monthly B12 injections will be necessary
- Daily ferrous sulfate (in oral form)
- Coagulation studies are important to monitor the effect of medications
- He should reduce his intake of leafy, green vegetables to decrease vitamin K.
1
Pernicious anemia is caused by lack of intrinsic factor to effectively utilize vitamin B12 and is treated by monthly vitamin B12 injections. Ferrous sulfate is given for iron deficiency anemia. Coagulation studies are not necessary because the client is not receiving anticoagulants. Decrease in vitamin K is not necessary because the client is not receiving Coumadin.
(Illustrated, p 302)
Laboratory studies are performed for a child suspected to have iron deficiency anemia. The nurse reviews the laboratory results, knowing that which of the following would indicate this type of anemia?
- Elevated hemoglobin level
- Decreased reticulocyte count
- Elevated red blood cell count
- Red blood cells that are microcytic and hypochronic
4
In iron deficiency anemia, iron stores are depleted, resulting in an increased supply of iron for the manufacture of hemoglobin in red blood cells. The results of a complete blood cell count in children with iron deficiency anemia show decreased hemoglobin levels and microcytic and hypochromic red blood cells. The red blood cell count is decreased. The reticulocyte count is usually normal or slightly elevated.
(Yellow book, p 523)
