exam 3: anemia + clotting Flashcards
fibrin clot
- last phase of blood clotting
- completes the clotting cascade
as the body ages. . .
- blood volume decreases
- plasma protein levels decrease d/t diet and liver function
- bone marrow produces less blood cells
- hgb levels decrease after middle age
- lymphocytes decrease d/t loss in immune function
- antibodies decrease in response
- WBC counts do not rise as high with infection
anemia
reduction in the number of RBCs, amount of Hgb or Hct in circulation
anemia is a ___ NOT a _____
clinical indicator
disease
types of anemia
- iron deficiency
- sickle cell
- vitamin B12
- folic acid
- aplastic
- glucose-6-phosphate dehydrogenase
most common deficiency worldwide
iron deficiency
causes of iron deficiency anemia
- iron-deficient diet
- chronic alcoholism
- malabsorption syndromes
- partial gastrectomy
- menorrhagia
common symptoms of iron deficiency anemia
- weakness
- pallor
- fatigue
- reduced exercise tolderance
- fissures at corners of mouth
- numbness/tingling in extremities
ferritin
blood protein that contains iron
if ferritin levels drop. . .
iron levels drop
normal ferritin range
12-300 mcg/L
iron deficiency anemia prevention
- food sources
- supplements (PO, IV, IM)
- balanced diet
eye symptoms of anemia
yellowing
skin symptoms of anemia
- paleness
- coldness
- yellowing
respiratory symptoms of amemia
SOB
muscular symptoms of anemia
weakness
intestinal symptoms of anemia
changing of stool color
CNS symptoms of anemia
- fatigue
- dizziness
- fainting
blood vessel symptoms of anemia
low BP
heart symptoms of anemia
- palpitations
- rapid HR
- chest pain
- angina
- heart attack
spleen symptoms of anemia
enlargement
pernicious anemia
direct malabsorption of B12
cause of pernicious anemia
autoimmunity
causes of vitamin B12 deficiency anemia
- vegan diet
- diet lacks dairy
- small bowel resection
- chronic diarrhea
- tapeworms
- overgrowth of intestinal bacteria
- gastric bypass surgery
common symptoms of vitamin B12 deficiency anemia
- jaundice
- glossitis
- fatigue
- weight loss
- infertility
- hypothyroidism
- depression
- cognitive decline
- low energy
- numbness
common causes of folic acid deficiency anemia
- poor nutrition (lacking in green leafy vegetables, yeast, citrus fruits, dried beans, nuts; elderly)
- Crohn’s disease
- Celiac disease
- anticonvulsants
- oral contraceptives
- alcohol consumption
- TPN
aplastic anemia
deficiency of RBCs d/t impaired bone marrow production
aplastic anemia typically occurs with
leukopenia (increased r/f infection)
thrombocytopenia (increased r/f bleeding)
pancytopenia
reduction in RBCs, WBCs, and platelets
causes of aplastic anemia
- toxic agents
- ionizing radiation
- infection
- unknown
symptoms of aplastic anemia
- fatigue
- pallor
- dyspnea
- petechiae
- bleeding
- tachycardia
hemolytic anemia intrinsic causes
warm and cold antibody anemia
hemolytic anemia inherited causes
- thalassemia (Mediterranean descent)
- G6PD (x-linked genetic disorder)
hemolytic anemia extrinsic causes
- drugs, chemicals
- toxins, venom
- infection
- trauma, burns
- mechanical damage
manifestations of thalassemia (hemolytic anemia)
- splenomegaly
- bronze skin tone
- bone marrow hyperplasia
- frontal bossing
- wide set eyes with flattened nose
thalassemia (hemolytic anemia)
body produces an abnormal form of Hgb
thalassemia requires a pt to . . .
have lifelong blood transfusions
risk associated with thalassemia
over-loading the heart and other organs with iron
glucose-6-phosphate-dehydrogenase anemia (G6PD)
genetic defect in RBC metabolism
- located on the X chromosome
G6PD is more prominent with what group of pts
males, African Americans, and adults in Middle East and Asia
causes of G6PD
- drugs
- ASA, sulfonamides, thiazide diuretics
- high doses of vitamin c
manifestations of G6PD
- jaundice
- anemia
sickle cell disease
- formation of abnormal Hgb S chain (sensitive to O2)
- RBCs are “sickle” shaped
sickle cell disease is most common in . . .
African Americans
causes of Sickle Cell crisis
- low oxygen
- dehydration
- infection
- venous stasis
- pregnancy
- alcohol
- high altitudes
- low/high body temp
- strenuous exercise
- emotional stress
- anesthesia
labs to assess with sickle cell crisis
- Hgb (low)
- reticulocyte count (high)
- bilirubin level (high)
- WBCs (high)
with sickle cell disease, pain most often occurs in. . .
- abdominal and long bones
- hand-foot syndrome
- joints
treatment for sickle cell disease mneumonic
hospital- HOP to it!
- Hydration
- Oxygenation
- Pain relief
risk factors for leukemia
- ionizing radiation (radiation therapy)
- viral infection
- myelodysplastic syndrome (MDS)
- genetic factors (down syndrome, Klinefelter syndrome)
- immune deficiencies
- environmental (smoking, chemicals, prev. chemo)
prevention for cancer
primary: smoking cessation, limit alcohol, exercise, wear sunscreen, avoid prolonged sun exposure, follow occupational safety protocols, healthy diets
secondary: screenings for cancer
priority pt education for pts with cancer
- report temp over 100.4
- high protein diet
- avoid large crowds
- no pets, gardening, fresh flowers
- good oral care after meals and before bed
- med side effects
diagnostic testing for cancer
- bone marrow/tumor biopsy
- PET scan
- direct visualization (colonoscopy)
- x-ray
- CT/MRI
- cytology exam (epithelial cells from PAP smear)
- tumor marker (proteins that may indicate malignancy)
passive euthanasia
letting the pt die of their own natural disease or condition
active euthanasia
killing the person before their own natural disease does (by murder)
voluntary euthanasia
euthanasia with the consent of the pt (OD of opioid of choice by physician
nonvoluntary euthanasia
euthanasia without the consent of the pt, but the family provides consent (“pulling the plug”)
involuntary euthanasia
euthanizing a competent person against their wishes
diagnostic screening procedure for leukemia
bone marrow biopsy
types of leukemia
- acute myelogenous leukemia (AML)
- acute lymphocytic leukemia (ALL)
- chronic myelogenous leukemia (CML)
- chronic lymphocytic leukemia (CLL)
s/s of oncological emergencies
- sepsis
- temp of 100.4+
- ANC
expected outcomes for individual with leukemia
remission
s/s of impending death
- disorientation
- increased sleep
- decreased dietary intake
- respiratory changes (Cheyne-stokes breathing, apnea, congestion)
- decreased temperature
- decreased BP
- cyanosis
- incontinence
- impaired muscle control
- restlessness
goal and priorities of palliative care
types of pts in palliative care
role of hospice
- provides care of body, mind, spirit
- pain relief
- symptoms management
- affirmation of life
- mental, emotional, spiritual support
- family support
- interdisciplinary
nursing considerations for palliative care of child
- family should be provided timely and clear information
- palliative care options implemented soon after diagnosis
- prevent and relieve pain and suffering
- support cognitive, emotional, and spiritual development
AML is most common. . .
acute leukemia in adults
ALL is most common. . .
in children
two types of leukemia that are Philadelphia chromosome -positive
- ALL
- CML
CLL is most common. . .
after age 50
CML is most common. . .
chronic leukemia in adults
systemic symptoms of leukemia
- weight loss
- fever
- frequent infections
respiratory symptoms of leukemia
SOB
muscular symptoms of leukemia
weakness
bone and joint symptoms of leukemia
pain or tenderness
psychological symptoms of leukemia
- fatigue
- loss of appetite
lymph node appearance of leukemia
swollen
spleen and/or liver appearance of leukemia
enlarged
clotting symptoms of leukemia
- decreased platelet function
- bruising and bleeding easily
- heavy menstrual flow
cardiovascular symptoms of leukemia
- tachycardia
- palpitations
- orthostatic hypotension
immunity symptoms of leukemia
- fevers
- night sweats
- WBCs can be high or low
hematological symptoms of leukemia
- anemia
- fatigue
- weakness
- pale skin, nail beds, conjunctivae
GI symptoms of leukemia
- anorexia
- weight loss
- loss of appetite
child’s response to loss: 2-5yrs
do not grasp the permanence of death
lab value results for leukemia
- H&H (low)
- platelets (low)
- WBC can be high or low
child’s response to loss: 5-7yrs
- death is viewed as reversible
- “magical thinking”
child’s response to loss: 8-11yrs
- understand that death is permanent
- curious about life after death
child’s response to loss: 12-18yrs
understand the abstract idea of death
older adult’s response to loss: four multi-faceted areas
- loss of family + friends
- loss of independence
- loss of health
- loss of memory
older adults are at risk for ____ as a response to loss
depression
bone marrow biopsy
- sample removed from posterior iliac crest
- pressure held at puncture site and transparent dressing is applied
three phases of chemo
induction
consolidation
maintenance
induction
- aggressive, combination therapy
- 4-6 week hospitalization
consolidation
- lower doses of induction regimen
- goal is to cure
- given as pt can tolerate
- transplants can be considered during this time
maintenance
- done to prevent relapse
- lower doses (IV or oral)
- months to years
side effects of chemotherapy
- alopecia
- stomatitis
- kidney, liver, cardiac toxicity
- nadir
precautions when chemo is adm.
- assess infusing lines
- always wear PPE
- oral chemo = do not break, crush, chew
- infiltration or extravasation = immediately STOP infusion
two types of stem cell transplant
allogenic and autologous
allogenic
bone marrow from a donor
allogenic donor and pt details
- donor must have closely matched tissue antigens
- total body exposure to radiation possibility prior to transplant
- pt must have little to no bone marrow prior to transplant
- donor marrow infused via IV
autologous
bone marrow from self
autologous donor and pt details
- 1 liter of bone marrow cells aspirated from iliac crest during disease remission, then frozen
- total body radiation exposure
- marrow is thawed and re-infused via IV
two types of lymphoma
hodgkins lymphoma and non-hogkins lymphoma
hodgkins lymphoma cell
Reed-Sternberg- predictable spread from one group of nodes to another
hodgkins lymphoma details
one of the most treatable types of cancer
non-hodgkins lymphoma details
spreads through lymphatic system in a disorderly fashion
hodgkins lymphoma treatment
radiation and chemo
non-hogkins lymphoma treatment
- varies depending on extent
- combination therapies including chemo, radiation, monoclonal antibodies
multiple myeloma
- cancer of WBCs
- involves the B-lymphocyte secreting too many antibodies
multiple myeloma risk factors
- cause is unknown
- radiation exposure
- chemical exposure
- infection certain Herpes virus
multiple myeloma treatment
- protease inhibitors
- immunomodulating drugs
- chemo (controls, doesn’t cure)
what does multiple myeloma put you at risk for
anemia, infection, bleeding
d/t fewer RBCs, WBCs and platelets
nursing interventions for dyspnea in dying pt
- position HOB at least 30 degrees
- oxygen
- opioid administration to slow breathing
nursing interventions for hypotension in dying pt
- assess color, cap refill, heart rate
- promote safety if confused and dizzy
nursing interventions for anorexia, nausea, dehydration in dying pt
- encourage favorite foods
- antiemetics: ondansetron or promethazine
- routine oral care to decrease oral mucosa
nursing interventions for altered LOC in dying pt
- reorient and promote safety if pt is confused and rambling
- speak slowly and be patient if pt has poor concentration
nursing interventions for pain in dying pt
- opioid administration
- assess at least 2x/day
- most feared symptom
advanced directives
legal documents outlining a client’s preferred treatment plan
living will
describes the client’s treatment preference regarding end-of-life care (intubation, tube feeding, resuscitation)
durable power of attorney for health care (DPOAHC)
empowers designated individual to make medical decisions (used only when pt cannot receive, evaluate, and/or communicate information)
VSED
refusal of feesing/hydration to speed death process
neoplasms
abnormal growths of new tissue that are classified as benign or malignant
benign
- localized growths
- usually doesn’t endanger life or health
- doesn’t invade other tissues, usually doesn’t reoccur once removed
malignant
- grows aggressively
- uncontrolled cells
- invades other tissues, causing inflammation, bleeding, necrosis until something stops them (surgery, radiation, chemo)
two things that need to be present for somebody to develop cancer
- damaged DNA
- impaired immune system
carcinogens
- cancer-causing substances
- chemical: tobacco, meds
- physical: radiation, UV
- viral: HPV
tumor lysis syndrome (TLS)
- oncologic emergency with rapid lysis of malignant cells
- usually the result of chemo or radiation
complications caused by TLS
- hyperkalemia
- hyperuricemia
- hyperphosphatemia
- cardiac arrhythmias
- renal failure
treatment for TLS
- monitor labs
- hydration
syndrome of inappropriate antidiuretic hormone (SIADH)
too much ADH = too much water = fluid volume overload
