Exam 4: Assessment and care of patients with hematologic problems (10 questions) Flashcards
Hematologic system physical assessment
- Pain
- Cardiovascular changes SOB, weakness, fatigue Heart sounds Cap refill Pulses
- Skin changes
pallor or cyanosis
jaundice - Renal and urinary
- Musculoskeletal
- Abdominal
- Central nervous system
- Psychosocial
RBC abnormal significance
Elevated > 5.4 million (females) & > 6.1 million (males)
- erythrocytosis, polycythemia vera, severe dehydration
Decreased < 4.2 million (female) & < 4.7 (males)
- anemia hemorrhage, kidney disease
WBC abnormal significance
Elevated > 10,000/mm3
- Infection, inflammation
Decreased < 5,000/mm3
- Immunosuppression, autoimmune disease
MCV abnormal significance
Elevated > 95 fL
- macrocytic (large) RBCs, megaloblastic anemia
Decreased < 80 fL
- microcytic (small) RBCs, iron deficiency anemia
MCH abnormal significance
Elevated > 31 pg/cell
- macrocytic (large) RBCs, megaloblastic anemia
Decreased < 27 pg/cell
- microcytic (small) RBCs, iron deficiency anemia
TIBC abnormal significance
Elevated > 460 mcg/dL
- Iron deficiency anemia, polycythemia vera
Decreased < 250 mcg/dL
- malnutrition, cirrhosis, pernicious anemia
Iron abnormal significance
Elevated > 160 mcg/dL (female) & > 180 mcg/dL (male)
- Hemochromatosis, iron excess, liver disorder, or lead toxicity
Decreased < 60 mcg/dL (females) & <80 mcg/dL (males)
- iron deficiency anemia, chronic blood loss, inadequate dietary intake of iron
Platelets abnormal significance
Elevated > 400,000 mm3
- malignancy, polycythemia vera, rheumatoid arthritis
Decreased < 150,000 mm3
- enlarged spleen, hemorrhage, leukemia
HGB abnormal significance
Elevated > 16 g/dL (females) & > 18 g/dL (males)
- erythrocytosis, COPD, severe dehydration
Decreased < 12 g/dL (female) & < 14 g/dL (male)
- anemia, hemorrhage, kidney disease
HCT abnormal significance
Elevated > 47% (female) & > 52% (male)
- erythrocytosis, COPD, severe dehydration
Decreased < 37% (female) & 42% (male)
- anemia, hemorrhage, kidney disease
APTT abnormal significance
Elevated > 40 seconds
- vitamin K deficiency, disseminated intravascular coagulation (DIC), liver disease, heparin administration
Decreased < 30 seconds
- extensive cancer
PT abnormal significance
Elevated > 12.5 seconds
- liver disease, warfarin therapy, disseminated intravascular coagulation (DIC)
Decreased < 11 seconds
- vitamin K excess, pulmonary embolus, thrombophlebitits
INR abnormal significance
Elevated > 1.1
- warfarin therapy
Decreased < 0.8
- cancer disorders
D-Dimer abnormal significance
Positive result > 0.4 mcg/L
- disseminated intravascular coagulation (DIC), malignancy
Negative result
- can rule out pulmonary embolus or deep vein thrmbosis
Fibrinogen abnormal significance
Elevated > 400 mg/dL
- acute inflammation, acute infection, heart disease
Decreased < 200 mg/dL
- liver disease, advanced cancer, malnutrition
Fibrin degradation abnormal significance
Elevated > 10 mcg/mL
- disseminated intravascular coagulation (DIC), massive trauma resulting in fibrinolysis
Decreased
- anticoagulation therapy
Bone Marrow Aspiration nursingpost op care
- apply pressure to site to prevent bleeding
- sterile dressing
- bedrest 30-60 min
- monitor signs of infection
- Ice
- mild analgesics
- avoid aspirin and anticoagulants
Iron deficiency anemia symptoms
- Pallor, fatigue
- Numbness of extremities
- Dyspnea on exertion
- Sensitivity to cold
- Tachycardia
- Dizziness, syncope
- Headache
- Increased somnolence
Iron deficiency anemia risk factors
Deficiency in components
- not enough iron in diet
Iron deficiency anemia treatment: diet
- Red meat, organ meat, egg yolks, kidney beans, green leafy vegetables
- Nuts, dairy products, citrus fruit
Iron deficiency anemia treatment: medication
- Ferrous sulfate orally
- Iron dextran parenterally
- Erythropoietin
Sickle cell symptoms
- Pain
- Cardiac
- Priapism
- Skin changes
- Organ damage
- Liver, kidneys, CNS
- Joint damage
Sickle cell diagnosis
Sickle cell test
- Evaluates the sickling of RBCs in the presence of decreased oxygen tension
Sickle cell management
- Hydration
- Oxygenation
- Pain control
Leukemia Treatment
- Chemotherapy
Induction, Consolidation, Maintenance - Bone marrow transplant
Leukemia bone marrow transplant
Hemopoietic stem cell transplantation (HSCT)
- Requires chemotherapy to purge leukemia cells
- Transplant of new stem cells are infused and begin hematopoiesis
Types
- Autologous (Pt. own)
- Syngeneic (from relative)
- Allogeneic (matching donor)
Lymphoma: Hodgkin’s
Begins in a subset of white blood cells called lymphocytes
- Reed-Sternberg cell present (usually derived from B lymphocytes, )
Lymphoma: Non-Hodgkin’s
- Begins in a subset of white blood cells called lymphocytes
- Reed-Sternberg cell NOT present
