exam 4- HEMATOLOGY Flashcards
1
Q
normal counts for
RBC
WBC
Hgb/Hct
platlets
A
RBC: 3-6
WBC: 4500-11,000
Hgb: 13-17 M or 12-15 F
Hct: 41-50 M or 36-48 F
platlets: 150-450k
2
Q
Hgb and s/s of mild anemia
A
10-12 exertional dyspnea, fatigue, palpitations
3
Q
Hgb and s/s of severe anemia
A
<6 - Pallor, glossitis, smooth tongue, tachycardia and murmurs, tachypnea, dyspnea at rest, bone pain
4
Q
Hgb and s/s of mod anemia
A
6-10 / dyspnea, fatigue and bounding pulse
5
Q
3 causes of decreased RBC production
A
deficient nutrients / dec erythropoetin / dec iron available
6
Q
4 causes of increased RBC destruction
A
SCD / incompatible blood / trauma / medication
7
Q
anemia is a def in what 3
A
number of RBC / quantity of Hgb / volume of RBC (Hct)
8
Q
interventions for anemia 5
A
RBC replacement with med erythropoetin
O2
increased iron intake (nutrition)
alternating rest and activity
monitoring cardiorespiratory
9
Q
hereditary vs acquired hemolytic anemia
A
hereditary = RBC defect themselves in SCD
acquired: RBC normal but outside factor causes destruction
both are destruction>production
10
Q
what is acquired hemolysis anemia a result of
A
hemolysis of RBC from extrinsic factors
11
Q
4 specific s/s to acquired hemolytic anemia
A
jaundice
splenomegaly
flank pain -
blood transfusion rxn
12
Q
major focus of tx for acquired hemolytic anemia
A
maintence of renal function
13
Q
focus of care for acquired hemolytic anemia 6
A
supportive care
emergency prep for crisis
aggressive hydration and electrolyte replacement
corticosteroids
blood products
splenectomy
14
Q
8 step pathphys of SCD
A
crescent shape RBC -> clogged vessel -> hemostasis -> self perpetuating hypoxia -> more sickling -> tissue necrosis -> major organ damage
15
Q
5 triggers to SCD
A
low O2
infection (most common)
stress
altitude
surgery
16
Q
how to prevent SCD crisis
A
O2 to reverse initial sickling
17
Q
5 s/s of SCD
A
usually asymptomatic unless in an episode
PAIN
pallor mucuous membranes
jaundice
gallstones
spleen and kindey dysfunction
18
Q
most common complication of SCD
A
pnemuococcoal pneumonia
19
Q
3 lung complications of SCD
A
pnuemonia, tissue infarction, fat embolism
20
Q
5 s/s of acute chest syndrome and what is it a complication of
A
fever, chest pain, cough, lung infiltrates, dyspnea
21
Q
9 priorities of SCD interventions
A
O2
assess respiratory
rest with VTE prophylaxis
fluids
transfusion therapy
pain management with opioids
folic acid
hydroxurea (increases Hgb production and alters adhesion of sickle RBC)
stem cell transplant
22
Q
clotting stages 5
A
vasoconstriction, vessel clogs
platlets adhere
platlets bind to fibrinogen
ADP released and platlet plug forms
thrombin converts fibrinogen to fibrin network
23
Q
thrombocytopenia vs hemophillia vs DIC defintions
A
Thrombocytopenia - reduction of platelets
Hemophilia - genetic disorder caused by a defective or deficient coagulation factor
Disseminated Intravascular Coagulation (DIC) - Abnormal response of the normal clotting cascade stimulated by a disease process or disorder
24
Q
2 causes of thrombocytopenia
A
drug and other diseases
25
platlet count for thrombocytopenia and what does it result in
<150,000 and abnormal hemostasis aka prolonged or spontaneous bleeding
26
tx for autoimmune thrombo.
corticosteroids and splenectomy
27
tx for thrombotic thrombo.
plasma
28
tx for heparin thrombo.
protamine sulfate
29
major complication of thrombocytopenia and the s/s
hemorrage - weakness, fainting, dizziness, tachycardia, abdominal pain, and
hypotension
30
main s/s of thrombocytopenia
usually asymptomatic but also Bleeding into the skin is seen as petechiae, purpura, or superficial
ecchymoses.
31
thrombocytopenia education
1. Notify your HCP of any symptoms of bleeding. These include:
* Black, tarry, or bloody bowel movements
* Black or bloody vomit, sputum, or urine
* Bleeding from the mouth or anywhere in the body
* Bruising or small red or purple spots on the skin
* Difficulty talking, sudden weakness of an arm or leg,
confusion
* Headache or changes in how well you can see
2. Ask your HCP about restrictions in your normal activities, such
as vigorous exercise or lifting weights. Generally, walking is
safe. Wear sturdy shoes or slippers. If you are weak and at risk
for falling, get help or supervision when getting out of bed or
chair.
3. Do not blow your nose forcefully; gently pat it with a tissue if
needed. For a nosebleed, keep your head up and apply firm
pressure to the nostrils and bridge of your nose. If bleeding
continues, place an ice bag over the bridge of your nose and the
nape of your neck. If you are unable to stop a nosebleed after 10
minutes, call your HCP.
4. Do not bend down with your head lower than your waist.
5. Prevent constipation by drinking plenty of fluids. Do not strain
when having a bowel movement. Your HCP may prescribe a
stool softener. Do not use a suppository, an enema, or a rectal
thermometer without the permission of your HCP.
6. Shave only with an electric razor. Do not use blades.
7. Do not tweeze your eyebrows or other body hair.
8. Do not puncture your skin, such as getting tattoos or body
piercing.
9. Do not use any medication that can prolong bleeding, such as
aspirin. Other medications and herbs can have similar effects. If
you are unsure about any medication, ask your HCP or
pharmacist about it in relation to your thrombocytopenia.
10. Use a soft-bristle toothbrush to prevent injuring the gums.
Flossing is usually safe if done gently using the thin tape floss.
Do not use alcohol-based mouthwashes since they can dry your
gums and increase bleeding.
11. Women who are menstruating should keep track of the number
of pads that are used per day. When you start using more pads
per day than usual or bleed more days, notify your HCP. Do not
use tampons; only use sanitary pads.
12. Ask your HCP before you have any invasive procedures done,
such as a dental cleaning, manicure, or pedicure.
The proper
32
cause and incidence of hemophillia
autosomal recessive genetic
if mom has it then sons have 50% chance
if dad has it and he has daughters then the daughters are carriers and their sons have 50%
33
thrombocytopenia vs hemophillia
thrombo: low platlets , normal labs
hemophillia : no clotting factors, normal PT and platlets but prolonged PTT
34
4 interventions general for thrombocytopenia
corticosteroids to supress spleen
splenectomy
treat underlying cause
stop heparin
35
9 ss of hemophillia
Slow, persistent, prolonged bleeding from minor trauma;
Delayed bleeding after minor injury;
Uncontrolled hemorrhage after dental procedure;
Frequent epistaxis
GI bleeding
Hematuria from GU trauma
Ecchymosis & subQ hematoma
Hemarthrosis
Pain, anesthesia from nerve compression
36
6 intervention/education for hemophillia
Factor replacement (fresh frozen plasma)
Managing bleeding emergencies
Rest affected joints, ice, analgesia
easy exercise
Daily oral care
avoid injury
37
3 dx for hemophillia
factor deficiency
prolonged PTT
normal PT and platlets
38
name wbc
lymphocytes, monocytes, granulocytes
39
when is neutropenia dx
ANC <1000
40
2 phagocytic mechanisms impaired in neutropenia
LACK OF inflammation, lack of puss
41
what to do if someone with neutropenia has sore throat, fever >100.4
go to ED or contact HCP
42
6 interventions for neutropenia
close monitoring
determine cause
identify organism
hematopoeitc growth factor
protective enviornmental practices
43
7 education for neutropenic
hand hygiene
avoid crowds
daily skin and mouth care
no uncooked meats and flowers and fruits
protective equipment
monitor temp
44
filgrastim moa, common SE, storage, admin, monitor
stimulates BM to produce neutrophils
bone pain common SE
store in fridge
dont shake
monitor CBC and WBC should increase
45
Acute hemolytic reaction and ss
most common cause is transfusion of ABO-incompatible blood
Low back pain
Dark urine
Renal failure
Tachypnea/Dyspnea
Tachycardia
Shock
46
Febrile, nonhemolytic reaction and ss
Sensitization to donor WBCs, platlets, plasma proteins
chills, fever, headache
47
anaphylaxis 7 ss
Anxiety
Urticaria (hives)
Wheezing
Bronchospasm
Dyspnea
Hypotension
Shock
48
fluid overload and 8 ss
fluid given faster than circulation can accomodate
cough
dyspnea
pulmonary congestion
adventitious breath sounds
headache
HTN,
tachycardia
Distended neck veins
49
how to prevent febrile non hemolytic rxn
Give diphenhydramine and acetaminophen 30 minutes prior;
50
if febrile nonhemolytic rxn , what to do about restarting blood
only per doctors order
51
how to prevent anaphylaxis rxn
Use washed RBCs from which all plasma has been removed or use autologous components
52
what to do if mild anaphylaxis rxn
antihistamine and may restart but give slowly
53
how to prevent fluid overload rxn
adjust flow rate and sometimes prophylactic diuretic
54
tx for fluid overload rxn
O2
55
nursing intervention for blood admin afterwards
Monitoring for at least first 15 minutes, then q30 minutes during, up to 1 hour after transfusion
56
once blood is obtained what is priority for nurse
to give within 30 min
57
4 characteristics of normal cell growth
Cell proliferation: starts in the stem cell
Cell differentiation: change from ova to specific function based on need & unique body tissue
Generation time of cell
Contact inhibition - cells respect the boundaries of other cells
58
proliferation of cancer cells
loss of feedback mechanisms
59
generation time of cancer cells
uncontrolled growth fraction
60
hematologic metastasis
penetrates vessel wall; sometimes protected by platelets & fibrin
61
what to do tumors need to spread
blood supply
62
5 ways cancer cells attack cells
Suppress reaction of T-cells to cancer cells
Weak surface antigens, cells “sneak through” surveillance
Develop tolerance to immune system
Cancer cells secrete products that suppress
Blocking antibodies prevent T cells from identifying tumor associated antigens
63
how are tumors classified
T = TUMOR: Increasing tumor size & involvement
N = NODES: Lymph node involvement (#)
M = METASTASIS: None to distant presence
64
4 ways to prevent cancer
Reduce exposure to carcinogens
Healthy weight, exercise, diet,
Stress management & rest
Encourage regular physical exams and screening to promote early detection
65
CAUTION for detecting cancer
Change in bowel/bladder
A nonhealing sore
Unusual bleeding
Thickening or lump
Indigestion
Obvious change in wart or mole
Nagging cough or hoarse
66
what is leukemia
Group of cancers affecting blood and blood-forming tissues of the bone marrow, lymph system, and spleen (wbcs) which results in accumulation of dysfunctional cells
67
ss of leukemia
poor wound healing, fatigue, sickness (anemia, thrombocytopenia)
68
what is lymphoma
Malignant neoplasms originating in the bone marrow and lymphatic structures
Result in the proliferation of abnormal lymphocytes.
69
hodgkins vs non hodgskins s/s
hodgkins is night sweats and non hodgkins is minimal symptoms and normal blood samples
70
what is multiple myeloma
Multiple myeloma occurs with abnormal proliferation of abnormal plasma cells into the bone marrow
71
multiple myeloma s/s are ____ and ___
incidious and slow
72
acronym for multiple myeloma assessment
high Ca
renal issues high BUN
anemia - pancytopenia
bone issues(osteoporosis)
CRAB
73
what to do if occlusion in CL 3
change position, flush w/ NSS, thrombolytic therapy
74
what to do if someone with CL has chest pain and resp distress
its an embolism so Clamp, oxygen, turn to left side (air emb), get MD & help STAT
75
what to do if someone has lung perf during insertion of cl
semi fowlers, O2 and chest tube
76
CL management
77
breast cancer risk factors
Family history
Environmental factors
Genetics (BRCA1, BRCA2)
Early menarche and late menopause
Age 60 or older
Most who develop breast cancer have no identifiable risk factors
78
age 40-44 / 45-54 / > 55 education for cancer screening
40-44 = choice to start annual breast cancer screening with mammograms
45-54 =mammograms every year.
>55 = can switch to mammograms every other year, or can continue yearly screening.
79
breast cancer manifestations
hard
irregular shape
margins not deliniated
nonmobile
non tender
discharge
thickening
orange peel dimpling
80
purpose of bx for cancer
to determine if malignant or benign
81
tamoxifen use , MOA, AE
estrogen receptor antagonist
treats hormone positive breast cancer
blood clot, stroke, DVT, cataracts, endometrial cancer
82
after mastectomy pt should report
infection, uncontrolled pain, lymphedema
83
what is lymphedema
Accumulation of fluid in the tissue after excision of lymph nodes.
84
6 education for lymphedema prevention
No BP readings, venipunctures, or injections in affected arm
Arm should not be dependent for long periods
Prevent infection, burns, or compromised circulation
Exercise and maintaining normal weight
Wear compression sleeve as directed
Perform arm exercises as directed
85
how often should pt come back after masrectomy
1 year check
86
3 goals of cancer tx
cure, control (no hope of cure but better quality of life), and palliation (comfort)
87
when cure is the goal, what tx is offered
expected to have the greatest chance of disease eradication and may involve local therapy (i.e., surgery or radiation)
88
emphasis of palliative tx
on minimizing treatment-related toxicity to the greatest extent possible. - relieve s/s of radiation and chemo
89
when is surgery used
eliminate or reduce risk of cancer in at-risk patients
90
benefits and risk of chemo
benefits:
risks: venous access problems, device- or catheter-related infection, extravasation, toxic to areas with high growth fractions , cannot distinguish between normal and cancer cells AKA causes pancytopenia
91
goal of chemotherapy
eliminate or reduce number of cancer cells
92
SE of chemo
pancytopenia - specifically in high GF areas like skin, GI, hair, nails, and BM
93
how to prevent infection, discomfort of chemo meds
use CVAD
94
safety considerations for chemo
can be absorbed through inhalation of particles through skin or droplets
95
how radiation works
Destroys cell’s ability to reproduce by damaging the malignant cell’s DNA causing cell death
96
brachytherapy
high dose internal radiation to a specific spot
97
what pt would benefit from brachytherapy
cervical cancer and prostate cancer
98
bracytherapy safety precautions
Time - limit amount spent in direct contact with client
Distance - small differences are critical
Shielding - employ when available, film badge monitoring
99
6 main big SE systems for radiation
Bone marrow suppression
Fatigue
GI problems
Integumentary and mucosal reactions
Pulmonary effects
Reproductive effects
100
most common SE of radiation and how to tx
myelosupression (reduced RBC and WBC) - give epoeitin alfa to stimulate RBC production and use filgrastim to stimulate neutrophil production
101
difference between radiation and chemo SE
with radiation (a local therapy) only bone marrow within the treatment field will be affected, whereas chemotherapy (a systemic therapy) affects bone marrow function throughout the body.
102
epoetin alfa - goal, use, 2 AE
hgb and hct rise over 2-3 weeks/ use lowest dose possible to not cause high hgb / hypertension and iron def anemia
103
5 GI effects of radiation
nausea, vomiting, diarrhea, mucositis, and anorexia
104
what to avoid when tx skin rxns
heating pads, ice packs, hot water bottles
105
4 pulmonary symptoms of chemo and radiation
cough, dyspnea, penumonitis, pulm edema
106
4 tx for pulmonary ss of chemo
bronchodilators, expectorants, bedrest, O2
107
6 ss of malnutrition
Fat and muscle depletion, protein and nutrient deficiencies, electrolyte depletion, dehydration, weight loss, impaired wound healing
108
if someone has 5% weight loss what is priority
nutritonal counseling
109
4 education for malnutrition
*Soft, nonirritating high-protein and high-calorie foods should be eaten throughout the day.
*Avoid extremes of temperature, as well as tobacco, alcohol, spicy/rough foods, and other irritants.
-Weigh the patient at least twice each week to monitor for weight loss.
-*Monitor albumin and prealbumin levels.
110
4 characteristics of cachexia(wasting syndrome)
Generalized tissue wasting
Skeletal muscle atrophy
Immune dysfunction
Metabolic abnormalities
111
best tx for wasting syndrome
tx the cancer, then nutritional supplements
112
where is tunneled catheter
tip in sup vena cava
113
what leukemia do kids have
acute lymphocytic
