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Mans - Dr. Thompson exam 3 > Exam 4: Mon 11/30 Hematologic disorders > Flashcards

Exam 4: Mon 11/30 Hematologic disorders Flashcards

1
Q

What are some exaggerated responses to minimal exercise?

A
  • Chest pain
  • Palpitations
  • Dyspnea
  • Severe weakness
  • Fatigue
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2
Q

Neurological symptoms include:

A
  • Headache
  • Drowsiness
  • Dizziness
  • Syncope
  • Polyneuropathy
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3
Q

What are some common S&S of Hematologic Disorder?

A
  • Skin and fingernail bed changes (cyanosis, clubbing)
  • Swelling, pain in joints
  • Exaggerated response to minimal exercise (dyspnea, chest pain, palpitations, severe weakness, fatigue)
  • Easy bruising
  • Neurological symptoms (headache, drowsiness, dizziness, syncope, polyneuropathy)

What the PT may have SSEEN in the patient.

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4
Q

What is Edema?

A

Excess fluid in interstitial tissues or body cavities

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5
Q

What is Congestion?

A

excess blood within vessels of an organ or tissue

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6
Q

What is an Infarction?

A

Area of necrosis

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7
Q

What is a Thrombus?

A

A solid mass of clotted blood

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8
Q

What is Lymphedema?

A

A Hematolymphatic disorder, obstruction of lymph vessels or nodes

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9
Q

What is Purpura?

A

A Hemorrhagic condition in which there is insufficient platelets to plug leaking vessels, blood moves under skin and through mucous membranes, producing spontaneous ecchymoses (bruises) or petechiae

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10
Q

What is Petechiae?

A

Small red pataches on skin

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11
Q

What is Thrombocytopenic purpura?

A

A decrease in circulating platelets, acute bleeding from any body orifice

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12
Q

When does Shock occur?

A

When the cardiovascular system fails to perfuse the tissues adequately

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13
Q

What are some effects of shock? (what it leads to)

A
  • Impaired cellular metabolism
  • Impaired oxygen use
  • Impaired glucose use
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14
Q

Manifestations of Shock:

A

Manifestations vary based on stage but often include

  • Altered mental status (AMS)
  • ↓ pulses and urine output
  • Increased respiratory rate
  • Tachycardia
  • Cool extremities
  • Hypotension

Make A last DITCH effort to save the patient in shock.

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15
Q

What are some types of Shock?

A
  • Cardiogenic –↓ cardiac output
  • Hypovolemic – loss of whole blood or interstitial fluid
  • Neurogenic – usually trauma to spinal cord or CNS, massive parasympathetic overstimulation and sympathetic understimulation
  • Anaphylactic – hypersensitivity/allergic reaction
  • Septic - infection
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16
Q

What is Cardiogenic Shock?

A

Decreased cardiac output

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17
Q

What is Hypovolemic Shock?

A

Loss of whole blood or interstitial fluid

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18
Q

Neurogenic Shock

A

Usually trauma to spinal cord or CNS, massive parasympathetic overstimulation and sympathetic understimulation

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19
Q

Anaphylactic shock

A

Hypersensitivity/allergic reaction

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20
Q

Septic shock

A

Infection

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21
Q

What is Lymphadenopathy?

A
  • Abnormal enlargement of lymph nodes
  • Should feel rubbery, mobile, small (≤1 cm)

https://www.youtube.com/watch?v=LjDAidSVs5A

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22
Q

What is Splenomegaly?

A

Splenomegaly present in many hematologic conditions, including:

  • Infectious mononucleosis
  • Hodgkin’s lymphoma, or
  • When spleen taking over for bone marrow and producing RBCs (extramedullary hematopoiesis

A palpable spleen indicates spleen pathology- should not be able to palpate the spleen

Palpating the spleen and liver (while we’re in the neighborhood…)

https://www.youtube.com/watch?v=d5XABa0tTyg

23
Q

What are some special considerations for Hematologic Disorders regarding changes in coagulation?

A

Changes in coagulation may ↑risk of thrombus, ↑ work for heart, breathing, tissue perfusion

24
Q

What are some special considerations for Hematologic Disorders regarding exercise and sports?

A

Exercise and sports – can ↑blood volume (plasma) immediately, and ↑erythrocytes over time

  • Blood doping through exogenous EPO – can ↑ blood viscosity and thrombus formation, risky process
25
Q

What are the 3 systems of the body that are linked in this section as we study blood

A
  1. hematological
  2. lymphatic
  3. immune
26
Q

True or False: We will see polycythemias much more commonly in our patients compared to anemias.

A

False

Anemias are more common

27
Q

What may occur during anaphylactic shock? (4)

A
  • loss of consciousness
  • hives
  • tongues swelling/ unable ot swallow
  • rapid swelling of throat tissues
28
Q

What is normovolemic?

A

a normal volume of blood in the body.

29
Q

What are some special considerations for Hematologic Disorders regarding platelet levels and exercise?

A
  • Platelet disorders – low platelets (40-60,000), keep exercise in low-load (1-2 lb.) resistance; OK for walk, bike, ADL
  • 20-40,000 range, low intensity and no resistance
  • Below 10,000, at risk for spontaneous bleed
30
Q

What are some special considerations for Hematologic Disorders regarding the spleen?

A
  • Splenomegaly usually associated with rapid destruction of blood cells
  • Follow clotting precautions (as in difficulty with clotting
  • Integrate breathing techniques and educate about avoiding injury (especially abdomen)
31
Q

What are some special considerations for Hematologic Disorders regarding blood pressure?

A

In general – any time systolic BP drops 20 points or more, accompanied by HR↑ 15 BPM or more, may indicate hypovolemia

  • Dehydration is most likely cause, or diarrhea, slow GI bleed
  • May be normovolemic but on antihypertensives
32
Q

What are recombinant human erythropoietin products and what are they good for?

A
  • pharmaceutical agents such as rHuEpo, EPO, Epogen developed through DNA technology
  • stimulate erythropoietin and elevate RBCs
  • Reduce need for human blood transfusions in clinical situations such as chronic renal disease, cancer-related anemia, or surgical procedures like joint arthroplasty
  • very important to certain religions such as Jehovah Witness
33
Q

7 possible reactions to a blood transfusion or blood products

A
  1. Febrile Nonhemolytic Reaction
  2. Transfusion-Related Acute Lung Injury
  3. Acute Hemolytic Transfusion Reaction
  4. Delayed Hemolytic Transfusion Reaction
  5. Allergic Reaction
  6. Anaphylaxis
  7. Septic Reaction
34
Q

What is a Febrile Nonhemolytic Reaction? (5)

A
  • occurs in <1% RB and 30% platelet transfusions
  • Reaction of either donor leukocyte cytokines, or alloantibodies of recipient
  • Stop the transfusion, administer antipyretics or corticosteroids
  • Usually transient
  • S/S: fever, chills, HA, GI upset, hypertension, tachycardia
35
Q

What is Transfusion-Related Acute Lung Injury? (3)

A
  • occurs in 1 in 2000 transfusions
  • Ranges from mild SOB to Adult Respiratory Distress Syndrome (ARDS)
  • S/S: pulmonary edema, acute respiratory distress, severe hypoxia
36
Q

What is Acute Hemolytic Transfusion Reaction? (4)

A
  • 1 in 25,000
  • ABO incompatibility (blood type, ex: I’m O+)
  • Can be fatal or result in DIC, renal failure, severe hypotension
  • S/S: fever, chills, GI upset, flank/ abdominal pain, HA, dyspnea, hypotension, tachycardia, red urine
37
Q

4 points about Delayed Hemolytic Transfusion Reaction

A
  • Donated erythrocytes quickly removed by recipient’s alloantibody
  • May occur 1-4 weeks post transfusion
  • Often asymptomatic, just no boost from transfusion
  • S/S: unexplained anemia, jaundice, increased LDH level
38
Q

3 points regarding allergic reactions to donated blood products

A
  • typically it is a reaction to Donated Plasma
  • Treated by antihistamines, corticosteroids
  • S/S: hives, rash, wheezing, mucosal edema
39
Q

3 points regarding anaphylaxis with donated blood products

A
  • occurs in 1 in 20,000-50,000
  • Treated as shock protocol
  • S/S abrupt hypotension, edema of larynx, difficlty breathing, GI upset, shock, respiratory arrest

Ana makes the GRADES

40
Q

4 points about septic reactions with donated blood products

A
  • Result of bacterial contamination but rare due to improved lab screening
  • Hepatitis B or C infection resulting from septic transfusions has significantly decreased over the years
  • Treat per source of sepsis
  • S/S: fever, chills, hypotension, HA, back pain, chest pain, abdominal pain, SOB
41
Q

What is bloodless medicine and surgery? (4)

A
  • Techniques reduce need for blood products and are acceptable for religious groups, such as Jehovah’s Witnesses
  • Minimally invasive surgery (scopes, gamma knife, harmonic scalpel, argon beams)
  • Normovolemic hemodilution
  • Cell salvage techniques, retransfusing own blood – but can increase infection/hemolysis rates
42
Q

What is Normovolemic hemodilution?

A

remove person’s own blood and replace with intravenous crystalline/colloid solution to maintain volume; post-op, person’s own blood is returned

43
Q

What can PTs do when working with patients who underwent bloodless procedures? (2)

A
  • monitor lab values when treating patients
  • adjust treatment and intensity accordingly
44
Q

What is Hemochromatosis? Etiology? (6 total)

A
  • Autosomal recessive hereditary disorder
  • 1 out of 8-12 people is a carrier of one abnormal gene
  • Prevalence is likely higher, as disease is underdiagnosed
  • Excessive absorption of iron from small intestine
  • Onset of symptoms usually in 40-60 years of age
  • Primarily affects Caucasians of Northern European descent
45
Q

Signs and symptoms of Hemochromatosis (5)

A
  • Weakness
  • chronic fatigue
  • myalgia
  • joint pain
  • Abnormal bronzing of the skin
46
Q

Diagnosis and treatment of hemochromatosis (5)

A
  • Diagnosis – blood tests & liver biopsy
  • Treated by bleeding patient (phlebotomy, can be a blood donation)
  • Initial treatment may be 1 pint/week
  • Maintenance therapy - 1 pint/2-4 months for life
  • May need Interventions for flexibility, strength, assistive devices, splints, AD as a result of some of the secondary conditions that may develop
47
Q

Hemochromatosis may lead to (8)

A
  • Pancreatic damage and diabetes mellitus
  • Arthritis
  • Liver failure
  • Cardiac myopathy, CHF, arrhythmias
  • Thyroid deficiency – fatigue & weight gain
  • Damage to the adrenal glands – immune and electrolyte regulation problems
  • Arthropathy in 40-60% of cases
  • Calcium deposits, acute inflammatory arthritis
48
Q

A place I visited frequently when I lived in Chaio Hsi, Taiwan in 2001

A

It was just up the street from where I lived! And it for realsies looked just like the picture

49
Q

Things to consider regarding anemia and exercise (4)

A
  • Anemia will ↓exercise tolerance and may impair oxygenation
  • As anemia becomes more severe, may see ↑ cardiac output and ↓exercise tolerance, resulting in dyspnea, tachycardia, palpitations
  • Anemia impairs wound healing
  • B12 (pernicious) anemia may affect the nervous system
50
Q

Things to consider regarding anemia and exercise in specific patient populations

A
  • Monitor older adults for circulation issues, changes in cognitive functioning with exercise; sedentary lifestyle may be the result of self-imposed changes to accommodate diminished oxygenation or anemia
  • Young female athletes at risk for anemia, iron deficiency; may also have inadequate dietary intake
  • Chronic renal failure (CRF) – patients should exercise at lower intensities, VO2 max is about 20% lower than normal
  • Patients with both anemia and cardiovascular disease at higher risk for angina
51
Q

Detailed explanation regarding “decreased” platelet levels and NSAID use

(WARNING: you may fall asleep reading this)

A
  • Aspirin (ASA) and NSAIDs inactivate platelet cyclooxygenase, which is an enzyme needed for thromboxane A2 (platelet aggregation and arterial smooth muscle constrictor)
  • Single dose of ASA can suppress normal platelet aggregation for 48 hours – up to a week. It irreversibly inhibits COX, so platelets are inactivated for the rest of their lifespan (they live about 8 days)
    • This is why the platelet count is decreased – they’re technically there, but useless.
  • NSAIDs effects on COX are reversible, so effects on platelets are milder, such as bruising and skin bleeding – but still safer to D/C NSAIDs pre-op.
52
Q

What is Disseminated Intravascular Coagulation? AKA: DIC (5)

A
  • Overactivation of the clotting cascade, with paradoxical clotting and hemorrhage at the same time
  • Widespread deposition of fibrin in circulation, major organs
  • Common after shock, sepsis, OB/GYN complications, cancer, trauma
  • Early recognition and treatment has ↓ mortality rate
  • Patients will be in ICU; no PT during bleeding episodes, monitor lab values carefully to see when safe to mobilize patient
53
Q

Picture of DIC (oh jeesh, not that kind, get your mind out of the gutter)

A
54
Q

Supposedly, the only things we need to know about finger nails for this test (2)

A
  • pale nails can be a sign of anemia/malnutrition
  • bluish nails are indicative of insufficient oxygen.

Mans - Dr. Thompson exam 3 (8 decks)

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