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Adult Health Nursing II > Exam 5 > Flashcards

Exam 5 Flashcards

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1
Q

Red Blood Cells

A

Erythrocytes

Transport oxygen, take away carbon dioxide, produced in red bone marrow

Live about 120 days

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2
Q

White Blood Cells

A

Leukocytes

Help to fight off pathogens

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3
Q

Characteristics of Blood

A

45% blood cells (RBCs, WBCs, platelets)

55% blood plasma

pH: 7.35-7.45

Volume: 5-6 L

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4
Q

Hematopoiesis

A

Process that continuously occurs to replace the blood components

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5
Q

Hemostasis

A

Balance between clot formation and fibrinolysis

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6
Q

Erythropoiesis

A

Red blood cell production

Takes about 5 days

Erythropoietin is a hormone that originates in the kidneys

Needs: healthy bone marrow, dietary iron, protein, vitamins

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7
Q

Blood Plasma

A

Fluid left over after all cells are removed

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8
Q

Blood Serum

A

If you let the plasma clot and then take away the rest, the serum is left

Does not have fibrinogen or clotting factors

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9
Q

Albumin

A

Given routinely to expand the volume of the blood

Major component of osmotic pressure of plasma

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10
Q

Reticulocyte

A

Immature red blood cell

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11
Q

Schistocytes

A

Irregular fragments of red blood cells

“Helmet Cell”

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12
Q

Polycythemia

A

Increased RBCs

Occurs with chronic hypoxia (e.g. COPD)

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13
Q

Bone Marrow

A

Site of hematopoiesis

Stem cells are primitive cells

Myeloid (erythrocytes, leukocytes, platelets)

Lymphoid (T or B lymphocytes)

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14
Q

Stroma

A

Supportive structures that do not directly produce cells but are there for everything else that needs to be done

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15
Q

Hematological Assessment

A

Ethnic and family history
Nutritional history
Medications
Symptoms and impact on functional ability
Assess bruising, unexplained bleeding, blood counts

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16
Q

Normal RBC Count

A

Males: 4.5-6.2 million cells/uL
Females: 4.0-5.5 million cells/uL

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17
Q

Normal Hemoglobin/Hematocrit

A

Males: 13-18 g/dL and 42-52%

Females: 12-16 g/dL and 35-47%

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18
Q

Normal WBC Count

A

4.5-11 cells/mm3

Differential: neutrophils, bands, eosinophils, basophils, lymphocytes, monocytes

“Shift to the Left” = increased immature neutrophils

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19
Q

Normal Platelet Count

A

150,000-450,000 cells/mm3

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20
Q

Bone Marrow Aspiration and Biopsy

A

Common site is iliac crest

Risk of rebleeding, risk of infection

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21
Q

Anemia

A

Hemoglobin concentration that is below normal

Not a disease, but a sign of underlying disorder

Most common hematologic condition

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22
Q

Hypoproliferative Anemia

A

Impaired production of RBCs

Tumor, bone marrow suppression, lack of EPO, long-term iron deficiency, lack of vitamin B12 and folic acid

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23
Q

Hemolytic Anemia

A

Increased destruction of RBCs

Increased bilirubin and reticulocytes

Sickle cell anemia, toxic chemicals, mechanical heart valves

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24
Q

Severity, Development, Complications of Anemia

A

Severity depends on how active the patient is; usually don’t show symptoms until less than 8

Slow development may indicate compensation (tachycardia, SOB)

Complications include heart failure, heart attack, paresthesias, confusion/delirium

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25
Q

Medical Management of Anemia

A

Treatment depends on the cause

Correct or control the cause

Supplementation and foods

Recombinant erythropoietin

Transfusions

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26
Q

Gerontologic Considerations for Anemia

A

Most common hematologic condition

Decreased mobility, increased depression, increased risk of falling, increased risk for delirium

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27
Q

Manifestations of Anemia

A

Fatigue, weakness, malaise, pallor

Jaundice

Tongue changes

Brittle, rigid, concave nails

Angular cheilosis

Stomatitis, pica

Cardiac and respiratory symptoms

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28
Q

Pernicious Anemia

A

Central and peripheral nervous system problems (paresthesia, ataxia) related to vitamin B12 deficiency needed for myelin production

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29
Q

Nursing Interventions for Anemia

A

Balance rest and activity, assist with ADLs as needed, prevent injuries associated with confusion/dizziness/weakness, encourage slow change of positions, orthostatic hypotension studies, discourage hot baths, turn q2h, try to keep them warm, look at nutrition

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30
Q

Nutrition for Anemia

A

Iron-Rich Foods (red meats, organ meats, whole wheat products, spinach, carrots)

Folic Acid Sources: green vegetables, liver citrus fruits

Vitamin B12: glandular meats, yeast, green leafy vegetables, milk and cheese

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31
Q

Oral Iron Use

A

Take iron on an empty stomach

Vitamin C increases absorption

If liquid, use straw and perform oral care

Stools may turn black

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32
Q

IM Iron Use

A

Z track method, air bubble

Do not use deltoid muscle, do not massage

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33
Q

IV Iron Use

A

Risk for anaphylaxis; may need test dose

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34
Q

Hypoproliferative Anemia Types

A

Iron deficiency anemia (most common)

Anemia in renal disease

Anemia of chronic disease

Aplastic anemia (decrease in bone marrow function)

Megaloblastic anemia

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35
Q

Aplastic Anemia

A

Decrease in bone marrow function

Primary (congenital–30%) and Secondary (infection, medication, chemicals, radiation, chemotherapy, AI)

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36
Q

S/S of Aplastic Anemia

A

Pancytopenia

Repeated infections related to decreased leukocytes

Fatigue, weakness, malaise

Dyspnea, palpitations

Bleeding tendencies

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37
Q

Treatment of Aplastic Anemia

A

Identify and remove cause

Reverse isolation, antibiotics

Platelet transfusion due to bleeding

Splenectomy

Immunosuppression (androgens, antithymocyte globulin)

Bone marrow transplant

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38
Q

Nursing Interventions for Aplastic Anemia

A

Prevent infections

Prevent hemorrhage

Keep warm

IV for hydration

Respiratory support (positioning, oxygen)

Skin care

Rest

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39
Q

Megaloblastic Anemia

A

Anemia caused by deficiencies of vitamin B12 or folic acid (both necessary for DNA synthesis)

RBCs are abnormally large

Pancytopenia

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40
Q

Vitamin B12 Deficiency Causes

A

Inadequate diet

Faulty absorption from the GI tract (Crohn’s, ileal resection, bariatric surgery, gastrectomy, PPIs, glucophage)

Absence of intrinsic factor (pernicious anemia, higher rate of gastric cancer)

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41
Q

S/S of Pernicious Anemia

A

GI (diarrhea, smooth red tongue)

Neurological: paresthesia, loss of proprioception

Vitiligo, premature graying

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42
Q

Treatment of Pernicious Anemia

A

Vitamin B12

Folic acid supplement

Iron replacement, RBC transfusion

Teach that diet cannot correct this problem, need periodic blood levels drawn

Diet high in protein, vitamins, and minerals

All anemia nursing interventions apply

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43
Q

Hemolytic Anemias

A

Life of RBC is shortened (increased reticulocytes and indirect bilirubin)

Inherited causes: sickle cell anemia, thalassemia, hereditary hemochromatosis

Acquired causes: immune hemolytic anemia, heart valve hemolysis, hypersplenism

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44
Q

Sickle Cell Anemia Precipitating Factors

A 
Dehydration
Overexertion
Infection
Cold
Alcohol
Smoking
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45
Q

Signs/Symptoms of Sickle Cell Anemia

A

Anemia (7-10 hgb always present)

Enlarged bones of the face and skull

Tachycardia, cardiac murmurs, enlarged heart, dysrhythmias, and heart failure

Thrombosis of any organ

Jaundice, PAIN

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46
Q

Complications of Sickle Cell Anemia

A

Infection, stroke, renal failure, impotence, heart failure, pulmonary hypertension

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47
Q

Vaso-Occlusive Crisis

A

Vessels are occluded, leads to lack of oxygenation, swelling, abdominal pain, fever

Need oxygen and pain medicine

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48
Q

Aplastic Crisis

A

Triggered by a viral infection or depletion of folic acid

Anemia worsens

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49
Q

Sequestration

A

Spleen is full of blood products

Causes problems in the liver and lungs

Fluids, rest, oxygen, pain medication

50
Q

Acute Chest Syndrome

A

Respiratory distress, fever, increased RR, coughing/wheezing, infiltrates on the CXR

Need antibiotics

51
Q

Pulmonary Hyptertension

A

Often the cause of death related to sickle cell anemia

Symptoms don’t show up clearly until the damage is already done

Damage is irreversible

Present with problems breathing, heart failure, microvascular occlusions throughout the pulmonary system leading to diminished perfusion of the lungs

52
Q

Treatment of Sickle Cell Anemia

A

HSTC
Medications (Hydroxyurea, Arginine, pain medication)
Oxygen, rest, fluids

Increased need for folic acid, protein, calcium, vitamins

53
Q

Education for Sickle Cell Anemia

A

Encourage genetic testing, avoid high altitudes, avoid dehydration and extreme temperatures, avoid iced liquids and vigorous exercise

Pregnant women are at high risk for complications

54
Q

Thalassemias

A

Group of hereditary anemia

Defective synthesis of hemoglobin which leads to hemolysis of the blood

55
Q

Treatment of Thalassemias

A

Blood transfusions
Bone marrow transplantation
Splenectomy

Encourage genetic counseling, prompt medical treatment for infections

56
Q

Immune Hemolytic Anemia

A

Exposure to antibodies

Caused by hemolytic transfusion reaction, dysfunctional immune system

57
Q

S/S of Immune Hemolytic Anemia

A

Depends on severity of anemia

Fatigue, dizziness, organs swelling, lymphadenopathy, jaundice

58
Q

Treatment of Immune Hemolytic Anemia

A

Remove any identified cause

Corticosteroids, splenectomy, immunosuppressive drugs (last ditch effort)

59
Q

Hypovolemic Anemia

A

Caused by losing blood

Severity depends on how much blood is lost

60
Q

S/S of Hypovolemic Anemia

A

Thirst, weakness, irritability and restlessness, stupor, mental disorientation, physical collapse, pale clammy skin, decreased temperature, urine output decreased

Low BP, increased RR, increased HR, increased pain

61
Q

Treatment of Hypovolemic Anemia

A

Elevate lower extremities, oxygen, replace fluid loss, give albumin or dextran or LR, encourage iron

Keep track of intake and output; minimum of 30mL/hour of urine output

62
Q

Blood Transfusions

A

Type and Cross match; 2 nurses must double check your numbers

Whole blood: 450mL
Packed RBCs: 300-350mL, concentrated hematocrit
Platelets: 50-70mL
Plasma: helps treat shock and has coagulation factors, 200mL
Albumin helps to get blood pressures up

63
Q

Polycythemia

A

Too many red blood cells, blood volume increases

Primary/polycythemia vera: malignancy problem

Secondary: hypoxia-driven polycythemia

64
Q

Pathophysiology of Polycythemia Vera

A

Hyperplasia in the bone marrow; increase in circulating erythrocytes, granulocytes, and platelets

Increased risk for infections because of increased immature circulating granulocytes

Increased risk of infarctions due to sluggish circulation

Multi-organ system problem

65
Q

S/S of Polycythemia Vera

A

Ruddy appearance, increased BP, problems with angina/chest pain/heart failure, extra clot formation, thrombophlebitis, venous distention, bleeding problems, esophageal varices, nosebleeds, GI bleeds, petechiae, hepatomegaly and splenomegaly, itching, headache, ringing in the ears, painful burning of hands and feet

66
Q

Diagnostic Tests for Polycythemia Vera

A

Elevated

CBC, alkaline phosphate levels, uric acid levels, histamine levels

67
Q

Treatment of Polycythemia Vera

A

Phlebotomy (1-2 times a week every week for years, 500mL-2L of blood)

Medications: chemotherapy, interferon alpha 2-b, low-dose aspirin, allopurinol

Avoid smoking and high altitudes, avoid foods high in iron

68
Q

Pathophysiology of Agranulocytosis

A

Acute problem, potentially fatal blood disorder characterized by profound neutropenia (<2000/mm3)

Caused by chemotherapy, drug toxicities/hypersensitivities, radiation, hereditary components, viral/bacterial infections

69
Q

Neutropenia

A

Fever would be a significant response

Treatment depends on the cause

Remove the cause of the bone marrow suppression

Prevent or treat infections

NEUPOGEN GIVEN SUBQ OR IV

70
Q

Failure in Platelet Production

A

Localized bleeding, petechiae

71
Q

Failure in Coagulation Factor

A

Bleeding deeper in the body

External bleeding diminished slowly

72
Q

Bleeding Precautions

A

Avoid aspirin and aspirin-containing products, as well as alcohol

No suppositories, enemas, or tampons

Prevent constipation, vigorous sexual intercourse, anal sex, contact sports, and aggressive manual labor

Use electric razor for shaving and a soft toothbrush

73
Q

Secondary Thrombocytosis

A

Increased platelet production

Platelet function is normal

Reactive Increase: infection, chronic inflammatory disorders, iron deficiency, malignant disease, acute hemorrhage, and splenectomy

74
Q

Thrombocytopenia

A

Decreased thrombocyte production, aplastic anemia, leukemia

Increased destruction: immune thrombocytopenic purpura

Increased consumption: disseminated intravascular coagulation

S/S include petechiae/purpura, ecchymosis

Watch for CNS bleeds, epistaxis, spontaneous GI bleeds

75
Q

Treatment of Thrombocytopenia

A

Treat the underlying cause

Platelet transfusions

Splenectomy: often not an option

Bleeding precautions

76
Q

Immune Thrombocytopenic Purpura

A

Body destroys the platelets

Pharmacological management includes corticosteroids, gamma globulin, and immunosuppressive therapy

Splenectomy is helpful 50% of the time

77
Q

Platelet Defects

A

Number of platelets normal, but do not function well

ASA: inhibits platelet function (7-10d)

NSAID: inhibits platelet function (4d)

End Stage Renal Disease: metabolic products produced affect platelet function

78
Q

Pathophysiology of Hemophilia

A

Lack of clotting factors

Genetically induced

Hemophilia A: factor VIII deficiency

Hemophilia B: factor IX deficiency

Common in boys

79
Q

S/S of Hemophilia

A

Chronic, crippling pain

Internal and external bleeding

Hemiarthrosis: ankylosis

Excessive blood loss from small cuts and dental procedures

80
Q

Treatment of Hemophilia

A

Minimize bleeding and avoid trauma

Relieve pain (NO ASPIRIN)

Transfusions (Factor VIII or IX concentrate, Cryoprecipitate, manufactured factor VIII or IX)

81
Q

Pathophysiology of Von Willebrand’s Disease

A

Disorder of coagulation; slow coagulation, spontaneous bleeds

Deficiency in Factor VIII

Common in girls

82
Q

S/S of Von Willebrand’s Disease

A

Bleeding tends to be mucosal

83
Q

Acquired Coagulation Disorders

A

Liver disease
Vitamin K deficiency
Complication of Anticoagulant Therapy: vitamin K antidote for Warfarin toxicity, protamine sulfate for Heparin toxicity

84
Q

Acquired Coagulation Disorders

A

Liver disease
Vitamin K deficiency
Complication of Anticoagulant Therapy: vitamin K antidote for Warfarin toxicity, protamine sulfate for Heparin toxicity

85
Q

Pathophysiology of DIC

A

Overstimulation of clotting and anti-clotting processes at the same time

86
Q

S/S of DIC

A

Compromised organ function

Bleeding, hemoptysis, dyspnea, diaphoresis, cold mottled digits, purpura, petechiae

87
Q

Lab Values with DIC

A

Low platelets and fibrinogen

Prolonged PT, aPTT and thrombin time

Elevated fibrin degradation products and D-dimer

88
Q

Chronic Myeloid Leukemia

A

Mutation in myeloid stem cell

Uncontrolled proliferation of cells

May be asymptomatic

May be cured with stem cell transplant

89
Q

Pathophysiology of Leukemia

A

Malignant disorder of the lymph nodes and the bone marrow

Excessive immature leukocytes that accumulate in the bone marrow and lymph nodes

Lead to problems with anemia (decreased RBCs), bleeding (decreased platelets), infection (immature WBCs)

Diagnosis based on blood count, bone marrow biopsy, CXR

90
Q

Acute Myeloid Leukemia

A

Develops without warning over a period of weeks

S/S from insufficient production of normal blood cells

Lymphadenopathy or splenomegaly rare

Immature blast cells on marrow biopsy

Bleeding and infection are major causes of death

High mortality, can happen in young people

91
Q

Chronic Myeloid Leukemia

A

Mutation in myeloid stem cell

Uncontrolled proliferation of cells

May be asymptomatic

May be cured with stem cell transplant

Thrombocytopenia, death in less than 5 years

92
Q

Acute Lymphocytic Leukemia

A

Results from uncontrolled proliferation of immature cells (lymphoblasts)

Common in young children

Very responsive to treatment

50% cure rate

93
Q

Chronic Lymphocytic Leukemia

A

Common in older adults

Most common form of leukemia in the US

S/S include lymphocytosis, enlarged lymph nodes, splenomegaly

B symptoms (fever, drenching sweat especially at night, unintentional weight loss, life-threatening infections common as disease advances)

Remission in 70% of people

94
Q

Treatment of Leukemia

A

Leukeran, Hydroxyurea, Corticosteroids, Cytoxan

Chemotherapy, radiation

Bone marrow transplant

95
Q

Lymphomas

A

Neoplasms of cells of lymphoid origin

Hodgkins or Non-Hodgkins

96
Q

Hodgkin’s Lymphoma

A

Reed-Sternberg cells

S/S include enlargement of cervical lymph nodes, anorexia, weight loss, pruritus, low-grade fever, night sweats, anemia, leukocytosis

Later: all organs susceptible to invasion of tumor cells, splenomegaly, bone pain

97
Q

Treatment of Hodgkin’s Lymphoma

A

Goal is to cure

Chemotherapy with radiation

Most are cured or have a long remission

Risk of second cancer elevated by 26%, most of which are leukemia (82%)

98
Q

Non-Hodgkin’s Lymphoma

A

No Reed Sternberg cells

S/S include enlarged cervical lymph nodes, fever, susceptibility to infection and bleeding, night sweats, weight loss, anorexia, cachexia, anemia, pruritus, fatigue, malaise, facial swelling

99
Q

Diagnosis of Multiple Myeloma

A

BENCE JONES PROTEIN

100
Q

S/S of Multiple Myeloma

A

Bone pain, pathological fractures

Infection, weight loss

Anemia, bleeding

Hypercalcemia, renal failure

101
Q

Pathophysiology of Multiple Myeloma

A

Malignancy

Excessive number of abnormal plasma cells invade the bone marrow, which leads to tumor formation, destruction of the bone, invasion of the lymph nodes, spleen, and liver

102
Q

Treatment of Multiple Myeloma

A

Symptomatic; not curable

Corticosteroids, analgesics

Radiation, chemotherapy

IV fluids

103
Q

S/S of Multiple Myeloma

A

Bone pain, pathological fractures

Infection, weight loss

Anemia, bleeding

Hypercalcemia (lethargic, weak, confused, depressed), renal failure

Nurses should encourage fluids to flush out the kidneys

104
Q

Common Symptoms of Leukemia

A

Weight loss, fever, frequent infections

Easy SOB, weakness, pain or tenderness in bones/joints

Fatigue, loss of appetite, swelling of lymph nodes, splenomegaly/hepatomegaly, night sweats, easy bleeding and bruising, purplish patches/spots

105
Q

Blood Transfusions

A

Type and cross match

106
Q

Whole Blood

A

450mL

107
Q

Packed RBCs

A

Last for 42 days, spin off of the plasma

300-350mL

108
Q

Platelets

A

Last for 5 days

Taken from different people and put together

50-70mL

109
Q

Fresh Frozen Plasma

A

Can last for up to a year

200-250mL

110
Q

Cryoprecipitate

A

Corrects fibrinogen deficiencies

About 20mL

111
Q

Albumin

A

Does not have to go through a filter

Increases blood volume in the vascular system

Different volumes

112
Q

Dextran

A

Reduces blood viscosity

Used to prevent clotting

113
Q

Type AB

A

Universal recipient

114
Q

Type O

A

Universal donor

115
Q

Nursing Care for Blood Transfusions

A

Need a permit and baseline vital signs

Licensed person collects from lab and checks info

RN and one other licensed nurse checks before transfusion

18 gauge needle and 0.9 NS

Given over 4 hours

116
Q

Transfusion Complications

A

Circulatory overload

Febrile reaction

Allergic reaction

Hemolytic reaction

117
Q

Circulatory Overload

A

Difficulty breathing, cyanosis, pink frothy sputum, distended neck veins, full bounding pulses

Stop the transfusion, call the doctor

118
Q

Febrile Reaction

A

See temperature elevation

Most common transfusion complication

Stop transfusion, start a normal saline line, call the doctor, take more vital signs

119
Q

Allergic Reaction

A

Starts within 30 minutes

Laryngeal edema, hives

Stop the transfusion, call the doctor, start a saline line, take vital signs, give an antihistamine

120
Q

Hemolytic Reaction

A

Blood is incompatible; most dangerous

Occurs within 10 minutes

Burning along the vein, itching, fever, chills, nausea, chest pain, red urine, vascular collapse

Stop the infusion and call the doctor, monitor vital signs, give oxygen

121
Q

Tips for Blood Transfusions

A

Never give meds through a blood line

All blood products must be administered using filtered transfusion administration set except for albumin

Nurse needs to make sure consent is signed

Adult Health Nursing II (22 decks)

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