final new info (blood, musculoskeletal, skin, cancer, EOL) Flashcards
(103 cards)
hematology - assessment - history
age related, clotting factors, drug use (bone marrow suppression meds, drugs causing hemolysis, drugs disrupting platelet action), nutrition status (diet, intake, protein rich/low protein, high fat, foods rich in vit K, iron deficient, alcohol), genetics/family hx (blood/clotting do, hemophilia, sickle cell, excessing bleeding/bruising)
hematology age related changes
↓ blood volume, ↓ plasma proteins (diet, liver malfunction), ↓ RBC/WBC produced, ↓ lymphocytes/antibodies to fight infection/immune response.
thick discolored nail beds, loss of hair, skin moisture and skin color changes in older adults w/ dryness, loss of turgor, pigment loss, yellowing of skin
hematology - assessment - current health problems (questions to ask)
bruising, bleeding, menstrual flow, exertional dyspnea, palpitations, weight loss, tinnitus, vertigo, sore tongue, fatigue! (anemia), trends of past month/months
hematology - assessment - physical
skin (nail beds, gums, conjunctiva, petechiae, ecchymosis, areas of poor circulation), head/neck (tongue, oral mucosa, sclera, lymph nodes), respiratory (rate, depth, fatigue w/ speaking - anemia = reduce tissue oxygen levels causing SOB and respiratory changes), CNS (CN, vit B12 deficiency, cognitive function, neuro checks), cardiovascular (weak pulses, thready, JVD, edema, BP), renal (hematuria, urine color, CKD → anemia), musculoskeletal (sternal/rib tenderness - leukemia, swelling or joint pain), abdominal (enlarged spleen and liver, chronic GI bleeding ulcer or poly)
hematology - assessment - diagnostic
XR (multiple myeloma or sickle cell: abnormal bone destruction), bone marrow aspiration and biopsy (invasive procedure, cells/fluids suctioned from the bone marrow w/ large bore needle - iliac crest or sternum, local anesthetic, sterile, post pressure
hematology - assessment - labs
CBC w/ RBC, reticulocyte count (bone marrow function), platelet (thrombocytopenia), bleeding and coagulation (clotting - PT, INR, PTT).
RBC
4.2-6.1
increased RBC/HGB/HCT
possible chronic hypoxia or polycythemia vera
decreased RBC/HGB/HCT
possible anemia or hemorrhage
HGB
12-18
HCT
37-52%
WBC
5,000-10,000
platelet
150,000-400,000
increased WBC
associated w/ infection, inflammation, autoimmune disorders, leukemia
decreased WBC
prolonged infection or bone marrow suppression
increased platelet
polycythemia vera or malignancy
decreased platelet
bone marrow suppression, autoimmune disease, hyperplenism
INR
0.8-1.1
increased INR
longer clotting time - thin blood (desirable for therapy w/ warfarin)
decreased INR
hyper coagulation and increased risk for VTE
PT
11-12.5 sec or 85-100%
increased PT
indicates possible deficiency of clotting factors V and VII
decreased PT
may indicate vitamin K excess
Sickle Cell Disease (SCD)
Genetic disorder in which a mutation in the gene causes chronic anemia, pain, disability, organ damage, infection risk due to poor perfusion. Autosomal recessive genetic d/o.
Risk factors = african american.
Assessment = Hx (long standing diagnosis and unaware of sickle cell trait w/ no symptoms until acute illness. Events leading up to symptoms - 24 hr prior including food, exposure, stress, injury - energy level, SOB w/ exertion), psychosocial (behavior/cognitive changes d/t poor perfusion), physical (pain, high risk for HF/pulmonary HTN/pneumonia, murmurs, S3, JVD, ↑ HR, hypotension, pallor, cyanosis, jaundice, severe abdominal pain, spleen and liver ischemia, CKD, proteinuria, joint pain, leg/arm pain, fever, seizure, stroke).
Labs = hemoglobin S on electrophoresis (80-100%), RBC, ↓ Hct, ↑ reticulocyte, ↑ bilirubin, EBC (chronic inflammation, hypoxia, ischemia).
Diagnostic = XR joints, US, PET, MRI, ECG, ECHO.
Priorities = pain d/t poor perfusion, joint destruction w/ low oxygen levels, high risk for infection/sepsis/MODS.
Interventions = O2, pain, hydration, HOB 30 degrees or less, extremities extended (venous return), drugs (endari which increases RBC & decreases sickling rates - crizanlizumab which helps platelets and RBC adherence), 3-4L fluid daily.