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Complex Care 2 > Haematological Conditions & Infectious Diseases > Flashcards

Haematological Conditions & Infectious Diseases Flashcards

1
Q

What is the composition of blood

A

55% Plasma
45% Red blood cells (erythrocytes)
0.1% White blood cells (leukocytes)
0.17% Platelets (thrombocytes)

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2
Q

What is plasma made up of

A

91% water
7% proteins
2% other solutes

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3
Q

What is the formed elements of blood made up of

A

Platelets
White blood cells
Red blood cells

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4
Q

Explain: Plasma

A

liquid part of blood

  • pale yellow
  • is a colloid solution

Contains:

  • albumin
  • globulins
  • fibrinogen
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5
Q

Describe: Ethryrocytes

A
  • no nucleaus
  • made up of hemoglobin, lipids, ATP and carbonic anhydrase
  • They transport oxygen from lungs to tissues and carbon dioxide from tissues to lungs
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6
Q

Describe: Hemaglobin

A

Consists of:

  • 4 globin molecules: Transport carbon dioxide (carbonic anhydrase involved), nitric oxide
  • 4 heme molecules: Transport oxygen
  • Iron is required for oxygen transport
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7
Q

Define: Erythropoiesis

A

is the process by which new erythrocytes are made.

  • It is stimulated by a decrease in oxygen in the blood
  • detected by the kidneys
  • kidney’s then secrete hormone erythropoiesis.
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8
Q

List types of Leukocytes

A 
Neutrophils: 
Eosinophils: 
Basophils: 
Lymphocytes: 
Monocytes:
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9
Q

Define: Hemostasis

A

is the process by which bleeding is stopped, which prevents excessive blood loss

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10
Q

What are the 3 steps on Hemostasis

A

Vascular spasm: smooth muscle of blood vessel contracts and pinches off blood supply to area injured

Platelet plug formation: Platelets detect and adhere to injured site, band together and release contents, ADP makes platelets sticky so other platelets stick to existing ones creating a platelet plug

Coagulation or blood clotting: aim is to contain blood into a gel.

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11
Q

What determines the a blood groups Rh

A

If a D antigen is present: Rh Positive (85% population)

Id D antigen is not present: Rh Negative (15% population)

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12
Q

Explain: Beta-Thalamassaemia

A

a group of hereditary disorders characterised by a genetic deficiency in the synthesis of beta-globin chain

Symptoms:
Pallor 
Lethargy 
Poor appetite 
Developmental delay 
Failure to thrive 
Irritability, difficulty settling 
Splenomegaly, growth failure with bone changes, fractures and leg ulcers also develop during childhood 
Haemolytic anaemia
Carriers for β-thalassaemia are usually asymptomatic but may have mild hypochromic anaemia
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13
Q

Explain: Alpha-Thalassaemia

A

is caused my a mutation in the alpha gene of the hemaglobin molecule

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14
Q

If a woman tests positive for thalassaemia or has a known family history, what needs to happen

A

She needs genetic counselling

Partner needs to be tested

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15
Q

Explain: Sickle Cell Disease

A

is an autosomal receptive condition caused by a mutation in both copies of the β-(beta) globin genes

  • carriers have 50% chance of passing the mutated gene onto their infant
  • Most common inherited conditions of hemoglobin worldwide
Symptoms:
• Anaemia
• Failure to thrive
• Repeated infections
• Painful swelling of the hands or feet
• Infarction
• Asplenia
• Abdominal pain
• Chest pain
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16
Q

Explain: Sickle cell trait

A

(term to describe the carrier state) is caused by a mutation in one copy of the β-globin
- carriers are usually healthy

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17
Q

Explain: Sickle cell pregnancy, labour/birth and postantal management

A

The risk in pregnancy depends on whether the woman has sickle cell disease or the sickle cell trait

Pregnancy

  • Sickle cell trait women- not at risk of significant pregnancy problems.
  • Specialist management
  • Iron deficient anaemia, need suppliment
  • May experience frequent UTI.
  • Hyperemesis may cause dehydration
  • U/S (IUGR)

Labour/Birth

  • IV fluids
  • pain relief
  • At risk: premature birth, placental abruption
  • Mobilisation (immobility can cause sickle cell crises)
  • PPH risk

Postnatal

  • Monitor for PPH, dehydration, sickle cell crises
  • Baby: screening for SC
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18
Q

What are 3 causes of Anaemia

A
  • Inadequate production of erythrocytes: dietary, low bone marrow production, autoimmune reaction or disease
    Rapid destruction of erythroctes: liver disease, lupus, sickle cell disease, malaria
    Blood loss: gastrointestinal bleeding, haemophilia, haemorrhoids
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19
Q

Define: Coagulopathy

A

is any condition where there is impaired clotting ability

- inc. reduced ability or inability to clot and an extra ability to clot

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20
Q

What are the 2 main types of coagulopathy

A

Inherited: Autosomal dominant deficiencies
Aquired: occur in chronic disease state, after severe infection/viral infection, or with VitK deficiency

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21
Q

What is the diagnostic criteria for Thrombocytopaenia

A

Normal range: 150 000 to 450 000/ per microLitre

Diagnostic: <50 000
Signs and symptoms:
Petichiea
Bleeding gums
Nosebleeds
Malaise
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22
Q

Define: Thrombocytopaenia

A

is an abnormally low amount of thrombocytes (platelets)

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23
Q

What are some cause of Thrombocytopaenia

A

Decreased platelet production: Leukaemia, anaemia, viral infections, HIV
Increased destruction: Autoimmune diseases, Blood borne bacterial infection
Medication induced: Quinine, alcohol abuse, interferon, chemotherapy, sulphur antibiotics

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24
Q

List common pre-existing infectious diseases

A 
Herpes simplex
Hepatitis C
Hepatitis B
Sexually acquired
Rubella
Varicella Zoster
Recurrent urinary tract infection
Chlamydia
Helicobacter pylori
Group B streptococcus
25
Q

What are 4 organisms responsible for infections in pregnancy

A
  • Viral
  • Bacterial
  • Fungal
  • Protozoan
26
Q

What are 6 most common no-sexually transmitted infections

A
  • Urinary tract infections - bacteriuria
  • Bacterial vaginosis (BV)
  • Candidiasis
  • Group B streptococcus infection (GBS)
  • Hepatitis B & C
27
Q

What are 7 most common STIs

A
  • Chlamydia
  • Gonorrhea
  • Herpes simplex virus type 2 (genital herpes)
  • Human immunodeficiency virus (HIV)
  • Human papillomavirus (HPV)
  • Syphilis (Treponema pallidum)
  • Trichomoniasis
28
Q

Explain: UTI

A

Cause: often bacteria from the GI tract contaminating the perineal area

  • common causative organisms: coliforms especially Escherichia coli, Klebsiella pneumoniae and Proteus species

Asympomatic bacturia: occurs in 2-10% of the pregnant population. During pregnancy, if the bacteriuria is left untreated 20-30%% of women will develop symptoms of UTI or pyelonephritis

Symptomatic bacteriuria: occurs in another 1-1.5%. Women with a UTI history and current bacteriuria are 10 times more likely to develop symptoms during pregnancy than women without either feature

29
Q

What are the signs and symptoms of Acute cystitis infection and Kidney infection

A

Acute cystitis infection:
Frequency, dysuria, and urgency of urination or suprapubic or low back pain, haematuria

.Kidney infection: Pyelonephritis is usually present when fever, chills, nausea and vomiting, malaise and flank pain occur (CVAT)
- Incidence 1-2.5% with an increased risk of recurrence

30
Q

Explain: Management of UTI

A
  • Antibiotics as per organism sensitivity: 7-10 day course
  • Increase fluids 1.5-2 litres/day
  • void before and after intercourse to decrease the risk of recurrent UTI
  • Hygiene: perineal hygiene, cotton underwear, avoidance of scented soaps, avoid tight fitting clothes
  • Probiotoc intake while on antibiotic
31
Q

What are 3 main types of Vaginal/Vulva infections

A

Bacterial vaginosis: anaerobic bacteria which change the normal vaginal flora to a small amount of lactobacilli which would normally produce lactic acid and maintain an acid pH

Trichomoniasis: vaginal infection caused by Trichomonas vaginalis, a flagellate protozoan that is most commonly sexually transmitted

Candidiasis: fungal infection causing vulvitis, vaginitis and vaginal discharge.

32
Q

Explain: Bacterial Vaginosis in pregnancy

A

BV is present in up to 20% of women and the majority are asymptomatic

Main symptoms

  • thin, grey/white vaginal discharge,
  • may have increased vaginal discharge
  • characterised by a fishy odour after intercourse
  • Does not cause vaginal itching or dysuria

Effect on pregnancy

  • increases the risk of spontaneous abortion
  • PROM
  • TPL an LBW infants
  • May cause neonatal septicaemia and postpartum endometritis
33
Q

Explain: Management of Bacterial Vaginosis

A

Treatment: Antibiotics are highly effective. 7 day course of metronidazole (Flagyl) or oral clindamycin

34
Q

Explain: Trichomoniasis in pregnancy

A

Signs/Symptoms:

  • Constant perineal itching
  • vaginal discharge may be profuse
  • frothy, yellow/green or grey and have a foul odour
  • dyspareunia
  • mild dysuria and lower abdominal pain

Effect on pregnancy
- Implicated in PROM, LBW and preterm birth

35
Q

Explain: Management of Trichomoniasis

A

Treatment is for 5-7 days daily or in a large single dose of oral metrondiazole (Flagyl) and
- Treat the partner(s) too.

36
Q

Explain: Candidiasis in pregnancy

A

Is a commensal and is found in the flora of the mouth, GIT and vagina

  • Highest candidal colonisation rate in pregnancy is the third trimester with up to 50% of women affected

Signs/Symptoms

  • Vaginal and vulva irritation
  • pruritic
  • white curd like vaginal discharge
  • yeasty odour
  • dysuria and dyspareunia
37
Q

Explain: Management of Candidiasis (in pregnancy)

A

Treatment: Clotrimazole most commonly in a vaginal suppository or cream is used for 7 days at night to relieve the maternal symptoms and avoid occurrence of neonatal thrush. Also treat the partner

38
Q

List 4 Bacterial infections and common perinatal complications

A

Chlamydia
Gonorrhoea
Syphilis
Group B streptococcus (GBS)

Most common perinatal complications associated with bacterial STIs are preterm labour, PROM and LBW babies

39
Q

Explain: Chlamydia in pregnancy and management

A

Infection rates in pregnancy range from 2-30%.

Diagnosed: First pass U/A

Signs/Symptoms:
asymptomatic (60%), vaginal discharge, abnormal bleeding, abdominal pain, fever, PID

Treatment: erythromycin, clindamycin or single dose azithromycin

Effect on pregnancy:

  • Can cause amnionitis and postpartum endometritis
  • 70% babies born to mothers with chlamydia become infected
40
Q

Explain: Syphilis in pregnancy and management

A

Most women who have syphilis have no symptoms.

Diagnosis: Blood test. Syphilis can present as a primary genital ulcer, a rash of secondary syphilis or as a large number of serious conditions as part of tertiary syphilis, if left untreated

Treatment: single dose of 2.4 million units IMI benzyl penicillin

Effect on pregnancy:

  • infect fetus
  • spontaneous abortion
  • preterm birth
  • death
  • Untreated primary or secondary syphilis in pregnant women causes almost a 100% infection rate in the fetus
41
Q

Explain: GBS in pregnancy and management

A

is a naturally occurring Gram positive bacteria found in the rectovaginal flora of up to 25% of healthy women.

Treatment: Antibiotics in labour

Effects on pregnancy:

  • Asymptomatic bacteriuria
  • Intra-amniotic infection
  • Endometritis
  • Stillbirth
  • PROM
  • Cultured in a urine sample and UTI
  • Wound infections
  • Preterm labour/birth
  • Spontaneous miscarriage
  • Sepsis across the perinatal period
42
Q

List Viral infections

A
  • Human papillomavirus (HPV) types 6 & 11
  • Herpes simplex virus HSV-2 (genital herpes)
  • Cytomegalovirus (CMV)
  • Hepatitis B
  • Hepatitis C
  • Human Immunodeficiency Virus (HIV)
43
Q

Explain: Human papillomavirus (HPV) and management

A

Responsible organisms are human wart viruses.

Signs/Symptoms

  • most are asymptomatic
  • can be transmitted before lesions appear
  • Visible warty are fleshy coloured, pale pink or red, raised or flat and small or large

Effect on pregnancy

  • In pregnancy warts tend to proliferate and become friable during pregnancy
  • during delivery can cause pelvic outlet obstruction and severe haemorrhage related to lacerations of the friable condylomatous tissue.
44
Q

Explain: Genital Herpes (HSV-2) and management

A

Is a double stranded DNA virus. Is a chronic infection characterised by periods of remissions and exacerbations

Signs/Symptoms: 
May be local or systemic
- Intense pain
- Dysuria
- Occasional itching vaginal discharge 
- lymphadenopathy
- Viraemia: fever, headache, nausea, malaise and myalgia

Treatment:
Aciclovir (Zovirax) therapy continues to be the recommended treatment for HSV during pregnancy, as well as analgesia and topical anaesthetic gels
- Rest and good nutrition are recommedned to reduce possibility of outbreak

Effect on pregnancy:

  • PROM increases chance of neonatal herpes
  • Pre-existing herepes provides the fetus from infection due to maternal antibodies
45
Q

Explain: Hep B and management

A

Transmitted by blood and body fluids.
- The organism is extremely hardy and can live outside the body in dried blood or body secretions for up to one week or more

Signs/Symptoms

  • Pregnant women with acute hepatitis may be asymptomatic or
  • chronic low grade fever,
  • anorexia
  • fatigue
  • skin rashes
46
Q

Explain: HepC and management

A

Hepatitis C is an RNA virus and is currently the most common bloodborne infection

Sign/Symptoms
- Majority of people are asymptomatic until significant liver damage results

Effect on pregnancy

  • Avoid ARM and FSE in labour
  • avoid B/F if cracked or bleeding nipples, or if the mother is symptomatic with a high viral load.
47
Q

Explain: Rubella and management

A

Effect on pregnancy

  • When maternal infection/exposure occurs in the first trimester, fetal infection rates are nearly 80% and the risk of miscarriage
  • The risk of congenital defects after maternal infection is essentially limited to the first 16 weeks of gestation
  • Maternal infection early in pregnancy can lead to fetal death, LBW, deafness, cataracts, jaundice, congenital heart disease, microcephaly and intellectual disability

Treatment: Rubella Vaccination POST delivery

48
Q

Define: DIC

A

Disseminated Intravascular Coagulopathy

is:

  • primarily a thrombotic process
  • a systemic process producing both thrombosis and haemorrhage
  • also called consumption coagulopathy and defibrination syndrome.
49
Q

Explain: DIC in obstetrics

A

is always a secondary complication of a condition that initiates coagulation-promoting factors into the maternal circulation. 

These conditions include amniotic fluid embolism, placental abruption, missed abortion, retained fetus syndrome, placenta praevia (occasionally), preeclampsia / eclampsia and HELLP syndrome.

50
Q

List DIC risk factors/underlying causes

A 
Infection 
Cancer 
Trauma, burns, surgery and snake bite 
Pregnancy: 
- placental abruption  
- major haemorrhage  
- pre-eclampsia  
- retained dead fetus or placenta 
- amniotic fluid embolism 
- Placenta praevia
- Preeclampsia
- Eclampsia
- HELLP syndrome
51
Q

List Warning Signs of DIC

A
  • Profound haemorrhage
  • Blood fails to clot
  • Petechiae appear
  • Bleeding from womans: eye, nose, gums, vagina, venipuncture site, surgical/episiotomy site
  • Flank pain
  • Abdominal distension
  • Hypotension
  • Cool skin
  • Tachycardia
52
Q

Explain: Management of DIC

A
  • Identify and treat underlying cause
  • If actively bleeding: platelet transfusion, fresh frozen plasma
  • Use anticoagulants: to block thrombin and secondary fibrinolysis
  • Insert indwelling urinary catheter, ideally with a measuring chamber, and monitor urinary output 
  • Strict monitoring and recording of fluid balance
53
Q

Explain: Toxoplasmosis

A

Is caused by a paralytic infection typically found in cats whose gut has digested the parasite and excretes it oocytes in their faeces

Acquired through

  • Ingestion of undercooked meat
  • Not washing hands thoroughly after gardening or cleaning cat litter
  • Eating fruit and vegetables that aren’t washed
54
Q

Explain: Management of Toxoplasmosis in pregnancy, labour/birth, postnatal

A 
Complications:
First &amp; Second Trimester Acquired Infection 
- Miscarriage 
- Congenital hydrocephalus 
- Mental retardation 
- Deafness or blindness  
- Growth problems 
Third Trimester Acquired Infection 
- Retinochoroiditis develops later 
- Stillbirth

Signs:

  • Mostly asymptomatic in healthy women
  • Headache
  • Sore throat
  • Fever
  • Fatigue

Antenatal issues:

  • Educate on precautionary measures
  • If woman has glandular like fever- consider toxoplasmosis and test bloods for: IgV and IgM (immunoglobulins)
  • Pos: give Spiramycin

Labour/Birth issues:

  • Normal practice
  • If any fetal abnormalities consult paed and medical intervention required

Postnatal considerations:

  • BF is ok- however check compatibility of drug if being treated for infection before BF
  • Baby’s born to infected mothers are monitored closely by the paediatrician
55
Q

Explain: Cares and management required for a woman with ASD

A

Pregnancy issues:

  • If treated, problems unlikely
  • Specialised cardiac U/S for fetus needed
  • Possible cardiac decompensation/ cardiac failure

Labour issues:

  • Normal care if treated
  • If untreated:
    • anaesthetic r/v prior to labour
    • compression stockings/ anticoagulation considered if immobile
    • 2nd Stage: restricted time frame for active pushing
  • 3rd Stage: active management

Postnatal Issues:

  • Baby needs cardio screening
  • Standard contraception advice
  • Encourage ambulation: decrease risk of thromboembolic disease
  • follow up with cardiac specialist 6 weeks postpartum

Risks:

  • atrial fibrillation
  • heart failure
  • stroke
56
Q

Explain: Cares and management required for a woman with Complex Hypertension

A

Pregnancy issues:

  • increase surveillance (CTG and U/S)
  • aspirin therapy
  • U/A at each visit
  • PE bloods: FBC, U&E, LFT
  • Corticosteroids <34wks
  • Psychosocial support
  • Individual care plan
  • ?admit as in-patient

Labour/Birth issues:

  • EDB useful in conjunction w/ antihypertensive thereapy
  • AVOID ergometrine, NSAIDs
  • Oxytocin should be given slowly
  • Hourly BP
  • Continuous EFM

Postnatal issues:

  • close observations of BP
  • Repeat bloods
  • Continue meds until BP stable
  • Obstetric r/v at 6-8wks

Risks:

  • increase risk cardiovascular morbidity, hypertension, ischemic heart disease, stroke, VTE
  • Annual BP check recommended
57
Q

Explain: Cares and management required for a woman with Pyelonephritis

A

Possible indicators:

  • UTI signs and symptoms
  • dysuria
  • haematuria
  • bacteriuria (sympomatic)
  • severe right flank pain
  • costvertebral angle tenderness (CVAT)
  • Acute pyelonephritis may present with pyrexia, rigors, abdominal/flank pain, nausea and vomiting

Pregnancy issues:

  • U/A for diagnosis
  • Obs
  • Urgent r/v
  • Bloods: cultures, FBC, LFT’s, U&E’s
  • Abx
  • CTG
  • Pain relief
  • Cannulate and Fluids

Labour/Birth issues:

  • Possible preterm labour
    • Steroids
    • Cont. EFM
    • Fluids
  • UTI/Pyelonephritis in labour:
    • EFM
    • Abx
    • Regular voiding/monitor
  • if possible avoid IDC

Postnatal issues:

  • Paed r/v and U/S for reflux nephropathy
  • GP follow up
  • Renal follow up

Risks: Sepsis

58
Q

Explain: Management of UTI in pregnancy, labour/birth and postnatal

A

Pregnancy

  • U/A screen
  • Antibiotic therapy
  • Risk of LBW and preterm birth if not treated

Labour and Birth

  • Antibiotics
  • EFM (for tachycardia is mother symptomatic)
  • Regular voiding
  • Monitor for maternal pyrexia and tachycardia

Postnatal

  • neonate r/v for reflux nephropathy
  • GP 6wks

Complex Care 2 (8 decks)

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