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NUR 440 Exam 3 > Hematologic Disorders > Flashcards

Hematologic Disorders Flashcards

1
Q

Anemia

A

RBC count is low

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2
Q

Polycythemia

A

RBC count is high

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3
Q

Agranulocytes

A

Lymphocytes: increased with infections
Monocytes: in chronic conditions

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4
Q

Granulocytes

A

Neutrophils: acute inflammation, bacterial infection
PMN: indicates infections
Bands: immature neutrophils
Eosinophil: allergic reactions
Basophils: healing phase of inflammation and hay fever

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5
Q

Platelets

A 
Used to stop bleeding
Made in bone marrow
Stored in spleen
Life span 8-10 days
150,000 - 300,000 is normal
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6
Q

Thrombocytopenia

A

Decreased platelet count from a bleeding disorder

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7
Q

Intrinsic pathway

A

Released by plasma

PTT measures abnormalities for pts on heparin

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8
Q

Extrinsic Pathway

A

Released by the injured tissue

PT measures abnormalities for pts on warfarin

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9
Q

Immunoglobulins

A

IgM - First responder, 2-3 days
IgG - Day 4-10, last for a new weeks
IgA - Located in GI tract, respiratory tract, and GU tract. Prevents adherence
IgE - Allergic response

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10
Q

T-Helper (CD4)

A

Involved in immune surveillance, stimulate B- lymphocyte production
CD4 count - HIV

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11
Q

T-Suppressor

A

Supresses production of immunoglobulins against specific antigens and prevents overproduction
Body fails to recognize self

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12
Q

T-Cytoxic

A

Aid in destroying viral, fungal, protozoan and some bacteria
Goes out and eats the cells

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13
Q

Natural Killer

A

Migrate to blood and spleen and aid the Tcells

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14
Q

Risk for Infection

A

Good hand washing, monitor VS, antibiotics, G-CSF to stimulate granulocytes
Aseptic technique for all procedures, insure good nutrition, and monitor CBC and WBC
Teach prevention!

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15
Q

Imbalanced Nutrition: Less Than

A

Promote nutrition with small high calorie feeds and maintain fluid balance
Dietary management, iron fortified formula for infants
Older child with PICA – eat ice

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16
Q

Risk for Injury: Bleeding

A

SAFETY!
Assess CNS, joints, GI/GU bleeding. Recognize and control bleeding
NO ASA or NSAIDs, IM injections
Give factor replacement
Platelets <50-100,00 limit contact sports, no bike riding, skateboarding, or climbing
Encourage quiet activity

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17
Q

Activity Intolerance

A

Assess color of skin and mucus membranes
Allow periods of rest
In bed activities
Good nutrition

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18
Q

Risk for Disturbed Body Image

A

Provide emotional support and allow them to discuss feelings

Have teens talk to someone with their condition

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19
Q

Impaired Physical Mobility

A

Promoting mobility is key
Physical therapy!!
Encourage ADL’s
Protect the joint

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20
Q

Caregiver Role Strain

A

May need to evaluate family coping
Provide emotional support and allow families to verbalize feelings
Parents may have guilt for being a carrier

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21
Q

Knowledge Deficit

A

Use a family approach
Teach disease process
Identify and avoid triggers
Treatment regimen

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22
Q

3 Types of Anemia

A 
Microcytic and Hypochromic
Normocytic and Normochromic
Macrocytic -- Rare
MCV- the size
MCH- the color, dependent on amount oh Hgb
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23
Q

3 Causes of Anemia

A

Increased RBC destruction
Increased RBC loss
Decreased RBC production (aplastic anemia)

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24
Q

Iron Deficiency Anemia

A

Low MCV, MCH
Serum Feritin is low
Fatigue, pale, irritable
Underweight or overweight from too much milk

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25
Q

Increased RBC Destruction S/Sx

A 
Pallor
Tachycardia, Heart Murmur
Fatigue, HA
Muscle Weakness
Frontal Bossing
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26
Q

Increased RBC Loss S/Sx

A 
Jaundice
Fatigue, HA
Dark Urine
Enlarged spleen and liver
Low BP
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27
Q

Decreased RBC Production S/Sx

A 
Pallor
Fatigue, HA
Muscle Weakness
Cool skin
Tachycardia
Decreased peripheral pulses
28
Q

Iron Deficient Anemia Causes

A

Cows milk is a poor source of iron
Iron supplements can begin at 2 months for preterm, 4-6 months for term babies
Appears around 9 to 12 months due to loss of iron stores from birth
In adolescents from poor diet and menstruating girls

29
Q

Iron Deficient Anemia Nursing Care

A

Prevention and Education
High risk- WIC children and low income families
Administer medication via syringe at back of the mouth, or drink through a straw
Take with something acidic, Orange juice
Encourage a rich diet of leafy green veggies
Medication causes constipation and tarry stool!

30
Q

Sickle Cell Anemia

A

A condition of normocytic, normochromis anemia with increased RBC destruction
Normal Hgb A is replaced with abnormal Hgb S
Cells are sickled
Autosomal recessive!
Girls > Boys
African American >
Newborn screening

31
Q

Sickle Cell Assessment Questions

A

Ask about past crisis
Ask about triggers
Past medical treatment and home management
Assess psychosocial

32
Q

Sickle Cell Signs and Symptoms

A

Asymptomatic until 4-6 months
Sickle cells cant flow easily
Clogged up – Trigger pain crisis
Blindness, enlarged liver and spleen, chest crisis
Joint swelling – also in penis and testes
Possible stroke, paralysis and death

33
Q

Sickle Cell Head to Toe Assessment

A

See Box 35-4

Page 1437

34
Q

Sickle Cell Treatment

A

Limit activity to reduce energy expenditure
Improve oxygenation
HYDRATION! I/O’s
Reduce Metabolic Acidosis – from hypoxia
PAIN MANAGEMENT!
Transfuse packed RBCs, Antibiotic – If needed
Home care: Penicillin K, multivitamin, folic acid

35
Q

B- Thalassemia Major

A 
Cooley's Anemia 
Autosomal Recessive 
Defective in the synthesis of hgb A
Microcytic and hypochromic
Leads to increased RBC destruction
Increased serum feratin 
EXTRA Iron- overload
Mediterranean Middle Eastern Decent
36
Q

B- Thalassemia Major Treatment

A

PRBC transfusions – prevent bone marrow expansion
Keep Hgb >9.5
Take Desferal (Deferoxamine)
Diet low in iron
Prophylactic antibiotics
Spleenectomy to decrease discomfort and rate of RBC destruction

37
Q

B- Thalassemia Major Nursing Care

A

Support family and child

Body Image disturbance – bony changes, decreased growth and sexual immaturity

38
Q

Aplastic Anemia

A

Formed elements of the blood are low, RBC, WBC and Platelets
Sudden onset
Life threatening
Autosomal recessive- primary or congenital

39
Q

Aplastic Anemia Acquired Causes

A

HPV, Hepatitis, an overwhelming infection
Immune disorders
Drugs, household chemicals

40
Q

Aplastic Anemia Congenital Cause

A

Fanconi’s Anemia
Patchy brown areas of skin discoloration
Genetic counseling is needed!
Autosomal Recessive Syndrome

41
Q

Aplastic Anemia Diagnosis

A

CBC is first step

Bone marrow aspirate– appear yello and fatty instead od red

42
Q

Aplastic Anemia Treatment

A

Immunosuppressant to limit aplasia
Stem Cell transplant
Treatment is supportive

43
Q

Hemophillia A

A

X-linked recessive disorder of Factor 8 deficiency
Boys > girls
Mild, moderate and severe

44
Q

Mild Hemophillia A

A

Bleeding with trauma or surgery

45
Q

Moderate Hemophillia A

A

Bleeding with trauma

46
Q

Severe Hemophilla A

A

Spontaneous bleeding without trauma

More common

47
Q

Hemophilla Concerns

A

Bleeding into the tissue –
Neck or thorax can impair breathing
Intracranial can be fatal
Retro peritoneal is an issue to due large space for blood accumulate
Hematoma on spinal cord = paralysis
Hemoarthosis in the joint– lead to loss of function

48
Q

Hemophilla Treatment

A 
Factor 8 Replacement as an infusion
Goal is to stop[ bleeding
Permanent IV access
R.I.C.E.
Parents can administer -- then child
49
Q

Hemophilla B

A

Christmas Disease
Sex linked Recessive trait
Factor IX deficiency
Treatment with replacement therapy

50
Q

Idiopathic Thrombocytopenia Purpura (ITP)

A

Autoimmune disease
Excessive destruction of platelets
Usually resolves within 6 months

51
Q

ITP Symptoms

A

Bruising, purpura
Bleeding that wont stop
RISK FOR INJURY
Wear helmets A LOT

52
Q

ITP Treatment

A

Supportive and observe if mild
Symptomatic – give IV IgG to raise platelet count
Prednisone up to 3 weeks

53
Q

HIV Etiology

A

Vertical Transmission - perinatal from mother – leading cause in children
Horizontal from sex or parental contact with blood or body fluid
Vertical # 1 way
Look at CD4 count

54
Q

HIV Diagnosis

A

Done by ELISA and Western Blot
Positive in infants with HIV+ mothers, maternal antibodies last 18 months
PCR x2 for proviral DNA – early as 1 to 3 months
CDC surveillance for AIDS

55
Q

HIV Treatment Goals

A

Slow growth of HIV Virus
Promote normal growth and development
Decrease infections and cancers
Improve quality of life and prolong survival

56
Q

HIV Treatment

A 
Antiretroviral agents
AZT first then HAART
Bactrim starting at 4 - 6 weeks 
MMR and Varicella as scheduled 
Monitor viral load and CD4
Standard isolation techniques
57
Q

HIV Prognosis

A

Earlier presentation of AIDS = Poor, esp 100,000 and CD4 < 15%

58
Q

SCIDS

A

Congenital X-linked
Autosomal Recessive
Prents the formatio nof T-lymphocytes
Affects maturation of B-lymphocytes

59
Q

SCIDS S/Sx

A 
Early infection (oral candidiasis)
Failure to thrive
Chronic diarrhea
Otitis media
Pneumonia
Failure to recover from an infection
Low or absent B & T lymphocytes
60
Q

SCIDS Treatment

A 
Goal: Restore immune function
Give IV Ig
Possible Stem cell transplant
HIGH RISK FOR GRAFT vs HOST
Prevent and promptly treat infections
61
Q

SLE

A

Girls > Boys
Chronic inflammatory disease with an unknown origin
Characterized by exacerbation and remission
Involves more than one body system

62
Q

SLE S/Sx

A

Nephritis
Arthritis or vasculitis
Butterfly rash
See pg 1683

63
Q

SLE Treatment

A

Goal is remission of symptoms and prevent complications
May need steroids
Anti-malarials help skin, renal and arthritis
NSAIDs for pain

64
Q

SLE Nursing Care

A 
Education and compliance with medication
Understanding triggers and episodes
Positive self- image r/t weight -- buffalo hump and moon shaped face
Sunscreen and protective clothing
Support groups
65
Q

Anaphylaxis

A

Clinical syndrome resulting from exposure to an allergen
Result of IgE release – histamine release – vasodilaion – multi-system involvement
MEDICAL EMERGENCY
EPIPEN!

NUR 440 Exam 3 (5 decks)

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