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Nurs 230 Exam 3 > Hematologic Problems > Flashcards

Hematologic Problems Flashcards

1
Q

Anemia

A

Low RBCs/Hgb or Hct

Mild: Hgb 10-12
Moderate: Hgb 6-10
Severe: Hgb <6

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2
Q

Anemia symptoms

A

Fatigue
Palpitations
Dyspnea
Tachycardia/hypotension

Can progress into HF

Symptoms depend on severity and onset
(If chronic may have Hgb of 7 with no s/s

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3
Q

Iron deficiency anemia ***

A

Vegetarians are most susceptible

Causes:
Inadequate intake
Malabsorption
Chronic GI bleed
Pregnancy/menses

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4
Q

Iron deficiency anemia clinical manifestation ***

A

Mild may be asymptomatic

Pallor
Glossitis (thick red tongue)
Cheilitis (chapped lips)
Symptoms of lack of oxygen in tissue:
*HA, paresthesia, burning of tongue

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5
Q

Iron deficiency anemia :***
Diagnostic studies

A

Labs:
CBC (low RBCs)
Iron studies (transferring, ferritin)
Hemoccult/guaic stool
MCV (low<80) *called microcytic (small RBCs)

Endoscopy/colonoscopy, bone marrow biopsy

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6
Q

Iron deficiency anemia:***
Nursing management

A

Treat cause:
Iron rich foods (leafy greens, red meats, liver)

Iron supplementation:
PO: ferrous sulfate
IV/IM: iron dextrase

If severe: PRBC transfusion (usually less than 6 Hgb)
PRBC: packed RBCs

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7
Q

Iron deficiency Oral iron ***

A

Adverse reactions:
GI common
staining of teeth liquid iron
dark stools
constipation

Take 1 hour before meals with orange juice

Do not take with coffee, tea, or dairy

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8
Q

How to tx iron deficiency anemia oral meds ARs ***

A

Stay upright for 30min after dose

Constipation: give laxative or stool softeners

Dilute liquid and use straw: to prevent staining

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9
Q

Iron deficiency anemia: parenteral iron (IV/IM) ***

A

Used if :
malabsorption
PO intolerance
poor pt adherence
need for higher dose

IM can stain skin so use Z track method

Monitor for anaphylaxis

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10
Q

Megaloblastic anemias ***

A

Large RBCs

MCV high > 100

Caused by folic acid/b12 deficiency

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11
Q

B12 deficiency ***

A

Inadequate intake

Lack of intrinsic factor (pernicious anemia)
*GI surgery: bowel resection
*Crohn’s disease (bowel disease (lack of intrinsic factor)
*insidious onset after age 40 (stop making as much intrinsic factor)

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12
Q

Folic acid deficiency anemia ***

A

Associated with:
ETOH
Medications
Malabsorption

Syomptoms:
Similar to B12 deficiency/pernicious anemia

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13
Q

Megaloblastic anemia***
Folic acid/b12 deficiency

Clinical manifestations and diagnostic tests

A

Sore/red/beefy tongue (Glossitis)

B12 deficiency: neuromuscular symptoms
*weakness, paresthesia, confusion/dementia

CBC(MCV, Hgb/Hct), B12/folate levels

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14
Q

Megaloblastic anemia***
Folic acid/b12 deficiency

Nursing management

A

B12 supplementation:
PO unless decreased intrinsic factor (malabsorption)
Parenteral (IM/SQ)

Folate:
PO, diet (green veggies/liver)

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15
Q

Anemia of chronic disease (ACD) ***

A

R/T kidney disease, chronic inflammation

Diagnosis of exclusion

Treat underlying disorder/manage symptoms

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16
Q

Sickle cell anemia ***

A

Genetic disorder: autosomal recessive
*if both parents have sickle cell trait 1/4 chance baby will have it

Life expectancy 42-47 years

Abnormal form of Hgb causes RBC to stiffen and elongate (sickle shape) when O2 levels are low

If inherited from one parent then it will be less severe

17
Q

Sickling episodes ***

A

Triggered by hypoxia:
*high altitudes, stress, surgery, infections
*dehydration

RBCs become sickled and cannot pass thru small vessels and cause occlusion

Self-perpetuating cycle(more cells deoxygenated) bc it blocks other cells

Sickled cells are hemolyzed by the spleen

18
Q

Sickling episodes***
How early sickling can be reveres
Hallmarks
What it can progress into

A

Early sickling can be reversed with oxygenation

Hallmarks: vaso-occlusion, hemolysis

Can progress to sickle cell crisis:
*pain in:
Chest, back, extremities, abdomen(where the blockage occurs)

*tissue ischemia, infarction(damage), and necrosis (death) can occur

19
Q

Sickle cell anemia symptoms ***

A

Asymptomatic outside of episodes

Pain during sickling episodes:
Pain in joins and other places

20
Q

Sickle cell anemia complications ***

A

Embolic events:
MI
VTE
CVA (stroke)
PE

Issue related to decrease circulation:
Chronic leg ulcers( due to lack of O2 for healing)
Renal failure

Spleen infarction:
Increased risk for infection (build up of RBCs their trying to destroy)

21
Q

Sickle cell anemia ***
Diagnostic studies

A

Peripheral blood smear:
sickled cells
Increased reticulocytes

Hgb electrophoresis:
Hgb S

22
Q

Sickle cell anemia***
Nursing management

A

Oxygen therapy
Hydroxyurea
Fluids (dilute and help blood flow)
VTE prophylaxis (no SCD bc itll cut off blood flow more)
Rest
Pain managment:
*PCA
*opioids, NSAIDS, nerve blocks
*NO ICE PACKS (causes vasoconstriction)
Monitor for infection and emboli

23
Q

Sickle cell anemia ***
Patient education

A

Avoid dehydration
hypoxia
High altitudes

Seek medical attention early for infections (can cause crisis)

Immunizations up to date

24
Q

thrmobocytopenia ***

A

under 150,000
causes:
-Immune thrombocytopenia (ITP) most common
*autoimmune issue causing destruction of plts

-Heparin induced thrombocytopenia
*immune response to heparin effecting clotting
* can develop 1-2 weeks after treatment

-Thrombotic thrombocytopenic purpura (TTP)

25
Q

thrombocytopenia
clinical manifestations ***

A

petechiae, purpura, ecchymoses

gingival bleeding, epistaxis

hemorrhage:
-cerebral, joints, GI, internal blood loss

depending on type look for signs of thrombosis:
chest pain, restlessness, hypoxia, leg swelling

26
Q

thrombocytopenia
diagnostic testing ***

A

plt count

prolonged pt/inr

bone marrow biopsy

test stool for occult blood

27
Q

plt count ***

A

prolonged bleeding starts at <50,000

<20,000 spontaneous life threatening hemorrhage

<10,000 expect plt transfusion

150,000-50,000 mostly asymptomatic

28
Q

thrombocytopenia
collaborative care ***

A

ITP:
*asymptomatic may just monitor
*corticosteroids, IV immunoglobin, plt transfusion
*splenectomy

TTP:
*treat infection/stop drug
*plasma exchange

HIT:
*discontinue all Heparin
*argatroban (antidote to HIT)

29
Q

thrombocytopenia
nursing management
Pt education ***

A

plt transfusion
monitor for bleeding
avoid IM infections
avoid rectal temps/exams
avoid invasive procedures

pt/family teaching:
-symptoms of bleeding
-shaving
-avoid asparin
-what to do for nose bleeding:
*call if last 15mins and go to hospital if goes to 30mins

30
Q

Neutropenia ***

A

Absolute neutrophil count (ANC) under 1000
severe = <500
ANC = WBC x % of neutrophils

sudden onset is most concerning

most common cause: chemo/immunosuppressive therapy

31
Q

neutropenia
clinical manifestation/complications ***

A

risk of infections
*oppotunistic, pt own flora

may not have normal s/s due to low WBC

low grade fever very concering if neutropeic
*emergency: 100.4 or high with ANC <500
*need blood culture ASAP
*ABX within 1 hour

32
Q

neutropenia
pt education ***

A

prevent infection:

avoid cleaning up after pets
freq hand washing
avoid crowds
food safety
report symptoms of infection (esp. fever)
good oral hygiene
bathing daily and moisturize

33
Q

hemophilia ***

A

xlinked recessive genetic disorder
*mostly males get it
*female carriers give to 50% of sons
*males give to no sons, but all females are carriers

defective or deficient coagulation factors:
hemophilia A: factor VIII deficiency (more common)
hemophilia B: factor IX deficiency

34
Q

hemophilia
clinical manifestations ***

A

bleed risk:

persistent bleeding from minor trauma
nosebleeds
hemarthrosis (joint bleeding)
GI bleeding
risk for splenic rupture

35
Q

hemophilia
collaborative care (tx)***

A

TX:
replacement of clot factors (cryoprecipitate)

bedrest during bleeding episodes

treat hemarthrosis with RICE (vasoconstriction), analgesia, immobilization

36
Q

hemophilia
pt education ***

A

how to control bleeding

severe pain/swelling of muscle joint call HCP

head injury, melena, abdominal pain

noncontact sports

medical alert tag

its good to exercise still just dont cause bleeding

Nurs 230 Exam 3 (6 decks)

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