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Med Surg > Hematologic Problems > Flashcards

Hematologic Problems Flashcards

1
Q

Anemia

A

Reduction in either the number of RBC’s, the amount of hemoglobin, or the hematocrit

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2
Q

Different types of anemias

A 
Aplastic: malfunctioning bone marrow
Hypochromic: iron or vitamin deficiency
Pernicious: lack of intrinsic factors 
Erythroblastosis fetalis: destruction by antibodies 
Secondary: bleeding
Genetic factors: sickle cell anemia
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3
Q

Clinical manifestations of Sickle cell anemia

A 
Pain
Fatigue
SOB
Murmurs
Jugular venous pulsation 
Cool to touch
Priapism: prolonged penile erection; excessive vascular engorgement 
Cyanosis 
Jaundice: top of mouth 
Ulcers on lower legs
Urine contains protein
Legs and arm swelling
During crisis: low grade fever
Bilateral hand grasp
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4
Q

Sickle cell anemia crisis complications

A 
Infections 
Stroke
URI's
Leg ulcers
Splenomegaly 
Cell clumping 
Pain!!
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5
Q

Treatment for sickle cell anemia crisis

A 
HOP
Hydration: NS
Oxygenation 
Pain Relief 
Remove constrictive clothing 
Check circulation
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6
Q

Prevention of sickle cell anemia crisis

A

Drink at least 3-4 liters of liquids everyday
Avoid alcohol
Avoid smoking
Be sure to get flu shot every year
Avoid temperatures of extreme hot or cold
Avoid travel to high altitudes
Avoid strenuous activity
Barrier methods of contraceptives for women are recommended with SCA

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7
Q

Iron deficiency anemia

A

Most common
Women
Older adults
People with poor diets

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8
Q

Manifestations of iron deficiency anemia

A

Fatigue
Reduced exercise tolerance
Fissures at corner of mouth

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9
Q

Management of iron deficiency anemia

A

Increasing oral intake of iron(red meat, egg yolks, kidney beans, leafy green veggies, raisins)

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10
Q

Megaloblastic anemia (Vitamin B12 deficiency anemia)

A

Failure to activate the enzyme that moves folic acid into precursor RBC cells so that cell division and growth function
Large size of these abnormal cells
Causes: vegan diets, diets lacking dairy products, small bowel obstruction, chronic diarrhea

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11
Q

Manifestations of megaloblastic anemia

A 
Pallor
Jaundice 
Glossitis: beefy-red tongue 
Fatigue
Weight loss
Paresthesias: abnormal sensations in feet or hands 
Poor balance
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12
Q

Aplastic anemia

A

Deficiency of circulating red blood cells
Failure of bone marrow to produce
Leukopenia: reduction in WBC
Thrombocytopenia: Reduction in platelets (pancytopenia)

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13
Q

Aplastic anemia causes

A

Exposure to toxic agents:
Drugs
Ionizing radiation
Infection

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14
Q

Aplastic anemia manifestations

A

CBC shows severe macrocytic anemia, leukopenia, and thrombocytopenia

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15
Q

Polycythemia vera patho

A 
Number of RBc in the blood are greater than normal 
Blood is hyperviscous: thicker in blood 
Cancer of the RBCs 
Excessive leukocyte productions
Excessive production of platelets
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16
Q

Manifestations of polycythemia vera

A 
Facial skin and mucous membranes have dark purple flushed appearance (plethoric) 
Distended veins 
Intense itching 
Hypertension
Hypoxia
17
Q

Management of polycythemia vera

A

Repeated phlebotomy
apheresis (2-5 times per week)
Apheresis: withdrawals of whole blood and removal of some of patients blood component

18
Q

Self-management with polycythemia vera

A 
Drink 2-4 liters of liquids 
Take anticoagulants 
Wear supoort stockings 
Elevate your feet
Use electric shaver
Do not floss
19
Q

Thrombocytopenia

A

Low platelets for blood clotting

20
Q

Autoimmune thrombocytopenia purpura patho

A

Number of circulating platelets is greatly reduced
Even though platelet production is normal
Make an antibody against their own platelets
Most common among women ages 20-50

21
Q

Autoimmune thrombocytopenic purpura assessment

A

Large ecchymoses (bruises)
Petechial rash on arms, legs, upper chest, neck
Stroke
Diagnosed: low platelet count and increased megakaryocytes

22
Q

Autoimmune thrombocytopenic purpura interventions

A 
Risk for poor clotting and increased bleeding 
Protection from bleeding 
Corticosteroids
Platelet transfusions;less than 10,000
Teach patients to avoid  crowds
23
Q

Thrombotic thrombocytopenic purpura

A 
Platelets clump together abnormally in the capillaries and too few remain in circulation 
Kidney failure
MI
Stroke 
Fatal If not tx in 3 months
24
Q

Thrombotic thrombocytopenic purpura management

A

Prevent platelet clumping
Plasma removal
Infusion of fresh frozen plasma
Aspirin

25
Q

Hemophilia

A 
Inherited blood disorder
Factor VIII
Classic
Type A 
No cure
X linked recessive trait (males)
26
Q

Hemophilia manifestations

A 
Intracranial hemorrhage 
Prolonged nosebleeds 
Bruises easily 
Warm, painful, swollen joints with decreased movement 
GI hemorrhage 
Tarry stools
Cola colored urine
Coffee ground emesis
27
Q

Interventions for hemophilia

A

Avoid injury and meds that promote bleeding
Good nutrition
Good dental hygiene
IV administration of deficient clotting factors

28
Q

Hemophilia laboratory test results

A

Prolonged aPTT
Normal bleeding time
Normal PT

29
Q

Nursing responsibilities blood pretransfusion

A

Verify prescription with another RN
Test donors blood for compatibility
Verify patients identity with another RN
Examine blood bag label, attached tag, and requisition slip for ABO and RH compatibility with patient and other RN
Check expiration date with another RN
Inspect blood for discoloration, gas bubbles, cloudiness

30
Q

Transfusion responsibilities during transfusion

A

Provide patient education
Assess vital signs immediately before starting infusion
Begin transfusion slowly
Stay with patient the first 15-30 minutes
Ask patient to report unusual sensations (chills, SOB, hives, itching)
Administer blood product per protocol
Assess for hyperkalemia

31
Q

Blood administration

A 
Determine clients allergies and previous transfusion reactions 
Never add ANY meds to blood products 
18 gauge needle 
Normal saline IV solution 
Do not warm unless risk of hypothermic 
Infuse each unit over 2-4 hours 
NO longer than 4
32
Q

Febrile reactions

A 
Chills
Fever
Headache
Flushing
Tachycardia
Increased anxiety
33
Q

Hemolytic transfusion reactions

A 
Low back pain
Hypotension
Tachycardia
Chest pain
Tachypnea
Hemoglobinuria 
May have immediate onest
34
Q

Allergic reaction: Mild:

A

Hives
Pruritus
Facial flushing

35
Q

Alergic reaction: Severe:

A

SOB
Bronchospasm
Anxiety

36
Q

Nursing implimincations blood transfusion reaction

A

Stop transfusion and notify physician
Change IV tubing
Treat symptoms: o2, fluids, epinephrine
Recheck crossmatch

Med Surg (11 decks)

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