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nursing 202 > Hematologics 2 > Flashcards

Hematologics 2 Flashcards

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1
Q

Hemoglobin:

A

Female 12-16g/dL

Male 14-18 g/dL

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2
Q

Hematocrit:

A

Female 37% - 47%

Male 42% - 52%

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3
Q

Erythropoietin –

A

kidney produces at same rate of RBC destruction

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4
Q

White blood cells (leukocytes)

A

5,000-10,000
-Formed in bone marrow
-Provide protection through inflammation & immunity
Neutrophil & Macrophage: Destroy and eliminate foreign invaders
Monocyte: Destruction of bacteria & matures into macrophage
Eosinophil & Basophil: Release chemicals that act on blood vessels to cause tissue level response

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5
Q

Platelets:

A

50,000-400,000

Form plugs to stop flow of blood at injured site

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6
Q

Spleen

A

White pulp

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7
Q

Liver

A

Prothrombin

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8
Q

3 sequential process of controlled blood clotting

A
  1. Platelet aggregation with platelet plug formation
  2. Blood clotting cascade
  3. Formation of a complete fibrin clot
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9
Q
  1. Blood clotting cascade
A

Intrinsic factors

Extrinsic factors

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10
Q
  1. Formation of a complete fibrin clot
A

Fibrinogen inactive protein made in liver
Active enzyme thrombin removes portions of fibrinogen converting into fibrin
Form into fibrin threads (meshlike base) making blood clot

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11
Q

Hematologic- Aging:

A

Decreased blood volume
Lower levels of plasma proteins
Bone marrow produces fewer blood cells

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12
Q

Hematologic- Aging: Abnormal findings

A

Nails beds (capillary refill)
Hair distribution
Skin moisture
Skin color

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13
Q

Patient history

A

Age, gender, known liver function, hematologic and immunologic disorders
Ask about jaundice, anemia, gallstones may indicate liver problems
Previous radiation therapy may impair hematologic function
Hobbies, occupation exposure to agents affecting bone marrow etc.

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14
Q

Assessment methods:

A 
Patient history 
Nutritional status
Family history
Generic risk
Current health problems
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15
Q

Nutritional status:

A

Fats, carbohydrates, protein, iron & vitamins
Vitamin K
Alcohol
Finances

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16
Q

Family history:

A

Blood/ blood clotting issues inherited

Hemophilia, Sickle Cell Disease

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17
Q

Genetic risk

A

Sickle Cell trait

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18
Q

Current health problems:

A
  • Lymph nodes swelling, excessive bruising/ bleeding

- Shortness of breath on exertion, palpitations, frequent infections, fever

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19
Q

Medications

A 
Blood “thinners” & NSAIDS
Anticoagulants 
Vitamin K antagonists 
Fibrinolytics 
Platelet inhibitors
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20
Q

Blood “thinners” & NSAIDS –

A

change clotting activity, not viscosity

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21
Q

Anticoagulants:

A
  • nterfere with one or more steps in the clotting cascade
  • prevent new clots and limit extension of previous clots
  • Classified as direct and indirect thrombin inhibitors and Vit K antagonists
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22
Q

Direct – thrombin inhibitors

A

Reduces amount of fibrinogen converted into active fibrin
Parenteral & oral
Rivaroxaban (Xarelto), apixaban (Eliquis)

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23
Q

Indirect – thrombin inhibitors

A

by activating antithrombin III, thrombin is indirectly inhibited
Parenteral
Enoxaparin (Lovenox)

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24
Q

Vitamin K antagonists –

A

decreases synthesis of Vit K in intestinal tract
Oral
Warfarin (Coumadin)

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25
Q

Fibrinolytics –

A

“clot busters” , break down fibrin threads
Intravenous
Alteplase (Activase)

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26
Q

Platelet inhibitors –

A

prevent platelet aggregation or activations
Oral and parentally
clopidogrel (Plavix)
Complementary medications

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27
Q

Skin assessment

A

petechiae

28
Q

Head and neck

A

Pallor/ ulceration oral mucosa; inspect lymph nodes

29
Q

Respiratory

A

Fatigue; shortness of breath

30
Q

Cardiovascular

A

Pulse weak and thread, systolic B/P lower with anemia, higher with excessive RBC

31
Q

Kidney and urinary

A

Hematuria; hormone

32
Q

Musculoskeletal

A

Rib/ sternal tenderness (leukemia) marrow overproduces cells, increasing pressure

33
Q

Abdominal

A

Palpable spleen; GI bleed

34
Q

Central nervous system

A

Vit B12 deficiency impairs nerve function; head trauma

35
Q

CBC

A

Hematocrit (HCT)– percentage of red blood cells in total blood volume
Hemoglobin (HGB)– oxygen carrying capacity
Mean corpuscular volume (MCV) – average volume/ size of RBC’s
Mean corpuscular hemoglobin (MCH) – average amount of HGB by weight in a single RBC
Mean corpuscular hemoglobin concentration (MCHC) – average amount by percentage

36
Q

Reticulocyte count

A

Determines bone marrow function; normally 2% are circulating

37
Q

Platelet Count

A

Reflects number of platelets in circulation

Thrombocytopenia

38
Q

Hemoglobin electrophoresis

A

Detects abnormal forms of hemoglobin (sickle cell)

39
Q

Coombs’ tests (direct and indirect)

A

Used for blood typing (antibodies & antiglobulins)

40
Q

Iron Studies:

A
  1. Serum ferritin – measures amount of free iron in plasma; represents 1%
  2. Transferrin – protein that transports dietary iron from the intestines to cell storage sites
  3. TIBC (total iron binding capacity) – measuring the amount of iron bound to serum transferrin
41
Q

Prothrombin time (Protime/PT)

A

measures how long blood takes to clot; value 11-12.5

42
Q

International normalized ratio (INR)

A

Same as PT by Establishing a normal mean or standard; value 0.7-1.8
Warfarin therapy – usually therapeutic level 2-3; also individualized for patients

43
Q

Partial thromboplastin time (PTT)

A
  • Assesses the intrinsic clotting cascade
  • Prolonged when deficient
  • Uses with heparin
44
Q

Anemia manifestations:

A 
Pallor
Cool to touch, intolerance to cold
Nails
Tachycardia, murmurs/ gallops (severe)
Orthostatic hypotension
Dyspnea on exertion
Fatigue, headache
45
Q

Sickle cell disease (sickle cell anemia)

A

Autosomal recessive inheritance, HbS
Chronic anemia
Pain
Increase risk for infection
Early death
40% of total hemoglobin is composed of hemoglobin S (sensitive to low oxygen content)
Sickle shape = hypoxia – reduces oxygen supply – more sickles – blood vessel obstruction and ischemia
Conditions – hypoxia, dehydration, infection, venous stasis, environmental extremes, pregnancy, alcohol, strenuous exercise
Hemolytic anemia

46
Q

Clinical Manifestations - SCD

A

-Pain – most common manifestation
-Cardiovascular
Heart failure – murmur, JVD
Slow capillary refill – distal, cool
Heart rate rapid, B/P normal to low
-Priapism – cannot urinate
-Skin
pallor/ cyanosis; jaundice; ulcers lower legs
-Abdomen
Liver and spleen feel firm
-Kidney
Decreased urine output, protein present
-Musculoskeletal
Joint necrotic degeneration; pain with movement
-CNS
Low grade fever, seizures

47
Q

Management - SCD

A

-Pain control
-Infection control
-Oxygen
-Hydroxyurea (Droxia) – stimulating fetal hemoglobin production
-Hydration – intravenous as well as oral
-Check circulation
-Complementary therapies
Warm room
Distraction
Relaxation

48
Q

Prevention - SCD

A 
Socks & gloves
Planes
Healthcare professionals- knowledge of disease
Genetic counseling
Physical activity
Low impact exercise
Hydration
Alcohol
Smoking
Contact HCP
Flu shot
? Pneumonia vaccine
Temperature extremes
49
Q

Iron deficiency anemia

A

Blood loss, poor GI absorption of iron, inadequate diet
Manifestations
Food sources

50
Q

Vitamin B12 deficiency anemia (Pernicious anemia)

A

Failure to activate enzyme that moves folic acid into RBC cells so cell division and growth into to functional RBC
Causes
Manifestations
Foods rich in B12

51
Q

Aplastic anemia

A

Deficiency of circulating red blood cells because of failure of bone marrow to produce these cells
Causes – exposure to toxic agents/ drugs, radiation, infection

52
Q

Polycythemia Vera

A 
# of RBC’s greater than normal
Hyperviscous
53
Q

3 major hallmarks of Polycythemia Vera

A

Massive production RBC’s
Excessive leukocyte production
Excessive production platelets

54
Q

Manifestations of Polycythemia Vera

A

Skin/ mucous membrane – dark purple
Flushed appearance
Itching, poor perfusion (heart, spleen & kidneys), thrombosis

55
Q

Treatment of Polycythemia Vera

A

Apheresis (2-5 times per week)

Hydration

56
Q

Autoimmune Thrombocytopenia Purpura (idiopathic) ITP

A

Amount of circulating platelets reduced, production normal
Antibody against surface of their own platelets
Destruction exceeds production, clotting impaired
Suspect viral infection
Women 20-50 and people with autoimmune disorders
Manifestations: ecchymosis, petechial rash, mucosal bleeding
Treatment: corticosteroids, drugs to suppress immune function, platelet transfusion
Safe environment, splenectomy

57
Q

Thrombotic Thrombocytopenia Purpura (TTP)

A

Platelets clump together abnormally in capillaries
Occurs in trauma; tissue becomes ischemic
Fresh Frozen Plasma, aspirin

58
Q

Coagulation Disorders- Hemophilia

A

Hereditary bleeding disorder
Form platelet plug but impairs formation of stable fibrin clot
Excessive bleeding cuts, bruised, joints
Treatment: synthetic factor VIII

59
Q

Pretransfusion Transfusion Responsibilities

A

Verify prescription with another RN
Test donor’s/recipient’s blood for compatibility
Verify patient’s identity with another RN
Examine blood bag label, attached tag, and requisition slip for ABO and Rh compatibility with the patient with another RN
Check expiration date with another RN
Inspect blood for discoloration, gas bubbles, cloudiness

60
Q

During transfusion responsibilities:

A

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

61
Q

RBC transfusions –

A

Given to replace cells lost from trauma or surgery

62
Q

Platelet transfusions –

A

Given for low platelet counts, active bleeding, scheduled for invasive procedure

63
Q

Plasma transfusions –

A

Given to replace blood volume and clotting factors

64
Q

Granulocyte (WBC) transfusions –

A

Given (rarely) to neutropenic patients

65
Q

Acute Transfusion Reactions

A

Bacterial
Circulatory overload
Transfusion-associated graft-versus-host disease (GVHD)

nursing 202 (20 decks)

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