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Adult Health II Exam 3 > Hematology > Flashcards

Hematology Flashcards

1
Q

Concepts of hematologic disorders

A

GAS EXCHANGE AND TISSUE PERFUSION
RBC = delivers oxygen (hemoglobin)
— heme needs iron to transport oxygen
— four molecules of O2 can attach to heme

Someone with 100% SPO2 reading -> how many molecules are attached to the heme

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2
Q

Anemia

A

Reduction of RBC, hemoglobin and/or hematocrit
Classifications:
— blood loss
— hemolytic
— impaired RBC production

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3
Q

Types of anemia

A

Iron-deficiency (microcytic)
— blood loss, poor nutrition

Hemolytic
— immune
— trauma
— sickle cell

Megaloblastic (macrocytic)
— vitamin B12 deficiency
— PERNICIOUS ANEMIA
— folic acid deficiency

Aplastic anemia
— bone marrow suppression

Chronic
— chronic renal failure
— kidneys no longer produce epogen

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4
Q

What are CM of anemia?

A

— fatigue
— dizziness
— possible fainting
— hypotension
— hypovolemia
— high HR -> dysrhythmias
— chest pain -> low oxygen delivery
— SOB
— yellowing of the eyes in colored persons

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5
Q

Sickle cell anemia

A

Genetic
RBC in sickle shape (C shape)
— decreased oxygen carrying capacity
— abnormal hemoglobin
— C’s clump together very easily -> occludes blood vessels
— organ damage
— PULM EBOLISM, MI, stroke, kidney disease

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6
Q

Clinical manifestations of sickle cell anemia

A

— retinopathy
— cardiomegaly
— CHF
— hematuria
— stroke
— pneumonia
— splenomegaly
— ulcers on extremities
— osteomyelitis

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7
Q

Triggers for sickle cell

A

— HYPOXIA
— high altitudes
— dehydration
— venous stasis
— physical/emotional stress
— anesthesia
— infections
— low or high body temp

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8
Q

Medical surgical tx for sickle cell

A

— PAIN MANAGMENT
— opioids -> constipation
— hydration to keep cells from clumping
— OXYGEN
— prevent infection
— do not bend over -> RBCs can clump
— blood transfusion (hgb <7.5)
— hydroxyurea -> reduces sickling -> CAN INCREASE CANCER RISK FOR INFANTS (make sure female is not pregnant)

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9
Q

Teaching for sickle cell

A

— prevent crisis -> STAY HYDRATED; stay oxygenated
— manage drugs -> women on birth control taking hydroxurea
— emotional support -> will have disease for rest of life

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10
Q

Education for hydroxyurea

A

Do not get pregnant
Risk for infant cancers

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11
Q

Sickle cell nursing dx and interventions

A

Nursing dx:
— acute pain
— ineffective peripheral tissue perfusion
— deficient fluid volume
— activity intolerance
— risk for decreased cardiac tissue perfusion
— risk for infection
— risk for ineffective cerebral tissue perfusion

Nursing interventions:
— admin OXYGEN
— admin pain medications
— do not bend the client -> restricted blood flow/clumping of sickle RBCs
— check circulation of peripheral extremities
— assess signs of central claudication
— keep pt warm -> NO HEATING PADS
— admin IV fluids and PO fluids

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12
Q

Generalized anemia

A

— complete blood count with diff and RBC indices
— reticulocyte count
— iron studies
— coomb’s test -> hemolytic anemia / looks for antibodies on surface of RBC
— bone marrow aspiration -> looks to see if there is anything preventing RBC production

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13
Q

Normal range for RBC
What does decreased/increased lab indicate

A

4.2-6.1

Decreased = anemia or bleeding
Increased = severely dehydrated or PV

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14
Q

Normal range for hemoglobin

A

12-18

Deceased = anemia, bleeding, fluid overload
Increased = severely dehydrated

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15
Q

Normal range for hematocrit

A

37-52%

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16
Q

Medical surgical tx for anemia

A

— determine underlying cause
— iron deficiency -> oral ferrous for mild anemia (take with food - hard on the stomach)
— vitamin C enhances absorption of oral ferrous

Severe: IV or IM dextran
— check BP
— tele monitoring

Vitamin B12
— diet
— oral supplments

Blood loss
— stop bleeding
— mass trauma

Immune
— transfusion
— bone marrow transplant
— immunosuppressive therapies
— HIGH RISK FOR INFECTION

Chronic disease
— procrit/epogen injections to help stimulate erythropoietin

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17
Q

Assessment for anemia

A

— diet
— meds

CM:
— FATIGUE
— pallor
— cyanosis
— jaundice -> hemolytic anemia
— bleeding
— dry skin
— mouth ulcers or fissures
— smooth tongue
— lymph node involvement -> infection/cancer
— tachycardia -> low blood volume
— VS -> O2 saturation (carbon dioxide/monoxide poisoning the SPO2 will not be accurate)

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18
Q

Nursing dx for anemia

A

— activity intolerance
— fatigue
— altered tissue perfusion
— impaired gas exchange
— anxiety
— impaired comfort
— risk for bleeding
— risk for injury
— impaired memory

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19
Q

Interdisciplinary interventions and nursing interventions for anemia

A

— oxygen
— oral or IM iron
— supplments -> VITAMIN B, FOLIC ACID
— epoetin SQ weekly
— RBC transfusion for hgb <7.5

Nursing interventions:
— energy conservation
— supportive care
— correct anemia -> diet changes
— teaching self care

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20
Q

Level of hemoglobin that indicates need for blood transfusion

A

<7.5

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21
Q

Primary polycythemia Vera

A

Loss of cellular regulation
— RBCs, WBC and platelet
— blood will become viscous (THICK) -> poor oxygenation
— HIGH HEMOGLOBIN AND HEMATOCRIT

Hyperkalemia, high hct + hgb, high uric acid

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22
Q

CM and complications of polycythemia Vera

A

CM:
— HTN
— headache
— dizziness
— itching
— dyspnea
— purple/gray color

Complications:
— angina
— claudication -> stopping of oxygen/clotting
— thromboses
— infarctions -> MI, CVA
— intracranial bleeds/CVA FROM HTN

Medical tx:
— ANTICOAGULANTS

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23
Q

Nursing interventions for primary polycythemia Vera

A

— prevent clots = get up and ambulate as frequently as possible
— HYDRATION -> 3L/day
— stop smoking
— promote venous return
— elevate feet to prevent pooling in lower extremities
— avoid tight clothing
— support hose
— thrombocytopenia precautions -> bleeding precautions
— use electric razor, soft toothbrush (anticoagulants)
— neutropenic precautions -> higher risk for infection

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24
Q

Primary polycythemia Vera education

A

— contact doctor first sign of infection or occlusion
— exercise slowly
— stop activity at first sign of chest pain or dizziness (possible MI)
— interdisciplinary -> anticoagulants, chemotherapy to thin down/stop overproduction

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25
Q

Nursing dx PPV

A

Ineffective protection
Risk for bleeding
Risk for ineffective tissue perfusion

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26
Q

Myelodysplastic syndrome (MDS)

A

PRECANCEROUS STATE
— abnormal cell formation in bone marrow
— destroyed by body after release; decrease in all blood cell types
— Pancytopenia
— 30% develop leukemia
Risk factors:
— >65 age
— exposure to chemicals
— tobacco smoke
— chemo/radiation

27
Q

Diagnostics for myelodysplastic syndrome

A

— cytogenetic testing -> looks at chromosomes that are identified as abnormal
— peripheral blood smears -> cell abnormalities

Medical tx:
— supportive care
— blood/platelet transfusion
— epogen injections

28
Q

Platelet disorders

A

— local bleeding-petichiae
— easier to control

— Idiopathic thrombocytopenic purpura -> immune system destroys platelets
— Thrombotic thrombocytopenic purpura -> platelets clump together and forms clots

29
Q

Clotting disorders

A

— occurs deeper in the body
— bleeding in joint spaces; SQ
— deeps bleeds difficult to control and often restarts

— hemophilia
— heparin-induced thrombocytopenia

30
Q

Reasons for platelet disorders

A

Decreased production
— cancers and tx
— aplastic anemia
— toxins; meds, alcohol

Increased destruction
— autoimmune
— infections, meds, spleen disorder, cancers

Increased consumption
— disseminating intravascular coagulation - body is running out of platelets

31
Q

Normal platelet count

A

150,000-400,000

32
Q

Thrombocytopenia

A

TOO FEW PLATELETS
— 40,000-80,000 platelets
— risk for bleeding with mild trauma

<20,000 risk for spontaneous bleed
<5,000 risk for fatal bleed in CNS or GI hemorrhage

Idiopathic thrombocytopenic purpura

33
Q

Thrombocytosis

A

TOO MUCH PLATELET
— platelets >60,000
— risk for clotting

Thrombotic thrombocytopenic purpura

34
Q

Idiopathic thrombocytopenic purpura

A

Autoimmune disorder
— patients makes antibodies against own platelets
— macrophages destroy

Viral infections thought to trigger condition
Most common in women 20-40

Dx: serial law platelets and bone marrow biopsy
— shows bone marrow is putting out normal rate
— body is chewing it up (platelets)

Tx:
— immunosuppressive drugs (prednisone)
— platelet transfusion
— splenectomy -> last resort

35
Q

Thrombotic thrombocytopenic purpura

A

Autoimmune disease
— platelets clump together abnormally in capillaries and too few available in circulation
— clotting occurs but also fails to clot when trauma occurs
— tissue becomes ischemic -> kidney failure, MI, CVA
— FATAL IN 3 MO. IF NOT TREATED

Tx:
— plasmaphoresis
— fresh frozen plasma to provide platelet aggregation inhibitors
— platelet inhibitor drugs

36
Q

Hemophilia

A

Genetic disorder
— chance of giving disorder to offspring
— women carrier

Types:
A = factor 8 (VIII)
— 80%
B = factor 9 (IX)
— 20%

Symptoms:
— abnormal bleeding to any trauma, specifically joints
— bleeding longer than normal
— problem forming stable fibrin clot -> allows for extensive bleeding

37
Q

PT range

A

11-12.5

Warfarin therapy
Liver failure

38
Q

INR range

A

0.8-1.1

39
Q

PTT range

A

60-70 seconds

Heparin therapy

40
Q

Medical and nursing management of hemophilia

A

Complications most common -> joint problems from repeated episodes of bleeding
Dx -> prolonged PTT
Tx -> replace missing factor with infusion of synthetic factors

41
Q

Nursing management of hemophilia

A

Minimize trauma and other causes of bleeding
— thrombocytopenia precautions
— risk assessment -> protect pt from injury
Assess s/s bleeding

Prepare to admin platelet infusion for counts below 10,000
— replace missing clotting factors with transfusion of synthetic factors
— educate patient and family -> risk for bleeding

42
Q

Cancers of the blood

A

— leukemia
— lymphoma
— multiple myeloma

43
Q

Leukemia

A

Uncontrolled NORMAL cell production
— cancer occurs in stem cells of bone marrow -> overcrowded with nonfunctional cells

Overproduction of blasts cells -> immature WBC

Exact cause unknown
— genetic and environmental factors involved
— 50% of pt have abnormal chromosomes

Normal cell production decreased results in:
— Pancytopenia
— neutropenia
— anemia
— thrombocytopenia
— infiltration of tissue/organs

44
Q

Acute leukemia

A

Sudden onset of abono al blood cells

45
Q

Chronic leukemia

A

Abnormal cells replicate slowly

46
Q

How is leukemia classified

A

By cell type
— lymphoid cells: lymphocytic
— myeloid cells: myelogenous

47
Q

Types of leukemia

A

Acute lymphocytic leukemia
— most common type in young children

Acute myelogenous leukemia
— most common type in adults

Chronic lymphocytic leukemia
— most common chronic adult leukemia

Chronic myelogenous leukemia
— asymptomatic for years enforce entering fast growth phase

48
Q

Leukemia risk factors

A

— prior exposure to chemo or ionizing radiation
— bone marrow hypoplasia (slow growth)
— genetic -> Down syndrome
— immune deficiency
— virus

49
Q

Definitive test for leukemia

A

Bone marrow biopsy

50
Q

Leukemia dx

A

Abnormal WBC
— high blast cells -> poor prognosis
— low hgb + hct
— low platelet

Chromosome analysis
X-ray, CAT scan, MRI

51
Q

Clinical manifestations of leukemia

A

Systemic:
— weight loss
— fever
— frequent infections

Psychological:
— fatigue
— loss of appetite

— SOB
— weakness (lack of oxygen)
— pain/tenderness in bones/joints
— lymph node swelling
— spleen/liver enlargement

Skin:
— night sweats
— easy bleeding and bruising
— purplish patches or spots

52
Q

Nursing interventions for bone marrow aspiration

A

— provide info to pt about blood cells and production

Nursing:
— prone or side lying position
— sedatives
— needle and incision will be made

Follow-up care:
— control bleeding
— inspection of site q2 hr
— pain control

53
Q

Medical tx of leukemia

A

Induction therapy
— started as soon as dx confirmed
— hospitalized 2-3 wk in protective isolation
S/S:
— severe bone marrow suppression
— alopecia
— n/v
— stomatitis
— organ toxicity

Consolidation therapy: once recovered
— repeat drugs or bone marrow transplant

Maintenance:
— months and years to maintain remission

54
Q

What are the two main types of lymphomas?

A

Hodgkin’s lymphoma
— teens and adults in 50s-60s

Nonhodgkin’s lymphoma
— all other lymphomas
— over 60 types
— older adult men

55
Q

Hodgkin’s lymphoma

A

Starts in single lymph node in neck, underarm, or chest
— proceeds in orderly fashion to next
— fatigue, anorexia, SOB
— sweats, fever, itching, weight loss
— pain in node areas after alcohol intake

56
Q

Risk factors and tx of Hodgkin’s lymphoma

A

Risk factors:
— viral infections
— chemical exposure

Tx:
— external radiation and chemo
— CURABLE

57
Q

Non-Hodgkin’s lymphoma

A

CHRONIC/NOT CURABLE
— lymphadenopathy in multiple sites
— spreads to other organs by the time of dx

Risk factors:
— autoimmune
— immunosuppressive disorders -> HIV
— chemicals

Tx:
— chemo/monoclonal antibodies
— radiation
— not curable

58
Q

Multiple myeloma

A

Overgrowth of plasma cells
— plasma cells overproduce gamma globulin (gammopathy)
— excess antibodies in blood CLOG BLOOD VESSELS of KIDNEY and other organs -> infects the organs

Produces excess cytokines
— increase cancer growth rate and destroy bone

Dx testing:
— serum electrophoresis test detects monoclonal immunoglobulin (high levels of calcium)
— bone marrow -> greater than 10% infiltrated plasma cells
— X-ray -> osteolytic bone lesions

59
Q

Early s/s of multiple myeloma

A

— fatigue
— anemia
— easy bruising
— bone pain
— infections

60
Q

Late s/s of multiple myeloma

A

— bone factures
— kidney dysfunction
— HTN
— RARE: hypercalcemia, hyper viscosity syndrome

Leads to progressive bone destruction, bleeding, kidney failure, immunosuppression and death

61
Q

Treatment and nursing interventions of multiple myeloma

A

Tx:
— chemo agents
— bone marrow transplant
— INCURABLE

Nursing:
— care of immunocompromised patient
— pain control

62
Q

Nursing care for leukemia, lymphoma and multiple myeloma

A

INFECTION PROTECTION
— prophylactic drugs -> antiviral, antibiotic, anti fungal
— neutropenic precautions
— monitor labs daily
— monitor for early manifestations of infection
— hygiene/skin care

THROMBOCYTOPENIC PRECAUTIONS (bleeding precautions)
— energy conservation
— teach self care -> avoid large crowds
— psychosocial support

63
Q

Neutropenic precautions

A

Infection protection
— avoid crows, children, ill people
— wear mask
— hand hygiene
— good personal hygiene, mouth care
— avoid constipation
— shave with electric razor
— do not handle feces
— NO FRESH FLOWERS OR GARDENING
— no invasive procedures
— no sexual relations
— no fresh fruits/veggies, raw meat, eggs, cheese
— assess temperature

64
Q

Thrombocytopenic precautions

A

Bleeding precautions
— assess for s/s of bleeding -> bruises/nose/gums/urine/stool/severe headache
— avoid IM/SQ/IV or invasive procedures
— NO ASPIRIN/NSAID
— soft toothbrush
— no flossing/dental procedures
— no razor blades -> electric
— stool softeners to prevent straining
— hold pressure for 5 min on venipuncture sites
— teach s/s of bleeding
— avoid situations where falls may occur

Adult Health II Exam 3 (4 decks)

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