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Illness and Patho 1 > Hematology > Flashcards

Hematology Flashcards

1
Q

Reduction in either the number of red blood cells, the amount of hemoglobin or the hematocrit

A

Anemia

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2
Q

Measure of the immature RBCs; reflection of bone marrow activity in producing RBCs

A

Reticulocyte count

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3
Q

What is the normal reticulocyte count?

A

0.5 - 2.0% of the total RBCs

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4
Q

What are the normal iron levels?

A

60-160 mcg/dL (F) and 80-180 mcg/dL (M)

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5
Q

What are the normal serum ferritin levels?

A

10-50 ng/mL (F) and 12-300 ng/mL (M)

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6
Q

What is the normal total iron binding capacity level?

A

250-460 mcg/dL

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7
Q

Measure of the gas-carrying capacity of the RBCs

A

Hemoglobin

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8
Q

Measure of the packed cell volume of RBCs, expressed as a percent of the total blood volume

A

Hematocrit

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9
Q

Amount of iron combined with proteins in serum; accurate indicator of status of iron storage and use

A

Iron

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10
Q

Major iron storage protein; normally present in blood in concentrations directly related to iron storage

A

Serum Ferritin

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11
Q

What should the bone marrow of an anemic patient be doing?

A

Producing lots and lots of RBCs

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12
Q

Measurement of all proteins available for binding iron; evaluation of the amount of extra iron that can be carried

A

Total Iron Binding Capacity

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13
Q

The ITBC is an indirect measurement of what?

A

Trasnferrin

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14
Q

What are the causes of anemia?

A

Blood loss, an impaired production of erythrocytes, and an impaired destruction of erythrocytes

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15
Q

What are many of the symptoms of anemia caused by?

A

The hypoxia created by the decreased oxygen being carried to tissues

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16
Q

What is the function of the RBC?

A

Transport oxygen from the lungs to systemic tissue and carry CO2 from the tissue to the lungs

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17
Q

How is anemia diagnosed?

A

CBC, Reticulocyte count, and peripheral blood smear

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18
Q

Which types of trauma can cause RBC destruction?

A

Ecmo, bypass, or left ventricular assist device

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19
Q

What is the physiological manifestation of anemia?

A

Reduced O2 carrying capacity

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20
Q

What are the classic signs of anemia?

A

Fatigue, weakness, dyspnea, pallor, and tachycardia

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21
Q

Why do anemic patients experience tachycardia?

A

Because their bodies are trying to increase cardiac output to compensate for the decreased oxygen levels

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22
Q

What determines the severity of the anemia?

A

Hemoglobin

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23
Q

Which severity of anemia leaves patients with few symptoms, including possible palpitations, dyspnea, and diaphoresis?

A

Mild (Hemoglobin 10-14)

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24
Q

Which severity of anemia causes increased cardiopulmonary symptoms at rest and activity with a roaring in the ears?

A

Moderate (Hemoglobin 6-10)

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25
Q

Which severity of anemia involves multiple body systems, causing pallor, glossitis, angina, HF, MI, tachycardia, a systolic murmur, orthostatic hypotension, SOB, DOE, decreased SpO2, vertigo, depression, headaches, anorexia, sore mouth, enlarged liver and spleen, fatigue, weight loss, bone pain and sensitivity to cold?

A

Severe (Hemoglobin

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26
Q

Why is anemia so dangerous?

A

It can speed up a lot of disease processes

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27
Q

Glycoprotein primarily produced in the kidneys that increase the number of stem cells commented to RBC production and shortens the time to mature RBCs

A

Erythropoietin

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28
Q

What are the side effects of taking epogen?

A

Hypertension and bone pain

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29
Q

What is the life cycle of a RBC?

A

120 days

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30
Q

What three alterations in erythropoiesis decrease RBC production?

A

Decreased hemoglobin synthesis, defective DNA synthesis in RBCs, and diminished availability of erythrocyte precursors

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31
Q

What kind of anemia results from a decrease in hemoglobin synthesis?

A

Iron-Deficiency Anemia

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32
Q

What kinds of anemias result from defective DNA synthesis in the RBCs?

A

Pernicious Anemia and Folic Acid Deficiency Anemia

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33
Q

What kind of anemia results from a diminished availability of erythrocyte precursors?

A

Aplastic Anemia

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34
Q

What would the Serum Ferritin values of a person with Iron-Deficiency Anemia be?

A

Less than 12 g/L

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35
Q

What are the symptoms of Iron-Deficiency Anemia?

A

Mild manifestations such as pallor, glossitis, koilonychia, and angular stomatitis

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36
Q

What does Iron-Deficiency Anemia result from?

A

Blood loss, poor intestinal absorption, or inadequate diet

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37
Q

At what stage is Iron-Defiency Anemia symptomatic?

A

Stage 3

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38
Q

Spoon shaped, brittle, and concave nails

A

Koilonychia

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39
Q

What is the treatment for Iron-Deficiency Anemia?

A

Two weeks of iron therapy

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40
Q

What foods are high sources of iron?

A

Liver, red meat, whole grains, leafy greens, egg yolks, raisins, and red wine

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41
Q

What do patients with iron deficiency anemia need to be evaluated for?

A

Abnormal Bleeding

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42
Q

How are iron solutions administered?

A

IM using the Z-track method

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43
Q

What causes decreased absorption of oral iron supplements?

A

Antacids, eggs or milk, coffee, and tea

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44
Q

How should oral iron supplements be administered?

A

On an empty stomach with ascorbic acid and a straw

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45
Q

Why is a straw used when giving liquid iron supplements PO?

A

To avoid teeth turning black

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46
Q

What are the side effects of iron supplements?

A

Constipation and the stool turns black/green

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47
Q

What would be the lab findings for a patients with Iron-Deficiency Anemia?

A

Decreases reticulocytes, iron, ferritin, iron saturation and MCV; Increased TIBC

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48
Q

What does proper production of the RBCs depend on?

A

Adequate DNA synthesis and adequate amounts of folic acid

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49
Q

What is the function of B12?

A

To activate enzymes that transport folic acid into the cells where DNA synthesis occurs

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50
Q

How does B12 deficiency cause anemia?

A

It inhibits folic acid transport and reduces DNA synthesis in the precursor cells

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51
Q

What causes B12 Deficiency Anemia?

A

Poor intake of foods containing B12, small bowel problems, diverticulits, tapeworms, and an overgrowth of intestinal bacteria

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52
Q

Who is susceptible for B12 Deficiency Anemia?

A

Vegetarians and people on low dairy diets

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53
Q

What are the clinical manifestations of B12 Deficiency Anemia?

A

Mild or severe pallor, jaundice, glossitis, fatigue, weight loss, paresthesia, and poor balance

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54
Q

What are the hallmarks of B12 Deficiency Anemia?

A

Paresthesias and poor balance

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55
Q

How is B12 Deficiency Anemia treated?

A

Increase the dietary intake of B12 and folic acid and use supplements if severe

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56
Q

What foods are good sources of B12 and folic acid?

A

Liver, beef, chicken, pork, ham, fish, whole grains, dairy, and whole eggs

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57
Q

Protein secreted by the parietal cells of the gastric mucosa required for cobalamin absorption in the small intestine

A

Intrinsic Factor

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58
Q

What is Pernicious Anemia caused by?

A

A decrease in the secretion of intrinsic factor, leading to the malabsorption of cobalamin

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59
Q

What are the causes of Pernicious Anemia?

A

Congenital, autoimmune, gastic atrophy, change in the pH of the stomach, ETOCH abuse, gastrectomy, smoking, and hot tea

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60
Q

What causes a change in the pH of the stomach?

A

Proton Pump Inhibitors

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61
Q

Who is Pernicious Anemia most common in?

A

Females over 30

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62
Q

What are the signs and symptoms of Pernicious Anemia?

A

Infections, mood swings, GI ailments, CV ailments, renal ailments, low hemoglobin, lemon yellow skin, hepatomegaly and splenomegaly

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63
Q

What would the hemoglobin of a patient with Pernicious Anemia be?

A

7-8 g/dL

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64
Q

Test for determining the amount of vitamin B12 excreted in the urine through a 24 hour sample

A

Shilling test of B12 absorption

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65
Q

How is Pernicious Anemia treated?

A

Life-long B12 injections

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66
Q

What would the lab findings of a patients with Pernicious Anemia be?

A

Decreased B12 levels and reticulocyte count; Increased MCV, methylmalonic acid, and homocysteine levels

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67
Q

How are B12 Deficiency and Folic Acid Deficiency Anemias differentiated?

A

In Folic Acid Deficiency Anemia, the nervous system functions normally but the RBCs have a shorter life span

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68
Q

What are the causes of Folic Acid Deficiency Anemia?

A

Poor nutrition, anti-seizure medications, birth control pills, and malabsorption due to ETOH

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69
Q

What are the signs and symptoms of Folic Acid Deficiency Anemia?

A

Cheilosis, stomatitis, watery diarrhea, painful ulcers on mucous membranes, difficulty swallowing, and flatulence

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70
Q

A disorder of the lips marked by scaling and fissures at the corners of the mouth

A

Cheilosis

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71
Q

What is the prevention for Folic Acid Deficiency Anemia?

A

Diets high in folic acid and B12

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72
Q

What is the treatment for Folic Acid Deficiency Anemia?

A

Folic acid replacement therapy

73
Q

What is an example of a Folic Acid Deficiency Anemia?

A

Megaloblastic Anemia

74
Q

What would the lab values of a patients with Folic Acid Deficiency Anemia be?

A

Decreased folate levels and increased MCV

75
Q

Deficiency of circulating RBCs due to the failure of the bone marrow in producing them

A

Aplastic Anemia

76
Q

Which stem cell is injured in patients with Aplastic Anemia?

A

Pluripotent stem cell

77
Q

What should patients with Aplastic Anemia be assessed for?

A

Pallor, Petechiae, and Ecchymosis indicated bone marrow failure

78
Q

What diseases does Aplastic Anemia generally occur with?

A

Leukopenia, thrombocytopenia, or pancytopenia

79
Q

What can cause Aplastic Anemia?

A

Long time exposure to toxic agents, ionizing radiation, pesticides, or infection

80
Q

What would the lab values of someone with Aplastic Anemia be?

A

Decreased reticulocyte found, WBC, Hgb, Hct, and platelets

81
Q

What is the immune response of Aplastic Anemia regulated by?

A

Cytotoxic T Cells

82
Q

What are the treatments for Aplastic Anemia?

A

Immunosuppressive Therapy, Splenectomy, or Bone Marrow Transplantation

83
Q

What is the treatment of choice for Aplastic Anemia?

A

Bone Marrow Transplant

84
Q

What do patients post splenectomy need to be supported with?

A

Platelets, FFP, RBCs and WBCs

85
Q

Stimulates the bone marrow to come back in patients with Aplastic Anemia

A

Immunosuppressive Therapy

86
Q

Anemia caused by renal disease

A

Decreased Erythropoietin Production

87
Q

Anemia marked by three defects: decreased erythrocyte life span, ineffective bone marrow response to erythropoietin, and altered iron metabolism

A

Anemia of Chronic Disease

88
Q

Anemia caused by hemolysis within blood vessels or lymphoid tissues

A

Autoimmune Hemolytic Anemia

89
Q

Anemias caused by cellular abnormalities of the hemoglobin structure, marked by an imbalance between the beta chain and the alpha chain of hemoglobin, resulting in RBC membrane damage, ineffective RBC production, and hemolysis

A

Thalassemias

90
Q

A chronic myleoproliferative disorder arising from ma chromosomal mutation in a single Pluripotent cell characterized by an abnormal proliferation of bone marrow stem cells with self destructive expansion of RBCs

A

Polycythemia Vera

91
Q

What are the erythropoietin levels in a patient with Polycythemia Vera?

A

Normal

92
Q

What would the CBC reveal in a patient with Polycythemia Vera?

A

Increased hemoglobin, RBCs, WBCs, and platelets

93
Q

How is Polycythemia Vera Treated?

A

Draining the bad blood and throwing it away, increasing hydration, and anticoagulants

94
Q

Why is Polycythemia Vera very bad?

A

The increase in all of the cells is so severe that blood circulation is impaired as a result of the increased blood viscosity and volume

95
Q

What would the hemoglobin of a person with Polycythemia Vera be?

A

18 g/dL

96
Q

What would the RBC of a person with Polycythemia Vera be?

A

6 million

97
Q

What would the hematocrit of someone with Polycythemia Vera be?

A

55% or higher

98
Q

What are the major hallmarks of Polycythemia Vera?

A

Massive RBC production, Excessive leukocyte production, and excessive platelet production

99
Q

What are the signs and symptoms of Polycythemia Vera?

A

Hypertension, hyperkalemia, dark, flushed appearance, distended veins, weight loss, fatigue, itching, hemorrhoids, swollen, painful joins, enlarged spleen, MI, strokes, and bleeding tendencies

100
Q

What causes the hyperkalemia seen in patients with Polycythemia Vera?

A

The breaking of RBCs

101
Q

Type of cancer with uncontrolled production of immature white blood cells in the bone marrow

A

Leukemia

102
Q

What kind of cells are seen in the peripheral blood smear of a patient with leukemia?

A

Blastic

103
Q

What are the risk factors for leukemia?

A

Ionizing radiation, exposure to certain chemicals and drugs, bone marrow hypoplasia, genetic factors, immunologic factors, stress, and environmental factors

104
Q

What happens to the RBCs and platelets of patients with leukemia?

A

The uncontrolled production of WBCs decreased their numbers

105
Q

What is the childhood leukemia?

A

Acute Lymphocytic Leukemia

106
Q

What is the adult leukemia?

A

Acute Myelogenous Leukemia

107
Q

Why are the chronic leukemias not as bad as the acute leukemias?

A

They don’t really affect the patient’s life span and are acquired most frequent after the 7th decade

108
Q

What are the clinical manifestations of leukemia?

A

Increased heart rate, decreased blood pressure, increased respiratory rate, pale and cool skin, weight loss, nausea, anorexia, and headache

109
Q

What would a lab assessment of a patient with leukemia reveal about their hemoglobin and hematocrit levels?

A

They would be decreased

110
Q

Which leukemia patients have the poorest prognosis?

A

Those with high white blood cells counts at diagnosis

111
Q

Which acute leukemia is worse?

A

Acute Myelogenous Leukemia

112
Q

What test confirms the diagnosis of leukemia?

A

Bone marrow biopsy

113
Q

Where is the bone marrow biopsy taken from to confirm the diagnosis of leukemia?

A

The posterior iliac crest

114
Q

What is the major cause of death for patients with leukemia?

A

Infection

115
Q

Normal flora become causative agent of infection

A

Auto contamination

116
Q

What are the priority nursing diagnoses for patients with leukemia?

A

Risk for infection, then risk for injury

117
Q

What are the drug therapies for acute leukemia?

A

Induction therapy, consolidation therapy, maintenance therapy and drugs for infections

118
Q

What is the goal of induction therapy?

A

It is given when patients are rebounding from nadir in the hopes that the new marrow will essentially cure itself

119
Q

What is the goal of consolidation therapy?

A

Remission of leukemia stays in remission

120
Q

What drugs are given to prevent infections in patients with acute leukemia?

A

Nystatin and bowel cleansers

121
Q

What infection precautions need to be in place for patients with acute leukemia?

A

Hand washing, private room, HEPA filtration, masks, minimal bacteria diet, not uncooked foods, meticulous skin care

122
Q

Standard treatment for leukemia, this procedure purges the present marrow of the leukemic cells and gives new, health marrow

A

Bone Marrow Transplant

123
Q

Why does a bone marrow transplant work in curing leukemia?

A

Because bone marrow is the source of stem cells, and new stem cells won’t be leukemic

124
Q

When are patients with leukemia given bone marrow transplants?

A

When they are in remission

125
Q

What happens to the bone marrow doner?

A

If they go on iron supplements they will be back to normal in three months

126
Q

What is the first sign of bone marrow rejection?

A

A rash on the palmar surface of the hands

127
Q

Cancer that starts in a single lymph node or single chain of lymph nodes with the Reed-Sternberg cell

A

Hodgkin’s Lymphoma

128
Q

What are the signs and symptoms of Hodgkin’s Lymphoma?

A

Large, painless lymph node, fever, malaise, and night sweats

129
Q

What is the treatment for Hodgkin’s Lymphoma?

A

External radiation alone or in combination with chemotherapy

130
Q

Cancer that starts in a single lymph node or single chain of lymph nodes without the Reed-Sternberg cell

A

Non-Hodgkin’s Lymphoma

131
Q

What is the treatment for Non-Hodgkin’s Lymphoma?

A

Radiation therapy and chemotherapy

132
Q

Which is worse, Hodgkin’s or Non-Hodgkin’s Lymphoma?

A

Non-Hodgkin’s Lymphoma

133
Q

Uncommon white blood cell cancer that involves a more mature lymphocyte

A

Multiple Myeloma

134
Q

What are the signs and symptoms of Multiple Myeloma?

A

Fatigue, easy bruising, bone pain, fractures, hypertension, increased infection, hypercalcemia, and fluid imbalance

135
Q

What is the treatment for Multiple Myeloma?

A

Chemotherapy

136
Q

Why do patients with Multiple Myeloma experience hypercalcemia?

A

Because calcium is being leeched from their bones

137
Q

What do the bone of patients with Multiple Myeloma look like?

A

Swiss Cheese

138
Q

Autoimmune disorder characterized by large ecchymosis or petechial rash on arms, legs, upper chest and neck

A

Autoimmune Thrombocytopenic Purpura

139
Q

What would the lab findings of a patients with Autoimmune Thrombocytopenic Purpura show??

A

Decreased platelet count and large numbers of megakaryocytic in the bone marrow

140
Q

How is Autoimmune Thrombocytopenic Purpura treated?

A

Therapy to prevent bleeding, drugs to suppress immune function, blood replacement therapy, and splenectomy

141
Q

Rare disorder in which platelets clump together abnormally in the capillaries and too few remain in circulation, causing inappropriate clotting

A

Thrombotic Thrombocytopenic Purpura

142
Q

What is the treatment for Thrombotic Thrombocytopenic Purpura?

A

Plasma pheresis, FFP, aspirin, alprostadil, plicamycin, and immunosuppressive therapy

143
Q

What is plasma pheresis?

A

Blood letting by the unit

144
Q

Deficiency of factor VIII in the blood causing the inability of the blood to clot

A

Hemophilia A

145
Q

Deficiency of factor VIIII in the blood causing the inability of the blood to clot

A

Hemophilia B

146
Q

Which is more common, Hemophilia A or B?

A

A

147
Q

What is the treatment for Hemophilia A?

A

Blood transfusion and factor VIII therapy

148
Q

What do patients with Hemophilia need to be assessed for?

A

Excessive hemorrhage and joint and muscle hemorrhage

149
Q

What lab tests do patients with Hemophilia A need to take?

A

PTT

150
Q

What is the most common problem for hemophiliacs?

A

The degeneration of joint function related to chronic bleeding into the joints

151
Q

In which of the hemophiliac’s joints does excessive bleeding take place?

A

Hip and knee

152
Q

Why are B12 injections given IM?

A

Because they will tattoo the skin

153
Q

Which test measure how long blood takes to clot?

A

PT/INR

154
Q

Which test assesses the intrinsic clotting cascade and the action of specific clotting factors?

A

PTT

155
Q

What is the nursing priority after a bone marrow or aspiration?

A

Prevent excessive bleeding

156
Q

What does multiple myeloma result in?

A

The overproduction of antibodies or gamma globulins

157
Q

What is the pathophysiology of Autoimmune Thrombocytopenic Purpura?

A

The body creates an antibody which is placed upon the surface of platelets, making them more likely to be destroyed by macrophages

158
Q

A client is scheduled for a bone marrow aspiration. What does the client’s nurse do before taking the client to the treatment room for the biopsy?

A

Verify that the client has given informed consent

159
Q

When assessing an adult client endurance in performing ADLs what question should the nurse ask?

A

How is your energy level compared with last year?

160
Q

Why is an accurate family history important when assessing a patient for a hematological disorder?

A

Because many disorders that affect blood and blood clotting are inherited

161
Q

What decreased lab value is concerning for a nurse because it is not age related?

A

Platelet count

162
Q

A client with a low platelet count asks why platelets are important. How does the nurse answer?

A

The clotting process begins with your platelets

163
Q

In which anemia would the patient have an elevated reticuloctye count?

A

Hemolytic Anemia

164
Q

What is the best way to assess the nutritional status of a client?

A

Ask the client to write down everything he or she has eaten for the past weak

165
Q

A clinic nurse is discharging a 20-year-old client who had a bone marrow aspiration performed. What does the nurse advise the client to do?

A

Place an ice pack over the site to reduce bruising

166
Q

A client has a bone marrow biopsy done. Which nursing intervention is the priority post procedure?

A

Applying pressure to the biopsy site

167
Q

How does aspiring interfere with blood clotting?

A

It inhibits the activation of platelets

168
Q

Which nursing action is most effective in reducing the potential for sepsis in clients?

A

Frequent and thorough hand washing

169
Q

What intervention most effectively protects a client with thrombocytopenia?

A

Encouraging the use of an electric shaver

170
Q

A patient with thrombocytopenia is being discharged. What information does the nurse incorporate into the teaching plan for this client?

A

Use a soft-bristled toothbrush

171
Q

A client with multiple myeloma reports bone pain that is unrelieved by analgesics. How does the nurse respond to this client’s problem?

A

“Would you like to try some relaxation techniques?”

172
Q

A nurse is caring for a client with neutropenia. Which clinical manifestation indicates that an infection is present or should be ruled out?

A

Wheezes or crackles

173
Q

A nurse is caring for a client with neutropenia who has a suspected infection. Which intervention does the nurse implement first?

A

Obtains requested cultures

174
Q

A nurse is assessing a newly admitted client with thrombocytopenia. What factor needs immediate intervention?

A

A nosebleed

175
Q

A nurse is infusing platelets to a client who is scheduled for a hematopoietic stem cell transplant. What procedure does the nurse follow?

A

Infuses the transfusion over a 15-10 minute period

176
Q

Why are patients with leukemia at extreme risk for infection even though their WBC is so high?

A

Their WBCs are too immature to fight infection

177
Q

Which predation is most important for the nurse to teach a client with leukemia to prevent an infection by autocontamination?

A

Perform mouth care three times daily

178
Q

Which precaution is most important for the nurse to teach a client with autoimmune thrombocytopenic purport who is receiving corticosteroid therapy to control the disease?

A

Avoid contact sports and any activity that could cause injury

179
Q

What is the most important environmental risk for developing leukemia?

A

Smoking cigarettes

Illness and Patho 1 (12 decks)

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