Hematology Flashcards

Question

Management of Sickle Cell Anemia

Answer 1

Medical Treatment = Bone marrow transplant (BMT), chemo, RBC transfusions (exchanged: take some blood out, replace it with new blood) Nursing - Manage pain, prevent infection, assess for leg ulcers (where you will see this first), priapism (erection that won’t go away) is a problem, Watch for drug abuse because they are in so much pain, Teach: Need to stay away from big crowds to avoid infection

Answer 2

Iron is excessively absorbed in GI tract - Deposited in organs causing dysfunction (liver, heart, testicles, pancreas (leads to diabetes) - Can be secondary to other anemias, liver disease and multiple transfusions - Mostly in men because women have periods Clinical manifestations - Fatigue, arthralgia, impotence, abd. pain, wt. loss - Liver enlargement (cirrhosis, CA) - Other organ involvement (low thyroid count, pancreas impacted, gonads) Medical Management- - Removal of excess iron via therapeutic phlebotomy- take 500mL away once a week for 2-3 years, then every 2-3 months - Chelation- medicine takes away heavy metals - Genetic counseling required- may not have children to avoid passing it on - Dietary modifications- low iron - Manage organ involvement- treat whichever organ is involved

Answer 3

Polycythemia Vera is a proliferative disorder that results in overproduction of RBCs, WBCs platelets - Increased viscosity/volume - Congested organs/tissues: Enlarged liver/spleen Secondary Polycythemia is caused by excessive production of erythropoietin - May occur as response to hypoxia or neoplasms Relative polycythemia: low plasma, high reds Medical management – no cure - removal of cause or therapeutic phlebotomy - Diet counsel: low fat, low sodium, low cholesterol, low purine. Should be on I&Os - Hydration - Meds: Coumadin, Benadryl for itching, allopurinol for gout - bone marrow suppression - plasmophoresis - Hypoxia: give oxygen S/S: Weak, fatigued, fat headache, SOB, vertigo, ear ringing, visual problems, joint pain, burning hand, flushed PC –clots, CVA, DVT Bleeding ,MI

Answer 4

Leukopenia - Fewer WBCs than normal, - Could be neutropenia or lymphopenia Neutropenia - Fewer neutrophils than normal - results from decreased production/increased destruction - Increased risk for infection Medical management- - varies depending on cause/severity - Administer Neutrogen for Neutropenia Nursing management- - preventing and managing infections - #1 thing you can do for this patient: wash your hands - Teach family to watch for infection (take temp AM and afternoon, etc) - Minor infection could lead to sepsis – could go into septic shock - May not have classic s/s of infection - Should probably have in reverse isolation

Answer 5

Leukocytosis = increased level of WBCs - Occurs in infection, injury, inflammatory disorders, some drugs - Should decrease as need decreases - Prolonged or increasing elevation should be evaluated - Evaluation = look for immature cells indicating disorder in the marrow Cause could be malignancy/leukemia ***Diagnostic – bone marrow biopsy Treatment: Start on antibiotics to decrease the need for the WBC so body will stop manufacturing them.

Answer 6

Splenectomy may be necessary after trauma possible treatment for some hematologic disorders Due to a problem with RBC, destroying or producing Therapeutic Apheresis removes certain cells (RBC, WBC, stem cells, platelets) from blood Therapeutic Phlebotomy removal of a certain amount of blood under controlled conditions Polycythemia Increased Iron

Answer 7

Cancer of the WBCs or cells that develop into WBCs Usually takes place in the bone marrow WBCS develop from stem cells - If development goes awry, chromosomes get rearranged, interfering with normal cell division - Multiply uncontrollably - Will have a lot of immature WBC and very few reds and platelets Types define how quickly the progress & the kind of cells affected Myeloid leukemia - Acute/chronic (AML/CML) - More rare Lymphocytic - Acute/chronic (ALL/CLL - More common S/S: fatigue, infection, low air, bleeding Usually occur in children Not completely sure what causes it: connected to possible genetics, viruses, chemical and radiation exposure Diagnostics: Labs: look for immature whites and low counts of all 3 components of the blood H&P Lumbar puncture to see if the CNS is involved Bone Marrow transplant: watch for bleeding! Put a pressure bandage on because the can develop a hematoma easily Unregulated proliferation of WBCs in the marrow leaving little room for normal cell production - Decreased RBCs/platelets = anemia, bleeding - Increased ***IMMATURE WBCs= increased R/F infection - Can also grow in liver and spleen—severely infected Acute/chronic =depends on time it takes for S/S to appear & the phase at which the cell stopped development In acute form can infiltrate other organs Meds: Chemo, can do it IV, if we know it has invaded the ____ system, can do it intrathecal. Medical management: May irradiate the brain if it has gone into the brain, Stem cell transplant (not recommended for the first episode, wait until the next episode) ***Although there is overproduction of the whites, it will still cause you to have a low Leukocyte number because they are immature. Clinical manifestations - Acute- Abrupt onset, WBCs undifferentiated or “blasts”, progresses rapidly, without aggressive tx death occurs in weeks-months - Chronic – S/S occur in months-years, majority of WBCs are mature, progression slow, typically more common with adults - Infection will probably be a UTI, fever, mouth ulcers, bone and joint pain, ptikiai, bruising , hemorrhage, enlarged lymph nodes

Answer 8

Neoplasms of lymphoid cells Can be cured but may lead to other malignancies like acute myeloid Leukemia Hodgkin’s Disease - Malignant neoplasms - Cause unknown, suspect virus but familial pattern noted - Painless enlargement of neck nodes (1 side) - Mediastinal mass: pushing on your trachea, lungs or heart to the side, dyspnea, cough - Aggravated by alcohol! - - Enlarged spleen - Ages: 15-24 - S/S: Fever, weight loss, night sweats, Jaundice, Itching, Shingles common, Bone, abd pain, Cough, pulmonary effusion - TX = Chemo, then radiation followed by BMT or stem cell transplant Non-Hodgkin’s Disease - Can impact different organs - Different treatment depending on the organ it is effecting - Test: lymphogram: insert a dye in between the toes, wait 30 minutes and do a scan. Scan every few hours for 24 hours, then every day for several days to watch the lymph system - Moves in an orderly fashion - Can diagnose early - Most treatable - Treatment can be aggressive - Will mostly impact the nodes of the upper body - Nodes infiltrated by malignant cells - Prevalent in immunocompromised clients (Old, Transplant, Weak) - Survival in mild early cases is over 10 years - Strong evidence this is viral - Involves 20 different disease processes - High cure rate with chemo, involves beta cells Same impact on bone marrow as leukemia - No S/S until late: Lymphadenopathy, May get rash - TX =localized radiation non aggressive type and radiation and chemo for aggressive type. May be followed by BMT and stem cell treatment Multiple Myeloma: Clinical Manifestations - All are lymphomas - Bone pain, increasing with movement, decreasing with rest, better in the AM - Bone breakdown due to osteoclast activating factor and other substances secreted from plasma cells - Due to the destruction, excessive ionized Ca++ enters the serum – hypercalcemia (thirst, dehydration constipation, confusion coma) - Excessive excretion of immunoglobulins - Renal failure (everything gets calcified), hyper viscosity of serum- (bleeding, HA, blurred vision paresthesia, heart failure - Due to less space for RBC production – anemia in late stages & decreased WBC, platelets - Blood test: Bens jones: Will have protein in urine due to kidney failure, increased creatinine (>2) - Treatment - Not curable – address end of life issues, Pain management, Teach limitations, Teach about S/S hypercalcemia, Maintain mobility and hydration (reduces chance of kidney problem), Dialysis may be necessary, Infection precautions, Chemo slows progression, Survivors develop leukemia

Answer 9

Chemotherapy yields systemic side effects - Myelosuppression, - Nausea, - Hair loss, - Infection - Watch platelets - Keep moving as much as possible Radiation is specific to area being treated - Abdominal = nausea, diarrhea

Answer 10

Blood is unique *** organ because it is a fluid Composed of plasma, various cells, protiens, clotting factors, electrolytes, nutirents to include O2 and waste products. formed by bone marrow in response to low O2 levels Kidney sends message to bone marrow (in long bones, pelvis, vertabre, sternum, ribs) to make more cells (erythopoesis) When you get a bone marrow biopsy, take it out of the sternum or hip bone