Hematology and Immunology Flashcards
Iron Deficient Anemia
Decrease in hemoglobin due to insufficient iron intake or some kino of malabsorption syndrome that prevents the absorption of iron
Anemia
Decreased red blood cell count
Medications we can provide to help with this epoetin alfa which helps to increase red blood cell count and Ferrus sulphate
Increase foods high in iron folate and B12
Extra rest periods, anemia can make you fell very fatigued
Risk factor off anemia in young children
Excess intake of cows milk
cows milk = low in iron, the milk will fill them up leading to less consumption fo iron rich foods
symptoms of anemia
Fatigue
Pallor
Shortness of breath
Tachycardia
Anemia Labs
Low Hemoglobin
Low Hematocrit
Decrease red blood cells
Low MCH, MCV, Ferritin
Treatment of anemia
Iron Supplementation
Ferrous sulfate oral
Iron dextrin IM or IV
if administering IM route, use the Z-track method in order to prevent leakage of the medication into the subcutaneous tissue
Z-track a technique in which the provider slightly pulls and holds pressure on the skin when giving an injection, which leaves a zigzag path behind when they remove the needle and release the skin.
Teaching anemia
Increase consumption of iron rich foods
Green vegetables, meat, raisins and iron-fortified foods
Vitamin C improves absorption of iron and calcium-rich products will decrease absorption of iron.
Give iron supplementation with orange juice and not with milk or antacids
Use a straw and brush teeth following administration in order to avoid stained teeth (if taking iron supplement in a liquid form)
Iron supplementation will cause green or black tarry stools, this is expected - nothing to worry about
Thalassemia
Group of genetic disorders characterized by defective hemoglobin formation and anemia
Thalassemia Signs and symptoms
Pallor
jaundice
decreased appetite and growth rates
enlarged liver
enlarged spleen
deformed facial bones
Thalassemia Diagnosis
CBC
Genetic testing
Thalassemia Treatment
Frequent blood transfusions
Because the child will be getting these transfusions frequently and regularly that causes the build up of iron in the body which necessitates chelation therapy to decrease iron levels
Hemochromatosis
Iron overload
A disorder where harmful levels of extra iron build up in the body, iim left untreated the iron can damage the heart, endocrine glands, joints of the body, liver and pancreas
Primary hemochromatosis = hereditary
Secondary hemochromatosis occurs due to other concurrent conditions such as certain types of anemia, frequent blood transfusions, liver disease
Hemochromatosis Signs and symptoms
Some patients have no symptoms but if they do symptoms include
Abdominal pain
Amenorrhea
Bronze or gray skin colour
Diabetes
Fatigue
HF
Joint pain
Liver failure
Loss of sex drive
memory fog
weakness
Hemochromatosis Treatment
Removing blood through venipuncture to remove and decrease iron levels
Done inn two phases:
Initial treatment, may need blood removal once or twice a week
Maintenance treatment
Blood removal will continue less frequently depending non the rate at which iron levels increase
Normalizing iron levels could possible take up to a year or longer
Polycythemia
Rare blood disorder, causes an increase in red blood cells. We have primary polycythemia and secondary polycythemia
Primary polycthemia: caused by a gene mutation that results in uncontrolled production of abdominal red blood cells, this makes the patients blood thicker which puts them at risk for clots, it also impaired blood flow so the patient is at risk for ischemia
Secondary polycythemia, this is due to long-term poor oxygenation that can be caused by a lung disorder or a heart disorder. the body will try to compensate for this poor oxygenation by increasing production off red blood cells
Polycythemia Signs and symptoms
Ruddy complexion (red complexion)
They may complain of dizziness, headache and fatigue, you may see clubbing present on their fingernails
Enlarged spleen
Polycythemia Diagnosis
CBC: red blood cell count will be elevated as well as hematocrit
Bone marrow biopsy may be used as well
Polycythemia Treatment
No cure
Pheresis to remove some of the patients red blood cells through phlebotomy
Mediations that are useful also include hydroxyurea as well as aspirin
Thrombocytopenia
Thrombocytopenia is a condition in which you have a low blood platelet count
Thrombocytopenia Risk factors
Thrombocytopenia might occur as a result of a bone marrow disorder such as leukemia or an immune system problem. Or it can be a side effect of taking certain medications. It affects both children and adults.
Thrombocytopenia signs and symptoms
Easy or excessive bruising (purpura)
Superficial bleeding into the skin that appears as a rash of pinpoint-sized reddish-purple spots (petechiae)
Prolonged bleeding from cuts
Bleeding from your gums or nose
Blood in urine or stools
Unusually heavy menstrual flows
Fatigue
Enlarged spleen
Thrombocytopenia Causes
Thrombocytopenia means you have fewer than 150,000 platelets per microliter of circulating blood.
Thrombocytopenia rarely is inherited; or it can be caused by a number of medications or conditions.
Whatever the cause, circulating platelets are reduced by one or more of the following processes: trapping of platelets in the spleen, decreased platelet production or increased destruction of platelets.
Thrombocytopenia things to watch out for
Monitor blood in the patients stool, urine and vomit
Avoid IVs and injections whenever possible - if a blood draw is needed, make sure to gold prolonged pressure over the area to ensure the patient stops bleeding
Thrombocytopenia Patient Teaching
Encourage patient to use an electric razor vs a straight razor
Soft tooth brush
Avoid blowing nose vigorously
Avoid NSAIDS such as ibuprofen because those medications carry a side effect of GI bleeding
Reduce risk of falls and implement safety precautions, if the patient we’re to fall they are at high risk for bleeding and this could potentially be fatal
Platelets
Platelets (thrombocytes) are colorless blood cells that help blood clot. Platelets stop bleeding by clumping and forming plugs in blood vessel injuries.
ITP immune thrombocytopenic purpura
Coagulation disorder
Autoimmune disorder where the body produces antibodies that attack its own thrombocytes/platelets this results in purpua (small bleeding spots beneath the skin)
Hemophilia
Severe inherited hemorrhagic disorder
X-linked recessive disorder that causes a deficiency in clothing factors. (not platelets, clotting factors)
Hemophilia Signs and symptoms
Excess bleeding and bruising as well as joint pain and swelling
Decreased range of motion
Hemophilia Lab work
Elevated in aPTT and a decrease in factor eight or nine depending on what type of hemophilia is present
It is important to note that platelet count and PT will not. be affected
Hemophilia Treatment
Factor replacement
(factor eight or nine depending on the type of hemophilia)
Hemophilia Teaching
Prevent bleeding: no NSAIDS or aspirin
avoid IM injections
Child should engage in physical; therapy in order to maintain range of motion
Should not engage in contact supports
For Acute bleeding
RICE mnemonic
Rest
Ice
Compression
Elevation
Hemophilia A
Results in a deficiency of factor eight
Hemophilia B
Results in a deficiency of factor nine
Disseminated Intravascular Coagulation
Disseminated intravascular coagulation (DIC) is a serious disorder in which the proteins that control blood clotting become overactive.
Causes of Disseminated Intravascular coagulation (DIC)
When you are injured, proteins in the blood that form blood clots travel to the injury site to help stop bleeding. If these proteins become abnormally active throughout the body, you could develop DIC. The underlying cause is usually due to inflammation, infection, or cancer
DIC Risk factors
Blood transfusion reaction
Cancer, especially certain types of leukemia
Inflammation of the pancreas (pancreatitis)
Infection in the blood, especially by bacteria or fungus
Liver disease
Pregnancy complications (such as placenta that is left behind after delivery)
Recent surgery or anesthesia
Severe tissue injury (as in burns and head injury)
Large hemangioma (a blood vessel that is not formed properly)
DIC Symptoms
Bleeding, from many sites in the body
Blood clots
Bruising
Drop in blood pressure
Shortness of breath
Confusion, memory loss or change of behavior
Fever
Treatment for DIC
There is no specific treatment for DIC. The goal is to determine and treat the underlying cause of DIC.
Supportive treatments may include:
Plasma transfusions to replace blood clotting factors if a large amount of bleeding is occurring.
Blood thinner medicine (heparin) to prevent blood clotting if a large amount of clotting is occurring.
Neutropenia
Neutropenia is when a person has a low level of neutrophils.
White blood cell count is down and we need to implant neutropenic precautions. PPE sued too prevent exposure for the patient to ensure they do not get sick
neutropenic precautions
Carefully monitor patients temperate
Restrict any visitors who are ill
no fresh plants or flowers in the patients room
Keep dedicated equipment in the patients room
Medication called filgrastim: helps boost up the patients neutrophil count
Neutropenia teaching
when the patient goes home
Take temperature daily
report temp above 100 degrees
Avoid crowds
Avoid sick people
Not consume raw foods
Avoid yard work or gardening
Not change their cats litter box
Wash dishes in hot water or use a dishwasher
wash toothbrush in the dishwasher daily
Neutrophils
Neutrophils are a type of white blood cell. All white blood cells help the body fight infection. Neutrophils fight infection by destroying harmful bacteria and fungi (yeast) that invade the body.
Myelodysplastic Syndrome
Myelodysplastic syndromes are a group of disorders caused by blood cells that are poorly formed or don’t work properly. Myelodysplastic syndromes result from something amiss in the spongy material inside your bones where blood cells are made (bone marrow).
In a healthy person, bone marrow makes new, immature blood cells that mature over time. Myelodysplastic syndromes occur when something disrupts this process so that the blood cells don’t mature.
myelodysplastic syndromes Causes
Most myelodysplastic syndromes have no known cause. Others are caused by exposure to cancer treatments, such as chemotherapy and radiation, or to toxic chemicals, such as benzene.
Risk factor:
Older age >60
Previous chemo or radiation
Exposure to certain chemicals
Myelodysplastic Syndrome signs and symptoms
Fatigue
Shortnesss of breath
Pallor
Bruising or bleeding
Petechiae
Frequent infections
Leukemia
Cancer of the bone marrow which causes overgrowth of cancerous white blood cells and this in turn prevents the growth of red blood cells, platelets and normal white blood cells
Lymphoma
Solid tumor in the lymphoid tissue - may be in a lymph node or in the spleen, causes the overgrowth of lymphocytes
Hodgkin’s Lymphoma
Hodgkin’s lymphoma is a type of cancer that affects the lymphatic system, which is part of the body’s germ-fighting immune system. In Hodgkin’s lymphoma, white blood cells called lymphocytes grow out of control, causing swollen lymph nodes and growths throughout the body.
Hodgkin’s Lymphomas Symptoms
Painless swelling of lymph nodes in your neck, armpits or groin
Persistent fatigue
Fever
Night sweats
Losing weight without trying
Severe itching
Pain in your lymph nodes after drinking alcohol
Non-Hodgkin’s Lymphoma
Non-Hodgkin’s lymphoma is a type of cancer that begins in your lymphatic system, which is part of the body’s germ-fighting immune system. In non-Hodgkin’s lymphoma, white blood cells called lymphocytes grow abnormally and can form growths (tumors) throughout the body.
Signs and symptoms of non-Hodgkin’s lymphoma
Swollen lymph nodes in your neck, armpits or groin
Abdominal pain or swelling
Chest pain, coughing or trouble breathing
Persistent fatigue
Fever
Night sweats
Unexplained weight loss
Difference Between Hodgkins lymphoma and non Hodgkins lymphoma
Both Hodgkin’s lymphoma and non-Hodgkin’s lymphoma are types of lymphoma. Lymphoma is a type of cancer that begins in white blood cells called lymphocytes. Lymphocytes are an important part of the body’s germ-fighting immune system.
The main difference between Hodgkin’s lymphoma and non-Hodgkin’s lymphoma is in the specific lymphocyte each involves
If a specific type of cell called a Reed-Sternberg cell is seen, the lymphoma is classified as Hodgkin’s. If the Reed-Sternberg cell is not present, the lymphoma is classified as non-Hodgkin’s.
Multiple Myeloma
Cancer that causes the overgrowth of plasma cells in the bone marrow. This in turn results in excess secretion of cytokines as well as antibodies. Prevents the growth of red blood cells. Platelets and normal white blood cells
Treatment for hematologic (blood) cancers
Chemotherapy, radiation, targeted therapy as well as stem cell transplant. With any of the blood cancers patient will be at risk for anemia, neutropenia and Thrombocytopenia = implement precautions and complete patient teaching
Oncological/Cancer
Cancer is a disease characterized by DNA damage that causes abnormal cell growth and development
Cancer Pathophysiology
Three processes: initiation, promotion then progression
During initiation damage or mutation to DNA causes excessive cell division
This is due to excessive oncogene function but decreased suppressor gene function
Promotion: Mutated cells are exposed to promoters that enhance their growth , estrogen is an example of a promoter that will promote the further development of certain types of cancer
Progression: Tumor cells afire additional mutations and their growth rate increases, this allows them to metastasize so basically spread throughout the body and makes them resistant to therapy
Cancer Risk factors
Older age
Genetics
Immunosupression
Viruses
Smoking
Sun exposure
High fat
Low-fibre diet
General Signs and Symptoms of Cancer
Unexplained weight loss
Fatigue
Pain
Infection
Bleeding
Diagnosis Cancer
Biopsy = gold standard for diagnosing
Other diagnostic tools can include MRI, CT scan and ultrasound as well
Treatment Cancer
Medications: chemotherapy which is used to destroy rapidly dividing cells, administer through an implanted port or through a central line
Give the patient hormonal therapy and immunotherapy as well
Other procedures include radiation and then surgery to remove the tumor (tumor excision)
Complications with Cancer/treatment of cancer
Malnutrition
Infection
Mucositis (inflammation and ulceration of thee mucosa in the mouth)
anemia
thrombocytopenia
alopecia
HIV/AIDS
HIV is a retrovirus that causes decreased immunity in the patient and increased susceptibility to infections
The disease enters the body through the blood or bodily fluids and it targets the CD4-plus lymphocytes which are. the helper T cells this results in immunodeficiency, autoimmunity and neurological dysfunction
HIV Risk factors
Unprotected sex
Multiple sex partners
Perinatal exposure (baby is born to a HIV positive mom)
IV drug use
Healthcare workers (prevent needle stick injuries and exposure to blood and bodily fluids whenever possible)
HIV signs and symptoms
Flu like symptoms
Lymphadenopathy (enlarged lymph nodes)
Thrush: a fungal infection on the tongue, weakness, night sweats, fever, weight loss and rashes
HIV Labs
White blood cell count will be decreased
CD4+ count under 500
Positive ELISA test - confirm with western blot test
If CD4+ count falls below 200 that is indicative of AIDS which is acquired immunodeficiency syndrome
Signs and Symptoms of AIDS
Kaposi’s sarcoma which is cancer of the skin and the soft tissue
Tuberculosis
Pneumonia
Wasting syndrome
Candidiasis of the airways: fungal. infection that affects respiratory system
Treatment for HIV and AIDS
ART
Antiviral therapy - on numerous anti virals for the rest of their lives
patient Teaching HIV and Aids
Safe sex practices
Pre-exposed prophylaxis for uninfected sexual partners
Emphasize need for ongoing monitoring of the patients CD4+ count
Prevent Infection due to compromised immune system
good hand hygiene, bathe daily
Avoid raw and undercooked foods as well as fresh plants
Do not clean cat letterboxes
Avoid crowds and sick people
Rh Negative
Rh factor is an inherited protein found on the surface of red blood cells. If your blood has the protein, you’re Rh positive. If your blood doesn’t have the protein, you’re Rh negative. The “+” or “–” you might see after your blood type refers to Rh positive or Rh negative.
Rh positive is much more common than Rh negative. Having an Rh negative blood type is not an illness, and it usually does not affect your health. But it can affect pregnancy.
Your pregnancy needs special care if you’re Rh negative and your baby is Rh positive.
RH during pregnancy
During pregnancy, problems can happen if you’re Rh negative and your baby is Rh positive. Usually, your blood doesn’t mix with your baby’s blood during pregnancy. However, a small amount of your baby’s blood could come in contact with your blood when the baby is born. It can also happen if you have bleeding or trauma to your abdomen during pregnancy.
If you’re Rh negative and your baby is Rh positive, your body might produce proteins called Rh antibodies if your blood and the baby’s blood mix. Those antibodies aren’t a problem during the first pregnancy. But problems can happen if you become pregnant again.
If your next baby is Rh positive, the Rh antibodies can cross the placenta and damage the baby’s red blood cells. This could lead to life-threatening anemia, a condition in which red blood cells are destroyed faster than the baby’s body can replace them. Red blood cells are needed to carry oxygen throughout the body.
If you’re Rh negative, you might need to have another blood test — called an antibody screen — several times: during your first trimester, during week 28 of pregnancy and when your baby is born. Some people need the test more often.
Monoucleosis
Infectious mononucleosis (mono) is often called the kissing disease. The virus that causes mono (Epstein-Barr virus) is spread through saliva. You can get it through kissing, but you can also be exposed by sharing a glass or food utensils with someone who has mono.
Mononucleosis Signs and Symptoms
Fatigue
Sore throat
Fever
Swollen Lymph nodes
Swollen tonsils
Headache
Skin rash
Swollen spleen
The virus has an incubation period of about four to six weeks, although in young children this period may be shorter. The incubation period refers to how long before your symptoms appear after being exposed to the virus. Signs and symptoms such as a fever and sore throat usually lessen within a couple of weeks. But fatigue, enlarged lymph nodes and a swollen spleen may last for a few weeks longer.
Mononucleosis Complications
Enlarged spleen
Liver issues: hepatitis, Jaundice
Hashimotos
Hashimoto’s disease is an autoimmune disorder affecting the thyroid gland.
Hashimoto’s disease, immune-system cells lead to the death of the thyroid’s hormone-producing cells. The disease usually results in a decline in hormone production (hypothyroidism).
Although anyone can develop Hashimoto’s disease, it’s most common among middle-aged women. The primary treatment is thyroid hormone replacement.
Hashimotos Signs and Symptoms
Fatigue and sluggishness
Increased sleepiness
Dry skin
Constipation
Muscle weakness
Irregular or excessive menstrual bleeding
Depression
Problems with memory or concentration
A puffy face
Brittle nails
Hair loss
Raynaud’s
rare vascular disorder that causes vasospasming of the arteries in the fingers and/or toes. Decreased blood flow to these extremities
Primary raynauds: Raynauds disease, cause is idiopathic. More common and symptoms tend to be a little less severe
Secondary Raynauds: raynauds phenomenon, underlying connective tissue disease such as lupus or scleroderma which damages the arteries
Raynaud’s Signs and symptoms
Upon exposure to cold or stress, the fingers will become cyanotic, cold, painful and numb. after spasming, blood flow will return to the area and cause those fingers to turn very red in colour
Raynauds signs and symptoms
Diagnosis can usually be done based on the clinical signs and symptoms
ANA titer: anti-nuclear antibody titer to assess for the presence of any underlying autoimmune disorders in the patient
Raynauds Treatment
Use of vasodilators and then for severe cases of raynauds = sympathectomy
Raynauds Patient teaching
Avoid cold, dress warmly
Cold can trigger the vasospasming associated with raynauds
Decrease caffeine intake because that causes vasoconstriction
Reduce stress levels and stop smoking
Sickle Cell Anemia
Autosomal recessive genetic disorder that causes chronic anemia, pain, infection as well as organ damage
Sickle Cell Anemia Pathophysiology
Normal hemoglobin (Hba) replaced with abnormal sickle hemoglobin (Hbs) and this causes the sickling of the red blood cells
Normally red blood cells are nice ad round, when we have the sickling they turn into a C shape and can easily get caught in the blood vessels which obstructs blood flow to the organs and can result in tissue hypoxia.
Sickle cell anemia Risk factors
family history is going to be a risk factor because this is a genetic disorder
African Americans and middle Eastern descent are at higher risk for sickle cell anemia
Diagnosis of Sickle cell anemia
Sickle turbidity test, detects abnormal hemoglobin
Hemoglobin electrophoresis
Sickle cell treatment
Opioid analgesics on a schedule
Provide antibiotics if there is an infection present
Administer IV fluids to help decrease the viscosity of the blood - help the flow of blood get to the organs that will help prevent tissue hypoxia
Give blood products and oxygen as ordered
Sickle cell anemia Pt teaching
Encourage our patient to get enough fluid intake to help prevent dehydration and prevent the onset of a vast-occulsive crisis. We want them to avoid getting infection so they need to perform meticulous hand hygiene and avoid crowds
Sickle cell anemia signs and symptoms
Pain
Fatigue
shortness of breath
Pallor
Jaundice
Vaso-occlusive crisis
Type of sickle cell crisis
Severe pain that will need to be treated with opiod analgesics around the clock
May have swelling in their hands and feet
Splenic sequestration Crisis
Type of sickle cell crisis
Blood flow is blocked out of the spleen due to the sickling of the red blood cells, causes enlargement of the spleen, patient also might experience hypovolemic shock
Aplastic Crisis
Type of sickle cell crisis
Severe anemia typically related to viral infection
Acute chest syndrome
Crisis where blood flow too the lungs is impaired so the patient will have dyspnea, fever and cough
Hyper-hemolitic crisis
Characterized by decrease in hemoglobin levels sin terms off diagnosis of sickle cell anemia
Epistaxis
Nosebleed
This can be caused by trauma, a bleeding disorder, dry air, allergies as well as certain medications
Treatment of Epistaxis
Lean the Childs head forward not back, avoid having them swallow blood
Maintain pressure with thumb and finger on the soft part of the nose, maintain pressure for ten minutes. We can also apply an ice pack to the bridge of the nose
For persistent bleeding we can use packing with epinephrine for the provider can cauterize the bleed
Epistaxis Teaching
Keep the Childs nose lubricated and use a cool mist humidifier in the room
Advise the child to avoid blowing their nose forcefully
A client with granulocytopenia has many visitors. What is the most important thing the nurse should tell the visitors to do to prevent infection?
Wash their hands.
The nurse is assessing a client who has aplastic anemia. Which finding indicates the client has physiologic changes as a result of the disease?
bleeding tendencies
The nurse is administering an intravenous (IV) infusion of packed red blood cells and normal saline solution to a client who is in hemorrhagic shock. Which is a priority for the nurse to assess for this client?
anaphylactic reaction
A client with rheumatoid arthritis is being discharged with a prescription for aspirin, 600 mg P.O. every 6 hours. Which statement by the client indicates understanding of the adverse effects of the medication?
The client with rheumatoid arthritis typically takes a relatively high dosage of aspirin for its anti-inflammatory effect. The nurse should instruct the client to report signs and symptoms of aspirin toxicity, such as tinnitus (ringing in the ears)
Which lab values should the nurse report to the health care provider (HCP) when the client has anemia?
intrinsic factor, absent
The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of the intrinsic factor which results from atrophy of the stomach wall. Without the intrinsic factor, vitamin B cannot be absorbed in the small intestine and folic acid needs vitamin B for deoxyribonucleic acid synthesis of RBCs. The gastric analysis is done to determine the primary cause of the anemia.
A nurse is preparing to administer a unit of blood to a client with anemia. After removal of the blood from the refrigerator, the transfusion of the blood must be completed within:
4 hours.
Pancytopenia
low levels of red blood cells, white blood cells and platelets. You may experience symptoms associated with low levels of each type, including anemia (low red blood cells), increased risk of infection (low white blood cells) and excessive bruising or bleeding (low platelets).
The nurse is preparing to administer platelets. What should the nurse do first?
The bag containing platelets needs to be gently rotated to prevent clumping
During a visit to the clinic, a client reports the onset of early symptoms of rheumatoid arthritis. The nurse should conduct a focused assessment for which symptom?
early morning stiffness
Initially, most clients with early symptoms of rheumatoid arthritis report early morning stiffness or stiffness after sitting still for a while. Later symptoms of rheumatoid arthritis include limited joint range of motion; deformed joints, especially of the hand; and rheumatoid nodules.
The teaching plan for a client with rheumatoid arthritis includes rest promotion. What position of the involved joints should the nurse tell the client to avoid when at rest?
maintaining the joints in a flexed position
A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority?
Risk for injury
Allopurinol is prescribed for a client who has chronic gout. Which comment indicates that the client understands how to take the allopurinol?
“I should drink plenty of fluids when taking allopurinol.”
It is important that the client force fluids to 3000 mL a day to avoid the development of renal calculi when taking allopurinol.
A client has moved into the acquired immunodeficiency syndrome (AIDS) phase of the human immunodeficiency virus (HIV) positive infection. The nurse advises the client to avoid what outdoor recreational activity?
swimming in rivers or lakes
The nurse interviews a client with systemic lupus erythematosus (SLE) who reports to the emergency department with severe back pain after a minor fall. What aspect of the client’s medical history is most relevant to the potential cause of this injury?
prescription for prednisone
The fact that the client is on a corticosteroid is the most relevant piece of information listed because it is associated with osteoporosis and can contribute to compression fractures of the spine
A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see?
hypercalcemia
A client from a Mediterranean country is admitted with thalassemia, jaundice, splenomegaly, and hepatomegaly. Which should be the primary focus of nursing care for this client?
Decrease cardiac demands by promoting rest.
A 35-year-old female client is diagnosed with aplastic anemia. Which nursing measure should the nurse incorporate into the client’s plan of care?
Alternate periods of activity with rest to decrease fatigue.
While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters?
platelet count, prothrombin time, and partial thromboplastin time
The diagnosis of DIC is based on the results of laboratory studies of prothrombin time, platelet count, thrombin time, partial thromboplastin time, fibrinogen level, and D-dimer, as well as client history and other assessment factors. Red blood cell count and hemoglobin are not utilized in this diagnosis.
A client with multiple myeloma presents to the emergency department complaining of excessive thirst and constipation. The client’s family members report that the client has been confused for the last day. Which laboratory value is most likely responsible for this client’s symptoms?
serum calcium level 13.8 mg/dl (0.766 mmol/L)
Excessive thirst, constipation, dehydration, confusion, and altered mental state are possible signs of hypercalcemia. Hypercalcemia is common in multiple myeloma because of the increased bone destruction.
A nurse applies standard precautions when caring for a client with human immunodeficiency virus (HIV). The nurse takes what action when applying standard precautions?
wearing gloves for providing mouth care
The client’s HIV status is irrelevant to the application of standard precautions, and the client should not be treated differently because of this diagnosis. A healthcare worker wears gloves when contact with any client’s blood or body fluids is anticipated, such as when providing mouth care.
Which iron-rich foods should a nurse encourage an anemic client requiring iron therapy to eat?
lamb and peaches
A client with thrombocytopenia has developed a hemorrhage. The nurse should assess the client for which finding?
tachycardia
A nurse is caring for a client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?
Pallor, tachycardia, and a sore tongue
A client with idiopathic thrombocytopenic purpura (ITP) is being treated with prednisone and rituximab. The nurse prioritizes what aspect of care planning?
infection control measures
Which step must be done first when administering a blood transfusion?
Verify the physician’s order.
A client who is receiving a blood transfusion suddenly experiences chills and a temperature of 101°F (38.3°C). The client also has a headache and appears flushed. Place the nursing actions in the order in which the nurse should perform them to properly respond to this client’s situation. All options must be used.
Stop the blood infusion.
Infuse normal saline to keep the vein open.
Obtain a blood culture from the client.
Send the blood bag and administration set to the blood bank.
The nurse is teaching a female client about taking folic acid supplements for folic acid deficiency anemia. What information should be included in the teaching plan?
Oral contraceptive use, pregnancy, and lactation increase daily requirements.
A nurse is caring for a client with human immunodeficiency virus (HIV). To determine the effectiveness of treatment the nurse expects the physician to order:
Quantification of T-lymphocytes is used to monitor the effectiveness of treatment for HIV. E-rosette immunofluorescence is used to detect viruses in general; it doesn’t confirm HIV infection.
The nurse is evaluating the laboratory results of a client who was recently admitted to the hospital. Which result indicates the presence of inflammation?
leukocytosis
A female client with a history of systemic lupus erythematosus was admitted with a severe viral respiratory tract infection and diffuse petechiae. Based on these data, what recent information about the client should the nurse assess further?
ength and amount of menstrual flow
ength and amount of menstrual flow
hemodilution
A client is diagnosed with rheumatoid arthritis, an autoimmune disorder. When teaching the client and family about autoimmune disorders, the nurse should provide which information?
Autoimmune disorders include connective tissue (collagen) disorders.
The nurse is completing a health history review of a client who has received long term medical steroid therapy for lupus. Which client data does the nurse recognize as potentially linked to the steroid use? Select all that apply.
three infections over the course of the year
acne noted on the forehead, cheeks, and back
A nurse is assigned to a client with acquired immunodeficiency syndrome (AIDS). The nurse takes what precautions?
The nurse uses the same precautions as with any client.
The nurse reviews the laboratory results for a client with type 2 diabetes who is scheduled for surgery in about one month. What result should the nurse notify the healthcare provider about as most relevant to the preoperative plan of care?
low hematocrit (HCT) and hemoglobin (Hb) levels
The nurse admits a 1-year-old child to the hospital with the diagnosis of sickle cell crisis. The nurse explains to the parents that which condition leads to local tissue damage during a sickle cell crisis?
obstruction to circulation
The couple with the lowest risk of having a child with sickle cell anemia disease is the one in which the
father is HbA and the mother is HbS.
If the father has normal hemoglobin (HbA) and the mother has sickle cell anemia (HbS), the couple has a 0% chance of having a child with sickle cell anemia. If both parents have sickle cell anemia, the couple has a 100% chance of having a child with sickle cell anemia. If the father has sickle cell anemia and the mother has sickle cell trait (HbAS), the couple has a 50% chance of having a child with sickle cell anemia. If both parents have sickle cell trait, the couple has a 25% chance of having a child with sickle cell anemia.
A client with acquired immunodeficiency syndrome (AIDS) is ordered zidovudine, 200 mg P.O. every 4 hours. When teaching the client about this drug, the nurse should provide which instruction?
“Take zidovudine every 4 hours around the clock.”
The nurse has been able to draw the daily blood specimen from a client’s Hickman catheter only after requesting that the client raise the arms and cough. The client asks the nurse why this is necessary. What should the nurse tell the client?
“The catheter may be lodged against a blood vessel wall.”
