HEMATOLOGY/BLOOD ADMINISTRATION Flashcards

Question

SYMPTOMS OF ANEMIA: 2 | TONGUE...

Answer 1

TONGUE: - GLOSSITIS (severe anemia) Inflammation of tongue - SMOOTH TONGUE (severe anemia)

Answer 2

``` ...how rapid anemia develops ...how long anemia has existed ...how severe the anemia is ...presence of coexisting disease ...patient's metabolic requirements ```

Answer 3

1) Less Fatigue 2) Adequate Nutrition 3) Adequate Perfusion 4) Absence of Complications

Answer 4

IRON DEFICIENCY ANEMIA IS THE MOST COMMON ANEMIA IN THE WORLD

Answer 5

1) DEPLETION OF IRON STORES 2) STRICT VEGETARIAN DIETS 3) BLEEDING: GI & GU 4) IRON MAL-ABSORPTION: Gastrectomy

Answer 6

1) ELDERLY 2) TEENAGER 3) FEMALE 4) IMMIGRANT 5) ABORIGINE 6) WIDOWER

Answer 7

1) LOW IRON/HEME IRON 2) LOW VITAMIN C 3) EXCESS PHYTATE (blocks iron) 4) EXCESS TEA/COFFEE (contain polyphenol compounds that negatively affect iron absorption in the body) 5) FAD DIETS

Answer 8

1) GENERAL ANEMIA SYMPTOMS 2) PALLOR (most common) 3) GLOSSITIS (2nd most common) 4) CHEILITIS (inflammation of lips) 5) LOW IRON SYMPTOMS - HEADACHE - PARESTHESIAS - BURNING TONGUE 6) BRITTLE, RIGID NAILS 7) ANGULAR CHEILOSIS (ulceration at mouth corners)

Answer 9

1) LOW SERUM FERRITIN 2) SMALL ERYTHROCYTES - DECREASED MCV (mean corpuscular volume) 3) ELEVATED TIBC (total iron binding capacity) 4) LOW HEMOGLOBIN

Answer 10

1) IRON REPLACEMENT THERAPY 6-12 MONTHS - Take on empty stomach (1 hour before meal) - Vitamin C can enhance absorption - Watch for constipation - Liquid/Oral preparations may stain teeth (dilute/use straw) - IV: watch for allergy reaction risk - IM: can stain skin; different needles for drawing/injecting - Z-track technique to stop seepage - Lifelong Therapy: watch for liver problems r/t iron storage 2) NUTRITION - Meat, organ meats, leafy green vegetables, raisins

Answer 11

1) PREMENOPAUSAL/PREGNANT WOMEN 2) LOW SOCIOECONOMIC CLASS 3) OLDER ADULTS 4) BLOOD LOSS

Answer 12

Characterized by the presence of large RBC's that are easily destroyed because of fragile cell membranes.

Answer 13

1) B12 (COBALAMIN) DEFICIENCY 2) FOLIC ACID DEFICIENCY 3) IMPAIRED DNA SYNTHESIS

Answer 14

``` -FAULTY ABSORPTION Intrinsic Factor (IF), secreted by parietal cells of gastric mucosa is needed for B12 absorption. So no IF = no B12 absorption ``` -PERNICIOUS ANEMIA: antibodies attack IF secreting parietal cells -OTHER CAUSES: GI Surgery, Problems Crohn's Disease

Answer 15

- Sore, red, beefy & shiny tongue - General Anemia Symptoms - Neuromuscular Manifestations - Premature grey hair

Answer 16

- RBCs are large & abnormal shaped - Low Serum Cobalamin (B12) - Normal Folate & low cobalamin = megaloblastic anemia due to low cobalamin - Schilling Test: measures amount of radioactive cobalamin excreted in the urine - < 8% in urine/24hrs = can't absorb cobalamin

Answer 17

Because of Intrinsic Factor deficiency/dysfunction, B12 ingestion wouldn't work... - Use Parenteral & Intranasal Cobalamin Meds. - start every 2 weeks -> weekly 'til normal... - Monthly IM B12 Injections (for life)

Answer 18

Folic acid is required for DNA synthesis leading to RBC formation and maturation

Answer 19

GI: beefy red tongue, dyspepsia (indigestion) | - NO NEURO SYMPTOMS (Different from B12 deficiency)

Answer 20

Low Serum Folate (< 3 - 25mg/ml) | - normal serum cobalamin

Answer 21

Folic Acid Replacement Therapy - 1mg - 5mg per day PO (Most vitamins don't have Folic acid)

Answer 22

- Pernicious Anemia (Familial Predisposition) - Decreased sensation to heat/pain b/c of NEURO. impairment = protect patient from injury - PRBCs- Remember this anemia happens slowly; check risk for overload

Answer 23

From Hemolysis of RBCs from Extrinsic Factors: 1) Physical Trauma (Surgery- hemodialysis) 2) Antibody Reactions (transfusion) 3) Infectious Agents/Toxins 4) Autoimmune

Answer 24

Erythrocytes- shortened life span Increased Reticulocyte count Increased Bilirubin

Answer 25

1) INHERITED 2) AUTOSOMAL RECESSIVE 3) ABNORMAL HEMOGLOBIN (S) ↓O2 cause RBC stiffen/elongate → sickle → doesn't flow well 4) COLD worsen the process

Answer 26

AS x AS = AA (normal) AS (carrier) AS (carrier) SS (has sickle cell)

Answer 27

Hypoxia from: 1) Viral/Bacterial Infection 2) High Altitude 3) Emotional/Physical Stress 4) Surgery/Blood loss

Answer 28

a severe, painful, acute exacerbation of RBC sickling → vaso-occlusive crisis →life threatening shock - affect spleen & all other organs (w/ high O2 need)

Answer 29

1) Dark Skin 2) Pallor 3) Skin Grayish Cast 4) Jaundice 5) Gallstone Risk 6) Sickle Cell Crisis PAIN (from tissue Ischemia) → back, chest, limbs, abdomen → w/ fever, swelling, tender, tachypnea, hypertension, nausea, vomiting

Answer 30

1) B/c of spleen negatively affected by sickle cells, spleen fail to phagocytize foreign substance 2) Spleen become small from scarring (autosplenectomy)

Answer 31

1) Sickle cells have a shortened half life- Hgb 7-10 2 Bone marrow expands during childhood- enlarged bones of face and skull 3) Tachycardia, cardiac murmurs 4) Thrombosis of any organ-symptoms 5) Susceptible to pneumonia (increase complication)

Answer 32

1) Peripheral Blood smear = sickled cells 2) Sickling Test 3) RBC breakdown → hemolysis → ↑ Bilirubin 4) Hemoglobin Electrophoresis = Hemoglobin S 5) Bone X-ray = bone/joint deformities/flattening

Answer 33

1) Treat Infection 2) Prevent Respiratory Failure (O2 admin.) 3) IV: fluids = reduce viscosity PRBC = to treat crisis 4) Pain Mgmt. during Crisis (Morphine/Hydromorphone) 5) Bone Marrow Transplant: chemo kills all bone marrow; then transplanted with new one 6) Teach PT to avoid crisis 7) hydroxyurea (Hydrea): Anti sickling Agent

Answer 34

The production and presence of increased numbers of RBCs

Answer 35

Myeloid stem cells gone wild: 1) overproduction of RBCs, WBCs & Platelets 2) Bone Marrow wears out 3) Spleen enlarges (may need chemo)

Answer 36

``` 1) Hypoxia Driven: Hypoxia → ↑ EPO production → ↑ RBC production (can normalize) 2) Hypoxia Indepent: EPO produced by malignant/benign tumor ```

Answer 37

1) Ruddy with a large spleen 2) Increased blood volume, increased blood viscosity (clumping) 3) Generalized pruritus-increased basophils 4) Increased leukocytes, and platelets

Answer 38

1) ↑ HGB & RBC Count 2) ↑ EPO Level (secondary) 3) ↑ WBC & Platelet (primary)

Answer 39

1) Phlebotomy: - Decrease iron stores (Remove blood) - Decreases blood viscosity (IV Hydration) 2) Chemotherapeutic therapy- suppress the bone marrow - → leukemia/myelofibrosis 3) Myelosuppressive Agent: hydroxyurea (Hydrea) 4) Prevent Hypoxia 5) Prevent fluid overload/underhydration 6) Prevent Thrombosis (major morbidity cause)

Answer 40

A decrease in the total WBC count | Granulocytes, monocytes, lymphocytes

Answer 41

A reduction in neutrophils. (500-1000 cells/uL) | Normal (4000-11000/uL)

Answer 42

1) Iatrogenic (chemo/immunosuppresive therapy) 2) Drug Induced 3) Hematologic Disorders 4) Auto immune 5) Infections 6) Other (sepsis, nutrition deficiency, hemodialysis, transfusion reaction)

Answer 43

Phagocytic mechanisms are impaired... - Classic Inflammation signs may not occur - Pus formation absent - Fever - Bacterial/Viral infection symptoms

Answer 44

1) WBC Count (Differential- to confirm) 2) Bone Marrow Aspiration 3) Biopsy 4) Blood Smear

Answer 45

1) Determine cause of Neutropenia 2) Identify Infection cause 3) Prophylactic/Empiric/Antibiotic Therapy 4) hematopoietic growth factors (G/GM-CSF) 5) Neutropenic Precautions

Answer 46

1) Prolonged or increasing number of leukocytes 2) Regulated reproduction of cells is out of control 3) Leaves little room for normal cells 4) Genetic influence and possible viral influence 5) Bone damage from chemicals or radiation

Answer 47

malignant disorders that affect: 1) blood 2) blood forming bone marrow 3) lymph system 4) spleen

Answer 48

1) Chemical Agents (benzene) 2) Chemotherapy Agents 3) Virus 4) Radiation 5) Immune deficiencies

Answer 49

1) ACUTE MYELOID LEUKEMIA | 2) CHRONIC MYELOID LEUKEMIA

Answer 50

1) Occurs in all age groups 2) survival rate=5 years 3) Rapid increase of cells in other organs 4) Symptoms develop without warning.

Answer 51

1) Rarely occurs in people younger than 20 2) Mutation in the myeloid stem cell. 3) Wide range of immature to mature cells 4) Leukocytes divide rapidly

Answer 52

``` 1) ECCHYMOSIS (Skin discoloration from bleeding under) 2) PETECHIAE (Small red/purple spot from bleeding in skin) 2) BLEEDING (b/c not producing RBCs & platelets) 3) INFECTIONS (WBCs produced are not well functioning) ```

Answer 53

1) Enlarged and tender spleen 2) Malaise, anorexia 3) Weight loss 4) Philadelphia Chromosome (Disease marker)

Answer 54

1) INDUCTION THERAPY - aggressive treatment to achieve remission; destroy leukemic cells 2) BLOOD PRODUCTS 3) BONE MARROW TRANSPLANT 4) SUPPORTIVE CARE

Answer 55

1) SUBQ Interferon Alpha and Cytosine 2) PO imatinib mesylate 3) Treat fatigue, depression, anorexia, mucositis and inability to concentrate

Answer 56

1) Most common type in children 2) 5 year event free survival rate S/S 3) abrupt bleeding/fever, fatigue,bone/joint pain 4) meningitis caused by arachnoid infiltration

Answer 57

1) Most common in adults 2) Characterized by production/accumulation of inactive/long lived small, mature looking lymphocytes S/S 3) lymph node enlargement 4) pressure on nerves from enlarged nodes cause pain & paralysis

Answer 58

malignant neoplasms originating in the bone marrow & lymphatic structures resulting in the proliferation (rapid increase) of lymphocytes

Answer 59

- characterized by proliferation of abnormal, giant, multinucleated cells called REED-STERNBERG cells - lymph nodes destroyed by hyperplasia

Answer 60

1) EPSTEIN-BARR Virus infection 2) Genetic Predisposition 3) Toxins exposure 4) HIV

Answer 61

1) Good cure rate 2) Peaks in early 20s and over 50 3) Reed-Sternberg cell (defining trait) 4) Possible viral origin 5) One Lymph Node (painless)

Answer 62

1) Enlarged cervical, axillary, inguinal nodes 2) FATIGUE, FEVER, NIGHT SWEATS, WEIGHT LOSS (B symptoms) 3) HEPATOMEGALY/SPLENOMEGALY

Answer 63

1) Radiation 2) Chemotherapy (ABVD) - A-driamycin, B-leomycin, V-inblastine, D-acarbazine - early stage = 2-4 cycles / late stage = 4-6 cycles 3) Teach about potential long term complications - toxicity from treatment - fertility issues

Answer 64

- Heterogenous group of malignant neoplasms of B-/T-cell origin affecting ALL AGES - Most common Hematologic Cancer

Answer 65

1) Multiple lymph nodes (can originate outside) 2) Increasing numbers 3) Increased in immunosuppressed - common in those who've used immunosuppresive meds. or chemo/radiation 4) Prognosis not as good as Hodgkin's

Answer 66

1) Painless Lymph node enlargement 2) Lymphadenopathy wax & wane (come & go) 3) Fever, Night Sweats, Weight Loss (B Symptoms)

Answer 67

1) Chemotherapy Combo 2) Protect from infection 3) Aggressive lymphomas more responsive to treatment than Indolent (lazy) lymphomas 4) Rituximab (Rituxan) - infusion allergy reactions - hypotension, bronchospasm, dysrhythmias, angioedema, cardiogenic shock

Answer 68

neoplastic plasma cells infiltrate bone marrow & destroy bone

Answer 69

1) Twice as common in men than women 2) excessive production of plasma cells that infiltrate bone marrow & abnormally produce IgG 3) Slow development 4) S/S: Bone pain, osteoporosis 5) Treatment: Chemo. w/ corticosteroids

Answer 70

a reduction of platelets below 150,000/uL; manifests as prolonged bleeding from minor trauma, to spontaneous bleeding without injury

Answer 71

1) Immune Thrombocytopenic Purpura - autoimmune disorder - caused by infection and decreased platelet 2) Thrombotic Thrombocytopenic - hemolytic anemia, thrombocytopenia, neuro dysfunction, fever & renal dysfunction 3) Heparin Induced Thrombocytopenia - platelet destruction/vascular endothelial injury are 2 major responses to an immune-mediated response to heparin

Answer 72

An X-linked recessive genetic disorder caused by defective/deficient coagulation factor - Hemophilia A most common (factor VIII) - Hemophilia B (Christmas disease; factor IX) - Von Willebrand Disease (Von Willebrand coagulation protein)

Answer 73

1) SLOW, PERSISTENT BLEEDING 2) DELAYED BLEEDING 3) UNCONTROLLED HEMORRHAGE AFTER DENTAL EXTRACTION/GUM IRRITATION (w/ toothbrush) 4) EPISTAXIS 5) GI BLEEDING (ULCERS & ...ITIS') 6) HEMATURIA FROM GU TRAUMA ....

Answer 74

1) STOP BLEEDING: - apply direct pressure/ice 2) GIVE SPECIFIC COAGULATION FACTOR 3) REST INVOLVED JOINT (prevent hemarthrosis) 4) MANAGE HEMORRHAGE/MEDICATION SIDE EFFECTS