🏩- Hematology Test Flashcards
0
Q
Hematological assessment
Alcohol
A
Chronic alcoholism is associated with nutritional deficiencies and liver impairment, which decreases the ability of blood to clot
1
Q
Hematological assessment
Vitamin K
A
Diets high in vitamin k may increase the rate of blood coagulation
2
Q
What past medical history should be asked in reference to hematological assessment
A
Ask about any chronic diseases
Liver disorders can cause decreases clotting factors
3
Q
How can cholelithiasis contribute to clotting deficiency
A
Cholelithiasis (gallstones)
Gallstones obstruct the bile duct interfering with bile secretion.
Bile is needed to absorb vitamin k
4
Q
Green tea
A
Goldenseal and green tea can reduce the effect of certain anticoagulants, which increases the risk thromboembolism
5
Q
Hemoglobin
A
O2 carrying component of a red blood cell
6
Q
What are the 2 main functions of erythrocytes (red blood cells)
A
- To pick up O2 from the lungs and transport it to systemic tissues
- To pick up carbon dioxide from the tissues and deliver it in the lungs
7
Q
Hemostasis
A
Blood clotting
8
Q
What are the 5 stages of hemostasis
A
1 vasospasm 2 formation of the platelet plug 3 clot formation 4 clot retraction 5 clot dissolution
9
Q
A low Hct would suggest
A
Anemia, hemodilution or massive blood loss
10
Q
A high Hct would suggest
A
Polycythemia or hemoconcentration caused by blood loss or dehydration
11
Q
A low Hb level may indicate
A
Anemia, recent hemorrhage or fluid retention causing hemodilution
12
Q
A high Hb level suggests
A
Hemoconcentration from polycythemia or dehydration
13
Q
Normal range of RBC in men and women
A
Men - 4.71 to 5.14 million
Women - 4.20 to 4.87 million
14
Q
Normal range of hematocrit in men and women
A
Women 38-44%
Men 43-49%
15
Q
Normal range of hemoglobin in men and women
A
Men 13-18
Women 12-16
16
Q
Normal reticulocyte count
A
0.5-2.5% of the total RBC count
Increased levels: hemolysis or blood loss; therapeutic response
Decreased levels: inadequate RBC production (pernicious anemia) or hypoproliferative bone marrow (hypoplastic anemia)
17
Q
What is a reticulocyte
A
A non-nucleated , immature RBC that remains in the peripheral blood for 24 to 48 hours while maturing
18
Q
Pernicious anemia
A
Occurs when the body can’t properly absorb vitamin b12 from the gi tract
19
Q
What is needed by the body to absorb vitamin b12
A
Intrinsic factor ; which is released cells in the stomach
Vitamin b12 is needed for the proper development of RBC
20
Q
Hemoglobin electrophoresis
A
Used to separate and measure normal and abnormal hemoglobin
Help diagnose thalassemia
21
Q
Thalassemia
A
Defective synthesis in one or more of the polypeptide chains needed for Hb production
22
Q
Leukocyte alkaline phosphate
A
Enzyme produced by normal mature neutrophils
Elevated levels may result from infection, stress, inflammation, steroid use and leukemia
23
Q
Coombs test
A
Detects the presence of immunoglobulins (antibodies) on the surface of RBC that develop through sensitization to antigens (such as Rh factor)
Performed to diagnose hemolytic disease of the newborn, to investigate hemolytic transfusion reactions and to aid in differential diagnosis of hemolytic anemias
Positive test may indicate sepsis
24
Ferritin
Is a protein that stores iron in the body(liver)
Low levels may indicated iron deficiency, chronic gi or heavy menstrual bleeding
High levels may indicate alcoholic liver disease, hemochromatosis , hemolytic anemia, Hodgkin's lymphoma and megaloblastic anemia
25
Hemochromatosis
Excessive iron absorption
26
Transferrin
A plasma protein, transports circulating iron obtained from dietary sources of from breakdown of RBC for use in Hb synthesis or to the liver, spleen and bone marrow for storage
Used to determine Fe transporting capacity of the blood and evaluate Fe metabolism in Fe-deficiency anemia
27
TIBC
Total iron-binding capacity
Measure the amount of Fe that appears in plasma if all transferrin is saturated with Fe
28
Why is Fe significant
Essential to the formation and function of Hb
29
What are bone marrow biopsies used to diagnose
Different blood disorders:
Thrombocytopenia , leukemias, granulomas, anemias and primary metastatic tumors
To determine cause of infection, to help stage diseases such as Hodgkins, to evaluate chemo and to monitor myelosuppression s
30
Name the 5 sites that a bone marrow biopsy can be performed
```
Sternum
Anterior/posterior iliac crest
Vertebral spinous process
Rib
Tibia
```
31
List bone marrow after procedure care
1 apply direct pressure until bleeding stops/ cover with a sterile dressing
2 rest for several hours
Report bleeding that soaks the dressing or continues for more than 24 hours
32
Hematological age related changes
Blood volume decreases
Bone marrow produces fewer blood cells
Lymphocytes decrease
33
Iron deficiency anemia
Inadequate intake of iron
Due to hemorrhage and chronic blood loss or poor absorption caused by celiac disease, Crohn's disease and chronic use of NSAIDS
Body exhausts its iron stores
34
Clinical manifestations of iron deficiency anemia
Fatigue and pallor due to O2 deficiency
Tachycardia , tachypnea due to ❤️ and lungs attempting to compensate for the hypoxemia
GLOSSITIS
KOILONYCHIAS
Shortness of breath
35
Glossitis
Painful swelling of the tongue, which appears smooth and shiny because of the flattening of the lingual papillae
36
Koilonychias
Are a result of severe, prolonged iron deficiency as the cells of the fingernail are soft and malleable
37
How is IDA diagnosed
From a CBC
With decreased Hb and Hct , low serum ferritin levels (less than or equal to 100)
Also: tibc, transferrin and mean corpuscular volume MCV
38
What are dietary sources of Fe
Meat (especially red meat), dark green leafy vegetables , beets, dried beans, iron-fortified breakfast cereals and breads and cream of wheat
Oranges and grapefruit increase vitamin C which may improve Fe absorption
39
Complications of ida
Psychomotor abnormalities and cognitive impairment occur in children which impairs learning and the ability of the child to function adequately
40
Name 3 nursing diagnoses associated with ida
1 inadequate tissue perfusion
2 fatigue
3 activity intolerance
41
What is a cause of cobalamin deficiency
Vitamin b12
Inadequate sources of b12 or malabsorption disorders that make b12 unavailable for body use
42
Give examples of malabsorption disorders
```
Gi resections
Autoimmune disorders including AIDS
Alcoholism
Crohn's disease
Celiac disease
Use of ppi's or h2 blockers
```
43
What are dietary sources of b12
Meat
Seafood
Eggs
Dairy products
44
Where is b12 absorbed
In the ileum of the small intestine
45
What causes pernicious anemia
Lack of intrinsic factor
46
Complications of b12 deficiency
Neurological and psychiatric dysfunction, visual disturbances (inability to distinguish yellow and blue or blindness)
Impairs DNA synthesis and the body's ability to produce RBC
47
Clinical manifestations of b12 deficiency
Clinical manifestations:
Pallor, Tachycardia ,Tachypnea , Shortness of breath Fatigue ,Dizziness
Neurological clinical manifestations:
Peripheral neuropathy ,Altered mental status ,Depression ,Visual disturbances ,PARESTHESIA , alternating constipation and diarrhea , anorexia, menstrual problems, weight loss, glossitis, low-grade fever and tinnitus (ringing in the ears)
Mood swings, coordination and balance, impaired taste/stinging sensation on tongue
48
Paresthesia
Tingling or prickling, “pins-and-needles” sensation; usually temporary, often occurs in the arms, hands, legs, or feet.
49
Methylmalonic acid (MMA) and what does an excess amount indicate
Tests for b12 deficiency
Excess amounts indicate lack of b12 in the tissues
50
Folic acid and b12 aid in what
DNA synthesis and the formation of heme
51
What are dietary sources of folic acid
Green leafy vegetables
Bran
Yeast
Legumes
Nuts
Fortified cereals, grains (wheat flour)
52
Complications of folic acid deficiency
Neural tube defects and some congenital orofacial abnormalities
53
Where is folic acid absorbed
In the jejunum of the small intestine
54
List 3 specific medications that may interfere with folic acid absorption
Oral contraceptives
Metformin
Chemotherapeutic agents (fluorouracil)
55
Clinical manifestations of folic acid deficiency
```
Pallor
Tachycardia
Tachypnea
Dizziness
Fatigue
Decreased platelets, ^ risk of bleeding
```
Neurological clinical manifestations
Confusion/disorientation
56
Pancytopenia
Overall decreased proliferation of RBC, WBC and platelets
Associated with alcoholism and folic acid deficiency
57
Why is it essential to differentiate between a folic acid deficiency and a b12 deficiency
Because folic acid replacement may reverse anemia , but the neurological degeneration that occurs in b12 deficiencies will continue and may become irreversible
58
Homocysteine and MMA levels in a folic acid deficiency
Homocysteine levels are elevated
MMA levels remain normal
59
Homocysteine and MMA levels in a b12 deficiency
Homocysteine levels are normal
MMA levels are elevated
60
Sickle cell anemia
Genetic disorder of hemoglobin
RBC become elongated and stiff , Vaso-occlusion of blood vessels
61
Sickle cell crisis is most often caused by
Hypoxia , increasing vasoconstriction and sickling of RBC
62
Where is sickle cell pain usually felt
Joints, bones, chest and abdomen
63
What 4 things are done/given to a patient during a SCD crisis
Oxygen
Hydration
Analgesia
Antibiotics
64
List 3 ways to treat SCD
- hydroxyurea
- exchange blood transfusion
- peripheral stem cell transplantation
65
Hydroxyurea
Chemotherapeutic agent
Increases fetal hemoglobin production
Results in reduction in acute chest syndrome in those with frequent and severe crises
****causes myelosuppresion (decreases ability of the bone marrow to produce any type of blood cell)
66
Exchange blood transfusions
Entire blood volume is exchanged
Goal is maintaining the sickles hemoglobin to no more than 50% of the total hemoglobin in order to prevent or delay episodes including CVA
67
Graft-versus-host disease
Occurs when the recipients immune system attacks the donor cells
Used in SCD and lymphoma
68
What are first line measures to decrease the incidence of crises
- prophylactic use of penicillin to prevent pneumococcal infection
- vaccinations
- maintaining adequate hydration
69
What are complications of SCD
Acute chest syndrome
CVA's
Infection
Death from long term organ damage
70
Infection and SCD
Pneumonia is common so annual flu vaccines are recommended
71
What are the clinical manifestations of SCD
```
Fatigue
Pallor
Tachycardia
Tachypnea
Shortness of Breath
Jaundice
```
72
What are 4 nursing diagnoses associated with SCD
1 impaired tissue perfusion
2 activity intolerance
3 acute pain
4 risk for powerlessness
73
True or false: Fever maybe present without infection in SCD
True
74
Why are SCD patients more prone to infection
Because of impaired function of the spleen , need for updated immunizations , annual flu and pneumonia vaccine ,
75
SCD teaching
- infection prevention
- preventing a crisis (avoid overexertion, tight clothes, being cold, dehydration, high altitudes)
- therapy and counseling for coping with chronic disease
- genetic counseling
76
Polycythemia
Aka erythrocytosis
Increase in the production of RBC
77
Polycythemia Vera
Primary polycythemia
A disorder of the bone marrow in which there is an increased production of RBC, WBC and platelets
78
What is the cause of polycythemia Vera
Mutation in Janus kinase 2 or JAK2 gene
JAK2 is associated with signal transduction to hematopoietic cells
79
What is the cause of secondary polycythemia
Occurs in response to the body's hypoxia state and maybe considered appropriate or inappropriate
80
Clinical manifestations of polycythemia Vera
```
Headache
Dizziness
Weakness
Splenomegaly (feeling full in L upper abdomen)
Shortness of breath while supine
Blurred vision
PRURITUS AFTER A BATH
Nosebleeds
Bleeding gums
```
81
What is the difference between primary and secondary polycythemia
Primary all blood products are elevated (RBC WBC and platelets)
Secondary WBC and platelets remain normal
82
Therapeutic phlebotomy
Involves removing blood to decrease blood volume and viscosity
** a unit of blood (350-500ml) is removed weekly until the hematocrit is less than 45% then only as needed
83
What treatments can be administered to manage polycythemia
```
1 therapeutic phlebotomy
2 chemotherapy (hydroxyurea or interferon to suppress bone marrow production)
3 antiplatelet medications (anagrelide or low dose aspirin)
```
84
List 5 Interventions for polycythemia
- medications to minimize itching
- avoid extreme temperatures
- drink atleast 3 L of fluid daily
- avoid tight clothing
- elevate feet at rest
85
Complications of polycythemia Vera
Thrombosis and hemorrhage
Increased risk of death secondary to CVA , ❤️ attack, pulmonary embolism
86
List 11 bleeding precautions
1. Soft bristle toothbrush , no flossing
2. Electric razor
3. Wear house shoes
4. Clutter-free environment
5. Daily stool softener
6. No rectal thermometers, suppositories, enemas or vagina know douches
7. No sex with low platelet count (< 50,000)
8. Don't blow nose
9. Use sharp blades on knives
10. Apply direct pressure or ice to cuts for no less than 5 minutes until bleeding stops
11. IM, arterial sticks and blood draws kept to a minimum
87
Thrombocytopenia
Reduced number of platelets below the range of 150,000-450,000
88
List 4 hemorrhagic conditions that cause thrombocytopenia
Idiopathic thrombocytopenic purpura
Hemophilia
Disseminated intravascular coagulation
Heparin induced thrombocytopenia
89
What is the concern of heparin use to maintain patency of central lines
May predispose patients to developing Heparin induced thrombocytopenia HIT
90
Hemophilia
Group of bleeding disorders where clotting factors are inadequate
VIII (hemophilia A)
IX (hemophilia B or Christmas disease)
91
Idiopathic thrombocytopenia purpura
Immune system destroys platelets
Antiplatelet antibodies are formed
92
Hemarthrosis
Bleeding in the muscles and joints
Rebates to hemophilia
93
Clinical manifestations of thrombocytopenia
Bruising and petechiae
Nosebleeds
Bleeding gums
GI bleeds/ black, tarry stools
Hematuria
94
Medical management of thrombocytopenia
Glucocorticoids- increase platelet count by decreasing antiplatelet antibody production
Replace clotting factors
Stop heparin therapy
95
Which anticoagulant should NOT be given with HIT
Warfarin (Coumadin) should not finna used cuz it can cause skin gangrene
96
Which anticoagulants should be used in patients with HIT
Lepirudin and argatroban
97
Complications of thrombocytopenia
Risk of hemorrhage and spontaneous bleeding
98
List 3 nursing diagnoses associated with thrombocytopenia
1 risk of injury: bleeding
2 risk for effective therapeutic regimen management
3 fear
99
Hodgkin's lymphoma is characterized by
The presence of Reed-Sternberg cells
Specific giant lymphocytes
100
Risk factors of obtaining Hodgkin's lymphoma
More prevalent in whites
Infection with Epstein-Barr virus
First degree (parent or sibling) of someone with Hodgkin's
101
Causes of non Hodgkin's lymphoma
Linked to exposure to certain pesticides
102
Clinical manifestations of lymphoma
PAINLESS swelling of lymph nodes in the neck, underarm and groin
```
Low grade fevers
Night sweats
Unexplained weight loss
Fatigue
SOB
Feeling of fullness- enlarged spleen or liver
```
Generalized pruritus with pronounced excoriated present in HD/alcohol induced pain
103
How is lymphoma diagnosed
Detailed history and physical examination
Lymph node biopsy
104
Medical management of lymphoma
Chemotherapeutic agents , radiation , stem cell transplant
| Destroy mutant lymphoid cells and then replace them with healthy donor cells
105
Splenectomy's can cause what
Respiratory problems due to inability to take deep breaths because of the spleens proximity to the diaphragm and high abdominal incision site
***Can cause pneumonia and atelectasis from not deep breathing
106
Complications from splenectomy surgery
Development of pancreatitis
| Infection/sepsis
107
Complications of lymphoma
```
SVC syndrome
Spinal cord compression
HYPERcalcemia
Myelodysplasia
Severe hepatic or renal dysfunction
Hyperviscosity
VTE
```
108
SVC syndrome
Superior vena cava syndrome
Enlarging lymph node compresses the flexible superior vena cava
Leads to engorgement of the upper torso
Manifestations: edema of face and one or both arms, sob, chest pain or dysphasia
109
Myelodysplasia
Abnormal/impaired blood cell production
Low neutrophil count = increased risk of infection
110
How is hypercalcemia a complication of lymphoma
Because of metastasis to the bones that causes bond breakdown and Ca is released into the bloodstream
Ca level exceeds: 11 mg/dL
Manifestations: dehydration, polyuria, decreased neuromuscular activity, confusion, stupor, heart block and death
111
List 3 nursing diagnoses associated with lymphoma
1 risk for infection
2 activity intolerance
3 risk for ineffective coping
112
Nursing interventions associated with lymphoma
Administer IV fluids (insensitive fluid loss due to fever and night sweats)
Administer blood products
Administer chemotherapy agents
113
Heparin induced thrombocytopenia
Appears to be an autoimmune response of the body to the administration of heparin occurring 5 to 14 days after introduction
Causes multiple thrombi formation and spontaneous bleeding
114
Hemolytic transfusion reaction
Antigens present on the surface of RBC determine the ABO blood type of the patient
Antibodies to the ABO antigens are in the plasma, which means ABO antigens present on transfused blood will be attacked by the antigens in the recipients blood if they don't have the same ABO antigens
115
What components of blood are commonly infused
```
RBC
FFP (fresh frozen plasma)
Platelets
Granulocytes
Clotting factors
Albumin
```
116
Acute hemolytic reaction
Caused by infusion of ABO incompatible blood
Manifestations: fever, chills, hypotension, flank pain, vascular collapse
Interventions: stop transfusion immediately , notify provider , maintain blood pressure
117
Febrile nonhemolytic reaction
Antibody reaction to granulocytes or platelets in infused blood component
Manifestations: temp increase (1 degree C or 2 F) , check lols, headache, chest pain
Interventions: stop transfusion, notify provider, Monitor VS, possible administration of antipyretics, restart transfusion slowly
118
Circulatory overload
Administration rate higher than patient tolerance
Manifestations: headache, dyspnea, JVD, edema, increased BP
Interventions: stop transfusion, notify provider, Monitor VS, elevate HOB, possible administration of diuretics and oxygen, restart transfusion slowly
119
How long should blood transfusion last
1 1/2 to 4 hours
120
Assessment/observation during blood transfusion
Monitor closely during first 15 mins and every hour after
Assessment includes: VS, respiratory status and any symptoms of discomfort , dyspnea or itching
121
Mental health
Is ones ability to cope with and adjust to the recurrent stresses of everyday living
122
Mental illness
Evidenced by a pattern of behaviors that is conspicuous, threatening and disruptive of relationships or deviates from acceptable behaviors
123
Flight of ideas
Verbalizations are continuous and rapid and flow from one to another
124
Associative looseness
Verbalizations shift from one unrelated topic to another
125
The omnibus budget reconciliation act of 1981
Deinstitutionalization was rapid
126
Id
"Pleasure principle"
Behaviors are impulsive and may be irrational
Aimed primarily at experiencing pleasure and avoiding pain
127
Ego
The rational self or "reality principle"
Experiences the reality of the external world, adapts to it and responds to it
128
Superego
"Perfection principle"
The ego ideal and the conscience
The moralistic censoring force; develops from the ego in response to reward or punishment from others
129
Stress
Is the no specific response to the body to any demand made on it
130
List 4 things the degree of anxiety is influenced by
- how the person views the stressor
- the number of stressors being handled at one time
- previous experience with similar situations
- magnitude of change the event represents for the individual
131
Motivation
The gathering of personal resources or inner drive to complete a task or reach a goal
132
Conflict
A mental struggle, either conscious or unconscious resulting from the simultaneous presence of opposing or incompatible thoughts, ideas, goals or emotional forces such as impulses, denials or drives
133
Adaptation
An individuals ability to adjust to changing life situations using various strategies
134
Defense mechanisms
Unconscious intrapsychic reactions that offer protection to the self from a stressful situation
Behavioral patterns that protect the individual against a real or perceived threat
135
Crisis
Is a time of change or turning point in life when patterns of living must be modified to prevent disorganization of the person or family
136
List 5 common behaviors seen with illness
```
Denial
Anxiety
Shock
Anger
Withdrawal
```
137
5 Phases of crisis
- confusion, disbelief and high anxiety
- denial
- reality; anger and remorse
- sadness and crying
- reconciliation and adaptation
138
Nursing interventions during crisis
- provide accurate information that aids in realistic perception of the situation
- encourage venting of feelings
- identify family supports and adequate coping mechanisms
139
Premorbid Phase
Premorbid personality often indicates social maladjustment, social withdrawal, irritability and antagonistic thoughts and behavior
140
Phase II: the prodromal phase
The proteome of an illness referred to certain signs and symptoms that precede the characteristic manifestations of the acute, fully developed illness
- Substantial function impairment
- sleep disturbance, anxiety, irritability
- depressed mood, poor concentration, fatigue
141
What heralds the onset of psychosis at the end of the prodromal phase
Positive symptoms such as perceptual abnormalities, ideas of reference and suspiciousness
142
Phase III: schizophrenia
Psychotic symptoms are prominent:
```
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Negative symptoms
```
143
Phase IV: residual phase
Schizophrenia is characterized by periods of remission and exacerbation
Flat affect and impairment in role functioning
144
Dopamine theory
Antipsychotics decrease dopamine and schizophrenic symptoms
145
Reaction formation
Preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors
146
Intellectualization
An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual process of logic, reasoning and analysis
147
Repression
Involuntarily blocking unpleasant feelings and experiences from ones awareness
148
Sublimation
Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive
149
Rationalization
Attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors
