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Nursing School > 🏩- Hematology Test > Flashcards

🏩- 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

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1
Q

Hematological assessment

Vitamin K

A

Diets high in vitamin k may increase the rate of blood coagulation

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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

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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

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4
Q

Green tea

A

Goldenseal and green tea can reduce the effect of certain anticoagulants, which increases the risk thromboembolism

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5
Q

Hemoglobin

A

O2 carrying component of a red blood cell

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6
Q

What are the 2 main functions of erythrocytes (red blood cells)

A
  1. To pick up O2 from the lungs and transport it to systemic tissues
  2. To pick up carbon dioxide from the tissues and deliver it in the lungs
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7
Q

Hemostasis

A

Blood clotting

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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
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9
Q

A low Hct would suggest

A

Anemia, hemodilution or massive blood loss

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10
Q

A high Hct would suggest

A

Polycythemia or hemoconcentration caused by blood loss or dehydration

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11
Q

A low Hb level may indicate

A

Anemia, recent hemorrhage or fluid retention causing hemodilution

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12
Q

A high Hb level suggests

A

Hemoconcentration from polycythemia or dehydration

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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

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14
Q

Normal range of hematocrit in men and women

A

Women 38-44%

Men 43-49%

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15
Q

Normal range of hemoglobin in men and women

A

Men 13-18

Women 12-16

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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)

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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

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18
Q

Pernicious anemia

A

Occurs when the body can’t properly absorb vitamin b12 from the gi tract

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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

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20
Q

Hemoglobin electrophoresis

A

Used to separate and measure normal and abnormal hemoglobin

Help diagnose thalassemia

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21
Q

Thalassemia

A

Defective synthesis in one or more of the polypeptide chains needed for Hb production

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22
Q

Leukocyte alkaline phosphate

A

Enzyme produced by normal mature neutrophils

Elevated levels may result from infection, stress, inflammation, steroid use and leukemia

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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

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24
Q

Ferritin

A

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

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25
Q

Hemochromatosis

A

Excessive iron absorption

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26
Q

Transferrin

A

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

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27
Q

TIBC

A

Total iron-binding capacity

Measure the amount of Fe that appears in plasma if all transferrin is saturated with Fe

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28
Q

Why is Fe significant

A

Essential to the formation and function of Hb

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29
Q

What are bone marrow biopsies used to diagnose

A

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

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30
Q

Name the 5 sites that a bone marrow biopsy can be performed

A 
Sternum 
Anterior/posterior iliac crest 
Vertebral spinous process
Rib 
Tibia
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31
Q

List bone marrow after procedure care

A

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

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32
Q

Hematological age related changes

A

Blood volume decreases

Bone marrow produces fewer blood cells

Lymphocytes decrease

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33
Q

Iron deficiency anemia

A

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

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34
Q

Clinical manifestations of iron deficiency anemia

A

Fatigue and pallor due to O2 deficiency

Tachycardia , tachypnea due to ❤️ and lungs attempting to compensate for the hypoxemia

GLOSSITIS
KOILONYCHIAS
Shortness of breath

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35
Q

Glossitis

A

Painful swelling of the tongue, which appears smooth and shiny because of the flattening of the lingual papillae

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36
Q

Koilonychias

A

Are a result of severe, prolonged iron deficiency as the cells of the fingernail are soft and malleable

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37
Q

How is IDA diagnosed

A

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

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38
Q

What are dietary sources of Fe

A

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

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39
Q

Complications of ida

A

Psychomotor abnormalities and cognitive impairment occur in children which impairs learning and the ability of the child to function adequately

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40
Q

Name 3 nursing diagnoses associated with ida

A

1 inadequate tissue perfusion

2 fatigue

3 activity intolerance

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41
Q

What is a cause of cobalamin deficiency

A

Vitamin b12

Inadequate sources of b12 or malabsorption disorders that make b12 unavailable for body use

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42
Q

Give examples of malabsorption disorders

A 
Gi resections 
Autoimmune disorders including AIDS 
Alcoholism 
Crohn's disease 
Celiac disease 
Use of ppi's or h2 blockers
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43
Q

What are dietary sources of b12

A

Meat
Seafood
Eggs
Dairy products

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44
Q

Where is b12 absorbed

A

In the ileum of the small intestine

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45
Q

What causes pernicious anemia

A

Lack of intrinsic factor

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46
Q

Complications of b12 deficiency

A

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

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47
Q

Clinical manifestations of b12 deficiency

A

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

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48
Q

Paresthesia

A

Tingling or prickling, “pins-and-needles” sensation; usually temporary, often occurs in the arms, hands, legs, or feet.

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49
Q

Methylmalonic acid (MMA) and what does an excess amount indicate

A

Tests for b12 deficiency

Excess amounts indicate lack of b12 in the tissues

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50
Q

Folic acid and b12 aid in what

A

DNA synthesis and the formation of heme

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51
Q

What are dietary sources of folic acid

A

Green leafy vegetables

Bran

Yeast

Legumes

Nuts

Fortified cereals, grains (wheat flour)

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52
Q

Complications of folic acid deficiency

A

Neural tube defects and some congenital orofacial abnormalities

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53
Q

Where is folic acid absorbed

A

In the jejunum of the small intestine

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54
Q

List 3 specific medications that may interfere with folic acid absorption

A

Oral contraceptives
Metformin
Chemotherapeutic agents (fluorouracil)

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55
Q

Clinical manifestations of folic acid deficiency

A 
Pallor 
Tachycardia 
Tachypnea 
Dizziness 
Fatigue 
Decreased platelets, ^ risk of bleeding

Neurological clinical manifestations
Confusion/disorientation

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56
Q

Pancytopenia

A

Overall decreased proliferation of RBC, WBC and platelets

Associated with alcoholism and folic acid deficiency

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57
Q

Why is it essential to differentiate between a folic acid deficiency and a b12 deficiency

A

Because folic acid replacement may reverse anemia , but the neurological degeneration that occurs in b12 deficiencies will continue and may become irreversible

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58
Q

Homocysteine and MMA levels in a folic acid deficiency

A

Homocysteine levels are elevated

MMA levels remain normal

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59
Q

Homocysteine and MMA levels in a b12 deficiency

A

Homocysteine levels are normal

MMA levels are elevated

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60
Q

Sickle cell anemia

A

Genetic disorder of hemoglobin

RBC become elongated and stiff , Vaso-occlusion of blood vessels

61
Q

Sickle cell crisis is most often caused by

A

Hypoxia , increasing vasoconstriction and sickling of RBC

62
Q

Where is sickle cell pain usually felt

A

Joints, bones, chest and abdomen

63
Q

What 4 things are done/given to a patient during a SCD crisis

A

Oxygen
Hydration
Analgesia
Antibiotics

64
Q

List 3 ways to treat SCD

A
  • hydroxyurea
  • exchange blood transfusion
  • peripheral stem cell transplantation
65
Q

Hydroxyurea

A

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
Q

Exchange blood transfusions

A

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
Q

Graft-versus-host disease

A

Occurs when the recipients immune system attacks the donor cells

Used in SCD and lymphoma

68
Q

What are first line measures to decrease the incidence of crises

A
  • prophylactic use of penicillin to prevent pneumococcal infection
  • vaccinations
  • maintaining adequate hydration
69
Q

What are complications of SCD

A

Acute chest syndrome
CVA’s
Infection
Death from long term organ damage

70
Q

Infection and SCD

A

Pneumonia is common so annual flu vaccines are recommended

71
Q

What are the clinical manifestations of SCD

A 
Fatigue 
Pallor 
Tachycardia 
Tachypnea 
Shortness of Breath 
Jaundice
72
Q

What are 4 nursing diagnoses associated with SCD

A

1 impaired tissue perfusion
2 activity intolerance
3 acute pain
4 risk for powerlessness

73
Q

True or false: Fever maybe present without infection in SCD

74
Q

Why are SCD patients more prone to infection

A

Because of impaired function of the spleen , need for updated immunizations , annual flu and pneumonia vaccine ,

75
Q

SCD teaching

A
  • 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
Q

Polycythemia

A

Aka erythrocytosis

Increase in the production of RBC

77
Q

Polycythemia Vera

A

Primary polycythemia

A disorder of the bone marrow in which there is an increased production of RBC, WBC and platelets

78
Q

What is the cause of polycythemia Vera

A

Mutation in Janus kinase 2 or JAK2 gene

JAK2 is associated with signal transduction to hematopoietic cells

79
Q

What is the cause of secondary polycythemia

A

Occurs in response to the body’s hypoxia state and maybe considered appropriate or inappropriate

80
Q

Clinical manifestations of polycythemia Vera

A 
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
Q

What is the difference between primary and secondary polycythemia

A

Primary all blood products are elevated (RBC WBC and platelets)

Secondary WBC and platelets remain normal

82
Q

Therapeutic phlebotomy

A

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
Q

What treatments can be administered to manage polycythemia

A 
1 therapeutic phlebotomy 
2 chemotherapy (hydroxyurea or interferon to suppress bone marrow production) 
3 antiplatelet medications (anagrelide or low dose aspirin)
84
Q

List 5 Interventions for polycythemia

A
  • medications to minimize itching
  • avoid extreme temperatures
  • drink atleast 3 L of fluid daily
  • avoid tight clothing
  • elevate feet at rest
85
Q

Complications of polycythemia Vera

A

Thrombosis and hemorrhage

Increased risk of death secondary to CVA , ❤️ attack, pulmonary embolism

86
Q

List 11 bleeding precautions

A
  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
Q

Thrombocytopenia

A

Reduced number of platelets below the range of 150,000-450,000

88
Q

List 4 hemorrhagic conditions that cause thrombocytopenia

A

Idiopathic thrombocytopenic purpura

Hemophilia

Disseminated intravascular coagulation

Heparin induced thrombocytopenia

89
Q

What is the concern of heparin use to maintain patency of central lines

A

May predispose patients to developing Heparin induced thrombocytopenia HIT

90
Q

Hemophilia

A

Group of bleeding disorders where clotting factors are inadequate

VIII (hemophilia A)
IX (hemophilia B or Christmas disease)

91
Q

Idiopathic thrombocytopenia purpura

A

Immune system destroys platelets

Antiplatelet antibodies are formed

92
Q

Hemarthrosis

A

Bleeding in the muscles and joints

Rebates to hemophilia

93
Q

Clinical manifestations of thrombocytopenia

A

Bruising and petechiae

Nosebleeds
Bleeding gums
GI bleeds/ black, tarry stools
Hematuria

94
Q

Medical management of thrombocytopenia

A

Glucocorticoids- increase platelet count by decreasing antiplatelet antibody production

Replace clotting factors

Stop heparin therapy

95
Q

Which anticoagulant should NOT be given with HIT

A

Warfarin (Coumadin) should not finna used cuz it can cause skin gangrene

96
Q

Which anticoagulants should be used in patients with HIT

A

Lepirudin and argatroban

97
Q

Complications of thrombocytopenia

A

Risk of hemorrhage and spontaneous bleeding

98
Q

List 3 nursing diagnoses associated with thrombocytopenia

A

1 risk of injury: bleeding

2 risk for effective therapeutic regimen management

3 fear

99
Q

Hodgkin’s lymphoma is characterized by

A

The presence of Reed-Sternberg cells

Specific giant lymphocytes

100
Q

Risk factors of obtaining Hodgkin’s lymphoma

A

More prevalent in whites

Infection with Epstein-Barr virus

First degree (parent or sibling) of someone with Hodgkin’s

101
Q

Causes of non Hodgkin’s lymphoma

A

Linked to exposure to certain pesticides

102
Q

Clinical manifestations of lymphoma

A

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
Q

How is lymphoma diagnosed

A

Detailed history and physical examination

Lymph node biopsy

104
Q

Medical management of lymphoma

A

Chemotherapeutic agents , radiation , stem cell transplant

Destroy mutant lymphoid cells and then replace them with healthy donor cells

105
Q

Splenectomy’s can cause what

A

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
Q

Complications from splenectomy surgery

A

Development of pancreatitis

Infection/sepsis

107
Q

Complications of lymphoma

A 
SVC syndrome 
Spinal cord compression 
HYPERcalcemia 
Myelodysplasia 
Severe hepatic or renal dysfunction 
Hyperviscosity 
VTE
108
Q

SVC syndrome

A

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
Q

Myelodysplasia

A

Abnormal/impaired blood cell production

Low neutrophil count = increased risk of infection

110
Q

How is hypercalcemia a complication of lymphoma

A

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
Q

List 3 nursing diagnoses associated with lymphoma

A

1 risk for infection

2 activity intolerance

3 risk for ineffective coping

112
Q

Nursing interventions associated with lymphoma

A

Administer IV fluids (insensitive fluid loss due to fever and night sweats)

Administer blood products

Administer chemotherapy agents

113
Q

Heparin induced thrombocytopenia

A

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
Q

Hemolytic transfusion reaction

A

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
Q

What components of blood are commonly infused

A 
RBC 
FFP (fresh frozen plasma) 
Platelets
Granulocytes 
Clotting factors
Albumin
116
Q

Acute hemolytic reaction

A

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
Q

Febrile nonhemolytic reaction

A

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
Q

Circulatory overload

A

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
Q

How long should blood transfusion last

A

1 1/2 to 4 hours

120
Q

Assessment/observation during blood transfusion

A

Monitor closely during first 15 mins and every hour after

Assessment includes: VS, respiratory status and any symptoms of discomfort , dyspnea or itching

121
Q

Mental health

A

Is ones ability to cope with and adjust to the recurrent stresses of everyday living

122
Q

Mental illness

A

Evidenced by a pattern of behaviors that is conspicuous, threatening and disruptive of relationships or deviates from acceptable behaviors

123
Q

Flight of ideas

A

Verbalizations are continuous and rapid and flow from one to another

124
Q

Associative looseness

A

Verbalizations shift from one unrelated topic to another

125
Q

The omnibus budget reconciliation act of 1981

A

Deinstitutionalization was rapid

126
Q

Id

A

“Pleasure principle”

Behaviors are impulsive and may be irrational

Aimed primarily at experiencing pleasure and avoiding pain

127
Q

Ego

A

The rational self or “reality principle”

Experiences the reality of the external world, adapts to it and responds to it

128
Q

Superego

A

“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
Q

Stress

A

Is the no specific response to the body to any demand made on it

130
Q

List 4 things the degree of anxiety is influenced by

A
  • 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
Q

Motivation

A

The gathering of personal resources or inner drive to complete a task or reach a goal

132
Q

Conflict

A

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
Q

Adaptation

A

An individuals ability to adjust to changing life situations using various strategies

134
Q

Defense mechanisms

A

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
Q

Crisis

A

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
Q

List 5 common behaviors seen with illness

A 
Denial 
Anxiety 
Shock 
Anger 
Withdrawal
137
Q

5 Phases of crisis

A
  • confusion, disbelief and high anxiety
  • denial
  • reality; anger and remorse
  • sadness and crying
  • reconciliation and adaptation
138
Q

Nursing interventions during crisis

A
  • provide accurate information that aids in realistic perception of the situation
  • encourage venting of feelings
  • identify family supports and adequate coping mechanisms
139
Q

Premorbid Phase

A

Premorbid personality often indicates social maladjustment, social withdrawal, irritability and antagonistic thoughts and behavior

140
Q

Phase II: the prodromal phase

A

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
Q

What heralds the onset of psychosis at the end of the prodromal phase

A

Positive symptoms such as perceptual abnormalities, ideas of reference and suspiciousness

142
Q

Phase III: schizophrenia

A

Psychotic symptoms are prominent:

Delusions 
Hallucinations 
Disorganized speech 
Grossly disorganized or catatonic behavior 
Negative symptoms
143
Q

Phase IV: residual phase

A

Schizophrenia is characterized by periods of remission and exacerbation

Flat affect and impairment in role functioning

144
Q

Dopamine theory

A

Antipsychotics decrease dopamine and schizophrenic symptoms

145
Q

Reaction formation

A

Preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors

146
Q

Intellectualization

A

An attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual process of logic, reasoning and analysis

147
Q

Repression

A

Involuntarily blocking unpleasant feelings and experiences from ones awareness

148
Q

Sublimation

A

Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive

149
Q

Rationalization

A

Attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors

Nursing School (36 decks)

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