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Medsurg 3 > Heme > Flashcards

Heme Flashcards

1
Q

what is thrombocytosis

A

too many platelets.

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2
Q

Thrombocyte range
thrombocytopenia
When prolonged bleeding
Spontaneous hem
Infusion
Cancer patients infusion?

A

150000-400000
Less than 150000
50,000
20,000
10,000
20,000

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3
Q

What are the mature and immature WBC called

A

Bands Segs

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4
Q

About
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils

A

N- Acute inflam, bacteria, phagocytosis mature/immature shift to the left
L- B and T cells
M- Macrophages eat big like RBC
E- Phagocytes, eat A/A some cancers
B-Inflam response

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5
Q

Absolute Neutrophil count

A

Determines if a pt is neutropenic or not
WBC count x % of neutrophils
Change percent to decimal
Neutropenic= <1000
<500 is severe

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6
Q

Thrombocytopenia precautions 12

A

No asprin
watch for petechia or nose bleed
nose bleed is hard to see how much
use small needles or no
black stool/vomit
dont blow nose hard
dont bend down with head lower than waist
prevent straining
shave only with electric razor
dont tweeze hair
soft tooth brush
ask about dental/mani/pedi

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7
Q

Leukopenia
granulocytopenia

A

White blood cell decrease
Neutrophils, eosinophils, basophils

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8
Q

What are reticulocytes range?

A

Immature RBC means someone has had a lot of bleeding. 0.5-2.5

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9
Q

Hem Range
M
F
Hct Range
M
F
RBC
M
F

A

HGB
m-14-18
F12-16
Hct
M-42-52
F-37-47
RBC
M-4.7-6.1X 10^6
F 4.2-5.4x10^6

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10
Q

Whats the anemia rule?

A

30 and 10
Less than 30 Hct
and 10Hgb we need to start watching

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11
Q

What is DIC 4

A

Abnormal response of clotting cascade
Not a diseases but caused by them
Must tx underlying issue
Accelerated clotting uses up clotting factors and platelets so we can’t clot anymore.

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12
Q

S/s of thrombus 9

A

Delirium, coma, integ, ischemia, ganggreen, oliguria, azotemia, ARDS, ileus

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13
Q

Lab results for DIC

A

Pt PTT aPTT thrombin time all increased
Fibrinogen and platelets all decreased
Antithrombin reduced
Fibrin split increased
Schistocytes present
Plasminogen reduced
Prot c and s reduced

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14
Q

How to tx DIC

A

Clots-Hep, hemody
RBC transfusion
TX THE CAUSE IS NUMBER 1

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15
Q

What is Myelodysplastic Syndrome 3

A

Hematopoiesis in ineffective
Clonal disorder- Abnormal clone of stem cell in bone marrow-have issues and take up space
Can progress to AML

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16
Q

How to diagnose Myelodysp
how to tx-4

A

Bone marrow biopsy
Tx depends on severity
Tx anemia, Thrombocyotopenia, Neutropenia, pain

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17
Q

What are the top 3 complications of cancer

A

Infection, Pain, malnut

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18
Q

Bone marrow suppression and cancer

A

Common complication of cancer because of proliferation. we need to watch for anemia, infection, bleeding, Fever in cancer pt is EMERGENT
Bone marrow suppression is more common with chemo but can happen with radiation if over a large area of bone.

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19
Q

What is Nadir

A

Lowest blood cell count during chemo
usually happens w/i 7-10 days of tx Measured with a CBC

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20
Q

How will bone suppression look over time with the blood cells

A

Neutropenia 1-2 weeks
Platelets-2-3 weeks
RBC-3-4 months

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21
Q

How to combat fatigue with cancer

A

Identify when they have energy and plan care
Walk

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22
Q

GI issues with Cancer

A

Highly mitotic cells cause N/V/D
increase fluids no matter what
watch fiber
Small frequent meals high prot high cal add spices for lack of taste but not for Mucositis
Mucositis-Inflam of mucas in GI tract Can cause legions, very painful-Soft bland food, frequent rinses, no smoking or Alcohol=Irritating

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23
Q

Skin problems with cancer

A

Alopecia,
Raditation skin changes-gental, no freg, baby shampoo, lotion, no ice or heating
Chemo skin changes-Hyperpig, photosensitivity
Extravasation-Whats IV sites, Why central lines,
Risk for infection from skin breakdown

24
Q

Side effects of immunotherapy

A

flu-like symptoms, Tachy ortho, capillary leak-pulmonary edema, Skin rashes
Give ty before therapy to help with s/s

25
Q

What are the three oncologic emergencies

A

Obstructive, Metabolic, Infiltrative

26
Q

What is HSCT
risks
Hint-One risk effects which three areas

A

Bone marrow transplant with high doses of chemotherapy and radiation then healthy stem cells infused. Intense procedure
Risks=Infection, graft vs host (Skin Liver, GI), bleeding, can be fatal
can come from peripheral blood of donor

27
Q

What is Multiple Myeloma

More common in 3

A

Cancerous plasma cells that proliferate in bone marrow and destroy bone. There is an overproduction of plasma cells that don’t make antibodies like they should. Instead they make Monoclonal antibodies that are undifferentiated and ineffective. They produce cytokines and infiltrate bone marrow a Decrease in antibodies= an increased risk of infection. pancytopenia.
Men, blacks, 65-74

28
Q

S/s of Multiple Myeloma 8

A

Slow and insidious, skeletal pain in pelvis Ribs, Spine
Osteoporosis
Osteolytic lesions from osteoclasts
can compress spine
Hypercalcemia-Seizures, AMS, Confusion, Cardiac dysR,
Kidneys renal stones, obstruction, fail, nephrosis,
Hyper-viscosity syndrome-Worse on kidneys, and organs from M prots
Bone marrow dysfunction-Pancytopenia

29
Q

Diagnosis of Multiple Myeloma 7

A

M prots in blood and urine
Hyperca+
Increased creatinine
pancytopenia
Bence-Jones Prots
Bone marrow examiniation,
Imaging-porosis or lesions

30
Q

Tx for Multiple Myeloma goal?
5 tx- regular

A

No cure no remission we tx s/s goal is to Decrease pain and prevent fractures.
Corticosteroids, chemo, immunotherapy, targeted therapy, HSCT

31
Q

Other tx for Multiple Myeloma

A

Kyphoplasty, furisemide, bisohosphonates, plasmapheresis, Weight baring, NSAID/OPS together

32
Q

Nursing considerations for Multiple Myeloma 5

A

No falls, No quick movements, Is and 0s for hyperca
increase fluids
braces

33
Q

What are reed-sternberg cells a sign for

A

Hodgkin’s Lymphoma

34
Q

What are the clinical manifestations of Hodgkins 5

A

Gradual onset, Enlargement of cervical, axillary or inguinal nodes, B symptoms, alcohol induced pain

35
Q

What are B symptoms

A

Fever weight loss, night sweats

36
Q

How do we diagnose Hodgekins?

A

CBC-But not diagnostic just looking for abnormalities.
Lymph node biopsy-Diagnostic
Radiologic studies to find where the spread is

37
Q

How do we classify hodg and nonhodg

A

stages
1-one site
2 two sites on same side of diaphragm
3-both sides of D
4-in organs
then A- no b symptoms and B-b symptoms are present

38
Q

How do we tx hodgekins?

A

Combination chemotherapy
ABVD-Early and Interm
BEACOPP-Advanced
Early stage-2-4 cycles
Intermediate 4-6
Advanced 6-8 cycles

39
Q

What are the nursing considerations for Hodg?

A

Can recieve HSCT after remission, Maintenance chemo not recommended, secondary toxicities, secondary malignancies-10yrs lung and breast most common.

40
Q

What is Non-Hodg lymp
and one risk factor

A

Group of cancers of B, T, and natural killers that occurs in all age groups most common heme cancer with no halmark signs
chromosomal translocation-mutation

41
Q

What are the clinical manifestations of Non H L 8

A

Variety of presentation
Indolent, Rapid, Spread is unpredictable, advanced disease at diagnosis, painless lymph enlargement, Lymphadenopathy and B symptoms

42
Q

Diagnostic for non-hodg

A

Same as hodg,
MRI, Lumbar puncture is worried about neuro, endoscopy

43
Q

WHat are the other stages for non hodg

A

Indolent-Low grade
Aggressive-High grade
Highly Aggressive

44
Q

Leukemia

A

malignant disorders of blood, bone marrow, lymph and spleen with loss of cell regulation in cell division occurs in all age groups cells are not dividing faster but no apoptosis

45
Q

How do we classify leukemia

A

Acute vs Chronic-
Myelogenous-Myeloblast granulocytes vs lymphocytic- B, T NK
Four types ALL, AML, CLL, CML

46
Q

Look at chart on leukemia
and table 30.24

A
47
Q

What is the most common type of child cancer

A

Acute Lymphocytic leukemia

48
Q

What is ALL
Most common?
Manifestations 7

A

Most common peds
Immature Lymphocytes- Mostly B
Abrupt, Insidious, CNA-ICP from mengie infiltration
Fever, Bleeding-spontaneous bleeding
Bone and joint pain, fatigue

49
Q

AML
! fact
about
Manifestations 4

A

1/3 of all leukemias
Uncontrolled proliferation of myeloblasts effects all blood cells because it is in the bone marrow. so shift to left is diagnostic
Hyperplasia of bone marrow-Actually starts destroying bonemarrow
Abrupt, Infection, Bleeding

50
Q

CLL

A

Most common adult Leukemia in older adults so lots of comfort care and quality of life.
Mature appearing lymphocytes but they don’t do anything. Can be in marrow, spleen, lymph, liver
Swollen lyphnodes, accumulate in bone marrow no tx or s/s in early stages

51
Q

CML

A

Excessive neoplastic granulocytes in all stages of development. Chronic stage can last for years, can move into blood stream and infiltrate liver and spleen. the blastic phase is treated like acute it has the Philadelphia chromosome we treat during chronic stage and chronic stage does’t usually have symptoms

52
Q

One thing to remember about leukemia

A

Can have pancytopenia with a high WBC because cells don’t go through apoptosis

53
Q

What are the most common sites for leukemia to spread

A

Brain, testis, Lymph, liver, spleen, Joints

54
Q

How do we diagnose leukemia?

A

Blood tests but need differential,
Peripheral smear-see abnormal cells
Bone marrow biopsy in post illiac crest- painful local anestethtic

55
Q

Chemo terms three and about
one problem

A

Induction-Severely deplete bone marrow big high doses 70 percent remission after first but need to continue
Postinduction-1intensification-2 x after few months
consolidation-a few more times
Matienance
Lower dose for weeks or years
For ALL
Pancytopenia

56
Q

Four other cancer tx

A

Corticosteroids-Destroys leukemia
Radiation-
immunotherapy-T cells targer-asprin
Hematopoietic stem cell transplant-Goal

Medsurg 3 (13 decks)

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