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Adult Health Pt 2 > Hemo Disorders Pt 2 > Flashcards

Hemo Disorders Pt 2 Flashcards

1
Q

What happens with DIC?

A

clotting is altered, causing small blood clots to form in the blood vessels some of which can clog the vessels and cut off the normal blood supply to organs

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2
Q

What happens during the clotting process during DIC?

A

platelets and clotting factors are consumed leaving the patient at high risk of serious bleeding even from minor injury or w/o injury

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3
Q

Lab Changes w/ DIC

A
  • decreased platelets
  • increased PT
  • increased PTT
  • decreased Fibrinogen
  • increased D-dimer
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4
Q

S/S of DIC as Micro-clots occur are?

A
  • kidney/liver failure
  • stroke like symptoms
  • symptoms of PE
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5
Q

S/S of DIC as Clotting Factor/Platelets are depleted

A
  • petechia
  • oral bleeding, epistaxis, conjunctival hemorrhage
  • increased bleeding from puncture sites
  • hematemesis/hematuria/melena
  • profuse bleeding from everywhere
  • internal bleeding
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6
Q

Primary Treatment for DIC

A

treat underlying cause

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7
Q

Secondary Treatment for DIC

A
  • treat the symptoms
  • O2/IV fluids/Electrolytes
  • transfusions
  • heparin or lovenox to disrupt micro-clots
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8
Q

Nursing Management for DIC

A
  • monitor those @ risk
  • early recognition and reporting is essential
  • administer O2/IV fluids/electrolytes
  • most will have central line
  • dialysis may be needed if kidney failure
  • monitor liver/neuro function
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9
Q

Essential Thrombocythemia is caused by what?

A

an excessive production of platelets that leads to abnormal clotting or bleeding

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10
Q

Essential Thrombocythemia occurs as a result of what?

A

acquired gene mutation or infections

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11
Q

What is the average survival rate post-diagnosis for Essential Thrombocythemia?

A

20 years

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12
Q

Essential Thrombocythemia is most common in who?

A

women > 50

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13
Q

S/S of Essential Thrombocythemia

A
  • often asymptomatic
  • headaches
  • dizziness
  • vision probs
  • burning/redness in hands and feet
  • coldness/blue fingers and toes
  • mildly enlarged spleen
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14
Q

Goals for Thrombocythemia

A
  • reduce the risk of occlusions r/t to clots

- alleviate symptoms

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15
Q

Rick Factors for Essential Thrombocythemia

A
  • history of clots
  • PVD
  • Atherosclerosis
  • Obesity
  • history of smoking
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16
Q

Treatment for high risk patients w/ thrombocythemia

A
  • hydroxyurea

- IV/sub q coagulation

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17
Q

For extreme cases you would treat thrombocythemia w/ what?

A

plateletpheresis

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18
Q

Aplastic Anemia results from what?

A

damage to the stem cells w/in bone marrow

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19
Q

Aplastic Anemia leads to what?

A

pancytopenia-decrease in RBC’s, WBC’s, and platelets

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20
Q

Causes of Aplastic Anemia

A
  • most cases are idiopathic
  • viral infection
  • pregnancy
  • meds
  • chemical exposure
  • chemo
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21
Q

S/S of Aplastic Anemia

A
  • often insidious
  • fatigue
  • SOB
  • rapid/irregular HR
  • pale skin
  • frequent/prolonged infection
  • easy bruising
  • nose/gum bleeds
  • prolonged bleeding
  • skin rash
  • dizziness/headache
  • neutropenia/thrombocytopenia/anemia
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22
Q

Treatment for Symptomatic Aplastic Anemia

A

packed RBC’s

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23
Q

Treatment for Thrombocytopenia

A

platelet transfusion

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24
Q

Treatment for Neutropenia

A

antibiotics

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25
Q

Treatment for Aplastic Anemia < 40 yrs old w/ matched Sibling Donor

A

stem cell transplant

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26
Q

Treatment for > 40 yrs old or NO matched sibling donor

A

immunosuppressive therapy

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27
Q

What is considered if immunosuppressive therapy is not successful?

A

Unmatched/unrelated stem cell donor should be considered

-high mortality rate from rejection

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28
Q

Nursing Management for Aplastic Anemia

A
  • infection prevention
  • monitor for bleeding
  • avoid ASA and aspirin products
  • birth control to diminish blood loss
  • educate
  • close monitor BP
  • educate on hirsutism and gingival hyperplasia
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29
Q

What is Leukemia?

A

rapid increase in the number of WBC’s w/ abnormal maturation of the cells; results in suppression of other cells

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30
Q

What happens w/ Leukemia and the bone marrow?

A

Bone marrow begins to over fill w/ WBC’s leading them to overflow into the circulatory system prematurely

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31
Q

An increase in WBC’s/Leukocytes is known as what?

A

leukocytosis

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32
Q

Acute Leukemia

A
  • immature leukocytes that don’t function normally
  • onset is rapid
  • symptoms progress quickly
  • death can occur w/in weeks to months w/o aggressive treatment
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33
Q

Chronic Leukemia

A
  • most leukocytes are mature and can still function normally
  • symptoms take months-years to progress
  • live longer and often die of secondary conditions in late age
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34
Q

Acute Myeloid Leukemia (AML)

A

-affects all age groups
-grows quickly
-prognosis is directly r/t age
-most lethal form
develops w/o warning-symptoms appear over weeks-months

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35
Q

Acute Lymphocytic Leukemia (ALL)

A
  • common in young children
  • grows quickly
  • 90% survival rate in kids < 5
  • 60% survival rate in adolescents
  • symptoms come on quickly but expected outcome w/ treatment is remission
36
Q

Chronic Myeloid Leukemia (CML)

A
  • Common adults > 60
  • grows slowly
  • symptoms progress slowly and in phases
  • early detection is most common and leads to high survival rate
37
Q

What is the survival rate like for a patient with Chronic Myeloid Leukemia?

A

80% 5 year survival rate w/ early detection; unless disease progresses to “blast crisis” phase (3-6 months)

38
Q

Chronic Lymphocytic Leukemia (CLL)

A
  • common in adults > 60
  • grows slowly
  • 90% 5 yr survival rate
  • symptoms progress slowly-often require monitoring w/ no treatment
39
Q

Chronic Phase of CML

A
  • mostly asymptomatic
  • incidental finding in blood work
  • increased WBC’s
40
Q

Accelerated Phase of CML

A
  • fatigue
  • fever
  • night sweats
  • abdominal pain
  • weight loss
  • increased WBC’s/low platelets
41
Q

Blast Crisis of CML

A
  • bone pain
  • enlarged spleen
  • bleeding
  • infections
  • confusion, vision changes, SOB
  • very high WBC’s/very low platelets
42
Q

AML S/S

A
  • neutropenia
  • fever/infection
  • anemia
  • weakness/fatigue
  • thrombocytopenia
  • bleeding
  • enlarged liver/spleen with pain/bone pain
  • anorexia, N/V, diarrhea
43
Q

ALL S/S

A

-pain from enlarged liver/spleen
-bone pain
-testicular swelling/pain
-visual changes
-N/V
-altered LOC
confusion

44
Q

Nursing Management for CML

A
  • focuses on medication
  • take meds before meals
  • do NOT take w/ antacids, protonix, grapefruit juice
45
Q

Nursing Management for AML

A
  • administer blood products/antibiotics
  • infection/bleeding prevention is priority
  • educate for self management and decrease anxiety
  • monitor for increased potassium and phosphates
  • monitor uric acid levels
  • increase fluid intake
46
Q

What is the priority nursing management for AML?

A

infection and bleeding prevention

47
Q

Monitor a patient w/ AML for what?

A
  • increased potassium and phosphates

- uric acid levels

48
Q

Nursing Management for ALL

A
  • educate men on testicular exam
  • prevent infection/bleeding
  • discuss fertility preservation w/ young girls
49
Q

Monitor all types of leukemia for what?

A

Monitor and treat side effects of chemotherapeutic treatment

  • nausea
  • mucositis
50
Q

What to use for Mucositis?

A
  • soft, bland foods
  • high protein
  • miracle mouthwash
  • no acidic or spicy foods
51
Q

What are the 2 types of lymphomas?

A
  • Hodgkin’s

- Non-Hodgkin’s

52
Q

Hodgkin’s Lymphoma

A
  • rare
  • high cure rate
  • more common in young men
  • has a specific cell that can be seen
53
Q

Non-Hodgkin’s Lymphoma

A
  • > 70,000 cases annually
  • rate of cure is lower/diagnosed at more advanced stage
  • more common in older men
54
Q

What is the treatment for Lymphomas?

A

chemotherapy

radiation

55
Q

You should monitor and treat what side effects from treatment for Lymphomas?

A
  • nausea
  • hair loss
  • infection
  • weight loss/anorexia
  • oral ulcers
56
Q

Blood can only be given up to how many hours?

A

Up to 4 hours

57
Q

Blood Transfusions

A
  • each unit given over 2-4 hours unless emergency
  • started w/in 30 minutes after picking up
  • check name, DOB, medical record #, unit #, blood type, expiration date
58
Q

How often are vitals taken when giving a blood transfusions?

A

Taken prior to starting blood, 15 minutes after starting, and at completion of blood

59
Q

What signs should you monitor for with transfusion reactions?

A
  • back/flank pain
  • dark urine
  • chills, fever, skin flushing
  • fainting/dizziness
  • SOB/restlessness
  • itching
60
Q

What are some alternatives to blood for religious or other reasons?

A
  • volume expanders (normal saline)
  • erythropoietin
  • blood salvage during surgery
  • autologous donation
  • artificial blood
61
Q

Types of Donations

A
  • directed donation
  • standard donation
  • autologous
  • intraoperative blood salvage
62
Q

Direct Donation

A

friends and family donation

63
Q

Standard Donation

A

blood received from donors at community/school/occupational blood drives

64
Q

Autologous Donations

A

patient donates own blood

65
Q

Intraoperative Blood Salvage

A

collected in cell saver and re-transfused to patient

66
Q

Complication of Transfusions

A
  • infection
  • iron overload
  • transfusion reaction
67
Q

Infection Risks from Blood transfusions

A
  • hepatitis B or C
  • HIV
  • CMV
68
Q

How would you treat iron overload from blood transfusion?

A

Chelation therapy

69
Q

Sensitization Transfusion Reactions

A
  • incorrect blood type and/or RH factor
  • Rh- needs Rh- only
  • Rh+ can have Rh- or +
  • emergency or unknown type should use O
70
Q

What is Platelet Dysfunction?

A

platelet numbers are WNL but function is altered

71
Q

What is the only IV fluid that you mix with blood?

A

Normal Saline

72
Q

How many nurses does it take to check blood?

A

2

73
Q

If patient begins to have a reaction to transfusion you should what?

A

Stop blood and call doctor

74
Q

What medications prevent platelets from clumping together and forming clots?

A

Aspirin
NSAIDS
Plavix

75
Q

How long does aspirin last in the blood?

A

7-10 days

76
Q

How long do NSAIDs last in the blood?

A

5-7 days

77
Q

How long does Plavix last in the blood?

A

2-3 days

78
Q

Blood has to ALWAYS given through what kind of IV?

A

20 gauge or greater with a pump

79
Q

Liver Disease

A
  • cirrhosis
  • hepatitis
  • administer fresh frozen plasma
80
Q

Vitamin K Deficiency

A
  • malnourishment
  • alcoholism
  • dietary deficiency
  • administer vitamin K (Mephytom) sub q or orally
81
Q

Fresh Frozen Plasma

A
  • a unit is usually administered over 15-30 mins
  • standard blood administration set is used
  • once thawed FFP must not be re-frozen and should be used immediately
82
Q

If a delay is unavoidable when delivering FFP you should do what with the component?

A

Store at ambient temperature (about 73 degrees) and used w/in 4 hours

83
Q

Vitamin K sources take how long to reach full effect?

A

6-24 hours

84
Q

What type of vitamin k works better with prolonged bleeding time w/ Coumadin administration?

A

Oral vitamin k

85
Q

With Autologous donations what should be done?

A
  • can only be given to that patient
  • need to take iron supplements/erythropoietin
  • donate 4-6 weeks in advance
86
Q

What is the universal blood type recipients?

A

Type AB +

87
Q

What is the universal blood type DONOR?

A

Type O

Adult Health Pt 2 (8 decks)

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