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Hemotology > Hemotology > Flashcards

Hemotology Flashcards

0
Q

Hgb values

A

12-16 females

13.5-18 males

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1
Q

RBC values

A

4-5 females

4.5-6 males

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2
Q

Hemoglobin and anemia values

A

10-14 mild
6-10 moderate
<6 severe

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3
Q

3 signs symptoms of severe anemia

A

Fatigue
Palpitations
Dyspnea

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4
Q

Hct values

A

3 times the Hgb value

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5
Q

If Hct is elevated then the patient is experiencing…

A

Fluid volume deficiet

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6
Q

If Hct is decreased then the patient is experiencing…

A

Fluid volume overload/ excess

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7
Q

WBC values

A

4000-11000

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8
Q

Neutrophils should be….

A

50-78% of wBCs

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9
Q

Neutropenia actions

A

Temp greater 100.4/38C report immediately and start IV antibiotic

Shift to left is high neutrophil= severe infection

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10
Q

Platelet values

A

100,000-250,000

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11
Q

Thrombocytopenia platelet count

A

Less than 100,000

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12
Q

Thrombocytopenia critical values

A

Critical less than 50,000
Hemorrhage if less than 20,000
Need platelet transfusion if less than 10,000

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13
Q

INR values for Coumadin therapy

INR values for No therapy

A

Coumadin = 2-3

No therapy= 1-2

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14
Q

Antidote for Coumadin therapy

A

Intramuscular injection Vitamin K

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15
Q

Coumadin is part of the ——–pathway for coagulation

A

Extrinsic

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16
Q

aPTT values for heparin therapy

aPTT vales for no therapy

aPTT Heparin critical value

A

Heparin therapy 75-112
1.5-2.5 times normal

No therapy 25-35 seconds

Critical greater than 130–heparin protocol

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17
Q

Antidote to heparin therapy

A

Protamine sulfate

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18
Q

Heparin is part of the——–pathway

A

Intrinsic

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19
Q

Patient teaching for iron liquid supplement

Where is IM iron injections given, by which method?

A

Acidic stomach, empty stomach, vitamin C increases absorption, causes black tarry stools and constipation. Stains teeth, drink with straw.

Deep gluteus with z-track

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20
Q

What is hydroxyurea (Hydrea)?

A

Medications used to increase fetal hemoglobin in sickle cell and leukemia patients

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21
Q

What is cyanocobalamin?

A

Medication for vitamin b12 deficient anemia. Available PO and IM.

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22
Q

What is the side effects of cyanocobalamin medication?

A

Decreased K+, secondary to improved RBC production and may need supplemental K+

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23
Q

What is the action of folic acid?

A

Increases production of RBCs; also prevents neural tube defects.

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24
Q

What are Epogen and Procrit used for?

A

Increase production of RBC in bone marrow for chemo and renal failure patients.

Watch for HTN secondary to increased Hct.

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25
Q

What are the uses of Neupogen?

A

Stimulate bone marrow production of neutrophils /WBC to decrease Risk of infection.

Watch for nine pain, notify mad and give Tylenol

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26
Q

What lab values are reduced in anemia?

A

Decreased RBC, Hgb and Hct

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27
Q

Patients with pernicious anemia lack what?

A

Intrinsic factor needed in the stomach to absorb vitamin b12

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28
Q

Define vitamin b12 anemia.

A

Decreased RBCs secondary to decreased b12. But have large RBCs.

Decreased cobalamin serum levels

Vitamin b12 is water soluble.

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29
Q

Define folic acid anemia

A

Decreased RBCs secondary to decreased serum folate.

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30
Q

What is the shillings test? How performed? How to interpret results?

A

Shillings is radioactive urine test for determining absorption of vitamin b12. 24 hour urine collection. If b12 found in urine then not absorbing it-lack intrinsic factors.

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31
Q

What are sources of dietary vitamin b 12?

A

Eggs, dairy, animal proteins

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32
Q

What are dietary sources of folic acid?

A

Fruits green leafy vegetables.

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33
Q

What are symptoms of vitamin b12 anemia

A

Fatigue, dyspnea, palpations

Parathesias, swollen red tongue, confusion.

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34
Q

What are some common causes of vitamin b12 anemia?

A 
Decreased diet intake
Alcoholism
Digestive disorders (chroma/celiac)
Wt loss surgery
Antacids (PPIs ⬇️acid needed to absorb iron).
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35
Q

HOP is used for the treatment of ——

A

Sickle cell anemia.
Hydration
Oxygenation
Pain

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36
Q

What are triggers for sickle cell anemia?

A

Anything that decreased oxygen -hypoxemia
Infection
Dehydration
Hypoxemia

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37
Q

What organs are damaged in sickle cell anemia?

A

Spleen-RBCs get caught up

Liver-jaundice from hemolysis of Hgb

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38
Q

Define polycythemia Vera.

Distinguish between primary and secondary.

A

Too many RBCs and WBCs and platelets

Primary: increased RBCs, WBCs, and platelets-hypercoagulability- clotting

Secondary: related to increased erythropoietin from hypoxia- body wants more 02 so kidneys secrete more.

39
Q

What are symptoms of polycythemia?

A

HA, dizziness, tinnitus, itchy, thrombus
HTN secondary to increased viscosity of blood.

RBCs WBCs and platelets have shorter life span. Lysis if cells spills contents leading to—Increased Uric acid and K+

40
Q

Define thrombocytopenia.

A

Decreased platelets. <100,000

41
Q

What are some indicators of thrombocytopenia ?

A

Bruising
Petechia -no blanching of skin
Increased bleeding.

42
Q

What is HITTS -thrombocytopenia

A

Heparin induced thrombolytic thrombocytopenia syndrome
NEVER heparin again or lovenox. Start Coumadin and thrombolytics.
Platelets decrease 50% from baseline after injection as immune system attacks platelets.

43
Q

What changes in lab values do you see with DIC?

Platelets, clotting factors

PT/PTT, FSP, d-dimer

A

Platelets, clotting factors: decreased

PT/PTT, FSP, d-dimer: increased

44
Q

Define DIC

A

Disseminated intravascular coaguapathy

Blood clots in small blood vessels, this ⬆️ clotting uses up platelets and clotting factors (proteins). Leads to ⬆️ bleeding.

45
Q

Define hemophilia.

Hemophilia A
Hemophilia B
Von will round

A

Deficiency in clotting factors.
Hemophilia A: factor 8
Hemophilia B: factor 9
Von will round: Von willibrond factors.

46
Q

How does DDAVP help with hemophilia?

A

DDAVP desmopressin helps release factors 8 stored in lining of blood vessels.

47
Q

What lab value changes would you see in hemophilia?

PPT
PT
Factor assay

A

PPT: increased. Intrinsic pathway and is slower than extrinsic
PT: normal
Factor assay: decreased

48
Q

Define neutropenia.

A

Decreased WBCs. Specifically neutrophils less than 1000

49
Q

What are precautions for neutropenic patients?

A 
Strict hand washing
No fresh foods or raw or flowers 
Private room
Reverse isolation
Assess temp q4 hrs
50
Q

What is the sign/symptom you would watch for in neutropenic patients?

A

Pain
As too little WBCs to produce normal inflammatory reaction ( redness, warmth, pus, elevated WBCs)

Temp greater than 100.4/38 requires IV antibiotics within an hour.

51
Q

Define leukemia.

What lab value changes would you expect?
RBCs, Hgb/Hct, platelets

WBCs

A

Malignancy affecting blood and blood forming tissues of bone marrow, lymph system, spleen.

RBCs, Hgb/Hct, platelets: all low, body not making

WBCs: elevated at first but ineffective. Low after diagnosis.

52
Q

What are some common manifestations of leukemia?

A

Acute: bone pain, anemia, bleeding, fever, weight loss, poor wound healing, enlarged liver or spleen.

53
Q

Define lymphoma.

Distinguish between hodgkins and non Hodgkin’s lymphoma.

A

Malignant neoplasm in bone and lymphatic structures. Lymphoma develops when lymphocytes divide uncontrollably and crowd out healthy cells/tissues with rumors.

Hodgkins: reed sternberg cells

Non-Hodgkins: NO reed sternberg cells.

54
Q

What are the common manifestations of lymphoma?

A

Painless enlargement of cervical, auxiliary, I guitar lymph nodes.

Fever, night sweats, and weight loss are late symptoms with poor prognosis.

55
Q

Define multiple myeloma.

What lab values would you expect? Ca++

RBCs WBCs platelets

A

Neoplastic plasma cells infiltrate the bone marrow and destroy bone.

Hypercalcemia secondary to bone destruction. Give corticosteroids to secrete Ca++.

56
Q

What lab value is assessed for intrinsic coagulation pathway?

What medication do we monitor for this value?

A

PTT

Heparin

Intrinsic pathway is activated via vessel damage (hemophilia)

57
Q

What lab value is assessed for extrinsic coagulation pathway?

What medication do we monitor for this value?

A

PT/INR
Coumadin/warfarin

Extrinsic pathway activated via release of thromboplastin by tissues

58
Q

What are fibrin split products?

A

Lab value used to measure the breakdown of clot/plug of injury to allow blood back I tot the injured area.

59
Q

What is streptokinase?

A

Thrombolytic used to break up cots in MI, ischemic stroke, PE.

Increase perfusion, decrease viscosity and aggregation of RBCs

60
Q

What is the acronym RANDI for bleeding precautions include?

A 
R- razors electric
A- aspirin-NO
N- needles-small gauge 
D- decrease needle sticks
I- injury- protect from
61
Q

Least the sign and symptoms of transfusion reactions.
Allergic
Febrile
Hemolytic

A

Allergic: face flushing, hives/rash, anxiety,wheezing hypotension

Febrile: HA, tachycardia, tachypnea, fever, chills, anxiety

Hemolytic: hematuria, chest pain, low back pain, fever, tachycardia, hypotension, SOB, chills

62
Q 
What is the effect of stress on organs/systems?
Heart
Blood vessels
Lungs
Adrenal medulla
Liver
GI system
A

Heart: ⬆️ BP and HR= ⬆️CO

Blood vessels: peripheral vasodilation and central vasoconstriction

Lungs: increased RR with shallow breathing, bronchi dilation

Adrenal medulla: release epi and norepinephrine

Liver: gluconeogensis=⬆️BS

GI system: decreased peristalsis

63
Q

Give an example of an emotion focused coping strategy.

Give an example of a problem focused coping strategy.

A

Emotion: help cope: hot bath, exercise, talking with friend

Problem: find solution: seeking advice, referral

64
Q

What effects do corticoids ( cortisol) have during stress?

A

Increase breakdown proteins
Gluconeogensis–⬆️BS
Decreased lymphocytes and decreased WBCs

65
Q

What effects does aldosterone have during stress?

A

Saves Na+ and H20 in kidneys

Leads to increased BV, increased BP

66
Q

What effects does ADH have during stress?

A

Saves water only

Leads to water retention, increased BV, increased BP

67
Q

What effects do catacholamines ( epi and norepinephrine) have during stress?

A

Flight or fight
⬆️HR, increased contractility, bronchodilation, vasoconstriction to nonessential tissues,vasodilation to periphery and essential organs. Pupil dilation, inhibit GI action, decrease insulin and increased BS

68
Q

Hypernatremia causes.

A 
Hypernatremia  causes
Dehydration
Decreased renal function 
HF secondary to aldosterone
Cushings (increased cortisol)

Na+ gain and water loss.

69
Q

Hypernatremia signs symptoms

A 
Hypernatremia symptoms 
Neuro changes - altered mental status
Mild muscle twitching
Severe weakness
Dry mouth
70
Q

Hypernatremia treatments

A

Hypotonic solutions
Diuretics
Fluids but restrict Na+

71
Q

Hyponatremia causes

A 
Hyponatremia causes
Diuretics
DKA
Addison's (decreased adrenal)
Fluid overload
Excessive sweating or GI fluid loss

Na+loss and water gain

72
Q

Hyponatremia sign and symptoms

A 
Hyponatremia symptoms
Neuro-confusion
General muscle weakness
Decreased reflexes
Increased GI motility 
Cardiac decreased BP, weak pulse.
73
Q

Hyponatremia treatments

A

Hyponatremia treatments
Increase oral sodium intake
IV fluids if from FVD
Diuretics if from FVE

Hypertonic soon to increase sodium

74
Q

Hyperkalemia causes

A 
Hyperkalemia causes:
Renal failure 
Addison's (decreased adrenal)
DKA
K+sparing diuretics
Crush injury
75
Q

Hyperkalemia symptoms

A 
Hyperkalemia symptoms:
Increased excitability so:
Cardiac changes, EKG changes, v-fib, decreased BP and HR
Muscle twitching
Abdominal cramping-diarrhea
Weakness paralysis
76
Q

Hyperkalemia treatment

A

Hyperkalemia treatment:
Decrease K+ oral intake
Diuretics, dialysis, insulin to decrease K+
IV Ca++ to decrease excitability

Kayexalate- increased GI elimination of K+

77
Q

Hypokalemia causes

A 
Hypokalemia causes:
Diuretics
Cushings ( increased cortisol)
Diarrhea vomiting
Alkalosis
Fluid overload due to increased aldosterone
Insulin
Digoxin toxicity
78
Q

Hypokalemia symptoms

A 
Hypokalemia symptoms: A SIC WALT. Decreased excitability 
Alkalosis
Shallow reaps
Irritability 
Confusion drowsiness 
Weakness fatigue
Arrhythmias
Lethargy
Threads pulse
79
Q

Hypokalemia treatment

A 
Hypokalemia treatments:
K+ supplement
K+ sparing diuretics
Dietary K+ intake
Insulin to move K+ into cell
80
Q

Hypercalcemia causes

A 
Hypercalcemia causes
Hyper parathyroid
Acidosis
Renal failure
Malignancy- multiple myeloma 
Prolonged immobility
81
Q

Hypercalcemia symptoms

A 
Hypercalcemia symptoms 
Decreased excitability
Muscle weakness
Decreased reflexes
Decreased peristalsis 
Blood clots
82
Q

Hypercalcemia treatments

A 
Hypercalcemia treatment
Loop diuretics
Isotonic fluids 
Ca++ binders 
Increased phosphate 
Calcitonin to decreased Ca++ absorption
Dialysis
Decreased dietary Ca++
Weight bearing exercises
Cardiac monitoring
83
Q

Hypocalcemia causes

A 
Hypercalcemia causes:
Renal failure
Hypo parathyroid
Alkalosis
Loop diuretics
Increased phosphorus intake
84
Q

Hypercalcemia symptoms

A 
Hypercalcemia symptoms: muscle excitability
Parathesias around mouth/ lip tingling
Muscle cramping
Hypotension
Osteoporosis
EKG changes
Positive chovsteks and trousseaus sign
85
Q

Hypercalcemia treatment

A

Hypercalcemia treatment:
Ca++ supplements
Oral Ca++ intake
Decrease phosphate

86
Q

Chvotek’s sign assesses for what electrolyte imbalance? How to perform.

A

Hypocalcemia

Tap cheek and notice muscle twitching from muscle excitability.

87
Q

Trousseau’s sign is used to asses for what electrolyte imbalance? How to perform

A

Hypocalcemia

BP cuff to arm and arm cramp

88
Q

What is the effect of calcitonin on Ca++ levels?

A

Calcitonin causes decreased GI absorption, promotes renal secretion and deposits Ca++ to bone.

89
Q

What effect does parathyroid hormone have on Ca++ levels?

A

Is released when Ca++ levels are low.

Causes Ca++ to be released from bone, increase GI absorption and increased renal absorption

90
Q

Acidosis causes K+ levels to——

A

Rise- hyperkalemia

91
Q

Alkalosis causes K+ levels to —-

A

Fall- potassium enters cells and Hypokalemia in serum.

92
Q

How much fluid is loss daily through insensible losses?

A

1000 cc

93
Q

What is normal urine output?

What is the minimal urine output?

A

Normal = 60 cc / hour

Minimal = 30 cc/ hr

94
Q

What affect does aldosterone have on Na+ and K+ levels?

A

Na + levels rise

K+ levels fall as it is excreted in urine.

95
Q

List physical symptoms of dehydration.

A 
Hypotension, orthostatic hypotension
Tachycardia
Increased RR
Decreased skin turgid
Dry mucous membranes
Confusion
Decreased urine output- high specific gravity- concentrated
Elevated Hct, BUN, osmolality.
96
Q

List physical symptoms of fluid overload.

A 
Pitting edema
Bounding pulses
JVD
Weight gain
Dyspnea
Crackles
Confusion
Enlarged liver

Hemotology (1 decks)

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