In-Class Questions Hematology System Flashcards
Which statement about hematologic changes associated with aging is true?
A. The older adult has increased blood volume
B. The older adult has increased levels of plasma proteins
C. Platelet counts decrease with age
D. Antibody levels and responses are lower and slower in older adults
Answer: D
Most times things decreased with aging
Decreased overall blood volume
Lower levels of plasma proteins
Bone Marrow produces less blood cells
Hemoglobin levels in men and women fall after middle age
Immune responses change
What are some other hematological changes with aging?
Could be related to decrease in protein intake - not eat as much as age; shake for extra protein; higher risk for infection
Lower levels of plasma proteins
RBC and WBC counts decrease - decreased IR; not see high fever or response as fast
Platelet counts do not change with age
Bone Marrow produces less blood cells
Could be related to decrease in iron intake
Hemoglobin levels in men and women fall after middle age
WBC counts may be lower
WBC count does not rise as high in response to infection in older adults
Increased risk for swelling and bleeding; not respond as quickly to an infection
Antibody levels and responses are lower and slower in older adults
Lymphocytes become less reactive to antigens
Immune responses change
The patient reports a history of splenectomy. Based on this information, what is the nurse most likely to assess for?
A.Signs of bleeding
B.Signs of infection
C.Digestive problems
D.Jaundice of the skin
Answer: B
An experienced nurse is supervising a new graduate who is assessing a patient with a suspected hematologic problem. The experienced nurse would intervene if the new nurse performed which action?
A.Auscultated the heart for abnormal heart sounds or irregular rhythm
B.Palpated the abdomen to attempt to locate an enlarged spleen
C.Assessed joints for swelling or pain
D.Assessed the skin for petechiae and ecchymoses
Answer: B
Not palpate to find enlarged spleen: hemorrhage and risk for rupture: not typically palpable
Spleen
Liver
Accessory organs of blood formation
Destroys old or imperfect RBCs
Breaks down the hemoglobin
Stores platelets
Antibody production and filters antigens
After a splenectomy patients have reduced immune functions - higher risk for infection
Spleen
Produces prothrombin and other blood clotting factors
Cirrhosis - high risk for bleeding
Assists in the forming of Vitamin K in the intestines
Stores blood cells
Stores iron in the form of ferritin
Liver
When assessing the patient with darker skin for pallor and cyanosis, which area would the nurse examine?
A.Chest and abdomen
B.General appearance of face
C.Fingertips and toes
D.Oral mucous membranes
Answer: D
Skin
Head & Neck
Respiratory
Cardiovascular
Kidney & Urinary
Musculoskeletal
Abdominal
Central Nervous System
Physical assessment
Inspect skin and mucous membranes for pallor
Assess nail beds for pallor or cyanosis: Not quite as reliable in nail beds; Pallor of the gums, conjunctivae, and palmar creases indicates decreased hemoglobin levels and poor tissue oxygenation
Inspect for petechiae (pin prick bruises) and ecchymoses
Skin
Check for pallor or ulceration of the oral mucosa
Inspect and palpate all diff lymph node areas
Head & Neck
Assess respirations and dyspnea at rest and on exertion
Assess for fatigue
Orthopnea
O2 carried by blood - issues with resp sys - think anemia
Respiratory
PERFUSION
Assess pulses
BP
Abnormal heart sounds
Irregular rhythms
Cardiovascular
Assess urine for hematuria
Kidney & Urinary
Rib or sternal tenderness may occur with leukemia
Assess range of joint motion, document any swelling or joint pain
Musculoskeletal
Evaluate spleen: Normal adult spleen is usually not palpable; Enlarged spleen may occur with many hematologic problems
Stool specimen to check for occult blood testing
Abdominal
Neurologic checks and checks of cognitive function
Central Nervous System
Which of the following interventions should the nurse implement for bleeding precautions? (SATA)
A.Assess skin and mucous membranes
B.Inspect stool and urine
C.Measure abdominal girth
D.Offer soft bristle tooth brush
E.Offer to shave patient with razor
F.Monitor lab values
Answer: A, B, C, D, F
Increased abdominal girth - internal bleeding
Soft bristle - not want gums bleed
Composed of plasma and cells
Plasma is an extracellular fluid with plasma proteins
Blood cells
Blood components
Albumin: maintain osmotic pressure of blood
Globulins: transport of antibodies
Fibrinogen: important in clotting
Plasma is an extracellular fluid with plasma proteins
RBCs
WBCs
Platelets
Blood cells
Largest proportion of blood
Produce hemoglobin which carries oxygen and carbon dioxide
Iron is important component of hemoglobin
RBCs
Role in inflammation and infection protection
WBCs
Smallest blood cell
Stick to injured vessel walls and aggregate to assist clotting
Stored in spleen
Platelets
Decrease RBC, Hgb, Hct: Bleeding, anemia, hemorrhage
Decrease WBC - suppression bone marrow
Increase WBC - infection, inflammation
Decrease platelet - bleeding
RBC
Hemoglobin
Hematocrit
WBC
Platelets
Lab profile
4.2-6.1
RBC
12- 18
Hemoglobin
37%-52%
Hematocrit
5,000-10,000
WBC
150,000-400,000
Platelets
All of the following is true about bone marrow aspiration, EXCEPT:
A.It is performed to evaluate patient’s blood cells and hematologic status
B.It is performed in OR
C.Biopsy could be obtained
D.It could provide a differential diagnosis
Answer: B
Can do at bedside or IR or office; not OR - not gen anesthesia
Local anesthetic is used and may feel stinging or burning sensation
Mild tranquilizer or a rapid-acting sedative could be used
Heavy sensation of pressure and pushing while the needle is being inserted
Usually use the iliac crest; sternum if need more
Patient should be placed in the prone or side-lying position
Emotional support if doing this; feel heavy pressure when into bone marrow
What is involved in the procedure? - Bone marrow aspiration and biopsy
Hold pressure briefly to site
Cover the site with a dressing after bleeding is controlled
Give mild analgesic for discomfort
Apply ice bag to the needle site to limit bruising
Observe site every 2 hours for 24 hours for signs of bleeding, bruising, and s/s infection
Advise the patient to avoid contact sports or any activity that might result in trauma to the site for 48 hours - avoid trauma to sight
What are the nursing interventions post procedure? - Bone marrow aspiration and biopsy
The nurse understands that anemia is a reduction in the number of which of the following? (Select all that apply)
A.WBCs
B.RBCs
C.Platelets
D.Hemoglobin
E.Hematocrit
F.Neutrophils
Answer: B, D, E
One of those three things; amount RBCs or amount of Hgb/Hct
Deficiency in one of the components needed to make a fully functional RBC
Decrease in RBC production
Increased in RBC destruction
RBC loss
Types or causes of anemias - Anemia
Ex. Iron deficiency; Folic acid deficiency; vitamin B12 deficiency
Deficiency in one of the components needed to make a fully functional RBC
Ex. aplastic anemia
Decrease in RBC production
Ex. hemolytic anemia
Increased in RBC destruction
Ex. GI bleed
RBC loss
What is the most common manifestation of anemia?
A. Fatigue
B. Long bone pain
C. Weight gain
D. Loss of appetite
E. Headache
Answer: A
Very tired and not know why
What are integumentary manifestations of anemia? (SATA)
A.Flushed cheeks
B.Cyanosis
C.Pallor
D.Cool skin
E.Intolerance of cold
F.Dry flaky skin
Answer: C, D, E
Cyanosis severe and later sign - gen paler; not as common
What are CV manifestations of anemia? (SATA)
A.Tachycardia
B.Bradycardia
C.Hypertension
D.Orthostatic hypotension
E.Systemic edema
Answer: A, D
What are respiratory manifestations of anemia? (SATA)
A.Dyspnea on exertion
B.Orthopnea
C.Decreased SaO2
D.Nagging cough
E.Decreased breath sounds
F.Tachypnea
Answer: A, C, F
May also have dyspnea at rest
Decreased O2 and trying to compensated for that
What are neurologic manifestations of anemia? (SATA)
A.Neuropathy
B.Somnolence
C.Fatigue
D.Headache
E.Confusion
F.Delirium
Answer: B, C, D, E
Somnolence - excessive need for sleep
Fatigue and could need if more severe for somnolence
Depends on how low O2 - may have confusion - more low O2 sat
Integumentary
Cardiovascular
Respiratory
Neurologic
Anemia: CM
Pallor
Cool to the touch
Intolerance of cold temperatures
Nails become brittle and become concave over time
Integumentary
Tachycardia
Murmurs and gallops when anemia is severe
Orthostatic hypotension - get up slowly; SAFETY
Cardiovascular
Dyspnea on exertion
Decreased oxygen saturation levels
Respiratory
Fatigue and somnolence
Headache
Neurologic
The nurse is caring for four patients. Which of these patients has the most common risk factor for anemia?
A.Patient on vegan diet
B.Patient with history of exposure to radiation
C.Patient with lower GI bleed
D.Patient with anorexia
Answer: C
Dietary problems - deficiencies
Genetic disorders
Bone marrow disease
Excessive bleeding
Can result from - Risk factors for anemia
GI bleeding
Most common reason for anemia in adults - Risk factors for anemia
What is the most common type of anemia
Iron Deficiency Anemia
Causes:
When iron deficient the stores will decrease first
Labs:
Clinical Manifestations:
Treatment:
Chronic anemia signs more mild compared to acute - s/s more often
Iron Deficiency Anemia
Blood loss
Poor GI absorption of iron
Inadequate iron in diet
Causes: - Iron Deficiency Anemia
Hbg/Hct & RBC decreased in CBC - not producing enough RBC or not have products to produce RBC
Ferritin decreased < 10ng/mL (12-300 normal)
MCV (mean corpuscular volume), MCH (mean corpuscular hemoglobin) and MCHC (mean corpuscular hemoglobin concentration) decreased
Labs: - Iron Deficiency Anemia
Weakness and pallor
Fatigue
Reduced exercise tolerance
Fissures at the corners of the mouth - sores, red cracks at corners of mouth
Clinical Manifestations: - Iron Deficiency Anemia
Increase iron in food - red meat, beans, eggs, green leafy veggies
Iron supplements
IV or IM iron - severe malabsorption issue; monitor closely
Blood transfusion - low Hgb
Treatment: - Iron Deficiency Anemia
Which of the following are risk factors for pernicious anemia?
A.Infections and chemotherapy
B.Sickle cell disease
C.Gastric resection and small bowel resection
D.Blood loss and poor iron absorption
Answer: C
Causes:
Clinical manifestations:
Treatment:
Vitamin B12 Deficiency anemia
Vegan diets or diets lacking dairy products
GI disorders: small bowel resection, chronic diarrhea, diverticuli, tapeworm, overgrowth of intestinal bacteria
Anemia resulting from failure to absorb vitamin B12 (pernicious anemia) secondary to gastritis
Intrinsic factor is a substance normally secreted by the gastric mucosa, which is needed for intestinal absorption of vitamin B12
Causes: - Vitamin B12 Deficiency anemia
Pallor
Jaundice
Glossitis (a smooth, beefy-red tongue)
Fatigue
Weight loss
Paresthesias in the feet and hands - neuro s/s - B12 imp for norm functioning of NS
Poor balance - neuro s/s - B12 imp for norm functioning of NS
Clinical manifestations: - Vitamin B12 Deficiency anemia
Increase vitamin B12 in diet
Vitamin B12 injections
Treatment: - Vitamin B12 Deficiency anemia
Which of the following is treatment for folic acid deficiency anemia? (SATA)
A.Blood products transfusion
B.Cyanocobalamin injections IM
C.Iron supplements IV
D.Epoetin alfa injections SQ
E.Folic acid tablets PO
F.Lentil, spinach and broccoli
G.Salmon, cantaloupe and eggs
Answer: E, F
Increase that
Common causes:
Clinical manifestations:
Treatment:
Folic acid deficiency anemia
Poor nutrition: Chronic alcohol abuse
Malabsorption
Drugs (anticonvulsants, oral contraceptives)
Common causes: - Folic acid deficiency anemia
similar to those of Vitamin B12 deficiency, but nervous system functions remain normal because folic acid deficiency does not affect nerve function
Clinical manifestations: - Folic acid deficiency anemia
Diet rich in foods containing folic acid and vitamin B12: leafy green vegetables, citrus fruits, beans, breads, cereal, rice, pasta
Folic acid replacement
Treatment: - Folic acid deficiency anemia
A deficiency in RBC, WBC and platelets?
A. Aplastic anemia
B. Pancytopenia
C. Neutropenia
D. Thrombocytopenia
Answer: B
Deficiency of circulating red blood cells because of failure of the bone marrow to produce these cells
Pancytopenia
Causes:
Patient will have manifestations of severe anemia
Aplastic anemia
Injury to the stem cells in the bone marrow
Deficiency of circulating red blood cells because of failure of the bone marrow to produce these cells - Aplastic anemia
Deficiency of RBCs, WBCs (leukopenia)and platelets (thrombocytopenia)
Pancytopenia - Aplastic anemia
Long-term exposure to toxic agents
Drugs
Ionizing radiation
Viral infection
Unknown
Causes: - Aplastic anemia
Treatment
Hematopoietic stem cell transplantation with donor cells
Immunosuppressive therapy medications
Splenectomy
Aplastic anemia: interventions
Assess for bone marrow failure
Close monitoring of CBC
Infection prevention
Bleeding precautions
Blood transfusions
Treatment - Aplastic anemia: interventions
Weakness, pallor, petechiae, ecchymosis
Poor oxygenation
Assess for bone marrow failure
When the anemia causes disability or when bleeding is life threatening because of low platelet counts
Blood transfusions
Best treatment
Hematopoietic stem cell transplantation with donor cells - Aplastic anemia: interventions
If spleen is enlarged either destroying normal RBCs or suppressing their development
Splenectomy - Aplastic anemia: interventions
