lp 7- immune / hemtology Flashcards
what is blood made up from
plasma,
solutes,
RBCs,
WBCs,
platelets
Hematopoietic
bone marrow function
originate
bone marrow tissues (where blood cells are formed)
-all cells originate in bone marrow
lymphoid tissues
what does
white blood cells mature & circulate)
Red blood cells
aka
shape
what does shape do
AKA erythrocytes- most common
biconcave disks
- allows cells to pass through small capillaries without disrupting cell membrane
Duty of RBCs & Hemoglobin
transport
excretion
Transport O2 to body tissues
Carbon dioxide excretion
normal levels of RBC/hemoglobin
in women/men
Normal levels are Hemoglobin-
(12-16 Women)
(13.5-18-men)
Anemia
low Blood cell count
Polycythemia
–High blood cell count
Erythropoiesis
production starts/end where
how long does it take
RBC production
Production starts in bone marrow
ends in blood/spleen
takes 3-5 days
What stimulates RBC production
when that occurs…
___ stimulates
tissue hypoxia
When this occurs, Kidneys release erythropoietin
erythropoietin stimulates bone marrow to produce RBC’
lifespan of rbc
Lifespan of 120 days
hemolysis-what is it
converted/ what is it/ where goes
Old damaged RBCs are lysed (damaged) by phagocytes
Lysed RBCs are converted into bilirubin
bilirubin( orange/yellow pigment that bilirubin is removed by liver
which is then excreted out
If someone has impaired liver function/disease process
causes
means
causes
, this causes increases hemolysis,
which means bilirubin will be accumulated into serum
causes jaundice
WBC
AKA
where come from
what is duty
leukocytes
Come from stem cells in bone marrow
Duty?- Defense against microorganisms
normal levels of WBC
(4000-11,000
Leukopenia
lower WBc count
Leukocytosis
higher WBc count
Granular Leukocytes
what are they
3 types
Mature fully in bone marrow, then release into blood stream
neutrophils
eosinophils
basophils
Neutrophils
active
first
increases
immature
lifespan
active phagocyte-
first cell to arrive to site of injury-
increases during inflammation-
immature forms will be released during inflammation/infection-
10 hr lifespan
Eosinophils
found
increase
found in large numbers of mucosa of intestines and lungs-
increase during allergic reaction or parasitic infestations
Basophils
contain
which do what
contain inflammatory mediators
which increase during allergic or inflammatory reactions.
Non-Granular Leukocytes
enter
active part
2 types
Enter bloodstream before fully mature
Active part in: inflammatory & Immune responses
2 types-monocytes, lymphocytes
platelets
aka
formed
live for how long
AKA Thrombocytes
Formed in bone marrow-
live for 10 days
duty of platelets
release
produce
Release mediators required for CLOTTING
Produce ATP
normal levels of platelets
Normal levels are 150,000-400,000
Thrombocytosis
excessive amountof platelets
Thrombocytopenia
risk
deficient amount
risk for injury dt bleeding, petechiae, ecchymosis
Anemia
abnormally low RBC count/ low hemoglobin concentration
Duty of RBCs & Hemoglobin
anemia –leads to
Transport O2 to body tissues & Carbon dioxide excretion
Anemia- reduces the oxygen carrying capacity of the blood-leads to hypoxia
Body can compensate and be asymptomatic; if not and symptoms do arise
symtoms
anemia
Pallor; skin, mucous membranes, nail beds
Heart and resp rate increases
Tissue hypoxia; angina, fatigue, dyspnea on exertion
Bone pain
Blood Loss Anemia
caused from
circulating bv->
Anemia caused from acute/chronic blood loss
Circulating blood volume decrease cardiac output falls
Compensatory mechanisms for blood loss anemia
heart rate increases,
blood vessels constricts,
fluid shift from interstical space to vascular space to help maintain fluid volume
Acute blood loss-when return to normal
Return to normal 3-4 weeks
Chronic blood loss-
iron store
microcytic
hypochromic
- iron store eventually depleted; RBCs ->
microcytic(small rbc)
& hypochromic ( pale RBC)
what are nutritional keys to RBC development
Iron
Protein, vitamins, minerals
B 12 and folate specifically
Vit C & Vit E
what are Nutrient Deficits causes
inadequate diet,
malabsorption,
increase need for nutrients
Iron- Deficiency Anemia
most
increases
cause by
Most common type of anemia
Risk factors increase with age,
Cause developed when supply of iron is inadequate for optimal rbc formation
iron deficiency anemia
may result from
defiecneies
decreased
increased
loss/excessive
chronic
Dietary deficiencies
Decreased absorption
Increased metabolic requirements
Blood loss /excessive bleeding
Chronic hemoglobinuria
manifestations for iron defunct anemia
Brittle spoon shaped nails,
sore tongue,
cheilosis-cracked mouth
pica-unusual taste
Treatment: iron deficiency anemia
High iron diet-chicken, beef, egg yolk, brown rice
dietary supplements causes an increase in H&H
Vitamin B 12 Deficiency Anemia
occurs
failure
lack of
Occurs when B 12 is not consumed or absorbed
Failure to absorb is called Pernicious anemia
Lack of intrinsic factor needed for absorption
Who is at risk for vitamin b12 anemia
pts who have had stomach resection.
, chronic gastritis
manifestations of vitamin b 12 Deficiency anemia
Pallor,
smooth sore beefy red tongue,
neurologic symptoms- paresthesia; numbness & tingling/pain of extremities
Treatment -Vitamin B 12 Deficiency Anemia
dietary sources
treatment
b12 found where
Dietary sources of B-12- Eggs, liver, milk, shrimp, cheese
Treatment B-12 injection
B12 is almost exclusively found in food derived from animals
Folic Acid Deficiency Anemia
folicacid is needed for
found in
Needed for normal maturation of RBCs
found in Inadequate dietary intake, increased metabolic needs, malabsorption, impaired metabolism
who is at risk Folic acid deficiency anemia
__older adults,
drug/alcohol issues,
pregnancy,
children dt increased metabolic needs/meds
Folic Acid Deficiency Anemia
Manifestations
similar
difference
Similar to anemia, and B 12- (pallor SOB, heart palpations) -
> difference though? Is folic acid does not have neurologic symptoms
Folic Acid Deficiency Anemia
Strongly associated with
Neural Tube Defects;
spina bifida- Prenatal vitamin
Folic acid anemia
treatment
nutrition
supplemental folic acid
nutrition- broccoli, Brussel sprouts, citrus, ceralacche, peas, beans, green veggies
Hemolytic Anemias
characterized by
Characterized by premature destruction of RBCs
Hemolytic Anemias
causes
causes can be
Causes:
RBC cell membrane defect
, HgB structure defects (Thalassemia, sickle cell),
Mechanical damage,
drugs/chemicals,
bacteria and other infections
Causes can be
intrinsic(disorder within rbc) or
extrinsic(disorder outside of rbc
Thalassemia
inherited
leads to
causing
Inherited disorder hemoglobin synthesis is incomplete meaning it is missing a molecule
Leads to deficient HgB production,->
causing fragile, microcytic, hypochromic characteristics to rbc
Hemolytic Anemias
can be
can cause
manifestations
Can be asymptomatic
Can cause Mild to moderate anemia
Manifestations->splenomegaly, brown skin color, bone marrow hypoplasia
Hemolytic Anemias
Accumulation of iron, following repeated transfusions…
leads to failure of major failure such as heart/liver
Hemolytic Anemias treatment
: Blood transfusions,
folic acid supplements,
splenectomy,
genetic counseling
Sickle cell anemia
what is
characterized by
can be
Hereditary
Characterized by episodes of sickling where rBC become crescent shaped
can be acute or chronic
sickle cell anemia patho
These will clump together and obstruct capillary blood flow, causing ischemia and possible infarction to surrounding tissue.
Symptoms of sickle cell
-pallor,
fatigue,
jaundice,
irritability,
and pain(when RBC clump together)
Aplastic Anemia-
bone marrow
leading to
replaced
will see
develops
Bone marrow fails to produce all three types of blood cells
leading to pancytopenia
Normal bone marrow is replaced by fat
Will see low count of RBC,WBC and platelets.
Anemia develops as bone marrows fails to replace
Manifestations aplastic anemia
Vary with severity of pancytopenia
Pallor, weakness, exertional dyspnea, headache…tachycardia, heart failure
anemia
goal
interventions
treatment
Goal- Ensure adequate tissue oxygenation
interventions- pace activités, encourage rest
TDB- withdrawal of causative agent, blood transfusions, bone marrow transplant
CBC- what looking for
Anemia- Diagnosis
blood cell count,
H&H,
severity of anemia,
shape,
volume,
and can help determine cause of anemia
iron-why
Anemia- Diagnosis
performed to detect iron deficiency anemia
Serum Ferritin-
low due to
reserves
Anemia- Diagnosis
low due to total depletion
iron reserves available for iron synthesis.
HgB electrophoresis-
seperates
used
diagnosis
Anemia- Diagnosis
separates normal hemoglobin from abnormal,
used to evaluate hemolytic anemia
, and to diagnose thalassemia
Schilling Test
what is it
helps determine
Anemia- Diagnosis
- 24 hr urine sample to measure b12 absorption, before and after intrinsic administration
. Helps determine between pernicious anemia and intestinal malabsorption of vitamin
Bone Marrow Examination-
diagnoses
if present then
Anemia- Diagnosis
diagnose aplastic anemia.
If this is present then normal levels are decreased as they are replaced by fat.
Iron Sources- anemia meds
given how
oral given w/
dont take w/
take w/
stools
increase
Given orally, iv, im
Oral is given with orange juice- helps enhance absorption-drink w/ straw to avoid teeth straining
Don’t take iron w/ milk-decreased absorption
If taken with food it’ll help decrease gi upset
Stools may be dark in color or black-can mask blood in stool
Increase fluids and fiber to decrease constipation
Vitamin B 12-anemia meds
given
do not
pts mat feel
taken for life
Given orally, subq or im
Do not expose medication to light, because it’ll compromise medication
Pts may feel burning sensation on administration -normal
Pernicious anemia=taken for life
Folic Acid Sources-anemia meds
given how
large doses
excessive
do not
Iv, subq, oral
Large doses causes urine to become darker
Excessive alcohol intake increases need for folic acid
Do not mix with other medications
Polycythemia-
aka
excess
hematocrit
“Erythrocytosis”
Excess amount of RBC’s –
hematocrit higher then 55%
primary Polycythemia
what is it
cause
overproduction of rbcs
Cause- unknown
primary Polycythemia
Manifestations-
inc blood volume->
hypertension,
dizziness
, headache
, inc blood viscosity,
inc risk for thrombosis,
Treatment- Polycythemia
phlebotomy removing 300-500 mls of blood to keep blood volume/viscosity within normal limits. ,
chemo to suppress marrow production
, prevent stasis-Thrombosis-> Elevate legs when sitting to prevent blood stasis
Secondary Polycythemia-
cause
manifestation
treatment
Cause- response to excess erythropoietin, due to prolonged hypoxia
Manifestations similar to primary
Treatment- Phlebotomy, treatment underlying cause
Mononucleosis-
invasion by
affects
mode of transmission
incubation period
Invasion of B cells in oropharyngeal lymphoid tissue by the Epstein- Barr Virus
Affects Young adults 15-30
Mode of transmission Saliva
Incubation period 4-8 weeks
Mononucleosis- manifestations
headache,
malaise,
fever
, fatigue,
sore throat,
enlarged lymph nodes
mononucleosis
labs
increased
elevation
low
Increased lymphocytes & monocytes,
WBC elevation later,
platelets low
mononucleosis
recovery
can be
fatigue lasts
can be in 2-3 weeks,
fatigue can last up to 3 months
mononucleosis
treatment
Bedrest
pain control
frequent rest periods
Thrombocytopenia-
platelet count
decline leads to
Platelet Count less than 100,000
Decline of less than 20,000/mL can lead to hemorrhage
Thrombocytopenia
bleeding
causes
Bleeding dt platelet deficiency occurs in small vessels
Petechiae & purpura-rash
Causes Thrombocytopenia-\
immune-what happens
micro-what happens
drug-what happens
: immune response-body destroys platelets
microcirculation issues- platelets clump together
drug induced(heparin therapy)- abnormal response to heperin
Thrombocytopenia- Diagnosis
CBC,
platelet,
Bone marrow examination,
history/ manifestations
Thrombocytopenia - treatment
meds
treatment
surgery-
meds-glucocorticoids, immunosuppressive drugs, withdrawal of heparin therapy
treatmentPlatelet transfusion
surgery-Splenectomy
Splenectomy-
spleen is site of
what’s altered
pts need to be at caution
Spleen is site of Platelet destruction and antibody production
Platelet destruction and immune function altered
-pts need to be at caution for infection,
Nursing Interventions to include:
Thrombocytopenia-
reduce risk
risk
promote
assessing
assessing
Reduce risk of bleeding,
risk of injury dt bleeding tendencies,
promote oral membrane health,
-assessing mouth and encouraging soft toothbrush,
assessing for evidence of peticular areas or bruising.
Type a
antigens
antibodies
blood has a antigens
has B antibodies
Type b
antigens
antibodies
has b antigens
A antibodies
Type ab
antigens
antibodies
universal
both a and b antigens
no antibodies
(Universal recipient
Type o
antigens
antibodies
universal
no antigens
Both antibodies
(Universal Donor
antigen d
if have
if not have
If have antigen d then rH +
If not have antigen d then rH -
Blood Transfusions-
watch-if non
reactions seen when
Watch for any agglutination, if non occurs then blood ins compatible
Reactions- most likely to be seen within first 15 minutes of administration
Reactions to blood manifestations
Fever, chills, hives, flushing, lumbar pain
nursing responsibilities-stop the blood, medicate and send blood to be analyzed.
Innate Immune Response
aka
first
3 barriers
AKA Natural immune response
First line of defense against infection
3 barriers:
Skin- Barrier protection
Mucous membranes Barrier
Body Fluids
Breach of these defenses ->
what is it
Inflammation-
response to injury,
brings fluid and blood cells to area in which damage/invasion has occurred
Adaptive Immune Response-
what is it
when will develop
2 types
More specific immune response-
when innate response is not enough and will develop over time
2 types- Antibody Mediated & Cell Mediated
Adaptive Immune Response-
directed at
specific
response
has what
Directed at materials recognized as foreign
Specific- initiated and directed at specific antigens
Response is systemic compared to localized
Has memory- repeated exposure= more rapid response
Anti-body Mediated
cells create
produced by
_ cells activated
when in contact
rapid response
cells create antibodies to fight against antigens
Produced by B cells
B Cells are activated by contact with an antigen
When in contact; cell changes into antibody producing & memory cells
Rapid response if antigen is encountered again
Cell-Mediated
secretes
antibodies
initaited
antigen
T cells
–secretes cytokines,
and antibodies will attack pathogen
Initiated by T cells
Antigen specific and that antigen must be present on another cells surface
T cells then form antigen specific clones
Immunity-
protection of the body from disease
Active immunity
- Occurs when the body produces antibodies or develops immune lymphocytes against specific antigen
Active-
artificial
natural
Vaccines- provide artificial acquired immunity
Infection with pathogen- Chickenpox (Natural)
Passive immunity
- Provides temporary protection against disease producing antigens
PassiveIMMUNITY
artificial
natural
Artificial- Acquired by admin of antibodies or antitoxins in immune globulin –glamalgobin injection following hep a exposure
Natural- transfer of maternal antibodies via placenta, breastmilk
Diagnosis for immunity is used for what
Used to assess the patients immune status
Serum protein
decreased/noted
diagnosis immunity
decreased levels noted with immune deficiency.
Antibody Testing-
Titer
negative titer indicated
diagnosis immunity
Titer: Example is Varicella Zoster (Chicken Pox)
Negative Titer Indicates: there has never been an infection with Varicella Zoster virus and person is susceptible to chicken pox virus
Skin Testing/prick testing
antigen where
site assessed for
if you see__ means exposure
diagnosis immunity
– antigen is injected intradermally
site is assessed for induration, redness, swelling,
If see induration/pruritic wheal/erythema this will indicate there has been exposure.
Vaccines
suspension
given why?
local reactions
Suspension that are treated to make them nonpathogenic
Given why? To gain immunity
Local reactions- redness, swelling, tenderness, muscle aches,
Vaccines
Health promotion/education
nurse safety
Health Promotion education and reinforce importance of immunizations.
Nurse safety – use dominant arm for administration, clean off site, and have epi pen for anaphylaxis/ allergic reaction
Immune System- Allergy
hypersensitivity ->
when environmental
tissue response
Hypersensitivity- immune response that results in harm to patient
When environmental this is called an allergy
Tissue response mild to severe
Anaphylaxis
manifestations
begins when
new meds-assess
- Tachycardia, Hypotension
Begins within minutes of exposure to antigen
New medication admin- watch for reactions-assess 30 minutes after administration of medications- always re
Latex Allergy
simple
always have
simple irritant that can cause dermatitis,
Always have nonsterile, non latex gloves readily available
Allergy- Diagnosis & Treatment
Blood Testing – used to identify allergens/ hypersensitivity to allergens.
Skin Testing –pin prick, intradermal antigen directly into skin,
Food Allergy Testing –keep dietary log,
Treatment- allergy
meds
antihistamines,
steroids for inflammatory response,
epi pen
Subjective data collection:
allergies
what’s causing this,
what medications are they on,
treatments,
OTC medications,
when/time of year do allergies happen ,
other family members, have they had other allergies in the past
Treatment of allergic reaction
avoid
explain
meds
see
avoid scratching area,- wear long sleeve with neck to avoid scratching
explain use of steroids
topical relief medications
see a alergist
Teaching allergies
see who
do what
directions
information
Allergist
Dietary
Epi Pen directions/instructions
Hereditary information
children with parents that have allergies are more prone to allergies
Cancer
what is it
incidence/mortality
keys to treatment
Uncontrolled growth and spread of abnormal cells
Incidence and mortality- causes 25% of deaths, second most common cause of death
Prevention, early detection and treatment-key to treatments
Cancer- AD
what is it
essential
hospice
Advance Directives
Essential for individuals with poor prognosis
Hospice- Not only for patient but also family
Cancer Risk Factors
Heredity
Age—75% diagnosed after age 55
Gender
Poverty
Stress
Diet
Occupation
Infection
Tobacco Use
Alcohol Use
Recreational Drug Use
Obesity
Sun
Malignant neoplasm cancer
i
N
no
growth
Invasive
Noncohesive
No borders
Rapid growth
Benign
where is it
defined
removed
reoccurrence
Localized
Well defined- capsulated
Easily removed,
minimal reoccurrence
Metastasis
definition
common sites
Definition—malignant cells from primary tumor travel to other tissues and organs
Common Sites bone, lymph , liver, brain
Cancer Consequences-Altered GI function
o/c
change in
change in
change in
A
Obstruction/compression
Change in metabolic rate
Change in digestion
Change in taste
Anorexia
Cancer Consequences
impaired
infection
Impaired immune and hematopoietic function
Leukopenia – Infection
Your patient is on neutropenic precautions….now what?
no
avoid
perform
stop
No fresh flowers in the room
avoid eating unwashed fruits/vegetables
Perform hand hygiene before touching
stop visitors who appear ill
Anorexia/Cachexia
no
syndrome
remove
No appetite,
wasting syndrome
Remove odors or anything that is unpleasent
Cancer-
infection-avoid
can cause(A/T/H)
Infection: avoid contact with infectious processes d/t compromised immune system
can cause Anemia
can cause Thrombocytopenia
can cause Hemorrhage
Pain in cancer
Can be acute/ chronic
Motor and/or sensory deficits
compression
change
invasion
Cancer Consequences
Compression of nerves
Change in cognitive function
Invasion of bones
Physical and Psychological stress
want
get pt
Cancer Consequences
Want pt to Express feelings, give lots of encouragement
Get pt to open up with Open ended questions and , therapeutic communication
surgery-types
Treatment of Cancers
Prophylactic—removal of a breast based on genetic findings
Diagnostic
Primary treatment
Reconstruction/rehabilitation
Palliative
Treatment of cancers
C-therapy
R-therapy
B-therapy
P-therapy
transplants
Chemotherapy
Radiation Therapy
Biotherapy
Photodynamic Therapy
Stem Cell Transplant
Mucous membranes
monitor for
oral pain complaints-
Chemotherapy- Side Effects
Monitor Mucous membranes for stomatitis
Oral pain complaints:
Assess, evaluate, then treat,
may need topical analgesic,
teach to avoid alcohol bases mouthwashes
Hair
Chemotherapy- Side Effects
- alopecia
– loss of hair
Bone marrow suppression
causes
allow
protect
prevent
Chemotherapy- Side Effects
(causes anemia, thrombocytopenia, neutropenia)
allow lots of rest
protect from illness- immunocompromised way from people with illness
prevent too much activity
Fatigue & Anemia
caused from
promote
activity intolerance
Chemotherapy- Side Effects
Caused from : decrease of erythrocytes (rbc)
Promote: rest, quiet activities,
Activity Intolerance: pace activities to how they are tolerating
Nausea and Vomiting
Nursing Interventions:
diet
liquids/food
high
low
minimize
Chemotherapy – Side effects
Bland diets,
cold liquids/foods,
high protein
low volume substances,
minimize odors
Movement; avoid laying flat
Chemo- Pharmacological management
non pharm
Pharm:
give iv fluids
Antiemetic before meals
non pharm:
Attention diversion –phone, tv , visitors, etc
Radiation
local treatment
s/e
Local treatment- Dosimetry, area marked w ink (instruct patient not to wash off markings)
Side effects- Burns
Radiation internal
implant
__or__
radioactive material
radioactive substance
Implant- radiation source implanted
temporary or permanent
Radioactive material is injected directly into tumor/body cavity
radioactive substance may transmit outside of body or into body fluids
radiation internal
Nursing Responsibilities
room
visitors
sit
instruct
asses
avoid
private room,
limit visitors,
sit away from pt,
instruct visitors to sit away.
Asses surrounding tissues,
avoid contanct with pregnant women
radiation internal
Patient and Family Teaching
dispose
avoid
dispose of urine in special containers,
avoid close contanct
Radiation external
what do
site
how often per week
how long does it take
for how long total
Marked;
pinpoint site of radiation,
treatment usually 5 days per week,
15-30 minutes
, 2-7 weeks
Radiation external
Nursing Responsibilities r/t to skin care
looking for
assess
looking for redness/peeling, - normal,
assess skin changes and mucous membranes
Education for radiation
risk for infection-wash with/no /dont want/ dont put
care
Education for patient and family
Risk for infection –washing skin that is red/peeling with plain water, no soaps or lotions, don’t want them to scrub or scratch it. Do not want heat/cold on areas.
Skin care
3 Types of Pain - treatments of cancer
and goals
tumor
treatment
noncancer pain
Goals: establish what idea is prior to treatment
Medication Administration cancer
acting
careful administration ->
Long Acting/short acting
Careful administration metabolism (what do they have cancer of, where is medication metabolized
pain meds for cancer treatment
meds can
assess before
a lot of meds can decrease respiratory rate/drive –
assess repository rate and sp02 before giving meds.
Cancer prevention
avoid:
carcinogen examples
associated factor examples:
Avoid carcinogens
SMOKING, industrial (asbestos), foundries, radiation
Avoid associated factors
Alcohol, obesity, lack of exercise
C
CAUTION-seven warning signs of cancer
– Change in bowel or bladder habits. This is a common sign of colorectal cancer
A
CAUTION-seven warning signs of cancer
– A sore that does not heal in a normal amount of time. If located on the skin or in the mouth, skin cancer or oral cancer could be the cause. Asymmetrical and irregular boarder lesion
U
CAUTION-seven warning signs of cancer
Unusual bleeding or discharge. Any bleeding from the bladder, vagina, or rectum could mean prostate, cervical, or colorectal cancer, postmenopausal bleeding
T
CAUTION-seven warning signs of cancer
Thickening of breast tissue or a lump. Any thickening of tissue or a lump on the breast can be a sign of cancer. A lump on a testicle can mean testicular cancer
I
CAUTION-seven warning signs of cancer
Indigestion. Indigestion and/or difficulty swallowing can be a symptom of stomach, throat, esophagus, or mouth cancer.
O
CAUTION-seven warning signs of cancer
Obvious changes to moles or warts. This is the most common sign of skin cancer. Asymmetrical and irregular boarders
N
CAUTION-seven warning signs of cancer
– Nagging cough. A cough that lasts for four weeks or longer can be a symptom of lung and/or throat cancer.
