Module 14 Exam Material Flashcards
What is the major function of WBC (Leukocyte)?
Fights infection
What is the major function of Neutrophil?
essential in preventing or limiting bacterial infection via phagocytosis
What is the major function of Eosinophil?
Involved in allergic reactions (neutralizes histamine); digest foreign proteins
What is the major function of Basophil?
contains histamine, integral part of hypersensitivity reactions
What is the major function of Lymphocyte?
integral component of immune system
What is the major function of T lymphocyte?
responsible for cell-mediated immunity; recognizes material as “foreign” (surveillance system)
What is the major function of Plasma cell?
secretes immunoglobulin (antibody); most mature form of B lymphocyte
What is the major function of RBC (Erythrocyte)?
carries hemoglobin to provide oxygen to tissues; average lifespan is 120 days
What is the major function of Platelet (Thrombocyte)?
fragment of megakaryocytic; provide basis for coagulation to occur; maintains hemostasis; average lifespan is 10 days
Describe cellular immunity
T lymphocytes are responsible for delayed allergic reactions, rejection of foreign tissue (e.g., transplanted organs), and destruction of tumor cells.
Describe humoral immunity
Plasma cells, in turn, produce antibodies called immunoglobulins (Igs), which are protein molecules that destroy foreign material by several mechanisms
Where is the site of activity for most macrophages?
Mainly in the spleen
Describe Hemostasis
the process of preventing blood loss from intact vessels and of stopping bleeding from a severed vessel, which requires adequate numbers of functional platelets.
Extrinsic Pathway
When tissue is injured, this pathway is activated by the release of thromboplastin from the tissue
** also known as tissue factor pathway
Intrinsic Pathway
activated when the collagen that lines the blood vessels is exposed
- slower and this sequence is less often responsible for clotting in response to tissue injury
**also known as contact activation pathway
Describe Leukopenia
Decreased number of circulating leukocytes
Autosomal Recessive Hematologic disorders
Hemochromatosis
Sickle cell disease
Thalassemia
Autosomal Dominant Hematologic Disorders
Factor V Leiden
Familial hypercholesterolemia
Hereditary angioedema
Hereditary spherocytosis
Von Willliebrand Disease
X-linked Hemtaologic Disorders
Hemophilia
Nursing Assessment for Hematologic Disorders
Collect family history information on both maternal and paternal relatives from three generations of the family
If risk suspected, carefully screen for bleeding disorders prior to surgical procedures
Patient Assessment Specific to Hematologic Disorders
Extreme fatigue
delayed clotting of blood
easy/deep bruising
abnormal bleeding - frequent nosebleeds
abdominal pain
joint pain
- Review blood cell counts for abnormalities
-Assess for presence of illness despite low risk (young adult with blood clot)
Physical assessment of an individual with hematologic disorder
Should be comprenhensive and include careful attention to skin, oral cavity, lymph nodes, and spleen
Health Findings = Potential Indications of Hematologic Disorder
Health History Findings:
Prior episodes of bleeding (epistaxis, menorrhagia, hematochezia, gastrointestinal bleeding, and/or ulcers)
What are the potential indications of hematologic disorders?
Thrombocytopenia
Coagulopathy
Anemia
Health Findings = Potential Indications of Hematologic Disorder
Health History Findings:
Prior blood clots
Pulmonary emboli
Miscarriages
What are the potential indications of hematologic disorders?
Thrombotic Disorder
Health Findings = Potential Indications of Hematologic Disorder
Health History Findings:
Fatigue and weakness
What are the potential indications of hematologic disorders?
Anemia
Infection
Malignancy
Clonal disorders
Health Findings = Potential Indications of Hematologic Disorder
Health History Findings:
Dyspnea, particularly dyspnea on exertion
Orthopnea
shortness of breath
What are the potential indications of hematologic disorders?
Anemia
Infection
Health Findings = Potential Indications of Hematologic Disorder
Health History Findings:
Prior radiation therapy (especially pelvic irradiation)
What are the potential indications of hematologic disorders?
Anemia
Pancytopenia
Melodysplastic syndrome
Leukemia
Health Findings = Potential Indications of Hematologic Disorder
Health History Findings:
Prior Chemotherapy
What are the potential indications of hematologic disorders?
Myelodysplastic syndrome
Leukemia
Health Findings = Potential Indications of Hematologic Disorder
Health History Findings:
Hobbies/occupational/military exposure history (especially benzene, agent orange)
What are the potential indications of hematologic disorders?
Myelodysplastic syndrome
Leukemia
Myeloma
Lymphoma
Health Findings = Potential Indications of Hematologic Disorder
Health History Findings:
Diet history
What are the potential indications of hematologic disorders?
Anemia (due to vitamin B12 , folate, iron deficiency
Health Findings = Potential Indications of Hematologic Disorder
Health History Findings:
Diet history
What are the potential indications of hematologic disorders?
Anemia (due to vitamin B12 , folate, iron deficiency
Health Findings = Potential Indications of Hematologic Disorder
Health History Findings:
Alcohol consumption
What are the potential indications of hematologic disorders?
Anemia (effect on hematopoiesis, nutritional deficiencies)
Health Findings = Potential Indications of Hematologic Disorder
Health History Findings:
use of herbal supplements
What are the potential indications of hematologic disorders?
Platelet dysfunctional
Health Findings = Potential Indications of Hematologic Disorder
Health History Findings:
Concurrent medications
What are the potential indications of hematologic disorders?
Neutropenia
Anemia
Hemolysis
Thrombocytopenia
Nonmalignant Hematologic Disorders
Anemia
Neutropenia
Lymphopenia
Polycythemia
Bleeding Disorders
Sickle Cell Disease
Acquired Coagulation Disorders - DIC
Hypoproliferative Anemia
resulting from defective RBC Production
- Iron deficiency (microcytic)
- Vitamin B12 deficiency (megaloblastic)
- Folate (megaloblastic)
- Decreased erythropoietin production (e.g. from chronic kidney disease)
- Cancer/inflammation
**low production of RBC
Hemolytic Anemia
Resulting from RBC Destruction
- Altered erythropoiesis (sickle cell, thalassemia, other hemoglobinopathies)
-Hypersplenism (hemolysis)
- Drug induced anemia
- Autoimmune anemia
- Mechanical heart valve -related anemia
Thalassemia
Type of genetic anemia
Often seen in Asian, African, Mediterranean, and Middle Eastern Individuals
- individuals have a high level of small RBCs, lab show small cells at a high volume
-Treatment does NOT include blood products
Neutropenia
Low volumes of neutrophils
puts individual at increased risk for infection, monitor patient closely
Neutropenia
Low volumes of neutrophils
puts individual at increased risk for infection, monitor patient closely
Lymphopenia
low volumes of lymphocyte
Causes
- exposure to radiation
- long-term use corticosteroids
- infections
- neoplasms
- alcohol abuse
Polycythemia
Increased levels of red blood cells does not mean anemia, understand that polycythemia is the increased volume of RBC
Seen in individuals with a Hx of chronic smoking, obstructive sleep apnea, COPD , live in a high altitude and small exposure to carbon monoxide
NOT A FORM OF ANEMIA
Causes of Bleeding Disorders
Trauma
Platelet abnormalities
Coagulation factor abnormality
Nursing management of bleeding disorders
Limit injury
Assess for bleeding
Bleeding precautions
Patients with platelet dysfunction should avoid substances that interfere with platelet function such as:
OTC medications such as aspirin, NSAIDs, as well as herbal supplements, and alcohol.
Hemophilia A is caused by:
genetic defect that results in deficient or defective factor VIII
5x more common
Hemophilia B is caused by:
genetic defect that causes a deficiency or defective factor IX
Also known as Christmas disease
Von Willebrand Disease
most common inherited bleeding disorder, affecting approx 1% of the general population.
Bleeding most often involves the mucous membranes. Nosebleeds, heavy menses, easy bruising, and prolonged bleeding from cuts and surgical sites are common
Integumentary S/s of Microvascular Thrombosis (DIC)
Decreased temp and sensation
increased pain
Cyanosis in extremities, nose, earlobes
Circulatory S/s of Microvascular Thrombosis (DIC)
Decreased pulses
Capillary filling time > 3 secs
Respiratory S/s of Microvascular Thrombosis (DIC)
Hypoxia
Dyspnea
Chest pain with deep inspiration
Decreased breath sounds over areas of large embolism
GI S/s of Microvascular Thrombosis (DIC)
gastric pain
heartburn
Renal S/s of Microvascular Thrombosis (DIC)
decreased urine output
increased creatinine
increased urea nitrogen
Neurologic S/s of Microvascular Thrombosis (DIC)
Decreased alertness and orientation
Decreased pupillary reaction
Integumentary s/s of Microvascular and Frank Bleeding (DIC)
Petechiae
bleeding gums, oozing from wounds
Circulatory s/s of Microvascular and Frank Bleeding (DIC)
tachycardia
Respiratory s/s of Microvascular and Frank Bleeding (DIC)
High-pitched bronchial breath sounds
tachypnea
s/s of ARDS
GI s/s of Microvascular and Frank Bleeding (DIC)
Hematemsis
tarry stools
Renal s/s of Microvascular and Frank Bleeding (DIC)
Hematuria
Neurologic s/s of Microvascular and Frank Bleeding (DIC)
Anxiety, restlessness
Decreased mentation
altered level of consciousness
headache
Disseminated Intravascular Coagulation (DIC)
Disseminated intravascular coagulation (DIC) is a rare but serious condition that causes abnormal blood clotting throughout the body’s blood vessels. You may develop DIC if you have an infection or injury that affects the body’s normal blood clotting process.
This is NOT a disease but a sign of a disorder
Sickle Cell Disease
Severe hemolytic anemia
Sickle Cell Disease vs Sickle Cell Trait
Sickle cell trait (SCT) is not a disease, but having it means that a person has inherited the sickle cell gene from one of his or her parents. People with SCT usually do not have any of the symptoms of sickle cell disease (SCD) and live a normal life.
Potential Complications of Patient with Sickle Cell Disease
Hypoxia, ischemia, and INFECTION
Dehydration - cells are sticky
CVA
Anemia
Typically individuals have a short life span
Substance abuse due to needing relief from the pain
Interventions for Patient with sickle cell disease
ANTIBIOTICS ARE ADMINISTERED ASAP - PRIORITY
Infection preventative
Complete full antibiotic regime
encourage vaccines - pneumonia, flu - due to increased risk
Nursing Process - Patient with Sickle Cell Crisis
Pain should always be assessed
Assess patient’s fatigue and impact of fatigue on quality of life
Particular assessment on assessing pain, fever, and swelling
Assess for signs or dehydration and presence of infection
What labs do you assess for DIC?
INR, PT, and PTT
Treatment: heparin - controversial in its use
Potential Complications of DIC:
Kidney injury
Gangrene
Pulmonary embolism or hemorrhage
Acute respiratory distress syndrome
Stroke
Interventions for the patient with DIC
Assessment and interventions should target potential sites of organ damage
Monitor and assess carefully
Avoid trauma and procedures that increase the risk of bleeding, including activities that would increase intracranial pressure
Is the following statement true or false?
Disseminated intravascular coagulation is caused by alteration of normal hemostatic mechanisms.
True
Rationale: Normal hemostatic mechanisms are altered in DIC. The inflammatory response generated by the underlying disease initiates the process of inflammation and coagulation within the vasculature. Normal anticoagulation pathways are impaired and fibrinolysis is suppressed allowing small clots to form. As platelets and clotting factors are consumed by the microthrombi, coagulation fails, leading to excessive clotting and bleeding.
Describe Allergy
An inappropriate, often harmful response of the immune system to normally harmless substances
Hypersensitive reaction to an allergen initiated by immunologic mechanisms that is usually mediated by IgE antibodies
Describe Allergen
the substance that causes the allergic response
Describe Atopy
refers to IgE-mediated diseases, such as allergic rhinitis, that have a genetic component
Describe an allergic reaction
Manifestation of tissue injury resulting from interaction between an antigen and an antibody
Body encounters allergens that are types of antigens
Body’s defenses recognize antigens as foreign
Series of events occurs in an attempt to render the invaders harmless, destroy them, and remove them from the body
Describe IgE antibodies
- antibody formed by lymphocytes and plasma cells
- involved in allergic reactions
- bind to an allergen and trigger mast cells or basophils
Describe B cells
also known as B lymphocyte
- programmed to produce one specific antibody
- stimulates production of plasma cells; antibody production
- results in outpouring of antibodies
Describe T cells
- also known as T lymphocytes
- assist B cells
- secrete substances that destroy target cells and stimulate macrophages
- Digest antigens and remove debris
Function of Chemical Mediators
Allergen triggers the B cell to make IgE antibody, which attaches to the mast cell. When that allergen reappears, it binds to the IgE and triggers the mast cell to release its chemicals.
Primary Chemical Mediators
Histamine
Eosinophil chemotactic factor of anaphylaxis
Platelet-activating factor
Prostaglandins
Secondary Chemical Mediators
Leukotrienes
Bradykinin
Serotonin
Is the following statement true or false?
An antigen is a protein substance developed by the body in response to and interacting with a specific antibody.
False
An antibody, not an antigen, is a protein substance developed by the body in response to and interacting with a specific antigen, not antibody.
The type of hypersensitivity reaction is the most severe?
Anaphylactic: type I
Characteristics of an anaphylactic reaction
Vasodilation
Increased capillary permeability
Smooth muscle contraction
Angioedema
Hypotension
Bronchial, GI, or uterine spasm
Hives
Extrinsic asthma
allergic rhinitis
What kind of reaction can a transfusion create?
Cytotoxic Reaction: result of a mistaken identity when the system identifies a normal constituent of the body as foreign and activates the complement cascade
What is an atopic allergic reaction?
Asthma, allergic rhinitis, atopic dermatitis
Familial
What is a nonatopic allergic reaction?
Latex
Lack of genetic component
Interventions for the patient with allergic rhinitis
Improving breathing:
- modify the environment to reduce allergens
- reduce exposure to people with URI
- take deep breaths and cough frequently
Patient teaching
- instruction to minimize allergens
- use of medications
- importance of keeping appointments
-desensitization procedures
Rebound anaphylactic reaction
A “rebound” anaphylactic reaction can occur 4 to 8 hours after an initial attack even when epinephrine has been given.
What are Rheumatic Diseases
Encompass autoimmune, degenerative, inflammatory, and systemic
conditions
Affects the joints, muscles, and soft tissues of the body
Manifestations caused by rheumatic diseases
limitations in mobility and activities
pain and fatigue
altered self image
altered self-image
sleep disturbances
systemic effects that can lead to organ failure and death
Is the following statement true or false?
Polyarticular refers to a rheumatic disease affecting more than one joint.
True
Rationale:
Monoarticular means affecting a single joint;
polyarticular means affecting multiple joints.
Three distinct characteristics of Rheumatoid Disorders:
Inflammation: complex process resulting in pannus (overgrowth of tissue, extra growth of tissue in the joints)
Autoimmunity: Hallmark of rheumatologic disease; body recognizes own tissue as foreign antigen
Degeneration: loss of function, secondary process to inflammation
Common Symptoms of Rheumatic Disease
Pain
Joint swelling
Limited movement
Stiffness
Weakness
Fatigue
Which of the following are common physicalsigns and symptoms of rheumatoid arthritis?
A. Pain on weight-bearing, rash, and low-gradefever
B. Small joint swelling, joint stiffness, and joint pain
C. Crepitus (osteoarithitis) , development of Heberden’s nodes, andanemia
D. Fatigue, leukopenia, and joint pain
B. Small joint swelling, joint stiffness, and joint pain
Rationale: The most common symptom in the rheumatic diseases is pain. Other common symptoms include joint swelling, limited movement, stiffness, weakness, and fatigue.
Describe Crepitus
cracking grinding, grating noise when flexing a joint-
NOT rheumatoid arthritis but osteoporosis-arthritis
Describe Development of Heberden’s nodes
when the cartilage starts to wear out, your bones don’t fit together as easily. As cartilage breaks down, your body responds by growing new bone at the joint. The new bone growths are called nodes or spurs. When they appear at the finger’s end joint, they are called Heberden’s nodes.
Osteoarthritis
Assessment of ALL Rheumatoid Conditions
Health history:
Include onset of and evolution of symptoms
Family history
Past health history
Contributing factors
Previous treatments and their effectiveness
Patient’s support systems
Diagnostic Tests for Rheumatoid Disorders
LONG PROCESS
Laboratory Studies
Imaging studies: X-ray, CT Scan, MRI, Arthrography
Which of the following statements should help guide nursing care for the patient with fibromyalgia?
A. Patients with fibromyalgia rarely respond to treatment
B. Patients with fibromyalgia may feel as if their symptoms have not been taken seriously
C. All patients with fibromyalgia have the same type of symptoms
D. Patients with fibromyalgia will eventually lose their ability to walk
B. Patients with fibromyalgia may feel as if their symptoms have not been taken seriously
Rationale: Typically, patients with fibromyalgia have endured their symptoms for a long period of time and may feel as if their symptoms have not been taken seriously. Nurses need to pay special attention to supporting these patients and providing encouragement as they begin their program of therapy. Symptoms of disease vary from patient to patient, as do responses to different treatments. Fibromyalgia does not lead to an inability to walk.
Describe fibromyalgia
chronic pain syndrome
S/S:
Chronic fatigue
General muscle aches
Stiffness
Functional impairment
Neuro pathways are heightened: light touch to be very painful
Difficult to diagnose, mostly because of generalized symptoms and lack of specific testing
Interventions for Patients with Rheumatic Disorders
Pain management - anti-inflammatory
Fatigue - explain energy conserving techniques
functional mobility - assess for the need for PT/OT and encourage independence
Self-care: provide a device/process that will reduce barrier to perform own care
Physical and psychological changes: encourage verbalization of feelings and fears (emotional support)
Effective coping behaviors: developing plan for managing symptoms
Absence of complications secondary to medications: want to break the cycle of inflammation, decrease joint deformities (pannus-overgrowth of tissue)
Medications used to reduce/treat rheumatic disorder
Humira
methotrexate - usually start with, target particular cells in the role of inflammation
Enbrel
used to reduce inflammation
want to treat as quickly and aggressively as soon as possible to slow down process of factors that limit functionality
WANT TO HIT HARD AND FAST
Interventions to maintain functional ability
Range of motion
Isometric exercise
Dynamic exercise
Aerobic exercise
Pool exercise - less pressure to the joints and gravity is less intense
Common Blood Studies for Rheumatic Disorders: Creatine
measure waste excreted through the kidneys
Men 0.6 - 1.2
Women 0.4 - 1.0
Increase may indicate kidney damage in SLE, scleroderma, and polyarteritis
Common Blood Studies for Rheumatic Disorders: Erythrocyte Count
Measures circulating erythrocytes
Men 4,200,000 - 5,400,000
Women 3,600,000 - 5,000,000
Decrease can be seen in RA and SLE
Common Blood Studies for Rheumatic Disorders: Hematocrit
Measures the size, capacity, and number of cells present in the blood
Men 42-52%
Women 36-48%
Decrease can be seen in chronic inflammation (anemia of chronic disease); also, blood loss through GI bleed.
Common Blood Studies for Rheumatic Disorders: WBC Count
Measuring circulating leukocytes
4500-11,000
Decrease may be seen in SLE
Common Blood Studies for Rheumatic Disorders: Uric Acid
Men: 3.4–7 mg/dL
Women: 2.4–6 mg/dL
Increase is seen with gout. During acute flare, levels may be normal. After flare has subsided, levels will be elevated in gout.
Serum Immunology: Rheumatoid Disorders - Antinuclear Antibody (ANA)
Measures antibodies that react with a variety of nuclear antigens
If antibodies are present, further testing determines the type of ANA circulating in the blood (anti-DNA, anti-RNP).
Normal Value : Negative
Healthy adults may also have a positive ANA.
Positive test may be associated with SLE, RA, scleroderma, Raynaud’s disease, Sjögren’s syndrome, necrotizing arteritis.
The higher the titer, the greater the inflammation.
The pattern of immunofluorescence (speckled, homogeneous, or nucleolar) helps determine the diagnosis.
Serum Immunology: Rheumatoid Disorders - Anti - DNA Binding
Titer measurement of antibody to double-stranded DNA
Normal value:Negative
High titer is seen in SLE; increases in titer may indicate an increase in disease activity.
Serum Immunology: Rheumatoid Disorders - C-reactive protein (CRP)
Shows presence of abnormal glycoprotein due to inflammatory process
Normal Value: <1 mg/dL (<10 mg/L)
A positive reading indicates active inflammation.
Serum Immunology: Rheumatoid Disorders - Immunoglobulin Electrophoresis
Measures the values of immunoglobulins
Normal Values:
IgA: 60–400 mg/dL (600–4000 mg/L)
IgG: 700–1,500 mg/dL (7–15 g/L)
IgM: 60–300 mg/dL (600–3000 mg/L)
Increased levels are found in people who have autoimmune disorders.
Serum Immunology: Rheumatoid Disorders - Rheumatoid Factor (RF)
Determines the presence of abnormal antibodies seen in connective tissue disease
Normal Value: Negative
Positive titer >1:80
Present in 80% of those with RA
Positive RF may also suggest SLE, Sjögren’s syndrome, or mixed connective tissue disease. The higher the titer (number at right of colon), the greater the inflammation.
Describe Arthrography
Arthrography is used to identify the cause of any unexplained joint pain and progression of joint disease.
A radiopaque contrast agent or air is injected into the joint cavity to visualize the joint structures, such as the ligaments, cartilage, tendons, and joint capsule.
The joint is put through its range of motion to distribute the contrast agent while a series of x-rays are obtained.
If a tear is present, the contrast agent leaks out of the joint and is evident on the x-ray image
