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Nurb Test 4: Hematology Flashcards

0
Q

Cancer affecting blood and bone marrow
No single cause: genetics, environmental influences, chromosomal changes, chemical agents, chemotherapy, viruses, radiation, and immunological deficiencies

A

. Leukemia

Etiology

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1
Q

– Uncontrolled proliferation of myeloblasts (precursor to granulocytes) and hyperplasia of the bone marrow, starts in bone marrow
Abrupt onset and dramatic

A

Acute myelogenous leukemia (AML

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2
Q
  • Excessive development of mature neoplastic granulocytes in bone marrow -> move into peripheral blood in massive numbers ->infiltrate liver and spleen / uncontrolled growth
  • no symptoms early in the disease
  • contain Philadelphia chromosome
A

Chronic myelogenous leukemia (CML)

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3
Q
  • Change in quantity and quality of bone marrow elements. Marked by peripheral blood cytopenias and hypercellular bone marrow
  • Can progress into AML
  • infection and bleeding most common found six
A

Myelodysplastic syndrome (MDS)

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4
Q

-Excessive production of malignant plasma cells -> infiltrate bone marrow and produce abnormal amount of immunoglobulin -> one is destroyed
-produce abn protein: 4 protein levels cause renal failure
More common in men, dev after 40, more common African American
-sx dev slow and icideous
Major sx skeletal pain
Hypercalcemia due to bone degeneration: prevent dehydration

A

Multiple myeloma (plasma cell myeloma)

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5
Q
  • solid masses that may occur from accumulation of leukemic cells
A

Chloromas

complication of leukemia

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6
Q 
Low RBC, Hct and Hb, platelets
Low to high WBC
-Tests differ depending on type of leukemia 
*affects bone marrow: biopsy important
* good baseline would be a CBC
A

Diagnostics leukemia

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7
Q

Monitor Wt I&O= fluid deficit related to inadequate intake vomiting and bleeding, Hemglobin and hematocrit levels, give meds for N/V= give meds, VS
- Offer foods they like
- Dehydration prevention= can cause hypocalcemia
Goal : is to attain remission
Put on chemo to help with remission

A

Care: leukemia

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8
Q
  • means there is an infection in the body. -do not have the ability to fight off infection, **needs to be addressed quickly.
  • 100.4 F and a neutrophil count of less than 500 is a medical emergency
A

Fever

neutropenia

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9
Q

= ANC 500-1000

= ANC is less the 500 cells per uL and is at severe risk for bacterial infection

A

Neutropenia

Severe Neutropenia

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10
Q

=500-1000 then they are at moderate risk for bacterial infection, only way to count and confirm the existence

A

Differential WBC count

neutropenia

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11
Q

This is associated with high risk of infection and death from sepsis

A

severe neutropenia

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12
Q
  1. Fever greater than 100.9, high heart rate, altered mental status, rapid breathing, significant edema or positive fluid balance, or blood sugar greater than 140 without being diagnosed with diabetes
  2. Inflammatory criteria-leukocytosis, elevated C-reactive protein, raised procalcitonin, or leukopenia
  3. Arterial hypotension
  4. Organ dysfunction criteria- arterial hypoxemia, acute decrease of urine output, serum creatinine increased, low INR, elevated PTT, absent bowel sounds, thrombocytopenia, and hyperbilirubinemia
  5. Altered tissue perfusion- decrease in capillary refill
A

sepsis neutropenia

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13
Q

Main tests for neutropenia:

A

peripheral WBC count and bone marrow aspiration

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14
Q

specific emphasis on the common sites of infection, such as the oral mucosa, paranasal sinuses, ear, chest, abdomen, skin, nails, groins, anal and vaginal areas, and vascular catheter insertion sites

A

Physical examination:
medical management
neutropenia

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15
Q

-Maintain isolation techniques
-Wash hands with antimicrobial soap before and after each patient care and have visitors do
Edu: patient and care giver how to avoid infections through personal hygiene, hand washing, oral care, skin hygiene and pulmonary hygiene.
-signs and symptoms of infection and when to report them to the health care provider
-Instruct the patient to take antibiotics as prescribed
-Monitor for systemic and localized signs and symptoms of infection
-Remove fresh flowers and plants from patient areas to avoid introduction of pathogens

A

Nursing Interventions:

neutropenia

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16
Q

Patient Education

  1. chemotherapy or immunosuppressive therapy: treatments would be stopped if the white blood cell count was too low and resumed once the cell counts returned to a safer level
  2. infection present treated promptly
  3. Blood cultures will continue to be drawn until all four bottles come back clean of any bacterial growth
  4. identifiable cause of the infection (i.e. port or PICC), that item would be removed and placed again if needed for chemotherapy treatment
  5. Patients could also have home IV antibiotics to take for up to two weeks to insure that the infection is gone
  6. Proper self-care:
A

pt edu neutropenia

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17
Q

frequent hand washing and the use of hand sanitizer if soap and water are not available, avoiding persons that are sick or appear sick, avoiding fresh fruits, vegetables, flowers, and uncooked meats, taking daily showers, proper oral care, washing hands after touching any pets or taking care of pets, taking your temperature at home and report any temperature over 100.4 F, and wearing a mask if in public

A

Proper self-care:

pt edu neutropenia

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18
Q
  • result from abnormally initiated and accelerated clotting, Char by profuse bleeding, always caused by underlying condition or situation
A

Dissmeninated Intravascular Coagulation

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19
Q

-abnormal response of the normal clotting cascade stimulated by a disease proves or disorder
Three types, different triggering mechanisms
1. acute
2. subacute
3. chronic

A

Etiology DIC

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20
Q

Need to tx holistically
Diagnosing quickly, stabilizing patient=o2, find underlying cause and correcting it
Monitoring vital signs and assessing for internal/ external hemorrhage
Respiratory: raise HOB or tripod position
Tachycardia: calcium channel blockers/ Beta Blockers
Petechiae: taking precautions
Can give blood products and anticoagulants

A

Management of symptoms DIC

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21
Q

Ongoing assessments, active attention to manifestation of syndrome= care of causative problem
Prompt administration of prescribed therapies
Early detection of overt and occult bleeding is primary goal
-Signs of external bleeding:
-Signs of internal bleeding:
Indications microemboli are cause organ damage: decreased renal output
Tissue damage minimized and protect pt form additional foci bleeding
Decreasing stimulation
petechiae can be managed with precaution in daily cares=bathing, shaving, and brushing teeth Blood products can also be given in order to replace the lost blood due to hemorrhage

A

Interventions:

DIC

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22
Q

petechial, oozing at iv sites

A

signs of external bleeding DIC

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23
Q

increased hear rate, changes in loc, increase in abd girth and pain

A

signs of internal bleeding DIC

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24
Q

Early s/s of bleeding, good skin care/ hygiene, Protect self from injury, Psychosocial support
Important to know the predisposing conditions
When to seek tx: if symptoms do not improve in 3 days, fever develops, shortness of breath, and lightheadedness

A

Pt Education:

DIC

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25
Q

-Decreased RBC production

A

anemia

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26
Q

General considerations: Can go unrecognized in elderly because they may be mistaken for normal aging
-Pallor, Confusion, Ataxia, Fatigue, Worsening angina, HF

A

Clinical Manifestations Anemia

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27
Q

hemoglobin range goes with symptoms
mild
moderate
severe

A

Mild- 10-14 Moderate- 6-10 Severe- less than 6

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28
Q

: Inadequate dietary intake, Malabsorption, Blood loss, Hemolysis

A

Iron-Deficiency Anemia Etiology

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29
Q

Can be asymptomatic, Fatique, Pallor, Glossitis (inflammation of tongue), Cheilitis (inflammation of lips), Headache, Paresthesis, Burning sensation of tongue

A

Clinical manifestations:

iron deficiency anemia

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30
Q

Treat underlying disease
Educate on which foods are good sources of iron
Iron supplement: hr before eat, best given with orange juice for absorption

A

Collaborative Care

iron deficiency anemia

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31
Q
  • Recognized those who bare increased risk: Premenopausal, Pregnant women, Low socioeconomic class, Older adults, Those who experience blood loss
  • *Diet Teaching with emphasis on foods high in iron=meat, green leafy vegetables, cantaloupe, beans and maximizing absorption
  • For life-long iron supplements, monitoring is necessary for potential liver problems
A

Nursing Management

iron deficiency anemia

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32
Q
  • Genetic based involving inadequate production of normal Hgb
    Absent or reduced globulin protein
    Abnormal Hgb synthesis
A

Thalassemia Etiology

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33
Q

: minor, which is a mild form of the disease

A

Heterozygous

Thalassemia Etiology

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34
Q
  • major, two genes, sever condition
A

Homozygous

Thalassemia Etiology

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35
Q

Frequently asymptomatic with minor case
Growth, both physical and mental, is often delayed
Pallor, Fatigue
developed by 2 years of age
Pronounced splenomegaly and hepatomegaly
Jaundice
Thickening of cranium and maxillary cavity

A

Clinical manifestations
Thalassemia
anemia

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36
Q

-No specific drug or diet therapies are effective
-Minor cases require no treatment because the body adapts
-Major cases managed with blood transfusions or exchange transfusions
-Hematopoietic stem cell transplantation is only cure: Risk out weights the benefit
Oral medication: deferasirox (Exjade), IV/SubQ: deferoxamine (Desferal)
-bind to iron to reduce iron overload that occurs with chronic transfusion therapy

A

Collaborative Care
Thalassemia
anemia

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37
Q

-Group of disorders caused by impaired DNA synthesis
Characterized by the presence of large RBCs
RBCs easily destroyed due to fragile cell membranes

A

Megaloblastic Anemias Etiology

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38
Q

deficiency Most common is Pernicious anemia: intrinsic factor is not being excreted by the gastric mucosa =which is required for bit b 12 absorption

A

Cobalamin (vitamin B12)

megaloblastic anemias

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39
Q

General symptoms of anemia
Folic: Sore, red, beefy, and shiney tongue
B12: Anorexia, Nausea, Vomiting, Abdominal pain, Weakness
Paresthesia of feet and hands
Position sense
Impaired thought process ranging from confusion to dementia

A

Megaloblastic Anemia Clinical Manifestations

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40
Q

*Absence of neurological problems is important dx finding and differentiates v b12 and folic acid,

A

B12 has the symptoms

Megaloblastic Anemia

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41
Q

-Parenteral or intranasal administration of treatment of choice
IM injection, daily for two weeks, monthly for life

A

Cobalamin deficiency

Megaloblastic Anemia

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42
Q

Prevent injury: Diminished sensations to heat and pain
Ensure good patient compliance
Neurological assessment

A

Nursing Management

Megaloblastic anemia

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43
Q
  • Rare

- Congenital or Acquired:70 % of acquired are idiopathic and thought to be autoimmune

A

. Aplastic Anemia Etiology

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44
Q

Sudden or insidiously over weeks to months
Mild to severe
General anemia symptoms
Dyspnea
Cardiovascular symptoms
WBC, Hgb, and platelets show decreased (other RBCs are generally normal

A

Clinical manifestations

aplastic anemia

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45
Q

-Inherited, progressive chronic course, rare
Blood is missing blood-clotting factors VIII IX
Main concern: Internal bleeding especially in the knees, ankles, and elbows.

A

Hemophilia Etiology

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46
Q

Age: First indication is after a circumcision, By __ years the first episode of bleeding occurs
-Seek medical attention if the child bruises easily or has heavy bleeding related to an injury

A

hemophilia

2

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47
Q

Inherited but also can develop later in life, more common

  • Lacking a protein called Von Willebrand factor (important in the blood-clotting process)
  • Increases time for individuals to form clots and stop the bleeding
A

Von Willebrand Disease: hemophilia

48
Q
  • Unexplained bleeding from cuts or injuries
  • Unusual bleeding after receiving vaccinations
  • Pain, swelling, or tightness in joints
  • Nosebleeds with an unknown cause
A

Signs and Symptoms Spontaneous bleeding in Hemophilia

49
Q 
Usually milder sx, skin and mucous membranes: nose mouth intestines uterus vagina
Abnormal bleeding and easy bruising 
Recurrent nosebleeds
Bleeding gums 
Increased menstrual flow
Injuries  
Blood in stool or urine 
After shaving with a razor
A

Von Willebrand Disease Most common s/s:

50
Q

Deep tissue more common in joints and muscles
slow persistent prolonged bleeding
-delayed bleeding after minor injuries several hours to days
-Uncontrollable hemorrhage after dental extraction of irritation of the gingiva
-epistaxis after a blow to the face
-GI bleed from ulcers and gastritis
- hematuria from GU trauma and splenic rupture from a fall or abd trauma
-ecchuymoses and subcutaneous hematomas
-neurological signs like pain, anesthesia, and paralysis
-hemarthrosis (bleeding of the Joints) can lead to joint injury and deformity that can be crippling

A

General Sx Hemophilia:

51
Q

Prothromnin time= no problem, Thrombin time= no problem, platelet count=adequate, Partial thromboplasitn time=prolonged b/c problem with clotting factor, bleeding times= prolonged in von/ norm in A and B , and factor assay= decrease VII A, decrease IX B, VWF decrease in Von

A

Dx Studies

hemophilia

52
Q

most common, 80 percent of all cases

-Injection of DDAVP to release more clotting factors to stop any bleeding

A

medical management

Mild Hemophilia A:

53
Q

= analog of Vasopressin stimulate and increase VIII and vWF
-given IV, Subq, or nasal spray
IV seen 30 min last 12 hours
* short lived pt monitor closely and repeat dose if necessary

A

Desmopression Acetate(DDAVP)

54
Q

Early Childhood: Easily bruise from activities
Internal bleeding
-Muscle bleeding: Occurs in forearm, knee, ankle, or elbow/ Edema may be present
Joints: Can lead to permanent joint damage and arthritis
S/S: Edema, pain, numbness, and difficulty moving
Brain hemorrhage: Can occur from a simple fall
-Can lead to blindness, mental retardation, and neurological deficits
-Dev of inhibitor to factor VIII and IX
-transfusion-transmitted infectious disorders
-allergic reactions
-thrombotic with use of IX because it contains activated coagulation factors

A

Complications

hemophilia

55
Q

Avoid NSAID’s or aspirin for pain
Institute bleeding precautions
Padding on cribs, corners
Lay on blankets/soft padding on floor
Handle gently to prevent bleeding/bruising
No contact sports, wear gloves around the house
*must wear a medical alert tag

A

Education

hemophilia

56
Q

minor bleeding episodes Tx min of 72 hours
Surgery and traumatic injury- prolonged therapy
1. stop topical bleeding asap=indirect pressure or ice/ pack and apply hemostatic agent=Thrombin
2. give specific coagulation factor to raise pt level/ monitor for signs of hypersensitivity
3. Joint bleeding important to totally rest involved joint, pack with ice, give analgesics to reduce severe pain * aspirin compounds should not be used
After bleeding stops- encourage mobilization with rom exercises and physical therapy , wt bering is avoided till all swelling is gone
Monitor for Compartment syndrome and Intracranial bleeding
psychosocial support

A

Nursing Acute intervention:

hemophilia

57
Q

Blood cancer
Unknown cause and malignant (Abnormal growth of Reed-Sternberg cells)
-Could be Epstein bar, genetics, occupational hazards=factory, radiology jobs

A

Hodgkin’s Lymphoma

58
Q

Enlargement of cervical, axillary, and inguinal lymph nodes;
weight loss, fatigue, fever, dyspnea and dysphagia=b symptoms worse prognosis

A

Initial s/s:

Hodgkin’s Lymphoma

59
Q

: Hepatomegaly, splenomegaly, and anemia

A

Hodgkin’s Lymphoma

Progressive s/s

60
Q

Dx: *CT and MRI reveals the stage, lymph node biopsy, bone marrow biopsy
Labs: *CBC= Increased platelets, leukopenia, and thrombocytopenia
-Ct and mri to stage
-Pet scan help to see what stage they are in then

A

Hodgkin’s Lymphoma

61
Q 
Hodgkin’s Lymphoma
Stage 1
stage 2
stage 3
stage 4
A

Stage 1: 1 lymph node
Stage 2: 2 or > lymph nodes
Stage 3: Above and below the diaphragm
Stage 4: Outside of the diaphragm

62
Q

Often begins with enlargement of the lymph nodes

Monitor for: Night sweats, Weakness, Fever, Weight loss

A

Hodgkin’s Teaching

63
Q

staging

  • absence of systemic symptoms
  • presence of systemic symptoms
A

Hodgkin’s Lymphoma
A
B

64
Q

Self-care:
Good hand washing
Stay away from people that are ill, going out at night less people
Pain management
Avoid alcohol (due to cause of increased pain in enlargement sites)
Discuss fertility issues: common in childbearing ages

A

Hodgkin’s Lymphoma

65
Q

Unknown cause and malignant, more common

Possible causes-B-cell and T-cell origination; WBCs and lymphocytes combine and create tumors anywhere in lymph system

A

Non-Hodgkin’s Lymphoma

66
Q

Risk factors: a suppressed immune system, history of Epstein-Barr virus, and a history of radiation or chemotherapy

A

Non-Hodgkin’s Lymphoma

67
Q
  1. lymphadenopathy (painless lymph node enlargement)

2. abdominal pain, difficulty breathing, fever, night sweats, and weight loss (also called constitutional or B symptoms)

A

Non-Hodgkin’s Lymphoma

  1. Common s/s:
  2. Progressive s/s:
68
Q 
Tx: Chemotherapy combo, possible radiation to affected area; other tx options for side effects
Subtypes
Low grade
intermediate grade
high grade
A

Non-Hodgkin’s Lymphoma
Low grade: Indolent
Intermediate grade: Aggressive
High grade: Very aggressive

69
Q

Assess and monitor respiratory rate, depth, and rhythm
Assist the patient and family with identifying other factors that precipitate or exacerbate episodes of ineffective breathing patterns
Encourage ambulation as tolerated
Encourage elderly patients to sit upright or stand and to avoid lying down for prolonged periods during the day
Refer to home health aide services as need to support energy conservation
Teach pursed-lip and controlled breathing techniques
Edu emotional support

A

Non-Hodgkin’s Lymphoma

Interventions:

70
Q

-can spread to lymph nodes, lymph vessels, or any organ containing lymph tissue
Includes: tonsils, adenoids, spleen, thymus, bone marrow
-Will experience pain and symptoms specific to region/organ affected d/t pressure from lymph node enlargement
Abdomen: n/v, feeling of fullness, urinary or digestive complications
Lungs: difficulty breathing
Brain or Spinal Cord: nervous system symptoms
Skin: itchy nodules
Bone Marrow: fatigue, anemia, bleeding/bruising
Nonspecific symptoms (fever, night sweats, weight loss) can occur in high grade

A

Non-Hodgkin’s Teaching

71
Q

*at easing their symptoms- looking for other involvement: becomes confused-brain, blood in stool- GI, Vomit blood
Pain management
Nutritious diet (fiber for constipation relief)
Exercise (energy, constipation relief)
Adequate rest
Adequate fluids (dehydration tx for vomiting/diarrhea)
Small, frequent meals (n/v control)
Stress management: support groups, healthy lifestyle, relaxation

A

Self-care:

non-hodgkin lymphoma

72
Q

= lymp system, red stern berg cells

= can go everywhere : more extensive and involve specific organs, b and T cells

A

Hodgkin

NON-Hodgkin

73
Q
  1. 1st thing get a consent
  2. Sign paper to sign off that they got it send it back to blood bank
  3. Verify pt name on arm band and on bag/ date of birth, blood bank id number, and type of blood= with other nurse in pt bedside
    - bag, bank, and tear off list
  4. Nurse must have take all vitals, must be in the room for 15 minutes can’t leave
  5. Tech can do the beginning vital signs before it started
  6. So if having a reaction stop the blood then have saline running to keep open
A

Homeostasis Management

Blood Products

74
Q

Prepared from whole blood
Preferred RBC source- more component specific
Given for severe or symptomatic anemia and acute blood loss

A

Packed RBC’s

75
Q

Prepared from RBC’s using glycerol for protection and frozen
Must be used within 24 hours of thawing
Used for auto-transfusions, stockpiling, or rare donors for patients with alloantibodies=naturally in scorn tissues
Used infrequently because filters remove most WBC’s

A

Frozen RBC’s

76
Q

Prepared from fresh whole blood
Multiple units can be obtained from one donor by plateletpheresis
Given for bleeding caused by thrombocytopenia

A

Platelets

77
Q

Obtained by acquiring liquid portion of whole blood separated from cells and frozen
Given for bleeding caused by deficiency in clotting factors:

A

Fresh frozen plasma

78
Q

-DIC, hemorrhage, massive transfusion, liver disease, vit. K deficiency, excessive warfarin use

A

Fresh frozen plasma

Given for bleeding caused by deficiency in clotting factors:

79
Q

Prepared from plasma

Given for hypovolemic shock and hypyalbuminemia

A

Albumin

80
Q

-19 gauge needle
-23 gauge may be used for administering albumin, platelets, and clotting factor replacements
-DO NOT piggy back blood with dextrose solutions or lactated ringers= Hemolysis will occur if this is done
-Make sure patient has signed consent form to receive blood product
-Once blood is on unit, check with primary nurse and secondary nurse to ensure correct patient and correct blood product/type
-Blood must be used within 30 minutes once it arrives to the floor
-Blood is not to be refrigerated on nursing unit
-Administration of Blood Products
-Review procedure with patient
-Possible s/s of reaction
VS

A

Administration of Blood Products

81
Q
  • Vital signs must be taken before transfusion begins
  • For first ___ minutes of infusion nurse must remain with patient: Due to high risk of reaction of the infusion, *Nurse may observe patient every ___minutes to ensure no reaction after this time
  • *Infusion must finish within _ hours: Due to bacterial growth
A 
Administration of Blood Products
VS
1. 15 
2. 30
3. 4 hr
82
Q
  • Education: Procedure, S/S to report
  • Ensuring proper identification of blood product(s) and patient
  • *Vital signs prior to transfusion, again 15 minutes into transfusion= when blood hits the patient, at the end of the tubing can take 3 min to get in
  • Constant pt. monitoring for first 15 minutes of transfusion, then periodically for up to an hour
A

Nursing Interventions

Administration of Blood Products

83
Q
  1. febrile
  2. allergic
  3. circulatory overload
  4. sepsis
  5. massive blood transfusion reaction
  6. Transfusion related acute lung injury TRALI
  7. Acute Hemolytic
A

Blood transfusion reactions

84
Q
  1. delayed hemolytic

2. infection

A

Delayed transfusion reactions

85
Q

-Hep B and C viruses, HIV, Human herpesvirus type 6 (HSV-6), Epstein-Barr virus, human T-cell leukemia virus type 1, cytomegalovirus, malaria

A

Delayed transfusion reactions

Infection

86
Q
  • usually result of leukocyte incompatibility

S/S: sudden chills and increase in fever, headache, flushing, anxiety, vomiting, muscle pain

A

Blood Transfusion Reactions

1. Febrile reaction

87
Q

Prevention: use additional filters in tubing to leukocyte-depelete RBC’s and platelets; use leukocyte-poor blood products (filtered, washed, frozen); physician ordered acetaminophen and diphenhydramine (given 30 minutes prior to transfusion)
Treatment: Antipyretics

A

Blood Transfusion Reactions

1. Febrile reaction

88
Q
  • recipient’s sensitivity to plasma proteins of donor’s blood
    S/S: mild- flushing, itching, urticaria (hives); severe- urticaria, dyspnea, wheezing, progressing to cyanosis, bronchospasm, hypotension, shock, cardiac arrest
A

Blood Transfusion Reactions

Allergic reaction

89
Q

Prevention: antihistamines
Treatment: Epinephrine, corticosteriods for severe reaction; symptoms mild/transient- transfusion may be restarted slowly

A

Blood Transfusion Reactions

Allergic reaction

90
Q

fluid administered faster than circulation can accommodate

S/S: cough, dyspnea, pulmonary congestion, headache, HTN, tachycardia, distended neck veins

A

Blood Transfusion Reactions
Circulatory overload reaction
Cause:

91
Q

Prevention: adjusting transfusion volume based on pt. size and clinical status
Treatment: Diuretics, oxygen, morphine for symptoms; Place pt. upright with feet in dependent position

A

Blood Transfusion Reactions

Circulatory overload reaction

92
Q

-Result of bacterially infected blood components

S/S: rapid onset of chills, high fever, vomiting, diarrhea, marked hypotension or shock

A

Blood Transfusion Reactions

Sepsis reaction

93
Q

Prevention: Proper handling and storage of blood products
Treatment: Antibiotics, IV fluids, vasopressors
Culture of pt’s blood will be obtained and remaining blood and tubing will be sent to blood bank for further study

A

Blood Transfusion Reactions

Sepsis reaction

94
Q

When replacement of RBC’s or blood exceeds total blood volume within 24 hrs
S/S: muscle weakness, nausea, diarrhea, paresthesias, flaccid paralysis of cardiac or respiratory muscles, cardiac arrest

A

Blood Transfusion Reactions

Massive blood transfusion reaction

95
Q

Sudden development of non-cardiogenic pulmonary edema
Usually 2-6 hours after transfusion
May occur as late as 72 hours after transfusion
Has surpassed hemolytic reactions as leading cause of transfusion-related death

A

Blood Transfusion Reactions

Transfusion-related acute lung injury (TRALI)

96
Q

S/S: fever, hypotension, tachypnea, dyspnea, deceased O2 sat., frothy sputum
Prevention: provide leukocyte-reduced products; identify donors implicated reactions and do not allow them to donate

A

Blood Transfusion Reactions

Transfusion-related acute lung injury (TRALI)

97
Q

Treatment: provide oxygen and administer corticosteroids, initiate CPR if needed and provide ventilatory and BP support if needed
Send bag w/ remaining blood and tubing to blood bank for further study; draw blood for ABGs and HLA; obtain chest x-ray

A

Blood Transfusion Reactions Transfusion-related acute lung injury (TRALI)

98
Q

1st 15 minutes
Most common cause: transfusion of ABO-incompatible blood
Antibodies in recipient’s serum react with antigens on donor’s RBC’s
-stop infusion right away

A

Blood Transfusion Reactions

Acute Hemolytic:

99
Q

S/S: chills, fever, low back pain, flushing, tachycardia, dyspnea, tachypnea, hypotension, vascular collapse, hemoglobinuria, acute jaundice, dark urine, bleeding, acute kidney injury, shock, cardiac arrest death

A

Blood Transfusion Reactions

Acute Hemolytic:

100
Q

Prevention: proper product-recipient identification; proper labeling of products
Treatment: immediately stop transfusion and maintain patent IV/BP with colloid solutions
Notify physician and blood bank immediately
Continuous monitoring of patient vitals
Treat symptoms per physician order
Blood samples and urine specimens collected
Do not transfuse any more blood products until blood bank provides newly cross-matched units

A

Blood Transfusion Reactions

Acute Hemolytic:

101
Q
  • inherited, autosomal recessive disorder characterized by the presence of an abnormal form of hemoglobin on red blood cells
  • crisis is a severe, painful very crucial, acute exacerbation of red blood cells sickling(abn shape, not as flexable) which cause vaso-occulsion( blocking off)
  • happens more often in African American and female
A

Sickle Cell Anemia

etiology

102
Q

*Pain, Nausea, Vomiting, Hypertension, Fatigue, Headaches, Shortness of breath, Cold hands and feet, Pallor, Bleeding

A

Clinical manifestations

sickle cell anemia

103
Q
  1. due to many pulmonary complications: include pneumonia, tissue infarction, fate embolism
    - characterized by fever, chest pain, cough, pulmonary infiltrates, and dyspnea
  2. =mi, pulmonary hypertension, heart failure, can lead to cord pulmonale
  3. =sickle rbc gets trapped and enlarges leads to more life threatening bacteria
A

Complications sickle cell anemia

  1. Acute Chest Syndrome tissue:
  2. Pulmonary infarction
  3. Splenicseqestration
104
Q
  1. =heart becomes ischemic and becomes enlarged
    *5. =morbidity and mortality, happens because spleen becomes dysfunctional
  2. =most common infection, most pneumococcal origin
    7=from increased blood viscosity and lack of oxygen, can lead to renal failure
A

Complications sickle cell anemia

  1. Heart Failure
  2. infections
  3. pneumonia
  4. kidney injury
105
Q

Treatment

  1. Pain: in combination with pain medication
  2. : hand washing, not being around people who are sick can go to grocery store at night time when not busy
  3. : To increase the number of normal RBCs
    • Impaired gas exchange- give ___ help with pain, and control sickling of the cells
A

Sickle cell anemia TX

  1. Hydromorphone, Morphine, Solu-medrol, pca with acute
  2. Prevent/treat infections with antibiotics
  3. Blood Transfusions
  4. oxygen
106
Q
  • Pain control
  • Range of motion exercise
  • Involve with pain management
  • Apply warm moist compress to joints avoid cold or ice
  • Monitor resp rate, depth, breath sounds, loc, alternate rest and activity, give o2
  • reposition frequently, elevate lower extermities
A

Nursing intervention

sickle cell anemia

107
Q

Platelet counts below 150,000uL
Can be acute, severe or prolonged
Prolonged bleeding from minor trauma and/or spontaneous bleeding without injury
Causes accelerated platelet destruction caused by drug dependent antibodies (antibodies attack platelets)

A

Thrombocytopenia

108
Q
  • most common
    Autoimmune deterioration of circulating platelets, Idiopathic
    Platelets coated with antibodies then destroyed by spleen
    Platelet production and presence of infection may contribute (platelet life is shortened)
A

Thrombocytopenia

Immune Thrombocytopenic Purpura

109
Q

Uncommon
Characterized by
1.Hemolytic anemia- blood cells break apart faster than they can replace them
2. Can cause neurologic and renal abnormalities and fever
Lack of plasma enzyme that causes platelet aggregation
Normally associated with hemolytic-uremic syndrome=more common in children
Medical emergency – bleeding and clotting occur simultaneously=can have seizure and lead to a coma

A

Thrombotic Thrombocytopenic Purpura

110
Q
  • blood cells break apart faster than they can replace them
A

Thrombotic Thrombocytopenia Purpura

Hemolytic anemia

111
Q

Life-threatening destruction of platelets caused by autoimmune response to Heparin
Occurs in 8% to 17 % of people on Heparin
Platelets drop to around 60,000 uL= rarely a sx of bleeding
Can result in PE and/or DVT
Arterial vascular infarcts resulting in skin necrosis, stroke, and end stage organ damage

A

Heparin-Induced Thrombocytopenia

112
Q

damages bone marrow where blood cells are produced
Lowers production of platelets
Usually temporary
Life-threatening complication of spontaneous hemorrhage
Major problem is venous thrombosis

A

Chemotherapy Induced Thrombocytopenia

113
Q 
Easy or excessive bleeding: weakness, fainting, dizziness, tachycardia, and pain, and hypotension
Superficial bleeding
Petechiae
Nose bleeds
Mucous membrane bleeding
Spontaneous bleeding from gums
A

Manifestations

Thrombocytopenia

114
Q

underlying condition
Blood transfusions
*TTP treatment: plasma phresis
*Heparin induced tx: need to know do not flush with heparin if they have this

A

Treatment:

Thrombocytopenia

115
Q

Discuss patterns of risk management to promote healthy lifestyle
Teach methods of injury prevention, soft toothbrush
Avoid contact sports: football, hockey
Develop a plan of low-risk activities

A

Thrombocytopenia

Nursing Interventions:

116
Q
  • Avoid activities that could cause injury such as contact sports, soft tooth brush
  • Limit alcohol consumption
  • Use caution with over-the-counter medication such as aspirin and ibuprofen which can affect platelet function
A

Thrombocytopenia

Prevention:

117
Q

Possible life threatening be sever oxygen depletion in the tissues and reduction in circulating volume

A

Sickle cell crisis

Shock

118
Q

Avoid dehydration
Avoid high altitudes
Seek medical attention for URI

A

Acute crisis

Sickle cell anemia

life span (23 decks)

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