Nursing Care of H&L Disorders Flashcards
1
Q
S&S of anemia
A
Extreme weakness Dyspnea Fever Hypoxia Weight loss Slight jaundice with pallor Lower extremity edema Intermittent constipation & diarrhea Flatulence, N, and indigestion Palpitations Dysphagia Hand/feet tingling Partial or total paralysis
2
Q
What is the pathophysiology of:
Aplastic anemia
Iron-deficiency anemia
Pernicious anemia
A
Impaired production of RBCs
3
Q
What is the pathophysiology of:
Sickle cell anemia
Thalassemia
A
Increased destruction of RBCs
4
Q
What is the pathophysiology of anemia r/t:
Trauma- hypovolemia
Chronic infection
Renal failure
A
Massive or chronic blood loss
5
Q
Aplastic anemia
A
Decrease of bone marrow function
Depression of erythrocyte production, which results in lowerd hgb and RBCs
All formed elements of blood are defective
6
Q
What may develop due to Aplastic anemia?
A
Leukopenia and thrombocytopenia
7
Q
Primary causes of aplastic anemia
A
Congenital
8
Q
Secondary causes of aplastic anemia
A
Viral invasion
Meds
Chemicals
Radiation/Chemo
9
Q
Diagnostic tests r/t aplastic anemia
A
CBC- all values low (except RBCs- they have longer life span)
Bone marrow aspiration- pale,yellow, fatty marrow
Total Iron-binding capacity
Serum iron level
Peripheral blood smears
10
Q
Medical management of aplastic anemia
A
Bone Marrow and Stem Cell transplant
Blood transfusions
Antibiotics
Immunosuppressant agents (if autoimmune) -
-Antithymocyte globulin, Cyclosporine,
Methyprednisolone
Medications that stimulate bone marrow
-Colony-stimulating factors, Epogen-RBCs,
Neupogen- WBCs
11
Q
Nursing interventions for aplastic anemia
A
Prevent infection
Neutropenic precautions
Hand hygiene
Avoid contact with those who have an infection
Bleeding precautions
Eliminate intake of raw meats, fruits, or veggies
Report S&S of infection or bleeding
Observe for blood in urine/stool, or petechiae
Use soft toothbrush or swab mouth
Avoid enemas or other rectal insertions
No nose picking or blowing nose forcefully
Avoid IMs
Avoid trauma, falls, bumps, and cuts
Avoid contact sports
Avoid aspirin
Use electric razor
Use lubrication and gentleness during intercourse
12
Q
Nutrients needed for RBC formation
A
Iron- meats, green leafy vegetables, seafood
Folic acid- dark green, leafy veggies, citrus foods, avocados, seeds, nuts
Vitamin B12- shellfish, cheese, eggs, veggie burgers
13
Q
Dietary deficiencies that lead to impaired RBC production
A
Iron
Folic acid
B12
14
Q
Pernicious anemia is a lack of what vitamin?
A
Vitamin B12
15
Q
Another term for pernicious anemia
A
Macrocytic anemia (large cells)
16
Q
Pernicious Anemia
A
Autoimmune dx
Abscence of the intrinsic factor due to destruction of parietal cells
-essential for absorptoin of vitamin B12, transport of vitamin B12 is prevented, and affects the frowth and maturation of RBCs
17
Q
Pernicious anemia has a insidious onset after what age?
A
40; higher in women
18
Q
Perniciuos anemia has highest incidence in what descent?
A
African
Scandinavian
19
Q
What can you get pernicious anemia from?
A
Gastrectomy
Bowel resection
Crohn’s
Other autoimmune diseases
20
Q
What kind of diet is required with pernicious anemia?
A
Diet that includes :
Citrus fruits
Leafy green vegetables
Fortified cereals
21
Q
S&S of pernicious anemia
A
Soreness/burning of the tongue
Chronic B12 deficiency can cause irreparable nerve damage (B12 is needed for production of myelin)
22
Q
Diagnositc tests for pernicious anemia
A
Schilling test
Serum megaloblastic anemia profile
Bone marrow aspiration (revelas abnormal RBC development)
Gastric analysis (decreased hydrochloric acid secretion)
23
Q
Medical management of pernicious anemia
A
Lifelong B12 injections, folic acid supplements, and iron supplements
-1000 mg vitamin B12 IM for life
*Daily for 2 weeks, weekly for 1 month, monthly
for life
-Intra-nasal form of B12 once a week
PRBCs if anemia is severe
CBC- every 3-6 months for life
Death can occur in 1-3 years if no treatment
24
Q
Who is at risk for Vitamin B12 deficiency?
A
Strict vegetarians
25
NIs for pernicious anemia
Mouth care- several times a day
High protein, vitamins, and minerals diet
Light weight blanket- cold sensitivity
Interventions should conserve energy and prevent injury
Teach about lifelong vitamin B12 treatment
26
Folic acid deficiency
Can occur in pregnancy
Can occur with sickle cell disease
ETOH can aggravate deficiency
Certain medications can cause it (ones used to treat cancer, RA, and seizures)
27
Amino acid sources
```
Eggs
Meat
Milk and milk products
Poultry
Fish
Nuts
Legumes
```
28
Folic acid sources
```
Green leafy veggies
Asparugus, broccoli
Organ meats
Whole grain breads
Enriched cereal
Fish
Legumes
```
29
Spina bifida
Linked to folic acid deficiency in the mother
| Babies have early exposure to latex products during surgery and develop allegy
30
Another term for iron deficiency anemia
Microcytic anemia
| smaller than normal cells
31
Iron deficiency anemia
Insufficent intake of iron, excess blood loss, or lack of stomach acid
32
What is the most common type of anemia in all ages?
Iron deficiency anemia
33
Infants and children who have a high milk intake are at a higher risk for what?
Iron deficiency anemia
34
What is the most common cause of iron deficiency anemia?
Excess iroin loss in adults
| Inadequate intake of iron in children
35
What is a common source of iron deficiency anemia
Chronic intestinal or uterine bleeding
36
Iron deficiency anemia may be caused by
```
bleeding from gastric or duodenal ulcer
Esophageal varices
Hiatal hernias
Colonic diverticulitis
Tumors
Celiac disease
Sprue
Malabsorption- less common
```
37
When can iron deficiency anemia occur?
When the body's demand for iron exceeds it's absorption
38
How much blood loss from upper GI is required for melena?
50-75 mLs
39
What is a common cause of iron deficiency anemia in young adult women?
Menstrual blood loss
40
Diagnositc tests for iron deficiency anemia
```
History- especially children
Reiculocyte count
CBC
Serum iron levels- (Ferritin- major iron storage protein)
+ Direct Coombs antigobulin test
```
41
What does a direct coombs antiglobulin test look for?
Antibodies that may bind to RBCs and cause premature RBC destruction
42
Hemolysis
premature RBC destruction
43
Food sources of Iron
```
Organ meats
Muscle meats
Eggs
Shellfish
Whole-grain bread and cereal
Iron-enriched breads and cereal
Legumes
Nuts
Dried fruits
Dark green vegetables
Orange juice
Grape juice
```
44
Medical management for iron deficiency anemia
```
Ferrous sulfate- 900 mg/day given with citrus fruits and juices;Oral or injection (z-track-staining)
Iron administered orally or injection
IM dextran or IV venofer
Ascorbic acid
Nutritional counseling
Treatment of underlying conditions
```
45
NIs for iron deficiency anemia
Plan rest periods
Diet adequate in iron
Teach SE of iron therapy (dark, tarry stool)
Balance between rest/activites
Report N/D
Do not take with tetracycline antibiotics
Toxic to children
46
Teaching for iron deficiency anemia
Stew acidic foods in iron cookware
Can give iron-fortified formula
Pregnancy can deplete mother's iron stores
For children, give liquid iron through a straw (avoids teeth staining)
Best solid food iron source for children is infant cereal
Infants need more than just milk
47
Erythropoietin
Protein made in the kidneys
| Stimulates bone marrow to produce RBCs
48
Erythropoietin can:
Cause: hives, dyspnea, swelling of face, lips, tongue or throat
Increase: risk of blood clots
49
Hemolyteic anemias cause what?
Increased destruction of RBCs
50
Main types of hemolytic anemias
Sickle cell anemia
| Thalassemia
51
More types of hemolytic anemias
```
G6PD deficiency
Aquired hemolytic anemia
Immune hemolytic anemia
Malaria
Tick-borne diseases
Snake venom
Toxic chemicals
```
52
Hemolytic anemia
Marrow produces enough RBCs, but they are destroyed
| R/T defects of the cell membrane of RBC, inherited enzyme defects, or trauma
53
Causes of hemolytic anemia include
Infections
Drug reactions
Certain cancers
Delivery of a newborn with Rh+ blood while mom is Rh-
54
What is the most common genetic disorder?
Sickle cell anemia
55
What is sickle cell?
Abnormal crescent/sickle shape RBC containing hemoglobin S
56
Sickle cell anemia is a _____, _______, ______ condition
Severe;chronic;incurable
57
The sickle cell cases the RBC to be .....
Unable to carry as much O2, which causes pt. to become more sickled due to lack of O2
Crises cna be life threatening- Hypoxia and ischemia
58
Sickle cell anemia is seen in descendants from?
```
People of:
Africa
Saudi arabia
India
Meditarranean area
```
59
1 in _____ african americans have sickle cell anemia
400
60
Sickle cell trait occcurs in the person wtih...
One defective gene and one normal one
61
Often the carrier of ____________ shows no S&S
sickle cell anemia
62
Infants with sickle cell anemia do not show S&S until what age?
>6 months
63
Sickles RBCs live how many days?
10-20 days
64
Sickle cell anemia crisis lasts how many days?
4-6 days; may come in clusters or far apart
65
What happens in sickle cell disease?
When O2 is released to the tissues, the abnormal hemoglobin becomes more viscous and crystallizes, causing the erythrocyte to change from a round shape to an elongated crescent shape.
As the sickles cells clump together, circulations slows, resulting in obstruction with severe hypoxia and necrosis
Precipitated by infection, fever, hypoxemia, dehydration, high altitudes, cold, or emotional stress
66
G6PD deficiency
Glucose-6-phosphate dehydrogenase
Genetic disorder
In affected individuals, a defect in the enzyme G6PD causes RBCs to break down prematurely.
67
G6PD deficiency occurs most often in?
Males
68
S&S of sickle cell anemia
```
Asymptomatic until a crisis
Pain in joints and back
Loss of appetite
Dehydration
Irritability with weakness
Fatigue
Fever
Dyspnea
Cough
Strokes- in children
Joint deformity
Abdominal elargement (pooling in liver and spleen)
Jaundice
Extremity edema
Skin irritation and ulceration
Priapism
```
69
Complications of sickle cell anemia
Multisystem failure
Infarctions
Hemorrhage
Retinal damage
70
Diagnostic tests for sickle cell anemia
Hemoglobin electrophoresis (7-10g/dL)
Peripheral blood smear (shows sickled cells)
CBC
MRI
X-rays
Sickledex test (along with hgb electrophoresis, can determine whether trait or disease)
71
Medical management of sickle cell anemia
Supportive care
Alleviate S&S
Antibiotics
Pneumovax, haemophilus influenza and hepatits immunizations
72
Medical management of sickle cell anemia during a crisis
```
O2
Rest
IVFs
Pain management
RBC exchanges (NOT TRANSFUSIONS)
Folic acid
Hydroxyurea therpay (reduces hemolysis)
Bone marrow transplant
```
73
NIs for sickle cell anemia
```
Supportive care
Hydration
Frequent VS and O2 sats
Analgesia
Watch for fever and infection
Blow nose gently
Genetic counseling
Good diet (increased need for folic acid)
I&O
```
74
Evaluation of NIs for sickle cell anemia
Activity levels increase
Client reports no SOB on exertoin
Client explains treatment plan, meds, and diet
Client remains free of injury
75
Client teaching to avoid sickle cell crisis
```
Avoid high altitudes and air travel
Increase fluid intake, avoid dehydration
Notify MD of D/V
High risk for pregnant women to develop pulmonary and/or renal conditions
ROM, encourage physical activity as tolerated (but not during a crisis)
Avoid trauma
Avoid extreme temperatures
Avoid ETOH and smoking
Wear loose clothing
Genetic counseling
```
76
Effects of sickle cell disease on the brain
Thrombosis
Hemorrhage
Stroke
77
Effects of sickle cell disease on the heart
Failure
78
Effects of sickle cell disease on the abdominal organs
Hepatomegaly
Gallstones (cholethiasis)
Splenic enlargement
Splenic infarction
79
Effects of sickle cell disease on the bones and joints
Hand and foot syndrome
80
Effects of sickle cell disease on the eye
Retinal or conjunctival hemorrhage
| Blindness
81
Effects of sickle cell disease on the lungs
Atelectasis
Infarctoin
Pneumonia
82
Effects of sickle cell disease on the kidney
Dilute urine
Diuresis
Hematuria
83
Effects of sickle cell disease on the penis
Priapism
84
Effects of sickle cell disease on the skin
Stasis ulcers
85
Sickle cell crisis: Acute attack
| What does it cause?
Causes occlusion and ichemia of distal blood vessels
86
Sickle cell crisis: Acute attack
| Where is the pain felt?
Pain in hands and feet
87
Sickle cell crisis: Acute attack
| What physical and emotional factors trigger an attack?
```
Dehydration
Change in O2 tension (changes in altitude)
Infection
Fever
V/D
Overexertion
Changes in climate (especially the cold)
ETOH
Smoking
Stress
```
88
Sickle cell crisis: Aplastic crisis
| What is it caused by?
Premature destruction of RBCs, = profound anemia
89
Sickle cell crisis: Aplastic crisis
| Medical management
Transfusions of PRBCs
NOTE: watch for iron build up
90
Sickle cell crisis:Vaso-occlusive
Obstruction of the small blood vessels in the hands and feet, resulting in edema, impaired ROM, and pain
91
Sickle cell crisis:Sequestration
Blood pools in the spleen and liver resulting in hepatosplenomegaly; can progress to CV collapse and death
92
Sickle cell crisis:Vaso-occlusive
| Palliative Tx:
Pain meds
| O2
93
Sickle cell crisis:Sequestration
| Treatment
Pain meds
Volume expanders
Transfusions
Splenectomy
94
Sickle cell crisis nursing Dx of pain
Pain r/t thrombotic crisis
95
Sickle cell crisis nursing Dx of pain interventions
```
Position in alignment
Protect joints
Position with slow, gentle movements
Apply warm, moist compresses to relieve discomfort
Administer and monitor pain meds
```
96
Sickle cell crisis nursing Dx of impaired skin integrity
Impaired skin integrity r/t alteration in circulation to tissues, resulting in hypoxia and inadequate nurtition
97
Sickle cell crisis nursing Dx of impaired skin integrity interventions
Remove constrictive clothing
Maintain room and body warmth
ROM
Inspect extremities for adequate circulation
Monitor gases for indictors of adeqaute tissue perfusion
98
Thalassemia
Insufficient production of normal Hgb - abnormal synthesis
| Recessive genetic disorder
99
Thalassemia affects what ethnic groups?
Ethnic groups with origins near the mediterranean area
100
Thalassemia has what kind of forms
Major and minor
101
Thalassemia is AKA..
Cooley's anemia
102
Treatment for major thalassemia
Blood transfusions
Folate therapy
Chelation therapy
Bone marrow transplant- may help
103
Treatment for minor thalassemia
None-
| Body adapts to reduction of normal Hgb
104
Anemia of Chronic Infection/Disease
| ACI or ACD
Human body limits the amount of iron available when potentially harmful things get into our body
Bacteria and cancer cells depend upon iron to sustain life
Iron gets shuttle to ferritin so the harmful invader cannot get the iron
105
ACI or ACD low normal range
9.5-10.5 g/dL
106
Anemia of Chronic Renal Failure
Kidneys are unable to secrete the hormone erythropoietin
Toxins may also depress bone marrow
Aluminum may accumulate in the bone marrow of dialysis patient and can contribute to anemia
107
Disseminated Intravascular Coagulation (DIC)
Overstimulation of clotting and anti-clotting processes in response to disease and injury
Clotting and hemorrhage issues
108
DIC is caused by
```
Infection (sepsis)
Obstetric complications
Neoplastic disorders
Hematological disorders
Trauma
```
109
Clots normally lyse in ______ while in DIC clots lyse_____
7-10 days; immediately
110
S&S of DIC
```
Bleeding GI bleeding
Hemoptysis Hematuria
Dyspnea Pulmonary edema
Diaphoresis PE
Cold, mottled digits
Purpura on the chest and abdomen- 1st sign
Petechiae Hypotension
Abdominal tenderness
Tachycardia Absent peripheral pulses
Restlessnes Confusion
Seizures Coma
```
111
Diagnostic tests for DIC
Decreased fibrinogen levels
Increased PT and PTT
Increased fibrin split products
Increased D-Dlmers
112
Treatment of DIC- Supportive
```
Administer blood
FFP
Platelets
Vitamin K
Cryoprecipitate
```
113
Treatment of DIC- controversial
IV heparin
114
Nurse teaching for DIC
Involve the family
Critical situation= IVs, N/G, Foley
Emotional support
115
Thrombocytopenia
| Idiopatic Thrombocytopenia Purpura (ITP)
Platelets reduced below 150,000/mm3; may be due to decreased production or decreased survival
Autoimmune disease, platelets are coated with antibodies. Although they function normally, are destroyed by macrophages in the spleen
116
ITP is assosciated with...
```
Aplastic anemia
Leukemia
Tumors
Chemo
Infection
Antibody destruction
Viral overload
Drug induced
```
117
ITP chronic form in common in who?
Women aged 20-40
118
Acute form common in children (ITP)
Bleeding beneath the skin
| Follows viral infection
119
S&S of ITP
```
Petechiae
Ecchymosis
Bleeding from mucous membranes
Splenomegaly from entrapment of blood in the spleen
Bleeding in brain
Nosebleeds
```
120
Diagnostic tests for ITP
CBC
Peripheral blood smear
Coags
Bone marrow aspiration (may show that precursor cells for platelets, the magarkaryocytes, are adequate)(Platelets live for a few hours rather than 7-10 days)
121
Medical management of ITP
```
Corticosteroid therapy (prolongs platelet life)
Splenectomy
IV immunoglobulin
Immunosuppressive drugs
PRBCs to treat hemorrhage
Platelet transfusions (counts <20K)
Vitamin K
Anti-D antibody therapy (new)
```
122
Meds assosciated with thrombocytopenia
```
ASA
Digitalis
Lasix
NSAIDs
ORal hypoglycemics
PCN
Quinidine
Rifampicin
Sulfonamides
Thiazides
```
123
NIs for thrombocytopenia
```
Meticulous aseptic technique
Careful positioning and moving of client
Watch for S&S of increased ICP
Bleeding precautions
*Avoid trauma, soft toothbrush, high fiber diet
blow nose gently
Transfusions- monitor for reaction
```
124
Heparin Induced Thrombocytopenia (HIT)
Development of thrombocytopenia due to heparin administration
HIT can predispose to thrombosis
125
What is HIT caused by?
Abnormal antibodies that activate platelets
126
Hemophilia
Hereditary coagulation disorder
Distrubance of clotting factor
2 types- A and B
X-linked hereditary trait (only affects males, women are carriers though)
127
Hemophilia A
most common
| Absence of factor VIII
128
Hemophilia B
Christmas disease
| Deficiency in factor IX
129
Von Wilebrand's disases
Mild factor VIII
130
Hemophilia- what happends after repeated bleeds?
Muscles become weak, scarred, and shorter than normal (sometimes permanently)
They can no longer protect the joints
131
Hemophilia- joints above and below the muscle cannot move prperly. They may ______
bleed more often
132
Hemophilia- what happends if nerves are damaged during muscle bleeds?
Muscle may become weake or paralyzed
133
Diagnositc tests for hemophilia
Normal INR and PT
Prolonged aPTT
Factors VIII and IX are absent
134
S&S of hemophilia
Internal & External bleeding
Ecchymoses from slight trauma
Hemarhrosis (indicates severe disease; seen in knees ankles and elbow; exibits pain, edema, erythema and fever)
Excessive blood loss from small cuts and dental procedures
135
Medical management of hemophilia
```
Minimize bleeding- avoid trauma
Relieve pain- no aspirin
Minor bleeds- ice packs
Transfusions (child needs Hep B vaccine)
Factor VIII or IX concentrate
Cryoprecipitate (rich in factor VIII)
Manufactured VIII or IX (less risk of viral transmission)
```
136
Treatment for Hemophilia A
Inhalation of desmopressin (DDAVP) which can stimulate body to release more clotting factors
137
Treatment for hemophilia B
Transfuse factor IX
138
NIs for hempophilia
```
Apply pressure & cold (ice)
Control hemorrhages
Educate family
Monitor transfusions
Pain management
Genetic counseling
No ASA products
Avoid injury
Medic alert bracelet
Diet
Dental care & preventive dental care
Non-contact sports
Soft, age appropriate toys
Immobilize affect part
Notify MD
Teach good diet to avoid obesity
Avoid over protection
```
139
Von Willebrand's disease
Inherited bleeding disorder
Characterized by abnormally slow coagulation of blod
Mild deficiency of factor VIII
Common in post-partum period
140
How is Von Willebrand's disease different from hemophilia?
VW's disease is not limited to males like hemophilia
141
S&S of von willebrand's disease
Spontaneous episodes of:
GI bleeding
Epistaxis
Gingival bleeding
142
Primary polycythemia
Polycythemia Vera (PV)
143
How are primary and secondary polycythemia different and similiar?
Etiologies and pathophysiology differe although S&S and compliactions are similiar
144
Polycythemia Vera
Myeloproliferative- characterized by excessive bone marrow production
145
S&S of PV
Increase in erythrocytes, granulocytes, and platelets
Stem cell abnormality
Pathologic response is a malignancy of blodd cells
146
Secondary polycythemia
Caused by hypoxia
Hypoxia stimulates erythropoietin in the kidneys, which in turn stimulates erythrocyte production (people who live in mountains, COPD)
147
S&S of secondary polycythemia
```
Gradual onset
Mainly affects men in middle age
Venous distention and platelet dysfunction can cause organ infarction
Florid or dark, flushed face
Esophageal varices
Epistaxis
GI bleeding
Petechiae
```
148
Medical management of polycythemia
Repeated phlebotomy
Myelosuppressive agents, such as Myleran, Hydrea, and radioactive phosphorus are often given to inhibit bone marrow activity
Main cause of morbidity and mortality is thrombosis
149
Nursing actions for polycythemia
Controlling chronic pulmonary disease and avoiding high altitudes (secondary)
Proper hydration to avoid fluid overload
150
NIs for the nursing DX Ineffective tissue perfusion r/t polycythemia
Comfy position
Provide passive ROM q2-4 hours
Report S&S of thrombosis
Avoid trauma
151
NIs for the nursing DX activity inolerance r/t polycythemia
Avoid high NA+ food
Encourage adequate exercises
Explain disease course
152
Lymphadenopathy
Swelling of lymph glands
153
Lymphagenopathy causes
Infection
Cancer
Autoimmune disease
154
Lymphangitis
Inflammation of one or more lymphatic vessels
155
S&Sof lymphangitis
```
Clinical symptom of infection important*
Fine red streaks from affected area
Groin or axilla
Not localized- edema is diffuse
Chills
Fever
Local pain
H/A
Myalgia
```
156
Medical management/NIs of lymphadenopathy/lymphangitis?
PCN or other antibiotics
Moist heat to area
Elevate extremity
Use aseptic technique
157
Lymphedema
Primary or secondary disorder
Accumulation of lymph in soft tissue due to obstruction, increased amount of lymph in area of removal of nodes(usually occurs for strep or staph infection in an extremity)
Extreme edema &tightness resulting in pain and pressure
Often a result of mastectomies
158
Lypmphedema- extreme edema & tightness in affected extremity resulting in pain and pressure is aggravated by?
Standing pressure
Pregnancy
Obesity
Warm environments
159
Medical management/NIs for lymphedema
```
Diuretics
Antibiotics
SCDs
Elastic stocking or sleep
Elevate extremity
Restricted Na+ diet
Avoid constrictive clothing/trauma
Meticulous skin care
Be supportive- body image disturbance may occur
```
160
Nursing problems for blood and lymphatic disorders
```
Risk for infection
Risk for injury (trauma, bleeding, falls)
Knowledge deficit
Pain (acute,chronic)
Impaired gas exchange
Activity intolerance
Ineffective coping
Impaied skin integrity
Disturbed body image
```
161
Splenomegaly
Enlarged spleen
| May not enlarge, but still destroys RBC and platelets?
162
Splenectomy problems
```
Bleeding
Pneumonia
Atelectasis
Pancreatitis
Fistulas
OPSI- overwhelming post-op infection (1 week - 20 years)
```
163
Cullen's sign
Sign of retroperitoneal bleeding/hemorrhage
| Superficial edema and bruising in the subQ fatty tissue around the umbilicus
164
Grey-Turner's sign
Sign of retroperitoneal bleeding/hemorrhage
Takes 24-48 hours to appear
Bruising/blue discolaration of the flanks
***A flank = the side of a person's body between ribs and hip! Who knew?! Not me!
165
Kehr's sign
Acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down with the legs elevated
**Pain in left shoulder is sign of a ruptured spleen
166
Neutropenic precautions
```
Reverse isolation
No raw meats, veggies, or fruit
No fresh flowers
Visitors= cannot show any S&S of infection; not a lot of visitors
Good handwashing
```
167
What is anemia?
Deficiency of RBCs, hemoglobin, or both
