Respiratory #1 Flashcards
1
Q
WHITE BLOOD CELLS (WBC) Normal
A
5,000 - 10,000/mm3
2
Q
WHITE BLOOD CELLS (WBC) Critically Low
A
< 2,000 mm3
3
Q
WHITE BLOOD CELLS (WBC) Critically High
A
> 40,000 mm3
4
Q
RED BLOOD CELLS (RBC) Normal
A
4.2 - 6.1 x 10^12/L
5
Q
HEMOGLOBIN (Hgb) Normal
A
12.0 - 18.0 g/dL
6
Q
HEMOGLOBIN (Hgb) Critically Low
A
< 7.0 g/dL
7
Q
HEMOGLOBIN (Hgb) Critically High
A
> 21 g/dL
8
Q
HEMATOCRIT (Hct) Normal
A
37% - 52%
9
Q
HEMATOCRIT (Hct) Critically Low
A
< 21%
10
Q
HEMATOCRIT (Hct) Critically High
A
> 65%
11
Q
PLATELET COUNT Normal
A
150,000 - 400,000/mm3
12
Q
PLATELET COUNT Critically Low
A
< 20,000/mm3
13
Q
PLATELET COUNT Critically High
A
> 1 million/mm3
14
Q
PARTIAL THROMBOPLASTIN TIME (PTT) Normal
A
60 - 70 seconds
15
Q
PARTIAL THROMBOPLASTIN TIME (PTT) Critically High
A
> 100 seconds
16
Q
PROTHROMBIN TIME (PT) Normal
A
11 - 12.5 seconds
17
Q
PROTHROMBIN TIME (PT) Critically High
A
> 20 seconds
18
Q
INTERNATIONAL NORMALIZED RATIO (INR) Normal
A
0.8 - 1.1
19
Q
INTERNATIONAL NORMALIZED RATIO (INR) Critically High
A
> 5.0
20
Q
Neutrophils
(Bands)
(Segments)
A
55-70%
(2.8%-3.6%)
(52.2%-66.4%)
21
Q
Concept Map Key
A
Type of Disorder
Disorder
Labs/ diagnostics
Signs & Symptoms
Medications
Interventions
Conceptual Concerns
Etiology
Pediatric Specifics
22
Q
Concept Map Key Example
A
Bleeding disorder- blood- anemia
Conceptual Concerns- perfusion
23
Q
Red Blood Cells
A
Type of disorder
24
Q
Decreased RBC, Hct, Hgb
A
Labs/Diagnostics
25
S/Sx: Hgb Decrease
Mild anemia
Hgb 10-14, Palpitations, dyspnea, fatigue
26
S/Sx: Hgb Decrease
Moderate anemia
Hgb 6-10
Cardio-pulmonary s/sx at rest
27
S/Sx: Hgb Decrease
Severe anemia
Hgb < 6
Pallor, Jaundice, Pruritis, Elevated HR, murmurs, angina, MI, HF, cardiomegaly, ascites, edema
28
Moderate and Severe anemia intervention
Blood transfusion
29
S/Sx: Hgb Decrease, SOB and
Weakness
30
Decreased Hgb conceptual concern
O2
31
Anemia
Disorder
32
Anemia Labs
Decreased RBCs, Hct, and Hgb
33
Anemia etiology
Massive / Chronic Blood loss
Impaired production
Increased destruction
34
Impaired production disorders
Folic Acid Deficiency anemia
Aplastic Anemia
Iron Deficiency Anemia
Pernicious Anemia (B12 Deficient)
35
Increased destruction disorders
Sickle Cell Anemia
Hemolytic Anemia
36
Happen during surgery or blood disorder
Anemia
37
Bad blood transfusion causes hemolytic anemia which is the
destruction of the RBCS, BODY cannot produce as fast as they were destroyed
38
Sickle cell anima-
shape of the RBCs look deformed
Chemo caused, break down easily, misshapen, die early, painful, no cure.
S/sx swollen hands, jaundice
39
Aplastic anemia-
bone marrow defect
40
Weak, SOB, dizzy
Anemia
41
RBC types
A, B, AB, O
42
Antibodies present in plasma Type A
Anti-B
43
Antibodies present in plasma Type B
Anti-A
44
Antibodies present in plasma Type AB
None
45
Antibodies present in plasma Type O
Anti-A and Anti-B
46
Antibodies Present on RBCs Type A
A Antigen
47
Antibodies Present on RBCs Type B
B antigen
48
Antibodies Present on RBCs Type AB
A and B antigen
49
Antibodies Present on RBCs Type O
None
50
Type: Presence or absence of A or B antigens
Blood reactions:
Agglutinate in reaction to antibodies
51
Rh factor Presence or absence of D antigen.
Rh – patient receives Rh – blood
Rh + patient receives Rh – or + blood.
52
Universal recipient=
AB+
53
Universal Donor=
O-
54
Adverse events
Range in severity
Transfusion Reactions
55
Acute transfusion reactions-
Flank pain, chills temp rises, brown or red urine
56
Delayed transfusion reactions-
Can happen days to weeks. Mild anemia, hyperbilirubemia
57
Immunologic (immediate reaction, type of blood given) vs
non-immunologic (immediate reaction damaged bag of blood)
58
Range in severity due to patients health
Transfusion Reactions
59
The time during the transfusion or during the next 24 hours
Acute- Transfusion Reactions
60
Monitor vital signs before, during and after
Transfusion Reactions
61
Blood transfusion patients- risk for reaction
Transfusion Reactions
62
Blood Transfusion Reactions
Febrile, Allergic Mild and Severe, Hemolytic
63
Febrile Reaction
Chills
Fever
Headchae
Flushing
Tachycardia
Increased anxiety
64
Allergic reaction Mild
Hives
Pruritus
Facial Flushing
65
Allergic reaction Severe
Severe SOB
Bronchospasm
Anxiety
66
Hemolytic reaction
Low pack and chest pain
Hypotension
Tachycardia and Tachypnea
Fever and Chills
Hemoglobinuria
Immediate Onset
67
Blood transfusion reaction NSG implications
Stop transfusion and notfy physician
Change IV tubing
Treat symptoms if present = O2, fluids, epinephrine as ordered
Recheck cross record with unit
68
Hemolytic reactions NSG Implications
Obtain 2 blood samples distal to infusion site
Obtain first UA test for hemoglobinuria
Monitor fluid/electrolyte balance
Evaluate serum calcium levels
69
Before transfusions-
Vital signs
70
More at risk for a reaction-
Fever symptoms
71
Incompletable blood products-
hemolytic transfusion reaction
72
Stop transfusion immediately and hook them to normal saline to
flush the blood out
73
Tylenol or Benadryl for
Mild Allergic reaction blood transfusion
74
Blood Transfusion Reaction Treatment
STOP the transfusion. Notify doctor
Keep IV line open with 0.9% normal saline.
Monitor vitals Q15min
Post-transfusion blood sample
Treat s/sx
75
Step 1 for Blood transfusion
Check blood pack for: Leaks, Discoloration, Clumping and Expiration date.
If there is any discrepancy do not transfuse
76
Step 2 for Blood transfusion
Ask the patient to tell you their full name and date of birth
Check information on the compatibility label on the component against the patients wristband
If there is any discrepancy do not transfuse
If you are interrupted stop and start the checking procedure again; do not leave the patient until the transfusion has commenced
77
Step 3 for Blood transfusion
Check that the correct compatibility label is attached to the blood bag. if there is any discrepancy do not transfuse.
There is a donation number and blood group
If the checks are satisfactory, complete the pink portion of the label before commencing transfusion
78
Step 4 for Blood transfusion
Commence the transfusion
79
Step 5 for Blood transfusion
Once the transfusion has started:
Peel off the completed pink portion and attach in the patient's medical notes- remember to sign the prescription to say you have undertaken the patient ID checks.
80
Step 6 for Blood transfusion
Once the transfusion has started:
Sign and complete the blue "return to laboratory" portion of the label, tear off and place in the container provided for return to hospital transfusion laboratory
81
Check with RN
Blood transfusion
82
One at the start and during, stay w the patient for the first 15 mins
Blood transfusion
83
Match the blood. Full set of vitals. Check policies and procedures
Blood transfusion
84
Be present. Time consuming
Blood transfusion
85
Blood Administration Monitoring Vitals
Pre-Blood
15 minutes after start
Must stay with patient for full 15 minutes
Follow institution guidelines for Vitals
When blood complete- vital signs
86
Blood Administration Monitoring Monitor for Complications
Febrile reactions
Hemolytic reactions
Anaphylaxis Shock
Circulatory overload- Too much blood
Death
87
Febrile reactions
Increase in temp, shaking, chills, HA, back pain
88
Hemolytic reactions
Back pain, chest pain chills, fever, SOB, N/V, impending doom
Shock, hypotension, oliguria, decreased LOC
89
Circulatory overload- Too much blood
Chest pain, cough, frothy sputum, distended neck veins, crackles, wheezes, tachycardia
90
Verify Name, DOB, Allergies compare with order, armband, blood bag
Blood transfusion
91
Blood label
Check compatibility
Blood transfusion
92
Verify number of bag and order
Verify blood group
Blood transfusion
93
Deficiency in iron
Iron Deficiency Anemia Pathophysiology
94
Due to malabsorption (GI surgery, Gastric bypass)
Iron Deficiency Anemia Pathophysiology
95
Body loses healthy RBC due to Poor consumption of iron nutrients= deficiency
Iron Deficiency Anemia Pathophysiology
96
Excessive blood loss due to dialysis
Iron Deficiency Anemia Pathophysiology
97
Childbearing year women have problems getting iron in their blood.
Iron Deficiency Anemia Pathophysiology
98
Lack of stomach acid cannot absorb iron
Iron Deficiency Anemia Pathophysiology
99
Indigestion of Lead, Iron and lead compete for the cells in the body. Competition. Can get lead from water.
Iron Deficiency Anemia Pathophysiology
100
Iron Deficiency Anemia S/Sx
Pallor, Tachypnea, Tachycardia, SOB, Fissures in corner of mouth, Glossitis- inflammation of the tonuge, Spoon shape finger nails
101
Iron Deficiency Anemia Diagnostics-
Blood work, CBC- RBC, WBC
Hemoglobin (12-18)
Hematocrit (37-52)
Serum iron
Ferritin
Total Iron binding capacity (TIBC)
102
Iron Deficiency Anemia Interventions-
Give IV or IM iron or Iron supplement PO
Sensitivity test
Educate the pt that the stool is going to be dark.
Will have fatigue so provide rest periods.
Monitor hemoglobin, platelet count and hematocrit.
Oral iron- educate if they feel better maintain drug regimen.
Educate food that has iron.
S/Sx of infection education.
103
Iron Deficiency Anemia Medications
Pherosulfate- helps absorb iron better but give GI discomfort
Phersoglucinate- Better for GI but does not absorb iron better as Pherosulfate
Iron supplement IV, IM
Give vitamin C to help iron absorption
104
Iron Deficiency Anemia Severe Medications
Blood transfusion
105
Iron Deficiency Anemia Caused by Peptic ulcer Med
antibiotics
106
Iron Deficiency Anemia Caused by Heavy menstrual periods Med
Oral contraceptives
107
Iron Deficiency Anemia Med if too much iron
Deferoxamine Mesylate (Deferral)
108
Anemia Etiology
Impaired production
109
Impaired production disorder
Iron Deficiency Anemia
110
Iron Deficiency Anemia Labs/ Diagnosis
Serum iron level, & transferrin saturation (diagnosis)
Increased TIBC
Decreased Hgb, Hct
Microcytic RBCs
111
Serum iron level, & transferrin saturation (diagnosis)- S/Sx
Glossitis
Cheilitis (inflamed lips)
Headache
Paresthesia
112
Decreased Hgb and Hct conceptual concern
O2
113
Decreased Hgb and Hct S/Sx
Anemia S/Sx
114
Iron Deficiency Anemia Etology
Malabsorption
Dialysis
Lead ingestion
Blood loss
Inadequate dietary intake
115
Malabsorption, Lead ingestion, Blood loss Intervention
Eliminate cause
116
Inadequate dietary intake Intervention
Meat, fish,& poultry = (Med) Vitamin C
117
Inadequate dietary intake Conceptual Concern
Nutrition = (Med) Iron Supplements
118
Vitamin C Education
EDUCATION: Take iron 1 hr ac, with Vit. C
GI side effects
119
Microcytic rbcs-
little blood cells
120
Consume Beans, green leafy veggies, meat, fish, poultry, iron supplements- Iron
Citrus- Vitamin C
Iron deficiency Anemia
121
High iron capacity = but not getting it, need more iron
Iron deficiency Anemia
122
Low iron capacity= GI absorption
Iron deficiency Anemia
123
Cirrhosis = low values of TIBC
Iron deficiency Anemia
124
Screen at 12-month well check
Pediatric Specifics for Iron deficiency anemia
125
More common with cow’s milk, use iron-fortified formula
Pediatric Specifics for Iron deficiency anemia
126
S/sx: irritability, anorexia, tachycardia, murmur, poor muscle tone, porcelain like skin, edematous, retarded growth, delayed learning
Pediatric Specifics for Iron deficiency anemia
127
Absorb lead more readily = lead poisoning (hyperactivity, impulsiveness, lethargy, irritability, hearing impairment, learning difficulties.
Pediatric Specifics for Iron deficiency anemia
128
Iron Deficient Anemia S/Sx
Cheilitis
Glossitis
129
Macrocytic Anemias
Folic Acid Deficiency & Pernicious Anemia
130
Folic Acid Deficiency & Pernicious Anemia Patho/Etiology
RBC= bigger
Don’t have nutrients to function
131
drug or alcohol use
Folic acid deficiency Patho/Etiology
132
Pernicious anemia Patho/Etiology
low extrinsic factor= glycoprotein in stomach which helps with absorption of b 12
133
Folic Acid Deficiency & Pernicious Anemia Signs/Symptoms
Pallor, fatigue, tachycardia, tachypnea, SOB
134
Folic Acid Deficiency & Pernicious Anemia Diagnostics-
CBC, B12, Folic acid levels (1.8-9 folic acid range)
135
Folic Acid Deficiency Interventions-
Teach to increase liver, egg, legumes for folic acid intake
136
Pernicious anemia Intervention-
increase meat, poultry, fish, egg, soy beans, peanuts, lentils, fortified cereals, milk
137
Folic Acid Deficiency & Pernicious anemia Medications-
Vitamin b 12, folic acid PO or IM
138
Impaired production disorders
Folic Acid Deficiency Anemia & Pernicious anemia
139
Pernicious anemia Etiology
GI surgery /diseases
Deficient intrinsic factor
Vegetarian
140
Deficient intrinsic factor Labs/Diagnostics
Intrinsic Factor Antibody
Schilling test- Vitamin B12 absorption test
141
Pernicious Anemia (B12 Deficient)
Cobalamin injections
142
Pernicious Anemia (B12 Deficient) Labs/Diagnostics
Decreased Hgb & Hct
Decreased B12
Increased MMA
Macrocytic
143
Decreased Hgb and Hct S/Sx
General S/SX of anemia
144
Decreased Hgb and Hct Conceptual Concerns
O2
145
Decreased B12 and Increased MMA S/Sx
Anorexia, N/V, abdominal pain
Sore Beefy red tongue
Numbness of hand and feet
146
Numbness of hand and feet Conceptual Concerns
Safety
147
Decreased B12 and Increased MMA and Anorexia, N/V, abdominal pain Conceptual Concerns
Nutrition
148
Decreased B12 and Increased MMA Interventions
Meat, fish, shellfish, poultry, eggs, dairy products, soy milk, tofu, breakfast cereals
149
Folic Acid Deficiency anemia Etiology Drugs and
Alcohol
150
Folic Acid Deficiency anemia Labs/Diagnostics
Decreased Folate Level
151
Decreased Folate Level Medications
Folate PO
152
Decreased Folate Level Interventions
Fortified flours, grains, cereals, wheat germ, liver, eggs, green leafy vegetables, legumes, bananas and oranges.
153
Craving for clay or dirt low
b12
154
Surgeries or GI problems- Pernicious Anemia
B12 Deficient
155
Evaluate b12 absorption-
Schilling test
156
Aplastic Anemia / Pancytopenia Patho/Etiology
Bone marrow is pale, fatty and fibrous.
Bone marrow forms RBCs.
Decrease of hemoglobin and hematocrit WBCs and platelets.
157
Aplastic Anemia / Pancytopenia Signs/Symptoms
Vary based on severity of bone marrow failure.
Weakness that is progressive, Pallor, SOB, headache, tachycardia, HF, ecchymosis, petechiae.
Oozing of blood from the membranes (ears, mouth, nose) bleeding in organs.
Careful when giving injections bc bleed at the site is common.
If get bad pts die from bleeding or infection
158
Aplastic Anemia / Pancytopenia Diagnostics
CBC w/ diff- looks at each WBC and RBCs. Bone marrow biopsy. Iron levels, TIBC serum
159
Aplastic Anemia / Pancytopenia Intervention
Immunosuppressive medications.
Educate to avoid exposure to sick people.
Blood transfusions.
Bone marrow transplant- severe
160
Aplastic Anemia / Pancytopenia Medications
Infection and bleed tx.
Steroids to stimulate production of cells in bone marrow and decrease immunity. Hormones to increase bone marrow availability.
Immunosuppressive agents if due to autoimmune disorder.
Colon stimulant factors- natural element,
Synthetic mimic erythropoietin.
Stimulates RBC. Epoetin-alfa, Filgrastim- WBCs
161
Anemia Etology = Impaired production DIsorder =
Aplastic Anemia
162
Aplastic Anemia Etology
Fatty Bone Marrow (fibrous)
163
Fatty Bone Marrow (fibrous) Etiology
Decreased cell production
164
Fatty Bone Marrow (fibrous) Labs/Diagnostics
Bone marrow biopsy
165
Fatty Bone Marrow (fibrous) Intervention
Bone marrow transplantation
166
Fatty Bone Marrow (fibrous) Medication
Steriods
167
Decreased cell production Disorder
Pancytopenia
168
Pancytopenia Labs/Diagnosis
Decreased Platelets, WBCs, RBCs, Hgb, Hct
169
Decreased Platelets Intervention
Platelet transfusion
170
Decreased Platelets S/Sx
Petechiae, Ecchymosis, Bleeding
171
Bleeding Interventions
Bleeding prevention/precautions
172
Bleeding conceptual concern
Clotting
173
Decreased WBC Intervention
Infection prevention
174
Decreased WBC Conceptual concern
Infection
175
Decreased RBCs, Hgb, Hct S/Sx
General S/SX of anemia
Tachycardia / Heart Failure
176
Decreased RBCs, Hgb, Hct Intervention
Packed RBC Transfusion
177
Decreased RBCs, Hgb, Hct Conceptual concern
O2
178
Aplastic Anemia Conceptual concern
Perfusion
179
TIBC increase due to overabundance of iron. Cells cannot use it
Aplastic Anemia
180
Infection- educate about wearing a mask
Aplastic Anemia
181
Bleeding- prevent falls, clots, injection careful
Aplastic Anemia
182
Notify provider for bleeding, teach patient
Aplastic Anemia
183
Pressure dressing for bleeding
Bone Marrow Biopsy
184
Consent paperwork before procedure and they can change their mind last minute
Bone Marrow Biopsy
185
Posterior ileac crest-
Bone Marrow Biopsy
186
Lie down 30 mins to an hour to control bleeding after
Bone Marrow Biopsy
187
Monitory BP, if drops look at the site
Bone Marrow Biopsy
188
Left side most of the time, recovery position. Post op
Left side = 2 lobes and right side 3 lobes for lungs
Bone Marrow Biopsy
189
Inherited, crescent shape.
Sickle Cell Anemia Patho/Etiology
190
Changes shape bc the organism Is sensitive to O2 changes.
Sickle Cell Anemia Patho/Etiology
191
The cells get destroyed or misshapen.
Sickle Cell Anemia Patho/Etiology
192
Break easily causing clumping congestion and clotting.
Very Painful
Sickle Cell Anemia Patho/Etiology
193
Leave up to 180 days but for this 10-12 days.
Sickle Cell Anemia Patho/Etiology
194
Due to autosomal recessive in both parents.
Sickle Cell Anemia Patho/Etiology
195
USA seen more in African, Mediterranean, Hispanic-Americans
Sickle Cell Anemia Patho/Etiology
196
Does not show until baby 4-5 months old- in the uterus the hemoglobin is manufactured that does not have a problem
Sickle Cell Anemia Patho/Etiology
197
Sickle Cell Anemia S/Sx
Sluggish blood flow, pallor, fatigue, tachypnea, pain swelling in joints, jaundice, priapism- erection more than 4 hours
198
Sickle Cell Anemia Diagnostics
CBC diff, hemoglobin levels, sickle dexterity test screening
199
Sickle Cell Anemia Interventions
O2
Antibiotics
Education of crisis prevention- stress changes in weather illness.
IV fluids.
Pain meds, assessing circulation q2h.
Pain to joints= warm packs
200
Sickle Cell Anemia Medications
Pain med during crisis (narcotics),
Folic acid supplements
Glutamine
201
Sickle Cell Anemia Etiology
Autosomal Recessive Disorder
Sickle Cell Crisis
Pneumonia, cold, Diabetic Acidosis, infection, etc.
202
Sickle Cell Anemia Labs/Diagnostics
Decreased RBC, Hgb, Hct
203
Decreased RBC, Hgb, Hct S/Sx
General S/SX of anemia
204
Sickle Cell Crisis Intervention
Educate on Crisis Prevention
205
Sickle Cell Anemia Labs/Diagnostics
Sickle Dexterity
Decreased ESR
206
Pneumonia, cold, Diabetic Acidosis, infection, etc. Labs/Diagnostics
Increased WBC
207
Pneumonia, cold, Diabetic Acidosis, infection, etc. Intervention
Antibiotics
208
Pneumonia, cold, Diabetic Acidosis, infection, etc. Etiology
O2 drop = sickle shape
209
O2 drop = sickle shape S/Sx
Hypoxia
210
Hypoxia Intervention
O2 Therapy
211
Hypoxia and O2 drop = sickle shape Conceptual concern
O2
212
O2 drop = sickle shape Labs/Diagnostics
Hgb Electrophoresis
213
O2 drop = sickle shape Conceptual concern
Perfusion and Clotting
214
Clotting Intervention
Assess circulation Q2H
215
O2 drop = sickle shape Etiology
Sickled cells break/get stuck
216
Sickled cells break/get stuck S/Sx
Jaundice, Pain and swelling in joints, Priapism, Sluggish flow
217
Pain and swelling in joints intervention
Pain management
218
Pain management conceptual concern
Comfort / Pain
219
Sluggish flow Intervention
IV fluids
220
Sickle Cell Anemia Pediatric
Asymptomatic until 4-6 months
221
Normal RBC section
Normal hemoglobin
222
Abnormal sickle red blood cell section
Abnormal hemoglobin form strands that cause sickle shape
223
Poly = many
Polycythemia Patho/Etiology
224
Genetic mutation
Polycythemia Patho/Etiology
225
Polycythemia vera is the most serious form
Polycythemia Patho/Etiology
226
Amyloses is another word for polycythemia
Polycythemia Patho/Etiology
227
Viscosity in the blood and hypervolemia concern
Polycythemia Patho/Etiology
228
Complain of head aches
Polycythemia S/Sx
229
Higher risk for clots
Polycythemia S/Sx
230
Sluggish blood flow
Polycythemia S/Sx
231
Hypertension
Polycythemia S/Sx
232
Vision changes
Polycythemia S/Sx
233
Nose bleeds
Polycythemia S/Sx
234
Gum bleeds
Polycythemia S/Sx
235
Retinal hemorrhage
Polycythemia S/Sx
236
Difficulty breathing with little excretion and chest pain.
Polycythemia S/Sx
237
increased RBCs more than 6 million
Polycythemia Diagnostics
238
hemoglobin high 18 or more
Polycythemia Diagnostics
239
Hct 55% or more
Polycythemia Diagnostics
240
immature WBC high 10,000 or more
Polycythemia Diagnostics
241
Increased platelets
Polycythemia Diagnostics
242
Chest xray, ct scan, ABGs, CBCs, Sputum analysis if cough present, bone marrow aspiration
Polycythemia Diagnostics
243
Donating blood, therapeutic phlebotomy.
Polycythemia Interventions
244
If on bed rest still promote movement (passive rom), elevating legs,
Polycythemia Interventions
245
Avoid restrictive clothing, small meals
Polycythemia Interventions
246
Platelets lowers and hypovolemia risk. IV fluids or hydrations help with hypovolemia (3L of water)
Polycythemia Interventions
247
Decrease amount of RBCs- Interferon alfa 2b, hydroxyurea
Polycythemia Medications
248
Anticoagulants- aspirin if too many platelets
Polycythemia Medications
249
Chemo therapy to decrease WBCs
Polycythemia Medications
250
Polycythemia Vera
(primary polycythemia) disorder
Panmyelosis
251
Panmyelosis S/Sx
Hypervolemia/ hyper viscosity
252
Hypervolemia/ hyper viscosity Interventions
Drink at least 3 L of water/day
253
Hypervolemia/ hyper viscosity S/Sx
Headache, Sluggish blood flow, HTN
254
HTN S/Sx
Vision Changes
Nosebleeds, bleeding gums, retinal hemorrhages, exertional dyspnea, chest pain
255
HTN conceptual concern
Perfusion and Clotting
256
Polycythemia Vera
(primary polycythemia)
Labs/diagnostics
Increased platelets and WBCs
Bone marrow aspiration
RBCs >6 million
Hgb >18mg/dL
Hct >55%
257
Increased platelets interventions
Thrombosis prevention
258
Increased platelets Medications
Anticoagulants/Antiplatelet, Low dose aspirin, Chemo agents
259
Increased platelets conceptual concern
Clotting and Perfusion
260
Increased WBC medications
Chemo agents
261
RBCs >6 million
Hgb >18mg/dL
Hct >55%
S/Sx
Enlarged liver/spleen
Abdominal pain, fullness
262
Abdominal pain, fullness interventions
Several small meals
263
RBCs >6 million
Hgb >18mg/dL
Hct >55%
Interventions
Therapeutic phlebotomy, education
264
Polycythemia Vera
(primary polycythemia)
Etiology
Genetic mutation
265
Genetic mutation disorder
Polycythemia
266
Polycythemia etiology
chronic hypoxia
267
chronic hypoxia disorder
Secondary polycythemia
268
Secondary polycythemia labs/diagnostics
Increased RBCs
269
Thrombo= blood clots together, low number of platelets.
Thrombocytopenia Patho/Etiology
270
Destroyed within the spleen = platelets, put on steroid.
Thrombocytopenia Patho/Etiology
271
Viral illness, drug induced, due to pregnancy.
Thrombocytopenia Patho/Etiology
272
Heparin, lovenox, and chemotherapy meds can cause
Thrombocytopenia Patho/Etiology
273
Ecchymosis, petechiae. If pt difficult to arouse- may have brain bleed
Thrombocytopenia S/Sx
274
Decreased number of platelets= 20,000 or less
Thrombocytopenia labs/diagnostics
275
Bleeding precautions, educate to watch for s/sx of bleeding when brushing teeth.
Thrombocytopenia interventions
276
Avoid trauma and restrict activities during episodes.
Thrombocytopenia interventions
277
If they give blood for lab work watch the site.
Thrombocytopenia interventions
278
If pt is not responding to meds, spleen may need to be removed.
Thrombocytopenia interventions
279
Acute episodes- steroids (platelets destroyed easily)
Thrombocytopenia Medications
280
Chemotherapy-immunoglobulin, blood transfusions, platelets transfusion and vitamin K.
Thrombocytopenia Medications
281
If pt goes to the dentist may stay longer bc of bleeding
Thrombocytopenia
282
Thrombocytopenia (ITP) Etiology
Viral illness, Drug induced, Pregnancy, Platelet Destruction
283
Drug induced Medications
Heparin, Lovenox, Chemotherapy
284
Platelet Destruction type of disorder
Hemorrhagic disorder
285
Platelet Destruction medications
Steriods
286
Thrombocytopenia (ITP) Labs/Diagnostics
Platelets <20,000/mm^2
287
Platelets <20,000/mm^2 S/Sx
Petechiae, Bleeding, Ecchymosis
288
Bleeding interventions
Vitamin K, Blood transfusion, Platelet transfusion
289
Platelets <20,000/mm^2 interventions
Spleenectomy, Prevent bleeding
290
Platelets <20,000/mm^2 conceptual concern
Clotting
291
Inherited bleeding disorders in which the blood does not clot properly.
Hemophilia Patho/Etiology
292
Makes few platelets or destroyed within spleen- thrombo.
Hemophilia Patho/Etiology
293
Hemophilia A=
classic, lack or decrease of clotting factor A.
294
Hemophilia B is also called-
lack or decrease of clotting factor IX
295
Gene on the X chromosome, more common in males, can happen in any ethnicity and race
Hemophilia Etiology
296
Any injury that results in bleeding.
Hemophilia S/Sx
297
Bleeding into the muscles and joint= common w acute pain.
Hemophilia S/Sx
298
Deformities caused by bleeding
Hemophilia S/Sx
299
Bleeding in gums, under skin, nose bleeds
Hemophilia S/Sx
300
CBC, hemoglobin, RBCs, = Low. PTT and PT= prolonged, more seconds.
Hemophilia Diagnostics
301
DNA genetic testing.
Hemophilia Diagnostics
302
Commonly passed from parents. Blood drawn from sample of umbilical cord if mother has hemophilia
Hemophilia Diagnostics
303
Icepack for bleeding in joints 24-48 hrs.
Hemophilia Interventions
304
Missing clotting factors= blood transfusions (uncommon).
Hemophilia Interventions
305
Severe= prophylactic to prevent bleeding.
Hemophilia Interventions
306
Vital sings, monitor H&H. prevent hypovolemic shock.
Hemophilia Interventions
307
Pain=IV or PO narcotics. Keep pt safe. Be cautious with children bc of bleeding.
Hemophilia Interventions
308
If mild- injection or nasal inhalation vasopressin= stimulate body to release more clotting factors.
Hemophilia Medications
309
Severe= factor A for A and factor IX for hemophilia B.
Hemophilia Medications
310
Emicizumab(hemlibra)- prevent bleeding for hemophiliac A.
Hemophilia Medications
311
antifibrinolytics- does not dissolve clots (preserves the clots)
Hemophilia Medications
312
Hemorrhagic disorders etiology
Clotting factor deficiency
313
Clotting factor deficiency disorders
Von Willebrand's and Hemophilia
314
Von Willebrand's etiology
Deficient von Willebrand factor
315
Deficient von Willebrand factor intervention
Factor VWB transfusion
316
Von Willebrand's medication
Desmopressin
317
Hemophilia disorders
Hemophilia A (classic hemophilia)
Hemophilia B (Christmas Disease)
318
Hemophilia A (classic hemophilia) medications
Desmopressin
319
Hemophilia A (classic hemophilia) etiology
Factor VIII (8) Deficiency, X-linked recessive trait
320
Factor VIII (8) Deficiency Labs/Diagnostics
decreased factor VIII
321
decreased factor VIII Interventions
Factor VIII transfusion
322
Hemophilia intervention
prevent bleeding
323
Hemophilia labs/diagnostics
Prolonged PTT
324
Factor IX (9) Deficiency labs/diagnostics
decreased Factor IX
325
decreased Factor IX interventions
Factor IX transfusion
326
Hemophilia S/Sx
Bleeding, Hemarthrosis, Pain
327
Hemophilia conceptual concern
clotting
328
Prevent injury
Children- have supervision, helmets
Hemophilia
329
Disorder that effects WBCs, malignant disease.
Leukemia Patho/Etiology
330
Cancer found in the blood and bone marrow= patho.
Leukemia Patho/Etiology
331
Caused by rapid production of normal WBCs.
Leukemia Patho/Etiology
332
WBCs are abnormal so they cannot fight infections.
Leukemia Patho/Etiology
333
Leukemia Acute=
lymphocytic leukemia
acute myelogenous leukemia (AML)
chronic lymphocytic leukemia (ALL)
chronic myelogenous leukemia (CML)
334
Chronic= low but progresses, needs to be tx right away, classified into lymphocytic leukemia- refers to normal cells that became lymphocytes or myelogenous leukemia
Leukemia Patho/Etiology
334
Acute or Chronic. Bone marrow problem producing WBCs.
Leukemia Patho/Etiology
335
Aspiration biopsy-
liquid out of bone marrow and spongy part.
336
Acute or chronic sudden sickness, low grade fever caused by infection, pallor, weakness, lethargy, malaise, fatigue, tachycardia, palpitations, abdominal pain, external pain (rib tenderness)= crowding of bone marrow In the bone marrow.
Leukemia S/Sx
337
If leukemia invaded CNS patient may experience confusion, headaches, personality changes.
Leukemia S/Sx
337
Immature WBCs= high
Leukemia Diagnostics
337
Pale, lymph nodes enlarged, liver enlarged, WBCs, CBC w/ diff, RBC’s low, platelets low.
Leukemia Diagnostics
338
If have leukemia can have combination of blood disorders. If seen petechiae notify doctor.
Leukemia S/Sx
338
If ecchymosis or petechia results of thrombocytopenia.
Leukemia S/Sx
339
Mature WBCs= low
Leukemia Diagnostics
340
Shift to the left=
immature WBCs
341
Neutropenic precautions
Leukemia Interventions
342
Discharge education: pt have to wear mask at home.
Leukemia Interventions
343
Monitor blood work, WBCs. S/Sx of bleeding.
Leukemia Interventions
344
Temperature is huge concern. If low fever- let doc know >99 degrees.
Leukemia Interventions
345
Chemotherapy, radiation, bone marrow transplant, Tylenol, steroids, analgesic opioids, antiemetics for nausea, sedatives
Leukemia Medications
346
Leukemia Priority-
protect from illness. Pay attention to fevers.
347
Leukemia Conceptual factors:
gas exchange, clotting- bone marrow producing all cells, infection
348
WBC disorder
Leukemia
349
Leukemia Labs/diagnostics
Decreased RBCs
350
Decreased RBCs disorder
Anemia
351
Anemia S/Sx
general S/Sx of anemia
352
Anemia conceptual concern
O2
353
Leukemia etiology
Malignant disease
354
Leukemia Malignant disease interventions
Radication
355
Leukemia Malignant disease medications
Chemo agents
356
Leukemia Malignant disease labs/diagnostics
Decreased platelets, Increased immature WBCs, Decreased Mature WBCs
357
decreased platelets conceptual concern
clotting
358
decreased platelets S/Sx
Thrombocytopenia S/Sx
359
Thrombocytopenia S/Sx interventions
monitor for s/sx of bleeding
360
Increased immature WBCs S/Sx
Low grade fever, Bone marrow crowding
361
Bone marrow crowding S/Sx
Sternal and rib pain
362
Bone marrow crowding labs/diagnostics
Bone Marrow Aspiration
363
Bone marrow crowding interventions
Bone marrow transplant
364
Decrease in mature WBCs conceptual concern
Infection
365
Infection interventions
Vitals Q4H, Monitory for s/sx of infection and neutropenic precautions
366
Neutropenic precautions=
avoid people with active vaccines
367
Neutropenia
Neutropenia Patho/Etiology
368
Low number for circulating neutrophils in the blood.
Neutropenia Patho/Etiology
369
Due to genetic conditions, infection, cancer, leukemia, lymphoma
Neutropenia Patho/Etiology
370
Due to some meds: chemoradiation, nutritional deficiencies (B12, folate, copper) or autoimmune disease.
Neutropenia Patho/Etiology
371
Fever > 103 degrees.
Neutropenia S/Sx
372
Fatigue, trouble breathing, chills, new or worsening cough, sore throat,
Neutropenia S/Sx
373
stiff neck, swollen lymph nodes, ulcers in mouth, abscesses, diarrhea.
Neutropenia S/Sx
374
CBC w/ diff, consequence of another illness,
Neutropenia Diagnostics
375
Monitor for s/sx for infection and fevers. Pts can become septic
Neutropenia Intervention
376
Antibiotics, antifungals, bone marrow stimulants- neupogen.
Neutropenia Medication
377
WBC disorder
Neutropenia
378
Neutropenia Etiology
Bone marrow damage, Infection, Medications
379
Bone marrow damage, infection, medications labs/diagnostics
Decreased neutrophils
380
Neutropenia Infection Medications
Antibiotics/Antifungals
381
Neutropenia Medication caused medications for it
Chemo agents
382
Decreased neutrophils medications
Bone Marrow Stimulants (Neupogen/ Filgrastim)
383
Decreased neutrophils conceptual concern
infection
384
Infection interventions
Monitor for s/sx of infection
Vitals Q4H
385
Infection S/Sx
Low grade fever
