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NSG > Respiratory #1 > Flashcards

Respiratory #1 Flashcards

1
Q

WHITE BLOOD CELLS (WBC) Normal

A

5,000 - 10,000/mm3

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2
Q

WHITE BLOOD CELLS (WBC) Critically Low

A

< 2,000 mm3

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3
Q

WHITE BLOOD CELLS (WBC) Critically High

A

> 40,000 mm3

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4
Q

RED BLOOD CELLS (RBC) Normal

A

4.2 - 6.1 x 10^12/L

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5
Q

HEMOGLOBIN (Hgb) Normal

A

12.0 - 18.0 g/dL

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6
Q

HEMOGLOBIN (Hgb) Critically Low

A

< 7.0 g/dL

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7
Q

HEMOGLOBIN (Hgb) Critically High

A

> 21 g/dL

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8
Q

HEMATOCRIT (Hct) Normal

A

37% - 52%

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9
Q

HEMATOCRIT (Hct) Critically Low

A

< 21%

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10
Q

HEMATOCRIT (Hct) Critically High

A

> 65%

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11
Q

PLATELET COUNT Normal

A

150,000 - 400,000/mm3

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12
Q

PLATELET COUNT Critically Low

A

< 20,000/mm3

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13
Q

PLATELET COUNT Critically High

A

> 1 million/mm3

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14
Q

PARTIAL THROMBOPLASTIN TIME (PTT) Normal

A

60 - 70 seconds

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15
Q

PARTIAL THROMBOPLASTIN TIME (PTT) Critically High

A

> 100 seconds

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16
Q

PROTHROMBIN TIME (PT) Normal

A

11 - 12.5 seconds

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17
Q

PROTHROMBIN TIME (PT) Critically High

A

> 20 seconds

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18
Q

INTERNATIONAL NORMALIZED RATIO (INR) Normal

A

0.8 - 1.1

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19
Q

INTERNATIONAL NORMALIZED RATIO (INR) Critically High

A

> 5.0

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20
Q

Neutrophils
(Bands)
(Segments)

A

55-70%
(2.8%-3.6%)
(52.2%-66.4%)

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21
Q

Concept Map Key

A

Type of Disorder
Disorder
Labs/ diagnostics
Signs & Symptoms
Medications
Interventions
Conceptual Concerns
Etiology
Pediatric Specifics

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22
Q

Concept Map Key Example

A

Bleeding disorder- blood- anemia
Conceptual Concerns- perfusion

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23
Q

Red Blood Cells

A

Type of disorder

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24
Q

Decreased RBC, Hct, Hgb

A

Labs/Diagnostics

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25
Q

S/Sx: Hgb Decrease
Mild anemia

A

Hgb 10-14, Palpitations, dyspnea, fatigue

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26
Q

S/Sx: Hgb Decrease
Moderate anemia

A

Hgb 6-10
Cardio-pulmonary s/sx at rest

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27
Q

S/Sx: Hgb Decrease
Severe anemia

A

Hgb < 6
Pallor, Jaundice, Pruritis, Elevated HR, murmurs, angina, MI, HF, cardiomegaly, ascites, edema

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28
Q

Moderate and Severe anemia intervention

A

Blood transfusion

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29
Q

S/Sx: Hgb Decrease, SOB and

A

Weakness

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30
Q

Decreased Hgb conceptual concern

A

O2

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31
Q

Anemia

A

Disorder

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32
Q

Anemia Labs

A

Decreased RBCs, Hct, and Hgb

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33
Q

Anemia etiology

A

Massive / Chronic Blood loss
Impaired production
Increased destruction

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34
Q

Impaired production disorders

A

Folic Acid Deficiency anemia
Aplastic Anemia
Iron Deficiency Anemia
Pernicious Anemia (B12 Deficient)

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35
Q

Increased destruction disorders

A

Sickle Cell Anemia
Hemolytic Anemia

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36
Q

Happen during surgery or blood disorder

A

Anemia

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37
Q

Bad blood transfusion causes hemolytic anemia which is the

A

destruction of the RBCS, BODY cannot produce as fast as they were destroyed

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38
Q

Sickle cell anima-

A

shape of the RBCs look deformed
Chemo caused, break down easily, misshapen, die early, painful, no cure.
S/sx swollen hands, jaundice

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39
Q

Aplastic anemia-

A

bone marrow defect

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40
Q

Weak, SOB, dizzy

A

Anemia

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41
Q

RBC types

A

A, B, AB, O

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42
Q

Antibodies present in plasma Type A

A

Anti-B

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43
Q

Antibodies present in plasma Type B

A

Anti-A

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44
Q

Antibodies present in plasma Type AB

A

None

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45
Q

Antibodies present in plasma Type O

A

Anti-A and Anti-B

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46
Q

Antibodies Present on RBCs Type A

A

A Antigen

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47
Q

Antibodies Present on RBCs Type B

A

B antigen

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48
Q

Antibodies Present on RBCs Type AB

A

A and B antigen

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49
Q

Antibodies Present on RBCs Type O

A

None

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50
Q

Type: Presence or absence of A or B antigens
Blood reactions:

A

Agglutinate in reaction to antibodies

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51
Q

Rh factor Presence or absence of D antigen.

A

Rh – patient receives Rh – blood
Rh + patient receives Rh – or + blood.

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52
Q

Universal recipient=

A

AB+

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53
Q

Universal Donor=

A

O-

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54
Q

Adverse events
Range in severity

A

Transfusion Reactions

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55
Q

Acute transfusion reactions-

A

Flank pain, chills temp rises, brown or red urine

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56
Q

Delayed transfusion reactions-

A

Can happen days to weeks. Mild anemia, hyperbilirubemia

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57
Q

Immunologic (immediate reaction, type of blood given) vs

A

non-immunologic (immediate reaction damaged bag of blood)

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58
Q

Range in severity due to patients health

A

Transfusion Reactions

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59
Q

The time during the transfusion or during the next 24 hours

A

Acute- Transfusion Reactions

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60
Q

Monitor vital signs before, during and after

A

Transfusion Reactions

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61
Q

Blood transfusion patients- risk for reaction

A

Transfusion Reactions

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62
Q

Blood Transfusion Reactions

A

Febrile, Allergic Mild and Severe, Hemolytic

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63
Q

Febrile Reaction

A

Chills
Fever
Headchae
Flushing
Tachycardia
Increased anxiety

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64
Q

Allergic reaction Mild

A

Hives
Pruritus
Facial Flushing

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65
Q

Allergic reaction Severe

A

Severe SOB
Bronchospasm
Anxiety

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66
Q

Hemolytic reaction

A

Low pack and chest pain
Hypotension
Tachycardia and Tachypnea
Fever and Chills
Hemoglobinuria
Immediate Onset

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67
Q

Blood transfusion reaction NSG implications

A

Stop transfusion and notfy physician
Change IV tubing
Treat symptoms if present = O2, fluids, epinephrine as ordered
Recheck cross record with unit

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68
Q

Hemolytic reactions NSG Implications

A

Obtain 2 blood samples distal to infusion site
Obtain first UA test for hemoglobinuria
Monitor fluid/electrolyte balance
Evaluate serum calcium levels

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69
Q

Before transfusions-

A

Vital signs

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70
Q

More at risk for a reaction-

A

Fever symptoms

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71
Q

Incompletable blood products-

A

hemolytic transfusion reaction

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72
Q

Stop transfusion immediately and hook them to normal saline to

A

flush the blood out

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73
Q

Tylenol or Benadryl for

A

Mild Allergic reaction blood transfusion

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74
Q

Blood Transfusion Reaction Treatment

A

STOP the transfusion. Notify doctor
Keep IV line open with 0.9% normal saline.
Monitor vitals Q15min
Post-transfusion blood sample
Treat s/sx

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75
Q

Step 1 for Blood transfusion

A

Check blood pack for: Leaks, Discoloration, Clumping and Expiration date.
If there is any discrepancy do not transfuse

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76
Q

Step 2 for Blood transfusion

A

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

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77
Q

Step 3 for Blood transfusion

A

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

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78
Q

Step 4 for Blood transfusion

A

Commence the transfusion

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79
Q

Step 5 for Blood transfusion

A

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.

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80
Q

Step 6 for Blood transfusion

A

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

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81
Q

Check with RN

A

Blood transfusion

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82
Q

One at the start and during, stay w the patient for the first 15 mins

A

Blood transfusion

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83
Q

Match the blood. Full set of vitals. Check policies and procedures

A

Blood transfusion

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84
Q

Be present. Time consuming

A

Blood transfusion

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85
Q

Blood Administration Monitoring Vitals

A

Pre-Blood
15 minutes after start
Must stay with patient for full 15 minutes
Follow institution guidelines for Vitals
When blood complete- vital signs

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86
Q

Blood Administration Monitoring Monitor for Complications

A

Febrile reactions
Hemolytic reactions
Anaphylaxis Shock
Circulatory overload- Too much blood
Death

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87
Q

Febrile reactions

A

Increase in temp, shaking, chills, HA, back pain

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88
Q

Hemolytic reactions

A

Back pain, chest pain chills, fever, SOB, N/V, impending doom
Shock, hypotension, oliguria, decreased LOC

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89
Q

Circulatory overload- Too much blood

A

Chest pain, cough, frothy sputum, distended neck veins, crackles, wheezes, tachycardia

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90
Q

Verify Name, DOB, Allergies compare with order, armband, blood bag

A

Blood transfusion

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91
Q

Blood label
Check compatibility

A

Blood transfusion

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92
Q

Verify number of bag and order
Verify blood group

A

Blood transfusion

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93
Q

Deficiency in iron

A

Iron Deficiency Anemia Pathophysiology

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94
Q

Due to malabsorption (GI surgery, Gastric bypass)

A

Iron Deficiency Anemia Pathophysiology

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95
Q

Body loses healthy RBC due to Poor consumption of iron nutrients= deficiency

A

Iron Deficiency Anemia Pathophysiology

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96
Q

Excessive blood loss due to dialysis

A

Iron Deficiency Anemia Pathophysiology

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97
Q

Childbearing year women have problems getting iron in their blood.

A

Iron Deficiency Anemia Pathophysiology

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98
Q

Lack of stomach acid cannot absorb iron

A

Iron Deficiency Anemia Pathophysiology

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99
Q

Indigestion of Lead, Iron and lead compete for the cells in the body. Competition. Can get lead from water.

A

Iron Deficiency Anemia Pathophysiology

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100
Q

Iron Deficiency Anemia S/Sx

A

Pallor, Tachypnea, Tachycardia, SOB, Fissures in corner of mouth, Glossitis- inflammation of the tonuge, Spoon shape finger nails

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101
Q

Iron Deficiency Anemia Diagnostics-

A

Blood work, CBC- RBC, WBC
Hemoglobin (12-18)
Hematocrit (37-52)
Serum iron
Ferritin
Total Iron binding capacity (TIBC)

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102
Q

Iron Deficiency Anemia Interventions-

A

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.

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103
Q

Iron Deficiency Anemia Medications

A

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

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104
Q

Iron Deficiency Anemia Severe Medications

A

Blood transfusion

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105
Q

Iron Deficiency Anemia Caused by Peptic ulcer Med

A

antibiotics

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106
Q

Iron Deficiency Anemia Caused by Heavy menstrual periods Med

A

Oral contraceptives

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107
Q

Iron Deficiency Anemia Med if too much iron

A

Deferoxamine Mesylate (Deferral)

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108
Q

Anemia Etiology

A

Impaired production

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109
Q

Impaired production disorder

A

Iron Deficiency Anemia

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110
Q

Iron Deficiency Anemia Labs/ Diagnosis

A

Serum iron level, & transferrin saturation (diagnosis)
Increased TIBC
Decreased Hgb, Hct
Microcytic RBCs

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111
Q

Serum iron level, & transferrin saturation (diagnosis)- S/Sx

A

Glossitis
Cheilitis (inflamed lips)
Headache
Paresthesia

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112
Q

Decreased Hgb and Hct conceptual concern

A

O2

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113
Q

Decreased Hgb and Hct S/Sx

A

Anemia S/Sx

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114
Q

Iron Deficiency Anemia Etology

A

Malabsorption
Dialysis
Lead ingestion
Blood loss
Inadequate dietary intake

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115
Q

Malabsorption, Lead ingestion, Blood loss Intervention

A

Eliminate cause

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116
Q

Inadequate dietary intake Intervention

A

Meat, fish,& poultry = (Med) Vitamin C

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117
Q

Inadequate dietary intake Conceptual Concern

A

Nutrition = (Med) Iron Supplements

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118
Q

Vitamin C Education

A

EDUCATION: Take iron 1 hr ac, with Vit. C
GI side effects

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119
Q

Microcytic rbcs-

A

little blood cells

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120
Q

Consume Beans, green leafy veggies, meat, fish, poultry, iron supplements- Iron
Citrus- Vitamin C

A

Iron deficiency Anemia

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121
Q

High iron capacity = but not getting it, need more iron

A

Iron deficiency Anemia

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122
Q

Low iron capacity= GI absorption

A

Iron deficiency Anemia

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123
Q

Cirrhosis = low values of TIBC

A

Iron deficiency Anemia

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124
Q

Screen at 12-month well check

A

Pediatric Specifics for Iron deficiency anemia

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125
Q

More common with cow’s milk, use iron-fortified formula

A

Pediatric Specifics for Iron deficiency anemia

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126
Q

S/sx: irritability, anorexia, tachycardia, murmur, poor muscle tone, porcelain like skin, edematous, retarded growth, delayed learning

A

Pediatric Specifics for Iron deficiency anemia

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127
Q

Absorb lead more readily = lead poisoning (hyperactivity, impulsiveness, lethargy, irritability, hearing impairment, learning difficulties.

A

Pediatric Specifics for Iron deficiency anemia

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128
Q

Iron Deficient Anemia S/Sx

A

Cheilitis
Glossitis

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129
Q

Macrocytic Anemias

A

Folic Acid Deficiency & Pernicious Anemia

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130
Q

Folic Acid Deficiency & Pernicious Anemia Patho/Etiology

A

RBC= bigger
Don’t have nutrients to function

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131
Q

drug or alcohol use

A

Folic acid deficiency Patho/Etiology

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132
Q

Pernicious anemia Patho/Etiology

A

low extrinsic factor= glycoprotein in stomach which helps with absorption of b 12

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133
Q

Folic Acid Deficiency & Pernicious Anemia Signs/Symptoms

A

Pallor, fatigue, tachycardia, tachypnea, SOB

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134
Q

Folic Acid Deficiency & Pernicious Anemia Diagnostics-

A

CBC, B12, Folic acid levels (1.8-9 folic acid range)

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135
Q

Folic Acid Deficiency Interventions-

A

Teach to increase liver, egg, legumes for folic acid intake

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136
Q

Pernicious anemia Intervention-

A

increase meat, poultry, fish, egg, soy beans, peanuts, lentils, fortified cereals, milk

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137
Q

Folic Acid Deficiency & Pernicious anemia Medications-

A

Vitamin b 12, folic acid PO or IM

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138
Q

Impaired production disorders

A

Folic Acid Deficiency Anemia & Pernicious anemia

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139
Q

Pernicious anemia Etiology

A

GI surgery /diseases
Deficient intrinsic factor
Vegetarian

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140
Q

Deficient intrinsic factor Labs/Diagnostics

A

Intrinsic Factor Antibody
Schilling test- Vitamin B12 absorption test

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141
Q

Pernicious Anemia (B12 Deficient)

A

Cobalamin injections

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142
Q

Pernicious Anemia (B12 Deficient) Labs/Diagnostics

A

Decreased Hgb & Hct
Decreased B12
Increased MMA
Macrocytic

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143
Q

Decreased Hgb and Hct S/Sx

A

General S/SX of anemia

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144
Q

Decreased Hgb and Hct Conceptual Concerns

A

O2

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145
Q

Decreased B12 and Increased MMA S/Sx

A

Anorexia, N/V, abdominal pain
Sore Beefy red tongue
Numbness of hand and feet

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146
Q

Numbness of hand and feet Conceptual Concerns

A

Safety

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147
Q

Decreased B12 and Increased MMA and Anorexia, N/V, abdominal pain Conceptual Concerns

A

Nutrition

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148
Q

Decreased B12 and Increased MMA Interventions

A

Meat, fish, shellfish, poultry, eggs, dairy products, soy milk, tofu, breakfast cereals

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149
Q

Folic Acid Deficiency anemia Etiology Drugs and

A

Alcohol

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150
Q

Folic Acid Deficiency anemia Labs/Diagnostics

A

Decreased Folate Level

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151
Q

Decreased Folate Level Medications

A

Folate PO

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152
Q

Decreased Folate Level Interventions

A

Fortified flours, grains, cereals, wheat germ, liver, eggs, green leafy vegetables, legumes, bananas and oranges.

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153
Q

Craving for clay or dirt low

A

b12

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154
Q

Surgeries or GI problems- Pernicious Anemia

A

B12 Deficient

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155
Q

Evaluate b12 absorption-

A

Schilling test

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156
Q

Aplastic Anemia / Pancytopenia Patho/Etiology

A

Bone marrow is pale, fatty and fibrous.
Bone marrow forms RBCs.
Decrease of hemoglobin and hematocrit WBCs and platelets.

157
Q

Aplastic Anemia / Pancytopenia Signs/Symptoms

A

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
Q

Aplastic Anemia / Pancytopenia Diagnostics

A

CBC w/ diff- looks at each WBC and RBCs. Bone marrow biopsy. Iron levels, TIBC serum

159
Q

Aplastic Anemia / Pancytopenia Intervention

A

Immunosuppressive medications.
Educate to avoid exposure to sick people.
Blood transfusions.
Bone marrow transplant- severe

160
Q

Aplastic Anemia / Pancytopenia Medications

A

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
Q

Anemia Etology = Impaired production DIsorder =

A

Aplastic Anemia

162
Q

Aplastic Anemia Etology

A

Fatty Bone Marrow (fibrous)

163
Q

Fatty Bone Marrow (fibrous) Etiology

A

Decreased cell production

164
Q

Fatty Bone Marrow (fibrous) Labs/Diagnostics

A

Bone marrow biopsy

165
Q

Fatty Bone Marrow (fibrous) Intervention

A

Bone marrow transplantation

166
Q

Fatty Bone Marrow (fibrous) Medication

A

Steriods

167
Q

Decreased cell production Disorder

A

Pancytopenia

168
Q

Pancytopenia Labs/Diagnosis

A

Decreased Platelets, WBCs, RBCs, Hgb, Hct

169
Q

Decreased Platelets Intervention

A

Platelet transfusion

170
Q

Decreased Platelets S/Sx

A

Petechiae, Ecchymosis, Bleeding

171
Q

Bleeding Interventions

A

Bleeding prevention/precautions

172
Q

Bleeding conceptual concern

A

Clotting

173
Q

Decreased WBC Intervention

A

Infection prevention

174
Q

Decreased WBC Conceptual concern

A

Infection

175
Q

Decreased RBCs, Hgb, Hct S/Sx

A

General S/SX of anemia
Tachycardia / Heart Failure

176
Q

Decreased RBCs, Hgb, Hct Intervention

A

Packed RBC Transfusion

177
Q

Decreased RBCs, Hgb, Hct Conceptual concern

A

O2

178
Q

Aplastic Anemia Conceptual concern

A

Perfusion

179
Q

TIBC increase due to overabundance of iron. Cells cannot use it

A

Aplastic Anemia

180
Q

Infection- educate about wearing a mask

A

Aplastic Anemia

181
Q

Bleeding- prevent falls, clots, injection careful

A

Aplastic Anemia

182
Q

Notify provider for bleeding, teach patient

A

Aplastic Anemia

183
Q

Pressure dressing for bleeding

A

Bone Marrow Biopsy

184
Q

Consent paperwork before procedure and they can change their mind last minute

A

Bone Marrow Biopsy

185
Q

Posterior ileac crest-

A

Bone Marrow Biopsy

186
Q

Lie down 30 mins to an hour to control bleeding after

A

Bone Marrow Biopsy

187
Q

Monitory BP, if drops look at the site

A

Bone Marrow Biopsy

188
Q

Left side most of the time, recovery position. Post op
Left side = 2 lobes and right side 3 lobes for lungs

A

Bone Marrow Biopsy

189
Q

Inherited, crescent shape.

A

Sickle Cell Anemia Patho/Etiology

190
Q

Changes shape bc the organism Is sensitive to O2 changes.

A

Sickle Cell Anemia Patho/Etiology

191
Q

The cells get destroyed or misshapen.

A

Sickle Cell Anemia Patho/Etiology

192
Q

Break easily causing clumping congestion and clotting.
Very Painful

A

Sickle Cell Anemia Patho/Etiology

193
Q

Leave up to 180 days but for this 10-12 days.

A

Sickle Cell Anemia Patho/Etiology

194
Q

Due to autosomal recessive in both parents.

A

Sickle Cell Anemia Patho/Etiology

195
Q

USA seen more in African, Mediterranean, Hispanic-Americans

A

Sickle Cell Anemia Patho/Etiology

196
Q

Does not show until baby 4-5 months old- in the uterus the hemoglobin is manufactured that does not have a problem

A

Sickle Cell Anemia Patho/Etiology

197
Q

Sickle Cell Anemia S/Sx

A

Sluggish blood flow, pallor, fatigue, tachypnea, pain swelling in joints, jaundice, priapism- erection more than 4 hours

198
Q

Sickle Cell Anemia Diagnostics

A

CBC diff, hemoglobin levels, sickle dexterity test screening

199
Q

Sickle Cell Anemia Interventions

A

O2
Antibiotics
Education of crisis prevention- stress changes in weather illness.
IV fluids.
Pain meds, assessing circulation q2h.
Pain to joints= warm packs

200
Q

Sickle Cell Anemia Medications

A

Pain med during crisis (narcotics),
Folic acid supplements
Glutamine

201
Q

Sickle Cell Anemia Etiology

A

Autosomal Recessive Disorder
Sickle Cell Crisis
Pneumonia, cold, Diabetic Acidosis, infection, etc.

202
Q

Sickle Cell Anemia Labs/Diagnostics

A

Decreased RBC, Hgb, Hct

203
Q

Decreased RBC, Hgb, Hct S/Sx

A

General S/SX of anemia

204
Q

Sickle Cell Crisis Intervention

A

Educate on Crisis Prevention

205
Q

Sickle Cell Anemia Labs/Diagnostics

A

Sickle Dexterity
Decreased ESR

206
Q

Pneumonia, cold, Diabetic Acidosis, infection, etc. Labs/Diagnostics

A

Increased WBC

207
Q

Pneumonia, cold, Diabetic Acidosis, infection, etc. Intervention

A

Antibiotics

208
Q

Pneumonia, cold, Diabetic Acidosis, infection, etc. Etiology

A

O2 drop = sickle shape

209
Q

O2 drop = sickle shape S/Sx

A

Hypoxia

210
Q

Hypoxia Intervention

A

O2 Therapy

211
Q

Hypoxia and O2 drop = sickle shape Conceptual concern

A

O2

212
Q

O2 drop = sickle shape Labs/Diagnostics

A

Hgb Electrophoresis

213
Q

O2 drop = sickle shape Conceptual concern

A

Perfusion and Clotting

214
Q

Clotting Intervention

A

Assess circulation Q2H

215
Q

O2 drop = sickle shape Etiology

A

Sickled cells break/get stuck

216
Q

Sickled cells break/get stuck S/Sx

A

Jaundice, Pain and swelling in joints, Priapism, Sluggish flow

217
Q

Pain and swelling in joints intervention

A

Pain management

218
Q

Pain management conceptual concern

A

Comfort / Pain

219
Q

Sluggish flow Intervention

A

IV fluids

220
Q

Sickle Cell Anemia Pediatric

A

Asymptomatic until 4-6 months

221
Q

Normal RBC section

A

Normal hemoglobin

222
Q

Abnormal sickle red blood cell section

A

Abnormal hemoglobin form strands that cause sickle shape

223
Q

Poly = many

A

Polycythemia Patho/Etiology

224
Q

Genetic mutation

A

Polycythemia Patho/Etiology

225
Q

Polycythemia vera is the most serious form

A

Polycythemia Patho/Etiology

226
Q

Amyloses is another word for polycythemia

A

Polycythemia Patho/Etiology

227
Q

Viscosity in the blood and hypervolemia concern

A

Polycythemia Patho/Etiology

228
Q

Complain of head aches

A

Polycythemia S/Sx

229
Q

Higher risk for clots

A

Polycythemia S/Sx

230
Q

Sluggish blood flow

A

Polycythemia S/Sx

231
Q

Hypertension

A

Polycythemia S/Sx

232
Q

Vision changes

A

Polycythemia S/Sx

233
Q

Nose bleeds

A

Polycythemia S/Sx

234
Q

Gum bleeds

A

Polycythemia S/Sx

235
Q

Retinal hemorrhage

A

Polycythemia S/Sx

236
Q

Difficulty breathing with little excretion and chest pain.

A

Polycythemia S/Sx

237
Q

increased RBCs more than 6 million

A

Polycythemia Diagnostics

238
Q

hemoglobin high 18 or more

A

Polycythemia Diagnostics

239
Q

Hct 55% or more

A

Polycythemia Diagnostics

240
Q

immature WBC high 10,000 or more

A

Polycythemia Diagnostics

241
Q

Increased platelets

A

Polycythemia Diagnostics

242
Q

Chest xray, ct scan, ABGs, CBCs, Sputum analysis if cough present, bone marrow aspiration

A

Polycythemia Diagnostics

243
Q

Donating blood, therapeutic phlebotomy.

A

Polycythemia Interventions

244
Q

If on bed rest still promote movement (passive rom), elevating legs,

A

Polycythemia Interventions

245
Q

Avoid restrictive clothing, small meals

A

Polycythemia Interventions

246
Q

Platelets lowers and hypovolemia risk. IV fluids or hydrations help with hypovolemia (3L of water)

A

Polycythemia Interventions

247
Q

Decrease amount of RBCs- Interferon alfa 2b, hydroxyurea

A

Polycythemia Medications

248
Q

Anticoagulants- aspirin if too many platelets

A

Polycythemia Medications

249
Q

Chemo therapy to decrease WBCs

A

Polycythemia Medications

250
Q

Polycythemia Vera
(primary polycythemia) disorder

A

Panmyelosis

251
Q

Panmyelosis S/Sx

A

Hypervolemia/ hyper viscosity

252
Q

Hypervolemia/ hyper viscosity Interventions

A

Drink at least 3 L of water/day

253
Q

Hypervolemia/ hyper viscosity S/Sx

A

Headache, Sluggish blood flow, HTN

254
Q

HTN S/Sx

A

Vision Changes
Nosebleeds, bleeding gums, retinal hemorrhages, exertional dyspnea, chest pain

255
Q

HTN conceptual concern

A

Perfusion and Clotting

256
Q

Polycythemia Vera
(primary polycythemia)
Labs/diagnostics

A

Increased platelets and WBCs
Bone marrow aspiration
RBCs >6 million
Hgb >18mg/dL
Hct >55%

257
Q

Increased platelets interventions

A

Thrombosis prevention

258
Q

Increased platelets Medications

A

Anticoagulants/Antiplatelet, Low dose aspirin, Chemo agents

259
Q

Increased platelets conceptual concern

A

Clotting and Perfusion

260
Q

Increased WBC medications

A

Chemo agents

261
Q

RBCs >6 million
Hgb >18mg/dL
Hct >55%
S/Sx

A

Enlarged liver/spleen
Abdominal pain, fullness

262
Q

Abdominal pain, fullness interventions

A

Several small meals

263
Q

RBCs >6 million
Hgb >18mg/dL
Hct >55%
Interventions

A

Therapeutic phlebotomy, education

264
Q

Polycythemia Vera
(primary polycythemia)
Etiology

A

Genetic mutation

265
Q

Genetic mutation disorder

A

Polycythemia

266
Q

Polycythemia etiology

A

chronic hypoxia

267
Q

chronic hypoxia disorder

A

Secondary polycythemia

268
Q

Secondary polycythemia labs/diagnostics

A

Increased RBCs

269
Q

Thrombo= blood clots together, low number of platelets.

A

Thrombocytopenia Patho/Etiology

270
Q

Destroyed within the spleen = platelets, put on steroid.

A

Thrombocytopenia Patho/Etiology

271
Q

Viral illness, drug induced, due to pregnancy.

A

Thrombocytopenia Patho/Etiology

272
Q

Heparin, lovenox, and chemotherapy meds can cause

A

Thrombocytopenia Patho/Etiology

273
Q

Ecchymosis, petechiae. If pt difficult to arouse- may have brain bleed

A

Thrombocytopenia S/Sx

274
Q

Decreased number of platelets= 20,000 or less

A

Thrombocytopenia labs/diagnostics

275
Q

Bleeding precautions, educate to watch for s/sx of bleeding when brushing teeth.

A

Thrombocytopenia interventions

276
Q

Avoid trauma and restrict activities during episodes.

A

Thrombocytopenia interventions

277
Q

If they give blood for lab work watch the site.

A

Thrombocytopenia interventions

278
Q

If pt is not responding to meds, spleen may need to be removed.

A

Thrombocytopenia interventions

279
Q

Acute episodes- steroids (platelets destroyed easily)

A

Thrombocytopenia Medications

280
Q

Chemotherapy-immunoglobulin, blood transfusions, platelets transfusion and vitamin K.

A

Thrombocytopenia Medications

281
Q

If pt goes to the dentist may stay longer bc of bleeding

A

Thrombocytopenia

282
Q

Thrombocytopenia (ITP) Etiology

A

Viral illness, Drug induced, Pregnancy, Platelet Destruction

283
Q

Drug induced Medications

A

Heparin, Lovenox, Chemotherapy

284
Q

Platelet Destruction type of disorder

A

Hemorrhagic disorder

285
Q

Platelet Destruction medications

A

Steriods

286
Q

Thrombocytopenia (ITP) Labs/Diagnostics

A

Platelets <20,000/mm^2

287
Q

Platelets <20,000/mm^2 S/Sx

A

Petechiae, Bleeding, Ecchymosis

288
Q

Bleeding interventions

A

Vitamin K, Blood transfusion, Platelet transfusion

289
Q

Platelets <20,000/mm^2 interventions

A

Spleenectomy, Prevent bleeding

290
Q

Platelets <20,000/mm^2 conceptual concern

A

Clotting

291
Q

Inherited bleeding disorders in which the blood does not clot properly.

A

Hemophilia Patho/Etiology

292
Q

Makes few platelets or destroyed within spleen- thrombo.

A

Hemophilia Patho/Etiology

293
Q

Hemophilia A=

A

classic, lack or decrease of clotting factor A.

294
Q

Hemophilia B is also called-

A

lack or decrease of clotting factor IX

295
Q

Gene on the X chromosome, more common in males, can happen in any ethnicity and race

A

Hemophilia Etiology

296
Q

Any injury that results in bleeding.

A

Hemophilia S/Sx

297
Q

Bleeding into the muscles and joint= common w acute pain.

A

Hemophilia S/Sx

298
Q

Deformities caused by bleeding

A

Hemophilia S/Sx

299
Q

Bleeding in gums, under skin, nose bleeds

A

Hemophilia S/Sx

300
Q

CBC, hemoglobin, RBCs, = Low. PTT and PT= prolonged, more seconds.

A

Hemophilia Diagnostics

301
Q

DNA genetic testing.

A

Hemophilia Diagnostics

302
Q

Commonly passed from parents. Blood drawn from sample of umbilical cord if mother has hemophilia

A

Hemophilia Diagnostics

303
Q

Icepack for bleeding in joints 24-48 hrs.

A

Hemophilia Interventions

304
Q

Missing clotting factors= blood transfusions (uncommon).

A

Hemophilia Interventions

305
Q

Severe= prophylactic to prevent bleeding.

A

Hemophilia Interventions

306
Q

Vital sings, monitor H&H. prevent hypovolemic shock.

A

Hemophilia Interventions

307
Q

Pain=IV or PO narcotics. Keep pt safe. Be cautious with children bc of bleeding.

A

Hemophilia Interventions

308
Q

If mild- injection or nasal inhalation vasopressin= stimulate body to release more clotting factors.

A

Hemophilia Medications

309
Q

Severe= factor A for A and factor IX for hemophilia B.

A

Hemophilia Medications

310
Q

Emicizumab(hemlibra)- prevent bleeding for hemophiliac A.

A

Hemophilia Medications

311
Q

antifibrinolytics- does not dissolve clots (preserves the clots)

A

Hemophilia Medications

312
Q

Hemorrhagic disorders etiology

A

Clotting factor deficiency

313
Q

Clotting factor deficiency disorders

A

Von Willebrand’s and Hemophilia

314
Q

Von Willebrand’s etiology

A

Deficient von Willebrand factor

315
Q

Deficient von Willebrand factor intervention

A

Factor VWB transfusion

316
Q

Von Willebrand’s medication

A

Desmopressin

317
Q

Hemophilia disorders

A

Hemophilia A (classic hemophilia)
Hemophilia B (Christmas Disease)

318
Q

Hemophilia A (classic hemophilia) medications

A

Desmopressin

319
Q

Hemophilia A (classic hemophilia) etiology

A

Factor VIII (8) Deficiency, X-linked recessive trait

320
Q

Factor VIII (8) Deficiency Labs/Diagnostics

A

decreased factor VIII

321
Q

decreased factor VIII Interventions

A

Factor VIII transfusion

322
Q

Hemophilia intervention

A

prevent bleeding

323
Q

Hemophilia labs/diagnostics

A

Prolonged PTT

324
Q

Factor IX (9) Deficiency labs/diagnostics

A

decreased Factor IX

325
Q

decreased Factor IX interventions

A

Factor IX transfusion

326
Q

Hemophilia S/Sx

A

Bleeding, Hemarthrosis, Pain

327
Q

Hemophilia conceptual concern

A

clotting

328
Q

Prevent injury
Children- have supervision, helmets

A

Hemophilia

329
Q

Disorder that effects WBCs, malignant disease.

A

Leukemia Patho/Etiology

330
Q

Cancer found in the blood and bone marrow= patho.

A

Leukemia Patho/Etiology

331
Q

Caused by rapid production of normal WBCs.

A

Leukemia Patho/Etiology

332
Q

WBCs are abnormal so they cannot fight infections.

A

Leukemia Patho/Etiology

333
Q

Leukemia Acute=

A

lymphocytic leukemia
acute myelogenous leukemia (AML)
chronic lymphocytic leukemia (ALL)
chronic myelogenous leukemia (CML)

334
Q

Chronic= low but progresses, needs to be tx right away, classified into lymphocytic leukemia- refers to normal cells that became lymphocytes or myelogenous leukemia

A

Leukemia Patho/Etiology

334
Q

Acute or Chronic. Bone marrow problem producing WBCs.

A

Leukemia Patho/Etiology

335
Q

Aspiration biopsy-

A

liquid out of bone marrow and spongy part.

336
Q

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.

A

Leukemia S/Sx

337
Q

If leukemia invaded CNS patient may experience confusion, headaches, personality changes.

A

Leukemia S/Sx

337
Q

Immature WBCs= high

A

Leukemia Diagnostics

337
Q

Pale, lymph nodes enlarged, liver enlarged, WBCs, CBC w/ diff, RBC’s low, platelets low.

A

Leukemia Diagnostics

338
Q

If have leukemia can have combination of blood disorders. If seen petechiae notify doctor.

A

Leukemia S/Sx

338
Q

If ecchymosis or petechia results of thrombocytopenia.

A

Leukemia S/Sx

339
Q

Mature WBCs= low

A

Leukemia Diagnostics

340
Q

Shift to the left=

A

immature WBCs

341
Q

Neutropenic precautions

A

Leukemia Interventions

342
Q

Discharge education: pt have to wear mask at home.

A

Leukemia Interventions

343
Q

Monitor blood work, WBCs. S/Sx of bleeding.

A

Leukemia Interventions

344
Q

Temperature is huge concern. If low fever- let doc know >99 degrees.

A

Leukemia Interventions

345
Q

Chemotherapy, radiation, bone marrow transplant, Tylenol, steroids, analgesic opioids, antiemetics for nausea, sedatives

A

Leukemia Medications

346
Q

Leukemia Priority-

A

protect from illness. Pay attention to fevers.

347
Q

Leukemia Conceptual factors:

A

gas exchange, clotting- bone marrow producing all cells, infection

348
Q

WBC disorder

A

Leukemia

349
Q

Leukemia Labs/diagnostics

A

Decreased RBCs

350
Q

Decreased RBCs disorder

A

Anemia

351
Q

Anemia S/Sx

A

general S/Sx of anemia

352
Q

Anemia conceptual concern

A

O2

353
Q

Leukemia etiology

A

Malignant disease

354
Q

Leukemia Malignant disease interventions

A

Radication

355
Q

Leukemia Malignant disease medications

A

Chemo agents

356
Q

Leukemia Malignant disease labs/diagnostics

A

Decreased platelets, Increased immature WBCs, Decreased Mature WBCs

357
Q

decreased platelets conceptual concern

A

clotting

358
Q

decreased platelets S/Sx

A

Thrombocytopenia S/Sx

359
Q

Thrombocytopenia S/Sx interventions

A

monitor for s/sx of bleeding

360
Q

Increased immature WBCs S/Sx

A

Low grade fever, Bone marrow crowding

361
Q

Bone marrow crowding S/Sx

A

Sternal and rib pain

362
Q

Bone marrow crowding labs/diagnostics

A

Bone Marrow Aspiration

363
Q

Bone marrow crowding interventions

A

Bone marrow transplant

364
Q

Decrease in mature WBCs conceptual concern

A

Infection

365
Q

Infection interventions

A

Vitals Q4H, Monitory for s/sx of infection and neutropenic precautions

366
Q

Neutropenic precautions=

A

avoid people with active vaccines

367
Q

Neutropenia

A

Neutropenia Patho/Etiology

368
Q

Low number for circulating neutrophils in the blood.

A

Neutropenia Patho/Etiology

369
Q

Due to genetic conditions, infection, cancer, leukemia, lymphoma

A

Neutropenia Patho/Etiology

370
Q

Due to some meds: chemoradiation, nutritional deficiencies (B12, folate, copper) or autoimmune disease.

A

Neutropenia Patho/Etiology

371
Q

Fever > 103 degrees.

A

Neutropenia S/Sx

372
Q

Fatigue, trouble breathing, chills, new or worsening cough, sore throat,

A

Neutropenia S/Sx

373
Q

stiff neck, swollen lymph nodes, ulcers in mouth, abscesses, diarrhea.

A

Neutropenia S/Sx

374
Q

CBC w/ diff, consequence of another illness,

A

Neutropenia Diagnostics

375
Q

Monitor for s/sx for infection and fevers. Pts can become septic

A

Neutropenia Intervention

376
Q

Antibiotics, antifungals, bone marrow stimulants- neupogen.

A

Neutropenia Medication

377
Q

WBC disorder

A

Neutropenia

378
Q

Neutropenia Etiology

A

Bone marrow damage, Infection, Medications

379
Q

Bone marrow damage, infection, medications labs/diagnostics

A

Decreased neutrophils

380
Q

Neutropenia Infection Medications

A

Antibiotics/Antifungals

381
Q

Neutropenia Medication caused medications for it

A

Chemo agents

382
Q

Decreased neutrophils medications

A

Bone Marrow Stimulants (Neupogen/ Filgrastim)

383
Q

Decreased neutrophils conceptual concern

A

infection

384
Q

Infection interventions

A

Monitor for s/sx of infection
Vitals Q4H

385
Q

Infection S/Sx

A

Low grade fever

NSG (13 decks)

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