Respiratory #1 Flashcards
WHITE BLOOD CELLS (WBC) Normal
5,000 - 10,000/mm3
WHITE BLOOD CELLS (WBC) Critically Low
< 2,000 mm3
WHITE BLOOD CELLS (WBC) Critically High
> 40,000 mm3
RED BLOOD CELLS (RBC) Normal
4.2 - 6.1 x 10^12/L
HEMOGLOBIN (Hgb) Normal
12.0 - 18.0 g/dL
HEMOGLOBIN (Hgb) Critically Low
< 7.0 g/dL
HEMOGLOBIN (Hgb) Critically High
> 21 g/dL
HEMATOCRIT (Hct) Normal
37% - 52%
HEMATOCRIT (Hct) Critically Low
< 21%
HEMATOCRIT (Hct) Critically High
> 65%
PLATELET COUNT Normal
150,000 - 400,000/mm3
PLATELET COUNT Critically Low
< 20,000/mm3
PLATELET COUNT Critically High
> 1 million/mm3
PARTIAL THROMBOPLASTIN TIME (PTT) Normal
60 - 70 seconds
PARTIAL THROMBOPLASTIN TIME (PTT) Critically High
> 100 seconds
PROTHROMBIN TIME (PT) Normal
11 - 12.5 seconds
PROTHROMBIN TIME (PT) Critically High
> 20 seconds
INTERNATIONAL NORMALIZED RATIO (INR) Normal
0.8 - 1.1
INTERNATIONAL NORMALIZED RATIO (INR) Critically High
> 5.0
Neutrophils
(Bands)
(Segments)
55-70%
(2.8%-3.6%)
(52.2%-66.4%)
Concept Map Key
Type of Disorder
Disorder
Labs/ diagnostics
Signs & Symptoms
Medications
Interventions
Conceptual Concerns
Etiology
Pediatric Specifics
Concept Map Key Example
Bleeding disorder- blood- anemia
Conceptual Concerns- perfusion
Red Blood Cells
Type of disorder
Decreased RBC, Hct, Hgb
Labs/Diagnostics
S/Sx: Hgb Decrease
Mild anemia
Hgb 10-14, Palpitations, dyspnea, fatigue
S/Sx: Hgb Decrease
Moderate anemia
Hgb 6-10
Cardio-pulmonary s/sx at rest
S/Sx: Hgb Decrease
Severe anemia
Hgb < 6
Pallor, Jaundice, Pruritis, Elevated HR, murmurs, angina, MI, HF, cardiomegaly, ascites, edema
Moderate and Severe anemia intervention
Blood transfusion
S/Sx: Hgb Decrease, SOB and
Weakness
Decreased Hgb conceptual concern
O2
Anemia
Disorder
Anemia Labs
Decreased RBCs, Hct, and Hgb
Anemia etiology
Massive / Chronic Blood loss
Impaired production
Increased destruction
Impaired production disorders
Folic Acid Deficiency anemia
Aplastic Anemia
Iron Deficiency Anemia
Pernicious Anemia (B12 Deficient)
Increased destruction disorders
Sickle Cell Anemia
Hemolytic Anemia
Happen during surgery or blood disorder
Anemia
Bad blood transfusion causes hemolytic anemia which is the
destruction of the RBCS, BODY cannot produce as fast as they were destroyed
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
Aplastic anemia-
bone marrow defect
Weak, SOB, dizzy
Anemia
RBC types
A, B, AB, O
Antibodies present in plasma Type A
Anti-B
Antibodies present in plasma Type B
Anti-A
Antibodies present in plasma Type AB
None
Antibodies present in plasma Type O
Anti-A and Anti-B
Antibodies Present on RBCs Type A
A Antigen
Antibodies Present on RBCs Type B
B antigen
Antibodies Present on RBCs Type AB
A and B antigen
Antibodies Present on RBCs Type O
None
Type: Presence or absence of A or B antigens
Blood reactions:
Agglutinate in reaction to antibodies
Rh factor Presence or absence of D antigen.
Rh – patient receives Rh – blood
Rh + patient receives Rh – or + blood.
Universal recipient=
AB+
Universal Donor=
O-
Adverse events
Range in severity
Transfusion Reactions
Acute transfusion reactions-
Flank pain, chills temp rises, brown or red urine
Delayed transfusion reactions-
Can happen days to weeks. Mild anemia, hyperbilirubemia
Immunologic (immediate reaction, type of blood given) vs
non-immunologic (immediate reaction damaged bag of blood)
Range in severity due to patients health
Transfusion Reactions
The time during the transfusion or during the next 24 hours
Acute- Transfusion Reactions
Monitor vital signs before, during and after
Transfusion Reactions
Blood transfusion patients- risk for reaction
Transfusion Reactions
Blood Transfusion Reactions
Febrile, Allergic Mild and Severe, Hemolytic
Febrile Reaction
Chills
Fever
Headchae
Flushing
Tachycardia
Increased anxiety
Allergic reaction Mild
Hives
Pruritus
Facial Flushing
Allergic reaction Severe
Severe SOB
Bronchospasm
Anxiety
Hemolytic reaction
Low pack and chest pain
Hypotension
Tachycardia and Tachypnea
Fever and Chills
Hemoglobinuria
Immediate Onset
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
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
Before transfusions-
Vital signs
More at risk for a reaction-
Fever symptoms
Incompletable blood products-
hemolytic transfusion reaction
Stop transfusion immediately and hook them to normal saline to
flush the blood out
Tylenol or Benadryl for
Mild Allergic reaction blood transfusion
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
Step 1 for Blood transfusion
Check blood pack for: Leaks, Discoloration, Clumping and Expiration date.
If there is any discrepancy do not transfuse
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
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
Step 4 for Blood transfusion
Commence the transfusion
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.
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
Check with RN
Blood transfusion
One at the start and during, stay w the patient for the first 15 mins
Blood transfusion
Match the blood. Full set of vitals. Check policies and procedures
Blood transfusion
Be present. Time consuming
Blood transfusion
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
Blood Administration Monitoring Monitor for Complications
Febrile reactions
Hemolytic reactions
Anaphylaxis Shock
Circulatory overload- Too much blood
Death
Febrile reactions
Increase in temp, shaking, chills, HA, back pain
Hemolytic reactions
Back pain, chest pain chills, fever, SOB, N/V, impending doom
Shock, hypotension, oliguria, decreased LOC
Circulatory overload- Too much blood
Chest pain, cough, frothy sputum, distended neck veins, crackles, wheezes, tachycardia
Verify Name, DOB, Allergies compare with order, armband, blood bag
Blood transfusion
Blood label
Check compatibility
Blood transfusion
Verify number of bag and order
Verify blood group
Blood transfusion
Deficiency in iron
Iron Deficiency Anemia Pathophysiology
Due to malabsorption (GI surgery, Gastric bypass)
Iron Deficiency Anemia Pathophysiology
Body loses healthy RBC due to Poor consumption of iron nutrients= deficiency
Iron Deficiency Anemia Pathophysiology
Excessive blood loss due to dialysis
Iron Deficiency Anemia Pathophysiology
Childbearing year women have problems getting iron in their blood.
Iron Deficiency Anemia Pathophysiology
Lack of stomach acid cannot absorb iron
Iron Deficiency Anemia Pathophysiology
Indigestion of Lead, Iron and lead compete for the cells in the body. Competition. Can get lead from water.
Iron Deficiency Anemia Pathophysiology
Iron Deficiency Anemia S/Sx
Pallor, Tachypnea, Tachycardia, SOB, Fissures in corner of mouth, Glossitis- inflammation of the tonuge, Spoon shape finger nails
Iron Deficiency Anemia Diagnostics-
Blood work, CBC- RBC, WBC
Hemoglobin (12-18)
Hematocrit (37-52)
Serum iron
Ferritin
Total Iron binding capacity (TIBC)
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.
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
Iron Deficiency Anemia Severe Medications
Blood transfusion
Iron Deficiency Anemia Caused by Peptic ulcer Med
antibiotics
Iron Deficiency Anemia Caused by Heavy menstrual periods Med
Oral contraceptives
Iron Deficiency Anemia Med if too much iron
Deferoxamine Mesylate (Deferral)
Anemia Etiology
Impaired production
Impaired production disorder
Iron Deficiency Anemia
Iron Deficiency Anemia Labs/ Diagnosis
Serum iron level, & transferrin saturation (diagnosis)
Increased TIBC
Decreased Hgb, Hct
Microcytic RBCs
Serum iron level, & transferrin saturation (diagnosis)- S/Sx
Glossitis
Cheilitis (inflamed lips)
Headache
Paresthesia
Decreased Hgb and Hct conceptual concern
O2
Decreased Hgb and Hct S/Sx
Anemia S/Sx
Iron Deficiency Anemia Etology
Malabsorption
Dialysis
Lead ingestion
Blood loss
Inadequate dietary intake
Malabsorption, Lead ingestion, Blood loss Intervention
Eliminate cause
Inadequate dietary intake Intervention
Meat, fish,& poultry = (Med) Vitamin C
Inadequate dietary intake Conceptual Concern
Nutrition = (Med) Iron Supplements
Vitamin C Education
EDUCATION: Take iron 1 hr ac, with Vit. C
GI side effects
Microcytic rbcs-
little blood cells
Consume Beans, green leafy veggies, meat, fish, poultry, iron supplements- Iron
Citrus- Vitamin C
Iron deficiency Anemia
High iron capacity = but not getting it, need more iron
Iron deficiency Anemia
Low iron capacity= GI absorption
Iron deficiency Anemia
Cirrhosis = low values of TIBC
Iron deficiency Anemia
Screen at 12-month well check
Pediatric Specifics for Iron deficiency anemia
More common with cow’s milk, use iron-fortified formula
Pediatric Specifics for Iron deficiency anemia
S/sx: irritability, anorexia, tachycardia, murmur, poor muscle tone, porcelain like skin, edematous, retarded growth, delayed learning
Pediatric Specifics for Iron deficiency anemia
Absorb lead more readily = lead poisoning (hyperactivity, impulsiveness, lethargy, irritability, hearing impairment, learning difficulties.
Pediatric Specifics for Iron deficiency anemia
Iron Deficient Anemia S/Sx
Cheilitis
Glossitis
Macrocytic Anemias
Folic Acid Deficiency & Pernicious Anemia
Folic Acid Deficiency & Pernicious Anemia Patho/Etiology
RBC= bigger
Don’t have nutrients to function
drug or alcohol use
Folic acid deficiency Patho/Etiology
Pernicious anemia Patho/Etiology
low extrinsic factor= glycoprotein in stomach which helps with absorption of b 12
Folic Acid Deficiency & Pernicious Anemia Signs/Symptoms
Pallor, fatigue, tachycardia, tachypnea, SOB
Folic Acid Deficiency & Pernicious Anemia Diagnostics-
CBC, B12, Folic acid levels (1.8-9 folic acid range)
Folic Acid Deficiency Interventions-
Teach to increase liver, egg, legumes for folic acid intake
Pernicious anemia Intervention-
increase meat, poultry, fish, egg, soy beans, peanuts, lentils, fortified cereals, milk
Folic Acid Deficiency & Pernicious anemia Medications-
Vitamin b 12, folic acid PO or IM
Impaired production disorders
Folic Acid Deficiency Anemia & Pernicious anemia
Pernicious anemia Etiology
GI surgery /diseases
Deficient intrinsic factor
Vegetarian
Deficient intrinsic factor Labs/Diagnostics
Intrinsic Factor Antibody
Schilling test- Vitamin B12 absorption test
Pernicious Anemia (B12 Deficient)
Cobalamin injections
Pernicious Anemia (B12 Deficient) Labs/Diagnostics
Decreased Hgb & Hct
Decreased B12
Increased MMA
Macrocytic
Decreased Hgb and Hct S/Sx
General S/SX of anemia
Decreased Hgb and Hct Conceptual Concerns
O2
Decreased B12 and Increased MMA S/Sx
Anorexia, N/V, abdominal pain
Sore Beefy red tongue
Numbness of hand and feet
Numbness of hand and feet Conceptual Concerns
Safety
Decreased B12 and Increased MMA and Anorexia, N/V, abdominal pain Conceptual Concerns
Nutrition
Decreased B12 and Increased MMA Interventions
Meat, fish, shellfish, poultry, eggs, dairy products, soy milk, tofu, breakfast cereals
Folic Acid Deficiency anemia Etiology Drugs and
Alcohol
Folic Acid Deficiency anemia Labs/Diagnostics
Decreased Folate Level
Decreased Folate Level Medications
Folate PO
Decreased Folate Level Interventions
Fortified flours, grains, cereals, wheat germ, liver, eggs, green leafy vegetables, legumes, bananas and oranges.
Craving for clay or dirt low
b12
Surgeries or GI problems- Pernicious Anemia
B12 Deficient
Evaluate b12 absorption-
Schilling test
Aplastic Anemia / Pancytopenia Patho/Etiology
Bone marrow is pale, fatty and fibrous.
Bone marrow forms RBCs.
Decrease of hemoglobin and hematocrit WBCs and platelets.
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
Aplastic Anemia / Pancytopenia Diagnostics
CBC w/ diff- looks at each WBC and RBCs. Bone marrow biopsy. Iron levels, TIBC serum
Aplastic Anemia / Pancytopenia Intervention
Immunosuppressive medications.
Educate to avoid exposure to sick people.
Blood transfusions.
Bone marrow transplant- severe
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
Anemia Etology = Impaired production DIsorder =
Aplastic Anemia
Aplastic Anemia Etology
Fatty Bone Marrow (fibrous)
Fatty Bone Marrow (fibrous) Etiology
Decreased cell production
Fatty Bone Marrow (fibrous) Labs/Diagnostics
Bone marrow biopsy
Fatty Bone Marrow (fibrous) Intervention
Bone marrow transplantation
Fatty Bone Marrow (fibrous) Medication
Steriods
Decreased cell production Disorder
Pancytopenia
Pancytopenia Labs/Diagnosis
Decreased Platelets, WBCs, RBCs, Hgb, Hct
Decreased Platelets Intervention
Platelet transfusion
Decreased Platelets S/Sx
Petechiae, Ecchymosis, Bleeding
Bleeding Interventions
Bleeding prevention/precautions
Bleeding conceptual concern
Clotting
Decreased WBC Intervention
Infection prevention
Decreased WBC Conceptual concern
Infection
Decreased RBCs, Hgb, Hct S/Sx
General S/SX of anemia
Tachycardia / Heart Failure
Decreased RBCs, Hgb, Hct Intervention
Packed RBC Transfusion
Decreased RBCs, Hgb, Hct Conceptual concern
O2
Aplastic Anemia Conceptual concern
Perfusion
TIBC increase due to overabundance of iron. Cells cannot use it
Aplastic Anemia
Infection- educate about wearing a mask
Aplastic Anemia
Bleeding- prevent falls, clots, injection careful
Aplastic Anemia
Notify provider for bleeding, teach patient
Aplastic Anemia
Pressure dressing for bleeding
Bone Marrow Biopsy
Consent paperwork before procedure and they can change their mind last minute
Bone Marrow Biopsy
Posterior ileac crest-
Bone Marrow Biopsy
Lie down 30 mins to an hour to control bleeding after
Bone Marrow Biopsy
Monitory BP, if drops look at the site
Bone Marrow Biopsy
Left side most of the time, recovery position. Post op
Left side = 2 lobes and right side 3 lobes for lungs
Bone Marrow Biopsy
Inherited, crescent shape.
Sickle Cell Anemia Patho/Etiology
Changes shape bc the organism Is sensitive to O2 changes.
Sickle Cell Anemia Patho/Etiology
The cells get destroyed or misshapen.
Sickle Cell Anemia Patho/Etiology
Break easily causing clumping congestion and clotting.
Very Painful
Sickle Cell Anemia Patho/Etiology
Leave up to 180 days but for this 10-12 days.
Sickle Cell Anemia Patho/Etiology
Due to autosomal recessive in both parents.
Sickle Cell Anemia Patho/Etiology
USA seen more in African, Mediterranean, Hispanic-Americans
Sickle Cell Anemia Patho/Etiology
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
Sickle Cell Anemia S/Sx
Sluggish blood flow, pallor, fatigue, tachypnea, pain swelling in joints, jaundice, priapism- erection more than 4 hours
Sickle Cell Anemia Diagnostics
CBC diff, hemoglobin levels, sickle dexterity test screening
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
Sickle Cell Anemia Medications
Pain med during crisis (narcotics),
Folic acid supplements
Glutamine
Sickle Cell Anemia Etiology
Autosomal Recessive Disorder
Sickle Cell Crisis
Pneumonia, cold, Diabetic Acidosis, infection, etc.
Sickle Cell Anemia Labs/Diagnostics
Decreased RBC, Hgb, Hct
Decreased RBC, Hgb, Hct S/Sx
General S/SX of anemia
Sickle Cell Crisis Intervention
Educate on Crisis Prevention
Sickle Cell Anemia Labs/Diagnostics
Sickle Dexterity
Decreased ESR
Pneumonia, cold, Diabetic Acidosis, infection, etc. Labs/Diagnostics
Increased WBC
Pneumonia, cold, Diabetic Acidosis, infection, etc. Intervention
Antibiotics
Pneumonia, cold, Diabetic Acidosis, infection, etc. Etiology
O2 drop = sickle shape
O2 drop = sickle shape S/Sx
Hypoxia
Hypoxia Intervention
O2 Therapy
Hypoxia and O2 drop = sickle shape Conceptual concern
O2
O2 drop = sickle shape Labs/Diagnostics
Hgb Electrophoresis
O2 drop = sickle shape Conceptual concern
Perfusion and Clotting
Clotting Intervention
Assess circulation Q2H
O2 drop = sickle shape Etiology
Sickled cells break/get stuck
Sickled cells break/get stuck S/Sx
Jaundice, Pain and swelling in joints, Priapism, Sluggish flow
Pain and swelling in joints intervention
Pain management
Pain management conceptual concern
Comfort / Pain
Sluggish flow Intervention
IV fluids
Sickle Cell Anemia Pediatric
Asymptomatic until 4-6 months
Normal RBC section
Normal hemoglobin
Abnormal sickle red blood cell section
Abnormal hemoglobin form strands that cause sickle shape
Poly = many
Polycythemia Patho/Etiology
Genetic mutation
Polycythemia Patho/Etiology
Polycythemia vera is the most serious form
Polycythemia Patho/Etiology
Amyloses is another word for polycythemia
Polycythemia Patho/Etiology
Viscosity in the blood and hypervolemia concern
Polycythemia Patho/Etiology
Complain of head aches
Polycythemia S/Sx
Higher risk for clots
Polycythemia S/Sx
Sluggish blood flow
Polycythemia S/Sx
Hypertension
Polycythemia S/Sx
Vision changes
Polycythemia S/Sx
Nose bleeds
Polycythemia S/Sx
Gum bleeds
Polycythemia S/Sx
Retinal hemorrhage
Polycythemia S/Sx
Difficulty breathing with little excretion and chest pain.
Polycythemia S/Sx
increased RBCs more than 6 million
Polycythemia Diagnostics
hemoglobin high 18 or more
Polycythemia Diagnostics
Hct 55% or more
Polycythemia Diagnostics
immature WBC high 10,000 or more
Polycythemia Diagnostics
Increased platelets
Polycythemia Diagnostics
Chest xray, ct scan, ABGs, CBCs, Sputum analysis if cough present, bone marrow aspiration
Polycythemia Diagnostics
Donating blood, therapeutic phlebotomy.
Polycythemia Interventions
If on bed rest still promote movement (passive rom), elevating legs,
Polycythemia Interventions
Avoid restrictive clothing, small meals
Polycythemia Interventions
Platelets lowers and hypovolemia risk. IV fluids or hydrations help with hypovolemia (3L of water)
Polycythemia Interventions
Decrease amount of RBCs- Interferon alfa 2b, hydroxyurea
Polycythemia Medications
Anticoagulants- aspirin if too many platelets
Polycythemia Medications
Chemo therapy to decrease WBCs
Polycythemia Medications
Polycythemia Vera
(primary polycythemia) disorder
Panmyelosis
Panmyelosis S/Sx
Hypervolemia/ hyper viscosity
Hypervolemia/ hyper viscosity Interventions
Drink at least 3 L of water/day
Hypervolemia/ hyper viscosity S/Sx
Headache, Sluggish blood flow, HTN
HTN S/Sx
Vision Changes
Nosebleeds, bleeding gums, retinal hemorrhages, exertional dyspnea, chest pain
HTN conceptual concern
Perfusion and Clotting
Polycythemia Vera
(primary polycythemia)
Labs/diagnostics
Increased platelets and WBCs
Bone marrow aspiration
RBCs >6 million
Hgb >18mg/dL
Hct >55%
Increased platelets interventions
Thrombosis prevention
Increased platelets Medications
Anticoagulants/Antiplatelet, Low dose aspirin, Chemo agents
Increased platelets conceptual concern
Clotting and Perfusion
Increased WBC medications
Chemo agents
RBCs >6 million
Hgb >18mg/dL
Hct >55%
S/Sx
Enlarged liver/spleen
Abdominal pain, fullness
Abdominal pain, fullness interventions
Several small meals
RBCs >6 million
Hgb >18mg/dL
Hct >55%
Interventions
Therapeutic phlebotomy, education
Polycythemia Vera
(primary polycythemia)
Etiology
Genetic mutation
Genetic mutation disorder
Polycythemia
Polycythemia etiology
chronic hypoxia
chronic hypoxia disorder
Secondary polycythemia
Secondary polycythemia labs/diagnostics
Increased RBCs
Thrombo= blood clots together, low number of platelets.
Thrombocytopenia Patho/Etiology
Destroyed within the spleen = platelets, put on steroid.
Thrombocytopenia Patho/Etiology
Viral illness, drug induced, due to pregnancy.
Thrombocytopenia Patho/Etiology
Heparin, lovenox, and chemotherapy meds can cause
Thrombocytopenia Patho/Etiology
Ecchymosis, petechiae. If pt difficult to arouse- may have brain bleed
Thrombocytopenia S/Sx
Decreased number of platelets= 20,000 or less
Thrombocytopenia labs/diagnostics
Bleeding precautions, educate to watch for s/sx of bleeding when brushing teeth.
Thrombocytopenia interventions
Avoid trauma and restrict activities during episodes.
Thrombocytopenia interventions
If they give blood for lab work watch the site.
Thrombocytopenia interventions
If pt is not responding to meds, spleen may need to be removed.
Thrombocytopenia interventions
Acute episodes- steroids (platelets destroyed easily)
Thrombocytopenia Medications
Chemotherapy-immunoglobulin, blood transfusions, platelets transfusion and vitamin K.
Thrombocytopenia Medications
If pt goes to the dentist may stay longer bc of bleeding
Thrombocytopenia
Thrombocytopenia (ITP) Etiology
Viral illness, Drug induced, Pregnancy, Platelet Destruction
Drug induced Medications
Heparin, Lovenox, Chemotherapy
Platelet Destruction type of disorder
Hemorrhagic disorder
Platelet Destruction medications
Steriods
Thrombocytopenia (ITP) Labs/Diagnostics
Platelets <20,000/mm^2
Platelets <20,000/mm^2 S/Sx
Petechiae, Bleeding, Ecchymosis
Bleeding interventions
Vitamin K, Blood transfusion, Platelet transfusion
Platelets <20,000/mm^2 interventions
Spleenectomy, Prevent bleeding
Platelets <20,000/mm^2 conceptual concern
Clotting
Inherited bleeding disorders in which the blood does not clot properly.
Hemophilia Patho/Etiology
Makes few platelets or destroyed within spleen- thrombo.
Hemophilia Patho/Etiology
Hemophilia A=
classic, lack or decrease of clotting factor A.
Hemophilia B is also called-
lack or decrease of clotting factor IX
Gene on the X chromosome, more common in males, can happen in any ethnicity and race
Hemophilia Etiology
Any injury that results in bleeding.
Hemophilia S/Sx
Bleeding into the muscles and joint= common w acute pain.
Hemophilia S/Sx
Deformities caused by bleeding
Hemophilia S/Sx
Bleeding in gums, under skin, nose bleeds
Hemophilia S/Sx
CBC, hemoglobin, RBCs, = Low. PTT and PT= prolonged, more seconds.
Hemophilia Diagnostics
DNA genetic testing.
Hemophilia Diagnostics
Commonly passed from parents. Blood drawn from sample of umbilical cord if mother has hemophilia
Hemophilia Diagnostics
Icepack for bleeding in joints 24-48 hrs.
Hemophilia Interventions
Missing clotting factors= blood transfusions (uncommon).
Hemophilia Interventions
Severe= prophylactic to prevent bleeding.
Hemophilia Interventions
Vital sings, monitor H&H. prevent hypovolemic shock.
Hemophilia Interventions
Pain=IV or PO narcotics. Keep pt safe. Be cautious with children bc of bleeding.
Hemophilia Interventions
If mild- injection or nasal inhalation vasopressin= stimulate body to release more clotting factors.
Hemophilia Medications
Severe= factor A for A and factor IX for hemophilia B.
Hemophilia Medications
Emicizumab(hemlibra)- prevent bleeding for hemophiliac A.
Hemophilia Medications
antifibrinolytics- does not dissolve clots (preserves the clots)
Hemophilia Medications
Hemorrhagic disorders etiology
Clotting factor deficiency
Clotting factor deficiency disorders
Von Willebrand’s and Hemophilia
Von Willebrand’s etiology
Deficient von Willebrand factor
Deficient von Willebrand factor intervention
Factor VWB transfusion
Von Willebrand’s medication
Desmopressin
Hemophilia disorders
Hemophilia A (classic hemophilia)
Hemophilia B (Christmas Disease)
Hemophilia A (classic hemophilia) medications
Desmopressin
Hemophilia A (classic hemophilia) etiology
Factor VIII (8) Deficiency, X-linked recessive trait
Factor VIII (8) Deficiency Labs/Diagnostics
decreased factor VIII
decreased factor VIII Interventions
Factor VIII transfusion
Hemophilia intervention
prevent bleeding
Hemophilia labs/diagnostics
Prolonged PTT
Factor IX (9) Deficiency labs/diagnostics
decreased Factor IX
decreased Factor IX interventions
Factor IX transfusion
Hemophilia S/Sx
Bleeding, Hemarthrosis, Pain
Hemophilia conceptual concern
clotting
Prevent injury
Children- have supervision, helmets
Hemophilia
Disorder that effects WBCs, malignant disease.
Leukemia Patho/Etiology
Cancer found in the blood and bone marrow= patho.
Leukemia Patho/Etiology
Caused by rapid production of normal WBCs.
Leukemia Patho/Etiology
WBCs are abnormal so they cannot fight infections.
Leukemia Patho/Etiology
Leukemia Acute=
lymphocytic leukemia
acute myelogenous leukemia (AML)
chronic lymphocytic leukemia (ALL)
chronic myelogenous leukemia (CML)
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
Acute or Chronic. Bone marrow problem producing WBCs.
Leukemia Patho/Etiology
Aspiration biopsy-
liquid out of bone marrow and spongy part.
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
If leukemia invaded CNS patient may experience confusion, headaches, personality changes.
Leukemia S/Sx
Immature WBCs= high
Leukemia Diagnostics
Pale, lymph nodes enlarged, liver enlarged, WBCs, CBC w/ diff, RBC’s low, platelets low.
Leukemia Diagnostics
If have leukemia can have combination of blood disorders. If seen petechiae notify doctor.
Leukemia S/Sx
If ecchymosis or petechia results of thrombocytopenia.
Leukemia S/Sx
Mature WBCs= low
Leukemia Diagnostics
Shift to the left=
immature WBCs
Neutropenic precautions
Leukemia Interventions
Discharge education: pt have to wear mask at home.
Leukemia Interventions
Monitor blood work, WBCs. S/Sx of bleeding.
Leukemia Interventions
Temperature is huge concern. If low fever- let doc know >99 degrees.
Leukemia Interventions
Chemotherapy, radiation, bone marrow transplant, Tylenol, steroids, analgesic opioids, antiemetics for nausea, sedatives
Leukemia Medications
Leukemia Priority-
protect from illness. Pay attention to fevers.
Leukemia Conceptual factors:
gas exchange, clotting- bone marrow producing all cells, infection
WBC disorder
Leukemia
Leukemia Labs/diagnostics
Decreased RBCs
Decreased RBCs disorder
Anemia
Anemia S/Sx
general S/Sx of anemia
Anemia conceptual concern
O2
Leukemia etiology
Malignant disease
Leukemia Malignant disease interventions
Radication
Leukemia Malignant disease medications
Chemo agents
Leukemia Malignant disease labs/diagnostics
Decreased platelets, Increased immature WBCs, Decreased Mature WBCs
decreased platelets conceptual concern
clotting
decreased platelets S/Sx
Thrombocytopenia S/Sx
Thrombocytopenia S/Sx interventions
monitor for s/sx of bleeding
Increased immature WBCs S/Sx
Low grade fever, Bone marrow crowding
Bone marrow crowding S/Sx
Sternal and rib pain
Bone marrow crowding labs/diagnostics
Bone Marrow Aspiration
Bone marrow crowding interventions
Bone marrow transplant
Decrease in mature WBCs conceptual concern
Infection
Infection interventions
Vitals Q4H, Monitory for s/sx of infection and neutropenic precautions
Neutropenic precautions=
avoid people with active vaccines
Neutropenia
Neutropenia Patho/Etiology
Low number for circulating neutrophils in the blood.
Neutropenia Patho/Etiology
Due to genetic conditions, infection, cancer, leukemia, lymphoma
Neutropenia Patho/Etiology
Due to some meds: chemoradiation, nutritional deficiencies (B12, folate, copper) or autoimmune disease.
Neutropenia Patho/Etiology
Fever > 103 degrees.
Neutropenia S/Sx
Fatigue, trouble breathing, chills, new or worsening cough, sore throat,
Neutropenia S/Sx
stiff neck, swollen lymph nodes, ulcers in mouth, abscesses, diarrhea.
Neutropenia S/Sx
CBC w/ diff, consequence of another illness,
Neutropenia Diagnostics
Monitor for s/sx for infection and fevers. Pts can become septic
Neutropenia Intervention
Antibiotics, antifungals, bone marrow stimulants- neupogen.
Neutropenia Medication
WBC disorder
Neutropenia
Neutropenia Etiology
Bone marrow damage, Infection, Medications
Bone marrow damage, infection, medications labs/diagnostics
Decreased neutrophils
Neutropenia Infection Medications
Antibiotics/Antifungals
Neutropenia Medication caused medications for it
Chemo agents
Decreased neutrophils medications
Bone Marrow Stimulants (Neupogen/ Filgrastim)
Decreased neutrophils conceptual concern
infection
Infection interventions
Monitor for s/sx of infection
Vitals Q4H
Infection S/Sx
Low grade fever
