π§πΎ- Respiratory & Hematology Test Flashcards
WBC (leukocytes)
Regulated by tissue damage
Normal range 4.5 - 13.5
Fights infection
WBC differential count
- neutrophils (54-62%) (bacteria)
- bands (immature neutrophils) (3-5%) leukemia
- eosinophils (1-3%) (allergies, parasites, cancers)
- basophils (0-0.1%) (healing tissues)
- lymphocytes (25-33%) (chronic inflammation)
- monocytes (3-7%) (early inflammation)
Shift to the left
More bands (immature or baby neutrophils, donβt fight infection) in circulation than there are segs (mature or grownup neutrophils)
Platelets
Function: clot formation
Normal range: 150-400
Life span 8-10 days
Who is most at risk for Fe deficiency anemia
Cause- inadequate Fe in diet
At risk-
Premature due to maternal Fe stores depleted to quickly
12-36 month olds due to whole milk intake with zero sources of Fe
Adolescents due to inadequate diet, growth spurts, menses
Infant feeding and Fe
Breast fed- Fe supplements by FOUR months
Premature - Fe supplements by TWO months of age
**give Fe on an acid stomach /between feedings or with vitamin C **
What should you educate the family on with Fe deficiency anemia and supplements
- Fe will turn stools greenish black color
- can stain teeth (use straw, brush after)
- milk babies are overweight due to increased whole milk consumption thatβs a poor source of Fe and causes increased fecal blood loss
What is the patho of Sickle cell anemia
AUTOSOMAL RECESSIVE DISORDER
- normal HgA is replaced with HgS
- sickling occurs with low O2
- sickled RBC are fragile and rapidly destroy
anemia results when rate of destruction is greater than production
What does autosomal recessive mean
Meaning 2 copies of an abnormal gene must be present from mom and dad to develop disease
Causes of sickling RBCs
Low O2
Dehydration
Strenuous exercise, infections, fever, anemia, high altitudes, underwater swimming, non-pressurized flights, stress, anesthesia
Vaso-occlusive crisis /hand foot syndrome
Obstruction of blood vessels and causes distal ischemia
Most common in small vessels but can occur ANYWHERE in the body
Presents as hand foot syndrome and is most common in 6months -2yrs
Sickle crisis occurs in what parts of the body
Chest - acute chest syndrome
Heart - heart attack
Brain - stroke
Liver - jaundice
Kidney - failure
Eyes - blindness
Abdomen - obstruction
Penis - priapism
Symptoms of a sickle crisis
Pain in abd, legs , arms, hands , etc
Swelling of joints
Fever
Pallor
Weakness
Jaundice
Enlarged spleen
Diagnostic evaluation of sickle cell
Sickle - turbidity (sickledex): simple blood test that doesnβt differentiate between trait or disease
HgB electrophoresis: differentiates between trait and disease , βfinger printingβ of protein
Care of a sickle cell client
Prevent sickling
Promote adequate O2
Maintain hemodilution
Penicillin phrophaxis by 2 months old
Meningococcal vaccine (MCV4)
What is to be expected to be seen in clients with sickle cell
Growth delays, delayed sexual maturation and very susceptible to sepsis
Treatment of sickle cell crisis
- bedrest
- hydration (100-125ml/kg/DAY)
- opioid analgesics (morphine)
- NSAIDS (ibuprofen and ketorolac)
- electrolyte replacement
- HEAT APPLICATION ! NO ICE = SLOWS CIRCULATION
- antibiotics
- daily folic acid
- hydroxyurea
- blood transfusions
- allogenic hematopoietic stem cell transplant
Cause of death with sickle cell
Infections causing severe sickling
Patho of beta thalassemia (Cooley anemia)
AUTOSOMAL RECESSIVE DISORDER
- disease causes deficiency in synthesis of beta chains
- leads to destruction of RBCβs
This destruction causes anemia
Diagnosis of beta thalassemia
- hemoglobin electrophoresis
- increased RBC with decreased HgB & Hct
Signs and symptoms of beta thalassemia
Mediterranean decent , anemia , fever , poor feeding , enlarged spleen AND liver , headache , bone pain , exercise intolerance , delayed growth and sexual maturation
Treatment of beta thalassemia
Blood transfusions (goal to keep HgB above 9.5 g/dl)
Treat for Fe overload (chelating therapy)
Stem cell transplant
Hemosiderosis
Fe overload
Nursing care for beta thalassemia
Administer blood
Death is caused by heart failure related to severe anemia
Signs of acute chest syndrome
Severe chest, back or abd pain
Fever of 38.5βC (101.3βF) or higher
Cough
Dyspnea , tachypnea
Retractions
Declining oxygen saturation
Signs of cerebrovascular accident (CVA) or stroke
Severe, unrelieved headaches
Severe vomiting
Jerking or twitching of the face, legs or arms
Seizures
Strange, abnormal behavior
Inability to move an arm or leg
Stagger or an unsteady walk
Stutter or slurred speech
Weakness in the hand, foot, or leg
Changes in vision
Hemophilia
Disturbance in blood clotting factors VIII & IX
X-LINKED RECESSIVE DISORDER
Transmitted by mom to sons
What is x-linked recessive disorder
Donβt have to have a strand from mom and dad (2) to have the disease
Name 2 complications of hemophilia
Hemorrhage
Hemarthrosis (bleeding into joint spaces of knee , ankle , elbow leading to impaired mobility)
Hemophilia labs
PT should be normal
Measures platelet and fibrinogen , anticoagulation therapy
PTT is prolonged
Measures all clotting factors
Nursing care and treatment of hemophilia
- replace missing factor
- corticosteroids (reduces inflammation)
- NSAIDS (no asprin)
- DDAVP (synthetic vasopressin, increases plasma factor VIII)
- PT (need regular exercise program to strength muscles around joints)
- avoid injections
- prenatal testing
What should the family be educated about hemophilia
Never USE ASPRIN
avoid contact sports
Oral care - soft tooth brush , water pick, toothetts
Electric razor
Medic alert tag
How do you treat bleeding at home in hemophilia
R rest (immobilize)
I ICE (NO HEAT)
C compression
E elevate (once bleeding stops active ROM)
Epitaxis
(Nose bleed)
Sit up and lean forward (no longer lean back)
Insert cotton in nostril
Apply pressure
APPLY ICE
cool mist humidifier
Frequent nose bleeds could mean what
Increased BP , leukemia or hemophilia
Signs and symptoms of HIV
Diffused lymphadenopathy (progressed)
Hepatosplenomegaly (90%)
Oral candidiasis & parotitis
Chronic diarrhea
FTT
developmental delays
Opportunistic infections
Signs and symptoms in newborns with maternal transmission
2-4 aids dysmorphic syndrome
Flattened nasal bridge
Short nose
Slanted eyes
Prominent triangular philtrum
Wide lips
Prominent forehead
Seroconvert and hiv
Seroconversion is the period of time during which HIV antibodies develop and become detectable.
Treatment of hiv
No cure
Supportive care
Prevent opportunistic infections (most common pneumocystis carinii pneumonia PCP)
Highly active antiretroviral therapy (HAART)
Gamma globulin
Blood transfusions
Monitor closely
Make sure to get base line VS (b4 starting blood) - VS q15 mins for 1 hr
Have NS ready / use blood filter set
Use blood within 30 min
Infuse 1 unit over 2-4 hrs
Signs of blood transfusions reactions
- sudden severe headache
- fever
- chills
- respiratory difficulty (wheezing, rales, dyspnea)
- chest pain
- nausea/vomiting
- changes in VS
- changes in behavior
- rash/hives
Treatment of blood transfusions reaction
Stop infusion
Take VS
Start NS with new tubing
Notify MD
save everything from infusion
Acute lymphatic leukemia
Most common
Best prognosis
80% survival rate
90% will go into remission
Onset= persistent cold
Signs and symptoms of leukemia
Cold fails to completely disappear
Pale, listless, irritable, febrile, anorexic
Decreased blood count
Increased blast cells (bands)
Diagnosis of leukemia
Assessment
Bone marrow aspiration= definitive diagnosis
Normal blast cells 1-5% - all > 25% blast cells in leukemia
Lumbar puncture: determines CNS involvement, protected by blood brain barrier
Induction therapy of leukemia
What role do corticosteroids and allopurinal play
Lasts 4-5 weeks
Chemotherapy
Corticosteroids: stimulates production of neutrophils, platelets and RBC / decrease inflammation / increases appetite
Allopurinal: prevents kidney damage from uric acid crystals
CNS prophylactic therapy
Kids with leukemia are at risk for invasion of the CNS by leukemic cells.
Intrathecal administration of Chemo drugs
Intrathecal= into the spinal column
Intensification therapy
Continued treatment to eradicate residual leukemic cells and prevent resistance
Phase II
Maintenance therapy
Maintains remission of leukemia
Continued treatment for 2-3 yrs
If myelosuppression is severe stop therapy (WBC count less than 1000)
Phase III
What is classified as leukemia remission
No clinical signs of cancer
Blast cells less than 5%
Collect bone marrow for possible BMT later
Two types of BMT
Allogenic: (most common) sibling or family member, must be a hystocompatible donor
Autologous: own marrow , must be in remission
Ablation therapy
Is a lethal dose of chemo/radiation that destroys cancer cells and normal immune system
Risk for rejection
Therefore itβs a life threatening procedure if BMT fails
What are the 2 sites of BMT
Posterior iliac crest and sternum
Nursing care for BMT
Monitor labs
Monitor infusion
Reverse isolation
Hematopoietic stem cell transplant HSCT
Used to transfer healthy cells
Harvested from : bone marrow, peripheral blood, umbilical blood from placenta
Potential nursing diagnosis for HSCT
Alteration in comfort
Impaired mobility
Potential for infection , hemorrhage
Alteration in mucosal membranes
Alteration in nutrition
Disturbance in self concept
Respiratory infections are mainly caused by viruses or bacteria
Viruses so no antibiotic cure
Tonsillitis vs adenoiditis
Enlarged tonsils cause difficulty swallowing & breathing
Enlarged adenoids obstruct nasal breathing and causes mouth breathing
Most serious complication: airway obstruction
What is the major complication of a tonsillectomy & adenoidectomy and how does it present
Hemorrhage
Signs and symptoms:
Frequent swallowing and clearing throat
Increased HR , decreased BP
Irritability & pallor
Vomiting bright red blood
Can occur up to 14 days post op
Post-op nursing care for T&A
Bed rest
Clear soft diet (no red drinks & no milk )
Cool mist therapy
Warm salt H2O gargles
Tylenol w/ codeine
Avoid coughing or blowing nose
Ice collar
Local anesthetic
Acute otitis media (AOM)
Follows an upper respiratory infection (cold)
Short and rapid onset w/ symptoms
Fever & otalgia (ear pain)
Otitis media w/ effusion (OME)
Fluid in the middle ear spaces without symptoms of infection
Cause: allergies
OM occurs most often between what ages
6 months - 2 years
5-6 years
Contributing factors of OM
2nd hand smoke
Day care attendance
Bottle fed infants