Symptom Management Flashcards
Hematologic alterations (3)
Anemia
Neutropenia
Thrombocytopenia
Pathophysiology of anemia (3)
Increased destruction of RBC
Decreased production of RBC
Blood volume loss
Causes of anemia (4)
Frank bleeding
Renal insufficiency
Hemolysis
Anemia of chronic disease
Anemia of Cancer
1) Suppression of _______
2) _____ production that kills rbcs prematurely
3) Tumors may cause chronic blood ____directly or change _____
4) Chemo/RT causes _____, or decreased production of ____ by kidneys
1) hematopoiesis
2) Cytokine
4) loss, coagulation
5) myelosuppression, erythropoietin
First subtle changes of Anemia
Decreased activity tolerance
Mild SOB/SOB on exertion
Fatigue
Cardiovascular effects of Anemia
Bruits, Murmurs, Tachycardia, Dysrhythmias, Postural Hypotension
Less rbcs in blood -> blood flows more aggressively, less viscosity
Pulmonary effects of Anemia
Dyspnea at rest
Hypoxia
Tachypnea
Pulmonary edema
Genitourinary effects of Anemia
Water retention
Menorrhagia
Amenorrhea
Proteinuria
CNS effects of Anemia
HA, Dizziness Confusion Inability to concentrate Irritability Weakness Retinal hemorrhage Loss of sensation
GI effects of Anemia
Indigestion Decreased motility/constipation Ascities Stomatitis Hepatosplenomegaly Blood loss
Musculoskeletal effects of Anemia
Bone pain
Integumentary effects of Anemia
Pallid skin Poor skin turgor Hair loss Brittle nails Ecchymosis Poor wound healing Cyanosis Hypothermia Edema
Grades of Anemia
Grade 1 (mild) = Grade 2 (moderate) = Grade 3 (severe) = Grade 4 = Grade 5 =
Hb 10g/dl (lower limit of normal Hb 8-10 Hb 6.5-8 Life threatening Death
Tx for Anemia (3)
RBC transfusion
Erythropoietic therapy
Iron (Ferritin) level monitoring
RBC transfusion show increased risk for?
Venous and arterial thromboembolism
Erythropoietic therapy
Types (2)
Black box warning =
Epoetin alfa
Darbepoetin alfa
Should only be used for chemo induced anemia and dc’d once chemo is complete
Iron deficiency defined as
Ferritin level < Transferrin saturation (TSAT) <
30ng/dl
20%
Neutropenia =
Decrease in # of circulating neutrophils
Causes of neutropenia (3)
1) Abnormal neutrophil production or function
2) Infection
3) SE of drug
Absolute neutrophil count =
Represents number of mature white blood cells in the peripheral circulation
Neutropenia is an ANC < _____
<500
or <1,000 with predicted decline to <500 in next 48 hours
Formula to calculate ANC =
%neutrophils (band and segments) x WBC
Patho of Neutropenia
1) Neutrophils are the most common type of _____ (a subtype of WBC)
2) Neutrophils are the ___ to respond to ____
3) Takes __-__ days to produce neutrophils in bone marrow
4) They only live _- _ hours once released into circulation therefore are in ___ production in bone marrow
1) Granulocyte
2) first, infection
3) 10-14
4) 4-8, constant
Neutropenia
Early infections =
Later infections with chronic neutropenia =
Bacterial
Fungal