Test 2 Flashcards
CWCM stands for
Colour
Warmth
Circulation
Movement
taken w meals and then w vitamin c
Pyrosulfate supplement
can stain teeth - rinse mouth out after
Oral liquid iron
When taking supplements iron will be checked, ________ will be checked
When things are back to normal continue therapy for at least 2 months after normalized
hemoglobin
-B12 deficiency, folic acid deficiency
Cobalamin deficiency is the most common
Neurological, nerve, muscle problems
Can have upset stomach, nausea, abdominal discomfort, vomiting
High alcohol intake – absorption of B12 (substance use consideration)
Wounds that don’t heal, changes in neuro, muscle weakness, thinking process impaired
Megaloblastic anemia
Rare, autoimmune
Can lead to cobalamin deficiency
Middle age
Ethnic groups - African, northern European ancestry ++ impacted
Women more than men
Can often be more severe
Lack of intrinsic factor (IF) - protein needed for cobalamin absorption **
Pernicious anemia
People w ____ have increased risk of gastric cancer
anemia
need to be on supplements parenteral, intranasal because they can’t absorb it. Won’t cure will help w blood levels. As long as they use supplement - symptoms can be reversed. Neuro problems won’t be reversed if symptoms left untreated
Pernicious anemia
part of megaloblastic anemia, some links to other diseases and deformities - deficiency could be related to diet, absorption, alcohol use, medications
Folic acid
Normal ______ levels 11-57
folate
Some anti-seizure medications in particular affect absorption - Dilantin
Folic acid
Under production of RBC
Possible underlying conditions: Chronic renal problems, chronic liver disease - on going inflammation
Thyroid problems, chronic endocrine disease
Looking for: Serum folate, iron store, cobalamin levels
Best thing to do is treat the underlying cause
Anemia related to disease
Decrease in all blood cell types - RBC, WBC, and platelets
Potential cause: malfunctioning bone marrow - stem cell transplants, repressive therapy, bone marry transplants
Lots of things cause this - even radiation, chemical stuff, chromosomal problems
Can be abrupt or gradual development
Aplastic anemia
Identify and treat ____________: Important to do for all forms anemia
Underlying cause
Gradual development is often missed until symptoms are really pronounced
Symptoms will manifest as general symptoms of anemia (fatigue, heart has to work harder, SOB, WBC decrease, neutropenia, thrombocytopenia (platelets are really decreased)
Aplastic anemia (Gradual Development)
Low neutrophil count is at risk for infection
Low platelet count is at risk for bleeding
Watch for signs / symptoms of infection (fever, chills, decreased LOC)
Thrombocytopenia - red spot rash, easy bruising, bleeding gum & nose
Aplastic anemia
can be acute or chronic
Blood loss
Trauma, cuts, heavy periods
Anything where there is a lot of blood loss - loss of RBC - decreased available oxygen
Decreased RBC will not be reflected in labs right away - reflection of actual blood loss will happen with 2-3 days, because of volume
Volume of blood has also decreased - so it will be proportionate
Acute Blood Loss
Goal: prevent shock
Replace blood volume - stop the bleeding
Acute Blood Loss
Clinical signs are key - we need to pick up clinical signs quicker than 2-3 days in order to prevent bleeding out
Acute Blood Loss
HR increase
BP decrease
As we lose more blood LOC will change, pallor/grey (noticeable)
Clinical signs of shock (in acute blood loss)
Symptoms
Pain - volume of blood pushing organs with internal bleeding, pressing on nerves
Acute blood loss
Major complication of acute blood loss is ____
shock
Need to do some kind of volume replacement
May get packed red blood cells, may need supplemental iron
As soon as we notice increase HR and decrease BP - pt heading toward shock
Shock prevention (blood loss)
Lab work will reflect blood loss
Symptoms very similar to iron deficiency
Treated w iron supplements
Chronic blood loss
Hemorrhoids, menstrual bleeding, epistaxis - identify the source
Effects are related to iron stores
Chronic blood loss
Vitamin C helps w absorption
Changes stools - not like Malena
Liquid - rinse mouth out, take w a straw
Metallic taste in mouth
Foods high in - beans, lentils, spinach, red meat
Iron Supplements - pt teaching
Destruction of erythrocytes greater than production can be caused by:
Hereditary problem
External factors
Destruction of hemoglobin or RBC is the spleen - primary site of destruction
Splenomegaly
Inherited
Abnormal form of hemoglobin
Prevent organ damage from happening
Since hereditary found in early childhood
Predominantly African descent, east Indian, Arabian
Sickle cell disorder
Antibodies are destroying RBCs
Acquired hemolytic
Iron overload
Jaundice, abdominal pain
Hemochromatosis
Goal to get rid of iron
Donate blood
Hemochromatosis
Increased production increase amount of RBC, increases thickness/viscosity of blood
Causes an Increase hyper viscosity
Thicker blood
Need to decrease thickness - increase volume and decrease thickness, look at bone marrow activity
Circulation is impaired
Polycythemia
_________ changes associated with blood disorders:
Pallor (decreased hemoglobin, blood flow to the skin)
Jaundice (increase concentration of serum bilirubin)
Bilirubin can cause skin itching as a symptom
Eyes often show jaundice, bottom of feet, palms of hands - darker skin people
Pruritus’ (increase serum and skin bile salt concentrations)
Integumentary changes
_________ changes associated with blood disorders:
Can eventually result in heart failure
Edema
Manifesting cardiopulmonary change
Cardiopulmonary
Anemia is not a normal finding in _________:
Person will have symptoms, be exhausted
Nutritional deficiencies - fixed income
Worsening cardiovascular & pulmonary problems w anemia
Pallor, confusion, fatigue, trouble walking - increase risk of falls
older adults
Organs enlarge w organs not getting enough blood
sickle cell
Changes in ________:
Eyes can be very sensitive
Erectile dysfunction
circulation
Includes RBC, WBC and platelets
Follows what is being formed in that bone marrow
CBC
Size & volume of blood cells
MCV
Ratio between CBC and MCV
MCH
A decrease in _____ can increase risk of infection.
Neutrophils are important to look at to look at
WBC
Combined amount of iron w proteins in serum
Looking at status of what is being used and what is being stored
Serum Iron
One of the largest proteins that bonds w iron
With this one you will see a decrease in iron deficiency anemia and increase in megaloblastic
Transferrin
Platelets can be low do to virus, chronic disease
The lower this number is, the risk of bleeding
Pregnancy
Can be inherited, acquired, autoimmune, splenomegaly
Thrombocytopenia
low platelets
Thrombocytopenia
_____ disorders can be caused be cause production impaired, destruction, abnormal amount
Platelet
most common, destruction of circulating platelets
ITP (Immune thrombocytopenic purpura)
Platelets function normally till they get to spleen then the spleen mistakes them as foreign & destroys
Big goal: prevent bleeding
ITP (Immune thrombocytopenic purpura)
Platelets normally live 10 days, in _____ they live 3 days
ITP (Immune thrombocytopenic purpura)
Splenectomy is treatment, steroids in high dosages
More common
ITP (Immune thrombocytopenic purpura)
When platelet count is <____ × 109/L increase in internal bleeding
Headaches, stroke symptoms, eye sight changes, pain
150
Related to certain drugs
Not common but very serious
Increased agglutination - clotting is out of wack
Hemolytic anemia, neurological changes happening
Body will react - fever but no infection
TTP (Thrombotic thrombocytopenic purpura)
IS a medical emergency
TTP (Thrombotic thrombocytopenic purpura)
What classifies any thrombocytopenia is when platelet count drops below 150 × ____/L
109
Can start within a couple of days when someone starts on heparin
As early as 5 days
Person has a clot - shouldn’t have that with heparin
Heparin-Induced Thrombocytopenia
Pressuring about a clot, pulmonary problem
Should be zero
Measures fibrin
We would see an increase in this value w a pulmonary emboli
D-dimer
comparison of prothrombin time
INR
Genetic disorder
Defective/deficient in coagulation factor
Chronic illness
Symptoms can be mild/severe
Hemophilia
factor 8 has a problem
Hemophilia A
factor 9 has a problem
Hemophilia B
a bleeding disorder caused by the qualitative or quantitative deficiency of the pro-von Willebrand factor.
Von Willebrand’s disease
Pt needs to be educated
Preventing situations where it can be a problem
Symptoms can be mild/severe
Von Willebrand’s disease
Affected people may complain of excessive bruising, prolonged bleeding from mucosal surfaces, and prolonged bleeding after minor trauma.
Pallor, melena, hemoptysis, changes in Mental Status, headaches, joint pain, abdominal pains
Coagulation part - clots form - inhibits circulation
Von Willebrand’s disease
Bad thing to have, serious bleeding, serious clotting changes that can lead to severe hemorrhage
Always caused by something underlying
- If cause is not identified - person will die
Has to be diagnosed quickly
Bleeding, clotting (thrombotic manifestations)
Clots forming anywhere
Disseminated intravascular coagulation (DIC)
Decrease in WBC
Cancer of the blood (malignant)
Accumulation of dysfunctional cells
Bone marrow is being replaced w leukocytes that are not functional (proliferating leukocytes)
Fatal if untreated
Leukemia
Causes: chemicals, radiation, genetics, viral impact, chromosomal changes
Incidence increased in radiologists, or work in radiology
People who previously had chemo increased risk
Leukemia
Myelocytes, along with metamyelocytes and promyelocytes, are the precursors of neutrophils
High percentage of adult leukemia
Abnormal bleeding, lots of infection
Onset is abrupt
Mostly adults
AML - acute myelogenous leukemia
Most common in KIDS
20% adults
Abrupt onset of symptoms: fever, feeling sick, bleeding gums (more blood than usual - usually first sign)
ALL - Acute lymphocytic leukemia
Excess development of neoplastic granulocytes
Move into blood system, infiltrate liver, spleen
Start off more chronic then become more acute
CML - chronic misogynist leukemia
Associated w changes in genetic materials in chromosome 9 and 22
CML - chronic misogynist leukemia
Chronic phase can last for years and usually treated and well controlled - can sometimes go into remission
Often eventually progress to accelerated phase where it rapidly changes and needs aggressive treatment
CML - chronic misogynist leukemia
Mature appearing lymphocytes but functionally inactive
Common in adults
Increased risk of infection
Often disease of older people
Symptoms often related to bone marrow failure - everything is changes - thrombocytopenia, anemia, changes in WBC in production & functioning, organ enlargement, lymphopenia (enlarged lymph nodes), brain symptoms, bone pain
CLL - chronic lymphocytic leukemia
decrease in neutrophil counts
Neutropenia
lots of diff symptoms related to anemia, neutropenia, thrombocytopenia; diagnosed through bone marrow biopsy; seen in older peoples (over the age of 80); risk increases w age
Myelodysplastic syndrome (MDS)
Symptoms of bleeding, infection Labs: # of platelets are not functioning the way they should
Often diagnosed when someone is doing tests for anemia, then they do the bone marrow biopsy - more complicated at >80 yrs
Myelodysplastic syndrome (MDS)
Aggressiveness of treatment will match aggressiveness of disease
_______ prone to more side effects / complications for aggressive treatments
Older ppl
________ - cancer of the lymphocytes
- Starts in bone marrow
- Hodgkin’s lymphoma and Non-Hodgkin’s
Lymphomas
Increase in Reed Sternberg Cells - located in lymph nodes
Connection w Epstein bar virus, genetic predisposition, toxics (HIV)
Chemotherapy is done w this one
Nursing is based on management of problems that come up - like pain
Hodgkin’s
Originates outside the lymph nodes
People with this will have a progressive disease by the time it’s diagnosed meaning treatment has to be aggressive (chemo, biotherapy, radiation)
Non-Hodgkin’s
A type of non-Hodgkin’s lymphoma (NHL) that grows and spreads slowly.
Treatment is better
Indolent lymphoma
Slow and insidious
Seldom cured, remission can occur w not trace of illness
Life can be extended
Chemo is treatment
Involves bones
Bone breakdown
Multiple Myeloma
Increased filtering and capacity of circulating blood cells, which decreases amount of circulating blood cells (lol what)
Can palpate when it’s large
Sometimes you have abdominal pain / sometimes you don’t
When enlarged there is a risk of pain
Enlarged Spleen (splenomegaly)
Problems that occur w/ _______ problems:
Teaching signs and symptoms to the family as well when someone is in isolation
Impaired oral mucous membrane integrity - soft bristle toothbrush
Possible Nursing Diagnoses:
Knowledge deficit
Risk of bleeding
hematological
on an EKG is the top of the QRS
S1
on an EKG is the little T wave
S2
with this condition the U wave will be opposite direction on an EKG
Hypokalemia
baroreceptors, autonomic NS, ANS impact on heart & blood vessels, chemoreceptors, blood pressure
What regulates your cardiovascular system? ***
Kyphosis can affect placement of everything, making pumping action hard & breathing hard
Heart can enlarge, increased vascular rigidity due to this our heart’s ability to pump will increase/decrease
Ability to adapt to exercise not the same
Blood vessels - arterial stiffening
Age related - impacts blood vessels, heart
Dyspnea - is this respiratory or cardiac? Can be hard to tell w/ out diagnostics
Dizziness
Postural blood pressure changes (orthostatic hypertension/hypo?)
Claudication, erectile dysfunction is often present when there is a change in a males body, any vascular change - it is impacted
QRS can become widened - heart arrythmia problem, medications - need to be watched - regular EKG
Older adults
Objective data: vitals, chest exam, trunk-al obesity, cardiovascular system can impact way a person is thinking, Mental Status changes, confusion/fogginess
Older adults - important info
troponin, CK-MB, myoglobin
Cardiac biomarkers
big one, if MI occurs it is released, can be detected 4-6 hrs and lasts 14 hrs. Anyone who has chest pain they check this level
Troponin
creatine kinase, specific to the heart MB, elevated with any kind of injury, starts to rise anywhere between 3-6 hours, peaks 12-24 hours then goes down to baseline - has to be caught in that other time frame. Returns to baseline anywhere between 12-48 hours after MI
CK-MB
protein, comes from skeletal muscle, released whenever any kind of problem, cardiac marker but it is not specific to that
Myoglobin
released from atrium & ventricles, and released in endothelial cells (renal), used to distinguish SOB is respiratory / cardiac *
Cardiac natriuretic peptide markers
HDL, LVL, triglycerides, cholesterol is a lipid panel, often bound to proteins so sometimes call lipoproteins. Increased LDL and something risk of cardiovascular disease increased, increased HDL (protective cholesterol - gets rid of that cholesterol) the risk is lower
Serum lipids
another one that is done, inflammation in general, history of MI / chest pain they probably will have this elevated - but this alone is not enough to say it’s cardiac, but goes along w the package to support it, CRP increase can indicate further risk of cardiac problems in people w cardiac history
C reactive proteins
portion that is released w protein breakdown, at increased risk of Cardiovascular/peripheral vascular disease & stroke, can be monitored w history/family history of cardiac stuff. Tell tale sign
Homocysteine
associated phospholipase A2 - is an enzyme that is elevated when plaque in blood vessels
Lipoprotein
