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Medical Surgical II 229 > Week 02 > Flashcards

Week 02 Flashcards

Hematological Dysfunction/ Pharmacology

1
Q

functions of a healthy hematological system

A
  • transports: oxygen, CO2, nutrients, waste, electrolytes
  • maintains: intravascular volume, coagulates blood, combats infection
  • hematopoietic system: blood, spleen, kidneys, liver, bone marrow
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2
Q

components of blood

A

red blood cells, white blood cells, plasma, platelets

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3
Q

red blood cells

A

largest portion of blood cells, produces hemoglobin

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4
Q

white blood cells

A

functions towards inflammation and immunity

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5
Q

plasma

A

liquid portion divided by three types of protein
- albumin
- globulins
- fibrinogen

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6
Q

platelets

A

blood cells, formed in bone marrow and stick together to plug injured vessel wall

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7
Q

albumin

A

maintains osmotic pressure of the blood (keeps plasma from leaking into tissues)

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8
Q

globulins

A

transports antibodies and protects body from infection

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9
Q

fibrinogen

A

critical in the blood clotting process, forms fibrin

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10
Q

bone marrow

A
  • functional site of blood formation in adults and produces RBC
  • 2.5 billion RBC’s, 2.5 billion platelets, 1 billion WBC’s per kg are released daily from the bone marrow
  • red blood stem cells are the first produced as immature and unspecialized
  • committed stem cells are the next phase as a growth pathway is entered and cells specialized depending on the needs of the body
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11
Q

erythropoietin (EPO)

A
  • stimulates the bone marrow to increase RBC production
  • hormone make and released by the kidneys to stimulate production and maintenance of RBC’s
  • hypoxia stimulates EPO
  • high levels of EPO cause polycythemia (too many RBC’s)
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12
Q

polycythemia

A

too many RBC’s

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13
Q

erythropoiesis

A

the process of RBC production

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14
Q

how many days does RBC’s life cycle last

A

120 days

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15
Q

which organ produces erythropoietin

A

kidneys

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16
Q

what does hypoxia do to erythropoietin production

A

stimulates increased release of erythropoietin

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17
Q

what does hyperoxia do to erythropoietin production

A

slows down the release of erythropoietin

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18
Q

what nutrients are needed for erythropoiesis

A

protein, iron, folate, B12, niacin, vitamin C, vitamin E

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19
Q

role of the spleen

A
  • destroys old, imperfect RBC’s
  • breaks down hemoglobin
  • stores platelets
  • filters antigens
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20
Q

spleen is made up of

A

red pulp, white pulp, marginal pulp

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21
Q

what is red pulp

A

stores RBC and platelets

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22
Q

what is white pulp

A

stores WBC and antibody production

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23
Q

what is marginal pulp

A

contains the end of blood vessels

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24
Q

function of the liver

A
  • prothrombin and clotting factor production
  • assist in vitamin K formation of intestinal tract
  • stores large amounts of whole blood and blood cells
  • stores extra iron within the protein ferritin
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25
Q

what is vitamin K essential for

A

clotting factors VII, IX, X

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26
Q

hemostasis

A

arrest of bleeding

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27
Q

what does hemostasis do when injury occurs

A

starts via a multi-step process of clotting
- platelets aggregation with plug formation
- blood clotting cascade
- formation of a fibrin clot

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28
Q

clotting

A

cascade triggered by the formation of a platelet plug
- works like a landslide, hard to stop once started
- activated by two pathways: intrinsic and extrinsic

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29
Q

intrinsic pathway

A

internal vessel damage

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30
Q

extrinsic pathway

A

external damage to the vessel

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31
Q

when does vasoconstriction occur

A

after vessel injury

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32
Q

clotting cascade activation

A

platelet activation process > change in shape > binds to adhesive proteins (fibrinogen) > platelet recruitment

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33
Q

where are glycoproteins mostly made and responsible for

A

in the liver, platelet plug

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34
Q

hematological changes associated with aging

A
  • decrease in blood volume with lower levels of plasma protein
  • bone marrow produces fewer blood cells
  • total RBC is lower
  • platelets unaffected, but may have increased adhesiveness as clotting factors increase with age
  • hemoglobin levels fall after middle-age in both male and females
  • no specific cause for anemia in 30-40% of the population
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35
Q

effects of aging on hematological studies: females

A
  • Hgb: normal
  • WBC: decreased
  • D-Dimer: elevated
  • ESR: significantly increased
  • factor V, VII, IX: may increase
  • fibrinogen: may increase
  • PTT: may decrease
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36
Q

effects of aging hematologic studies: males

A
  • Hgb: slightly decreased
  • WBC: decreased
  • D-Dimer: elevated
  • ESR: significantly increased
  • factor V, VII, IX: may increase
  • PTT: may decrease
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37
Q

sodium

A

136-145

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38
Q

potassium

A

3.5-5

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39
Q

calcium

A

9-10.5

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40
Q

magnesium

A

1.3-2.1

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41
Q

phosphorous

A

3.0-4.5

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42
Q

chloride

A

98-106

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43
Q

blood pH

A

7.35-7.45

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44
Q

PaCO2

A

35-45

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45
Q

PaO2

A

80-100

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46
Q

HCO3

A

22-26

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47
Q

total serum cholesterol

A

<200

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48
Q

LDL

A

<130

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49
Q

HDL

A

> 45

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50
Q

triglycerides

A

<150

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51
Q

therapeutic INR

A

2.0-3.0

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52
Q

PT

A

11-12.5 seconds

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53
Q

PTT

A

30-40 seconds

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54
Q

INR

A

0.8-1.1

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55
Q

platelets

A

150,000-400,000

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56
Q

fasting glucose

A

70-105

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57
Q

glycosylated hemoglobin (HbA1c)

A

4%-6%

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58
Q

RBCs

A
  • females: 4.2-5.4 million
  • males: 4.7-6.1 million
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59
Q

Hgb

A
  • females: 12-16
  • males: 14-18
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60
Q

albumin

A

3.5-5

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61
Q

ammonia

A

15-45

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62
Q

total bilirubin

A

0.1-1.0

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63
Q

total protein (liver)

A

6-8

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64
Q

specific gravity

A

1.005-1.030

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65
Q

protein (UA)

A

0-8

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66
Q

glucose (UA)

A

less than 0.5/day

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67
Q

ketones

A

none

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68
Q

pH (UA)

A

4.6-8

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69
Q

WBC (UA)

A
  • females: 0-5
  • males: 0-3
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70
Q

serum creatinine

A
  • females: 0.5-1.1
  • males: 90-139
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71
Q

BUN

A

10-20

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72
Q

creatinine clearance test

A
  • females: 80-125
  • males: 90-139
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73
Q

digoxin level

A

0.8-2.0

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74
Q

lithium level

A

0.4-1.2

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75
Q

phenobarbital level

76
Q

theophylline level

77
Q

dilantin level

78
Q

coombs test

A

used for blood typing, detects antibodies against RBC’s attached to the patient’s blood type

79
Q

serum ferritin

A

free iron present in plasma

80
Q

transferrin

A

transports iron from the intestines to cell storage site

81
Q

low iron and low TIBC contribute to

A

iron deficiency anemia

82
Q

radioisotope imaging

A

shows active blood cell formation and iron storage

83
Q

standard x-ray

A

can show bone destruction (looks like swiss cheese)

84
Q

bone marrow aspiration and biopsy patient care

A
  • provide accurate information and emotional support
  • explain procedure
  • get informed consent
85
Q

bone marrow aspiration and biopsy follow up care

A
  • teach to inspect site every 2 hours for 24 hours
  • avoid activity that could cause trauma
  • analgesic (avoid aspirin)
    ice packs
86
Q

health promotion and maintainence

A
  • nutritional status: food intake and diet alter cell quality and affect clotting
  • anemia
  • ETOH consumption alters liver functioning
  • diet high in vitamin K affects clotting
87
Q

anemias alterations

A
  • sickle cell anemia
  • thalassemia
  • pancytopenia (aplastic anemia)
  • iron deficiency anemia
  • pernicious anemia (vitamin B12 deficiency)
  • hemorrhagic anemia
  • hemolytic anemia
88
Q

anemia pathophysiology

A
  • reduction in either the number of RBC’s, amount of hemoglobin, or hematocrit
89
Q

anemia clinical indicators

A

occurs with many health problems

90
Q

common causes of anemia

A
  • dietary problems
  • genetic disorders
  • bone marrow disease
  • excessive bleeding
91
Q

anemia treatment

A
  • B12
  • ferrous sulfate
  • folic acid
  • epoetin
92
Q

B12 for

A

pernicious anemia

93
Q

ferrous sulfate for

A

iron deficiency anemia

94
Q

folic acid for

A

megaloblastic anemia

95
Q

Epoetin (Epogen) for

A

stimulation of RBC production

96
Q

sickle cell disease pathophysiology

A
  • genetic hemoglobin disorder
  • autosomal recessive
  • formation of abnormal hemoglobin chains
  • cells are distorted into sickle shape which clumps together
  • clumps block blood flow then tissue becomes hypoxic
97
Q

which ethnicity is sickle cell anemia most common among

A

african americans in the US

98
Q

thalassemia pathophysiology

A
  • inherited blood disorder
  • less hemoglobin than normal
99
Q

who is thalassemia most common in

A

people of mediterranean decent

100
Q

thalassemia assessment

A
  • fatigue
  • weakness
  • pallor
  • slow growth
101
Q

thalassemia treatment

A
  • mild: may not require treatment
  • severe: may require blood transfusions or donor stem-cell transplants
102
Q

thalassemia complications

A
  • progressive severe anemia
  • heart failure arrhythmia
  • hepatomegaly
  • skeletal deformity
  • dark skin
  • poor growth
  • pituitary failure
  • hypothyroidism
  • diabetes
  • splenomegaly
  • infertility
103
Q

iron deficiency anemia pathophysiology

A

most common in occurrence resulting from blood loss, poor GI absorption, inadequate diet

104
Q

iron deficiency anemia treatment

A

increase oral intake of iron, iron supplements

105
Q

aplastic anemia pathophysiology

A
  • occurs with damage to bone marrow
  • causes such as chemo drugs, chemicals, radiation, viral hepatitis
106
Q

aplastic anemia treatment

A
  • encourage high protein, high calorie diet
  • blood/ platelet transfusion
  • immunosuppressive therapy
  • may need splenectomy
107
Q

pernicious anemia pathophysiology

A
  • vitamin B12 deficiency
  • caused by autoimmune disorder
  • prevalent in older adults
  • develops slowly
108
Q

pernicious anemia treatment

A
  • increase intake of foods rich in B12
  • B12 injections
  • oral preparations
  • nasal sprays
  • sublingual cobalamin
109
Q

hemorrhagic anemia pathophysiology

A

characterized by sudden and acute blood loss where RBCs are destroyed faster than they are made

110
Q

hemorrhagic anemia causes

A
  • excessive bleeding forms a lesion or a wound leading to loss of blood, and this can lead to severe acute anemia, this kind of condition is followed by shock
  • hemophilia and other bleeding disorders
  • family history of anemia or blood diease
  • certain medications like anti-platelets or blood thinning agents
111
Q

hemorrhagic anemia treatments

A
  • blood transfusion to replace lost blood
  • surgery to treat an injury or to stop the internal bleeding
  • intravenous supply of fluids to increase blood pressure
  • supplementation of iron, if levels are low
  • oxygen supply in case of inadequacy
112
Q

coagulation alterations

A
  • thrombocytopenia
  • hemophilia
  • disseminated intravascular coagulation
  • heparin induced thrombocytopenia
  • factor V deficiency
  • von willebrand disease (VWD)
113
Q

factors VIII, IX

A

hemophilia

114
Q

desmopressin

A
  • controls trauma induced bleeding
  • diabetes insipidus
  • hypernatremia
115
Q

protamine sulfate

A

heparin reversal

116
Q

aminocaproic acid

A

acute bleeding from elevated fibrinolytic activity (disease, surgery, drug therapy)

117
Q

heparin

A

decreases the ability to clot

118
Q

warfarin

A

prevents blood clots

119
Q

lovanox

A

prevents blood clots in high risk patients (bedrest)

120
Q

aspirin

A
  • anti platelet properties
  • inhibits platelet aggregation
  • used for pain/ fever
121
Q

filgrastim

A

increases WBC production in patients undergoing chemo or HIV

122
Q

vitamin B12

A

used for healthy RBC development

123
Q

clopidogrel

A

anti platelet, prevents clots from forming

124
Q

alteplase

A

dissolves blood clots, high risk for bleeding

125
Q

vitamin K

A
  • increases blood clotting
  • warfarin antidote
126
Q

thrombocytopenic purpura pathophysiology

A
  • destructive reduction of circulating platelets after normal platelet production
  • impaired clotting occurs
  • there are two types: autoimmune and thrombotic
127
Q

autoimmune thrombocytopenia purpura (ATP)

A

makes antibodies against ones own platelets

128
Q

thrombotic thrombocytopenia purpura (TTP)

A

autoimmune triggers platelet clumping

129
Q

thrombocytopenic purpura assessment

A
  • ecchymosis
  • purpura
  • anemia may present
130
Q

thrombocytopenic purpura treatment

A
  • platelet transfusion
  • anticoagulants
  • splenectomy
  • protect from injury
131
Q

hemophilia pathophysiology

A

blood does not clot properly resulting in excessive bleeding after an injury or damage

132
Q

hemophilia assessment

A
  • bruising
  • joint pain
  • swelling
  • unexplained bleeding
  • hematuria
  • hemoccult
133
Q

hemophilia treatment

A

clotting factors and plasma

134
Q

disseminated intravascular coagulation pathophysiology

A

abnormal clotting in the body, all clotting factors are messed up, causes abnormal bleeding

135
Q

disseminated intravascular coagulation assessment

A

clotting, bleeding

136
Q

disseminated intravascular coagulation treatment

A

supportive care, fluids, blood transfusion

137
Q

heparin induced thrombocytopenia (HIT) pathophysiology

A
  • immune system causes patient to clot in the presence of heparin
  • body forms clots instead of preventing them
  • more common with unfractionated heparin
  • higher incidence in female patients
138
Q

HIT assessment

A
  • signs of EU-DVT
  • ischemic limb necrosis
  • necrotic skin lesions
  • abdominal tenderness
  • signs of PE
  • hypotension
  • CNS findings (dural venous sinus thrombosis)
139
Q

factor V leiden pathophysiology

A
  • a mutation of one gene that controls factor V
  • linked to an increase in blood clots
  • inherited form parents
140
Q

factor V leiden assessment

A
  • easy bruising
  • nose bleeds
  • excessive bleeding after surgery or trauma
141
Q

factor V Leiden treatment

A
  • infusion of FFP, blood, platelets
  • avoid contact sports or activities that cause injury
142
Q

Von Willebrand Disease (VWD) pathophysiology

A

bleeding disorder caused by low levels of clotting protein in the blood, inherited but rarely may develop later in life

143
Q

VWD assessment

A
  • desmopressin
  • replacement therapies
  • oral contraceptives
  • clot stabilizing meds
144
Q

cancer alterations

A
  • hodgkin’s lymphoma
  • non hodgkin’s lymphoma
  • multiple myeloma
  • leukemia
145
Q

hodgkins lymphoma pathophysiology

A

type of cancer that affects the lymphatic system, which is part of the body’s germ fighting immune system

146
Q

possible causes of hodgkin’s lymphoma

A
  • viral infections
  • chemical exposure
147
Q

reed-sternberg

A

cells that are also called hodgkin cells, found in people with hodgkin lymphoma

148
Q

non hodgkin lymphoma pathophysiology

A

starts in white blood cells called lymphocytes, more common in males and older adults

149
Q

possible causes of non hodgkin’s lymphoma

A
  • organ transplant
  • immunosuppressive drug therapy
  • HIV
150
Q

non hodgkin’s lymphoma assessment

A
  • large painless lymph nodes
  • fever, drenching night sweats
  • unplanned weight loss
  • some have no symptoms at the time of diagnosis
151
Q

non hodgkin’s lymphoma treatment

A
  • external radiation of lymph nodes
  • for more extensive disease, radiation and combo chemotherapy is used
  • CAR-T therapy (enhances the immune system by killing cancer cells
152
Q

multiple myeloma pathophysiology

A
  • WBC cancer of mature B Lymphocytes
  • more common in men over the age of 60
  • 13,500 deaths yearly in north america
153
Q

multiple myeloma assessment

A
  • brain fog
  • excessive thirst
  • N/V
  • SOA
  • frequent urination
  • extreme weakness and fatigue
  • bone pain
  • constipation
154
Q

multiple myeloma treatment

A
  • watch for progression
  • proteasome inhibitors
  • immunomodulating drugs
  • hematopoietic stem cell transplant (HSCT)
155
Q

pre leukemia and leukemia pathophysiology

A
  • blood cancer
  • uncontrolled production of WBCs (blast cells), in the bone marrow that over take the healthy cells
  • acute or chronic
  • classified by cell type: lymphocytic or lymphoblastic
  • prevalent in down, klinefelter, and bloom syndromes
156
Q

pre leukemia and leukemia causes

A
  • ionizing radiation
  • viral infection
  • exposure to chemicals and drugs
157
Q

pre leukemia and leukemia assessment

A
  • SOA
  • tiny red spots
  • bone and joint pain or tenderness
  • weakness and low energy
  • lymph node swelling
  • swelling of liver and spleen
  • muscle aches
158
Q

neutropenia pathophysiology

A

abnormally low number of neutrophils in the blood, less than 1500

159
Q

neutrophils

A

subtype of white blood cells that fight off bacterial and fungal infections

160
Q

packed red blood cells (PRBC’s)

A

1 unit of whole blood

161
Q

fresh frozen plasma (FFP)

A
  • contains all factors of the soluble coagulation system
  • fibrinogen, II, V, VII, VIII, and X factor
  • should never be used as a plasma extender
162
Q

most important factors

163
Q

when is FFP used and with what

A
  • in emergency bleeding problems
  • with warfarin
164
Q

where is factor V made in the body and what does it do

A
  • liver
  • coverts prothrombin into thrombin
165
Q

what does thrombin convert fibrinogen into

A

fibrin which forms fibrin clots

166
Q

platelets

A
  • stored at room temp and cannot be frozen
  • clump together to form a colt when endothelial damage occurs
167
Q

acute hemolytic

A

a triad of symptoms
- fever
- flank pain
- red/brown urine

168
Q

febrile

A

unexpected temp rise at initiation of blood products

169
Q

blood transfusion allergic reaction symptoms

A
  • fever
  • chills
  • itching
  • hives
  • all common
170
Q

transfusion reaction treatments

A
  • stop transfusion
  • follow facility protocol
  • Tylenol, Diphenhydramine per order
  • document
171
Q

Alteplase (Activase)

A
  • thrombolytic agent
  • coagulation test may be unreliable during therapy because alteplase may degrade fibrinogen in blood sample
  • to dissolve blood clots that have formed in blood vessels
  • will increase risk of bleeding, avoid activities that could cause bleeding
  • monitor temp, limit venipuncture, assess neuro status
  • bleeding and anaphylaxis, can cause headaches
172
Q

Warfarin (Coumadin)

A
  • anticoagulant
  • for overdoes antidote is vitamin K
  • to prevent clotting in people who have had a condition that can cause blood clotting (mechanical valve, clotting, A fib)
  • do not double dose
  • do not over eat green leafy veggies
  • monitor PT/INR and for bleeding
  • INR levels for a patient on warfarin are higher because we have decreased their ability to clot
173
Q

Phytonadione (Vitamin K, Mephyton)

A
  • fat soluble vitamin
  • necessary for normal clotting of blood
  • produced by the liver
  • found in leafy green vegetables
  • monitor PT and INR
174
Q

Clopidogrel (Plavix)

A
  • platelet thinner
  • monitor for signs of abdominal pain and other signs of GI bleeding
  • should be held 5 days before elective surgery
  • PPIs, Prozac, diflucan, grapefruit juice make plavix less effective
  • prevent blood clots from forming in hardened blood vessels (artherothrombosis) or platelet inhibitors
  • easy bruising, prolonged bleeding
  • bleeding, neutropenia, thrombolytic thrombocytopenic purpura, petechiae, weakness, vision changes, pY12 (plavix responsiveness)
175
Q

Heparin

A
  • anticoagulant
  • hold when platelet count is 100,000/mm or lower
  • to decrease the clotting ability and help prevent clots from forming by suppressing factor Xa and thrombin
  • does not dissolve clots but keeps new ones from forming
  • avoid OTC NSAIDS and aspirin
  • avoid activity that can cause bleeding
  • watch for bleeding and HIT
  • can be used along with warfarin until therapeutic levels are reached
  • monitor VS, bleeding, aPtt (20-30) or Xa
  • used with new onset dysrhythmias to prevent clots
  • antidote is Protamine Sulfate
176
Q

Desmopressin (DDAVP, Minirin, Stimate)

A
  • hormones
  • take without eating
  • to treat central cranial diabetes insipidus
  • weigh daily and avoid alcohol
  • adverse reactions: hyponatremia and seizures
  • use precaution in patients with hypertension
177
Q

Ferrous Sulfate (Fesol)

A
  • transitional metal sulfate
  • liquid will stain teeth, use with straw and rinse mouth after
178
Q

Protamine (Prosulf)

A
  • heparin antagonist
  • should be administered slowly over at least 30 minutes via IV
  • to counteract the effects of heparin or given before and after surgery and after dialysis
  • the antidote to heparin overdose
  • anaphylaxis, rapid hypotension, increased pulmonary artery pressure
179
Q

aminocaproic acid (Amicar)

A
  • antifibrinolytics
  • to treat serious bleeding conditions, especially when bleeding occurs after surgery or dental procedues
  • stop taking if you have unexplained muscle pain, sudden numbness or weakness, tingling or cold feeling in an arm or leg, trouble breathing, sudden cough or chest pain
  • headache, stomach pain, N/V, diarrhea, dizziness, watery eyes, stuffy nose
180
Q

Cyanocobalamin (vitamin B12, Nascobal)

A
  • antianemics, water soluble vitamin
  • vials should be protected from light
  • used to treat pernicious anemia
  • monthly injection
  • know baseline levels before starting and monitor levels every 3-6 months
  • adverse effects include hypokalemia, erythema, and hypertension
  • report muscle weakness, nausea, palpitations, or paresthesia
181
Q

Aspirin (Bayer)

A
  • anti platelet agent
  • can relieve pain and reduce the risk of serious problems like heart attacks and stroke
  • watch for hives, tinnitus, difficulty breathing, allergic reaction, and severe headaches
182
Q

Filgrastim (Granix)

A
  • stimulating factor
  • helps bone marrow make new WBCs
  • call doctor if you develop signs of infection such as fever, chills, redness, swelling, or pain around a cut or sore
  • may cause mild to moderate bone pain
183
Q

Epoetin Alpha (Epogen)

A
  • to treat severe anemia in patients who have CKD, on chemo, or some HIV drugs
  • stimulates RBC production
  • blood clots, heart attack, stroke, tumor progression, or heart failure
  • contraindicated in patients with hypertension, and blood pressure should be monitored closely
  • patients with CKD often have HTN and anemia and would not be able to use these medications
184
Q

Folic Acid (Vitamin B9)

A
  • treat or prevent folate deficiency
  • folate (broke down from folic acid) is needed for the body to make RBCs
  • take while trying to get pregnant and during the first 12 weeks of pregnancy
  • rash
  • long term use can cause colorectal or prostate cancer
185
Q

Factor VII and IX (NovoSeven RT, Sevenfact)

A
  • used to treat hemophilia
  • helps blood clot and stop bleeding
  • have epinephrine and resuscitation equipment ready
  • Avoid NSAIDS
  • for mild reaction avoid Benadryl
186
Q

Enoxaparin (Lovanox)

A
  • anticoagulant
  • lower molecular weight than heparin
  • Sub Q injection
  • leave a bubble of air in the syringe and administer the air last

Medical Surgical II 229 (5 decks)

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