Week 6- Blood/ Lymphatic Disorders Flashcards
What does blood do?
- Provides major transport system of the body for essentials such as oxygen, glucose, and other nutrients, hormones and electrolytes
- Parts of the bodies defense
- Body contains approx. 5 L of blood
- Consists of water and its dissolved solutes (55% of blood volume). Plasma falls into this category
- Cells or formed elements (45% of blood volume)
Hematocrit
- Proportion of RBC (erythrocytes) to the total blood volume
- In men, higher (48%)
- Female (42%)
- Elevated hematocrit can indicate dehydration or excess RBC
- Low hematocrit can result from blood loss of anemia
Plasma
- Makes up part of the 55% of non-blood cells i the blood proportion
- Includes proteins, water and other electrolytes
- Albumin- maintains osmotic pressure in the blood
- Antibodies (Globulins)
- Fibrinogen- blood clotting
- Clear, yellowish fluid remaining after the cells have been removed
What is anemia?
- Causes a reduction in oxygen transport in the blood caused by a decrease in hemoglobin content
- This can result from several things: (Declining RBC production, Decrease in RBC, or Combination of these 2)
- There are many different types of anemia
What is the patho of anemia?
The oxygen deficit leads to a sequence of events:
- Less energy is produced in all the cells
- Body compensates to improve the oxygen supply by increasing HR and peripheral vasoconstriction
- These changes lead to symptoms being evidenced such as fatigue, pallor, dyspnea and tachy
- Epithelial cells in the GI system cause inflammation and ulcers, on the skin cause dry lips, and the hair & skin may begin to show degeneration
- In cases of severe anemia- chest pain during stress or exercise
What is iron deficient anemia?
- Insufficient iron impedes the creation of hemoglobin in the blood (this then reduces the amount of oxygen carried in the blood)
- This results in smaller, less concentrated RBC’s, owing to a low concentration of hemoglobin in each cell
What are some causes of iron deficient anemia?
- Diets low in iron
- Chronic blood loss from things such as ulcers, hemorrhoids, cancers, and excessive menstrual flow
What are the S/S of iron deficient anemia?
Mild= typically asymptomatic
As the hemoglobin levels drop, signs are:
- Pallor of the skin and mucous membranes
- Fatigue, lethargy and cold intolerance
- Irritability (CNS response to hypoxia)
- Brittle hair, ridged nails, dry skin
- Inflammation of the oral mucosa and tongue
- Menstrual irregularities
- Delayed healing
- Tachy, syncope, and dyspnea
What is the treatment for iron deficient anemia?
- Find out the underlying cause
- Treatment & prognosis depends on the cause
- Iron rich foods or iron supplements
What is pernicious anemia?
B12 DEFICIENCY
- Caused by large, immature RBC’s
- This typically results from a deficit folic acid (B9) or B12 (need B12 to create blood cells)
- These deficiencies usually develop gradually
- High occurrence in the first 2 months of pregnancy (this can result in high instances of birth defects such as spina bifida)
What is the patho of pernicious anemia?
- Malabsorption of B12 in the glands of the gastric mucosa
- This is caused by lack of the intrinsic factor production (occurs when the body produces antibodies against the IF, and the subsequent immune response causes atrophy of the gastric mucosa and glands
- This B12 impairment leads to immature RBC production
(They are destroyed prematurely when they are being reproduced- This results in low RBC count (anemia))
What are the causes of pernicious anemia?
- Rarely caused by dietary insufficiency as the body needs very small amount of B12
- Most common cause is malabsorption
- Caused from either autoimmune response
- Older individuals- chronic gastritis (atrophy of gastric mucosa)
- Chronic inflammatory conditions
What are the S/S of pernicious anemia?
- Same as anemia
Additionally:
- Enlarged tongue, red, sore & shiny
- Decrease in gastric acid leads to digestive discomfort often with nausea and diarrhea
- Tingling and burning sensations to extremities or loss of coordination
What is the treatment for pernicious anemia?
- Oral supplements
- Vitamin B12 injections
What is aplastic anemia?
- Impairment or failure of bone marrow function
- This leads to a loss of stem cells and decreased number of RBCs, leukocytes and platelets
What are some causes of aplastic anemia?
- Approx. half the cases, the patient are middle aged and the cause is unknown
- Radiation, industrial chemicals and drugs have been shown to damage bone marrow
- Viruses (HEP C)
- Autoimmune disease may affect bone marrow
- Genetic abnormalities
- In cancer treatment- risk to bone marrow & stem cells is possible, they will harvest the stem cells prior to treatment and then transfuse them later when needed
What are the S/S of aplastic anemia?
B/C entire bone marrow is affected:
- pallor, weakness, dyspnea
- multiple and recurrent infections
- tendency to bleed excessivelu
- As WBC/s diminish, uncontrolled infection and hemorrhage are likely
What is the treatment for aplastic anemia?
Removal of any bone marrow suppressants
- This aids in the recovery of the bone marrow
- Bone marrow transplants
- Stem cell transplants
What is Sickle Cell Anemia?
Inherited characteristic leads to abnormal hemoglobin
- When this altered hemoglobin is deoxygenated, it crystalizes and changes the shape from a disc to a crescent (“sickle”)
- Cell membrane is now damaged and the RBC can only live for approx. 20 days as opposed to a normal 120 day lifespan of a healthy RBC
- These RBC’s can carry oxygen normally, but the low count of hemoglobin causes lower amount of oxygen to be carried
What is a major issue with sickling process?
- the obstruction of small vessels by the elongated and rigid RBC’s, resulting in thrombus formation and areas of necrosis
What are the S/S of Sickle Cell Anemia?
- Usually evident at approx. 12 months old
- Severe anemia symptoms such as pallor, weakness and dyspnea
- High bilirubin (evidenced by yellowing of skin and whites of the eyes)
- Vascular occlusions and infarction can lead to periodic, painful crises & permanent damage to organs and tissues
- Chest= SOB, pain, fever
- Vessels of hands and feet= pain and swelling, ulcers
- Growth & development are late
What is the treatment for Sickle Cell Anemia?
No real treatment at this time
Supportive & preventative:
- Use of HYDROXYUREA has reduced the frequency of crises
- Avoidance of strenuous activity
- Prevent dehydration & infection
- Ensure immunizations against pneumonia, meningitis and influenza
Many don’t live past 20 yrs old
What is Hemolytic Anemia?
- Pemature destruction of RBC’s
- May not appear as anemia if the bone marrow can keep up the production of new RBCs
- Classified as either inherited or accquired
What are the causes of Hemolytic Anemia?
- Infectious disease
- Inherited disorders
- Toxic agents (venom)
- or drugs
What is primary polycythemia?
increased production of RBCs in the bone marrow
What is secondary polycythemia?
increase in RBC secondary to hypoxia
What does primary & secondary polycythemia result in?
- Higher blood volume, often more viscous
- Blood vessels are distended
- Blood flow is sluggish- leads to frequent clots and infarctions
- BP is elevated
- Heart is hypertrophied
- Hemorrhage is hypertrophied
- Hemorrhage is frequent in places where the vessels distended
What are the causes of primary and secondary polycythemia?
- Primary: unknown origin, usually develops between 40-60 yrs old
- Secondary: Compensation mechanism intended to provide increased oxygen transport in the presence of chronic lung or heart disease
What are the S/S of Polycythemia?
- Cyanotic- bluish/ red tone to the skin (from engorged blood vessels and sluggish blood flow)
- High BP
- HR= full & bounding
- Dyspnea
- Headaches and visual disturbances
- Clots
- Infarctions
What is hemophilia?
- Deficiency of clotting factors
- Most common inherited clotting disorder
- Varying degrees of severity depending on the amount of clotting factor present in the blood
- In mild forms, excessive bleeding occurs only after trauma
- Severe- frequent, spontaneous bleeding is common
What are the S/S of Hemophilia?
- Prolonged or severe hemorrhage after minor tissue trauma
- Persistent oozing of blood after minor injuries
- Spontaneous bleeding may occur (in urine & feces and sometimes in the joints causing chronic pain and crippling deformities from the recurrent inflammation)
What is the treatment for Hemophilia?
Replacement therapy of the clotting factor is available through IV administration
- Especially prior to any procedures
- Preventative= ensuring regular blood work to monitor blood cell counts, avoiding any activities that have a high likelihood for trauma & bleeding
What is Disseminated Intravascular Coagulation- DIC
- Involves both excessive bleeding and excessive clotting
- Body creates clots when it doesn’t need them- causes multiple thrombosis and infarction
- This uses up the clotting factor so when the body needs it, its not available, resulting in excessive bleeding (hypotension or shock)
What are the S/S of DIC?
Presentation depends on the underlying cause:
- Obstetrical patients often manifest increased bleeding
- Cancer pt’s often manifest more thromboses
Hemorrhage is typically the critical issue
- Low clotting factor levels and prolonged bleeding
- Creates low BP
- Multiple bleeding sites are common
Thromboses are typically in smaller vessels so they aren’t as damaging
- Can occur in big vessels causing damage to major organs
What is Leukemia?
- Disorder involving the white blood cells
What is the patho of leukemia?
One of more of the leukocyte types are present
- Immature, non functional
- Multiply uncontrollably in the marrow and are released into the circulation
- As the number of these increase, they infiltrate into lymph nodes, spleen, liver, brain and other organs
With the proliferation of the leukemic cells in the bone marrow, this suppresses the production of other normal cells
- Leads to anemia
- Crowding of the bone marrow from the excess production of the WBC leads to severe bone pain from the pressure on the nerves
What are the causes of leukemia in children?
- Acute leukemia is more common
- Most common type of childhood cancer
- Typically affects children between 2 and 5 years old
- Cause has not been established
What are the causes of leukemia in adults?
- Chronic leukemia is more common
- Exposure to radiation, chemicals and certain viruses
- Chromosomal abnormalities (Down syndrome)
What are the S/S of leukemia?
- Typically marked initially by a infection that is unresponsive to treatment or by excess bleeding
Symptoms:
- Multiple infections (non functional WBC’s)
- Hemorrhage
- Signs of anemia
- Bone pain= even during test
- Weight loss & fatigue
- Fever
- Enlarged lymph nodes
- If the cells infiltrate the nervous system- headaches, drowsiness, vomiting, visual disturbances
What is the treatment for leukemia?
- Chemo (typically, leukemia responds well to drugs and the prognosis is good)
- Ensure proper levels of nutrition and hydration
- Blood tranfusions
- Bone marrow transplant
What are the 2 types of lymphoma?
- Hodgkin’s lymphoma
- Non hodgkin’s lymphoma
Primarily involve the lymph nodes of the body
What is hodgkins?
- Initially involves a single lymph node
- Spread systematically to multiple and then to organs via the lymphatics
What are the stages of hodgkins?
- Stage 1: single lymph node or area
- Stage 2: 2 or more regions on the same side of the diaphragm
- Stage 3: affects lymph nodes on both sides of the diaphragm
- Stage 4: involvement of bone, liver or lungs
What are the S/S of hodgkins?
- Initially- usually a lymph node that is large, painless and non tender
- Later, enlarged lymph nodes at other locations may cause pressure effects
- General signs of cancer such as weight loss, fever, fatigue, and night sweats
- Recurrent infection- abnormal lymphocytes interfere with the immune response
- Pruritus (itchy skin)
What is the treatment for hodgkins?
- Radiation
- Chemotherapy
- Surgery
What is Non Hodgkins?
- Multiple node involvement scattered through the body
- Non organized pattern of widespread metastases
- Often involves intestinal nodes and organs
More difficult to treat due to its nature
What is HIV- AIDS
- HIV= Human Immune Deficiency from a virus that affects the lymphocytes and suppresses the immune system
- Attacks the T-cells, leading to low numbers and increased risk of infections and cancers
- AIDS= Acquired Immune Deficiency Syndrome
- Usually acquired in 10 years after HIV
What is the assessment and management?
- Note any s/s in your initial assessment that are life threatening
- Be very inquisitive with SAMPLE history
Look for:
- Changes in LOC
- Vertigo, fatigue, syncope (feel like your going to blackout or is the room spinning)
- Dyspnea, chest pain
- Coughing up blood
- Muscle pain/ stiffness
- Burning/ itching
- Bleeding from the mouth, nose, gums or insides
What are the common complaints of Anemia?
- I feel worn down
- I can’t catch my breath
- My chest hurts
What is the general management of anemia?
- Recheck vitals frequently
- Check monitor and SPO2 frequently
- Use IV fluids cautiously
- Use 12-lead ECG to rule out MI
- Allow pt. to rest in comfortable position
What complaints relate to severity of the disease and current treatment of leukemia?
- Fatigue or neurological problems are common
- Pain, fever, diaphoresis, unexplained bleeding, and dyspnea
- Signs of shock are common due to low BP and high HR as compensation from the body is occurring
- Fever can be very serious as immune system is suppressed
What is the general management for leukemia?
- Airway support & oxygen therapy
- Analgesics for pain management
- Constant positive support- often have grim outlooks
- Assess and monitor vitals
- IV fluid bolus for signs of shock
- Be ready- patient condition may deteriorate quickly
- Support families
- Speak to families to regarding end of life care in extreme situations
What is the assessment of lymphoma?
Ask specific questions:
- What type do you have?
- What kind of treatment are you getting?
- Where are you at in the treatment plan?
Full body assessment- focus on their complaints
What is the management of lymphoma?
General management to include:
- Aggressive pain management- they are often in constant, extreme pain
- IV fluid if inadequate perfusion
- ECG to watch for and treat dysrhythmias
- Transport to appropriate facility if possible
- Supplemental O2 if needed
- Support pt. and their families
- Chemo precautions
What is the assessment of DIC?
Prehospital treatment must be started early:
- Maintain the airway and give supplemental O2
- Keep the pt. warm
- Treat early shock aggressively
- Provide medications for pain
- Heart rhythm control- last case of absolutely necessary
- Pt’s who have DIC due to severe trauma have a poor survival rate and will need strong support
- Be optimistic, but be honest
What are the common complaints of hemophilia?
- Pallor, weak pulse, and hypotension
- Frequent bleeding of unknown origin
- Bloody noses, blood in sputum or stool (hypoxia due to reduction of O2 carrying capacity)
- Ascertain a detailed history- you may hear/ see previous hemophilia conditions
- Be aware of signs of acute blood loss (low BP, weak pulse, pallor)
What is the management of hemophilia?
- Treatment for heart dysrhythmias
- IV line is temporary measure to help raise the BP in the interim, ultimately they will need a tranfusion or plasma
- Analgesics for pain
- At times, when you arrive, the bleeding may have stopped (some pt have their own replacement clotting factor they can self administer, should still go to the ER)
What is the assessment of sickle cell anemia?
- These pt’s are often in life threatening situations
S/S to assess for:
- SOB
- Skin will show inadequate perfusion
- Hypotension
- Jaundice
- May report multiple system involvement- including chest, abdo, and arthritic type pain
