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NUR171-Hemato-2
Hematology - Ch 30 - File 2
| Question | Answer |
|---|---|
| Smoking __ platelet reactivity | increases – also hematocrit and blood viscosity |
| Hematemesis | bright red, brown, or black vomitus |
| __ problems should be anticipated in cases of known alcohol abuse | bleeding |
| Iron and folic acid deficiencies are associated with | inadequate intake of liver, meat, eggs, whole grain, breads/cereals, potatoes, citrus fruits, legumes |
| Folic acid deficiencies may be offset by a diet including foods high in | iron |
| A nontender swollen lymph node may be a sign of | Hodgkin’s lymphoma or non-Hodgkin’s lymphoma |
| Cardiovascular disorders such as valvular disease or hypertension may predispose pts to | hemolysis |
| Meds used to treat cardio disease can cause | abnormalities in hematopoietic cell production or coagulation |
| Pulmonary disorders that lead to hypoxemia may cause | chronic stim of erythropoietin and result in polycythemia |
| Arthralgia | joint pain |
| Aching bones may result from | pressure of expanding bone marrow with diseases Diuretics interfere with |
| H2 blocking agents affect hematologic function how? | interfere with platelet production |
| Hemarthrosis | blood in joint – with bleeding disorders – painful |
| Agent Orange is associated with? | leukemia and lymphoma |
| Epistaxis may occur with | low platelet counts, especially if they strain |
| Smooth tongue sign of | pernicious anemia, iron-deficiency anemia |
| Purpura can be sign of | decreased platelets or clotting factors |
| Flusing of the palms of the hands or soles of the feet may indicate | anemia |
| Paresthesias of feet and hands; ataxia could be sign of | Cobalamin (B12) deficiency or folate deficiency. |
| Superficial lymph nodes can be evaluated by | light palpation |
| Deep lymph nodes should be evaluated by | radiologic exam – cannot be palpated |
| Lymph nodes should be assess for? | symmetry, size, fixation, tenderness, and texture |
| Tender nodes are usually sign of inflammation, while hard/fixed nodes suggest | malignancy |
| Erythrocytosis often produces | sm. Vessel occlusions causing a purple, mottled appearance of face, nose, fingers or toes. |
| Clubbing of fingers send with | chronic anemia as in pt with sickle cell disease. |
| Telangiectasia | dilation of a group of small blood vessels – like a spider nevus |
| What skin signs can indicate bleeding disorders? | petechiae, ecchymoses, spider nevus |
| Pancytopenia | marked decreases in number of ALL blood cells – RBCs, WBCs, and platelets |
| Hb value is reduced in cases of? | anemia, hemorrhage, hemodilution (FVE). |
| Hb value increases in | polycthemia, hemoconcentration (dehydration FVD). |
| Hct values reduced in | anemia, hemorrhage, hemodilution (FVE). |
| Hct values increased in | polycthemia, hemoconcentration (dehydration FVD). |
| Hct is usually __ times that of Hb. | 3 |
| Hb | measurement of gas-carrying capacity of RBC – 12-16 woman, 13.5-18 man |
| Hct | measure of packed cell volume of RBCs |
| Red cell indices | Indicators of RBC volume, color, hemoglobin saturation – can provide insight into cause of anemia – marcro vs microcytosis |
| RBC morphologies | Dohl bodies, Heinz bodies, anisocytes, schistocytes, and sickled cells |
| Dohl bodies | usually associated with burns, systemic infections, cytotoxic agents, and neoplastic diseases – leukocyte includsion in neutrophils |
| Heinz bodies | Granules in RBCs – seen in thalassemias and after splenectomy |
| Anisocytes | various sized RBCs |
| Schistocytes | Fragmented RBC – hemolytic anemias, severe burns |
| WBC counts over 11,000 indicates | infection, inflammation, tissue injury or death, and malignancies (leukemia, lymphoma) |
| WBC less than 4000 is associated with | leukopenia – bone marrow depression, severe or chronic illness, leukemia |
| WBC differential is significant because | WBC count main be normal, despite marked change in 1 type of leukocyte |
| Neutropenia | absolute neutrophils count less than 1000 cells |
| Severe neutropenia | less than 500 cells |
| Thrombocytopenia | platelet count below 100,000 |
| Spontaneous bleeding can occur once platelet count falls below | 20,000 |
| Thrombocytosis | excessive platelets – inflammation and some malignant disorders |
| Complications from a splenectomy | Increase in RBCs, WBCs, platelets, immunologic deficiencies – infection |
| Medications that can cause petechiae | heparin, thiazide diuretics, digoxin, ibuprofen, antibiotics, H2 antagonists, quinine |
| Nursing care for patient w/post bone marrow aspiration | sterile pressure dressing – lie on site for 30-60 mins to maintain pressure |
| Assessment of lymph nodes on patient | lt palpation for superficial, radiologic for deep – assessed symmetrically for location, fixation, tenderness (inflame), and texture |
| What the term shift to the left means | increase in immature forms of WBCs (bands) being released before they have matured |
| Expected lab findings in pt with iron deficiency anemia | lower hb/hct, low iron, low MCV, flow ferritin, yet increase in TIB (tot. iron-bind capacity) |
| Foods nurse would recommend for pt w/iron def. anemia | liver, muscle meat, eggs, dk green leaf veg, whole-grain, enriched breads |
| Lab finding in CBC of pt w/folic acid def r/t chronic alcohol abuse | dec. hct/hb, increase in iron, bili, transferring & ferritin |
| Pt teaching r/t pernicious anemia | need to take cobalamin to absorb intrinsic factor, protect from falls, burns, & trauma due to neuro impair, incr. GI cancer |
| Care of pt w/sickle cell crisis | bed rest, oxy ther, pain mngt, fluids & ele, infection cntr, folic acid |
| Complications of thrombocytopenia | bleeding – petechiae, ecchymosis, epistaxis |
| Care of pt rec. blood trans | Baseline vitals, slow infus for 15 mins, then vital 15 min, watch for trans rxn, fluid bal ass |
| Care of pt w/heparin-induced thrombocytopenia and thrombosis syndrome | watch for bleed, DVTs, vascular ischemiaw/stroke, seizure, discontinue hep flush, use soft toothbrush |
| Care of pt w/acute polycythemia vera | reduce blood volume, hydration, adequate oxy, I/O, med, dietary, DVT avoidance, monitor hct/hb, anemia |
| Care of pt w/immune thrombocytopenia purpura (ITP) | avoid asparin, cntr bleed, use soft toothbrush, avoid inject, avoid causative agents |
| Care of pt w/type A hemophilia | prevent & treat bleed, preventative care, avoid accidents, health pro, daily oral care |
| Care of pt w/von Willebrand’s disease | prevent & treat bleed, preventative care, avoid accidents, health pro, daily oral care |
| Causes of disseminated intravascular coagulation (DIC) | abnormally initiated & accelerated clotting, tumors, gram neg bact, leukemia, blood transfusion rxn |
| Lab value in pt w/myelodysplastic dyndrome (MDS) | periperial blood cytopenias & hypercellular bone marrow w/dysplastic changes |
| Neupogen/Filgrastim | management of servere chronic neutropenia – stims immature neutrophils to divide and diverentiate – activates mature neutrophils |
| How is Neupogen beneficial for bone marrow transpalantation? | Improves harvest of progenitor cells |
| Complications of neutropenia | infection from norm flora, pathogens, impaired inflame., masks signs of infection, sepsis, systemic infections |
| Complications in pt w/non-Hodgkin’s lymphoma | can involve CNS, spleen, liver, GI tract, & bone marrow – raidiation therapy causes skin issues |
| Nursing interventions for pt w/multiple myeloma | ambulation & hydration to deal w/hypercal, weight-bearing, pain, monitor ele & I/O, fracture prevent, infect cntrl |
| Coumadin | Warfarin - anticoagulant – evaluate INR or PT and watch for intracranial bleeding |
| Heparin | anticoagulant – antithrombin, anemic thrombocytopenia can result after long use, bleeding |
| Lovenox | Enoxaparin – prevent DVT and PE, anticoag, bleeding, anemia, thrombocytopenia |
| Myodyplastic syndrome (MDS) can turn into | acute leukemia |
Created by:
Ladystorm