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Hematology!
Hematology
| Question | Answer |
|---|---|
| Alterations in the hematoligic system | Disorders of erythrocytes (RBCs), platelets,leukocytes (WBCs),coagulation |
| Anemia | A deficiency in the Number of erythrocytes (red blood cells [RBCs]) Quantity of hemoglobin Volume of packed RBCs (hematocrit) Not a specific disease Manifestation of a pathologic process Identified and classified by laboratory diagnosis |
| Anemia General Symptoms of Anemia Integumentary Manifestations | Pallor ↓ Hemoglobin ↓ Blood flow to the skin Jaundice ↑ Concentration of serum bilirubin Pruritus ↑ Serum and skin bile salt concentrations |
| Anemia General Symptoms of Anemia Cardiopulmonary Manifestations | Tachycardia Tachypnea Fatigability Dyspnea Orthopnea Orthostatic hypotension MI |
| Anemia General Symptoms of Anemia Neurological manifestations | Inability to concentrate Vertigo Irritability |
| Anemia General Symptoms of Anemia GI Manifestations | Anorexia Abdominal pain |
| Diagnostic findings | Mild = Hb 10 to 14 g/dl May exist without symptoms Possible symptoms Palpitations, dyspnea, diaphoresis Moderate = Hb 6 to 10 g/dl Increased cardiopulmonary symptoms Experienced at rest or during activity |
| Diagnostic findings | Severe = Hb <6 g/dl Involve multiple body systems Integument Eyes Mouth Cardiovascular Pulmonary Neurologic Gastrointestinal (GI) Musculoskeletal |
| Iron-Deficiency Anemia | One of the most common chronic hematologic disorders Iron is present in all RBCs as heme in hemoglobin and in a stored form, ferritin |
| Iron-Deficiency Anemia Etiology | Inadequate dietary intake 5% to 10% of ingested iron is absorbed Malabsorption Blood loss Hemolysis |
| Iron-Deficiency Anemia Diagnostic Studies | Laboratory findings Hb, Hct, MCV, MCH, MCHC, reticulocytes, serum iron, TIBC, bilirubin, platelets Stool guaiac test Endoscopy Colonoscopy |
| Iron-Deficiency Anemia Collaborative Care | Goal is to treat the underlying disease Increased intake of iron Nutritional therapy Oral or occasional parenteral iron supplements Transfusion of packed RBCs |
| Iron-Deficiency Anemia Nursing Management | At-risk groups Premenopausal women Pregnant women Persons from low socioeconomic backgrounds Older adults Individuals experiencing blood loss |
| Megaloblastic Anemias | Classification Cobalamin (vitamin B12) deficiency Folic acid deficiency |
| Cobalamin Deficiency Etiology | Absence of intrinsic factor (IF) Acid environment required for IF secretion GI surgery Long-term users of H2-histamine receptor blockers |
| Cobalamin Deficiency Clinical Manifestations | General symptoms of anemia Sore tongue Anorexia Nausea Vomiting Abdominal pain |
| Cobalamin Deficiency Diagnostic Studies | Normal serum folate levels and decreased cobalamin levels suggest megaloblastic anemia due to cobalamin deficiency Schilling test |
| Cobalamin Deficiency Collaborative Care | Parenteral administration of cobalamin Increase in dietary cobalamin does not correct the anemia Still important to emphasize adequate dietary intake |
| Cobalamin Deficiency Nursing Management | Familial disposition Early detection and treatment can lead to reversal of symptoms Ensure that injuries are not sustained because of the patient’s diminished sensations to heat and pain |
| Folic Acid Deficiency | Common causes Poor nutrition Malabsorption syndromes Drugs Alcohol abuse and anorexia Lost during hemodialysis |
| Folic Acid Deficiency Clinical manifestations are similar to those of cobalamin deficiency | Insidious onset Absence of neurologic problems Treated by replacement therapy Encourage patient to eat foods with large amounts of folic acid |
| Anemia of Chronic Disease | Underproduction of RBCs Mild shortening of RBC survival Causes End-stage renal disease Primary factor: ↓ Erythropoietin Chronic liver disease Chronic inflammation Malignant tumors Chronic endocrine diseases |
| Anemia of diagnostic findings | ↑ Serum ferritin ↑ Iron stores Normal folate and cobalamin levels Treating underlying cause is best Rarely blood transfusions Erythropoietin therapy |
| Chronic Blood Loss | Reduced iron stores Bleeding ulcer Hemorrhoids Menstrual and postmenopausal blood loss |
| Chronic Blood Loss Management | Identify source Stop bleeding Possible use of supplemental iron |
| Acute Blood Loss | Result of sudden hemorrhage Trauma Complications of surgery |
| Acute Blood Loss Clinical Manifestations | Tissue hypoxia Tachycardia Tachypnea Bone pain Internal hemorrhage Tissue distention, organ displacement, nerve compression Pain Retroperitoneal bleeding Numbness Pain in the lower extremities Shock is the major complication |
| Diagnostic Studies | Laboratory data do not adequately assess RBC problems for 2 to 3 days |
| Collaborative Care | Replacing blood volume to prevent shock Identifying the source of the hemorrhage Stopping blood loss Correcting RBC loss |
| Aplastic Anemia | Rare Damage or decrease in the# of stem cells in bone marrow Congenital Chromosomal alteration |
| Aplastic Anemia | Acquired Caused by exposure to benzene &benzene derivatives(air plane glue),radiation, infections,pregnancy Results in neurtopenia& thrombocytopenia Unknown etiology in 50% of the cases |
| Aplastic Anemia Clinical Manifestations | Symptoms of anemia Infection Purpura Lymphadenopathies Splenomegaly Retinal hemorrhages |
| Aplastic Anemia Diagnostic findings | Decreased RBCs, WBCs and platelets Decreased reticulocyte count (immature RBCs) Bone marrow examination Decrease activity of bone marrow/no cell activity |
| Aplastic Anemia Collaborative Care | Remove the cause Treat symptoms Transfusions RBCs Platelets Bone marrow transplant/peripheral stem cell transplant |
| Anemia Nursing Diagnoses | Activity intolerance Imbalanced nutrition: Less than body requirements Ineffective therapeutic regimen management Potential complication: Hypoxemia |
| Anemia Nursing Management | Goals Maintain adequate oxygenation Assume normal activities of daily living Maintain adequate nutrition Develop no complications related to anemia Monitor labs Monitor oxygenation status Monitor for signs of bleeding Pace activities to avoid fati |
| Anemia Nursing Implementation | Blood or blood product transfusions Drug therapy Oxygen therapy Patient teaching Nutrition intake Plan frequent rest periods Compliance with drug therapy |
| Polycythemia | Excessive production of RBCs as well as platelets and leukocytes Increased blood viscosity Congestion of blood in tissues Liver Spleen Evolves to Acute Myelocytic Leukemia (AML) |
| Polycythemia Clinical manifestations | Headaches Dizziness Parasthesias Visual disturbances Hypertension Thrombophlebitis Joint pain Hepatosplenomegaly Ruddy complexion Angina Pruritis |
| Polycythemia Diagnostic findings | Increased RBCs Increased Hgb & Hct Increased uric acid levels (due to increased RBC destruction) |
| Polycythemia Collaborative Care | Phlebotomy Myelosuppressive therapy Pain relief Monitor for organ failure Kidneys Heart Cerebral perfusion |
| Polycythemia Nursing Management | Pain management Monitor for organ failure Monitor for altered nutrition (less than body requirements) Monitor for complications post phlebotomy Orthostatic hypotension Tachycardia Decreased LOC Chest pain |
| Thrombocytopenia | Reduction of platelets below 150,000/ul Immune thrombocytopenic purpura (ITP) Most common acquired form Autoimmune – platelets destroyed in the spleen Thrombotic thrombocytopenic purpura Uncommon Cause: unknown |
| Thrombocytopenia | Heparin Induced Thrombocytopenia an Thrombosis Syndrome (HITTS) |
| Thrombocytopenia Clinical manifestations | Epistaxis(nose bleed) Gingival bleeding Petechiae Purpura Ecchymosis Internal bleeding |
| Thrombocytopenia Complications | Hemorrhage Cerebral hemorrhage fatal |
| Thrombocytopenia Collaborative Care | Stop bleeding Replace coagulation factors Blood & blood product transfusion Plasmaphoresis Treat underlying cause Splenectomy Medications Corticosteriods Imuran |
| Thrombocytopenia Safety | Bleeding precautions Avoid IM injections Avoid rectal manipulation Prevent constipation Apply direct pressure to venipuncture sites Avoid anticoagulants,anti-platelet medications Use soft tooth brush Avoid dental floss Use electric razor |
| Thrombocytopenia Safety | Bedrest(platelet count < 20,000/mm3) |
| Thrombocytopenia Nursing Management | Pain management Hemarthrosis Fluids & Electrolytes Maintain hydration status (IV/PO) – blood loss leads to decreased circulating volume |
| Thrombocytopenia Nursing Management | Nutrition Promote erythropoiesis – Folic acid, B12 - RBC maturation Iron, B6 - Hgb synthesis Vitamin C - converts folic acid to active form, Fe absorption |
| Focus Assessment/Complications Cardiovascular | Hypovolemia/Hypovolemic Shock: VS changes; S/S low cardiac output/decreased perfusion manifested in the following body systems: Integument Respiratory Neuro Renal |
| Focus Assessment/Complications | Integument: petechiae/ecchymosis Hematological: prolonged bleeding w/ invasive procedures; occult blood Gastrointestinal: splenomegaly; abdominal pain & distention Neuro: CVA - cerebral bleed; retinal bleed Musculoskeletal: hemarthrosis |
| Neutropenia | Decrease in neutrophil count as a result of decreased production or increased destruction Increased risk for infection Not a disease but a syndrome |
| Neutropenia Etiology | Nutritional deficiencies Folic acid Cobalamin Medication induced Chemotherapeutic agents Autoimmune disorders Infections Sepsis |
| Neutropenia Clinical Manifestations | Low WBC Low grade fever |
| Neutropenia Complication | Infection Sepsis |
| Neutropenia Diagnostic Findings | WBC; < 4000/ul Absolute Neutrophil < 1000 - 1500/ul presence of neutropenia 500 - 1000/ul moderate risk for infection < 500/ul severe risk for infection Bone marrow examination Determine the cause |
| Neutropenia Collaborative Care | Prevention of infection Hand washing Private room if possible Medications Antibiotics Analgesics Antipyretics G-CSF (Neupogen) |
| Neutropenia Nursing Management Fluids & Electrolytes | Adequate intake to prevent dehydration & possible urinary tract infection; up to 3-4L daily Monitor I&O |
| Neutropenia Nursing Management Nutrition | Low microbial High nutritional value |
| Neutropenia Nursing Management Safety | Avoid exposure/risk for infection Strict hand washing Avoid invasive procedures Pulmonary hygiene (IS, TCDB) |
| Neutropenia Nursing Management Discharge teaching | Meticulous personal hygiene Avoid crowds Avoid persons known to have a cold or other contagious illness Avoid swimming in lakes and crowded pools Keep home free of dust/dirt |
| Leukemia | A group of malignant disorders affecting the blood and blood-forming tissues of Bone marrow Lymph system Spleen Occurs in all age groups Fatal if untreated Progressive |
| Leukemia Etiology | Type of white blood cell involved (WBC) Acute lymphocytic leukemia (ALL) Acute myelogenous leukemia (AML) Also called acute nonlymphoblastic leukemia (ANLL) Chronic myelogenous leukemia (CML) Chronic lymphocytic leukemia (CLL) |
| Leukemia Clinical Manifestations | Relate to problems caused by Bone marrow failure Overcrowding by abnormal cells Inadequate production of normal marrow elements Anemia, thrombocytopenia, neutropenia |
| Leukemia Clinical Manifestations | Relate to problems caused by Leukemic cells infiltrate patient’s organs Splenomegaly Hepatomegaly Lymphadenopathy Bone pain Seizures (meningeal irritation) |
| Leukemia Diagnostic Studies | Peripheral blood evaluation Bone marrow evaluation (definitive diagnosis) Diagnose and classify Identify cell subtype and stage |
| Leukemia Collaborative Care | Goal is to attain remission/disease control Chemotherapy regimen Radiation Bone marrow and stem cell transplantation |
| Bone Marrow and Stem Cell Transplantation | Eliminate leukemic cells from patient’s body Replaced with those of an HLA-matched Sibling Volunteer Identical twin Patient’s own stem cells removed before |
| Bone Marrow and Stem Cell Transplantation Nursing Management | Assess for signs and symptoms of disease progression,infection,bleeding,Provide nutrition,Prevent fatigue,Promote safety Observe for side effects of tx |
| Bone Marrow and Stem Cell Transplantation Nursing Management | Patient empowered by knowledge of the disease& tx can have a more positive outlook& improved quality of life Nurses face special challenges when meeting the intense psychosocial needs of a patient with leukemia |
| Hemophilia | Hereditary coagulation disorder Sex-linked recessive disorder Von Willebrand’s disease Hemophilia A (most common) Hemophilia B |
| Hemophilia Diagnostic Findings | Assays for factors VIII, IX and vWF PTT is prolonged due to the intrinsic pathway problem Normal platelets and PT |
| Hemophilia Clinical manifestations | Persistent and prolonged bleeding from injuries Delay of onset of bleeding Subcutaneous echymosis and subcutaneous hematomas Gingival bleeding GI bleeding Hematuria Hemarthrosis |
| Hemophilia Collaborative Care | Replace the deficient coagulation factor Supportive treatment of symptoms Control bleeding Management complications |
| Hemophilia Nursing Management | Supportive care Assess for symptoms; pain, bleeding Bleeding precautions Patient education Genetic counseling National hemophilia foundation Medical alert bracelet |
| Disseminated intravascular coagulation /coagulopathy (DIC) | Imbalance between coagulation and anticoagulation Caused by sepsis, anoxia, burns, multiple trauma, amniotic fluid embolus, snake bites, metabolic acidosis, hypotension 80% mortality rate Net effect is hemorrhage |
| DIC Diagnostic Findings | Prolonged PT Prolonged PTT Prolonged thrombin time Decreased fibrinogen Decreased platelets Elevated FDP/fibrin split products Elevated D-dimer |
| DIC Clinical Manifestations | Related to the cause Purpura Ecchymoses Bleeding from various sites with pain and clinical manifestations associated with bleeding Hypotension Shock Death |
| DIC Collaborative Care | Treat cause Symptom management Administer blood products Replace clotting factors Fresh frozen plasma (FFP) Cryoprecipitate |
| DIC Nursing Management | Assess for hemorrhage Implement bleeding precautions Monitor for signs of fluid overload (transfusions) Assess for signs of renal failure Assess for signs of respiratory failure Supportive care |
| Complex protein-iron compound that binds with oxygen and carbon dioxide | Hemoglobin |
| Process by which WBCs engulf and kill organisms | Phagocytosis |
Created by:
LauraHall
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