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chpt 31 blood dz
anemia etc
| Question | Answer |
|---|---|
| mild anemia classification (#) | 10-14 g/dl; experiences dyspnea, diaphoresis, palpitations |
| moderate anemia classification (#) | 6-10 g/dl; pt experiences dyspnea at rest |
| severe anemia (#) | <6 g/dl; pt has multiple symptoms |
| At what # (g/dl) would you call the doctor for anemia and recieve a blood transfusion? | around 8 g/dl (moderate) |
| what are the s/s of anemia | pallor, jaundice, heart murmur/bruit(low viscosity), fatigue, pruritis, angina, MI, HF |
| anemia is caused by what 3 things? | 1)blood loss 2)dec erythrocyte production 3)erythrocyte destruction |
| how do u inject iron? | z-track w/0.5 ml of air left in it so skin doesn't stain. Also change syringe and do NOT massage area |
| when a person has anemia-like s/s, what do u determine 1st? | the cause |
| what is the major cause of iron deficiency in adults? | blood loss (menstruation) |
| s/s of mild case iron deficiency from hypoxia include what? | glossitis, cheilitis |
| what is a pt rteaching when providing iron supplements? | fluids & fiber |
| what might iron supplements cause (besides constipation) | black stools |
| nursing intervention for iron deficiency anemia | plan/pace activities |
| what can be done to inc iron absorption? | PO empty stomach, take w/OJ |
| what is usually done for iron deficiency? | blood transfusions- outpt as well |
| what can prosthetic heart valves cause? | destruction of RBC |
| what is the #1 reason for hemolysis & what do you do? | blood transfusion of mismatched blood- STOP it 1st then call doctor |
| what causes Thalassemia? | genetic deficit which causes dec amt Hb due to inadequate synthesis of the globulin chains |
| who gets Thalassemia | Mediteraneans :( |
| what is a nursing intervention for thalassemia | genetic testing, counseling |
| what is the mild form of thalassemia | alpha-thalassemia |
| what is is the asymptomatic form of thalassemia? | T-minor |
| what is the most common form of thalassemia? | beta-T |
| what is another name for thalassemia major? | cooley's thalassemia |
| what is thalasemia major marked by? | homozygous dz both parants- severe anemia, marked by hemolysis of erythrocytes and jaundice |
| what do you NOT give to a thalassemia pt | iron (liver toxicity)- the blood cell cannot carry it |
| what is done for a thalassemia pt? | blood transfusions (frequent) w/IV dereroxamine: cheleating agent to reduce iron overload |
| what does thalassemia cause during childhood | developmental deficits |
| what are s/s of thalassemia | hepatomegaly, splenomegaly, jaundice, chronic BM hyperplasia |
| Is tx for thalassemia palliative | yes |
| is thalassemia life threatening? | yes |
| those over the age of 25 have what d/t thalassemia blood transfusions? | Hep C |
| what is megablastic anemia caused by? | deficiency of B12 or folic acid |
| why are megablastic cells easily destroyed | large cells pop |
| what is the most common cause of vit B 12 deficiency anemia? | perniscious anemia (gastric mucosa not secreting IF) |
| what is the hallmark for vit B 12 deficiency anemia? | parasthesia |
| VIT B12 IS IRREVERSIBLE- HOW? | 1000 mg cobalamine IM injections QD, then weekly, then monthly--> FOR LIFE or you DIE |
| what are s/s of of B12 anemia? | smooth, sore, red tonguefatique, confusion, n/v/d, ataxia, parasthesia |
| what causes folic acid deficiency? | poor nutritional intake, malabsorption, drugs such as Dilantin, alcohol, prego, anorexia, hemodialysis |
| do pts take folic acid supplements only for anemia? | no, it's also for cardiac pts... |
| in B12 deficiency anemia, what is cautioned? | heat causes neuro pain |
| what kind of diet should those w/folic acid deficiency follow? | uncooked & green leafy veggies, liver, citrus fruits, folic acid supplements, and yeast |
| why do prego moms experience folic acid deficiency? | b/c the baby takes it all |
| what causes anemia of chronic dz? | inflammation, autoimmune, infectious & malignant diseases |
| what does renal dz cause? | insufficiency of erythropoiten |
| How is anemia of chronic dz best tx? | tx the underlying cause |
| what medication is given to those w/chronic dz anemia? | epogen (synthetic erythropoiten) & prokrit |
| what type of condition is aplastic anemia? | the BM does not produce wbc,rbc 7 plts- it's a decrease in or damage to B< cells |
| what is pancytopenia | dec amount of rbc, wbc and plts |
| congenital vs acquired aplastic anemia | chromosomes; radiation, chemical agents, viral, bacterial, or prescription drugs |
| what can infx lead to in aplastic anemia? | septicemia |
| nursing intervention for aplastic anemia | do not have pt wait in the waiting room (infx) |
| pt education for aplastic anemia | have pt use electric razor, do not blow nose, wear gloves when doing housework |
| what are nursing interventions for neutropenia? | handwashing, no flowers or raw fruits in the room- reverse isolation |
| which pt should you see 1st? | the one w/the lowest WBC count |
| what are the s/s for aplastic anemia? | dyspnea on exertion, weakness, neutropenia, abnormal bleeding d/t thrombocytopenia |
| what does the pt experience w/acute blood loss? | hypotention, hypovolemic, B/P is down |
| what happens when a pt loses 50% blood volume? | shock and death |
| what is the tx for acute blood loss | 1st IV fluids b/c type-n-cross takes time, ID source of bleeding, blood transfusion, supplement w/iron |
| what happens with chronic blood loss? | ulcer, hemorrhoids, menstrual depletes iron stores |
| how do you tx chronic blood loss | find the source and stop it, dr. may order colonoscopy, supplement w/iron |
| what are the major hallmarks for hemolytic anemia? | shortened RBC life span, failure of the BM to replace them |
| what causes hemolytic anemia? | trauma, meds, chemical agents, systemic dz, Ab-Antigen reactions |
| s/s of hemolytic anemia | dyspnea, pale, cholelithiasis, jaundice, hepato/splenomegaly |
| what causes splenomegaly? | macrophages engulphing cells |
| What do you maintain in hemolytic anemia? | renal fx- can cause acute renal failure, lyte/fluid balance, pace & plan activities |
| what is a nusing dx for hemolytic anemia? | Activity intolerance |
| what causes sickle cell anemia? | genetic disorder r/t to the mutant Hb sickle cell hemoglobin (Hbs) |
| who does sickle cell effect? | African americans |
| What factors cause cells to sickle? | hypoxia: high altitude, exercise, stress, dehydration, infx, cold temperature |
| what causes the pain associated w/sickle cell anemia? | LACTIC ACIDOSIS and ISCHEMIA |
| when should the pt seek tx in sickle cell | @ 1st sign of illness |
| what is the problem in sickle cell? | hemoglobin S |
| what are the s/s of sickle cell? | jaundice, pallor, dec exercise tolerance, childhood growth impaired, |
| how is anemia caused in sickle cell? | spleen destroys cell b/c it's deformed |
| how could a pt prevent an episode? | avoid infx, get vaccinated, cold temperature, stress, remain hydrated (8 GLASSES OF WATER QD), avoid high altitudes and folic acid |
| nursing intervention for sickle cell | listen to lung sounds (pulmonary complications) |
| what do you give pt for sickle cell? | O2, morphine/dilaudid for pain (not demerol), procardia, antisickling agents; usually a chemo drug (hydroxyurea w/epogen)- stimulates RBC production & rids of iron |
| what is autosplenectomy? | spleen becomes smaller d/t repeated scarring- inc risk for infection |
| multiple transfusions for sickle cell cause what? | iron overload |
| Acquired hemolytic anemia is caused by what? | extrinsic physical factors, immune reactions, toxins & infectious agents |
| what physical factors cause acquired hemolytic anemia? | prothetic heart valves (on coumadin) d/t extreme force, hemodialysis, cardiopulmonary bypass |
| how is acquired hemolytic anemia tx? | corticosteroids, removal of the spleen b/c splenomegaly can occur |
| what is hemochromatosis caused by? | autoimmune disorder which causes inc intestinal absorption of iron which causes inc iron deposits in tissues/organs disrupting fx |
| who is hemochromatosis most common in? | europeans |
| hemochromatosis is secondary to what? | thalassemmia and siderobastic anemia |
| when a person has a splenectomy, they are at inc risk for what? | infection |
| what organs does hemochromatosis effect? | the pancreas, heart, adrenal glands and liver (cirhossis) |
| what must you hold if the Hct is high? | epogen |
| how else can you gethemochromatosis? | too many blood transfusions |
| what is the tx for hemochromatosis? | weekly phlebotomy for 2-3 years |
| what is hemachromatosis similar to? | arthritis |
| what foods do you avoid w/hemachromatosis? | vitamin c (inc iron absorption), iron supplements, uncooked seafood, iron-rich foods |
| what is polycethemia? | opposite of pancytopenia, inc blood viscosity d/t inc # of RBC--> impairs circulation |
| what is primary polycethemia? | polycythemia vera: chromosomic mutation causing myeloproliferation (also involves WBC & plt) |
| what are the hallmarks of polycythemia? | hypervolemia, hyperviscosity (capillaries become plugged by viscous blood) |
| what is a nursing intervention for polycythemia? | ambulate pt |
| clinical s/s for polycythemia | HA, tinnitus, vertigo, pruritis, spleno/hepatomegaly |
| what is contraindicated with polycythemia? | iron supplements |
| what is the pt w/polycythemia at risk for? | underhydration & overload |
| what is sign of polycythemia? | itching while in a hot bath |
| how is polycythemia tx? | by reducing blood volume, BM activity and viscosity. PHLEBOTOMY is mainstay, hydration |
| meds for polycythemia | myelosuppressive, radiation therapy, monitor blood studies |
| which two blood dz involve phlebotomy? | hemachromatosis & polycythemia |
| what is secondary polycythemia caused by? | hypoxia-driven, demand for more O2 |
| what is the difference between primary and secondary polycythemia? | normal wbc & plt & spleen is not enlarged |
| what is the pt teaching for secondary polycythemia | STOP SMOKING, avoid high altitudes |
| what is the difference between primary and secondary (always) | primary is idiopathic, and secondary has a cause |
| What med is given for all autoimmune disorders and what risk does it cause? | corticosteroids- @ risk for infx |
| what causes thrombocytopenia? | an autoimmune attack which destroys plts. The normal plt is covered w/an Ab which is recognized as foreign and destroyed by the spleen` |
| what is the plt count for thrombocytopenia? | <150,000 |
| @ what pt is a plt transfusion required for thrombocytopenia? | <20,000, and <10,000 causes spontaneous bleeding |
| what do you check for thrombocytopenia? | check the stool for occult blood |
| what do you teach w/thrombocytopenia? | bleeding precaution, no IM or SQ injections (could cause hematoma), no ASA, avoid vasalva, avoid blowing nose, report trauma |
| s/s of ITP | purpura, petechiae, ecchymosis |
| what do corticosteriods suppress in ITP? | phagocytosis & if it doesn't work, then splenectomy |
| what is the goal for the pt w/thrombocytopenia ITP? | no bleeding |
| how do u know tx for ITP is working | inc plt count |
| heparin-induced thrombocytopenia & thrombosis (HITTS) is caused by what? | heparin cause bleeding and clumping at the same time. major problem is venous thrombosis (DVT & PE can occur) |
| s/s of HITTS? | need for more heparin |
| what must be discontinued w/HITTS? | heparin, especially when 50% plt count drops or pt- Notify the HCP & check for clots |
| what do you look at before the heparin is started? | baseline & compare the two. |
| what do you monitor for HITTS? | PTT (30-45 seconds is the norm) |
| what causes hemophilia & von willebrand? | congenital, sex-linked x(men get it)coagulation & prolonged bleeding |
| what are the 3 major types of hemophilia? | hemophilia A (most common) factor VIII deficiency; hemophilia B (christmas dz) factor IX deficiency & von willebrand deficiency which helps plts clump and stick to the blood vessel wall |
| how do hemophiliacs bleed | for a much longer time, not more intensely |
| how is hemophilia tx? | fresh frozen plasma |
| how should green leafy veggies be eaten with hemophiliacs | they should be eaten at a constant level w/coumadin (vitamin k) |
| what are hemophiliacs at high risk for? | GI bleeding- dark tarry stools require immediate tx |
| home management for hemophiliacs | no ROM or heat, apply ice & bed rest |
| hematoma causes what in the joints/ | hemarthrosis- bleeding in the joints |
| what is bleeding tx with in hemophilia? | replacement of clotting factors- raise the level for ANTIHEMOPHILIC FACTOR temporarily, immediate transfusion of factor VIII and IX is PRIMARY tx. pt needs infusion Q12 hours till bleeding stops |
| what can the pt w/hemophilia not do? | floss |
| what is DIC caused by? | accelerated clotting followed by diffuse bleeding- life threatening- bleeding and clotting occur simultaneously |
| how do you tx DIC? | tx underlying cause 1st, and ALWAYS give antibiotic 1st |
| what does DIC cause? | microembolus disrupt the blood flow, ischemia, organ damage, fibrin degredation products are released, ICU high mortality rate |
| what does the pt feel w/DIC? | impending doom |
| what is DIC tx with? | transfusion, but w/out finding cause, it's useless |
| what do you need to know w/DIC? | plt count |
| What is DIC caused by? | always occurs in response to something else: shock, cirrhosis, glomerulonephritis, snake bitesfat emboli, factor III release, dead fetus, induced HTN from prego, d/t intrinic & extrinsic factor activation |
| management of DIC | correct precipitating factor, correct infx, deliver fetus, control bleeding, provide RBC for hypovolemia & O2, cryoprecipitate, plt transfusion if < 100,000 |
| what is cryoprecipitate? | best source for fibrinogen, factor V, VIII, XIII |
| DIC management | limit physical activity, and keep venipuncture to a minimum, hold pressure for 10 min |
| what is neutropenia? | abnormally low amt of neutrophils <1500 |
| what is the normal neutrophil count? | 4000-11000 |
| what is important to know about neutropenia | how fast the count drops (greater risk for infection) |
| what is the first sign of neutropenia? | fever |
| what can't a pt w/neutropenia have? | flowers, tap water, cesar dressing |
| what could cause neutropenia? | iatrogenic; chemo, immunosuppresive tx, s/e of medication, syndrome which occurs w/dz, most dz will inc neutrophils, but typhoid fever & many viral could decrease it |
| what dx test is done for neutropenia? | wbc count, bone marrow aspiration & biopsty, peripheral blood smear to assess for bands, Hct, reticulocyte count, plt count |
| what is constantly checked in neutropenia? | temperature, slight inc & notify HCP--> start anbx after culture (broad to narrow) |
| s/s of neutropenia | classic sign of inflammation not present (fever), normal flora leads to infx, sore throat, dysphagia, lesion on pharyngela mucosa, diarreah, vaginal itching, SOB significant |
| what is Nupogen | stimulates neutrophils |
| what type of room is used for neutropenia | + pressure, hand washing, visitor restriction |
| Myelodisplastic syndrome is caused by what? | stem cell disorders resulting in ineffective hematopoisis- progressive BM failure |
| what is the hallmark for myelodysplastic | peripheral blood cytopenias & hypercellular BM exhibiting dysplastic changes |
| blood cytopenias include what 3 things | 1) anemia 2) neutropenia 3)thrombocytopenia |
| what is the goal of myelodysplastic syndrome? | goal is to improve heatopoisis and quality of life through hematologic monitoring, antbx use, blood transfusion, CHEMO, hematopoietic stem cell transplantation |
| what is leukemia? | BM FAILURE: uncontrolled proliferation of immature & undifferentiated wbc which circulate and infiltrate blood forming organs |
| what's the difference of acute and chronic leukemia? | acute is more immature, and chronic is mature |
| what is acute myelogenous CA caused by? | a fast growing CA of the blood & BM characterized by uncontrolled proliferation of myeloblasts (precursors to granulocytes) which crowd out all normal cells (hyperplasia) |
| Acute lymphocytic leukemia is caused by what? | a large # of lymphocytes, IMMATURE ones take over the bone marrow (CA) BM failure |
| what are the s/s of acute lymphocytic leukemia? | bleeding, fever, and CNS manifestations |
| chronic myelogenous leukemia is caused by what? | abmormal growth of myeloblasts (precursor to granulocytes)- caused by excessive MATURE neoplastic granulocytes in BM- more gradual |
| what is chronic lymphocytic leukemia caused by? | uncontrolled spread of small lymphocytes- progresses more slowly |
| acute lymphoblastic occurs in what age group and what's a s/s | children; CNS manifestations |
| chronic lymphocytic occurs in which age group | adults |
| labs for acute leukemia | differential reveals 1 type of leukocyte is predominant, immature blasts, abnormal leukocytes |
| what dx tools are used to determine acute leukemia? | bone marrow aspiration (#1), lumbar puncture, ct scans & MRIs to locate lesions |
| what is the goal for acute leukemia | prevent remission w/restoration of normal BM fx and prevent/tx anemia, bleeding & infx |
| 3 phases of chemo for acute leukemia | induction phase, consolidation therapy and maintenance therapy |
| what does the induction phase of chemo consist of? | intensive to induce complete remission, pt may be critically ill d/t BM suppression, nursing interventions focus on neutropenia, thrombocytopenia, & anemia |
| what does the consolidation phase of chemo consist of? | modified courses to eradicate any remaining dz |
| what does the maintenance therapy od chemo consist of? | small doses of different combos given Q 3-4 weeks for 1 year |
| what are some nursing interventions for acute leukemia? | flu shot, vaccines, PSYCHOLOGICAL SUPPORT THROUGH SUPPORT GROUPS |
| what is a lymphoma? | a solid neoplasm enlargement that originates in the lymph nodes tumor |
| what is Hodgkin's dz? | enlarged lymph nodes starting at the neck & spreading throughout the body. A distict cell called the REED-STERNBERG. When the cell is absent, it is NHL |
| what is hairy cell leukemia & what does it cause? | b-lymphocyte proliferation causing splenomegaly (males) |
| what could cause Hodgkins? | infectious component: epstein-barr, virus, organ transplant recipients, mononucleosis- JEWS |
| s/s of Hodgkins | enlarged painless nodes (firm rubbery & moveable), pain at site w/alcohol, loss of appetite/wt, fever, lethargy, itching, painful lump in abdomen, cough |
| dx for Hodgkins | LN/BM biopsy, chest x-ray, thoracic, abdominal & pelvic CT |
| tx for hodgkins | starts w/classification & staging, radiation for early, 2 combo chemo |
| what is the 2 combo chemo for hodgkins? | 1)MOPP 2)ABVD; given in 6 or more cycles w/baldness, n/vfatigue, myelosuppression & stomatitis (inflammed mouth) as s/e. Give antiemetics & pain meds |
| what is non-hodgkins lymphoma? | malignant lymphoma: a group of malignancies which originate in the lymphoid cells- the cells become fixed & cont to proliferate (B & T cells proliferate in LN)- obstruction of the enlarged LN |
| s/s of NHL | enlarged generalized/localized LN (lymphadenopathy); B SYMPTOMS: noc sweats, fever & wt loss, hepato/splenomegaly |
| labs/dx for NHL | CBC, ESR, UA, peripheral smear, LN bx, x-ray, barium enema, ct/MRI |
| tx for intermediate NHL | CHOP & radiation for tumor shrinkage |
| what do the lymph nodes feel like w/HD, NHD? | firm, moveable, rubbery |
| what assessment is important w/lymphomas? | phycosocial b/c dx of CA is devastating- effects retirement in older adults |
| what is an outcome for lymphoma? | the dz will become a chronic condition the family can cope with in a posistive menner |
| NHL & HL nursing invertions | prevent infx, low bacteria dt, wash hands, analgesics, BLEEDING PRECAUTIONS, avoid ASA, avoid catheters, limit injections, NO tampons, pressure reducing mattress |
| what causes multiple myeloma? | |
| what causes multiple myeloma? | neoplastic plasma cells (activated b-cells)infiltrate BM & prod excessive immunoglobulins & cytokines, normal plasma cells reduced, bone destroyed, lymph nodes, kidney, liver & spleen invaded |
| in multiple myeloma, CA cells involve plasma cells and the body does what? | produces more and more of these cells |
| in multiple myeloma, un-needed plasma cells are abnormal, and exactly alike- what are they called? | myeloma cells |
| what is a plasmacytoma? | in multiple myeloma, the myeloma cells gather in the BM & outer hard parts of bone- forming a tumor |
| when myeloma cells collect in many bonrs it is called what? | multiple myeloma |
| what are the s/s for mult. myeloma? | BONE PAIN; osteoperosis,hypercalcemia from bone degredation, renal failure d/t high protein lvls, anemia, granulocytopenia, and thrombocytopenia d/t BM destruction |
| what are important nursing interventions for mult.myeloma? | #1 adequate hydration & be gentle & assist pt to ambulate d/t frax & osteoperosis, corticosteroids to excrete Ca, braces, prompt infex tx |
| what is the tx for mult. myeloma? | chemo, radiation, corticosteroids, marrow stem cell transplantation, ALLOPURINOL for hyperuricemia, LASIX to excrete Ca, CALCITONIN to tx hypercalcemia |
| what is Apherisis? | removing a component of the blood & putting the rest back in- process is longer than a whole blood donation |
| what are other names for synthetic erythropoiten? | epogen, procrit, EPO, erythropoiten human glycoform alpha, rHuEPO-alpha |
| what is oerioperative blood recovery? | blood loss during surgery is returned to pt |
| In blood recovery, why is the time factor important? | it takes about 3-5 minutes so as not to intrude upon the surgical process |
| What is done for blood storage? | ABO testing & Rh type- testing for west nile virus |
| what's in whole blood? | RBC which can be refrigerated for 42 days or frozen for 10 yrs. RBC carry O2 and are used to tx anemia |
| what are plts used for? | used to contol bleeding: leukemia pts and other CA. can be stored for 5 days @ room temp |
| what is fresh frozen plasma used for? | to control bleeding for those w/dec clotting factors. can be frozen for 1 year |
| what is cryoprecipitated antihemophylic factor? | clotting factors made from fresh frozen plasma for those w/von willebrands dz or hemophilia. Can be stored for 1 year |
Created by:
arsho453
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