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68WM6 Phs 2 Test 14

68WM6 Phase 2 test 14 blood, lymph, & immune

QuestionAnswer
anemia Blood disorder characterized by red blood cell, hemoglobin, and hematocrit levels below normal range
aplasia (Aplastic Anemia) failure of the normal process of cell generation and development
Disseminated Intravascular Coagulation Acquired hemorrhage syndrome of clotting, cascade overstimulation, and anti-clotting processes
Erythrocytosis abnormal increase in the number of circulating red blood cells
Hemarthrosis bleeding into a joint space
Hemophilia A hereditary coagulation disorder; caused by lack of antihemophilic factor VIII, which is needed to convert prothrombin into thrombin through thromboplastin component
Heterozygous having two different genes
Homozygous having two identical genes inherited from each parent for a given hereditary characteristic
Idiopathic cause unknown
Leukemia malignant disorder of the hematopoietic system in which an excess of leukocytes accumulates in the bone marrow and lymph nodes
Lymphangitis inflammation of one or more lymphatic vessels or channels that usually results from an acute streptococcal or staphylococcal infection in an extremity
Lymphedema primary or secondary disorder characterized by the accumulation of lymph fluid in soft tissue, resulting in edema
Multiple Myeloma malignant neoplastic immunodeficiency disease of the bone marrow
Myeloproliferative excessive bone marrow production
Pancytopenic deficient condition of all three major blood elements (red cells, white cells and platelets) results from bone marrow being reduced or absent
Pernicious capable of causing great injury or destruction; deadly fatal
Reed-Sternberg cell Atypical histiocytes; large abnormal, multinucleated cells in the lymphatic system, found in Hodgkin’s disease
Thrombocytopenia An abnormal hematologic condition in which the number of platelets is reduced to fewer than 100,000/mm3
make up 70% of WBC. The initial responder to any invasion Neutrophils
key in the inflammatory response Basophils
key in allergic responses Eosinophils
Monocytes phagocytes that circulate in the blood stream and work similarly to neutrophils
Macrophages mature monocytes that live in tissue (i.e., alveolar macrophages in the lung and Kupffer cells in the liver
Lymphocytes T cells and B cells that directly kill invaders and produce antibodies, respectively. (Lymphoid cells)
what is the function of the Lymphatic system? Maintain fluid balance Produce (mature) lymphocytes WBC produced in the bone marrow but matured in lymph tissue Absorption and transportation of lipids from the intestine to the stream
lymph tissues Lymph nodes Tonsils Spleen Thymus
where is the spleen located? Located in left upper quadrant, just below the diaphragm
what is the function of the spleen? Stores approximately 500ml Matures lymphocytes, monocytes and plasma cells (B cells) Destroys worn out RBCs Removes bacteria by phagocytosis (macrophages) Produce RBCs before birth
where is the Thymus located? Located between the lungs in the mediastinum
what is a function of the Thymus? to develop the immune system, matures T cells
Measurements of the size and hemoglobin content of erythrocytes. These include Mean corpuscular volume (MCV) Mean corpuscular hemoglobin (MCH) Mean corpuscular hemoglobin concentration (MCHC)
The average amount of (weight) hemoglobin within an RBC Mean Corpuscular Hemoglobin (MCH
The average concentration or he percentage of hemoglobin within an RBC Mean Corpuscular Hemoglobin Concentration (MCHC
Often accompanies the differential WBC count and permits examination of the size, shape, and structure of individual RBCs, WBCs and platelets Peripheral Smear
Most informative of all hematologic tests Peripheral Smear
Adaptive Immunity provides a specific reaction to each invading antigen and has the unique ability to remember the antigen that caused the attack
Allergen a substance that can produce a hypersensitive reaction in the body
Antigen a substance recognized by the body as foreign that can trigger an immune response
Attenuated the process of weakening the degree of virulence of a disease organism
Autoimmune pertains to the development of an immune response to one's own tissue
Autologous something that has it's origin within an individual
the mechanism of acquired immunity characterized by the dominant role of small T cells Cellular immunity
one of the two forms of immunity that responds to antigens; it is mediated by B cells Humoral immunity
an abnormal condition characterized by an excessive reaction to a particular stimulus Hypersensitivity
Immunity the quality of being insusceptible to or unaffected by a particular disease or condition
Immunization a process by which resistance to an infectious disease is induced or increased
Immunocompetence the ability of an immune system to mobilize and deploy its antibodies and other responses to stimulation by an antigen
Immunodeficiency an abnormal condition of the immune system in which cellular or humoral immunity is inadequate and resistance to infection is decreased
Immunogen any agent or substance capable of provoking an immune response or producing immunity
Immunology the study of the immune system
Immunosuppressive the administration of agents that significantly interfere with the ability of the immune system to respond to antigenic stimulation by inhibiting cellular and humoral immunity
Immunotherapy a special treatment of allergic responses; involves the administration of increasingly larger doses of the offending allergens to gradually develop immunity
Innate immunity the body's first line of defense; provides physical and chemical barriers to invading pathogens and protects the body against the external environment
Lymphokine one of the chemical factors produced and released by T cells that attract macrophages to the site of infection or inflammation and prepare them for attack
Plasmapheresis removal of plasma that contains components causing or thought to cause disease
Proliferation reproduction or multiplication of similar forms
three functions of the Immune system protect the body against invaders, maintain homeostasis, surveillance network for recognizing and guarding against the development and growth of abnormal cells
natural immunity includes Composed of skin and mucous membranes, cilia, stomach acid, tears, saliva, sebaceous glands and secretions and flora of the intestine and vagina
what is the body's 2nd line of defense? acquired/adapted immunity - Composed of highly specialized cells and tissues, including the thymus, spleen, bone marrow, blood, and lymph
Provides specific immunity Results from production of antibodies in the cells Natural - after infection acquired/adapted immunity
Unique ability to remember the antigen that caused attack and Consists of humoral immunity and cellular immunity acquired/adapted immunity
an acquired condition that impairs the body's ability to fight disease; it is the end stage of a continuum of HIV infection AIDS
CD4+Lymphocyte these cells play a pivotal role in the ability of the immune system to recognize and defend against foreign invaders
Enzyme-Linked Immunoabsorbent Assay (ELISA - a rapid enzyme immunochemical assay method to detect certain bacterial antigens and antibodies; the first test for HIV/AIDS
is a broad diagnostic terms that includes the pathology and clinical illness caused by HIV infection HIV disease
Human Immunodeficiency Virus (HIV) a retrovirus that causes HIV infection and HIV disease
HIV infection the state in which HIV enters the body under favorable conditions and multiplies, producing injurious effects
a rare cancer of the skin and mucous membranes characterized by blue red or purple raised lesions Kaposi's sarcoma
Pneumocystis Carinii Pneumonia (PCP) an unusual pulmonary disease caused by a fungus and primarily associated with people who have suppressed immune systems
a virus that carries its genetic material in RNA rather than DNA, and it replicates by converting RNA into DNA Retrovirus
Seroconversion a person is said to have seroconverted when there is development of a detectable level of HIV antibodies found in the blood
Seronegative means there is not a detectable level of HIV antibodies found in the blood
Vertical transmission can occur during pregnancy, delivery or through postpartum breastfeeding
amount of measurable HIV virions Viral Load
Western Blot- Technique for analyzing small amounts of antibodies; the 2nd test for HIV/AIDS
Define the difference between HIV an AIDS AIDS is defined as an acquired condition that impairs the body's ability to fight disease. It is the end stage of a continuum of HIV infection
Found worldwide but more prevalent in the US and Europe HIV 1
HIV 2 Is prevalent in Western Africa and countries with historical and commercial ties to that region. It appears to be less virulent
Seroconversion takes place ___ days to ___ months after exposure, generally within one to three weeks. Process is accompanied by flu like or mononucleosis-like syndromes 5 ; 3
s/s of HIV/AIDS mononucleosis or flu like symptoms. Some patients may experience vague symptoms indicative of a viral infection
is the median time between HIV infection and the development of end-stage HIV disease or AIDS in an untreated individual is anywhere from 10 to 14 years Symptomatic infection, Early infection;
A physical exam may reveal persistent generalized lymphadenopathy (PGL); recurrent or localized infections; and neurological manifestations, such as numbness and tingling or weakness in the extremities This phase is called AIDS-related complex
what are some ways that HIV is spread? sexual practices, IV drug use/sharing needles, infected blood, vaginal secretions, breast milk
HIV is NOT transmitted by: Hugging, dry kissing, shaking hands, food utensils, animals, insects, cough, sneezing
The three most common modes of transmission are: Anal or vaginal intercourse Using contaminated drug-injecting equipment Transmission from mother to child
s/s of HIV Disease.... Persistent unexplained fever, night sweets, weight loss, fatigue, and lymphadenopathy: S&S may not occur until 10-14 years after initial infection
How long does it take after exposure to detect HIV antibodies? 1-12 weeks; detected with ELSA or Western Blot
Blood and plasma: CD4+ count _____ as disease progresses decreases
Gastrointestinal System manifestations r/t HIV Watery diarrhea, abdominal pain, weight loss, nausea, stomatitis, esophagitis, gastritis, yellow patches in the GI tract
Neurologic System manifestations r/t HIV Cognitive dysfunction, motor impairment, decreased LOC, hemiparesis, mental and motor declines with progressive miltifocal leukoencephalopathy
what are the 4 steps of hemostasis vessel spasm, platelet plug, clotting cascade, fibrinolysis
describe vessel spasm contraction of blood vessel immediately after damage to control the loss of blood
describe platelet plug platelets become activated, controls loss if vessel break is small
general description of clotting cascade damage-prothrombin~thrombin~fibrinogen~fibrin =meshes w/ platelet plug/entraps RBCs&WBCs = serum released and clot is stable
describe fibrinolysis process which breaks down a clot. Plasmin dissolves fibrin & dissolves the clot
Condition in which a component that is necessary to control bleeding is missing or inadequate Coagulopathies
three examples of coagulopathies thrombocytopenia, hemophilia, DIC(Disseminated Intravascular Coagulation)
Platelet disorder exhibiting a deficiency of the number of circulating platelets or change in the function of platelets Thrombocytopenia
what are three causes of thrombocytopenia aplastic anemia, leukemia, tumors and chemotherapy
Platelet sequestration can occur in the ____ spleen
Most common cause for platelet destruction is thrombocytopenia purpura
Significant bleeding can occur with platelet count of _____ < 20,000/mm3
Spontaneous bleeding can occur with platelet count of____ < 5,000/mm3
what are some examples of subjective info r/t Thrombocytopenia Recent viral infection Current use of medications Extent of alcohol ingestion History of bleeding tendencies
objective examples r/t Thrombocytopenia Melena, hematuria  Petechiae and ecchymosis  Epistaxis and gingival bleeding  Signs of increased intracranial pressure caused by cerebral hemorrhage Any bleeding tendencies
diagnostic tests r/t Thrombocytopenia Complete blood count- shows decreased platelets  Peripheral blood smear- to identify abnormalities in all cell lines Bleeding time  Bone marrow aspiration
examples of medical tx r/t thrombocytopenia Corticosteroid therapy, Intravenous gamma globulin or immunosuppressive drugs Transfusion of platelets, Plasmapheresis Splenectomy
what is one unique nursing intervention r/t thrombocytopenia that we should teach pts to avoid? Avoiding trauma (avoid sports with high risk of injury
recommended diet r/t thrombocytopenia use of stool softners & high fiber diet
Hemophilia B (Christmas Disease) is caused by a deficiency of factor IX
Hemophilia A is the most common type (85% of cases)- Antihemophilic factor ___ is absent VIII
A decrease in the formation of prothrombin activators occurs as a result of decreased clotting factors hemophilia
there are several clinical manifestations r/t hemophilia.....ready GO! Internal or external hemorrhage with large ecchymosis into tissues Muscles show deformity and joints become ankylosed (immobile)  Hemarthrosis- ankles, knees, and elbows   Pain, erythema and fever with hemarthrosis
Hemarthrosis bleeding into the joints
diagnostic tests r/t hemophilia serum blood tests, PT, INR, PTT, Hgb, Hct
medical tx r/t hemophilia minimize bleeding, relieve pain, transfusion, admin factor VIII & IX
Teach/assess understanding of emergency care  r/t hemophilia Immobilize/Pressure  Ice  Contract physician  Obtain medical alert tag and wear constantly
AGRANULOCYTOSIS A severe reduction in the number of granulocytes (basophils, eosinophils, and neutrophils
common causes of agranulocytosis Adverse medication reaction or toxicity Neoplastic disease Chemotherapy and radiation therapy Viral and bacterial infections Heredity
clinical manifestations of agranulocytosis fever, chills, headache, fatigue, ulcerations of the mucous membranes, bronchial pneumonia and urinary tract infections in later stages
objective findings during an assessment r/t agranulocytosis Fever over 100.6 F Erythema and pain from ulcerations Crackles and rhonchi due to exudates
diagnostic tests r/t agranulocytosis WBC w/differential- decreased WBC Bone marrow biopsy – suppressed activity Cultures to identify possible infective organism
neutropenic diet - avoid what? fresh fruits and veges, uncooked items, flowers, plants, bugs... UNCOOKED items.
name ways to protect against infection r/t agranulocytosis Monitor pt closely Handwashing and strict asepsis Observe for s/s of infection Enforce neutropenic precautions Prevent infected visitors from contact w/pt Monitor mucous membranes for ulcerations
A malignant disorder of the hematopoietic system in which an EXCESS of leukocytes accumulates in the bone marrow and lymph nodes Leukemia
r/t leukemia, cells infiltrate lymph nodes, spleen, and liver and cause damage
3 things that leukemia is attributed to genetics, viruses, exposure to radiation / chemotherapeutic agents
clinical manifestations of Leukemia anemia, thrombocytopenia, Leukopenia, enlarged lymph nodes and painless splenomegaly may be first sign
diagnostic tests r/t Leukemia CBC, bone marrow biopsy, CXR, peripheral smear, CT/Lumbar puncture
subjective assessment findings r/t Leukemia Pain in bones or joints Fatigue, malaise, and irritability Bleeding abnormalities
objecive assessment findings r/t Leukemia Infection Occult blood in stools and urine Petechiae, ecchymoses, bleeding of mucous CBC
what are three types of Drugs that could be used r/t Leukemia Chlorambucil, Hydroxyurea, Corticosteroids
tx r/t Leukemia is aimed at eradicating the Leukemia w/ ______ and ______ chemotherapy and bone marrow transplant
Nursing interventions r/t Leukemia Prevent infection, NEUTROPENIC PRECAUTIONS, avoid infectious agents, observe for s/s of infections, monitor graft vs host complications
r/t Leukemia, name pt teaching topics S/S of infection Avoiding infected persons Contact physician for s/s of infection Medication/dietary All procedures and interventions to patient and family
these meds are used to tx Leukemia and can significantly increase survival rate vincristine/prednisone and daunorubicin or doxorubicin
ALL Acute lymphocytic leukemia
Malignant neoplastic immunodeficiency disease of the bone marrow MULTIPLE MYELOMA
bone pain increasing with movement; ribs, spine, & pelvis is r/t ?? multiple myeloma
clinical manifestations of multiple myeloma bone destruction, pathological fractures, panytopenia, hypercalcemia, bence jones protein
objective assessment findings r/t multiple myeloma expression of pain, able to form ADLs, fever, s/s of infection esp resp & urinary, monitor for bleeding
diagnostics r/t multiple myeloma CBC, radiography, bone marrow biopsy(large amount of immature plasma), blood and urine(monoclonal protein is marker) Protein electrophoresis (bence jones protein)
medical management r/t multiple myeloma Treatment is symptomatic; disease is incurable Radiation and chemotherapy Antineoplastic drugs Monitor CBC Treat hypercalcemia and pain
diet r/t a pt with d/o of Leukocytes or Plasma depressed WBC production, Maintain neutropenic precautions/clean patient environment, Monitor CBC and report abnomal values, Administer antibiotics, as ordered
diet r/t Disorders of Leukocytes or Plasma Provide high protien, high calorie, high vitamin diet
Inflammation of one or more lymphatic vessels or channels caused by an acute streptococcal or staphylococcal infection in an extremity LYMPHANGITIS
Fine red streaks from the affected area in the groin or axilla Usually not localized, and edema is diffuse Chills, fever, and local pain accompany headache and myalgia clinical manifestations of lymphangitis
how would you medically manage lymphangitis? penicillin or other antimicrobial drugs to control infection, hot / moist heat-soaks or packs for comfort, elevate extremity
Primary or secondary disorder characterized by the accumulation of lymph in soft tissue and edema lymphedema
causes for lymphedema obstruction, removal of the lymph channels and nodes, hereditary, disturbed lymphy drainage
someone w/ lymphedema may complain of pain & pressure, medical hx of varicosities, pregnancy, or modified radical mastectomy is impt
______ is used to differentiate lymphedema from venous disorder lymphangiography
what type of diet would you expect r/t managing lymphedema? limit Na+ & avoid spicy foods which trigger thirst
nursing interventions r/t lymphatic drainage elevate extremeties while sleeping and periodically during day, massage toward trunk, avoid constrictive clothing
T/F: There is a cure for lymphedema. False. No cure just manage symptoms
More common in men older than 60 years of age, whites and those of Jewish ancestry MALIGNANT LYMPHOMA
r/t malignant lymphoma, Tumors usually start in lymph nodes and spread to lymphoid tissue in the: spleen, liver, GI tract, and bone marrow
s/s of malignant lymphoma Painless lymphadenopathy in the cervical area Fever Weight loss Anemia Pruritus,GI malabsorption Bone lesions, bone fractures
diagnostic tests r/t malignant lyphoma bone scan, CBC(increased RBCs, WBCs, platelets, ESR and anemia), chem 10, Coomb's test(+ result for antiglobulin),
what is crucial to determine the tx regimen r/t malignant lyphoma? accurate staging
types of tx r/t malignant lyphoma Chemotherapy and radiation. Immunotherapy with monoclonal antibodies Bone marrow transplant
pt teaching r/t malignant lymphoma Frequently reassess knowledge Explanations of the extensive diagnostic workup and its importance of staging the disease for determining the treatment plan are an important focus of patient teaching during the diagnostic period
Chemotherapy agents used are cyclophosphamide (Cytoxan) vincristine (Oncovin) Prednisone doxorubicin (Adriamycin) Bleomycin methotrexate
where is radiation commonly given r/t lymphomas tx Commonly receive radiation to the chest wall, mediastinum, axillae, and neck
MONOCLONAL ANTIBODY THERAPY- RITUXIMAB (RITUXAN) is what? Immunotherapy to eliminate malignant cells and induce remission Human cancer cells are injected into laboratory mice
T/F: Autologous grafts have a higher incidence of recurrence than allogenic True
List three treatments of lymphomas radiation, monoclonal antibody therapy, bone marrow transplant
Malignant disorder characterized by painless, progressive enlargement of lymphoid tissue Affects males twice as frequently as females HODGKIN’S DISEASE
Lymphoid tissue enlargement is first noticed in the cervical nodes and spleen
r/t hodgkin's disease, Characterized by abnormal or atypical cells called Reed-Sternberg cells
s/s of hodgkin's disease Anorexia Weight loss Malaise Extreme pruritus Low-grade fever Night sweats Anemia, leukocytosis followed by respiratory infections
subjective findings in an assessment r/t hodgkin's disease Malaise Appetite loss Pruritus is often severe Bone pain occurs later in the disease’s course
objective findings in an assessment r/t Hodgkin's Disease Cervical and supraclavicular lymphadenopathy Splenomegaly, hepatomegaly, and abdominal tenderness Excoriation of skin and evidence of scratching from pruritus Edema of the face and neck may be noticed Weight and nutritional status are recorded
diagnostic tests r/t Hodgkin's Disease CBC-shows anemia, increased WBCs, increased ESR (shows an inflammatory process
hallmark sign for Hodgkin's Disease presence of Reed-Sternberg Cells
what is the tx for stage I & II r/t Hodgkin's Disease radiation
what is the tx for stage III & IV r/t Hodgkin's Disease chemo & radiation
reduction of RBCs, a deficiency in hemoglobin and hematocrit, or an increased destruction of RBCs Anemia
medical management of anemia Depends on cause Bone marrow transplant Avoid blood transfusions if possible Splenectomy Drug therapy Treatment is often specific to the particular anemia
r/t hypovolemic anemia, what are the critical blood loss amounts? Blood loss of 1000 ml or more in adult can be severe Blood loss < 500ml can be tolerated
s/s of hypovolemic anemia Poor peripheral pulses Hypotension with increased capillary refill time Tachycardia Hypothermia Decreased hemoglobin and hematocrit
how long will it take for a pt to show signs of hypovolemic anemia? Caution: lab results may not be accurate indicators until hours after injury
methods to control hemorrhage/medical management r/t hypovolemic anemia Blood transfusion Plasma Dextran or other volume expanders Crystalloids
what would you teach a pt r/t hypovolemic anemia? Signs/symptoms of bleeding Bleeding occasions Home management When to contact physician
Autoimmune disorder resulting from the destruction of parietal cell and eventual gastric mucosa atrophy pernicious anemia
what is the Vit associated w/ pernicious anemia? Vit B12
what is the etiology of pernicious anemia? Parietal cell damage Intrinsic factor not available to combine with Vitamin B12, systemic absorption in the ileum is prevented Vitamin B 12 is needed for growth and maturation of all body cells
r/t pernicious anemia, The bone marrow produces large, abnormal red blood cells called megaloblasts
clinical manifestations r/t pernicious anemia Fever Extreme weakness Dyspnea Hypoxia Slight jaundiced Edema of legs Constipation or diarrhea
Characteristic lemon-yellow–tinged pallor with "raw-beef" tongue Pernicious anemia
what is the drug therapy for Pernicious anemia Vit B12, folic acid, iron supplements
nursing interventions for pernicious anemia Systematic approach Monitor vital signs every 4 hours Keep patient warm Oral care several times day High protein, vitamin, and mineral diet
T/F: Pt must understand the need for life-long replacement of Vit B12. True - LIFE-LONG
failure of the normal process of generation and growth; not enough RBCs,Usually pancytopenic (low RBCs, platelets and WBCs) aplasia
what are some causes of aplastic anemia Causes Viral infections Medications Chemicals Radiation Chemotherapy
clinical manifestations r/t aplastic anemia repeated infections, fatigue, palpations, dyspnea, bleeding tendencies, high mortality r/t high infections & hemorrhage, tachycardia
If you do a bone marrow biopsy on an aplastic anemia, what may be the results? "dry tap", decreased cellular elements, decreased hematopoietic activity, may not show RBC irregularities
medical management r/t aplastic anemia Blood transfusions are avoided, if possible Splenectomy may be required if that is the cause of thrombocytopenia Drug therapy Bone marrow transplant
what is one nursing diagnosis r/t aplastic anemia Activity intolerance, related to inadequate tissue oxygenation
Why are blood transfusions avoided in patients with aplastic anemia? Prevention of iron overloading, prevention of antibody development for transplant candidates, platelet transfusion, as needed – must be HLA typed
RBCs contain decreased levels of hemoglobin Causes Excessive iron loss Chronic bleeding of GI or genitourinary tract iron deficiency anemia
occurs when an individual is given a killed or weakened antigen, which stimulates the formation of antibodies against the antigen Artificially Acquired Active Immunity:
result of the activity of many leukocyte actions, reactions, and interactions that range from simple to complex Cell-Mediated Immunity (CMI):
Humoral Immunity antibody-antigen response. B lymphocytes produce circulating antibodies to act against a foreign substance
Antibody is a globulin (protein) produced by the ___ lymphocytes as a defense against an antigen B
occurs when the person is expose to a disease, experiences the disease, and the body manufactures antibodies to provide future immunity to the disease Naturally Acquired Active Immunity
is provided to the person by ready-made antibodies from another human or from an animal source. Immediate immunity to the invading antigen, but only last a short time Passive Immunity
Products providing passive immunity Hepatitis B immune globulin. Palivizumab. Rabies immune globulin. Cell-mediated defenses
Humoral immunity is mediated by B cells
DTap vaccine is used for: prevent diphtheria, tetanus, and pertusis
DTap vaccine is used for: prevent diphtheria, tetanus, and pertusis
Immunity from immune globulins is rapid, but short-lived, up to ___ months 3
r/t contraindications: Anaphylactic allergy to yeast Hep B Vaccine
r/t contraindications: Hypersensitivity to eggs/egg products Flu vaccine
r/t contraindications: Avoid becoming pregnant 4 wks after immunization, Allergy to egg, gelatin or neomycin measles, mumps, rubella vaccine (MMR II):
what is a nursing diagnosis r/t Leukemia or plasma d/o? Hemorrhage, related to decreased physiologic clotting capabilities secondary to thrombocytopenia
Chills, fever, and local pain accompany headache and myalgia, Fine red streaks from the affected area in the groin or axilla,Lymphadenopathy (swollen lymph nodes LYMPHANGITIS
what is the medical management for lymphangitis? penicillin or other antimicrobial drugs for infection and hot moist heat-soaks or packs for comfort
what is the tx for Hodgkin's disease depend on? staging process
what is the tx for stages I and II r/t hodgkin's disease? Radiation therapy
what is the tx for stages III & IV r/t Hodgkin's disease chemo and radiation
what type of meds could you see r/t chemo r/t Hodgkin's disease? (ABVD) doxorubicin (Adriamycin) bleomycin (Blenoxane) vinblastine (Velban) dacarbazine (DTIC-DOME)
what is Neupogen used for? r/t Hodgkin's disease Stimulates proliferation and differentiation of neutrophils Used to decrease infection in patients receiving antineoplastics that suppress neutrophil production
What cells are hallmark to Hodgkin’s Disease? Reed-Sternberg cells
stage I Hodgkin's disease abnormal single lymph nodes, regional or single extranodal site
Stage II Hodgkin's disease Two or more lymph nodes on the same side of the diaphragm Localized involvement of extranodal site and one or more lymph node regions of the same side of diaphragm
Stage III Hodgkin's disease Abnormal lymph node regions on both sides of diaphragm May be accompanied by spleen involvement subdivided into lymphatic involvement of the upper abdomen in the spleen (Splenic, celiac, and protal nodes
Stage IV Hodgkin's disease Diffuse and disseminated involvement of one or more extralymphatic tissues and/or organs-with or without lymph node involvement; the extranodal site is identified as H, Hepatic; L. lung; P, pleural; M, marrow; D, dermal; O, osseous
Ingestion of large amounts of _____ and other _________ medications commonly taken by older adults increase risk of GI bleeding and can lead to alteration in clotting aspirin; anti-inflammatory
Oral administration of ____ preparations increase the risk of GI bleeding and can lead to alteration in clotting iron
Blood products should be administered with caution, since older adults are at increased risk of developing congestive heart failure
cause of thrombocytopenia usually idiopathic
cause of hemophilia X-linked hereditary trait
cause of DIC secondary process with massive over stimulation of the clotting cascade
is an inherited bleeding disorder characterized by abnormally slow coagulation of blood and spontaneous episodes of GI bleeding, epistaxis, and gingival bleeding caused by a mild deficiency of factor VIII Von Willibrand's disease
when is Von Willibrand's disease commonly found? post partum periods, menorrahgia, post surgery/trauma
tx for Von Willibrand' disease cryoprecipitate transfusion w/factor VIII, fibrinogen and/or plasma, and DDVAP
Name two nursing diagnosis associated with a patient with a coagulation disorder Altered tissue perfusion, related to hemorrhage Fluid volume deficit, related to hemorrhage Pain, related to thrombosis
Disseminated Intravascular Coagulation (DIC) Grave coagulopathy resulting from the over stimulation of clotting and anticlotting processes in response to disease or injury
Massive stimulation of the clotting cascade results in the formation of clots in the microvasculature; Secondary process resulting in the over stimulation of normal clotting and anticlotting processes due to a primary medical process DIC
When thrombosis is stimulated, fibrinolysis is also stimulated DIC
Microvascular clotting causes decreased perfusion in organs and can lead to end organ damage DIC
manifestations r/t DIC noted bleeding from 3 unrelated sites: mucous membranes, IV, GI, GU tract, orifices, lungs, Diaphoresis with cold and mottled digits
diagnostic tests r/t DIC DIC panel- shows prolonged PT/PTT, positive D-dimer (reveals elevated levels of fibrin breakdown products- indicates fibrinolysis
examples of fluid replacement r/t DIC Crystalloids Transfusion (PRBCs, platelets, FFP) and cryoprecipitate (concentrated fibrinogen) Vitamin K  Heparin therapy Aminocaproic acid- fibrinolysis inhibitor  Anti-thrombin III- thrombosis inhibitor
Medications that may have a Thrombocytopenic Effect Aspirin  Digitalis derivatives  Furosemide Nonsteroidal anti-inflammatory agents Oral hypoglycemics Penicillins Quinidine  Rifampicin  Sulfonamides Thiazides Rantitidine
Laboratory test that identifies the etiology of pernicious anemia May involve multiple stages of testing to determine whether B12 intake is low, or B12 absorption is altered Schilling Test and Megaloblastic Anemia Profile
r/t schilling test, normal findings are excretion of 8% to 40% of radioactive Vit B12 within ____ hours 24
Evaluates presence of intrinsic factor Gastric Analysis
In pernicious anemia the gastric secretions are _____ and the pH remains ____, after injection of histamine. minimal; elevated
A radiological examination used to detect metastatic involvement of the lymph nodes Lymphangiography
explain the process of a lymphangiography Contrast medium is injected into a lymphatic vessel of the foot or hand, followed by radiological visualization of the lymphatic system
Bone marrow aspiration is most commonly performed in persons with: marked anemia, neutropenia, acute leukemia, and thrombocytopenia
____ ____ must be assessed prior to procedure, as contrast may severely damage poorly functioning ______. r/t lymphangiography renal function; kidneys
r/t bone marrow aspiration, limit the client's activity for approx ____ minutes after procedure 30
RBCs contain decreased levels of hemoglobin Iron Deficiency Anemia
Iron Deficiency Anemia is common in who? infants, adolescents, prego women
Glossitis inflammation and soreness of the tongue
Glossitis and pagophagia (desire to eat ice, clays, or starches) Headache, paresthesias, burning sensation of tongue and the most common objective sign is Pallor. All this is r/t what? Iron Deficiency Anemia
objective signs r/t iron deficiency anemia Tachycardia Finger nail fragility with spoon shape and raised border Stomatitis Lips are erythemic with cracking at the angles
what would you expect to see in the results from a CBC r/t iron deficiency anemia decreased RBC, Hgb, Hct, decreased serum levels
drug therapy r/t iron deficiency ferrous sulfate, Vit C, food high in iron
foods high in iron include: organ meats, white beans, leafy veges, raisins, molasses, dry fruits and egg nog...well egg yolk
What is the most common clinical manifestation of iron deficiency anemia? pallor
what are some things that can precipitate sickle cell anemia dehydration, infection, overexertion, weather changes(cold), ingestion of alcohol & smoking, emotional stress
clinical manifestations of sickle cell anemia abd enlargement w/ pooling of blood in liver, spleen, other organs. Jaundice, joint/back pain, edema, infarcts, hemorrhage, retinal damage, blindness, multisystem failure
r/t sickle cell anemia, CBC results=?? and WBC results=?? CBC=decreased Hct & Hgb; WBC=increased
r/t sickle cell anemia, what would you tell your pt to get every year? pneumovax and flu vaccine
What are the two priorities in treating patients with a Sickle Cell Crisis? Fluid management and pain control
Myeloproliferative disorder with hyperplasia of bone marrow causing increased circulating erythrocytes, granulocytes and platelets Polycythemia Vera (primary polycythemia)
Secondary polycythemia Caused by hypoxia rather than a defect in the evolution of the RBC Hypoxia stimulates erythropoietein in the kidneys which stimulates erythrocyte production
Secondary polycythemia may result from: May result from high altitude, pulmonary disease, cardiovascular disease, or tissue hypoxia Physiologic response to hypoxia, not pathologic
Clinical Manifestations of polycythemia Venous distention and platelet dysfunction cause esophageal varices, epistaxis, GI bleeding, and petechiae Hepatomegaly and splenomegaly from organ engorgement
s/s of polycythemia Sensitivity to hot and cold Pruritus Headaches, vertigo, tinnitus and blurred vision are often present, Eczema and dermatological changes, including erythema Hypertension with ventricular hypertrophy and angina
diagnostic tests r/t polycythemia Arterial blood gases CBC Bone marrow examination BMR (Basic Metabolic Rate-increased)
what is the medical management for polycythemia decreasing blood volume and viscosity and bone marrow activity. Drugs: all decrease bone marrow response
r/t secondary polycythemia, you want to avoid what? high altitudes - airplanes
What is the major complication of polycythemia vera? Thrombosis due to the abnormal increased number of circulating RBCs and platelets
Jehovah's Witnesses may accept what types of blood products? Autologous transfusions and certain volume expanders
HIV cannot replicate unless it has a host; it attaches itself to: CD4+ molecules; T-helper lymphocytes, monocytes and macrophages
diagnostic tests for HIV / AIDS ELISA Enzyme Immunoassay (EIA) Viral Load CD4+ count CBC
two diff test methods r/t HIV / AIDS confidential and anonymous
barriers to prevention r/t HIV/AIDS denial, stereotyping, fear, cultural and community attitudes, education is a long term process
innate barriers r/t immunity skin, mucous membranes, cilia, tears, flora of intestine & vagina
innate response is nonspecific, inflammatory response adaptive response is specific immune response humoral immunity/cellular immunity
Innate - phagocytes, natural killer cells adaptive - T lymphocytes, B lymphocytes
Specificity and Memory: Innate - NONE Adaptive - Present
the basics of Humoral Immunity mediated by B Cells, B cells produce antibodies, first response is slow compared to subsequent exposure,
Cell-Mediated Immunity characterized by the dominant role of small T cells, Primary defense against intracellular organisms
Mechanism of action r/t Cell-Mediated Immunity T cells produce lymphokines Lymphokines attract macrophages and neutrophils to the site for phagocytosis, or cytotoxic killer T cells can respond directly
what are some things we have to look forward to r/t getting older r/t our immune system? High incidence of tumors, Greater susceptibility to infections, Delayed hypersensitivity response is decreased, decreased movement of respiratory secretions
what are some things we have to look forward to r/t getting older r/t our immune system?...as if that wasn't enough... Decreased production of saliva and gastric secretions Decreased tear production increases risk of eye inflammation and infection Structural changes in urinary system leads to urinary retention or stasis s/s of infection are more subtle
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