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Exam 14 Lymph
68WM6 Phase 2 Exam 14- Blood/Lymph/Immune
| Question | Answer |
|---|---|
| Anemia | blood disorder characterized by red blood cell, hemoglobin, and hemtocrit levels below normal range |
| Aplasia | (aplastic anemia) failure of the normal process of cell generation and development |
| Disseminated Intravascular Coagulation | aquired hemorrhage syndrome of clotting, cascade overstimulation, and anti-clotting processes |
| How much blood does the average adult have? | 5-6 L |
| Erthrocytosis | 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 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 hemtopoietic 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 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, 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 | number of platelets reduced to fewer than 150,000/mm3 |
| Granulocytes | (WBC) phagocytes- cells that surround and "eat" invaders 1. neutrophils 2. basophils 3. eusinophils |
| neutrophils | make up 70% of wbc. initial responder to any invasion |
| basophils | key in the inflammatory response |
| eusinophils | key in the allergic response |
| Agranulocytes | (WBC) 1. monocytes 2. macrophages 3. lymphocytes |
| Monocytes | phagocytes that circulate in the blood stream and work similarly to neutrophils |
| macrophages | mature monocytes that live in the tissue |
| lymphocytes | T cells and B cells that directly kill invaders and produce antibodies |
| Functions of the lymphatic system | 1. maintain fluid balance 2. produces lymphocytes 3. absorption and transportation of lipid from the intestine to the stream |
| What is lymph fluid? | excess fluid and protein that remains in the tissues, and is trasnported back to the blood stream via lymphatic vessesl to avoid volume overload in the tissues |
| Lymph tissue consists of | 1. lymph nodes 2. tonsils 3. spleen 4. thymus |
| functions of lymph nodes | 1. filter impurities from the lymph 2. produce lymphocytes |
| functions of the tonsils | 1. protect the body against invasion 2. produce lymphocytes and antibodies 3. trap bacteria and may become enlarged |
| functions of the spleen | 1. serves as a reservoir for blood. stores 500 ml 2. matures lymphocytes, monocytes, and plasma (B)cells 3. destroys worn out RBCs 4. removes bacteria by phagocytosis 5. produces RBCs before birth |
| functions of the thymus | 1. located between the lungs and the mediastinum 2. functions in utero and for several months after birth to develop the immune system 3. matures T cells 4. atrophies at puberty |
| What is Red Cell Indices | measurement of the size and hemoglobin content of erythrocytes: 1. mean corpuscular volume (MCV) 2. mean corpuscular hemoglobin (MCH) 3. mean corpuscular hemoglobin concentration (MCHC) |
| What is Mean Corpuscular Volume (MCV)? | the average volume or size of a single RBC |
| What is Mean Corpuscular Hemoglobin (MCH)? | the average amount of (weight) hemoglobin within an RBC |
| What is Mean Corpuscular Hemoglobin Concentration (MCHC)? | the average concentration or the percentage of hemoglobin within an RBC |
| Differential count | actual cell count of leukocytes, identifies the number and percentage of individual SBC types |
| peripheral smear | accompanies differential WBC count and permits examination of the size, shape and structure of individual RBCs, WBCs and platelets *most informative of all hematologic tests* |
| What is the Schilling test and megaloblastic anemia profile? | laboratory test that identifies etiology of pernicious anemia, measures the excretion of vitamin B12 after parenteral administration |
| Normal findings of Schilling test and megaloblastic anemia profile | excretion of 8-40% of radioactive vitamin B12 within 24 hours |
| gastric analysis | evaluates presence of intrinsic factor, in pernicious anemia the gastric secretions are minimal and ph remains elevated, after injection of histamine |
| What is Mean Corpuscular Hemoglobin Concentration (MCHC)? | radiological examination used to detect metastatic involvement of lymph nodes |
| Differential count | actual cell count of leukocytes, identifies the number and percentage of individual SBC types |
| attenuated | the process of weakening the degree of virulence of a diseased organism |
| lymphangiography | radiologic examination used to detect metastatic involvement of the lymph nodes |
| Most commonly used site for a bone marrow aspiration | iliac crest |
| cellular immunity | the mechanism of acquired immunity characterized by the dominant role of small T cells |
| adaptive immunity | provides a specific reaction to each invading antigen and has the unique ability to remember the antigen that cause the attack |
| humoral immunity | one of the two forms of immunity that responds to antigens, it is mediated by B cells |
| allergen | a substance that can produce a hypersensitive reaction in the body |
| immunogen | any agent or substance capable of provoking an immune response or producing immunity |
| antigen | a substance recognized by the body as foreign that can trigger an immune response |
| 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 |
| attenuated | the process of weakening the degree of virulence of a diseased organism |
| autologous | something that has its origin within an individual |
| 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 |
| cellular immunity | the mechanism of acquired immunity characterized by the dominant role of small T cells |
| humoral immunity | one of the two forms of immunity that responds to antigens, it is mediated by B cells |
| immunogen | any agent or substance capable of provoking an immune response or producing immunity |
| 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 allegic responses, involves the administration of increasingly larger doses of the offending allegens 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 T cells that attrack microphages 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 |
| 3 functions of the immunne system | 1. protect the body from invading organisms 2. maintain homeostasis 3. serve as a surveillance netowrk for recognizing and guarding against growth of abnormal cells |
| Body's first line of defense, provides non-specific immunity | natural (innate) immunity |
| body's second line of defense, provides specific immunity | acquired (adaptive) immunity |
| What does innate immunity have that azquired doesnt? | physical barriers |
| What is humoral immunity? | mediated by B cells, which produce antibodies in response to antigen change |
| Assist B cells to proliferate, snthesize, and secrete the appropriate antibody | T-helper cells |
| What is cell-mediated immunity? | the mechanism of acquired immunity caracterized by the dominant role of small T cells, primary defence against intracellular organisms |
| Characteristics of humoral immunity | 1. B cells 2. antigen/antibody 3. outside cells 4. immediate 5. bacteria/viruses |
| Characteristics of cell-mediated immunity | 1. T cells 2. natural killer cells 3. inside cells 4. delayed 5. virus, bacteria, tumor, fungus |
| Classifications of immunodeficiency | 1. T-cell 2. combination T/B cell |
| Primary immunodeficiency disease | 1. rare and serious 2. immunte cells are improperly developed or absent |
| Secondary immunodeficiency disease | 1. more common, less serious 2. deficiency caused by illness or treatment |
| Systemic lupus erythematosus | autoimmune disorder characterized by inflammation of almost any body part, chronic and incurable |
| clinical manifestations of lupus | 1. oral ulcers 2. arthralgias or arthritis 3. vasculitis 4.rash 5. nephritis 6. pericarditis 7. peripheral neuropathies 8. anemia 9. leukopenia |
| most common complication of lupus | anemia |
| How is lupus diagnosed? | positive results on one or more diagnositc test along with at least 3 other criteria |
| criteria for diagnosing lupus | 1. erythematous butterfly rash 2. photosensitivity 3. oral ulcers 4. polyarthralgias and polyarthritis 5. pleuritic pain, pleural effusion 6. pericarditis, vasculitis 7. renal disorders |
| How long before administration should blood be refridgerated? | 1/2 hours before administration |
| Within what time frame must blood be administered after refridgeration? | 4 hours |
| Within what time frame must blood components be administered after refridgeration? | 6 hours |
| Only compatible solution with blood products | 0.9% NS |
| Acquired Immunodeficiency Syndrome (AIDS) | aquired condition that impairs the body's ability to fight disease, it's the end stage of a continuum of HIV infection |
| Adherence | maintaining a prescribed regimen |
| CD4+Lymphocyte | these cells pay a pivotal role in 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 |
| Kaposi's sarcoma | a rare cancer of the skin and mucous membranes characterized by blue red or purple lesions |
| opportunistic | caused by normally nonpathogenic organisms in a host whose resistance has been decreased by such disorders as HIV illness |
| Pneumocystitis Carinii Pneumonia | an unusual pulmonary disease caused by a fungus and primarily associated with people who have suppressed immune systems |
| retrovirus | a virus taht carries its genetic material in RNA rather than DNA and it replicates by converting RNA into DNA |
| 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 lvel of HIV antibodies found in the blood |
| Vertical transmission | can occur during pregnancy, delivery, or through postpartum breastfeeding |
| viral load | amount of measurable HIV virions |
| virulent | toxic |
| western blot | technique for analyzing small amounts of antibodies |
| HIV-1 | found worldwide but more prevalent in the US and Europe |
| HIV-2 | prevalent in Western Africa and countries with historical and commerical ties to that region. appears to be less virulent |
| Opportunistic infections resulting from HIV: | 1. Pneumocystitis Carnii Pneumonia 2. Kaposi's sarcoma |
| Acute retroviral syndrome | acute infection period in which viral replication occurs |
| when does seroconversion occur? | 1. 5 days-3 months after exposure, generally within 1-3 weeks. 2. process accompanied by flu or mononucleosis-like syndromes |
| early infection | median time between HIV infection and development of end-stage HIV disease or AIDS (in an untreated individual, generally 10-14 years) |
| early symptomatic disease | AIDS-related complex (ARC) only appiles if CD4+ cell count is above 500 cells/ml |
| AIDS | end-stage or terminal phase of HIV infection |
| transmission of HIV | 1. sexual practice 2. IV drug use with shared needles of HIV infected 3. infected blood 4. ceriovaginal secretions 5. breast milk |
| 1. persistent unexplained fever 2. night sweats 3. weight loss 4. fatigue 5. lymphadenopathy 6. s/s may not occur until 10-14 yrs after infection | HIV disease |
| 1. acute illness w/flu-like symptoms, develop antibodies in 1-12 weeks 2. can be asymptomatic 3. infectious but no sign of illness except for HIV antibodies test | HIV infection |
| 1. advanced HIV disease 2. chronic illness in development of opportunistic infections after immune suppression | AIDS |
| HIV blood and plasma manifestations | 1. CD4+ count decreases 2. HIV viral RNA in peripheral circulation increases |
| respiratory manifestations of HIV | 1. non-productive cough 2. progressive SOB 3. pneumonia 4. vesicular eruptions on mucosa |
| integumentary manifestations of HIV | 1. vesicular eruptions on mouth and perineum 2. shingles 3. rash 4. pruritis 5. lesions of retina |
| GI manifestations of HIV | 1. watery diarrhea 2. abd. pain 3. weight loss 4. nausea 5. gastritis |
| Neuro manifestations of HIV | 1. cognitive dysfunction 2. motor impairment 3. decreased LOC |
| Diagnositic tests for HIV/AIDS | 1. ELISA 2. enzyme immunoassay 3. viral load 4. CD4+ count 5. CDC |
| 4 steps of hemostasis | 1. vessel spasm 2. platelet plug 3. clotting cascade 4. fibrinolysis |
| 1. contraction of blood vessel immediately after damage to control blood loss 2. effect lasts 30 minutes | vessel spasm- step 1 |
| 1. platelets become activated 2. controls blood loss if vessel break small | platelet plug- step 2 |
| 1. dependent on clotting factors and calcium 2. intrinsic and extrinisc pathways both end with prothrombin 3. prothrombin converts to thrombin 4. thrombin degrades fibrinogen into fibrin, which is relatively insoluble and maintains stability of clot | clotting cascade- step 3 |
| 1. process of breaking down a clot 2. tissue plasminogen activator (t-PA) released after clot formation 3. turns plasminogen into plasmin, which dissolves fibrin, and clot is dissolved | fibrinolysis- step 4. |
| coagulopathies | condition in which a component that is nessary to control bleeding is missing or inadequate 1. thrombocytopenia 2. heomphilia 3. disseminate intravascular coagulation (DIC) |
| causes of thrombocytopenia | 1. decreased platelet production (aplastic anemia, leukemia, tumors and chemo) 2. decreased platelet survival (antibody destruction, infection) 3. altered platelet function 4. platelet sequestration |
| manifestations of thrombocytopenia | 1. petechiae 2. ecchymoses 3. severity of s/s corretlates w/ platelet count |
| platelet count < 20,000/mm3 | significant bleeding |
| platelet count < 5,000/mm3 | spontaneous bleeding |
| a decrease in the formation of prothrombin activators occurs as a result of decreased clotting factors | hemophilia |
| manifestations of hemophilia | 1. internal or external hemorrhage w/large ecchymosis into tissues 2. deformed muscles and immobile joints 3. hemarthrosis 4. pain, erythema and fever 5. excessive bleeding |
| grave coaguloathy resulting from the over-stimulation of clotting and anticlotting processes in response to disease or injury. mortality reaches 80-90% | disseminated intravascular coagulation |
| causes of DIC | 1. obstetrical 2. neoplastic 3. trauma |
| major manifestation of DIC | bleeding noted from 3 unrelated sites |
| diagnostic results for DIC | 1. prolonged PT/PTT 2. positive D-dimer 3. decreased fibrinogen 4. decreased clotting factors |
| treatment of DIC | 1. crystalloids 2. transfusion 3. vitamin K 4. heparin therapy |
| 1. aspirin 2. dig 3. furosemide 4. NSAIDS 5. oral hypoglycemics 6. penicillins 7. quinidine 8. sulfonamides 9. thiazides 10. ranitidine | medications that have a thrombocytopenic effect |
| usually idiopathic | thrombocytopenia |
| X-linked heredity trait | hemophilia |
| secondary process with massive over-stimulation of the clotting cascade | DIC |
| 1. inherited bleeding disorder 2. abnormally slow coagulation of blood 3. spontaneous episodes of GI bleeding, epitaxis, and gingival bleeding 4. mild deficiency of factor VIII | Von Willibrand's disease |
| agranulocytosis | 1. severe reduction in the number of granulocytes 2. characterized by low white blood count, bone marrow suppression, fatality from severe bacterial infections |
| clinical manifestations of agranulocytosis | 1. fever and chills 2. headache and fatigue 3. ulcerations of mucous membranes 4. bronchial pneumonia 5. UTI in later stages |
| assessment of agranulocytosis | 1. subjective- fever and extreme fatigue 2. objective- fever over 100.6, erythema and pain from ulcerations, crackles and rhonchi |
| precautions for agranulocytosis | neutropenic precautions |
| diet for agranulocytosis | high protein, high calorie |
| leukemia | 1. malignant disorderof hematopoietic system 2. excess of leukocytes accumulate in bone marrow and lymph nodes 3. white cells replace bone marrow 4. immature cells in circulation infiltrate lymph nodes, spleen and liver, causing damage |
| manifestations of leukemia | 1. anemia 2. thrombocytopenia 3. leukopenia 4. enlarged lymph nodes and painless splenomegaly |
| acute leukemia | treated with complex combination of chemotherapeutic drugs and total body radiation |
| chronic leukemia | drug therapy is palliative, not curative |
| 1. Chlorambucil 2. Hydrocyurea 3. Corticosteroids | drugs for leukemia |
| 1. untreated patients 4-6 month prognosis 2. 50% of kids can be cured | Acute Lymphocytic Leukemia (ALL) |
| 1. remission w/75% of cases 2. 20-25% of adults experience 5 year remission | Acute Myelogenous Leukemia (AML) |
| 1. survival rate variable 2. early stage survival is 10-12 years 3. late stage survival rate 18 months | Chronic Lymphocytic Leukemia |
| Multiple myeloma | 1. malignant neoplastic immunodeficiency disease of the bone marrow 2. tumor destroys osseous tissue 3. plasma cells proliferate, destroys bone by crowding bone marrow 4. abnormal antibody formation- prone to infection |
| primary marker of multiple myeloma | Bence Jones protein- monoclonal protein found in blood or urine |
| Dx of multiple myeloma | 1. CBC (pancytopenia) 2. radiographic studies- demineralization of bones 3. bone marrow biopsy- large amt of immature plasma cell 4. blood and urine, plasme electrophorses- Bence jones protein |
| graft vs host. | cells from the transplanted tissue of a donor initiate an immunologic attack on the cells and tissue of the recipient |
| lymphangitis | inflammation of one or more lymphatic vessels or channels caused y acute strep/staph infection in an extremity |
| manifestations of lymphangitis | 1. fine red streaks from affected area in groin or axilla 2. diffuse edema 3. chills, fever, and local pain 4. swollen lymph nodes 5. septicemia |
| dx of lymphangitis | made via inspection and palpation |
| lymphedema | primary or secondary disorder characterized by the accumulation of lymph in soft tissue and edema |
| if lymph drainage is disturbed... | an inflammatory process may result. |
| manifestation of lymphedema | massive edema and tightness cause pressure and pain in the affected extremeties |
| used to differentiate lymphedema from venous disorders | lymphangiography |
| diet restrictions for lymphedema | 1. limit sodium 2. avoid spicy foods or anything that precipitate thirst |
| 1. neoplastic disorder of lymphoid tissue 2. cause unknown- viral suspected 3. includes non-Hodgkin's lymphoma | malignant lymphoma |
| manifestations of malignant lymphoma | 1. painless lymphadenopathy in cervical area 2. fever 3. weight loss 4. anemia 5. pruritis 6. susceptibility to infections 7. GI malabsorption 8. bone lesions |
| dx for malignant lymphoma | 1. bone scan 2. CBC 3. Coombs' test 4. radiographic studies |
| 1. cyclophosphamide 2. vincristine 3. prednisone 4. doxorubicin 5. bleomycin 6. methotrexate | chemotherapy agents used in lymphomas |
| where is radiation often recieved in radiation of lymphomas? | 1. chest wall 2. mediastinum 3. axillae 4.neck |
| Rituximab (rituxan) | 1. monoclonal antibody therapy 2. immunotherapy to eliminate malignant cells and induce remission 3. cancer cells injected into mice 4. mice create antibodies 5. antibody cells cloned and administered to patient |
| carry risk of infection with development of graft v. host disease | allogenic grafts |
| have higher incidence of recurrence than allogenic | autologous grafts |
| Hodgkin's Disease | 1. malignant disorder 2. painless, progressive enlargement of lumphoid tissue 3. cause unknown but thought to be an immune disorder 4. characterized by Reed-Sternberg cells |
| manifestations of Hodgkin's disease | 1. anorexia 2. weight loss 3. malaise 4. extreme pruritus 5. low-grade fever 6. night sweats 7. anemia, leukocytosis followed by respiratory infections |
| stages of Hodgkin's treated with radiation | Stages I and II |
| stages of Hodgkin's treated with chemo/radiation | Stages III and IV |
| traditional chemo regimen for Hodgkin's | MOPP: 1. mustargen 2. oncovin 3. procarbazine 4. prednisone |
| alternative reginmen to MOPP | ABVD: 1. Adriamycin 2. Blenoxane 3. Velban 4. dacerbazine |
| Why are oncologists switching from MOPP to ABVD? | Mustargen was causing secondary leukemia |
| 1. abnormal or single lymph nodes 2. regional or single extranodal site | Stage I Hodgkin's |
| 1. two or more lymph nodes on same side of diaphragm 2. localized involvement of extranodal site and one or more lymph node regions | Stage II Hodgkin's |
| 1. abnormal lymph node regions on both sides of diaphragm 2. possible spleen involvement | Stage III Hodgkin's |
| 1. diffuse and disseminated involvement of one or more extralymphatic tissue and/or organs w/out lymph node involvement | Stage IV Hodgkin's |
| Clincal manifestations of anemia | 1. anorexia 2. cardiac dilation 3. disorientation 4. dizziness 5. dyspnea 6. fatigue 7. insomnia 8. paloor 9. SOB 10. tachycardia 11. vertigo |
| dx tests for anemia | 1. CBC 2. iron 3. reticulocyte 4. bone marror biopsy 5. peripheral blood smears 6. vitamin b12 level |
| In anemia you want to avoid ______ ___________ as much as possible | blood transfusions |
| 1. decreased RBC, HGB, HCT resulting from hemorrhage | hypovolemic anemia |
| how much blood loss can be tolerated in an adult? | <500 ml |
| blood loss of _____ or more in an adult can be severe | 1000 ml |
| clinical manifestations of hypovolemic anemia depend on what? | severity and speed of blood loss |
| what will be found in an assessment of a client with hypovolemic anemia? | 1. thirst 2. weakness 3. irritability 4. restlessness 5. hypotension 6. rapid, weak, thready pulse 7. cool clammy skin with pallor 8. oliguria |
| 1. autoimmune disorder resulting from the destruction of parietal cell and eventual gastric mucosa atrophy 2. parietal cell damage 3. decreased intrinsic factor production | pernicious anemia |
| 1. glycoprotein produced by parietal cells 2. necessary for absorption of vitamin b12 | intrinsic factor |
| what will vitamin b12 deficiency cause? | 1. erythrocyte membranes fragile and easy to rupture 2. progressive demyelination and degeneration of nerves and white matter |
| manifestations of pernicious anemia | 1. fever 2. extreme weakness 3. dyspnea 4. hypoxia 5. slight jaundiced 6. edema of legs 7. constipation or diarrhea |
| 1. vitamin b12 2. folic acid 3. iron | drug therapy for pernicious anemia |
| diet for pernicious anemia | high protein, vitamin, and mineral |
| 1. congenital-chromosomal alterations 2. hematopoietic tissue replaced by fatty tissue 3. depression of erythrocyte production 4. pancytopenic | aplastic anemia |
| manifestations of aplastic anemia | 1. repeated infections w/high fever 2. weakness 3. fatigue 4. bleeding tendencies 5. high mortality w/complications of infection and hemorrhage |
| medical management of aplastic anemia | 1. identify cause and remove 2. if possible, avoid blood transfusion 3. possible splenectomy 4. drug therapy 5. bone marrow transplant |
| aplastic anemia, also known as | bone marrow failure |
| 1. body's demands for iron exceed its absorption 2. malabsorption caused by celiac disease and sprue, subtotal gastrectomy or poor dietary intake | iron deficiency anemia |
| s/s of iron deficiency anemia | 1. pallor 2. fatigue, weakness 3. glossitis 4. pagophagia 4. s/s of angina and heart failure may occur |
| Clinical manifestations of sickle cell anemia | 1. asymptomatic for first 10-12 weeks of life 2. loss of appetite and irritability 3. abdominal enlargement 4. jaundice 5. joint and back pain 6. edema 7. multi-system failure |
| 1.myeloproliferative disorder w/hyperplasia of bone marrow 2. increased RBCs, WBCs and platelets 3. stem cell abnormailty of unknown cause | polycythemia vera (primary polycythemia) |
| 1. caused by hypoxia rather than defect in RBC evolution 2. usually results from high altitude, pulmonary disease, CV disease, or tissue hypoxia 3. physiologic, not pathologic | secondary polycythemia |
| 1. mainly effects middle age-men 2. gradual onset 3. venous distention and platelet dysfunction 4. esophageal varices, epitaxis, GI bleeding 5. hepatomegaly and splenomegaly | manifestations of polycythemia |
| assessment findings in polycythemia | 1. hot/cold sensitivity 2. pruritis 3. headaches, vertigo, tinnitus, blurred vision 4. eczema 5. hypertension |
| Medical management of polycythemia includes repleated phlebotomy to maintain HCT between _________ | 45-48% |
| nursing interventions for secondary polycythemia | 1. maintain adequate oxygenation 2. control pulmonary disease 3. avoid altitude |
| major complication with polycythemia | thrombosis due to the abnormal increased number of circulatings RBCs and platelets |
| Jehovah's witness opposed to ___________ blood transfusions, but may agree to certain types of ________ blood transfusions. | homologous, autologous |
| artificially aquired active immunity | occurs when an individual is given a killed or weakened antigen, which stimulates the formation of antibodies against the antigen |
| naturally acquired active immunity | person is exposed to a disease, experiences it, and the body manufactures antibodies to provide future immunity to said disease |
| passive immunity | ready-made antibody from another human or animal source. provides immediate immunity to invading antigen, but is temporary |
| provide passive immunization to infectious diseases by providing antibodies | immune globulins |
| 1. administered to rho(D) neg patients who have been exposed to rho(D) pos blood 2. management of immune thrombocytopenic purpura | RHO(D) immune globulin |
| 1. prevention of sytomegalovirus disease associated with transplant of kidney, lung, liver, pancrease, or heart | cytomegalovirus immune globulin |
| prevention of hepatitis B virus in exposed patients | heptitis B immune globulin |
| contraindications for DTaP diphtheria pertussis vaccine | 1. actue febrile infection 2. immunosuppressive therapy 3. previous CNS damage 4. convulsions |
| contraindications for hemophilus b conjugate vaccine | 1. febrile illness 2. active infection |
| contraindications for hepatitis b vaccine | anaphylactic allergy to yeast |
| flu vaccine contraindications | 1. allergy to eggs 2. acute neurologic compromise 3. FluMist to be avoided in patients using salicylates |
| contraindications for MMR II vaccine | 1. active infection 2. immunosuppression 3. pregnancy 4. avoid becoming pregnant for 4 weeks |
| pneumococcal 7-valent vaccine contraindications | thrombocytopenia or coagulation disorder |
| pneumococcal vaccine polyvalent contraindications | 1. Hodgkin's disease 2. ARDs |
| polio vaccine contraindications | 1. active infection 2. allergy to neomycin/streptomycin 3. immunosuppression 4. vomiting, diarrhea |
| varicella vaccine contraindications | 1. allergy to gelatin/neomycin 2. active infection 3. immunosuppression 4. pregnancy 5. blood/blood products |
| 1. azathioprine 2. cyclosporine 3. mycophenolate | immunosuppressants used with corticosteroids for the prevention of transplantation rejection reactions |
| 1.basiliximab 2. daclizumab 3. sirolimus | immunosuppressants used to prevent acute organ rejection (renal), used with corticosteroids and cyclosporine |
| Muromonab-CD3 | manages rejections not controlled by other agents |
| tacrolimus | prevention of organ rejection (liver), used with corticosteroids |
| 1. azathrioprine 2. cyclophsphamide 3. methotrexate | management of selecter autoimmne diseases (nephrotic syndrome, severe rheumatoid arthritis) |
| side effects of immunosuppressants | 1. increased risk of infection 2. trembling or shaking of hands 3. anorexia 4. n/v 5. megalopblastic anemia 6. leukopenia 7. pancytopenia 8. thrombocytopenia |
| normal values for neutrophils | 3000-7000 mm3 |
| neutropenia | <1000 mm3 |
| severe neutropenia | <500 mm3 |
| nursing implications for Muromonab-CD3 | 1. assess fluid overload 2.chest x-ray nefpre therapy 3. vs |
| Cytokine Release Syndrome (CRS). | systemic inflammatory response caused by release of cytokine from T cells. |
| 1. used in treatment of solid tumors, lymphomas, and leukemias 2. used in some autoimmune disorders 3. used in combinations to minimize individual toxicities | antineoplastics |
| methotrexate toxicity is increased by ________ or large doses of __________ or ___________ | nephrotoxic drugs, aspirin, NSAIDS |
| nursing implications for antineoplastics | 1. monitor for bone marrow depression 2.assess for bleeding 3 assess for signs of infection/neutropenia 4. monitor for gout 5. monitor for fatigue, dyspnea, and orthostatic hypertension |
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