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ch39 Hemat and Lymph
Mrs. Deneal -med surg hematopoietic and lymphatic disorders
Question | Answer |
---|---|
Nutrients involved in erthropoiten | iron, B12, folic acid, Vitamin C (inhances absorbtion), B6 (hemoglobin formation), copper (transfer of iron storage to plasma) |
Hemoglobin is made from | protein |
epoetin (Epogen) | stimulate production of RBC |
Filgrastim (Neupogen) | promote proliferation of neutrophils |
reasons for anemia | 1) blood loss, 2)inadequate or abnormal erythrocyte formation, destruction of normal RBC |
hypovolemia | large volume loss of blood or chronic blood loss |
compensatory mechanisms for hypovolemia | rapid HR, rapid respiratory |
hypovolemia treatment | give blood, treat cause |
iron def. anemia | iron is insufficient to produce hemoglobin |
sickle cell trait | only inherited one gene for sickle cell |
sickle cell crisis | sickle shaped celsss lodge in small blood vessels blocking flow of blood and oxygen |
Sickledex test | determines the presence of abnormal HbS screeing for sickle cell |
sickle cell hemoglobin levels | 7-10 |
hemolytic anemia | chronic premature destruction of erythrocytes |
causes of hemolytic anemia | cardiopul bypass, arsenic/lead poisioning, malria parasite, infectious agents, toxins or chemical exposure |
treatment of hemolytic anemia | remove cause, corticosteriods, blood trans, splenectomy (when medical treatment fails) |
Thalassemias | hereditary hemolytic anemia-no cure |
Thalassemia treatment | supportive-require more frequent blood trans, place on bed rest protect from infection |
Pernicious Anemia | client lacks intrinsic factor interfere with absorbtion of B12 |
B12 | extrinsic factor needed for maturation of erythrocytes |
Schilling test | given radioactive B 12 and urine tested to see if it made it through the system. If not there is a intrinsic problem |
Pernicious anemia Tx | B12 |
Folic Acid deficiency anemia | lack of B9 intake causing immature erythrocytes |
S&S sickle cell | jaundice, dysfunctional spleen, severe pain, fever, joint swelling, chronic leg ulcers |
S&S Hemolytic and Hypovolemic anemia | extreme pallor, tachycardia, reduce urine output In hemolytic sever-jaundice enlarged spleen |
S&S iron def anemia | cold, fatigue, dypnea on exertion, fast HR |
S&S pernicious anemia | stomatitis, jaundice, irritabolity, confusion, depresion, glossitis diarrhea, numbness and tingling in legs |
S&S folic acid def anemia | severe fatigue, sore beefy red tongue, dypnea, nausea, anorexia, headached, weakness, light headness |
treatment folic acid anemia | supplements, diet high in folic acid |
polycythemia vera | greater then normal erythrocytes, leukocytes, and platelets |
problem with polycythemia vera | blood gets too thick and clots, more uria from dead cells causing gout like symptoms |
S&S plycythemia vera | face and lips reddish-purple, fatigue, weakness, headache, pruritus, exertional dyspnea, dizziness, splemomegaly, swollen joints |
splenomegaly | enlargement of the spleen |
diagnostic findings of polycythemia vera | high levels of serum K, high uric acid |
Tx polycythemia vera | lessen blood volume, lessen viscosity, curb excessive erythrocyte production phlebotomy-500ml several times a week, drink 3 quarts of fluid a day |
leukocytosis | increased # of leukocytes causing quality to go down |
Leukemia | malignant blood disorder in which proliferation of leukocytes in immature form is unregulated often acompanied by decrease RBC and platlets |
S&S Leukemia | prone to bleeding, infections, fatigue from anemia, bruising |
Some TX for leukemia | supportive care, profilactic antibiotics, transfuse platlets, radiation, bone marrow transplant |
neutropenic precautions | private room, wash hands , daily shower, mask if leaving room or in crowds, no flowers int he room, no raw fruits or veg |
mulitple myeloma | malignancy invloving plasma cells which are B-lymph cells in bone marrow- plasma cells invade bone marrow |
S&S multiple myeloma | pain in pelvis spine ribshigh incidence of infection, anemia symptoms, brusing, nosebleeds |
TX multiple myeloma | bolld trans for anemia, steroids and anticance drugs, braces for bones, autologus bone marrow and peripheral stem cell transplants, SAFETY |
Agranulcytosis | decreased # of granulocytes including neutriphils, basophils, eosinophils |
leukopenia | general reduction in WBC |
Most common cause of agranulocytosis | toxicity from drugs |
Tx agranulocytosis | removal of cause |
S&S agranulocytosis | fatigue, chills, headache, opportunistic infections |
pancytopenia | # of marrow-produced cells blood cells are reduced |
disseminated intravascular coagulation | hypercoagulation is followed by diffuse bleeding as clotting factors are exhausted |
thrombocytopenia | when platlet manufacture by the bone marrow is decreased or platlet destruction by the spleen is increased |
thrombocytopenia TX | corticosteriods, blood trans |
hemophilia | disorder of clot factors inherited from mother to son |
hemophilia pt teachings | no aspirin, med alert bracelet, soft toothbrush |
food sources of heme iron | meat, egg yolks, oyster, shell fish dark meat |
to maximize onheme absorption | vitamin c, no coffee or tea during meals |
folic acid rich foods | enriched breads, fortified cereals, broccoli, green leafy veg, milk , eggs |
do no take oral iron with | cofee, tea, milk, eggs |
do not give sickle cell pt | demerol- liver converts it to normeperidine which is toxic and can cause grand mal seizures |
sickle cell pt need to avoid | hugh altitudes, dehydrating fluids, , cold fluids, cigarettes, tight clothes |
hemolytic anemia pt needs to avoid | greens/turnips becuase vitamin K |
anything that affects bone marrow affects... | platlet production |
corticosteriods do what? | interrupt inflammatory process |
HCT count | m42%-52% w 37%-47% |
Potassium level | 3.5-5.0 mEq/L |
Platlet | 150,000-400,000 |
Na level | 136-145 |
Cr serum level | 0.7-1.2 mg/dL |
CrCl level | 85-135 |
Hgb level | 14-18 g/dL (male) |
BUN level | 10-20mg/dL |
WBC | 5000-10,000 |
RBC | 4.7-6.1 (male) 4.2-5.4 (female) |