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Med Surg 1
Hematology
| Question | Answer |
|---|---|
| Hemarthrosis | Bleeding into joint spaces |
| Anemia | Disorder characterized y levels of RBCs hemoglobin, and hematocrit that are below normal range |
| Erythropoiesis | Process of RBC production |
| Erythrocytosis | Increase in circulating erythrocytes |
| Aplasia | Hematological term for a failure of the normal process of cell generation and development |
| Hemophilia A | Characterized by a disturbance of the clotting factor (the more common type of hemophilia) |
| Homozygous | Having two identical genes inherited from each parent for a given hereditary characteristic |
| Disseminated Intravascular Coagulation (DIC) | Grave coagulopathy resulting from the overstimulation of anticlotting processes in response to disease or injury |
| Heterozygous | Having two different genes |
| Lymphangitis | Characterized by fine red streaks from the affected area in the groin or axilla |
| Pernicious | Is one that is capable of causing great injury, destruction, or death |
| Myeloproliferative | Characterized by excessive bone marrow production |
| Pancytopenic | All three major blood elements (RBC, WBC, Platelets) from bone marrow are reduced or absent |
| Thrombocytopenia | An abnormal hematological condition in which the number of platelets is reduced to fewer than 150,000 |
| Reed-Sternberg cells | Are atypical histocytes consisting of large, abnormal, multinucleated cells in the lymph nodes found in Hodgkin's Lymphoma |
| Idiopathic | Cause unknown |
| Multiple myeloma | Malignant neoplastic immunodeficiency disease of the bone marrow |
| Leukemia | Malignant disorder of the hematopoietic system in which an excess of leukocytes accumulates in the bone marrow and lymph nodes |
| Leukopenia | White blood count is extremely low |
| Lymphedema | Is a primary or secondary disorder characterized be the accumulation of lymph in soft tissue and edema |
| The nurse is caring for clients in an oncology unit. Which neutropenia precautions should be implemented? | Limit fresh fruit and flowers |
| The client diagnosed with leukemia has central nervous system involvement. Which instructions should the nurse teach? | Explain radiation therapy to the head may result in hair loss |
| The client diagnosed with leukemia is scheduled for bone marrow transplantation. Which interventions should be implemented to prepare the client for this procedure? | Provide central line care per protocol. Monitor the complete blood cell count daily, have the family members HLA typed, administer high-dose chemotherapy |
| The nurse is caring for a client diagnosed with acute myeloid leukemia. Which assessment data support this diagnosis? | Pain in the left upper quadrant |
| A nurse is admitting a client diagnosed with anemia. Which interventions should be included in the plan of care? | Move the client to a room near the nurses desk, Allow for rest periods during the day for the client, Monitor the client's hemoglobin and hematocrit, Assess the client for numbness and tingling |
| The nurse is admitting a client with a diagnosis of rule-out Hodgkin's lymphoma. Which assessment data support this diagnosis? | Night sweats and fever without chills |
| The nurse is transcribing the HCP's order for an iron supplement on the MAR. At which time should the nurse schedule the daily dose? | 1000 |
| Which client would be most at risk for developing disseminated intravascular coagulation (DIC)? | A 78 yr old client diagnosed with septicemia |
| Which laboratory result would the nurse expect in the client diagnosed with DIC? | Low fibrinogen level |
| The unlicensed assistive personnel (UAP) ask the primary nurse, "How does someone get hemophilia A?" Which statement would be the primary nurse's best response? | The mother carries the gene and gives it to the son |
| Which sign would the nurse expect to assess in the client diagnosed with idiopathic thrombocytopenic purpura (ITP)? | Petechia on the anterior chest, arms, and neck |
| The student nurse ask the nurse, "What is sickle cell anemia?" Which statement by the nurse would be the best answer to the students question? | The blood becomes thick when the client is deprived of oxygen |
| Coagulation profiles | Reveal a normal platelet count, bleeding time, Prothrombin time, and Internal Normalized Ratio (INR) |
| D-dimer | Reveals the breakdown of fibrin and is a specific marker for the degree of fibrinolysis in the serum |
| List three critical functions of the blood | Transport (carry) O2 & nutrients to cells and waste products away from cells, transports hormones from endocrine glands to tissues & cells; Regulates acid base balance; Protects body against infection |
| List four components of blood | Erythrocytes (RBC), Leukocytes (WBC), Plasma, Platelets |
| Describe RBC | Also called erythrocytes, function is transportation, shape is biconcave disk with no nuclei |
| Describe WBC | Also called leukocytes, function is body defense, shape is biconcave disk with a nucleus |
| Describe platelets | Also called thrombocytes, role in process of hemostasis & prevention of blood loss, shape is circular cell fragments with no nuclei |
| Give three facts that support the statement, "Blood is classified as tissue of the body" (connective tissue) | Cells are similar, cells are closely associated, and cells perform similar functions |
| Explain the functions of hemoglobin | Carries oxygen from lungs to the cells and carbon dioxide away from the cells to the lungs |
| What does hematocrit measure? | Percentage of red blood cells in whole blood |
| What is the role of the erythrocyte (RBC) in supplying the body with oxygen and nutrients and in ridding the body of carbon dioxide and waste? | Carries O2 & nutrients to capillary, diffuse into body tissues. CO2 and waste in the capillaries attach to Hgb to be eliminated through respirations & filtration in the kidneys |
| List two broad categories of leukocytes (WBC) | Granulocytes & nongranulocytes (agranulocytes) |
| Name two types of agranulocytes | Lymphocytes & monocytes |
| What is done during a differential white blood count? | Measures five types of WBC's and reports them as percentages of the total examined |
| What is hemopoiesis? | Production of blood cells |
| What is hemocytoblast? | All blood cells develop from this stem cell |
| What is hypovolemic anemia? | Secondary anemia when deficiencies in RBCs & other components are caused by abnormally low circulating blood volume resulting from acute/chronic blood loss |
| List three possible causes of hypovolemic anemia | Surgical procedure, trauma, severe burns, menorrhagia, GI bleed |
| Why is urine output carefully monitored in a patient with hypovolemic anemia? | You need to monitor whether or not the kidneys are receiving adequate blood flow to prevent irreversible damage to kidney's, (toxins will remain in body if there is less than 30cc/hr) |
| How does the lack of the intrinsic factor cause anemia? | B12 cannot be absorbed from food, B12 is necessary for manufacturing RBCs |
| List four symptoms specific to pernicious anemia | Extreme weakness, paresthesia, hypoxia, reddened smooth tongue |
| What type of diet is best for patients with pernicious anemia? | High protein, vitamins & minerals, foods high in B12 |
| What happens to bone marrow in secondary aplastic anemia? | Bone marrow is with fatty deposits, can't produce RBCs |
| What does the term Pancytopenic mean? | All three major elements (RBC, WBC, Plt) from bone marrow are reduced or absent |
| Why might patients with aplastic anemia have repeated infections and hemorrhage as well as anemia's? | Decreased WBC = infections, decreased platelets = hemorrhage, decreased RBC = anemia's |
| What types of medications commonly cause aplastic anemia? | Antineoplastic medications |
| List three categories of people whose bodies have an increased demand for iron (Fe) | Infants, young adolescents, and pregnant women |
| What is the most common cause of iron-deficiency anemia in adults | GI or uterine bleeding |
| What foods should be included in the diet of a patient with iron-deficiency anemia? | Organ meat, red meats, eggs, dark green leafy vegetables, beans, and nuts |
| What is the incidence of sickle cell anemia? | Mostly African Americans, is the most common genetic disorder in USA |
| What happens to the erythrocytes in sickle cell anemia? | RBC's become crescent shaped when O2 is low, which means RBC's cannot carry normal Hgb (Hgb-S) |
| What occurs during a sickle cell crisis? | RBC's take on sickle form & cannot flow smoothly through the blood vessels, clump in small vessels = edema in extremities joint pain, back pain. As the sickle cells congest the liver, abdominal enlargement, jaundice, and hemorrhage result |
| List three ways patients with sickle cell anemia can avoid crisis | 0 increase in altitudes, 0 unpressurized planes, 0 dehydration, 0 vigorous exercise, 0 ice liquids or cold exposure, 0 ETOH, and reduce stress |
| What is polycythemia? | Excessive bone marrow production - Primary (aka polycythemia vera) cause is unknown, patient with this disorder may also have elevated levels of granulocytes and platelets in the blood |
| What is secondary polycythemia? | Caused when the body becomes hypoxic, stimulates erythropoietin, which produces more erythrocytes to meet the demand. Cause may be due to high altitude, cardiac or pulmonary disease |
| What is agranulocytosis? | Potentially fatal condition of blood characterized by severe reductions in the number of granulocytes |
| What are the causes of agranulocytosis? | Adverse medication reaction or toxicity |
| What type of precautions should be used with a patient with agranulocytosis? | Protect patient from potential sources of infection (family & friends with colds and fevers) |
| What are three subjective assessments to make about a patient with leukemia? | Complains of pain in joints, fatigue, malaise (lack of strength & lack of stamina) |
| What are three objective assessments to make about a patient with leukemia? | Enlarged lymph nodes, spleen (splenomegaly), anemia, thrombocytopenia (decreased platelets) |
| Why would bone marrow transplant be used to treat acute leukemia? | Because with leukemia, all bone marrow is infected/diseased |
| What types of complications of leukemia can be fatal? | Anemia, thrombocytopenia, neutropenia |
| How can you protect at patient with leukemia from exposure to potential pathogens? | Neutropenic precautions - reverse isolation and meticulous hand hygiene. Restrict visitors if they have colds/fevers |
| What is thrombocytopenia? | Deficiency in the number of circulating platelets (less than 150,000) or change in the functions of platelets alters the process of coagulation |
| What is thrombocytopenia purpura? | When platelets are destroyed by the body (caused by meds) |
| What is idiopathic thrombocytopenia purpura? | Autoimmune disease with unknown origin (platelets covered in antibodies, when they reach the spleen the body sees antibodies as foreign) |
| What is hemophilia? | When body does not manufacture one of the components for clotting |
| Compare & contrast hemophilia A & hemophilia B | A = clotting factor VIII (8) is missing, most common B = clotting factor IX (9) is missing |
| What are the risk associated with hemophilia? | Bleeding/hemorrhage |
| What is happening during DIC? | Overstimulation of clotting and anticlotting processes; thrombosis & bleeding occur simultaneously |
| What happens in multiple myeloma? | Malignant (not curable) immunodeficiency disease of bone marrow |
| How is multiple myeloma diagnosed? | Radiographic skeletal studies, bone marrow biopsy, blood & U/A test |
| How is multiple myeloma treated? | Symptomatic (no cure); Nursing interventions: pain relief, preventing infection & bone injury & maintain hydration (3-4 L/day), use caution when moving patient |
| What is Hodgkin's lymphoma? | Malignant disorder characterized by painless progressive enlargement of lymphoid tissue |
| How is Hodgkin's lymphoma diagnosed? | Lymphoscintigraphy/Reed-Sternbergs cells in lymph node biopsy specimens |
| How is Hodgkin's treated? | Depends on staging; 1-2 = radiation, 3-4 = Chemo or radiation or combination of both |
| What is a bone marrow transplant? | Infusion of healthy bone marrow via IV |
| Why are bone marrow transplants performed? | To reproduce healthy RBCs in someone who has diseased bone marrow |
| Describe a bone marrow aspiration | Needle is bored into bone marrow and bone marrow is siphoned (aspirated) out |
| What is the prognosis for a patient with aplastic anemia | Guarded, unless untreated. Untreated = 75% fatal |
| How is hemophilia treated? | Infusions of missing clotting factor |
| How is DIC treated? | Heparin (prevents further clots), blood transfusion to replace blood loss antifibrinolytic's should be given to adults |
| List three nursing diagnosis for a patient with leukemia | Risk for infection, Risk for injury, Risk for ineffective coping |
| What is the desired effect for the medication cyancobalamin (B12) | Replaces B12 that can't be absorbed in the stomach |
| What is the desired effect for the medication Folic Acid (B6) | Erythropoiesis - production of RBC |
| What is the desire effect for Iron Dextran (Imeferon) | Replaces iron (Fe) via deep IM, Z-track |
| What is the desired effect for Ferrous sulfate (Feosol) | Replaces iron (Fe) via orally - give tablets with OJ or tomato juice to increase absorption, give liquid Ferrous sulfate thru a straw to prevent staining on teeth |
| What is phagocytosis? | The process of WBC surrounding and ingesting bacteria |
| What percentage of the body's fluid is plasma? | 55% |
| Describe hemoglobin (Hgb) | Normal range 12-18, contains Fe (iron) and is carried by RBC's. Carries O2 and exchanges it for CO2 at the capillary level |
| Describe hematocrit (Hct) | Normal range 38-50, measures the percent of blood that is made up of packed red blood cells (PRBC) |
| What does the (RBC) erythrocyte do? | Carries O2 and nutrients to capillary, diffuse into body tissue. CO2 and waste in the capillaries attach to Hgb to be eliminated through respirations and filtration of the kidney |
| What is a reticulocyte? | Immature RBC |
| What happens when a patient has low levels of erythrocytes, Hgb, and Hct? | Patient will exhibit lack of energy and not stamina |
| Where does the production of blood cells (hemopoiesis) occur? | Mostly in the red bone marrow of sternum, ribs, skull, vertebrae, iliac crests and end of long bones (occurs continually) |
| What is a hemocytoblast? | All blood cells develop from this stem cell |
| What are thrombocytes (platelets)? | Smallest cells in the blood; form clots to seal off break in blood vessel |
| What are immature neutrophils called? | Bands |
| What is it called when there is a presence of excess bands? | Shift to the left |
| What is the test called that looks at the different types of blood cells? | Differential "diff" |
| What does it mean when immature neutrophil count exceeds 8% of total count? | Bone marrow has used up its reserves |
| What does it mean when there are excessive bands present? | Severe infection |
| What is the treatment for pernicious anemia? | B12 injections for life, can add folic acid & Fe supplements |
| What patients are at higher risk for aplastic anemia? | Cancer patients who are undergoing chemotherapy |
| What blood test determines pancytopenia? | CBC |
| What is the pathophysiology of sickle cell anemia? | RBCs become crescent shaped when O2 is low, cannot carry normal Hgb (Hgb-S) |
| What is the treatment for sickle cell crisis? | Fluids, O2, and rest |
| What happens during a sickle cell crisis? | Blood cells clump is small vessels = edema of extremities, joint pain & back pain |
| What is the treatment for polycythemia? | Therapeutic phlebotomy (may need to be done every 2-3 months |
| What is the major nursing focus for agranulocytosis? | Alleviate factors responsible for bone marrow depression, protect patient from infection, METICULOUS HAND HYGEINE |
| What is the treatment for leukemia? | Chemo & radiation, once leukemia is in remission - replace with healthy bone marrow (bone marrow transplant) |
| What is the patient teaching for idiopathic thrombocytopenia purpura? | Increased risk for bleeding because body is destroying platelets |
| What are the symptoms for hemophilia? | Hemarthrosis = ankyloses (fixation of the joint) PETECHIAE & ECCHYMOSIS (bruising) |
| What are nursing interventions for thrombocytopenia? | Assess for bleeding; institute bleed precautions; teach patient to avoid trauma |
| What is patient teaching for hemophilia? | No cure, avoid injury, avoid meds that increase bleeding (NSAIDS); risk for intracranial hemorrhage, prolonged nose bleeds; warm, painful, swollen joints w/decreased movement; risk of GI hemorrhage; watch for tarry stools, cola colored urine |
| What are bleeding precautions? | R.A.N.D.I - no Razor blades, no Aspirin, use small Needles, Decrease needle sticks, protect from Injury |
| What is nursing interventions for Hodgkin's lymphoma? | Pruritus is often severe - soothing baths with an antipruritic medication can be effective |
Created by:
tandkhopkins
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