Hematology - Ch 30 - File 2
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| Smoking __ platelet reactivity | increases – also hematocrit and blood viscosity
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| Hematemesis | bright red, brown, or black vomitus
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| __ problems should be anticipated in cases of known alcohol abuse | bleeding
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| Iron and folic acid deficiencies are associated with | inadequate intake of liver, meat, eggs, whole grain, breads/cereals, potatoes, citrus fruits, legumes
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| Folic acid deficiencies may be offset by a diet including foods high in | iron
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| A nontender swollen lymph node may be a sign of | Hodgkin’s lymphoma or non-Hodgkin’s lymphoma
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| Cardiovascular disorders such as valvular disease or hypertension may predispose pts to | hemolysis
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| Meds used to treat cardio disease can cause | abnormalities in hematopoietic cell production or coagulation
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| Pulmonary disorders that lead to hypoxemia may cause | chronic stim of erythropoietin and result in polycythemia
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| Arthralgia | joint pain
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| Aching bones may result from | pressure of expanding bone marrow with diseases Diuretics interfere with
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| H2 blocking agents affect hematologic function how? | interfere with platelet production
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| Hemarthrosis | blood in joint – with bleeding disorders – painful
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| Agent Orange is associated with? | leukemia and lymphoma
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| Epistaxis may occur with | low platelet counts, especially if they strain
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| Smooth tongue sign of | pernicious anemia, iron-deficiency anemia
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| Purpura can be sign of | decreased platelets or clotting factors
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| Flusing of the palms of the hands or soles of the feet may indicate | anemia
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| Paresthesias of feet and hands; ataxia could be sign of | Cobalamin (B12) deficiency or folate deficiency.
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| Superficial lymph nodes can be evaluated by | light palpation
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| Deep lymph nodes should be evaluated by | radiologic exam – cannot be palpated
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| Lymph nodes should be assess for? | symmetry, size, fixation, tenderness, and texture
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| Tender nodes are usually sign of inflammation, while hard/fixed nodes suggest | malignancy
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| Erythrocytosis often produces | sm. Vessel occlusions causing a purple, mottled appearance of face, nose, fingers or toes.
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| Clubbing of fingers send with | chronic anemia as in pt with sickle cell disease.
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| Telangiectasia | dilation of a group of small blood vessels – like a spider nevus
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| What skin signs can indicate bleeding disorders? | petechiae, ecchymoses, spider nevus
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| Pancytopenia | marked decreases in number of ALL blood cells – RBCs, WBCs, and platelets
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| Hb value is reduced in cases of? | anemia, hemorrhage, hemodilution (FVE).
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| Hb value increases in | polycthemia, hemoconcentration (dehydration FVD).
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| Hct values reduced in | anemia, hemorrhage, hemodilution (FVE).
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| Hct values increased in | polycthemia, hemoconcentration (dehydration FVD).
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| Hct is usually __ times that of Hb. | 3
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| Hb | measurement of gas-carrying capacity of RBC – 12-16 woman, 13.5-18 man
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| Hct | measure of packed cell volume of RBCs
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| Red cell indices | Indicators of RBC volume, color, hemoglobin saturation – can provide insight into cause of anemia – marcro vs microcytosis
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| RBC morphologies | Dohl bodies, Heinz bodies, anisocytes, schistocytes, and sickled cells
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| Dohl bodies | usually associated with burns, systemic infections, cytotoxic agents, and neoplastic diseases – leukocyte includsion in neutrophils
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| Heinz bodies | Granules in RBCs – seen in thalassemias and after splenectomy
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| Anisocytes | various sized RBCs
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| Schistocytes | Fragmented RBC – hemolytic anemias, severe burns
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| WBC counts over 11,000 indicates | infection, inflammation, tissue injury or death, and malignancies (leukemia, lymphoma)
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| WBC less than 4000 is associated with | leukopenia – bone marrow depression, severe or chronic illness, leukemia
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| WBC differential is significant because | WBC count main be normal, despite marked change in 1 type of leukocyte
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| Neutropenia | absolute neutrophils count less than 1000 cells
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| Severe neutropenia | less than 500 cells
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| Thrombocytopenia | platelet count below 100,000
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| Spontaneous bleeding can occur once platelet count falls below | 20,000
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| Thrombocytosis | excessive platelets – inflammation and some malignant disorders
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| Complications from a splenectomy | Increase in RBCs, WBCs, platelets, immunologic deficiencies – infection
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| Medications that can cause petechiae | heparin, thiazide diuretics, digoxin, ibuprofen, antibiotics, H2 antagonists, quinine
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| Nursing care for patient w/post bone marrow aspiration | sterile pressure dressing – lie on site for 30-60 mins to maintain pressure
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| Assessment of lymph nodes on patient | lt palpation for superficial, radiologic for deep – assessed symmetrically for location, fixation, tenderness (inflame), and texture
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| What the term shift to the left means | increase in immature forms of WBCs (bands) being released before they have matured
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| Expected lab findings in pt with iron deficiency anemia | lower hb/hct, low iron, low MCV, flow ferritin, yet increase in TIB (tot. iron-bind capacity)
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| Foods nurse would recommend for pt w/iron def. anemia | liver, muscle meat, eggs, dk green leaf veg, whole-grain, enriched breads
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| Lab finding in CBC of pt w/folic acid def r/t chronic alcohol abuse | dec. hct/hb, increase in iron, bili, transferring & ferritin
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| Pt teaching r/t pernicious anemia | need to take cobalamin to absorb intrinsic factor, protect from falls, burns, & trauma due to neuro impair, incr. GI cancer
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| Care of pt w/sickle cell crisis | bed rest, oxy ther, pain mngt, fluids & ele, infection cntr, folic acid
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| Complications of thrombocytopenia | bleeding – petechiae, ecchymosis, epistaxis
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| Care of pt rec. blood trans | Baseline vitals, slow infus for 15 mins, then vital 15 min, watch for trans rxn, fluid bal ass
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| Care of pt w/heparin-induced thrombocytopenia and thrombosis syndrome | watch for bleed, DVTs, vascular ischemiaw/stroke, seizure, discontinue hep flush, use soft toothbrush
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| Care of pt w/acute polycythemia vera | reduce blood volume, hydration, adequate oxy, I/O, med, dietary, DVT avoidance, monitor hct/hb, anemia
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| Care of pt w/immune thrombocytopenia purpura (ITP) | avoid asparin, cntr bleed, use soft toothbrush, avoid inject, avoid causative agents
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| Care of pt w/type A hemophilia | prevent & treat bleed, preventative care, avoid accidents, health pro, daily oral care
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| Care of pt w/von Willebrand’s disease | prevent & treat bleed, preventative care, avoid accidents, health pro, daily oral care
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| Causes of disseminated intravascular coagulation (DIC) | abnormally initiated & accelerated clotting, tumors, gram neg bact, leukemia, blood transfusion rxn
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| Lab value in pt w/myelodysplastic dyndrome (MDS) | periperial blood cytopenias & hypercellular bone marrow w/dysplastic changes
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| Neupogen/Filgrastim | management of servere chronic neutropenia – stims immature neutrophils to divide and diverentiate – activates mature neutrophils
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| How is Neupogen beneficial for bone marrow transpalantation? | Improves harvest of progenitor cells
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| Complications of neutropenia | infection from norm flora, pathogens, impaired inflame., masks signs of infection, sepsis, systemic infections
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| Complications in pt w/non-Hodgkin’s lymphoma | can involve CNS, spleen, liver, GI tract, & bone marrow – raidiation therapy causes skin issues
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| Nursing interventions for pt w/multiple myeloma | ambulation & hydration to deal w/hypercal, weight-bearing, pain, monitor ele & I/O, fracture prevent, infect cntrl
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| Coumadin | Warfarin - anticoagulant – evaluate INR or PT and watch for intracranial bleeding
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| Heparin | anticoagulant – antithrombin, anemic thrombocytopenia can result after long use, bleeding
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| Lovenox | Enoxaparin – prevent DVT and PE, anticoag, bleeding, anemia, thrombocytopenia
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| Myodyplastic syndrome (MDS) can turn into | acute leukemia
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