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