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Chap. 32

Care of Clients with Hematologic Disorders

QuestionAnswer
Erythropoiesis is? The production of RBCs
________ _______ is the stimulus for RBC production? Tissue hypoxia
This hormone is released by the ________ in response to tissue hypoxia? erythropoietin
How long does it take to produce a new RBC? 3-5 days
Essential nutrients for erythropoiesis are? Iron, Cobalamin (Vitamin B12), Folic acid
What are the three essential nutrients for erythopoiesis? Iron, Cobalamin (Vitamin B12), Folic acid
Iron, Cobalamin (Vitamin B12), Folic acid are? the three essential nutrients for erythopoiesis
Less mature RBC which mature in 48 hours of entering circulation? Reticulocytes
Baby RBCs are called? Reticulocytes
Primary function of RBC is? The transportation of gases
The transportation of gases is the primary function of which cell? Red Blood Cell
Tissue oxygenation is affected by Total number of RBC and Total amount of hemoglobin in each RBC
The number of circulating RBCs per mm3 of blood = RBC count
The normal range of RBC counts for men? 4.5-6.0 million/mm3
The normal range of RBC counts for wommen? 4.0­5.0 million/mm3
4.5-6.0 million/mm3 is? The normal range of RBC counts for men
4.0­5.0 million/mm3 is? The normal range of RBC counts for wommen
4.9 million/mm3 is WNL, high or low for a man's RBC count? WNL -- normal is 4.5-6.0 million/mm3
3.9 million/mm3 is WNL, high or low for a man's RBC count? Low -- normal is 4.5-6.0 million/mm3
3.6 million/mm3 is WNL, high or low for a man's RBC count? Low -- normal is 4.5-6.0 million/mm3
4.9 million/mm3 is WNL, high or low for a man's RBC count? WNL -- normal is 4.5-6.0 million/mm3
4.7 million/mm3 is WNL, high or low for a man's RBC count? WNL -- normal is 4.5-6.0 million/mm3
3.3 million/mm3 is WNL, high or low for a man's RBC count? Low -- normal is 4.5-6.0 million/mm3
4.1 million/mm3 is WNL, high or low for a man's RBC count? Low -- normal is 4.5-6.0 million/mm3
6.1 million/mm3 is WNL, high or low for a man's RBC count? High-- normal is 4.5-6.0 million/mm3
5.5 million/mm3 is WNL, high or low for a man's RBC count? WNL -- normal is 4.5-6.0 million/mm3
6.6 million/mm3 is WNL, high or low for a man's RBC count? High -- normal is 4.5-6.0 million/mm3
5.3 million/mm3 is WNL, high or low for a man's RBC count? WNL -- normal is 4.5-6.0 million/mm3
3.5 million/mm3 is WNL, high or low for a woman's RBC count? Low -- normal is 4.0­5.0 million/mm3
4.3 million/mm3 is WNL, high or low for a woman's RBC count? WNL -- normal is 4.0­5.0 million/mm3
5.1 million/mm3 is WNL, high or low for a woman's RBC count? High -- normal is 4.0­5.0 million/mm3
4.8 million/mm3 is WNL, high or low for a woman's RBC count? WNL -- normal is 4.0­5.0 million/mm3
4.5 million/mm3 is WNL, high or low for a woman's RBC count? WNL -- normal is 4.0­5.0 million/mm3
3.2 million/mm3 is WNL, high or low for a woman's RBC count? Low -- normal is 4.0­5.0 million/mm3
3.9 million/mm3 is WNL, high or low for a woman's RBC count? Low -- normal is 4.0­5.0 million/mm3
6.0 million/mm3 is WNL, high or low for a woman's RBC count? High -- normal is 4.0­5.0 million/mm3
5.0 million/mm3 is WNL, high or low for a woman's RBC count? WNL-- normal is 4.0­5.0 million/mm3
5.4 million/mm3 is WNL, high or low for a woman's RBC count? High -- normal is 4.0­5.0 million/mm3
4.9 million/mm3 is WNL, high or low for a woman's RBC count? WNL-- normal is 4.0­5.0 million/mm3
RBC counts in the 3's are always? low
RBC counts between 4 and 5 are always? WNL
For men RBC counts in the 5's are always? WNL
Ror women RBC counts above 5.O are always? high
For men RBC counts above 6.0 are always? high
Women 12-16, men 13.5-18.0 (blank)
Hemoglobin (Hgb) per dL of blood is normally? Men 13.5-18.0 g/dL Women 12-16 g/dL
13.5-18.0 g/dL is? The normal range of Hemoglobin (Hgb) for Men
12-16 g/dL is? The normal range of Hemoglobin (Hgb) for Women
13.5 g/dL is WNL, high or low for a woman's Hgb count? WNL -- normal is 12-16 g/dL
14.5 g/dL is WNL, high or low for a woman's Hgb count? WNL -- normal is 12-16 g/dL
14.1 g/dL is WNL, high or low for a woman's Hgb count? WNL -- normal is 12-16 g/dL
12.1 g/dL is WNL, high or low for a woman's Hgb count? WNL -- normal is 12-16 g/dL
15.5 g/dL is WNL, high or low for a woman's Hgb count? WNL -- normal is 12-16 g/dL
11.8 g/dL is WNL, high or low for a woman's Hgb count? Low -- normal is 12-16 g/dL
15.9 g/dL is WNL, high or low for a woman's Hgb count? WNL -- normal is 12-16 g/dL
16.5 g/dL is WNL, high or low for a woman's Hgb count? High -- normal is 12-16 g/dL
16.8 g/dL is WNL, high or low for a woman's Hgb count? High -- normal is 12-16 g/dL
17.5 g/dL is WNL, high or low for a woman's Hgb count? High -- normal is 12-16 g/dL
10.1 g/dL is WNL, high or low for a woman's Hgb count? Low -- normal is 12-16 g/dL
17.0 g/dL is WNL, high or low for a woman's Hgb count? High -- normal is 12-16 g/dL
16.1 g/dL is WNL, high or low for a woman's Hgb count? High -- normal is 12-16 g/dL
15.3 g/dL is WNL, high or low for a woman's Hgb count? WNL -- normal is 12-16 g/dL
16.5 g/dL is WNL, high or low for a man's Hgb count? WNL -- normal is 13.5-18.0 g/dL
13.8 g/dL is WNL, high or low for a man's Hgb count? WNL -- normal is 13.5-18.0 g/dL
12.3 g/dL is WNL, high or low for a man's Hgb count? Low -- normal is 13.5-18.0 g/dL
16.5 g/dL is WNL, high or low for a man's Hgb count? WNL -- normal is 13.5-18.0 g/dL
13.4 g/dL is WNL, high or low for a man's Hgb count? Low -- normal is 13.5-18.0 g/dL
18.0 g/dL is WNL, high or low for a man's Hgb count? WNL -- normal is 13.5-18.0 g/dL
12.5 g/dL is WNL, high or low for a man's Hgb count? Low -- normal is 13.5-18.0 g/dL
17.5 g/dL is WNL, high or low for a man's Hgb count? High -- normal is 13.5-18.0 g/dL
14.5 g/dL is WNL, high or low for a man's Hgb count? WNL -- normal is 13.5-18.0 g/dL
18.5 g/dL is WNL, high or low for a man's Hgb count? High -- normal is 13.5-18.0 g/dL
15.5 g/dL is WNL, high or low for a man's Hgb count? WNL -- normal is 13.5-18.0 g/dL
15.0 g/dL is WNL, high or low for a man's Hgb count? WNL -- normal is 13.5-18.0 g/dL
16.8 g/dL is WNL, high or low for a man's Hgb count? High -- normal is 13.5-18.0 g/dL
16.1 g/dL is WNL, high or low for a man's Hgb count? WNL -- normal is 13.5-18.0 g/dL
An Hgb in the 11's is always? Low
For Men an Hgb in the 12's is always? Low
For women an Hgb in the 12's, 13's, 14's, or 15's is always WNL
For Men an Hgb in the 14's, 15's, 16's, or 17's is always WNL
An Hgb above 16.0 is always high for a? Woman
An Hgb in the 17's is always? high for women and WNL for men
An Hgb in the 12's is always? low for men and WNL for women
An Hgb above 18.0 is always high for a? both men and women
For a man, an Hgb in the 15's is always? WNL
An Hgb in the high 16's is always? High (>16.5 is high for men, >15 is high for women)
An Hgb in the 13's is always? WNL
Which of these are always WNL for both men and Women? 11's 12's 13's 14's 15's 16's 17's 13's and 14's
Which of these are always WNL for Women? 11's 12's 13's 14's 15's 16's 17's 18's 19's 12's, 13's, 14's, and 15's
Which of these are always WNL for both men? (11's 12's 13's 14's 15's 16's 17's 18's 19's? 14's,15's,16's, and 17's
The packed volume of RBCs in 100ml of blood expressed as a percentage is called? Hematocrit (Hct)
The normal Hematocrit (Hct) for men is? 40% - 50%
The normal Hematocrit (Hct) for women is? 37% - 47%
40% - 50% is? The normal Hematocrit (Hct) for men
37% - 47% is? The normal Hematocrit (Hct) for women
Hematocrits in the low to mid 40's are always? WNL
Hematocrits in the 50's are always? High (men >50%, women >47%)
Hemaotcrits in the 30's are always?Low (blank)
30% is WNL, high or low for a man's Hct? Low -- normal is 40% - 50%
32% is WNL, high or low for a man's Hct? Low -- normal is 40% - 50%
34% is WNL, high or low for a man's Hct? Low -- normal is 40% - 50%
36% is WNL, high or low for a man's Hct? Low -- normal is 40% - 50%
38% is WNL, high or low for a man's Hct? Low -- normal is 40% - 50%
40% is WNL, high or low for a man's Hct? WNL -- normal is 40% - 50%
42% is WNL, high or low for a man's Hct? WNL -- normal is 40% - 50%
44% is WNL, high or low for a man's Hct? WNL -- normal is 40% - 50%
46% is WNL, high or low for a man's Hct? WNL -- normal is 40% - 50%
48% is WNL, high or low for a man's Hct? WNL -- normal is 40% - 50%
50% is WNL, high or low for a man's Hct? WNL -- normal is 40% - 50%
52% is WNL, high or low for a man's Hct? High -- normal is 40% - 50%
53% is WNL, high or low for a man's Hct? High -- normal is 40% - 50%
54% is WNL, high or low for a man's Hct? High -- normal is 40% - 50%
55% is WNL, high or low for a man's Hct? High -- normal is 40% - 50%
58% is WNL, high or low for a man's Hct? High -- normal is 40% - 50%
62% is WNL, high or low for a man's Hct? High -- normal is 40% - 50%
28% is WNL, high or low for a woman's Hct? Low -- normal is 37% - 47%
30% is WNL, high or low for a woman's Hct? Low -- normal is 37% - 47%
32% is WNL, high or low for a woman's Hct? Low -- normal is 37% - 47%
34% is WNL, high or low for a woman's Hct? Low -- normal is 37% - 47%
36% is WNL, high or low for a woman's Hct? Low -- normal is 37% - 47%
38% is WNL, high or low for a woman's Hct? WNL -- normal is 37% - 47%
40% is WNL, high or low for a woman's Hct? WNL -- normal is 37% - 47%
42% is WNL, high or low for a woman's Hct? WNL -- normal is 37% - 47%
44% is WNL, high or low for a woman's Hct? WNL -- normal is 37% - 47%
46% is WNL, high or low for a woman's Hct? WNL -- normal is 37% - 47%
48% is WNL, high or low for a woman's Hct? High -- normal is 37% - 47%
50% is WNL, high or low for a woman's Hct? High -- normal is 37% - 47%
52% is WNL, high or low for a woman's Hct? High -- normal is 37% - 47%
53% is WNL, high or low for a woman's Hct? High -- normal is 37% - 47%
54% is WNL, high or low for a woman's Hct? High -- normal is 37% - 47%
55% is WNL, high or low for a woman's Hct? High -- normal is 37% - 47%
58% is WNL, high or low for a woman's Hct? High -- normal is 37% - 47%
62% is WNL, high or low for a woman's Hct? High -- normal is 37% - 47%
Types of Leukocytes (WBC) Granulocytes (Neutrophils, Eosinophils, Basophils), Monocytes, Lymphocytes
Neutrophils act by Aggressive phagocytosis
“Segs”= mature neutrophils
“Bands”= less mature neutrophils
Baby neutrophils are called? Bands
Mature neutrophils are called? Segs
Neutrophils are the Primary cell in _____________ response? Neutrophils are the Primary cell in inflammatory response?
The number of usually neutrophils is increased/decreased/the same during bacterial infections? increased
Eosinophils are less ________ than neutrophils? Less phagocytic than neutrophils
WBCs that primarily phagacize antigen­antibody complexes related to allergies? Eosinophils
WBCs that defend against parasitic infection? Eosinophils
Which WBC's have a very limited role in phagocytosis Basophil
Which WBC's primary role is to release Histamine, Heparin, Serotonin? Basophil
The Second type of WBC to arrive at an injury during the inflammatory response =? Monocytes
Which WBCs differentiate into macrophages When they leave the blood and migrate into tissue? Monocytes
WBCs that provide humeral and cell mediated immunity? Lymphocytes
Which WBCs usually increase in number with viral infections? Lymphocytes
Which cells aid in blood clotting by sticking together and act as a plug? Thrombocytes (Platelets)
For ________ to be effective in clotting must be in sufficient numbers and structurally/metabolically "sound" Thrombocytes (Platelets)
Blood forming tissues located in hollows of large bones? Bone marrow
whicch organ filters blood,holds supply of lymphocytes and monocytes for immune response, and stores platelets? Spleen
Which system carries fluids from the interstitial spaces back to blood? Lymph system
The vascular system of lymphatic capillaries and channels=? Lymph system
These small structures are stationed along channels filter out bacterial and foreign matter? Lymph nodes
RBC count , RBC indices, and Hgb/Hct are the results of which lab test? Complete Blood Cell Count (CBC)
One of the RBC Indices, Mean corpuscular volume (MCV), is a measure of the? average size (volume) of RBCs
The average size or volume of RBCs is given as what lab value? MCV (mean corpuscular volume)
82-98 fL/cell is the normal range for? MCV
macrocytic anemias have MCV values above? 98 fL/cell
microcytic anemiase have MCV values below? 82 fL/cell
Hemolysis is? The destruction of old or damaged RBCs
bilirubin an orage-yellow pigment is an endproduct of what process? hemolysis
Which pigment/substance causes a yellowish appearance of the skin and sclera (jaundice)? bilirubin
Jaundice, the yellowish appearance of skin and/or sclera is caused by? An accumulation of bilirubin during disease processes causing increased hemolysis or impaired liver function
An abnormally low RBC (and/or abnormally low Hgb) is called? anemia
Hgb result is a measurement of the ______ of Hgb? weight of Hgb (gm/dl)
Hct is a measurement of the ______ ____ ______ expressed as a percentage of total blood volume? packed RBC volume
Anemia is a decrease in ____ ____, ___, and ___? Decrease in RBC number, Hgb, and Hct
The three possible, general causes of anemia are? Rapid blood loss, Impaired RBC production, Accelerated RBC destruction
Rapid blood loss, Impaired RBC production, Accelerated RBC destruction can cause ________? Anemia
Every type of anemia reduces the _____ _______ _______ of the blood, leading to tissue hypoxia? Oxygen carrying capacity
With the reduction of RBCs, a redistribution of blood to vital organs and the lack of hemoglobin produces ______ of the skin, mucous membranes, conjunctiva and nail beds? Pallor
Tissue hypoxia may ______ heart rate and ______ respiratory rate? Increase and Increase
Angina, fatique, dyspnea on exertion, and night cramps may all be caused by _______ ______ which is a result of anemia? Tissue hypoxia
Jaundice may be present if anemia is due to accelerated RBC destruction which causes increased _¬¬________ levels? bilirubin
Cardiovascular symptoms of anemia caused by increased cardiac demands to compensate for anemia include? Dizziness, dyspnea, fatigue, C.H.F
Heart increases _________ to get the RBCs that are left to the tissues faster? Output (rate)
Anemia is categorized by cause. The four categories are? blood loss, nutritional, hemolytic, and bone marrow suppression
In chronic blood loss anemia, iron stores are depleted as the body tries to maintain the RBC supply. The result is the RBCs are _______________ and ______________ in appearance? microcytic (small) and hypochromic (pale)
The three most common types of nutritional anemias ( caused by nutritional deficits affecting RBC or Hgb production) are? Iron deficiency anemia, Vitamin B12 deficiency anemia, and Folic acid deficiency anemia
In which two nutritional anemias are sometimes called megaloblastic anemias (because enlarged nucleated RBCs called megaloblasts are seen)? Vitamin B12 deficiency anemia and Folic acid deficiency anemia
The most common type of anemia is? Iron Deficiency Anemia
Iron Deficiency Anemia causes include ________ deficiencies, decreased ___________ (gastrectomy, diahrrhea), increased ___________ requirements (pregnancy, lactation), ________ loss (menstruation or GI ________)? Iron Deficiency Anemia causes include _dietary_ deficiencies, decreased _absorption of iron_ (gastrectomy, diahrrhea), increased _metabolic_ requirements (pregnancy, lactation), _blood_ loss (menstruation or GI _bleeds (ulcers,etc.)
Looking through a microscope at an iron deficiency anemic blood sample your might describe it as a _________, ________ anemia? Microcytic, hypochromic anemia
Clinical Manifestations of iron deficiency anemia include? The general symptoms (pallor, fatique, dyspnea/dizziness) plus smooth, sore tongue (Glossitis), stomatitis, spoon-shaped nails, cheilosis (cracks at the corner of the mouth), pica (unusual dietary cravings –clay or starch)
The primary treatment for iron deficiency is? increased dietary intake of iron-rich foods and oral or parenteral iron supplements.
Identifying and treating bleeding source and correcting nutritional deficits are treatments for _________ __________ anemia? iron deficiency anemia
Red meats, Legumes, whole grains, Dark green leafy vegetables are all good sources of _____ for anemias? iron
A woman who experiences heavy flow during her monthly menstruation is at risk for _____ __________ anemia? iron deficiency anemia
A client who has chronic bleeding ulcers is at risk for _____ __________ anemia? iron deficiency anemia
The demands of pregnancy or lactation may lead to _____ __________ anemia? iron deficiency anemia
Use a straw with oral iron therapy to avoid? staining teeth
Give iron preparations with orange juice because _________ __ enhances the absorption of nonheme iron? vitamin C
Coffee and tea _______ the absorption of nonheme iron? inhibits
Parenteral administration of iron uses the ____________ technique to minimize skin staining? “Z” track injection technique
Large doses of folic acid may cause the urine to become ______ ________? darker yellow
Taking iron supplements may cause the stools to become (hamlessly) ________ or ______? dark green or black
Vitamin B12 is necessary for ____ synthesis and is almost exclusively found in foods derived from animals? DNA synthesis
Deficiency of vitamin B!2 impairs cell division and maturation of rapidly proliferating cells like ____? RBC
Large (macrocytic), immature RBCs with thin membranes are produced in _______ ____ _______ anemia? vitamin B12 deficiency
Pernicious Anemia is a type of _______ ____ _______ anemia? vitamin B12 deficiency
The type of anemia resulting from a failure to absorb dietary vitamin B12 is called? Pernicious anemia
The lack of ________ ______ which is secreted by the gastric mucosa and binds to vitamin B12 and travels with it to the ileum where the vitamin is absorbed is the cause of pernicious anemia ? intrinsic factor
What substance is required for absorption of dietary vitamin B12? intrinsic factor
Cobalamin is also known as? Vitamin B12
Vtiamin B12 is also known as? Cobalamin
Meats, eggs, and dairy products are good sources of __________ ____ for treatment of pernicious anemia caused by dietary insufficiency? Vitamin B12
RBCs with pernicious anemia are ______cystic and ______chromic? Macrocytic, normochromic
Treatment of pernicious anemia due to gastric mal-absorption of Cobalamin (Vitamin B12) is ? parenteral (injections) of Cobalamin
How long will the client need parenteral (injections) of Cobalamin for the treatment of pernicious anemia? for his or her lifetime
Neuromuscular symptoms such as parathesias of the hands and feet, weakness, ataxia, problems with proprioception occur with _________ anemia, and may not be reversible? pernicous
Folic Acid Deficiency Anemia is seen with alcoholics because alcohol suppresses _________ metabolism? folate
Chronically undernourished, older adults, alcoholics, drug addicts are at risk for ________ ______ deficiency anemia/ folic acid
Persons with ceiliac sprue, a mal-absorption disorder, may develop ________ ______ deficiency anemia/ folic acid
Symptoms of folic acid deficiency anemia are similar to pernicious anemia but without the ___________ symptoms ? neurological
The treatment for folic acid deficiency anemia is? Oral replacement therapy
Good sources of folic acid include? Meats, Legumes, Whole grains, green leafy vegetables
Sickle cell anemia, thalassemia, anad glucose-6-phosphate dehydrogenase anemia are all examples of __________ anemias? hemolytic
An inherited disorder of hemoglobin synthesis in which either the alpha (Asian’s) or beta chains (Mediterranean’s) are missing leading to “target cells” aka “bull’s eye RBCs” is called? Thalassemia
Sickle Cell Anemia is a hereditary, chronic ______________ anemia? hemolytic
Less than ___% of African Americans are homozygous for sickle cell anemia? less than 1%
Sickle cell’s autosomal, recessive genetic defect causes synthesis of an abnormal for of hemoglobin calle ___? Hbs
Hbs crystallizes into rodlike structures that deform the RBC into a crescent or sickle shape when ___________ develops? hypoxemia
Repeated sickling and unsickling causes RBC ___________ and ____________? weakening and destruction
When the sickle shaped, abnormally shaped RBCs clump together and occlude capillaries causing severe local hypoxia with severe pain and fever it is called? sickle cell crisis
Sickle cell crisis causes excruciating pain due to _______ _________? tissue necrosis
What is the priority nursing intervention during sickle cell crisis? effective management of pain
The sickle cell crisis, occurring only in children, where large amounts of blood is pooled in the liver and spleen is called a? sequestration crisis
Acute Hemolytic Anemia causes include? Idiopathic, secondary to diagnosis such lupus, leukemia and lymphoma, Drug reaction, Infectious agents/toxins, Blood transfusion reactions
The condition where the bone marrow fails to produce all three types of blood cells (leading to pancytopenia) is called? Aplastic Anemia
With aplastic anemia the bone marrow is replaced by? fat
With aplastic anemia the cells produced are of _______ quality but ______ quantitiy? good quality but poor quantity
Very severe form of anemia whose manifestations include fatique, pallor, progressive weakness, exertional dyspnea, headache, and ultimately tacycardea and heart failure =? aplastic anemia
Which type of anemia presents with a low RBC count, leukopenia, and thrombocytopenia? aplastic anemia
Potential complications of aplastic anemia include __________ due to thrombocytopenia and ____________ due to leukopenia? _hemorrhage_ due to thrombocytopenia and _infection_ due to leukopenia
Aplastic anemia has a poor prognosis with a __% fatality rate? 75%
When you have too many RBCs it is called? Polycythemia (or erthrocytosis)
“Primary polycythemia is also known as? Polythycemia Vera
Polycythemia is characterized by a Hct greater than ___%? 55%
What are the three types of polycythemia? Primary, secondary, and relative
Relative polycythemia is not caused by an excess of RBCs but, rather, by a ________ deficit? fluid
Which type of polycythemia is a compensatory response to prolonged hypoxia as occurs with living at high altitude, smoking, or chronic lung disease? secondary polycythemia
40 – 70 year-old men of European Jewish ancestry are more commonly affected by ______ polycythemia? Primary polycythemia (PV)
Rehydration is the treatment for _________ polycythemia? relative polycythemia
Too many RBC resulting in Hypervolemia + hyperviscosity cause symptoms like Circulatory stasis/thrombosis, Vessel rupture/hemorrhage in this disease? polycythemia
Phlebotomy reduces Hypervolemia and Hydration reduces hyperviscosity are treatments for which RBC disorder? polycythemia
When treating polycytemia with phlebotomy or hydration there is a risk of under or over hydrating so the priority nursing intervention is? evaluation a nd management of fluid balance
Which organ produces procoagulants to aid clotting? The liver
The five stages of hemostasis (blood clotting) are? 1. vessel spasm 2. formation of the platelet plug 3. development of an insoluble fibrin clot 4. clot retraction 5. clot dissolution
Both the intrinsic and extrinsic clotting cascades eventually form _________? thrombin
Both the intrinsic and extrinsic clotting cascades eventually form thrombin that converts ___________ to fibrin? fibrinogen
Both the intrinsic and extrinsic clotting cascades eventually form thrombin that converts fibrinogen to _______? fibrin
The structure or framework of a clot is formed by _________? fibrin
Decrease in hemoglobin and decrease in the ability to rapidly increase the number of WBC in face of infection are both effects of ¬¬¬¬¬¬_____ on the hematological System? Aging
ASA and NSAIDS _______ platelet aggregation? decrease
Oral contraceptives _________ clotting factors? increase
Normal platelet count =? 150K­400K
A platelet count of 60K is (low, WNL, or high)? low (Normal platelet count =150K­400K)
A platelet count of 70K is (low, WNL, or high)? low (Normal platelet count =150K­400K)
A platelet count of 80K is (low, WNL, or high)? low (Normal platelet count =150K­400K)
A platelet count of 90K is (low, WNL, or high)? low (Normal platelet count =150K­400K)
A platelet count of 100K is (low, WNL, or high)? WNL (Normal platelet count =150K­400K)
A platelet count of 110K is (low, WNL, or high)? WNL (Normal platelet count =150K­400K)
A platelet count of 120K is (low, WNL, or high)? WNL (Normal platelet count =150K­400K)
A platelet count of 150K is (low, WNL, or high)? WNL (Normal platelet count =150K­400K)
A platelet count of 180K is (low, WNL, or high)? WNL (Normal platelet count =150K­400K)
A platelet count of 210K is (low, WNL, or high)? WNL (Normal platelet count =150K­400K)
A platelet count of 250K is (low, WNL, or high)? WNL (Normal platelet count =150K­400K)
A platelet count of 310K is (low, WNL, or high)? WNL (Normal platelet count =150K­400K)
A platelet count of 324K is (low, WNL, or high)? WNL (Normal platelet count =150K­400K)
A platelet count of 360K is (low, WNL, or high)? WNL (Normal platelet count =150K­400K)
A platelet count of 380K is (low, WNL, or high)? WNL (Normal platelet count =150K­400K)
A platelet count of 400K is (low, WNL, or high)? WNL (Normal platelet count =150K­400K)
A platelet count of 420K is (low, WNL, or high)? high (Normal platelet count =150K­400K)
A platelet count of 420K is (low, WNL, or high)? high (Normal platelet count =150K­400K)
A platelet count of 450K is (low, WNL, or high)? high (Normal platelet count =150K­400K)
A platelet count of 460K is (low, WNL, or high)? high (Normal platelet count =150K­400K)
A platelet count of 500K is (low, WNL, or high)? high (Normal platelet count =150K­400K)
A platelet count of 510K is (low, WNL, or high)? high (Normal platelet count =150K­400K)
Too little= thrombocytopenia (blank)
Too much= thrombocytosis (blank)
A platelet count less than 100K =? thrombocytopenia
A platelet count less than __________ is a high risk for spontaneous hemorrhage =? 20,000-30,000
A platelet count less than __________ causes serious, potentially fatal, bleading? 10,000
Thrombocytopenia results from one of three mechanisms _________ production, _________ sequestration in the spleen, or accelerated _____________? _DECREASED_ production, _INCREASED_ sequestration in the spleen, or accelerated _DESTRUCTION_
Platelet sequestration is usually caused by an enlarged ___________ aka ___________? spleen aka splenomegaly
Aplastic anemia, bone marrow malignancy, infection, radiation therapy, or drug therapy may cause ___________ thrombocytopenia? Secondary thrombocytopenia
Chronic ITP, a primary thrombocytopenia, typically affects young adults between __ and __, and ________ (men/women) are affected more often? 20-40 years-old; women more than men
Acute ITP typically lasts for 1-2 months and is more common in _________? children
Small red of purple spots, d/t bleeding from platelet deficiency, that do not blanch with pressure are called? petechiae
Areas of red of purple bruising, d/t bleeding from platelet deficiency, that do not blanch with pressure are called? purpura
Immune (or Idiopathic) Thrombocytopenia Purpura (ITP) is an ___________ response that causes destruction of platelets? autoimmune
Thrombocytopenia causes capillary leaks which causes _______ to appear/ petechiae
A reddish bruise from many petechiae crowded together is called? purpura
ITP puts clients at a high risk for __________? hemorrhage
With ITP (immune thrombocytopenic purpura) autoantibodies produced by the platelets membranes causes which organ to view the platelets as foreign (and then destroys the platelets)? spleen
Oral glucocoriticoids, such as prednisone, are prescribed to suppress the autoimmune response in which clotting disorder? ITP (immune thrombocytopenic purpura)
What is the surgical procedure of choice when a client’s ITP relapses after ceasing treatment with oral glucocorticoids? Splenectomy (removal of the spleen)
An early sign of of immune Thrombocytopenic Purpura is? bleeding of the gums
Nursing diagnoses for ITP include? Ineffective protection, Impaired Oral Mucous Membranes
Nursing Management of thrombocytopenia includes ____________ injuries, __________ venipuncture, and protecting _________? preventing injuries, limiting venipuncture, and protecting mucosa
Serious bleeding disorder that results from abnormal clotting that exhausts supply of platelets and clotting factors is called? Disseminated Intravascular Coagulation (DIC)
Spontaneous hemorrhage results when abnormal clotting in DIC exhausts the supply of __________________________________? platelets and clotting factors
Any seriously ill patient at risk of which serious bleeding disorder? Disseminated Intravascular Coagulation (DIC)
The most common cause of Disseminated Intravascular Coagulation (DIC) is ________? sepsis
Disseminated Intravascular Coagulation may be precipitated by __________ damage, _______ damage, or _________? Tissue damage, vessel damage, or infections
Long-term ________ therapy may be necessary for clients with chronic DIC? heparin therapy
Normal WBC Count=? 4000-11,000/mm3
WBC count that is too high=? leukocytosis
WBC count that is too low=? leukopenia (blank)
A decrease in circulating neutrophils (<1500/mm3) is called? neutropenia
Severe neutropenia (<200/mm3) is called? agranulocytosis
In leukopenia, the most common cell affected are the _________ which make up the majority of WBCs? neutrophils
When the neutropenia is severe, it is known as agranulocytosis (blank)
Impaired immunity and inflammatory response, which in turn, leads to a great risk for infection from opportunistic organisms are all associated with which blood cell condtion? Neutropenia
Two treatments for neutropenia are? hematopoietic growth factors to stimulate growth of WBC’s and antibiotics for infection
A group of chronic malignant disorders of WBCs and WBC precursors is called? Leukemia
Leukemias are classified by their ______ and by the predominant ____ of cells involved? Leukemias are classified by their acuity (acute or chronic) and by the predominant type of cells involved (lymphocytic or lymphoblastic, myelocytic or myeloblastic)
Lymphocytic (ALL, CLL) leukemias involve immature _________? lymphocytes (and precursors)
Myelocytic (AML, CML) leukemias involve ______________________? myeloid stem cells in bone marrow
Myelocytic leukemias involve the myeloid stem cells in bone marrow and interfere with the maturation of all types o f ______ _____? all types of blood cells (granulocytes, RBCs, thrombocytes)
Acute lymphoblastic leukemia is the most common in which age group? children
Acute myeloblastic leukemia and chronic lymphocytic leukemia are the most common in which age group? adults
The usual ratio of RBC’s to WBCs is reversed with which disorder? leukemia
Leukemic cells leave the bone marrow and travel through the circulatory system, __________ other body tissues (liver, spleen, and lymph nodes)? infiltrating
General manifestations of leukemia are? anemia, pallor, fatigue, tachycardia, malaise, lethargy, dyspnea on exertion, neutropenia, fever, night sweats, frequent or recurring urinary, integumentary, repiratory or other infections, thrombocytopenia,bruising, petechiae, bleeding gums, etc
With leukemia, death usually is due to? internal hemorrhage and infection
Treatments for leukemia include? single agent or combination chemotherapy, radiation therapy, bone marrow and stem cell transplant
Why are hematopoietic factors sometimes used following chemotherapy for leukemia? To “rescue” the bone marrow
Allogenic BMT infuses the bone marrow from ________? a healthy donor
Autologous BMT infuses the bone marrow from ____________? the client themselves (previously collected and stored) – used for bone marrow rescue
Common nursing diagnoses for leukemia include? Risk for infection, Imbalanced nutrition: less than body requirements Impaired oral mucous membranes, Ineffective protection (Risk for bleeding), Fear, Anxiety, Spiritual distress, Anticipatory grieving
Palpate lymph nodes using the pads of the index and 3rd fingers. A normal result would be (size and characteristics)? Less than 1 cm., symmetrical, mobile, soft and non­tender
Malignancies of lymphoid tissues are called? lymphomas
_____________ are malignancies that are characterized by the proliferation of lymphocytes, hisitiocytes (resident monocytes or macrophages) and their precursors and derivatives? lymphomas
Lymphomas are either __________ disease or _________ ________? Hodgkin’s disease or Non-Hodgkin’s Lymphoma
Which lymphoma is among the most curable of cancers? Hodgkin’s disease
What are two factors that appear to play a role in the development of Hodgkin’s disease? EBV (Epstein-Barr Virus) infection and genetic factors
With Hodgkin’s disease, involved lymph nodes contain _____-________ cells surrounded by host inflammatory cells? Reed-Sternberg
HIV or immunosuppression due to drug therapy following a transplant increases the risk of whch type of lymphoma? Non-Hodgkin’s
The primary treatment for early-stage Hodgkin’s disease is? Radiation therapy
The most common symptom of Hodgkin’s disease is ? one or more painlessly enlarged lymph nodes, usually in the cervical or subclavicular region
Which lymphoma tends to arise in peripheral lymph nodes and spread early to tissues throughout the body? Non-Hodgkin’s
Which indicates moderate anemia (female)? a. Hematocrit 45% b. Pulse rate 140 c. complains of shortness of breath with exercise d. WBC 14,000/uL c.
Why would you administering platelets to a client with DIC? a. Replace specific clotting factors b. promote intravascular clotting c. restore tissue oxygenation d. replace depleted platelets d.
If a client’s husband has hemophilia, can a client’s baby have the disease?a. the most common are transmitted as sex-linked recessive genes; her daughter may carry the gene b. because it ‘s on the Y chromosome, no risk c. hemophilia is autosomal domininan a.
Which Dx is highest priority for one marrow transplant to treat relapase of Acute Myelocytic Leukemia? a. disturbed body image b. ineffective protection c. anxiety d. imbalanced nutrition b.
90% of Blood Transfusion Reactions are caused by? improper product/ patient ID procedure
At the first sign of any reaction, _____the transfusion and ____________________? stop the transfusion and maintain IV line with saline
Types Of Blood Transfusion Reactions: most common is? febrile reactions
The most common type of blood transfusion reaction is aFebrile reactions, which is a reaction of the ciient’s antibodies against donor’s? WBCs
Febrile blood transfustion reactions usually manifest within _______min with ______ and chills? within first 15 min; fever and chills
Blood transfusion reaction types: Hypersensitivity reactions, antibodies against _____ in the donor’s blood? proteins (ex. immunoglobulin A) in the donor’s blood
Hypersensitivity blood transfusion reactions may manifest as ________ or __________? urticaria (itching) or anaphylaxis
The most dangerous type of blood transfusion reaction is? hemolytic recation
The most dangerous blood transfusion reaction, Hemolytic reaction is the result of? result of ABO or Rh incompatibility
Hemolytic blood transfusion reactions results in? clumping block capillaries, macrophages engulf clumped RBCs dumping Hgb into blood, free Hgb clogs renal tubules causing renal failure
Hemolytic blood transfusion reactions usually begin after ____mL t o ____mL of incompatible blood? 100mL to 200mL, The manifestations of Hemolytic blood transfusion reactions include?
Created by: hwk