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Chap. 32
Care of Clients with Hematologic Disorders
| Question | Answer |
|---|---|
| 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? |
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