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Adult Hlth 2 Test 3
Care of the Client with Hematological Alterations
| Question | Answer |
|---|---|
| What are normal levels for RBC’s FOR FEMALES AGES 18-64? | 4.2-5.4 |
| What are normal levels for RBC’s for MALES ages 18-64? | 4.7-6.1 |
| What are normal levels for RBC’s for FEMALES ages >64? | 3.8-5.2 |
| What are normal levels for RBC’s for MALES ages > 64? | 3.8-5.8 |
| A decreased level of RBCs could indicate possible ___ or ____? | anemia or hemorrhage |
| An increased level of RBCs could indicated possible ____ or ____ (a chronic life-shortening myeloproliferative disorder resulting from the reproduction of a single clone-Tabers)? | An increased level could indicate possible chronic hypoxia or polycythemia vera |
| What is the normal HgB for FEMALE ages 18-64? | 12-16 |
| What is the normal HgB for MALE ages 18-64? | 14-18 |
| What is the normal HgB for FEMALE ages >64? | 11.7-16.1 |
| What is the normal HgB for MALE ages 64? | 12.6-17.4 |
| A decreased level of HgB could indicate possible ___ or ___? | anemia or hemorrhage |
| An increased level of HgB could indicate possible ___ or ___ (a chronic life-shortening myeloproliferative disorder resulting from the reproduction of a single cell clone-Tabers) | An increased level could indicate possible chronic hypoxia or polycythemia vera (a chronic life-shortening myeloproliferative disorder resulting from the reproduction of a single cell clone-Tabers) |
| What is the normal Hct for FEMALE ages 18-64? | 37-47% |
| What is the normal Hct for MALE ages 18-64? | 42-52% |
| What is the normal Hct for FEMALE ages >64? | 35-37% |
| What is the normal Hct for MALE ages >64? | 37%-51% |
| A decreased level of Hct could indicate possible? | A decreased level could indicate possible anemia or hemorrhage |
| An increased level of Hct could indicate possible? | An increased level could indicate possible chronic hypoxia or polycythemia vera (a chronic life-shortening myeloproliferative disorder resulting from the reproduction of a single cell clone—Tabers). |
| What is the normal WBC for both males and females of all ages? | 5000-10,000 |
| Increased levels of WBC are associated with__,___,___ & ___? | Increased levels are associated with infection, inflammation, autoimmune disorders and leukemia |
| Decreased WBC levels may indicate ___ or ___? | Decreased levels may indicate prolonged infection or bone marrow suppression. |
| What is the normal platelet (PLT) count for men and women of all ages? | 150,000-400,000 mm3 |
| Increased PLT levels may indicate __ or ___? | Increased levels may indicate polycythemia vera or malignancy. |
| Decreased PLT levels may indicated ___, ___, or ____? | Decreased levels may indicate bone marrow suppression, autoimmune dissease, or hypersplenism |
| What is a common name for Microcytic Anemia? | Iron deficiency anemia |
| What is the common name for Macrocytic Anemia? | Vitamin B12 deficiency anemia |
| With ____ the iron stores are depleted first, followed by the hemoglobin stores? | With iron deficiency, the iron stores are depleted first, followed by the hemoglobin stores. |
| What happens as a result of iron deficiency to RBCs? | As a result, RBCs are small (microcytic), and the client has mild manifestations of anemia, including weakness and pallor. |
| In iron deficiency anemia, serum ferritin values are less than ____? | 12 g/L |
| ______ is a common type of anemia and can result from blood loss, poor intestinal absorption, and an inadequate diet? | Iron deficiency anemia |
| What is the basic problem of Iron deficiency anemia? | The basic problem is a decreased iron supply for the developing RBC. |
| Iron deficiency anemia can occur at any age but is more frequent in who? | women, older adults, and people with poor diets. |
| ______ causes anemia by inhibiting folic acid transport and reducing DNA synthesis in precursor cells. These precursor cells then undergo improper DNA synthesis and increase in size. Only a few are released from the bone marrow | Vitamin B12 deficiency |
| ____anemia is called megaloblastic (macrocytic) because of the large size of these abnormal cells? | Vitamin B12 deficiency |
| ______results result from poor intake of foods containing vitamin B12? | Vitamin B12 deficiency |
| ______ can occur with vegetarian diets or diets lacking dairy products? | Vitamin B12 deficiency |
| Conditions such as small bowel resection, diverticula, tapeworm, or overgrowth of intestinal bacteria can lead to poor absorption of ____? | vitamin B12. |
| Anemia caused by failure to absorb vitamin B12 (pernicious anemia) is caused by a deficiency of intrinsic factor (a substance normally secreted by the gastric mucosa), which is needed for intestinal absorption of vitamin B12? | (pernicious anemia) |
| Folic acid deficiency can also cause ____? | megaloblastic anemia. |
| Manifestations of ____ are similar to those of vitamin B12 deficiency but nervous system functions remain normal, because folic acid does not affect nerve function? | Folic acid deficiency |
| What helps distinguish folic acid deficiency from vitamin B12 deficiency? | The absence of neurologic problems helps distinguish folic acid deficiency from vitamin B12 deficiency. |
| T/F Folic acid deficiency develops slowly, and symptoms may be attributed to other problems or diseases? | True |
| The three common causes of folic acid deficiency are? | poor nutrition, malabsorption, and drugs. |
| What is the most common cause of folic acid deficiency? | Poor nutrition, especially a diet lacking green leafy vegetables, liver, yeast, citrus fruits, dried beans, and nuts, is the most common cause. |
| What are the second most of folic acid deficiency? | Malabsorption syndromes, such as Crohn's disease, are the second most common cause. |
| Chronic alcohol abuse with malnutrition is another cause of? | folic acid deficiency Anticonvulsants and oral contraceptives slow or prevent the absorption and conversion of ___ leading to? Anticonvulsants and oral contraceptives slow or prevent the absorption and conversion of folic acid to its active form, leading |
| What manifestations might you see in a cl with Vitamin B12 Deficiency Anemia? | Severe pallor; Slight jaundice; Smooth, beefy red tongue (glossitis); Fatigue; Wt loss; Paresthesias of the hands and feet; Difficulty with gait |
| Folic acid deficiency anemia can be distinguished from B12 anemia how? | by the lack of neurological problems; folic acid deficiency retains neurological functions. |
| What common food sources would you suggest for a client who has Iron deficiency? | liver (especially pork & lamb); Red meat; organ meats; kidney beans; Whole-wheat breads & cereals; leafy green veggies; carrots; egg yolks; & raisins |
| What common food sources would you suggest for a cl who has Vit B12 deficiency? | Liver; organ meats; dried beans; nuts; green leafy veggies; citrus fruit; & brewer’s yeast |
| What common food sources would you suggest for a cl who has folic acid deficiency? | Liver; organ meats; eggs; cabbage; broccoli; & Brussels sprouts |
| Most often Aplastic Anemia is accompanied by a decrease in circulating RBC, leukopenia and thrombocytopenia. This is called___? | Pancytopenia (a deficiency of all three types). |
| ____ is a disease with sustained increase in hemoglobin levels to 18g/dL; RBC count of 6 million/mm3 or hematocrit 55% or higher? | Polycythemia Vera (PV) |
| Persistently elevated Hct value (>55%); HTN; Dark, flushed appearance of hands & face; Distented superficial veins; Wt loss; Fatigue; intense itching; Enlarged hemorrhoids; Swollen, painful joints; Enlarged, firm spleen; Infarctions of heart; chest pain; | Polycythemia Vera (PV) |
| Strokes and bleeding tendency are also SS of ___? | polycythemia vera (PV) |
| What electrolyte imbalance might you see in polycythemia vera (PV) condition? | Gout & hyperkalemia-because the actual number of cells in the blood is greatly increased & the cells are not completely normal, cell life spans are shorter. Causing increased cell debris that includes uric acid and potassium. |
| What is the primary treatment for PV? | Monitor the CBC to assess response to treatment. Conservative treatment of repeated phlebotomies (2-5x per week) can prolong life for 10 to 20 yrs. Increasing hydration & promoting venous return help prevent clot formation, including prevention. |
| _______ is the blood drawing with removal of the client's RBCs to decrease the number of RBCs and reduce blood viscosity? | Phlebotomy |
| What patient education would you conduct with a patient with PV? | Drink at least 3 L of liquids each day; Avoid tight or constrictive clothing, especially garters or girdles. |
| T/F Pt with PV should wear gloves when outdoors in temperatures lower than 50° F (10° C)? | True |
| T/F It is not important for a pt with PV to keep all health care—related appointments? | False it is important |
| When should a pt with PV contact their dr? | Contact your physician at the first sign of infection. |
| T/F A pt with PV should take anticoagulants as prescribed; Wear support hose or stockings while you are awake and up; Elevate your feet whenever you are seated; Exercise slowly and only on the advice of your physician? | True |
| When performing activities or exercise when you have PV you should stop at the first sign of? | Stop activity at the first sign of chest pain |
| T/F it is not important for a pt with PV to use an electric shaver? | False it is |
| What type of toothbrush should a person with PV use and should they floss? | Use a soft-bristled toothbrush to brush your teeth and Do not floss between your teeth. |
| What is given to replace cells lost as a result of trauma or surgery? | RBC transfusion |
| Who else besides trauma and surgery pts might benefit from a RBC transfusion? | Clients with problems that destroy RBCs or impair RBC maturation also may benefit from RBC transfusions. |
| ______, supplied in 250-mL bags, are a concentrated source of RBCs and are the most common component given to RBC-deficient clients? | Packed RBCs |
| What is given to clients with a hemoglobin level less than 6 g/dL (or a hemoglobin value of 6 to 10 g/dL if manifestations are present)? | Packed RBCs |
| ______ are given to clients with platelet counts below 20,000 mm3 and to clients with thrombocytopenia who are actively bleeding or are scheduled for an invasive procedure? | Platelets |
| T/F Platelet transfusions are usually pooled from as many as 10 donors and do not have to be of the same blood type as the client? | True |
| For clients who are going to receive a bone marrow transplant (BMT) or who need multiple platelet transfusion, what might need to be prescribed? | single-donor platelets may be prescribed |
| _____ are taken from just one donor and decrease the amount of antigen exposure to the recipient, helping to prevent the formation of platelet antibodies? | Single-donor platelets |
| With ___the chances of allergic reactions to future platelet transfusions are thus reduced? | Single-donor platelets |
| ____ may be given fresh to replace blood volume? | Plasma infusions |
| More commonly, plasma is frozen immediately after donation, forming____? | fresh frozen plasma (FFP) |
| What does freezing do for plasma? | Freezing preserves the clotting factors, and the plasma can then be used for clients with clotting disorders |
| When should you infuse FFP? | Infuse FFP immediately after thawing while the clotting factors are still active. |
| What pts are candidates for an FFP infusion? | Clients who are actively bleeding with a prothrombin time (PT) or partial thromboplastin time (PTT) greater than 1.5 times normal are candidates for an FFP infusion |
| ____ is a product derived from plasma? | Cryoprecipitate |
| Clotting factors VIII and XIII, von Willebrand's factor, and fibrinogen are precipitated from pooled plasma to produce ____? | cryoprecipitate |
| Clients with a fibrinogen level of less than 100 mg/dL are candidates for a ____? | cryoprecipitate infusion |
| How should Cryoprecipitate transfusions be given? | Give this highly concentrated blood product to clients with clotting factor disorders at a volume of 10 to 15 mL/unit. Although cryoprecipitate can be infused, it is usually given by IV push within 3 minutes. |
| Dosages of ____are individualized, and it is best if the ____is ABO compatible? | Cryoprecipitate; Cryoprecipitate |
| WBC Transfusion is also called? | Granulocyte (White Cell) Transfusion |
| What types of pts receive granulocyte (white cell) transfusions? | At some centers, neutropenic clients with infections receive white blood cell (WBC) replacement transfusions. |
| What practice is controversial because the potential benefit to the client must be weighed against the potential severe reactions that often occur with ___ transfusions? | granulocyte (white cell transfusions; WBC transfusions |
| The surfaces of ____ contain many antigens that can cause severe reactions when infused into a client whose immune system recognizes these antigens as non-self. In addition, transfused ___have a short life span and provide minimal protection? | WBCs, WBCs |
| Assess lab values; verify medical prescription; assess cls VS, urine output, skin color, & Hx of transfusion reactions; Obtain venous access. Use central catheter/19-gauge needle if possible; obtain blood products from a blood bank. Transfuse immediately; | Nursing interventions for BEFORE blood infusions |
| Administer the blodd product using the appropriate filtered tubing; if blood prdt needs to be dilutes, use only normal saline solution; remain w/ pt during the 1st 15-30 min of infusion; infuse the blood prdt at the prescribed rate and monitor VS are all | Nursing interventions for during blood infusions |
| What do you do after a blood infusion? | when the transfusion is completed, discontinue infusion & dispose of the bag and tubing properly & DOCUMENT |
| How soon after you get a blood bag from the refrigerator should it be given? | IMEDIATELY; once a blood prdt has been released from the blood bank, the prdt should be transfused as soon as possible (e.g. RBCs should be completed w/in 4 hours of removal from the refrigerator) |
| Hemolytic reactions occur most often with in the first ___ mL of infusion? | 50 mL |
| ___ is a potential complication of rapid infusion? | fluid overload |
| Sepsis leading to _____ shock occurs when organisms are present in the blood? | distributive |
| Distributive shock is most commonly called ____? | septic shock |
| ____often occurs with disseminated intravascular coagulation (DIC)? | sepsis |
| _____ occurs most often with bacterial infection and has also been reported among clients with viral and yeast sepsis? | Septic shock (sepsis-induced distributive shock) |
| T/F Distributive shock caused by sepsis does not resemble other types of shock in that it has two distinctive phases (Figure 40-2)? | True |
| The first phase of ____can be long, often lasting from hours to a day or longer? | Distributive shock/ septic shock |
| Manifestations during phase 1 of distributive/septic shock are ____ and the chance for recovery is ____ when the cl is recognized being in the first phase? | subtle. The chance for recovery is good when the client is recognized as being in the first phase of septic shock and appropriate interventions are started. |
| The second phase of ____ has a sudden onset and a rapid downhill course? | septic shock |
| If septic shock progresses to the second phase, chances for recovery are ____? | poor. |
| T/F Identifying clients in the first phase of septic shock can make the greatest difference in survival? | True |
| ___ increases during the first phase of septic shock? | cardiac output |
| The first phase of septic shock is hyperdynamic and also may be called the ___ or ___? | high-output or warm-shock phase. |
| Increased cardiac output is reflected by ….? | increased cardiac output is reflected by tachycardia, increased stroke volume, a normal-to-elevated systolic blood pressure, and a normal CVP. |
| Increased cardiac output and vasodilation make the skin color appear____ with ___ mucous membranes and may feel __ to touch? | normal with pink mucous membranes and may feel warm to the touch. |
| T/F Phase 1 of septic shock is temporary and eventually the cardiac output is greatly reduced? | True |
| What marks the beginning of the second phase of septic shock.? | In the hyperdynamic phase of septic shock, respiratory rate and depth are increased, leading to respiratory alkalosis. |
| Lab assessment of a client with septic shock would include specimens of? | The presence of bacteria in the blood supports the diagnosis of sepsis. Obtain specimens of urine, blood, sputum, and any drainage for culture to identify the causative organisms. |
| A reduction of what protein might indicate sepsis? | Another indicator of sepsis and septic shock is a reduction in the blood levels of activated protein C |
| What does activated protein C do? | This protein is an enzyme that helps prevent inappropriate clot formation. |
| ___ is activated when it binds to healthy endothelial cells of blood vessels? | protein C |
| In septic shock, the endothelial cells injured by endotoxins cannot activate protein C and thousands of small ____ form in the capillaries of vascular organs? | clots |
| Decreasing levels of ____ indicate the beginning of septic shock even before other manifestations are evident? | activated protein C |
| Drug therapy in septic shock includes ___ and ___ to enhance cardiac output & restore blood volume? | antibiotics and drugs used to enhance cardiac output and restore blood volume. |
| The same drugs used to enhance cardiac output and restore vascular volume in hypovolemic shock are used for ____? | septic shock |
| A major focus of drug therapy is antibiotics to combat ___? | sepsis |
| T/F In addition to antibiotics for sepsis, drugs to counteract disseminated intravascular coagulation (DIC) are not needed? | False they may be needed |
| Septic shock and DIC have two distinctly different phases, and the drugs for each phase of ____are different? | septic shock |
| Drug therapy in the first phase of septic shock and disseminated intravascular coagulation (DIC) is aimed at preventing coagulation by administering ____? | heparin |
| Drug therapy in the second, late phase of septic shock & DIC is aimed at increasing the blood's ability to clot. This therapy consists of what? | clotting factors, plasma, platelets, or other blood products. |
| Although septic shock can be caused by any organism, the most common agents are ____? | gram-negative bacteria. |
| When blood cultures have identified specific bacteria, IV ____ with known activity against the bacteria are given? | antibiotics |
| Multiple drugs with wide activity are prescribed when the causative organism of septic shock is ____? | not known |
| Drugs and drug categories commonly used for septic shock include…? | vancomycin, aminoglycosides, systemic penicillin or cephalosporins, macrolides, and quinolones |
| When clients are in the early phase of septic shock and are beginning to form many small clots, ____ may be given to limit unneeded clotting and to prevent the consumption of clotting factors? | heparin |
| When septic shock progresses to the late phase and small clots have formed to such an extent that the client no longer has enough clotting factors to prevent hemorrhage, ____ are infused? | clotting factors |
| Clotting factors (cryoprecipitate) are obtained from __? | pooled human serum |
| Infusing ____ also helps to replace clotting factors? | fresh frozen plasma (FFP) |
| T/F Platelets or other blood products may also be needed to replace clotting factors? | True |
| ______ has been shown to stop the inflammatory responses and small clot formation of septic shock (Kleinpell, 2003a)? | Synthetic activated protein C |
| Name a type of synthetic activated protein C drug that is given as a continuous infusion over 4 days? | drotrecogin alpha (Xigris), is given as a continuous infusion over 4 days. |
| T/F Antibodies against the body's mediators for inflammation are being tested for their effectiveness in septic shock? | True |
| T/F Antibodies have been developed against the some proinflammatory cytokines, particularly interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor (TNF). This experimental therapy shows promise in reducing the extensive mortality associated | True |
Created by:
cgwayland
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