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TEST 4 hem/onc/imm

NUR171

QuestionAnswer
what role does iron supplements/diet play in prevention of anemia? to provide amt of iron not rec'd by pt diet. Iron aids in RBC production.
compare/contrast pathogenic/opportunistic organisms. Pathogenic can infect healthy system. Opportunistic happens with a compromised immune system.
MCV normal value..what does it measure.. 80-95. size
MCH normal value..(MC-heavy) 27-31. wt of hgb
MCHC normal value.. 32-36. hgb concentration
RDW normal value.. 11-14.5, size of rbc
Create diorama that depicts the immune system. Include B and T cells.. B cells-surveillance, and produce antibodies. T cells are killer/attack cells. Cd4 are the Helper T Cell (helper & fighter), CD8 are Killers, they kill virus-infected/damaged cells
what disease condition will the dr. be screening for if he orders a Western Blot test HIV
how would someone acquire innate immunity? from mother at birth. "passive" comes from placenta.
How does adaptive immunity relate to the admin of immunizations, versus gamma gobulin? Immunizations-take time for immunity, not immediate, but lasts longer. Gamma Globulin is immediate but short lived.
What is neutropenia? decreased neutrophils.
What is function of neutroPhils? Phagocytosis, ingest and kill microorganisms, aids in bacterial infections.
At what number do you do neutropenic precautions? < 1000
S/sx of anemia Pallor, fatigue, SOB, beefy tongue, dizzy
Justify bone pain w admin of epogen.. RBC production increases, that happens in bone marrow. Can cause bone pain.
In a "shift to the left", is there more segmented or band neutrophils? Band (immature)
what does this shift suggest? infection
Is this something you would call dr. about yes
How is HIV spread Blood, semen, breast milk, vag secretion, birth canal. (bodily fluids except saliva)
Lymphocyte values (hint: in %) 20-40%. they protect immune system.
neutrophils % is.. 55-70% Aid in bacterial infections
monocytes % is 2-8% Clean up junk when neutrophils are done.
basophils % is.. 0.5-1% will be elevated w Allergies
eosinophils % is.. 1-4% will be elevated w Allergies
Stem cells start out as undifferentiated cells. The more they grow and divide, the more _____ they become. differentiated
Are B cells humoral? yes
lymphocyte ___ cells come from the thymus T
Lymphocyte___cells come from bone marrow B
How is CD4 count and viral load related to one another? If viral load is ____, then CD4 is ____. Increased, decreased.
What are immunoglobulins? Antibodies.
Identify the immunoglobulin IgG, and role. IgG- responsible for 2* immunity. can go btwn intracellular and extracellular spaces.
IgA and role lines all mucus membranes, (tears, nose) protects from invaders.
IgM and role Primary immune system. confined to intravascular space. Produces antibodies
IgE and role fixes to basophils and mast cells. Helps get rid of allergy causes, and parasytic infections.
HIV attacks CD_ cells. CD 4 cells
Immunocompromised patients have to go by _____, not WBC count, to monitor infection. *definitely on test* temperature
Can bone marrow be given in IV? yes
what teaching is important w iron supplements take w OJ. can cause black stools, constipation. if liquid, drink thru straw.
In an ELISA test, a viral load is coded as non detected instead of negative. Why? Non detected, the virus is under control, but doesn't mean free from virus. that would be negative.
How would you care for a pt w thrombocytopenia fall precautions, bleeding precautions, soft tooth brush, stool softener, electric razor, etc.
What is a normal CD cell count? 600-1500
what is considered a low/compromised cd count 200-600
what is dangerous? < 200. usually AIDS
what assessment data suggests that person who is HIV+ has converted to AIDS CD4 <200, and presence of one or more opportunistic infections
what do cephalosporins and pcn hav in common if you are allergic to one, usually allergic to the other.
What normal organisms is the immune person at risk against? themselves, their own flora.
Differentiate from Primary and 2* polycythemia vera. Primary is from disease, 2* is from complications (hi altitude, copd, etc)
what clotting factor is not made in liver platelets
therapeutic and dangerous aPTT values 30-40 wnl. 50-70 therapeutic. > 70 dangerous.
therapeutic and dangerous PTT values 60-70 wnl. 90-100 therapeutic. > 100 danger.
goal of radiation therapy? tx localized tumor
How does radiation affect normal tissue? doesn't discriminate btwn good and bad tissue
what lab values support the dr rx for epogen? RBC
what lab values support the dr rx for neupogen WBC
what lab values support the dr rx for numega platelets
Name 3 functions of immune system "DSH" Defense, Surveillance, Homeostasis.
What is an ESR? Sed Rate. Indicates non specific inflammation
How does the role of B cells differ from the role of T cells in immunity? B are surveillance, make antibodies. T are fighter/attack/destroy cells.
Why do you wash pillows in hot water, dry in hot dryer? kill pollens and bacteria.
What cross sensitivity do you look for w one allergic to banana, avocado, tree nuts, tomatoes? latex
differentiate btwn malignant and benign cancers Benign- non ca, WELL differentiated. Malignant- can invade other tissue. POORLY differentiated
#1 priority w anaphylaxis is airway
Describe the s/sx of early and late latex rx. Early: red, itch, rash. Late: anaphylaxis. use non latex stuff.
if a person exposed to Hep B she receives gamma globulin instead of immunization. why? GG- immediate protection. IMM- takes time.
a HIV/AIDs person says they are at greater risk from getting infection from you, then you are from them. Explain. They are immunocompromised.
What info recorded on med bracelet allergies, dx, med hx, esp blood thinner therapy
What is a RAST test used to dx allergies
Explain patho of autoimmune disease. Body attacks itself.
Explain stages of HIV. 3 Acute-virus happens. Latent-silent. 3. AIDS
what is goal of anti-retroviral replication? prevent replication of RNA (virus)
What is HARRT therapy for HIV 3 drug combo for all stages of development.
what is health promotion for HIV+ pt? safe sex, med compliance, manage stress, stay away from sick people.
reversal for heparin? protamine sulfate
reversal for coumadin? vit k
why do we type/cross prior to blood admin? it will attack "bad" blood, die.
explain the patho of ca cells uncontrolled growth of cells that poorly differentiate.
which is more dangerous, a malignant or benign brain tumor. depends where it is, and is it treatable.
Is it a person's legal responsibility to disclose HIV+ dx? No
what is diagnostic considered the definitive wen making a ca dx? Bx
7 warning signs of cancer. CAUTION C-CHANGE in bladder/bowel. A-sore throat. U-UNUSUAL bleeding. T-THICKENING,lump. I-INDEGESTION. O-OBVIOUS wart/mole. N-NAGGING cough
List 4 CA tx used today, explain when each would be appropriate. Radiation- localized tumor. Chemo-spread. Surgery-if it is in capsule. Biological response modifiers.
Describe mission of hospice. to make time left the best it can be.. will help the person LIVE the rest of life.
what does TNM tell the health provider? Tumor (size, location), Nodes involved (or not), Metastases. Tells provider how to tx.
why would a nurse offer anti emetic to a person receiving chemo N/V
how can we best be pt advocates? find out goals of pt, promote safety
What cells are hit the hardest w chemo fastest growing ones, GI, hair.
how can we help the person w cancer cope psychosocial/ support,help family, understand side effects.
Why isn't hospice such a bad word after all have pallaitive care also.
what is the patho of anemia that makes someone sob RBC carries O2
how is tx of pain different w pt w acute, chronic, post op and terminal pt different? Acute-push drugs, chronic-use non narc interventions also. post op- keep ahead of severe pain. terminal-keep comfortable.
Explain inflammatory response. 1. Trauma 2. Vasodilation-brings phagocytes to eat bad tissue. 3.formation of exudate.
which wbc in charge of ATTACKING antigen? which ones are helpers? which ones form surveillance team? Attack- T cell CD8. Helpers- CD4. Surveillance- B
do ca cells grow faster than normal cells? explain No. they just don't die like a normal cell.
How do BRM (biological response modifiers) work in tx of ca? Intereferes w cancer growth.
Explaine protective isolation practices for immune compromised pt neutropenic precautions
example of neutropenic precaution bottled water only, no fresh fruit/veggies. avoid sick people, no mani/pedi, no hand washed dishes.
what is patho of jaundice breakdown of bilirubin.
what is patho of 2* polycythemia vera? Hypoxia driven- hypoxia stimulate EPO production in kidney,so increase RBCs. Hypoxia independent- produced by malignant tumor or benign tumor, or altitude
what is therapeutic phlebotomy? take out 500ml blood, dilute w saline.
what is pancytopenia? what is most common cause? Decreased rbc, wbc, platelets. Common cause is aplastic anemia, and ca tx
why are terms leukopenia and neutropenia often used interchangeably neutrophils are leukocytes
what organism often cause of infection for immunocompromised pt opportunistic staph and strep, and persons own flora
explain plasmapharesis. when is it used in pt care take blood out, go thru plasma, filter out immune complexes that may cause exacerbation
what role do glucocorticoids play in the care of a person w autoimmune disease decrease inflammatory response, suppresses immune response.
what does + ANA (anti nuclear antibodies) indicate Lupus
explain patho of autoimmune disease Sees its own cells as invaders.
Exacerbation/remission is seen in.. autoimmune disease.
why is someone with SLE at risk for glomerulonephritis and CRF? Immune complex gets clogged in kidneys.
**compare various types of immunity. what immunity are babies born with? active and passive. babies born w passive, it comes from placenta. active is when you come in contact with it. Active are immunizations, unless GG..then it is passive.
B-12 can't be activiated without _____ _____. (hint: made in stomach) intrinsic factor.
B-12 converts folic acid (inactive) into ______ (active). folate
which type of anemia causes numbness/tingling of fingers and lips? They will be on B12 supplements for rest of life. Pernicious
We need _____ ____ for building nervous system and aid in RBC production folic acid
normocytic, normochromic is.. normal size/color
macrocytic, normochromic is.. large size, normal color
microcytic, hypocromic is... small size, pale color
what is aplastic anemia? Aplastic anemia develops when damage occurs to your bone marrow, slowing or shutting down the production of new blood cells.
what is a common condition that manifests from aplastic anemia? pancytopenia. (decreased wbc, rbc, platelets)
Why would you give Fe supplements w meals? prevent GI upset.
Examples of high iron diet include.. red meat, organ meat, whole wheat products, spinach.
What foods high in folic acid? citrus fruits, green veggie, liver
what foods high in vit B-12 milk, cheese, yeast, green leafy veggies.
to determine neutropenia, we multiply total ___ by % of _______ WBC x % of NEUTROPHILS
what is the single most important preventative measure in neutropenic pt? hand washing.
in neurtopenic pt, what is more accurate in determining infection, WBC count, or temperature? Temperature. Because WBC's main component is pus, in a neutropenic pt, pus formation is absent.
Leukopenia is.. decreased WBC count.
What is antibiotics are commonly rx'd for neutropenic pt? cephalosporins/aminoglycosides
common side effect of aminoglycosides nephrotoxicity, ototoxicity.
common side effect of cephalosporins pruritis, rash.
the longer the neutropenia, the greater the risk of _____ infection fungal
what do biologic response modifiers do? stimulate bone marrow to make more cells.
Grade I (histolic classification) means.. cells differ SLIGHTLY from normal cell. WELL DIFFERENTIATED
Grade II class histo means.. cells more abn. MODERATELY differentiated.
Grade III class histo means cells VERY abn. POORLY differentiated.
Grade IV class histo means.. immature cells, difficult to determine. Bad bad bad
Stage 0 ca disease class means Cancer in situ. no ca yet
Stage IV ca means metastasis. :(
Created by: scynba36