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ch39 Hemat and Lymph
Mrs. Deneal -med surg hematopoietic and lymphatic disorders
| Question | Answer |
|---|---|
| Nutrients involved in erthropoiten | iron, B12, folic acid, Vitamin C (inhances absorbtion), B6 (hemoglobin formation), copper (transfer of iron storage to plasma) |
| Hemoglobin is made from | protein |
| epoetin (Epogen) | stimulate production of RBC |
| Filgrastim (Neupogen) | promote proliferation of neutrophils |
| reasons for anemia | 1) blood loss, 2)inadequate or abnormal erythrocyte formation, destruction of normal RBC |
| hypovolemia | large volume loss of blood or chronic blood loss |
| compensatory mechanisms for hypovolemia | rapid HR, rapid respiratory |
| hypovolemia treatment | give blood, treat cause |
| iron def. anemia | iron is insufficient to produce hemoglobin |
| sickle cell trait | only inherited one gene for sickle cell |
| sickle cell crisis | sickle shaped celsss lodge in small blood vessels blocking flow of blood and oxygen |
| Sickledex test | determines the presence of abnormal HbS screeing for sickle cell |
| sickle cell hemoglobin levels | 7-10 |
| hemolytic anemia | chronic premature destruction of erythrocytes |
| causes of hemolytic anemia | cardiopul bypass, arsenic/lead poisioning, malria parasite, infectious agents, toxins or chemical exposure |
| treatment of hemolytic anemia | remove cause, corticosteriods, blood trans, splenectomy (when medical treatment fails) |
| Thalassemias | hereditary hemolytic anemia-no cure |
| Thalassemia treatment | supportive-require more frequent blood trans, place on bed rest protect from infection |
| Pernicious Anemia | client lacks intrinsic factor interfere with absorbtion of B12 |
| B12 | extrinsic factor needed for maturation of erythrocytes |
| Schilling test | given radioactive B 12 and urine tested to see if it made it through the system. If not there is a intrinsic problem |
| Pernicious anemia Tx | B12 |
| Folic Acid deficiency anemia | lack of B9 intake causing immature erythrocytes |
| S&S sickle cell | jaundice, dysfunctional spleen, severe pain, fever, joint swelling, chronic leg ulcers |
| S&S Hemolytic and Hypovolemic anemia | extreme pallor, tachycardia, reduce urine output In hemolytic sever-jaundice enlarged spleen |
| S&S iron def anemia | cold, fatigue, dypnea on exertion, fast HR |
| S&S pernicious anemia | stomatitis, jaundice, irritabolity, confusion, depresion, glossitis diarrhea, numbness and tingling in legs |
| S&S folic acid def anemia | severe fatigue, sore beefy red tongue, dypnea, nausea, anorexia, headached, weakness, light headness |
| treatment folic acid anemia | supplements, diet high in folic acid |
| polycythemia vera | greater then normal erythrocytes, leukocytes, and platelets |
| problem with polycythemia vera | blood gets too thick and clots, more uria from dead cells causing gout like symptoms |
| S&S plycythemia vera | face and lips reddish-purple, fatigue, weakness, headache, pruritus, exertional dyspnea, dizziness, splemomegaly, swollen joints |
| splenomegaly | enlargement of the spleen |
| diagnostic findings of polycythemia vera | high levels of serum K, high uric acid |
| Tx polycythemia vera | lessen blood volume, lessen viscosity, curb excessive erythrocyte production phlebotomy-500ml several times a week, drink 3 quarts of fluid a day |
| leukocytosis | increased # of leukocytes causing quality to go down |
| Leukemia | malignant blood disorder in which proliferation of leukocytes in immature form is unregulated often acompanied by decrease RBC and platlets |
| S&S Leukemia | prone to bleeding, infections, fatigue from anemia, bruising |
| Some TX for leukemia | supportive care, profilactic antibiotics, transfuse platlets, radiation, bone marrow transplant |
| neutropenic precautions | private room, wash hands , daily shower, mask if leaving room or in crowds, no flowers int he room, no raw fruits or veg |
| mulitple myeloma | malignancy invloving plasma cells which are B-lymph cells in bone marrow- plasma cells invade bone marrow |
| S&S multiple myeloma | pain in pelvis spine ribshigh incidence of infection, anemia symptoms, brusing, nosebleeds |
| TX multiple myeloma | bolld trans for anemia, steroids and anticance drugs, braces for bones, autologus bone marrow and peripheral stem cell transplants, SAFETY |
| Agranulcytosis | decreased # of granulocytes including neutriphils, basophils, eosinophils |
| leukopenia | general reduction in WBC |
| Most common cause of agranulocytosis | toxicity from drugs |
| Tx agranulocytosis | removal of cause |
| S&S agranulocytosis | fatigue, chills, headache, opportunistic infections |
| pancytopenia | # of marrow-produced cells blood cells are reduced |
| disseminated intravascular coagulation | hypercoagulation is followed by diffuse bleeding as clotting factors are exhausted |
| thrombocytopenia | when platlet manufacture by the bone marrow is decreased or platlet destruction by the spleen is increased |
| thrombocytopenia TX | corticosteriods, blood trans |
| hemophilia | disorder of clot factors inherited from mother to son |
| hemophilia pt teachings | no aspirin, med alert bracelet, soft toothbrush |
| food sources of heme iron | meat, egg yolks, oyster, shell fish dark meat |
| to maximize onheme absorption | vitamin c, no coffee or tea during meals |
| folic acid rich foods | enriched breads, fortified cereals, broccoli, green leafy veg, milk , eggs |
| do no take oral iron with | cofee, tea, milk, eggs |
| do not give sickle cell pt | demerol- liver converts it to normeperidine which is toxic and can cause grand mal seizures |
| sickle cell pt need to avoid | hugh altitudes, dehydrating fluids, , cold fluids, cigarettes, tight clothes |
| hemolytic anemia pt needs to avoid | greens/turnips becuase vitamin K |
| anything that affects bone marrow affects... | platlet production |
| corticosteriods do what? | interrupt inflammatory process |
| HCT count | m42%-52% w 37%-47% |
| Potassium level | 3.5-5.0 mEq/L |
| Platlet | 150,000-400,000 |
| Na level | 136-145 |
| Cr serum level | 0.7-1.2 mg/dL |
| CrCl level | 85-135 |
| Hgb level | 14-18 g/dL (male) |
| BUN level | 10-20mg/dL |
| WBC | 5000-10,000 |
| RBC | 4.7-6.1 (male) 4.2-5.4 (female) |
Created by:
gdemuth
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