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E1 Hematology
Care for the adult patient with a hematologic disorder
| Question | Answer |
|---|---|
| What are the three general functions of blood? | TransportationCoagulation and ClottingInfection Control |
| List the general characteristics of blood: Color, Viscosity, pH, Volume, Composition | A - Bright Red V - Dard Red3 - 4X that of H2O7.35 - 7.455 - 6 L55% Plasma / 45% Cells & Platelets |
| What is the site of all hematopeoiesis? | Bone Marrow |
| Bone marrow is one of the largest organs in the body (accounting for 4% - 5% of body weight) and contains what two types of marrow? | Red, Yellow |
| Mature erythrocytes contain __________ . | Hemoglobin |
| __________ is an iron-containing oxygen-transport metalloprotein. | Hemoglobin |
| List five major WBC. | Neutrophils, Lymphocytes,Monocytes, Eosinophils, Basophils |
| Irregularly-shaped, colorless, sticky surfaced fragment of megakaryocytes instrumental in clotting are called: _____ | Platelets |
| Term used to describe too many platelets: | Thrombocytosis |
| Term used to describe too few platelets: | Thrombopenia |
| When bleeding suddenly occurs, platelets for and the vessel begins to constrict. The term used to describe this process: | Primary Hemostasis |
| Ca+, Vitamin K and fibrinogen come together to form a clot in this: | Secondary Hemostasis |
| This is found in all body fluids. Protein forms into plasmin and this breaks down fibrin and the clot dissolves | Plasminogen |
| This particular growth inducer is formed in the kidney and triggers blood cells to turn into RBCs. Therefore, kidney failure will lead to decreased RBCs. | Erythropoeitin |
| This blood component is 90% water. It is straw colored and transports blood cells. | Plasma |
| What is the difference between blood vessels and lymph vessels? | Blood vessels are interconnected and lymph vessels are not. They dump waste into nodes. |
| This organ removes old erythrocytes, produces lymphocytes, stores platelets and is responsible for fetal hematopoiesis. | Spleen |
| This organ removes old erythrocytes, synthesizes albumin and clotting factors and is responsible for fetal hematopoiesis. | Liver |
| Lympohocytes become T-Cells in the _____ _____. | Thymus Gland |
| List eight signs / symptoms of a Transfusion Reaction: | Restlesness, Fever, Nausea, CP, Back Pain, Dyspnea, Hematuria, Chills |
| When administering a blood transfusion use only ______ to flush the tubing. | Normal Saline |
| Why shouldn't you use Dextrose when administering a a blood transfusion. | Dextrose will facilitate clotting |
| When administering a blood transfusion stay with the patient during the first ___ minutes of the infusion. Why? | 15 min, Most people who have a reaction will have it in the first 15 min |
| List 5 general types of transfusion reactions: | Hemolytic, Allergic, Febrile, Bacterial, Circulatory Overload |
| What laboratory tests are included in the Complete Blood Count? | RBCs - Hgb, Hct, MCV, MCHC, RDW: WBCs- WBC differential ("diff"): PlT - PLATELETS MPV |
| Hematocrit (Hct) is a measurement of what? | The percentage of RBCs in the blood |
| Mean Corpuscular Volume (MCV) is a measurement of what? | Average RBC volume (size) |
| In patients with anemia, it is the MCV measurement that allows classification as either a _____ anemia (MCV below normal range) or _____ anemia (MCV above normal range). | microcytic, macrocytic |
| Mean Corpuscular Hemoglobin Concentration (MCHC). | The MCHC is a measure of the concentration of hemoglobin within a red blood cell. |
| MCHC measurement is useful in evaluating the clinical response of an anemic patient to therapy. Elevated MCHC is associated with: | spherocytosis |
| MCHC measurement is useful in evaluating the clinical response of an anemic patient to therapy. Normal MCHC is associated with: | pernicious anemia |
| MCHC measurement is useful in evaluating the clinical response of an anemic patient to therapy. Diminished MCHC is associated with: | Iron deficiency, Chronic blood loss, Thalassemia |
| MCHC Normal Range: | 31-37 g Hgb/dl |
| Red Cell Distribution width (RDW) is a measurement of what? | A measure of the variation of red blood cell (RBC) width that is reported as part of a standard complete blood count. |
| If _____ is observed, RDW test results are often used together with mean corpuscular volume (MCV) results to figure out what the cause might be. | Anemia |
| _____ deficiency produces a macrocytic (large cell) anemia with a normal RDW. | Vitamin B12 |
| However, _____ deficiency anemia initially presents with a varied size distribution of red blood cells, and as such shows an increased RDW. | Iron |
| In the case of a mixed _____ and _____ deficiency we will have a mix of both large cells and small cells hence the RDW will usually be elevated. An elevated RDW, i.e. red blood cells of unequal sizes, is known as anisocytosis | Iron, B12 |
| Name three Coagulation Tests (Coags): | PT, INR, PTT |
| What is the reference range for prothrombin and a normal INR? | The reference range for prothrombin time is usually around 12–15 seconds; the normal range for the INR is 0.8–1.2. |
| What two Coagulation Tests are used to measure the efficacy of Coumadin (Warfarin)? | PT INR |
| What Coagulation Test is used to measure the efficacy of Heparin? | PTT |
| List medications and foods which may affect coagulation times: | MEDS: Antibx, ASA, HRT, VitK; FOODS: Liver, Great Tea, Broccoli, Spinach, Kale. |
| What are two main purposes of the PTT? | Evaluation of the efficacy of Heparin; Used as a "starting point" in investigating bleeding or clotting irregularities |
| List five factors which may affect PTT: | Elevated Hct. Inherited or acquired deficiencies. Heparin use (>1.5 - 2.5 controls). Warfarin use. Leukemias. |
| Reticulocytes | (young red blood cells) in blood |
| What is the clinical significance of Reticulocytes present in the blood. | As the body receives a call for additional RBCs the Reticulocyte count increases and RBCs that are immature are released ... Unable to function properly |
| What is Transferrin? | Protein in the plasma synthesized in the liver that carries iron derived from food intake to the liver, spleen, and bone marrow. |
| About 65% of the iron in the body is carried in: | Hemoglobin |
| About 4% of iron is carried in a part of muscle tissue called: | Myoglobin |
| About 30% of the iron in the body is stored as a substance called _____ in the liver, bone marrow, and spleen | Ferritin |
| Each transferrin molecule can carry __ iron atoms. Normally, about __ of the free "spaces" for iron in transferrin are filled | 2; 30% |
| By filling up all the available spaces, doctors can measure the total iron binding capacity, or TIBC, of your blood. TIBC is usually higher-than-normal when the body's iron stores are HIGH / LOW. | LOW |
| The following diagnostic findings are commonly associated with what disease process? DECREASED RBC, Hgb,FERRITIN, SERUM IRON | Iron Deficiency Anemia |
| List three types of Hypoproliferative Anemia: | Iron Deficiency Andemia; Aplastic Anemia; Megaloblastic Anemia |
| List the medications and techniques employed in the treatment of Iron Deficiency Anemia: | Ferrous Sulfate, Ferrous Gluconate PO (straw to avoid staining); Iron Dextran: IM(ZTrack Method of injection), IV |
| What is the most serious but not the most common form of Hypoproliferative Anemia? | Aplastic Anemia |
| Bone marrow suffers from an aplasia (reduced heatopoiesis) that renders it unable to function properly. These patients have lower counts of all three blood cell types: RBCs, WBCs, and Platelets. Dmgd marrow stem cells replace marrow with fat. Condition? | Aplastic Anemia |
| The primary diagnostic for determining the presence of Aplastic Anemia? | Bone Marrow Aspiration |
| _____ _____ is located in the stomach and enables the absorption of Vitamin B12. | Intrinsic Factor |
| What are two types of Megaloblastic Anemias? | Vitamin B12 Anemia; Folic Acid Anemia |
| When evaluating a patient for Megaloblastic Anemias what is the biggest differnce between Vitamin B12 Anemia and Folic Acid Anemia? | Vitamin B12 Anemia = Neuro Dysfunctions |
| Why do patients who are chronic alcoholics become more prone to Folic Acid Anemia? | They use more folic acid than they can take in |
| What is the progression of neurosensory loss commonly accompanying Vitamin B12 Anemia? | From feet superiorly to waist |
| A classic method to determin Vitamin B12 deficiency is the _____ Test. | Schilling |
| List three assessment / diagnostic findings related to Megaloblastic Anemias. | Schilling Test; MMA and Momocysteine Levels; Intrinsic Factor Antibody Test |
| List three general treatments of Megaloblastic Anemias: | Folic Acid; B12 Replacement; Transfusions (Used Cautiously) |
| Folic Acid can be used to treat Megaloblastic Anemias so long as: | Causative factors have been ceased (ie alcoholic stops drinking so FA is not used up) |
| What are the primary and secondary concerns with people who have sensory deficit? | Safety; Good sckin care due to neurological deficit |
| List four patters of crisis for Sickle Cell patients: | Acute Chest Syndrome; Abdominal Crisis; Bone Crisis; Joint Crisis |
| SICKLE CELL CRISIS: Sudden acute CP, Fever, and NonProductive Cough which may lead to scarring of the lungs are symptoms of: | Acute Chest Syndrome |
| SICKLE CELL CRISIS: Pain is sudden, constant, and unrelenting. It may be diffuse. Nausea, Vomiting and Diarhea are symptoms of: | Abdominal Crisis |
| SICKLE CELL CRISIS: Acute pain in large bones of arms and legs (but can be any bone) are symptoms of: | Bone Crisis |
| SICKLE CELL CRISIS: Acute atraumatic pain in one or several joints is a symptom of: | Joint Crisis |
| Term used to describe too many cells in the blood: | Polycythemia Vera |
| What is the progression of neurosensory loss commonly accompanying Vitamin B12 Anemia? | From feet superiorly to waist |
| A classic method to determin Vitamin B12 deficiency is the _____ Test. | Schilling |
| List three assessment / diagnostic findings related to Megaloblastic Anemias. | Schilling Test; MMA and Momocysteine Levels; Intrinsic Factor Antibody Test |
| List three general treatments of Megaloblastic Anemias: | Folic Acid; B12 Replacement; Transfusions (Used Cautiously) |
| Folic Acid can be used to treat Megaloblastic Anemias so long as: | Causative factors have been ceased (ie alcoholic stops drinking so FA is not used up) |
| What are the primary and secondary concerns with people who have sensory deficit? | Safety; Good sckin care due to neurological deficit |
| List four patters of crisis for Sickle Cell patients: | Acute Chest Syndrome; Abdominal Crisis; Bone Crisis; Joint Crisis |
| SICKLE CELL CRISIS: Sudden acute CP, Fever, and NonProductive Cough which may lead to scarring of the lungs are symptoms of: | Acute Chest Syndrome |
| SICKLE CELL CRISIS: Pain is sudden, constant, and unrelenting. It may be diffuse. Nausea, Vomiting and Diarhea are symptoms of: | Abdominal Crisis |
| SICKLE CELL CRISIS: Acute pain in large bones of arms and legs (but can be any bone) are symptoms of: | Bone Crisis |
| SICKLE CELL CRISIS: Acute atraumatic pain in one or several joints is a symptom of: | Joint Crisis |
| Term used to describe too many cells in the blood: | Polycythemia Vera |
| What is the progression of neurosensory loss commonly accompanying Vitamin B12 Anemia? | From feet superiorly to waist |
| A classic method to determin Vitamin B12 deficiency is the _____ Test. | Schilling |
| List three assessment / diagnostic findings related to Megaloblastic Anemias. | Schilling Test; MMA and Momocysteine Levels; Intrinsic Factor Antibody Test |
| List three general treatments of Megaloblastic Anemias: | Folic Acid; B12 Replacement; Transfusions (Used Cautiously) |
| Folic Acid can be used to treat Megaloblastic Anemias so long as: | Causative factors have been ceased (ie alcoholic stops drinking so FA is not used up) |
| What are the primary and secondary concerns with people who have sensory deficit? | Safety; Good sckin care due to neurological deficit |
| List four patters of crisis for Sickle Cell patients: | Acute Chest Syndrome; Abdominal Crisis; Bone Crisis; Joint Crisis |
| SICKLE CELL CRISIS: Sudden acute CP, Fever, and NonProductive Cough which may lead to scarring of the lungs are symptoms of: | Acute Chest Syndrome |
| SICKLE CELL CRISIS: Pain is sudden, constant, and unrelenting. It may be diffuse. Nausea, Vomiting and Diarhea are symptoms of: | Abdominal Crisis |
| SICKLE CELL CRISIS: Acute pain in large bones of arms and legs (but can be any bone) are symptoms of: | Bone Crisis |
| SICKLE CELL CRISIS: Acute atraumatic pain in one or several joints is a symptom of: | Joint Crisis |
| Term used to describe too many cells in the blood: | Polycythemia Vera |
| What is the progression of neurosensory loss commonly accompanying Vitamin B12 Anemia? | From feet superiorly to waist |
| A classic method to determin Vitamin B12 deficiency is the _____ Test. | Schilling |
| List three assessment / diagnostic findings related to Megaloblastic Anemias. | Schilling Test; MMA and Momocysteine Levels; Intrinsic Factor Antibody Test |
| List three general treatments of Megaloblastic Anemias: | Folic Acid; B12 Replacement; Transfusions (Used Cautiously) |
| Folic Acid can be used to treat Megaloblastic Anemias so long as: | Causative factors have been ceased (ie alcoholic stops drinking so FA is not used up) |
| What are the primary and secondary concerns with people who have sensory deficit? | Safety; Good sckin care due to neurological deficit |
| List four patters of crisis for Sickle Cell patients: | Acute Chest Syndrome; Abdominal Crisis; Bone Crisis; Joint Crisis |
| SICKLE CELL CRISIS: Sudden acute CP, Fever, and NonProductive Cough which may lead to scarring of the lungs are symptoms of: | Acute Chest Syndrome |
| SICKLE CELL CRISIS: Pain is sudden, constant, and unrelenting. It may be diffuse. Nausea, Vomiting and Diarhea are symptoms of: | Abdominal Crisis |
| SICKLE CELL CRISIS: Acute pain in large bones of arms and legs (but can be any bone) are symptoms of: | Bone Crisis |
| SICKLE CELL CRISIS: Acute atraumatic pain in one or several joints is a symptom of: | Joint Crisis |
| Term used to describe too many cells in the blood: | Polycythemia Vera |
| What is the progression of neurosensory loss commonly accompanying Vitamin B12 Anemia? | From feet superiorly to waist |
| A classic method to determin Vitamin B12 deficiency is the _____ Test. | Schilling |
| List three assessment / diagnostic findings related to Megaloblastic Anemias. | Schilling Test; MMA and Momocysteine Levels; Intrinsic Factor Antibody Test |
| List three general treatments of Megaloblastic Anemias: | Folic Acid; B12 Replacement; Transfusions (Used Cautiously) |
| Folic Acid can be used to treat Megaloblastic Anemias so long as: | Causative factors have been ceased (ie alcoholic stops drinking so FA is not used up) |
| What are the primary and secondary concerns with people who have sensory deficit? | Safety; Good sckin care due to neurological deficit |
| List four patters of crisis for Sickle Cell patients: | Acute Chest Syndrome; Abdominal Crisis; Bone Crisis; Joint Crisis |
| SICKLE CELL CRISIS: Sudden acute CP, Fever, and NonProductive Cough which may lead to scarring of the lungs are symptoms of: | Acute Chest Syndrome |
| SICKLE CELL CRISIS: Pain is sudden, constant, and unrelenting. It may be diffuse. Nausea, Vomiting and Diarhea are symptoms of: | Abdominal Crisis |
| SICKLE CELL CRISIS: Acute pain in large bones of arms and legs (but can be any bone) are symptoms of: | Bone Crisis |
| SICKLE CELL CRISIS: Acute atraumatic pain in one or several joints is a symptom of: | Joint Crisis |
| Term used to describe too many cells in the blood: | Polycythemia Vera |
| A decrease in the number of white blood cells (leukocytes) found in the blood, which places individuals at increased risk of infection. | Leukopenias |
| As Absolute Neutrophil Count (ANC) correlates with: | Risk for infection. As ANC decreases the risk for infections increases. |
| Anyone with low neutrophil count cannot show: | Symptoms of infection (ie Fever and Reactions) |
| Absolute Neutrophil Count (ANC) Normal Value: | 2000 |
| The overproduction of WBCs is generally classified as: | Leukemia |
| What are four classifications of Leukemia: | Acute Myeloid Leukemia (AML); Acute Lymphocytic Leukemia (ALL) Pedi; Chronic Myeloid Leukemia (CML); Chronic Lymphocytic Leukemia CLL |
| AGE: All age groups - peak >60; PROGNOSIS: Highly cariable younger the pt the better the prognosis; PRESENTATION: Neutropenia, fever, weakness, bleeding; Tx: Chemo; Aggressive induction therapy, bone marrow transplant | Acute Myeloid Leukemia (AML) |
| AGE: Peak 4 ... rare > 15; PROGNOSIS: Children-5 yr survival 80% ... Adults-40%; PRESENTATION: Bone, ABD, CNS Pain; Tx: Chemo; Corticosteroids and vinca alkaloids, bone marrow transplant | Acute Lymphocytic Leukemia (ALL) |
| AGE: <20-Median age 55-60; PROGNOSIS: Chronic = 3-5 years Acute = Months; PRESENTATION: Malaise, anorexia, wheight loss; Tx: Gleevac, Interferon, hydroxyurea, bone marrow transplant | Chronic Myeloid Leukemia (CML) |
| MOST COMMON; AGE: 2/3 >60; PROGNOSIS: 2(late) - 14(early) years SYMPTOMS: Painful enlarged lymph nodes, B Symptoms: Night sweats, weight loss, fever; Tx: Chemo: Monoclonal antibodies Infections: Antibiotics, immunoglobulin | Chronic Lymphocytic Leukemia (CLL) |
| List some general manifestations of Leukemia: | Bruises, petechiae, pallor, open lesions, bleeding gums, anorexia, weight loss, enlarded lier and spleen, tachycardia, palpitations, orthostatic hypotension, DOE, fatigue, headache, fever, bone or joint pain and swelling, hematuria |
| AGE: Peaks in 20s in Males then again in 50s; PROGNOSIS: One of most cureable types of CA SYMPTOMS: Begins as 1 enlarged lymph node in neck. Total body itching. Reed Sternberg Cells | Hodgkin's Lymphoma |
| AGE: Average age of dx 50 - 60; PROGNOSIS: 1/3 Curable; SYMPTOMS: Lymph node enlarged in many sites NOTE: Common in military personel exposed to agent orange. | Non-Hodgkin's Lymphoma |
| Non-Hodgkin's Lymphoma | AGE: Average age of dx 50 - 60; PROGNOSIS: 1/3 Curable; SYMPTOMS: Lymph node enlarged in many sites NOTE: Common in military personel exposed to agent orange. |
| List some general manifestations of Leukemia: | Bruises, petechiae, pallor, open lesions, bleeding gums, anorexia, weight loss, enlarded lier and spleen, tachycardia, palpitations, orthostatic hypotension, DOE, fatigue, headache, fever, bone or joint pain and swelling, hematuria |
| AGE: Peaks in 20s in Males then again in 50s; PROGNOSIS: One of most cureable types of CA SYMPTOMS: Begins as 1 enlarged lymph node in neck. Total body itching. Reed Sternberg Cells | Hodgkin's Lymphoma |
| AGE: Average age of dx 50 - 60; PROGNOSIS: 1/3 Curable; SYMPTOMS: Lymph node enlarged in many sites NOTE: Common in military personel exposed to agent orange. | Non-Hodgkin's Lymphoma |
| List four general signs and symptoms of Multiple Myeloma. | CRAB: Calcium Elevation. Renal Failure. Anemia. Bone Lesions. |
| Hodgkin's Lymphoma | AGE: Peaks in 20s in Males then again in 50s; PROGNOSIS: One of most cureable types of CA SYMPTOMS: Begins as 1 enlarged lymph node in neck. Total body itching. Reed Sternberg Cells |
| AGE: 2/3 >65; SEX: >50%=Female; PROGNOSIS: 3-5 yrs life expectancy, Death usually results from infection; SYMPTOMS: 1st Symptom = Bone Pain, CRAB; RACE: 2wice as likely in Blacks; FAMILY: 4 times more comn in families; OCCUP: Petroleum | Multiple Myeloma |
| Multiple Myeloma | AGE: 2/3 are > 65; SEX: >50% = Female; PROGNOSIS: 3-5 years life expectancy, Death usually results from infection; SYMPTOMS: 1st Symptom = Bone Pain, CRAB; RACE: 2wice as likely in Blacks; FAMILY: 4 times more comn in families; OCCUP: Petroleum |
| Bence-Jones Proteins | Responsible for some of kidney damage which cause tubular damage. ONLY seen in Multiple Myeloma. |
| SYMPTOMOLOGY: Plasma cells invate the bone and take up space which leads to decreased marrow. | Multiple Myeloma |
| Explain C-R-A-B | C - Increased serum Calcium due to bone destruction. R - Redal Faluire as kidneys clog. A - Anemia - plasma cells invade marrow. B - bone lesions / Fx. |
| List 3 different types of Coagulopathies: | Thrombocytothemia; Thrombocytopenia; Hemophilia |
| Thrombocytothemia: Tx | Hydoxyurea; anagrelide; Interferon - alfa 2b; Plateletpheresis |
| PLATELETS: Normal Values | 140,000 - 450,000 /ml |
| PLATELETS: Values for patient with Thrombocytothemia. | > 600,000/mm3 |
| PLATELETS: Values for patient with Thrombocytopenia. | < 150,000/mm3 |
| List five general causes of Throbocytopenia. | Inadequate production; HIV Infection; Platelet sequestration; Dilution; Destruction ATP or ITP / TTP |
| Note the major difference in the pathophysiology and appearance of symptoms between ATP and TTP. | ATP - Platelets are DESTROYED / Insidous Onset / S&S related to bleedingTTP - Platelets are USED UP/Rapid Onset / S7S related to clots |
| What is the Tx for ATP? | AntiInflammatory - PrednisoneSplenectomyDanocrineInjections of High-Dose Gamma Globulin (immune factor) |
| What is the Tx for TTP? | Plasmapheresis (Plasma Exchange)Plasma Infusions |
| What are some S&S for people with TTP? | CVA, Seizure, Coma, Death, Kidney Pain, ABD pain |
| What are some S&S for people with ATP? | Heavy Menses; Pinpoint red spost / Petechial rash; Epistaxis or bleeding in the mouth |
| Is TTP common or rare? | TTP = Rare |
| List three types of hemophilia bleeding disorders: | Hemophilia A; Hemophilia B; von Willebrand's Disease |
| If a hemophilia patient presents to you with active bleeding you should: | Treat the bleeding first and before ANY other testing. |
| List four treatments for Hemophilia | Factor VIII; Factor IX; DDAVP, FFP (Fresh Frozen Plasma) |
| List and define three levels of prevention: | PRIMARY PREVENTION: Education, Modifiable Risk Factors; SECONDARY PREVENTION: Screenings, Routine Bloodwork; TERTIARY PREVENTION: Preventing complication, disease management |
Created by:
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