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Anemia Hodgkin and c

A lot of nursing stuff

Iron level in men 75-175
Iron level in women 65-165
RBC's in Men 4.7-6.1
RBC's in Women 4.2-5.4
Hgb levels in Men 13-18
HGB levels in Women 12-16
Reticulocytes in Men .5-1.5
Reticulocytes in Women .5-2.5
Hct in Men 45-54
Hct in Women 36-46
MCV in Men and Women 81-98
Iron deficiency anemia lab values low mcv, low mchc, low hgb, low hct, low serum iron, HIGH tibc
Pernicious anemia (vit B12 deficiency anemia) lab values HIGH mcv, low serum B12(<.1), low hct, low hgb, NORMAL mchc
Folic acid deficiency lab values HIGH mcv, NORMAL mchc, low hgb, low hct, low folate
MCHC levels in men and women 32-36
Platelet normal values 150,000-400,000
PT normal value 11-15 sec
PTT normal value 60-70 sec
APTT normal value 25-38 sec
Fibrinogen normal value 200-200
D-dimer normal value <400-500
The nurse should be aware that following a gastrectomy, a client may develop pernicious anemia becaus a. Vitamin B12 is only absorbed in the stomach
A patient is diagnosed with thrombocytopenia. The nurse should explain to the patient that with this condition, there could be: b. Decreased production of platelets
A patient is diagnosed with a hypoproliferative anemia. The nurse is aware that this type of anemia is due to: a. Lack of production of RBC’s
A patient reports symptoms of fatigue and pica. Laboratory findings reveal a low serum iron level and a low ferritin level. Upon evaluation of this assessment and laboratory data, the nurse suspects that the patient will be diagnosed with: a. Iron deficient anemia
A physican prescribes one tablet of ferrous sulfate daily experiences heavy menstral cycles. The nurse advises the patient and her mother that this over the counter medication must be taken for how long for iron replenishment to occu c. 6-12 months
Sickle shaped erythrocytes cause: a. Cellular blockage in small vessels b. Decreased organ perfusion c. Tissue ischemia d. All of the above
Nursing assessment of a patient with leukemia should include observation for which of the following signs/symptoms (select all that apply). _X__ Fever _X__Ecchymosis and/or petichiea _X__Infection _X__Dehydration _X___Confusion _X___Bone pain
Vitamin B12 deficiency develops when your body is not able to absorb this vitamin.
Vitamin B12 deficiency can be caused by medications, stomach or bowel surgery, and certain diseases
Sometimes vitamin B12 deficiency occurs in strict vegetarians and people who eat less meat, eggs or milk
In older people, the most common cause of vitamin B12 deficiency is when their bodies do not make enough acidic gastric juice to release the B12 from the food you eat. This is known as achlorhydria
Folate deficiency is often caused by an unbalanced diet that does not include enough fresh fruits and green, leafy vegetables.
Other common causes of folate deficiency are pregnancy, breastfeeding, alcohol abuse, and growth spurts
With folate and vitamin B12 deficiency, anemia often causes symptoms such as fatigue, poor appetite, weight loss, and diarrhea
The earliest symptoms of vitamin B12 deficiency may be weakness, poor coordination, and numbness or a “pins and needles” feeling in the hands and feet. Mild irritability and forgetfulness are other early signs
A severe untreated deficiency can result in serious damage to the nerves, spinal cord, and brain
Ferritin: Normal levels 18 to 160 mg/dl
Hct: Normal 36% to 48%. A value of 27.3% means the mass of the RBCs is low.
Hgb: Normal 12 to 16 g/dl. A value of 8.3 g/dl means the heme, or oxygen-carrying capacity of the RBC, is low
MCV: Normal 82 to 98 cmm. A value of 31.6 cmm means the RBCs are small—hence the name microcytic anemia
RDW: Normal 11.5% to 14.5 %. RDW refl ects the size of the individual RBCs compared to one another. A value of 15.6% means the cells are large and defi cient in iron. This is helpful in distinguishing anemia of chronic disease from iron defi ciency anemia.
Fe: Normal 65 to 165 mcg/dl. An iron value of 30 mcg/dl indicates iron defi ciency.
Ferritin: Normal 18 to 160 mg/dl. Ferritin is more specifi c and sensitive than the iron level. A low level indicates iron defi ciency anemia
Anemia is a deficiency in Number of erythrocytes (red blood cells or RBC’s) Quantity of hemoglobin Volume of packed RBC’s (hematocrit)
anemia causes Impaired production of erythrocytes (Hypoproliferative) ↑ Destruction of erythrocytes (Hemolytic) Blood Loss (acute or chronic
Hemoglobin (Hgb) levels are used to determine the severity of anemia Mild 10-14 g/dl Moderate 6-10 g/dl Severe < 6 g/dl
Elderly Decreased marrow response suppressed from medications Highly susceptible to anemia's Iron Deficiency (blood Loss) Nutritional deficiency (Vitamin B12 or Folate) May not tolerate well if underlying cardiac or pulmonary disease is present
anemia pallor Pallor ↓ hemoglobin ↓ blood flow to the skin
anemia jaundice ↑ concentration of serum bilirubin
anemia puritis...itching ↑ serum and skin bile salt concentrations
leukemia causes Genetic Viral pathogens Radiation damage Chemical exposure
Acute leukemia Symptoms occur suddenly
acute Leukocyte development is halted causing a rapid progression of the leukemia and death if not aggressively treated
Chronic Leukemia Symptoms occur over several months to years
chronic Leukocyte development is not halted and therefore progresses slowly and can extend over years
AML Defects in the stem cells that differentiate into all myeloid cells: Monocytes Granulocytes Erythrocytes Platelets
AML is Most common nonlymphocytic leukemia
AML Affects all ages with a peak at age ??? 60
AML Clinical manifestations Fever and infection (Neutropenia) Weakness and fatigue (Anemia) Bleeding tendencies (Thrombocytopenia) Pain from an enlarged liver or spleen (Proliferation of leukocytes) Hyperplasia of the gums (Proliferation of leukocytes) Bone pain (Expansion
AML Diagnostic Findings Complete Blood Count (CBC) ↓ erythrocytes ↓ Platelets Bone marrow analysis ↑ immature blast cells
AML COMPLICATIONS Infection (Lack of mature granulocytes) Bleeding (Thrombocytopenia) Purpura Gastrointestinal Intracranial Pulmonary
AML Goal is to achieve REMISSION
AML treatment is aggressive chemotherapy
Induction therapy (Irradiate leukemic cells
AML supportive care Administration of blood products PRBC’s Platelets
Tumor Lysis Syndrome ↑ Potassium ↑ Phosphate ↑ Uric acid (renal stone formation and Acute Renal Failure ARF)
AML complication of treatment Tumor Lysis Syndrome
Gastrointestinal complications of AML treatment Anorexia Nausea/Vomiting Mucositis
Chronic Myeloid Leukemia is... Mutation of myeloid stem cell with uncontrolled proliferation of cells (Philadelphia chromosome) Marrow expand into the lone bones and the liver & spleen
CML Uncommon in people under 20 under incidence increases with age (mean is 55-65 and life expectancy 2-5 years)
CML clinical manifestations Asymptomatic Increased leukocyte count Shortness of breath Confusion Splenomegaly (Painful) Hepatomegaly Malaise Anorexia
CML medical management Chronic Stage Gleevevc (imatinib mesylate) Injectable chemotherapeutic agents Roferon A (interferon alfa)
CML blast crisis management Induction therapy Consolidation
A patient with chronic myeloid leukemia (CML) is receiving chemotherapy. What precautions should this patient be taking while on chemotherapy Ensure the patient understands that there is an increased bleeding risk associated with chemotherapy due to decreased platelets. Explain patient’s immune system is altered while receiving chemotherapy. Patients are also vulnerable to uric acid, phosph
ALL is-------- Uncontrolled proliferation of immature cells from lymphoid cells
ALL is most common in;;;;; Most common in young children Boys
All'''' Leukemic cell infiltration is more common with this leukemia
All has the following Menigeal involvement Liver Spleen Bone marrow pain Headache Vomiting
ALL medical management Expected outcome is complete remission Induction Therapy Corticosteroids Vinc Alkaloiods Chemotherap
CLL definition Malignant B lymphocytes, most of which are mature may escape apoptosis (programmed cellular death) resulting in excessive accumulation of cells in marrow and circulation
CLL is--------- Most common form of leukemia More common in older adults and affects men more often
CLL clinical manifestations Early ↑ Lymphocyte count (>100,000 mm3) Small lymphocytes
More CLL clinical manifestations Late Anemia Thrombocytopenia
CLL B symptoms include Fever Sweats Weight loss
Other CLL manisfestations Lymphadenopathy Hepatomegalgy/Splenomegaly Anemia Thrombocytopenia Autoimmune complications Destruction of RBC and platelets
Cll early stage treatment no treatment/ most often initiated in the later stage
CLL nursing diagnosis Risk for infection Risk for bleeding Risk for impaired skin integrity r/t toxic effects of chemotherapy, alteration in nutrition and impaired mobility Impaired gas exchange Acute pain Grieving Deficient knowledge
CLL manage bleeding by: Avoid aspirin and aspirin-containing medications or other medications known to inhibit platelet function, if possible. Do not give intramuscular injections. Avoid indwelling catheters if at all possible. Take no rectal temperatures; do not give supposi
CLL manage bleeding by: Use stool softeners, oral laxatives contraceptives Use smallest possible needles when performing venipuncture. Apply pressure to venipuncture sites for 5 minutes or until bleeding has stopped.
CLL manage bleeding by: Permit no flossing of teeth and no commercial mouthwashes. Use only soft-bristled toothbrush for mouth care.
CLL mouth care Consider using toothettes for mouth care if platelet count is <10,000/mm3, or if gums bleed. Lubricate lips with water-soluble lubricant every 2 hours while awake
CLL coughing and suctioning Avoid suctioning if at all possible; if unavoidable, use only gentle suctioning. Discourage vigorous coughing or blowing of the nose.
More CLL preventions Use only electric razor for shaving. Pad side rails as needed. Prevent falls by ambulating with patient as necessary
More CLL preventions Control mucocitis Analgesics and Antiemetics Small, frequent feedings of foods that are soft in texture and moderate in temperature (avoiding uncooked fruits or vegetables and those without a peelable skin)
CLL nutrition Nutritional supplements Daily body weight with I and O is useful in monitoring fluid status Both calorie counts and more formal nutritional assessments are useful. Parenteral nutrition is often required to maintain adequate nutrition
CLL and Tylenol Acetaminophen is typically given to decrease fever, but it does so by increasing diaphoresis
CLL and water Sponging with cool water may be useful, but cold water or ice packs should be avoided because the heat cannot dissipate from constricted blood vessel
CLL sheets and massage Bedclothes need frequent changing as well Gentle back and shoulder massage may provide comfort
CLL and Faigue Physical activity is necessary to prevent physical deconditioning Wear HEPA mask Stationary bike Chair Physical Therapy
CLL and fluids Febrile episodes, bleeding, and inadequate or overly aggressive fluid replacement can alter the patient's fluid status and persistent diarrhea, vomiting, and long-term use of certain antimicrobial agents can cause significant deficits in electrolytes
CLL nursing fluid actions Assess for dehydration, fluid overload, with particular attention to pulmonary status and the development of dependent edema.test results, particularly electrolytes, blood urea nitrogen, creatinine, hct Replace electrolytes,particularly potassium, magnesi
what happens in the cardiac during anemia Additional attempts by the heart and lungs to provide adequate O2 to the tissues Cardiac output maintained by ↑ the heart rate and stroke volume Complications MI CHF/Cardiomegaly
what happens in the GI during anemia Nutrition Intake/Anorexic Nausea/Vomiting
what happens nueromuscular in anemia Activity Tolerance Fatigue/Weakness Coordination Unsteady Gait Judgment Irritability Confusion
what are some nursing diagnos for anemia Fatigue r/t decreased hemoglobin and decreased oxygen carrying capacity of the blood Altered nutrition: less than body requirements Altered tissue perfusion r/t inadequate blood volume Noncompliance with therapeutic regime
nursing goals for anemia Decrease Fatigue Maintain Adequate Nutrition Increase Tissue Perfusion Compliance with Therapeutic Regime Absence of complications
facts on iron oral meds Best absorbed on an empty stomach/acidic environment (1 hour before meals) Do not take with antacids/ dairy products Take with Orange Juice/with Vitamin C
facts on iron liquid meds Stain teeth Take with a straw/Rinse after use
Hypoproliferative: defect in production of RBCs Due to iron, vitamin B12, or folate deficiency, decreased erythropoietin production, cancer
Hemolytic: excess destruction of RBCs Due to altered erythropoiesis, or other causes such as hypersplenism, drug-induced or autoimmune processes, mechanical heart valves
3 alterations in Erythropioesis that ↓ RBC production ↓ Hemoglobin synthesis Defective DNA synthesis in RBC's Diminished availability of erythrocyte precursors
Most common type of anemia Related to ↓ hemoglobin synthesis AT Risk Groups Pre-menopausal women Pregnant women Persons from low socioeconomic backgrounds Older adults Individuals experiencing blood loss
Most common cause of anemia is? Bleeding
General manifestations of anemia What is the most common finding Pallor
Lab values for iron def. anemia? ↓ Ferritin ↓ Hemoglobin ↓ MCV ↓ Hematocrit (Hct) ↑ TIBC
positioning for bone marrrow aspiration/biopsy Side lying or prone
patient education on aspiration/bone biopsy Skin is anesthetized a sharp brief pain is experienced during the actual aspiration from the bone Biopsy – if aspiration is done, will use a different location A small incision is made put the needle to core out the bone May feel pressure not pain
location for bone aspiration or biopsy iliac crest or sternum
Post biopsy/aspiration care Apply pressure to the site for several minutes Cover with a sterile dressing Monitor for complications which include bleeding and infection Warm tub baths and mild analgesics may be used Avoid ASA
prevention and compliance iron teaching Diet teaching Supplemental iron Discuss diagnostic studies Iron therapy for 6-12 months after the hemoglobin levels return to normal (sometimes lifelong)
megoblastic anemia is caused by Disorders caused by impaired synthesis of DNA
Disorders caused by impaired synthesis of DNA are---- Large erythrocytes Abnormal ↑ in the number of cells (Hyperplasia) Pancytopenia (↓leukocytes and platelets) Increased MCV due to large erythrocytes (110um3) Majority of deficiencies from Folic Acid and Vitamin B
is there IF in vitamin b12 deficiency? no, there is Absence of IF
causes for absence of IF Protein secreted by the parietal cells of the gastric mucosa (needs acidic environment) GI surgery Long-term users of H2-histamine receptor blockers
what is another name for Vit b12 deficiency? Cobalamin
pernicious anemia is caused by? by a B12 Deficiency No secretion of IF
clinical manifestations of pernicious anemia General symptoms of anemia Gradual onset Glossitis Gastrointestinal Anorexia Nausea Vomiting Abdominal pain
neuromuscular symptoms in pernicious anemia Weakness Paresthesias of the feet and hands ↓ Vibratory and position senses Ataxia Muscle weakness Impaired thought process
what test due you use for pernicious anemia? Schillings Test
Schillings Test info 24H urine test determine if patient lacks intrinsic factor by measuring excretion of radioactive, oral Vitamin B12 RBC's large abnormal contributes rbc destruction Normal folate levels, ↓ iron levels suggest megaloblastic anemia due to iron deficiency
what is IF intrinsic factor
Folic acid is required for DNA synthesis
A deficiency in iron can be detected in about 4 months
Erythrocyte (RBC) formation and maturation is altered in? Folic Acid Deficiency
causes for Folic Acid Deficiency Poor nutrition Malabsorption syndromes Drugs Alcohol abuse and anorexia Lost during hemodialysis
Clinical manifestations for Folic Acid deficiency are? Clinical manifestations are similar to those of Vitamin B12 (cobalamin) deficiency Insidious onset Absence of neurologic problems Treated by replacement therapy Encourage patient to eat foods with large amounts of folic acid
nutrition info for Folic Acid deficiency are? Fortified soy milk Folic Acid is found in green leafy vegetables
medication for Folic Acid deficiency are? Oral Folic Acid Vitamin B12 injections for patients with absorption problems
Skin assessment for Folic acid def. is? Assessment of the skin and mucous membranes is important Jaundice Vitiligo
Nutritional counseling for folic acid def. related to eating with glossitis
for walking watch their? gate
Aplastic anemia definition Damage to marrow stem cells (related to diminished availability of erythrocyte precursors
in aplastic anemia, T lymphocytes attack the marrow cells
in aplastic anemia, Bone Marrow is replaced with Fat cells
fat cells in bone marrow? and impairs the production of: Erythrocytes Platelets Leukocytes
aplastic anemia Acquired Idiopathic-------- n Damage (ionizing) Infection (viral or bacterial) Medication (Anti-seizure, ABX) Pregnancy Radiatio
aplastic anemia can be genetic due to Alterations in chromosomes
clinical maifestation of aplastic anemia Fatigue Pallor Dyspnea Prevalent infections Purpura
medical management for aplastic anemia Bone Marrow Transplant (BMT) Peripheral Blood Stem Cell Transplant (PBSCT) Immunosuppressant Therapy Supportive Therapy Packed Red Blood Cells (PRBC’s) Palettes
Your blood is made of Red blood cells (which carry oxygen to your tissues) White blood cells (which fight infection) Platelets (which help your blood clot
In a bone marrow transplant, you will receive you will receive healthy stem cells after your own bone marrow has been destroyed
bone marrow is is the soft, fatty tissue inside your bones. Stem cells are immature cells in the bone marrow that give rise to all of your blood cells
types of bone marrow transplants Autologous Allogeneic Umbilical cord blood transplant
during a bone marrow transplant you do what as a nurse? Monitor patient for Pain, Chills, Fever, Hives, Chest pain, Drop in blood pressure, Shortness of breath, Nausea, Flushing, Headache, and Funny taste in the mouth
complications of a bone marrow transplant Infection Neutropenia (↓ neutrophils) Bleeding Thrombocytopenia (↓ platelets) Safety
Neutrophil count <2,000 mm3 this is neutropenia, why? Decreased production Increased destruction Seen with chemotherapy Diagnosied with CBC
medical management for neutropenia Corticosteroids Withholding or reducing chemotherapy dosage Hospitalization If febrile cultures of urine, blood and sputum are obtained for adequate treatment
neutropenic precautions Hygiene Hand Body Oral Private room Care for Neutropenic patients first (if possible) Ensure adequate cleaning of the room
neutropenic precautions No visitors with colds No fresh flowers No fresh fruits or vegetables Have patient wear HEPA filter mask when they ambulate
neutropenic precautions patient teaching Oral Care Preventing Infections Self-care Nutrition Photosensitivity Monitoring for potential problems
what is Graft-versus-host disease (GVHD complication can occur after stem cell/bone marrow transplant in which newly transplanted material attack transplant recipient body.Acute GVHD usually within 1st 3mths post transplant Chronic GVHD usually starts more > 3mths post transplant,can b 4 life
in Hemolytic anemia Erythrocytes have a shortened life span ↓ the number present in circulation and O2 levels (related to diminished availability of erythrocyte precursors)
also in hemolytic anemia ↑ production of erythropoietin from the kidneys to produce more erythrocytes Erythrocytes are released prematurely as reticulocyte
Causes of hemolytic anemia Inherited Sickle cell Increased incidence in African American Decent Diagnosed in infancy Acquired Autoimmune
clinical manifestations of hemolytic anemia Cardiac Hemoglobin 7-10 g/dl Tachycardia Gastrointestinal Jaundice Enlarged liver/spleen ↑ facial bone size (widening medullary spaces)
complications of hemolytic anemia? Heart Failure Infection Pneumonia Acute Chest Syndrome Pulmonary Hypertension Osteomylitis (infection of the bone) Renal Failure
S and S of sickle cell crisis Signs & Symptoms Pain Swelling Fever Cold/Chills
medical management of sickle cell crisis Bone Marrow Transplantation (BMT) RBC Transfusion (long-term) Hydroxyurea (Chemotherapy Agent) Arginin
what should a nurse do for sickle cell crisis Monitor/Treat Complications Infection Acute Chest Syndrome ABX Incentive Spirometry Fluid Restriction Supportive Therapy Pain Management Hydration
Blood loss and anemia Result of sudden hemorrhage Trauma Complications of surgery Disruption vascular integrity
diagnostic studies for blood loss anemia Laboratory data do not adequately assess RBC problems for 2-3 days Patient H&P and physical assessment
complications of blood loss anemia Hypovolemic Shock ↑ Plasma Volume ↓ O2 related to ↓ RBC’s
what should nurse do for blood loss Identifying the source of the hemorrhage Stopping blood loss Replacing blood volume to prevent shock Correcting RBC loss
what should nurse prepare to administer Administration of Blood Products PRBC’s Platelets Plasma
what is lymphoma? Neoplasm of lymph origin Start in lymph nodes but can involve lymphoid tissue in the spleen, GI tract, liver or bone marrow Lymphocytes undergo malignant changes and produce tumors
what is hodgkins Originates in a single node Contains the Reed-Sternberg cell Causes: Unknown Suspected viral etiology (Epstein-Barr – Herpes virus
what happens to lymphnodes in hodgkins Painless, enlarged, firm lymph nodes are a hallmark of both types of Hodgkin’s
hodgkins has to types???? Type A (no symptoms) Type B (symptoms include fatigue, weight loss 10%, fever w/o chills, and night sweats
what are the type B symptoms? symptoms include fatigue, weight loss 10%, fever w/o chills, and night sweats)
diagnostic findings in hodgknis Lymph node biopsy (Reed-Sternberg cell) Staging is performed to determine the extent of the disease
staging tests for hodgkins Chest x-ray Computed tomography (CT) scans of the head and neck, chest, abdomen, and pelvis Positron emission tomography (PET) of the entire body
1 stage of hodgkins Stage I – involves a single lymph node or localized involvement
2nd stage of hodgkins Stage II – involves two or more lymph node regions on the same side of the diaphragm
3rd stage of hodgkins Stage III – involves several lymph node regions on both sides of the diaphragm
4th stage of hodgkins Stage IV – involves extralymphatic tissue, such as the bone marrow
hodkins radiation therapy Preferable for early disease staging. May be used after aggressive chemotherapy for more advanced disease staging. Used for bulky disease types
hodgkins chemotherapy Used in advanced stages or with reoccurrence of Hodgkin’s Standard ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) regimen is used.
chemo long term errors in hodgkins ABVD may cause infertility Sperm abnormalities and birth defects,pregnancy prevention and sperm bank discussed.Chemo radiation increaserisk of another secondary malignancy Breast CA in women treated before 30 Most common 2nd malignancy is lung cancer
NHL definition Multiple lymphoid tissues become infiltrated with malignant B lymphocytes that spread unpredictably; localized disease is rare
NHL causes Cause is unknown/Several potential risk factors Spread through the bloodstream
clinical manifestations of NHL Lymphadenopathy - Most common Indolent (less aggressive) NHL– Early Stages Asymptomatic Aggressive NHL “ B-Symptoms” Fever Night sweats Unintentional weight loss Bone pain Anemia
staging tests for NHL Computed tomography (CT) scans of the head and neck, chest, abdomen, and pelvis Positron emission tomography (PET) of the entire body. Bone Marrow Biopsy Bence-Jones protein (urine
what protein can be found in the urine in NHL Bence-Jones protein
What cell is looked for in hodgkins? reed-sternberg cell
chemo side effects Fatigue Mylosuppression Nausea Hair loss Infection
may patients have stem cell transplant for reoccuring NHL? YES
what is treat for non aggressive nhl? radiation
treatment for aggressive NHL - Both CHOP (cyclophosphamide, hydroxydaunomycin, oncovin, and prednisone) chemo-therapy offers 40% cure rate; CHOP-R (rituximab added) chemotherapy offers 60% cure rate; or radiation/ chemotherapy combination
Created by: lupde01