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chpt 31 blood dz

anemia etc

QuestionAnswer
mild anemia classification (#) 10-14 g/dl; experiences dyspnea, diaphoresis, palpitations
moderate anemia classification (#) 6-10 g/dl; pt experiences dyspnea at rest
severe anemia (#) <6 g/dl; pt has multiple symptoms
At what # (g/dl) would you call the doctor for anemia and recieve a blood transfusion? around 8 g/dl (moderate)
what are the s/s of anemia pallor, jaundice, heart murmur/bruit(low viscosity), fatigue, pruritis, angina, MI, HF
anemia is caused by what 3 things? 1)blood loss 2)dec erythrocyte production 3)erythrocyte destruction
how do u inject iron? z-track w/0.5 ml of air left in it so skin doesn't stain. Also change syringe and do NOT massage area
when a person has anemia-like s/s, what do u determine 1st? the cause
what is the major cause of iron deficiency in adults? blood loss (menstruation)
s/s of mild case iron deficiency from hypoxia include what? glossitis, cheilitis
what is a pt rteaching when providing iron supplements? fluids & fiber
what might iron supplements cause (besides constipation) black stools
nursing intervention for iron deficiency anemia plan/pace activities
what can be done to inc iron absorption? PO empty stomach, take w/OJ
what is usually done for iron deficiency? blood transfusions- outpt as well
what can prosthetic heart valves cause? destruction of RBC
what is the #1 reason for hemolysis & what do you do? blood transfusion of mismatched blood- STOP it 1st then call doctor
what causes Thalassemia? genetic deficit which causes dec amt Hb due to inadequate synthesis of the globulin chains
who gets Thalassemia Mediteraneans :(
what is a nursing intervention for thalassemia genetic testing, counseling
what is the mild form of thalassemia alpha-thalassemia
what is is the asymptomatic form of thalassemia? T-minor
what is the most common form of thalassemia? beta-T
what is another name for thalassemia major? cooley's thalassemia
what is thalasemia major marked by? homozygous dz both parants- severe anemia, marked by hemolysis of erythrocytes and jaundice
what do you NOT give to a thalassemia pt iron (liver toxicity)- the blood cell cannot carry it
what is done for a thalassemia pt? blood transfusions (frequent) w/IV dereroxamine: cheleating agent to reduce iron overload
what does thalassemia cause during childhood developmental deficits
what are s/s of thalassemia hepatomegaly, splenomegaly, jaundice, chronic BM hyperplasia
Is tx for thalassemia palliative yes
is thalassemia life threatening? yes
those over the age of 25 have what d/t thalassemia blood transfusions? Hep C
what is megablastic anemia caused by? deficiency of B12 or folic acid
why are megablastic cells easily destroyed large cells pop
what is the most common cause of vit B 12 deficiency anemia? perniscious anemia (gastric mucosa not secreting IF)
what is the hallmark for vit B 12 deficiency anemia? parasthesia
VIT B12 IS IRREVERSIBLE- HOW? 1000 mg cobalamine IM injections QD, then weekly, then monthly--> FOR LIFE or you DIE
what are s/s of of B12 anemia? smooth, sore, red tonguefatique, confusion, n/v/d, ataxia, parasthesia
what causes folic acid deficiency? poor nutritional intake, malabsorption, drugs such as Dilantin, alcohol, prego, anorexia, hemodialysis
do pts take folic acid supplements only for anemia? no, it's also for cardiac pts...
in B12 deficiency anemia, what is cautioned? heat causes neuro pain
what kind of diet should those w/folic acid deficiency follow? uncooked & green leafy veggies, liver, citrus fruits, folic acid supplements, and yeast
why do prego moms experience folic acid deficiency? b/c the baby takes it all
what causes anemia of chronic dz? inflammation, autoimmune, infectious & malignant diseases
what does renal dz cause? insufficiency of erythropoiten
How is anemia of chronic dz best tx? tx the underlying cause
what medication is given to those w/chronic dz anemia? epogen (synthetic erythropoiten) & prokrit
what type of condition is aplastic anemia? the BM does not produce wbc,rbc 7 plts- it's a decrease in or damage to B< cells
what is pancytopenia dec amount of rbc, wbc and plts
congenital vs acquired aplastic anemia chromosomes; radiation, chemical agents, viral, bacterial, or prescription drugs
what can infx lead to in aplastic anemia? septicemia
nursing intervention for aplastic anemia do not have pt wait in the waiting room (infx)
pt education for aplastic anemia have pt use electric razor, do not blow nose, wear gloves when doing housework
what are nursing interventions for neutropenia? handwashing, no flowers or raw fruits in the room- reverse isolation
which pt should you see 1st? the one w/the lowest WBC count
what are the s/s for aplastic anemia? dyspnea on exertion, weakness, neutropenia, abnormal bleeding d/t thrombocytopenia
what does the pt experience w/acute blood loss? hypotention, hypovolemic, B/P is down
what happens when a pt loses 50% blood volume? shock and death
what is the tx for acute blood loss 1st IV fluids b/c type-n-cross takes time, ID source of bleeding, blood transfusion, supplement w/iron
what happens with chronic blood loss? ulcer, hemorrhoids, menstrual depletes iron stores
how do you tx chronic blood loss find the source and stop it, dr. may order colonoscopy, supplement w/iron
what are the major hallmarks for hemolytic anemia? shortened RBC life span, failure of the BM to replace them
what causes hemolytic anemia? trauma, meds, chemical agents, systemic dz, Ab-Antigen reactions
s/s of hemolytic anemia dyspnea, pale, cholelithiasis, jaundice, hepato/splenomegaly
what causes splenomegaly? macrophages engulphing cells
What do you maintain in hemolytic anemia? renal fx- can cause acute renal failure, lyte/fluid balance, pace & plan activities
what is a nusing dx for hemolytic anemia? Activity intolerance
what causes sickle cell anemia? genetic disorder r/t to the mutant Hb sickle cell hemoglobin (Hbs)
who does sickle cell effect? African americans
What factors cause cells to sickle? hypoxia: high altitude, exercise, stress, dehydration, infx, cold temperature
what causes the pain associated w/sickle cell anemia? LACTIC ACIDOSIS and ISCHEMIA
when should the pt seek tx in sickle cell @ 1st sign of illness
what is the problem in sickle cell? hemoglobin S
what are the s/s of sickle cell? jaundice, pallor, dec exercise tolerance, childhood growth impaired,
how is anemia caused in sickle cell? spleen destroys cell b/c it's deformed
how could a pt prevent an episode? avoid infx, get vaccinated, cold temperature, stress, remain hydrated (8 GLASSES OF WATER QD), avoid high altitudes and folic acid
nursing intervention for sickle cell listen to lung sounds (pulmonary complications)
what do you give pt for sickle cell? O2, morphine/dilaudid for pain (not demerol), procardia, antisickling agents; usually a chemo drug (hydroxyurea w/epogen)- stimulates RBC production & rids of iron
what is autosplenectomy? spleen becomes smaller d/t repeated scarring- inc risk for infection
multiple transfusions for sickle cell cause what? iron overload
Acquired hemolytic anemia is caused by what? extrinsic physical factors, immune reactions, toxins & infectious agents
what physical factors cause acquired hemolytic anemia? prothetic heart valves (on coumadin) d/t extreme force, hemodialysis, cardiopulmonary bypass
how is acquired hemolytic anemia tx? corticosteroids, removal of the spleen b/c splenomegaly can occur
what is hemochromatosis caused by? autoimmune disorder which causes inc intestinal absorption of iron which causes inc iron deposits in tissues/organs disrupting fx
who is hemochromatosis most common in? europeans
hemochromatosis is secondary to what? thalassemmia and siderobastic anemia
when a person has a splenectomy, they are at inc risk for what? infection
what organs does hemochromatosis effect? the pancreas, heart, adrenal glands and liver (cirhossis)
what must you hold if the Hct is high? epogen
how else can you gethemochromatosis? too many blood transfusions
what is the tx for hemochromatosis? weekly phlebotomy for 2-3 years
what is hemachromatosis similar to? arthritis
what foods do you avoid w/hemachromatosis? vitamin c (inc iron absorption), iron supplements, uncooked seafood, iron-rich foods
what is polycethemia? opposite of pancytopenia, inc blood viscosity d/t inc # of RBC--> impairs circulation
what is primary polycethemia? polycythemia vera: chromosomic mutation causing myeloproliferation (also involves WBC & plt)
what are the hallmarks of polycythemia? hypervolemia, hyperviscosity (capillaries become plugged by viscous blood)
what is a nursing intervention for polycythemia? ambulate pt
clinical s/s for polycythemia HA, tinnitus, vertigo, pruritis, spleno/hepatomegaly
what is contraindicated with polycythemia? iron supplements
what is the pt w/polycythemia at risk for? underhydration & overload
what is sign of polycythemia? itching while in a hot bath
how is polycythemia tx? by reducing blood volume, BM activity and viscosity. PHLEBOTOMY is mainstay, hydration
meds for polycythemia myelosuppressive, radiation therapy, monitor blood studies
which two blood dz involve phlebotomy? hemachromatosis & polycythemia
what is secondary polycythemia caused by? hypoxia-driven, demand for more O2
what is the difference between primary and secondary polycythemia? normal wbc & plt & spleen is not enlarged
what is the pt teaching for secondary polycythemia STOP SMOKING, avoid high altitudes
what is the difference between primary and secondary (always) primary is idiopathic, and secondary has a cause
What med is given for all autoimmune disorders and what risk does it cause? corticosteroids- @ risk for infx
what causes thrombocytopenia? an autoimmune attack which destroys plts. The normal plt is covered w/an Ab which is recognized as foreign and destroyed by the spleen`
what is the plt count for thrombocytopenia? <150,000
@ what pt is a plt transfusion required for thrombocytopenia? <20,000, and <10,000 causes spontaneous bleeding
what do you check for thrombocytopenia? check the stool for occult blood
what do you teach w/thrombocytopenia? bleeding precaution, no IM or SQ injections (could cause hematoma), no ASA, avoid vasalva, avoid blowing nose, report trauma
s/s of ITP purpura, petechiae, ecchymosis
what do corticosteriods suppress in ITP? phagocytosis & if it doesn't work, then splenectomy
what is the goal for the pt w/thrombocytopenia ITP? no bleeding
how do u know tx for ITP is working inc plt count
heparin-induced thrombocytopenia & thrombosis (HITTS) is caused by what? heparin cause bleeding and clumping at the same time. major problem is venous thrombosis (DVT & PE can occur)
s/s of HITTS? need for more heparin
what must be discontinued w/HITTS? heparin, especially when 50% plt count drops or pt- Notify the HCP & check for clots
what do you look at before the heparin is started? baseline & compare the two.
what do you monitor for HITTS? PTT (30-45 seconds is the norm)
what causes hemophilia & von willebrand? congenital, sex-linked x(men get it)coagulation & prolonged bleeding
what are the 3 major types of hemophilia? hemophilia A (most common) factor VIII deficiency; hemophilia B (christmas dz) factor IX deficiency & von willebrand deficiency which helps plts clump and stick to the blood vessel wall
how do hemophiliacs bleed for a much longer time, not more intensely
how is hemophilia tx? fresh frozen plasma
how should green leafy veggies be eaten with hemophiliacs they should be eaten at a constant level w/coumadin (vitamin k)
what are hemophiliacs at high risk for? GI bleeding- dark tarry stools require immediate tx
home management for hemophiliacs no ROM or heat, apply ice & bed rest
hematoma causes what in the joints/ hemarthrosis- bleeding in the joints
what is bleeding tx with in hemophilia? replacement of clotting factors- raise the level for ANTIHEMOPHILIC FACTOR temporarily, immediate transfusion of factor VIII and IX is PRIMARY tx. pt needs infusion Q12 hours till bleeding stops
what can the pt w/hemophilia not do? floss
what is DIC caused by? accelerated clotting followed by diffuse bleeding- life threatening- bleeding and clotting occur simultaneously
how do you tx DIC? tx underlying cause 1st, and ALWAYS give antibiotic 1st
what does DIC cause? microembolus disrupt the blood flow, ischemia, organ damage, fibrin degredation products are released, ICU high mortality rate
what does the pt feel w/DIC? impending doom
what is DIC tx with? transfusion, but w/out finding cause, it's useless
what do you need to know w/DIC? plt count
What is DIC caused by? always occurs in response to something else: shock, cirrhosis, glomerulonephritis, snake bitesfat emboli, factor III release, dead fetus, induced HTN from prego, d/t intrinic & extrinsic factor activation
management of DIC correct precipitating factor, correct infx, deliver fetus, control bleeding, provide RBC for hypovolemia & O2, cryoprecipitate, plt transfusion if < 100,000
what is cryoprecipitate? best source for fibrinogen, factor V, VIII, XIII
DIC management limit physical activity, and keep venipuncture to a minimum, hold pressure for 10 min
what is neutropenia? abnormally low amt of neutrophils <1500
what is the normal neutrophil count? 4000-11000
what is important to know about neutropenia how fast the count drops (greater risk for infection)
what is the first sign of neutropenia? fever
what can't a pt w/neutropenia have? flowers, tap water, cesar dressing
what could cause neutropenia? iatrogenic; chemo, immunosuppresive tx, s/e of medication, syndrome which occurs w/dz, most dz will inc neutrophils, but typhoid fever & many viral could decrease it
what dx test is done for neutropenia? wbc count, bone marrow aspiration & biopsty, peripheral blood smear to assess for bands, Hct, reticulocyte count, plt count
what is constantly checked in neutropenia? temperature, slight inc & notify HCP--> start anbx after culture (broad to narrow)
s/s of neutropenia classic sign of inflammation not present (fever), normal flora leads to infx, sore throat, dysphagia, lesion on pharyngela mucosa, diarreah, vaginal itching, SOB significant
what is Nupogen stimulates neutrophils
what type of room is used for neutropenia + pressure, hand washing, visitor restriction
Myelodisplastic syndrome is caused by what? stem cell disorders resulting in ineffective hematopoisis- progressive BM failure
what is the hallmark for myelodysplastic peripheral blood cytopenias & hypercellular BM exhibiting dysplastic changes
blood cytopenias include what 3 things 1) anemia 2) neutropenia 3)thrombocytopenia
what is the goal of myelodysplastic syndrome? goal is to improve heatopoisis and quality of life through hematologic monitoring, antbx use, blood transfusion, CHEMO, hematopoietic stem cell transplantation
what is leukemia? BM FAILURE: uncontrolled proliferation of immature & undifferentiated wbc which circulate and infiltrate blood forming organs
what's the difference of acute and chronic leukemia? acute is more immature, and chronic is mature
what is acute myelogenous CA caused by? a fast growing CA of the blood & BM characterized by uncontrolled proliferation of myeloblasts (precursors to granulocytes) which crowd out all normal cells (hyperplasia)
Acute lymphocytic leukemia is caused by what? a large # of lymphocytes, IMMATURE ones take over the bone marrow (CA) BM failure
what are the s/s of acute lymphocytic leukemia? bleeding, fever, and CNS manifestations
chronic myelogenous leukemia is caused by what? abmormal growth of myeloblasts (precursor to granulocytes)- caused by excessive MATURE neoplastic granulocytes in BM- more gradual
what is chronic lymphocytic leukemia caused by? uncontrolled spread of small lymphocytes- progresses more slowly
acute lymphoblastic occurs in what age group and what's a s/s children; CNS manifestations
chronic lymphocytic occurs in which age group adults
labs for acute leukemia differential reveals 1 type of leukocyte is predominant, immature blasts, abnormal leukocytes
what dx tools are used to determine acute leukemia? bone marrow aspiration (#1), lumbar puncture, ct scans & MRIs to locate lesions
what is the goal for acute leukemia prevent remission w/restoration of normal BM fx and prevent/tx anemia, bleeding & infx
3 phases of chemo for acute leukemia induction phase, consolidation therapy and maintenance therapy
what does the induction phase of chemo consist of? intensive to induce complete remission, pt may be critically ill d/t BM suppression, nursing interventions focus on neutropenia, thrombocytopenia, & anemia
what does the consolidation phase of chemo consist of? modified courses to eradicate any remaining dz
what does the maintenance therapy od chemo consist of? small doses of different combos given Q 3-4 weeks for 1 year
what are some nursing interventions for acute leukemia? flu shot, vaccines, PSYCHOLOGICAL SUPPORT THROUGH SUPPORT GROUPS
what is a lymphoma? a solid neoplasm enlargement that originates in the lymph nodes tumor
what is Hodgkin's dz? enlarged lymph nodes starting at the neck & spreading throughout the body. A distict cell called the REED-STERNBERG. When the cell is absent, it is NHL
what is hairy cell leukemia & what does it cause? b-lymphocyte proliferation causing splenomegaly (males)
what could cause Hodgkins? infectious component: epstein-barr, virus, organ transplant recipients, mononucleosis- JEWS
s/s of Hodgkins enlarged painless nodes (firm rubbery & moveable), pain at site w/alcohol, loss of appetite/wt, fever, lethargy, itching, painful lump in abdomen, cough
dx for Hodgkins LN/BM biopsy, chest x-ray, thoracic, abdominal & pelvic CT
tx for hodgkins starts w/classification & staging, radiation for early, 2 combo chemo
what is the 2 combo chemo for hodgkins? 1)MOPP 2)ABVD; given in 6 or more cycles w/baldness, n/vfatigue, myelosuppression & stomatitis (inflammed mouth) as s/e. Give antiemetics & pain meds
what is non-hodgkins lymphoma? malignant lymphoma: a group of malignancies which originate in the lymphoid cells- the cells become fixed & cont to proliferate (B & T cells proliferate in LN)- obstruction of the enlarged LN
s/s of NHL enlarged generalized/localized LN (lymphadenopathy); B SYMPTOMS: noc sweats, fever & wt loss, hepato/splenomegaly
labs/dx for NHL CBC, ESR, UA, peripheral smear, LN bx, x-ray, barium enema, ct/MRI
tx for intermediate NHL CHOP & radiation for tumor shrinkage
what do the lymph nodes feel like w/HD, NHD? firm, moveable, rubbery
what assessment is important w/lymphomas? phycosocial b/c dx of CA is devastating- effects retirement in older adults
what is an outcome for lymphoma? the dz will become a chronic condition the family can cope with in a posistive menner
NHL & HL nursing invertions prevent infx, low bacteria dt, wash hands, analgesics, BLEEDING PRECAUTIONS, avoid ASA, avoid catheters, limit injections, NO tampons, pressure reducing mattress
what causes multiple myeloma?
what causes multiple myeloma? neoplastic plasma cells (activated b-cells)infiltrate BM & prod excessive immunoglobulins & cytokines, normal plasma cells reduced, bone destroyed, lymph nodes, kidney, liver & spleen invaded
in multiple myeloma, CA cells involve plasma cells and the body does what? produces more and more of these cells
in multiple myeloma, un-needed plasma cells are abnormal, and exactly alike- what are they called? myeloma cells
what is a plasmacytoma? in multiple myeloma, the myeloma cells gather in the BM & outer hard parts of bone- forming a tumor
when myeloma cells collect in many bonrs it is called what? multiple myeloma
what are the s/s for mult. myeloma? BONE PAIN; osteoperosis,hypercalcemia from bone degredation, renal failure d/t high protein lvls, anemia, granulocytopenia, and thrombocytopenia d/t BM destruction
what are important nursing interventions for mult.myeloma? #1 adequate hydration & be gentle & assist pt to ambulate d/t frax & osteoperosis, corticosteroids to excrete Ca, braces, prompt infex tx
what is the tx for mult. myeloma? chemo, radiation, corticosteroids, marrow stem cell transplantation, ALLOPURINOL for hyperuricemia, LASIX to excrete Ca, CALCITONIN to tx hypercalcemia
what is Apherisis? removing a component of the blood & putting the rest back in- process is longer than a whole blood donation
what are other names for synthetic erythropoiten? epogen, procrit, EPO, erythropoiten human glycoform alpha, rHuEPO-alpha
what is oerioperative blood recovery? blood loss during surgery is returned to pt
In blood recovery, why is the time factor important? it takes about 3-5 minutes so as not to intrude upon the surgical process
What is done for blood storage? ABO testing & Rh type- testing for west nile virus
what's in whole blood? RBC which can be refrigerated for 42 days or frozen for 10 yrs. RBC carry O2 and are used to tx anemia
what are plts used for? used to contol bleeding: leukemia pts and other CA. can be stored for 5 days @ room temp
what is fresh frozen plasma used for? to control bleeding for those w/dec clotting factors. can be frozen for 1 year
what is cryoprecipitated antihemophylic factor? clotting factors made from fresh frozen plasma for those w/von willebrands dz or hemophilia. Can be stored for 1 year
Created by: arsho453