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Hematology Problems
BC3 - Hematology Problems
| Question | Answer |
|---|---|
| What 3 ways can a body have anemia | Decreased production of RBC's; Blood Loss; Increased RBC destruction |
| Anemia r/t decreased production of RBC's | Decreased hemoglobin synthesis - bone marrow is not producing enough Defective DNA synthesis - congenital (ex: Sicle cell & thalesemia) |
| Anemia r/t blood loss | Acute (ex: car wreck) Chronic (ex: GI Bleeds in elderly; menstruating women) |
| Anemia r/t increased RBC destruction | (the body destroys) Intrinsic - congenital (ex: sicle cell - genetic) Extrinsic - chemotherapy - meds - radiation |
| Physiologic Effects of Anemia | Result from tissue hypoxia and compensatory mech - (^HR); Dec O2-casrrying capacity of blood; Hgb give up O2 easier to tissues; Blood goes to vital organs first; Inc cardiac output ^HR, ^BP; Inc rate of RBC production |
| Hbg Level of Mild Anemia | 10-14 |
| S/S of mild anemia | Palpitations, dyspnes, diaphoresis |
| Hgb Level of Moderate Anemia | 6-10 |
| S/S of Moderate Anemia | Inc. Cardiopulmonary s/s - chest pain; Pallor, Jaundice, Pruritis, Changes in fingernails - spoon-shaped, pale nail beds |
| Cardiopulmonary changes r/t anemia | Tachycardia, Tachypnea, dyspnea |
| Cardiopulmonary changes r/t anemia with prolonged chronic anemia | Murmurs, bruit in carotid, Angina, MI, CHF |
| Neurologic Changes r/t anemia | HA because of lack of O2, Vertigo, Mood changes, Impaired through process |
| GI Changes r/t anemia | Anorexia, Hepatomegaly, Splenomegaly |
| Musculosketal Changes r/t anemia | Bone pain because bone marrow is stimulated and is making more RBC |
| General s/s of anemia | Fatigue, weight loss, lethargy, sensitivity to cold |
| Etiology of Iron Deficiency Anemia | Inadequate dietary intake Malabsorption Blood loss & not replacing it; Over time - GI bleed Hemolysis - breaking down cells too quickly |
| Nutrients needed for erythropoiesis | Iron, Vitamin B 12 - cobalamin, Folic Acid, Proteins, Enzymes, Minerals - Fe & Calcium |
| Nursing Implications of Iron Preps | Absorbed best in acidic environment, Cause GI Upset, Liq preps stain teeth, Constipation, Black, Tarry stools; IV preferred(irritating) but can be given Z-track) |
| Most important nursing diagnosis r/t anemia | Risk for Injury!! |
| Thalassemia | patient's make defective protein; cells are being broken down (^jaundice); Mediterranean ethnic groups |
| Thalassemia Minor | Recessive trait - little bit |
| Thalassemia Major | Poor Prognosis |
| Aplastic Anemia | Rare stem cell disorder; do not produce WBC, RBC or Platelets; Can be congenital or acquired |
| S/S of Aplastic Anemia | S/S of anemia, Bleeding, Infection |
| Etiology of Acquired Aplastic Anemia | Radiation, Chemicals, Drugs, Chemo drugs, Infection, Pregnancy, Idiopathic |
| Dx of Aplastic Anemia | A bone marrow that is called a "dry tap" |
| Tx of Aplastic Anemia | Bone marrow transplantation/ immunosuppressant drugs |
| Anemia Caused by Blood loss can be both | acute & chronic |
| Acute blood loss r/t anemia can cause | Hypovolemic shock (see dramatic symptoms); decreased O2 carrying capacity (ex: car accident) |
| Anemia caused by chronic blood loss | depletion of iron stores - body compensates (ex: GI bleed, heavy periods) |
| Def of Hemolytic Anemia | anemia caused by increased erythrocyte destruction |
| Etiology of Hemolytic Anemia | (NOT Fe Deficiency) Premature destruction of RBC Increased hematopoeisis Increased reticulocytes Normochromic, normocytic RBC's |
| Causes of Hemolytic Anemia can be | intrinsic and extrinsic |
| Causes of Intrinsic Hemolytic Anemia | RBC membrane defects, Hgb structure defect, Inherited enzyme defects |
| Causes of Extrinsic Hemolytic Anemia | Drugs, chemicals, toxins, trauma, burns |
| Definition of Sickle Cell Anemia | Homozygous recessive heredity - have to have 2 parents carry trait; African American |
| Pathophysiology of Sickle Cell Anemia | Decreased O2 tension, have abnormal Hgb, RBC's enlongated and obstruct capillaries - get stuck - occludes circulation; Ischemia and infarction |
| Manifestations of Sickle Cell | Classic s/s of anemia, Damage to organs - heart, lungs, kidneys, Priapism, Hand-foot syndrome, Susceptible to infection |
| Priapism | penile erection that won't go away - painful |
| Dactylitis | effect on hands/feet - malformed |
| Manifestations of Sickle Cell in Children | Small, short, thin, Delayed growth & development, Acute splenic sequestration, Dactylitis |
| Acute splenic sequestration | Blood gets trapped in spleen - spleen enlarges - goes into shock and can die in 30 minutes (under age 2) |
| Sickle Cell patient's can develop | blindness, Stroke, chest/abd pain, painful joints, freq. pneumonia, enlarged hearet, fever |
| Triggers of a Sickle Cell Crisis | Hypoxia, Dehydration, Infection, Overexertion, Anesthesia, Weather changes, Alcohol, Smoking |
| Tx of Sickle Cell Crisis | HOP - Hydration, Oxygenation, Pain Relief |
| Manifestations of a Sickle Cell Crisis | INTENSE PAIN, fever, Tissue hypoxia - - tissue pain & death |
| Dx of Sickle Cell Anemia | Peripheral smeal, Sickle cell preparation, Hemoglobin electrophoresis |
| Care for Patient with Sickle Cell Anemia | Rest, Analgesia, Oxygen, Hydration, Treat precipating factors, Hydroxyures, Transfusion tx if Hgb dec., Therapeutic apheresis |
| General management of Sickle Cell Anemia | Vaccination against everything, Hydration, Trigger avoidance, Prophylactic antibiotics, Bone marrow transplant, Client education, Good nutrition |
| Polycythemia means | many cells - affects all cells |
| Patho of Polycythemia | Myeloproliferative disorder - bone marrow; Increased production of cells, Increased blood viscosity & volume, Congestion of organs/tissue; splenomegaly |
| S/S of Polycythemia Vera | Hypertension, HA, Tinnitus, Blurred vision, Cyanosis, Plethora, Fatigue, Pruritus, Pain in extremities, Night sweats, Wt. Loss, Epistaxis, GI bleeding, Dizziness |
| Complications of Polycythemia | CHF, CVA, Thrombophlebitis, Hemorrhage, Hyperuricemia |
| Dx tests for Polycythemia | ^ H/H, ^WBC, basophilia, ^platelets & platelet dysfunction, ^alkaline phos, uric acid, cobalamin, ^ histamine |
| Care for a patient with Polycythemia | Phlebotomy - bleed them, Hydration, Bone marrow suppressant drugs, anti-immune drugs, Allopurinol, anti-platelets |
| Nursing care for a patient with Polycythemia | Control of COPD, Phlebotomy, Fluid management, safe medication mgmt, Prevention of thrombus formation |
| Primary Polycythemia affects | all cells |
| Secondary Polycythemia affects | RBC's only - NO itching, NO bleeding, Elevated Hct |
| Secondary Polycythemia occurs from | COPD because the lack of O2 causes increaased RBC production |
Created by:
okrecota
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