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exam 14
beat caval
| Question | Answer |
|---|---|
| define disseminated intravascular coagulation | acquired homorrhage syndrome of clotting, cascade overstimulation, and anti-clotting processes |
| what type of infection usually causes lymphangitis | streptococcal or staphylococcal infection in an exremity |
| define multiple myeloma | malignant neoplastic immunodeficiency disease of the bone marrow |
| reduction or absence of bone marrow results in | pancytopenia |
| define pernicious | capable of causing great injury or destruction; deadly fatal |
| a platelet count of fewer than 100,000/mm3 is | thrombocytopenia |
| disorder characterized by RBC and homglobin and hematocrit levels below normal range is known as | anemia |
| Transportation, regulation of pH, and protection vs infection is the job of | blood |
| what are ganulocytes? name and explain 3. | have a grainy appearance, neutrophils-inital responder to any invasion; basophils-inflammatory response; eosinophils- allergic responses |
| define monocyte, macrophage, and lymphocyte | monocytes-cirulate and work similaryly to neutrophils; macrophages-mature monocytes tha tlive in tissue; lymphocytes- t cells (kill invaders) B cells (produce antibodies) |
| where are WBC produced and matured | bone marrow / lymph tissue |
| absorption and transportation of lipids from the intestine to the bl stream is the function of which system | lymphatic |
| name four types of lymph tissue | lymph nodes, tonsils, spleen, thymus |
| what is the function of the tonsils | protect vs invasion, produce lymphocytes and antibodies, trap bacteria |
| which WBCs are matured in the spleen | lymphocytes, monocytes, and plasma cells (B cells) |
| Macrophages can be found in the spleen | yes, macrophages can be found in the spleen |
| what organ develops the immune system in utero and several months after birth | thymus |
| describe the Red Cell Indices | Measurements of the size and hemoglobin content of erythrocytes; mean corpuscular volume (MVC) size of RBC, mean corpuscular hemoglobin (MCH) wt, mean corpuscular hemoglobin concentration (MCHC)- concentration |
| describe the perpheral smear test | permits examination of the size, shape, and structure of individual RBCs, WBCs and platelets- most informative of all hematologic tests |
| describe the Schilling Test and Megaloblastic Anemia Profile | A test that identifies the etiology of pernicious anemia by measuring the excretion of Vit B12 after parenteral admin. to determine whether B12 intake is low, or B12 absorption is altered. normal findings are excretion of 8-40 within 24 hours |
| describe gastric analysis | evaluates presence of intrinsic factor and pernicious anemia (the gastric secretions are minial and the pH remains elevated, after injection of histamine |
| what disease processes is bone marrow aspiration most commonly performed | marked anemia, neutropenia, acute leukemia, and thrombocytopenia |
| Pt are fully awake for a lymphnode biopsy T/F | F-may receive conscious sedation of the procedure |
| What are the two factors the nurse should consider before lymphangiography | renal function and iodine sensitivity |
| How longe should activity be limited prior to a bone marrow aspiration | 30 min |
| reduction of RBCs, deficiency in hbg and hct, or an increased destruction of RBCs causes | anemia |
| what are clinical manifest of anemia | pallor, anorexia, fatigue, dyspnea, SOB, tachycardia, vertigo, late signs: cardiac dilation, disorientation, dizziness |
| What are some dx test for anemia | CBC, Iron, reticulocyte count, bone marrow bx, peripheral bl smears, vit b12 level |
| medical management of anemia includes | bone marrow transplant, avoid bl transfusions if possible, splenectomy, drug therapy, |
| how much bl can an adult lose without complications | 500mL |
| s&s of hypovolemic and hypoxemia include | weakness, stupor, irritability, signs of hypovolemic shock, poor peripheral pulses, hypotension c increased cap refill, tachycardia/pnea, hypothermia, decreased hbg and hct, |
| Lab results are an accurate indicator of bl loss and hypoxemia t/f | f- labs results may not be accurate indicaors until hours after injury |
| medical management for hypovolemic/hypoxemia anemia include, why | crystalloids- expand volume Spo2 > 92%- provide O2 |
| nrsg interventions for hypvolemic/hypoxemia anemia include | control bleeding, monitor bl and fl resoration -keep pt flat and warm, strick i&O prevent injury |
| what is pernicious anemia | autoimmune d/o resulting from the destrution of parietal cell and eventual gastric mucose atrophy |
| patho for pernicious anemia- | parietal cell damage causes decrease intrinsic factor production; without intrinsic factor vit b12 cannot be absorbed in the ileum |
| what is vit b12 used for and what happens in its absence | growth and maturation of all body cells- RBC membranes fragile and easy to rupture; nerve myelination- progressive demyelination and degeneration of nerves and white matter |
| clinical manifest. of pernicious anemia include | exteme weakness, hypoxia, slight jaundiced, edema of legs, constipation or diarrhea |
| pernicious anemia- subjetive | palpitations, parasthesia, soreness and burning of the tongue, nausea, dyspagia, flatulence and indigestion |
| pernicious anemia-objective | smooth and eryhematous tongue, infections of teeth and gums, partial or total paralysis, AMS |
| pernicious anemia- dx | megablastic anemia profile, bone marrow aspiration, gastric analysis, perpheral blood smear, schilings test |
| pernicious anemia- medical manage | vit b12, folic acid and fe supplements bl transfusion if anemia severe |
| pernicious anemia- nrsg Inter. | systematic approach, keep pt warm, oral care, high protein, vitamin, and mineral diet, frequent rest periods |
| Aplastic anemia etio/pathophysiology | failure of the norm. process of generation and growth. hematopoietic tissue replaced by fatty tissue causing the pression of RBC production, pancyopenic |
| Aplastic anemia can be caused by | viral infections, medications, radiation, chemotherapy, chemicals |
| Aplastic anemia- clinical manifest. | repeated infections c high fever, weakness fatigue, malaise, dyspnea, palpitations, paralytic ileum, petechiae, ecchymoses |
| Aplastic anemia- subj/obj | hx of chemical exposure fatigue with ADLs / pallor, SOI, bl, dyspnea, |
| Aplastic anemia bone marrow bx dx test may reveal what | dry tap, decreased celluar elements and hematopoietic activity |
| Aplastic anemia- Nrsg Inter. | *monitor/prevent infections, netropenic precaustion, aseptic technique |
| why are bl transfusions avoided inpt with aplastic anemia | prevention of iron overloading; abx development for transplant candidates; platelet transfusion (HumanLuekocyteAntigen typed) |
| Fe deficiency anemia def. and path. | excessive fe loss, chronic bleeding of GI or GU tract. malabsorption of fe caused by celiac and sprue (glutin), subtaotal gastrectomy, diet |
| Fe deficiency anemia- clinical manifest | *pallor-most common, glossitis, s&s typical to angina and HF |
| Fe deficiency anemia sub/obj | pagophagia / finger nail fragility with spoon shape and raised border, stomatitis, kips are erythemic c cracking at the angles |
| Fe deficiency anemia- dx | CBC, Serum fe |
| Fe deficiency anemia- medical mangae | ferrous sulfate vit c fe rich food |
| Fe deficiency anemia- nrsg process | nutrition, imbalanced; less than body requirements, r/t glossitis: admin meds to stimulate bone marrow encourage high vit, fe, protein diet |
| foods high in fe | organ meats, muscle meats (dark meat from poultry), eggs shellfish whole-grains, breads, cereal dark green veges, dried frutis, legumes and nuts |
| what foods are high in folic acid | green leafy veges, asparagus, broccoli, liver, fish, legumes, whole-grain breads and cereals |
| what foods are high in vb12 | liver, kidney, muscle meats, milk cheese, eggs |
| what foods are high in vitc | strawberries, cantaloupewhat |
| what is the most common clinical manifest of fe deficiency anemia | pallor |
| sickle cell anemia is precipitated by | *infection, dehydration, weather changes (cold) |
| sickle cell anemia- clinical manifest. | abd enlargement, jaundice, joint and back pain, edema of extremities, multisystem failure, infarctions, hemorrhage and retinal damage causing blindness |
| sickle cell anemia- medical mangage | supportive care, rest, |
| sickle cell anemia- nrsg inter. | F and E, pain control avoid triggers regular exercise |
| sickle cell anemia- nrsg process pain, r/t thrombotic crisis | maintain adequate vl status, body in proper alignment, protecting joints warm soaks or compresses analgesics |
| what are the two priorities in tx pt with sickle cell crisis | fl management and pain control |
| discuss the two types of polycythemia | polycythemia vera- myeloproliferative d/o causing increased circulating RBC; stem cell abnorm, elecated WBC c basophilia 2nd polycythemia is caused by hypoxia-high altitudes, pulmonary disease, CVD |
| polycythemia- Hypervoemia and hyperviscosity may cause | infarctions of vital organs, clots |
| polycythemia- clinical manifest | venous distention an dplatelet dysfunction cause esophageal varices, epistaxis, GI bleeding, and petechiae, satiety d/t hepato/splenomegaly |
| polycythemia- subj/obj | sensitivity to hot and cold, prurtus, headaches, vertigo, tinnitus and blurred vision / eczema and dermatological changes, htn c ventricular hypertrophy and angina |
| polycythemia- dx | BMR increased without thyroid function alteration |
| polycythemia- medical manage | phlebotomy to maintain hct between 45 and 48% |
| what is the major cmplication of polycythemia vera | thrombosis d/t abnormal increased number of circulating RBCs and platelets |
| low wbc, bone marrow suppression, fatlity may result from severe bacterial infecions | agranulocytosis |
| agranulocytosis- common causes | cancer, cancer tx, viral and bacterial infections, heredity, toxicity |
| agranulocytosis- clinical manifest | fever, fatigue, ulcerations of the mucous membrans, bronchial pneumonia and UTI |
| agranulocytosis- subj/obj | fever and exteme fatigue / 100.6, redness and pain from ulcerations, crackles and rhonchi due to exudates, complete medical hx |
| agranulocytosis- dx | WBC w/diff, BM bx, CNS of ulcers |
| agranulocytosis-med manage | alleviate bone marrow depression and tx infections neutropenic precautions, transfusions as needed |
| agranulocytosis- nrsg interv. | high protein/cal diet, avoid crowds 3-4L water a day. |
| discuss Leukemia | white bl replaces bone marrow and concentrate in immature forms, cells infiltrate lymph nodes, spleen and liver, |
| Leukemia- clinical manifest | thrombocytopenia, enlarged lymph nodes and painless splenomegaly, URI, UTI |
| Leukemia- dx | CT/Lumbar puncture, peripheral smear, chest radograph, lymp node biopsy, CBC |
| Leukemia- subj/obj | pain in bones or joints, fatigue, bleeding abnormalities / infection, petechiae, ecchymoses, |
| Leukemia- med manage | remission or control |
| what are the drugs used to tx Leukemia | chlorambuciil, hydroxyurea, corticosteroids |
| Leukemia- nrg interventions prevent infection prevention of hemorrhage pain control | neutropenic precaustions protect from trauma meds and non-medical |
| plasma cells proliferate, destroy bone by crowding bone marrow | multiple myeloma |
| multiple myeloma- clincal manifest | bone pain increasing c movement, hypercalcemia c potential renal problems, bence jones protein |
| multiple myeloma- dx | blood urine-monoclonal protein is marker, protein electrophoresis- bence jones protein |
| multiple myeloma- nrsg process ROI | ROI, high protien, cal, vitamin diet |
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