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immunology and hematology
| Question | Answer |
|---|---|
| A platelet count less than 100,000/ml is called what? | thrombocytopenia |
| thrombocytopenia can cause this? | abnormal bleeding |
| Petechiae and purpura are caused by this? | small vessel bleeding caused by thrombocytopenia |
| Fatal bleeding can be caused by thrombocytopenia if the level is less than? | 10,000/ml |
| Nursing diagnosis for thrombocytopenia? | ineffective protection, risk for bleeding, impaired oral mucous membranes |
| Tissue hypoxia is a problem with which disorder? | anemia |
| The RN will notice pallor of the skin, mucous membranes and nail beds with this disorder? | anemia |
| Heart rate and respiratory rate rise to compensate for cardiac output and tissue oxygenation in this disorder? | anemia |
| Angina, fatigue, dyspnea on exertion and night cramps are common symptoms of this disorder? | anemia |
| Cerebral hypoxia can cause these symptoms? | dizziness, headache and dim vision |
| Rapid blood loss associated with anemia can cause? | Increased heart rate, respiratory rate and decreased blood pressure |
| Nursing diagnosis of anemia include? | activity intolerance, impaired oral mucous membranes, risk for decreased cardiac output and self-care deficit |
| A decrease in total circulating WBC's is linked to what disorders? | neutropenia and leukopenia |
| Clients with neutropenia and leukopenia are at risk for this? | increased infections |
| Clients with neutropenia and leukopenia may be placed in this? | isolation |
| The patient has a risk for infection diagnosis what are the nursing interventions? | promptly report any signs of infection, institute infection protection methods, monitor vitals every 4 hours, monitor neutrophil levels and explain that isolation and other interventions are only temporary |
| What type of infections develop with nuetropenia and leukopenia? | opportunistic, bacterial, fungal and protozoan |
| Infections that are associated with neutropenia and leukopenia are associated with these body systems? | respiratory tract, mucous membranes of the mouth, GI tract and vagina |
| Malaise, chills and fever are common signs and symptoms of this disorder | neutropenia and leukopenia |
| Extreme weakness and fatigue are manifestations of this disorder? | neutropenia and leukopenia |
| Infections associated with disorders are treated with what? | antibiotics |
| If chemotherapy is causing neutropenia, what will happen? | chemo is temporarily stopped |
| the primary concern with a patient with immunodeficiency is what? | infection |
| have resuscitation equipment available while doing skin allergy testing in case of what? | allergy may induce an anaphylactic reaction |
| For a client with an autoimmune disease such as SLE what lab tests would you want to monitor? | BUN & creatinine for renal impairment |
| Monitor chemotherapy clients WBC closely for what? | risk for neutropenia |
| what does a shift to the left represent? | an increased number of immature neutrophils in the blood |
| infection is a major cause of death in which patients? | immunosuppressed |
| What can cause an older adult to develop autoimmune disorders? | the aging process |
| What is desensitization? | a weekly process of introducing increasing amounts of known allergy subdermally |
| Immunity develops when the body recognized foreign bodies as what? | non-self |
| Which condition is caused by a type 1 IgE hypersensitivity reaction? | anaphylaxis |
| A patient is taking Retrovir, what adverse reaction should she be aware of? | leukopenia |
| The order of administering antigens in allergy testing is based on the prevention of anaphylaxis, which method would the RN use first? | prick test because the smallest amount of allergen enters the blood stream |
| A hypersensitivity response is suspected when a blood product is infusing, what priority intervention would the nurse perform? | replace all tubing and attach a new line with NS |
| What is natural active immunity? | Acquired by infection with an antigen, resulting in the production of antibodies, example chickenpox and hepatitis A |
| What is artificial active immunity? | acquired by immunization with an antigen,such as a live virus, examples are MMR, polio, DTP and Hep B |
| What is natural passive immunity? | Acquired by transfer of maternal antibodies by the placenta or breast milk |
| What is artificial passive immunity? | acquired by admission of antibodies or antitoxins in immune globulin, example gamma globulin injection following hep a exposure |
| How long should the RN observe the patient following a vaccine? | 20-30 minutes to observe for possible adverse reactions |
| What are the 5 factors that may impair healing? | malnutrition, vitamin deficits, tissue hypoxia, impaired blood supply, impaired inflammatory and immune processes |
| When a patient receives gamma globulin following hep a the RN can expect the patient to develop which type of immunity? | acquired passive immunity |
| What is the priority RN intervention in a patient with an infection? | obtain a specimen for culture and sensitivity |
| When administering medications, the RN would know that which medication inhibits prostaglandin synthesis? | aspirin |
| Thalassemia affects which cultures? | Mediterraean, Asians & African Americans |
| Thalassemia causes what to happen to the hemoglobin? | decrease |
| Thalassemia causes what organ to work harder? | the spleen |
| Thalassemia has systemic effects including what? | increased RBC destruction, fractures (bone marrow is thinner) and organ failure due to hemolysis and accumulation of iron |
| A patient with neutropenia is not to have what brought into their room? | fresh flowers or fruit |
| Remember that the suffix -cidial means what? | to kill |
| Titers are done how? | diluted to see how many times it can dilute before no response |
| What can cause changes in the immune system? | steroids, immunosuppressants, chemo drugs, polutants, stress, aging process and health status |
| A patient with an immune disorder will present with what symptoms? | enlarged lymphnodes, joint pain and general appearance of weakness |
| Allergic rhinitis and hay fever are mediated by what? | IGe |
| What are the signs and symptoms of an anaphylaxic shock? | itching in palms and scalp, vasodilation, decreased BP, shock, smooth muscle contraction, closing of the bronchis, swelling larynx, fluid loss from capillary permeability |
| anaphylaxis is which type of hypersensitivity | Type 1 |
| Type 2 hypersensitivity is know as what? | cytotoxic (hemolytic reactions during blood transfusions) |
| Type 3 hypersensitivity is known as what? | Immune complex |
| Immune complex causes what signs and symptoms | systemic response, fever, rash, joint and muscle aches, swelling lymphnodes |
| A type 3 hypersensitivity can occur from what? | penicillin, animal based drugs & vaccines |
| Type 4 hypersensitivity is called what? | Delayed |
| What is an example of a type 4 delayed hypersensitivity? | latex allergy |
| What is avoidance therapy? | staying away from the causative allergy |
| What does an antihistamine do? | decreases secretions and vasoconstriction |
| What do decongestants do? | vasoconstriction and reduces edema |
| What do steroids do? | reduce inflammation |
| Mast cell stabilizers do what? | prevent but do not treat hypersensitivity |
| Leukotrines work against what? | inflammation |
| Desensitization does what? | dilutes, process known as titers |
| To identify allergies what labs will be ordered? | WBC with differential, will show increased esinophils in patients with type 1 |
| The RAST test will show what? | increased IgE in specific allergens |
| Blood type and cross match are ordered before what? | any blood transfusion |
| Immune complex assays are ordered for which type of hypersensitivity? | Type 3 |
| Complement assay is useful in which disorder? | Immune complex |
| What is hyperplasia? | increase in the number or density of normal cells |
| hyperplasia occurs in response to what? | stress, increased metabolic demands or elevated levels of hormones |
| hyperplasia cells are under normal or loss of DNA control | normal |
| Metaplasia is what? | cells going into areas where they don't belong |
| metaplasia is under normal DNA or loss of DNA control | normal |
| dysplasia represents what? | loss of DNA control |
| metaplasia is a protective response to what? | adverse conditions |
| dysplastic cells show a differentiation in what? | size, shape, appearance and a disturbance in normal arrangement |
| What is anaplasia? | loss of a cell into an immature or undifferentiated cell type |
| anaplasia is loss of dna control or normal | loss |
| What are describers of malignant neoplasms? | no borders, rapid growers, invasive and non-cohesive |
| What are some consequences of cancer? | GI tract obstruction, increased metabolic rate, altered taste and smell and anorexia |
| Cancer can cause these symptoms? | stress, bleeding, depression, lowered bone marrow and leukocytes and impaired immune system |
| Cancer also causes motor sensory deficits as evidenced by? | compression of nerves, impaired cognitive function and bone fractures |
| Hormonal manipulation in cancer therapy does what? | controls but does not cure cancer, it mimics the hormone causing problems |
| hormonal manipulation is used to stop what? | growth |
| When a patient is under chemo they may develop mucositis and skin changes, what are the RN interventions? | assess oral cavity q4hr, soft bristle tooth brush, no alcohol mouth wash, normal saline rinse before and after meals |
| Xerostomia is what? | excessive dryness of mucous membranes |
| Chemotherapy can cause many concerns for the patient, what are some of the RN diagnoses? | anxiety, disturbed body image, anticipatory grieving, risk for infection and injury, imbalanced body nutrition:less than required, impaired tissue integrity |
| To prevent cancer patients can? | avoid carcinogens, high fat diet and know the 7 warning signs of cancer |
| What are the 7 warning signs of cancer | unusual bleeding/discharge, a sore that does not heal, change in bowel or bladder habits, lump in breast or other part of body, nagging cough, obvious change in moles, difficulty swallowing |
| What is the ABCD rule in regards to moles | asymmetry, border, color and diameter |
| What is the life span of a RBC? | 120 days |
| what are some age related changes? | CRT increases, hair thinner, hairless legs, increased risk for infection, lower protein equals lower fibrogen, dizziness and orthostatic troubles |
| What is the normal hemoglobin value for women? | 12-16 g/dL |
| What is the normal hemoglobin for men? | 13.8-18 g/dL |
| What is the normal hematocrit for women? | 38-47% |
| what is the normal hematocrit level for men? | 40-54% |
| What is a normal WBC level? | 4,000-11,000 |
| what is a normal platelet count? | 150,000-400,000 |
| an IV bolus would do what to the hematocrit concentration? | decrease it |
| a patient with a fluid volume deficit would have what effect on hematocrit? | increased value |
| Neutrophils do what? | active phagocytes they are the 1st to respond to site of injury |
| what indicates a shift to the left | immature (bands) of neutrophils |
| Eosinophils are found where? | mucosa of intestines and lungs, their numbers increase during allergic reactions and parasitic infections |
| Neutrophil numbers increase during what? | inflammation |
| Basophils contain what? | histamine, heparin and other inflammatory mediators |
| Basophils increase when? | during allergic and inflammation |
| Which anemia causes CNS manifestations? | vitamin b 12 deficiency |
| which is the most common anemia | iron deficiency |
| without iron the body can not make what | hemoglobin |
| what should a patient take with iron replacement drugs | vitamin c |
| aplastic anemia can lead to what | pancytopenia |
| polycythemia is a RBC concentration greater than what number? | 55% |
| When draining blood for polycythemia how much should the RN drain? | 300-500mL |
| A patient with an acute infection shows a shift to the left on WBC, what does this indicate? | increased band neutrophils |
| A patient admitted with MRSA should be under which isolation? | contact precautions |
| The T cells of the immune system adapt to kill which type of cell? | intracellular organisms |
| How would the RN describe thrombocytosis? | increased platelets |
| An RN is making the diagnosis of risk for infection, who is she making that for? | the infected patient, health care workers and other patients |
| what does the RN primarily monitor when giving antibiotics? | hypersensitivities and teaching |
| The 7 warning signs of cancer spell what to help us remember? | CAUTION |
| A patient with colon cancer has cells from the colon travel to his liver, what is this process called? | metastasis |
| A patient is receiving external radiation, what would the RN teach the patient? | do not rub the area, do not use lotions, creams, do not wear tight clothing or belts and stay away from the sun and extreme cold or hot |
| A patient experiences bone marrow depression as a result of chemotherapy, what would the RN expect to see? | low platelet count |
| tumor lysis syndrome can cause high levels of uric acid, what would the RN give the patient? | allopurinol |
| What is a characteristic of oncogenes? | they promote cell growth when activated |
| What are sources of iron? | meat, eggs, dried fruits, greens, oatmeal, bran, brown rice, dried beans |
| what are sources of folic acid? | green veggies, liver, milk, yeast, eggs, kidney beans and wheat |
| what are sources of vitamin b 12 | liver, kidney, shrimp, meats, eggs, cheese, milk |
| what should you dose prior to chemotherapy | antiemetics to prevent N/V |
| avoid invasive procedures to prevent bleeding related to what disorder? | thrombocytopenia |
| in assessing a patient with moderate anemia, what would the RN expect to see? | complaints of SOB with exercise |
| nutritional deficiency anemia related to absorption would include which of the following? | numbness and tingling of extremities |
| which RN diagnosis is priority for bone marrow patient? | ineffective protection, risk for infection |
| the RN observes a newly admitted patient with reddish purple spots and bruising, what lab test does this support? | a low platelet count, increasing the risk of bleeding and bruising |
| Assess the cancer patients pain, it is what they say it is, which means? | never undermedicate the cancer patient |
| After a transplant the patient has no what? | natural immunity |
| Infection is a major cause of death in which immune type patients? | immunosuppressed |
| a client with a latex allergy needs to be questioned for which food allergy | bananas |
| a schilling test is done to determine the clients ability to do what with vitamin b 12 | Absorb it |
| Epogen injections cause the stimulation of RBC therefore causing what to rise? | hematocrit |
| Vitamin B 12 is non toxic because it is water or fat soluble? | water |
| A client with aplastic anemia should be monitored for what? | bleeding and bruising |
| Children with iron deficient anemia are more prone to infection because of what? | decreases in bone marrow functioning |
| what is the normal WBC level? | 4,000-11,000 |
| what is the normal platelet level | 150,000-400,000 |
| what is a womans normal hemoglobin level? | 12-16 |
| what is a man's normal hemoglobin level | 13.5-18 |
| what is a normal level for hematocrit in woman? | 38-47% |
| what is a normal hematocrit level in men? | 40-54% |
| what triggers the development of red blood cells? | hypoxia |
| What is the type of anemia where the red cells are destroyed due to a toxin or virus? | aplastic anemia |
| Manifestations of this body system are seen in B12 anemia but not folic acid anemia? | neurologic |
| What is any protein that is non-self? | antigen |
| A way of expressing the concentration of an antibody in the blood | titer |
| medication to constrice blood vessels in allergic reaction | epinepherine |
| These WBC's are elevated with an allergic reaction | eosinophils |
| These WBC's cause obvious signs of inflammation | basophils |
| These WBC's are elevated with bacterial infection | neutrophils |
| What can be characterized by a hemoglobin greater than 18 and a hematocrit greater than 55 | polycythemia |
| What is one of the cardiovascular manifestations of anemia? | tachycardia |
| what is a medication that lowers inflammatory response | steroid |
| What is a medication used to prevent vasodilation and capillary leak? | antihistamine |
| Fatigue is a nursing diagnosis common with which two disorders? | cancer and anemia |
| Growth of cells not needed for normal development or replacement is called what? | neoplasia |
| Patients with thrombocytopenia are at a risk for what? | bleeding |
| what are treatment options for thrombocytopenia? | platelets transfusion, plasmapheresis, immunosuppressive drugs and steroids, splenectomy if necessary |
| what is pancytopenia? | reduced WBC's, RBC's and platelets |
| The spleen is the site of what? | platelet distruction and antibody production |
| Polycythemia is more common in this male culture? | jewish |
| Polycythemia usually results as hypoxia due to these factors? | smoking, high altitudes and heart disease |
| with polycythemia the blood is thick also called what? | viscous |
| What are the steps in an anaphylasic reaction? | assess airway, call rapid response team, administer o2, start iv and infuse ns, administer benadryl or epinephrine finally document |
| In which anemia will you see PICA, smooth sore tongue, brittle nails and cheilosis? | iron deficiency |
| alcohol, drugs and pregnancy can all be caustic with which anemia | folic acid |
| vitamin b12 deficiency is also known as? | pernicious anemia |
| what diagnostic tests will you do with b12 deficiency? | schilling test, rhomburg test and CBC |
| In a patient with vitamin b12 anemia you can expect to see what? | red tongue, tingles, and proprioception (balance issues) |
| what are the signs of polycythemia? | chronic hypoxia, hypertension, tinnitus, blurred vision, plethora (darkening of lips, feet, ears and fingernails, enlarged spleen, weight loss and night sweats |
Created by:
bkgrota
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