Question | Answer |
CBC consists of/identifies: | total # blood cells
hemoglobin/hematocrit %
RBC indices (shape/size) |
bone marrow aspiration/biopsy | assess formation of blood cells, quantity/quality of each type. Used to confirm marrow infection/tumor. |
bone marrow aspiration/biopsy hazards | bleeding- apply pressure
infection- aseptic technique
acetaminophen/Tylenol for pain
avoid NSAID's (risk of bleeding) |
ANEMIA | < normal hemoglobin/RBC's =
< normal oxygen delivery |
types of anemia | Hypoproliferation=
defective RBC production)
Bleeding = RBC loss
Hemolytic = RBC destruction |
complications (s/s) of
severe anemia: | heart failure
paresthesias
delirium/confusion
(angina if heart disease) |
treatment of anemia | correcting / controlling cause
if severe:
packed red blood cell (PRBC) transfusion |
pica | craving of ice, starch, or dirt
found in those with iron deficient anemia |
subjective s/s anemia
objective s/s anemia | S: weakness, fatigue, malaise, palor, pica
O: jaundice, palor, tongue = red/sore (smooth), angular cheilosis, brittle rigid nails |
possible RN Dx @ anemia | fatigue r/t < Hgb & < O2 carrying of blood
altered nutrition < body required
altered tissue perfusion r/t < Hgb/Hct |
RN anemia interventions | -manage fatigue
-adequate diet (iron,B12,Folic Acid,protein)
-FVD = IV fluids and/or transfusion |
most common anemia= | iron deficient anemia
cause should be thought BLEEDING
until proven otherwise |
anemia labs
(iron deficiency) | -low serum Fe = low Hbg
-MCV decreases
-Low Hct / RBC related to Hgb
-elevated TIBC |
Iron IV/IM | -parenteral test dose (anaphylaxis)
-staining / Z-track |
oral iron supplements | -best empty stomach, with orange juice (Vit C)
-w. food ok, if GI upset
-avoid dairy and antacids
(1h a.c. / 2h p.c.)
-liquid stains teeth =
use straw & rinse mouth |
foods high in iron | organ meats, meats, beans, leafy greens, raisins, molasses |
foods high in Vit C | citrus juices, orange, strawberry, tomato, broccoli |
manage constipation w/ iron supplements by... | -stool softeners
-high fiber diets |
end stage renal / hemodialysis
anemia.. | -monitor for folate and iron deficiency
-maintain Hgb 11-12g/dL
DO NOT EXCEED 13
-CK Hgb FREQUENTLY |
APLASTIC ANEMIA | (rare)decreased-damaged marrow stem cells.
-marrow aplasia
-neutorpenia / thrombocytopenia also occur |
s/s aplastic anemia | -complications of marrow failure
-infections / anemia
-purpura
-retinal hemorrhages common |
treatment of aplastic anemia | -bone marrow transplant (BMT)
-periph. blood stem cell Xplant (PBSCT)
-immunosuppresive therapy |
MEGALOBLASTIC anemia | anemia caused by Vit B12 or folic acid deficiency |
Folate / Folic Acid foods | liver
green veggies |
megaloblastic (folate) anemia more common in .. | alcoholism
poor diet (few/no veggies)
pregnancy
hemolytic anemias
GI malabsorptive diseases |
megaloblastic (B12) anemia more common in .. | strict vegetarians (no meat/dairy)
Crohn's disease
Pernicious anemia
gastric cancers |
schilling test | used to determine B12 vs. Folate deficient megaloblastic anemia.
oral B12, raidoactive B12, intrinsic factor admin, then urinalysis. |
intrinsic factor antibody test | used to confirm / rule out pernicious anemia along side other tests |
hemolytic anemia | rbc shortened lifespan =
<RBC, hypoxia |
hemolytic anemia labs | elevated reticulocytes
increased indirect bilirubin
less haptoglobin
more hemoglobin |
Hemolytic & Cycle Cell anemias treatment | mainly transfusions |
transfusion complications include: | iron overload, poor venous access, infections, alloimmunization, increased blood viscosity |
Sickle Cell management includes | -daily folic acid
-strict infection monitoring
-pneumococcal & flue vaccines
-careful hydration
-pain management (ASA, NSAID, morphine PCA) |
thalassemia
2 types
alpha / beta | hereditary anemias
associated with defective synthesis of hemaglobin..more often mediterranean, african, asian |
glucose-6-phosphate dehydrogenase deficiency
G6PD deficiency | inherited enzyme deficiency
african american, greek, italian, mediterranean, asian, jewish, more MEN. |
G6PD deficiency events caused by... | fever, specific meds, fava beans |
immune hemolytic anemia caused by.. | antibodies, results in
hemolytic transfusion reaction |
most hemolytic amemias are which type? | WARM |
immune hemolytic anemia manifestations | mild - life threatening
fatigue / dizziness
splenomegally
hepatomegally
lymphadenopathy / jaundice |
immune hemolytic anemia mgt | -stop offending Rx
-high doses corticosteroid
-blood Xfusions possible
-splenectomy possible (=lifelong risk for infection, need flu/pneu vaccines
-immunosuppressive agents |
hereditary hemochromatosis | excess iron absorbed from GI
> 1-2mg daily
excess iron deposited into various organs which become dysfxnal |
leukopenia | < normal lymphocytes / neutrophils |
Neutropenia | < 2000/mm squared neutrophil count
increased risk for bacterial infection exogenous & opportunistic |
ANC readings & risk for infection.. | significant if <1000
high if < 500
almost certain if <100 |
patient with neutropenia often do not present signs of ___. Therefore... | patient with neutropenia often do not present signs of INFECTION. Therefore, FEVER, may not occur
(especially if corticosteroids) |
thrombocytopenia risk for infection values | not significant until
<20,000
or if invasive procedure
<50,000
(Plt) |
Acute Myeloid Leukemia (AML) | most common non-lymphocytic leukemia |
most common complications and/or causes of death in AML-acute myeloid leukemia | major hemorrhages (thrombocytopenic)
and infections (neutropenic) |
RN DX related to Leukemia | risk for: infection,bleeding,impaired skin integrity, imbalanced nutrition, mobility, fatigue, acute pain, EFV / FVD, diarrhea, impaired mucus membranes, etc |
RN interventions for Leukemia | prevent/mgt infections-bleeding
mgt mucositis
improve nutrition
ease pain
decrease fatigue
maintain fluid-electrolytes
improve self care
mgt anxiety/grief
spiritual well being
promote self/home/community care |
MYELOMA | -2nd most common hematologic cancer
-back or rib pain
-elevated total protein levels
-hypercalcemia
-dehydration, thirst, constipation, confusion, (coma) |
primary thrombocythemia
essential thrombocthemia | -bone marrow/stem cell disorder
-increased platelet production
- >600,000/mm(cubed)
(normal 150-450 X 10(cubed)) |
thrombocythemia s/s | -painful burning, warmth, redness in localized distal area of extremity
-hemorrhage / occlusion
-DVT / pulmonary embolism
-headacheds, diplopia |
secondary thrombocytosis | increased number of platelets
can be caused by many other Dx:
infections, chronic inflammation, iron deficiency, cancers, hemorrhage, splenectomy |
thrombocytopenia | decreased platelet counts
normal = ? |
causes of thrombocytopenia | < production (LEUKEMIA..)
> destruction (LUPUS/LYMPHOMA..)
> consumption (DIC) |
treatment of 2ndary thrombocytopenia | platelet transfusion
thrombocytopenia bleeding precautions p. 938 |
idiopathic thrombocytopenic purpura
ITP | more common women/young children
acute or chronic (2 forms)
macrophages ingest platelets
marrow increases platelet production |
s/s of ITP
idiopathic thrombocytopenic purpura | -easy bruising
-heavy menses
-petechiae
-GI bleeding and/or hemoptosis |
thrombocytopenia platelet count #'s | 30,000-50,000 = carefully observed
20,000/bleeding = improve count
10,000 = increased risk of bleeding
5,000 = spontaneous/fatal CNS or GI hemorrhage may occur |
hemophelia A
hemophelia B/ Christmas disease | -inherited, X-linked = males
-hemorrhages into body parts (mostly joints)
-poor clotting/ poor healing |
treatment of hemophelia A/B | -factor VIII or IX transfusion
(-recombinant factor VIIa for those with VIII, IX antibodies)
-Aminocaproic Acid helps stabilize clots |
hemophalia teachings | -avoid alcohol, nsaids, aspirin,
-good dental hygeine
-avoid injections/invasive procedures
-id bracelets
-prophylactic factor Xfusions
-genetic testing |
disseminated intravascular coagulation (DIC) | sign of underlying other condition
variable severity, potentially life threatening
massive amounts tiny clots form in microcirculation / excessive clotting = bleeding |
DIC can be triggered by... | sepsis, trauma, cancer, shock, toxins, allergic response |
s/s of DIC | p. 956 per system
bleeding
multiple organ dysfxn syndrome (MODS)
renal failure |
treatment of DIC | -O2, fluids, electrolytes, vasopressor, cryoprecipitate, fresh-frozen plasma, HEPARIN, aminocaproic acid |
most common causes of DIC | SEPSIS & ACUTE PROMYELOCYTIC LEUKEMIA |
THROMBOTIC DISORDERS | hyperhomocysteinemia
antithrombin deficiency
protein C deficiency
protein S deficiency
activated protein C resistance
Factor V Leiden Mutation
acquired thrombophilia |
various types of ANEMIAS | iron defifiency anemia
renal disease anemia
aplastic anemia
megaloblastic anemia
sickle cell anemia
thalassemias |
conditions resulting from thrombosis include: | MI, CVA, periph. arterial occlusive disease, DVT, pulmonary embolism
-ANTICOAGULATION THERAPY NECESSARY- |
hyperhomocysteinemia | -elderly, renal failure, smokers
-deficient folic acid, B6, B12
test = admin methionine, measure serum homocysteine in 4 hours |
antithrombin deficiency | -hereditary
-later in life >50yrs
-DVT, and other thrombi
-heparin resistance |
protein C deficiency | -hereditary
-thrombotic events 30-45yrs of age
-warfarin induced skin necrosis**
**antidote = Vitamin K
**infuse heparin & fresh frozen plasma, purified protein C concentrate |
protein S deficiency | -spontaneous recurrent venous thrombi
-as early as 15 years of age
-axillary, mesenteric, cerebral
**warfarin induced skin necrosis possible |
factor V Leiden Mutation | most common cause of inherited hypercoagulability in caucasians
-homozygous=anticoag Rx for life
-heterozygous=anticoag Rx few months |
heparin induced thrombocytopenia (HIT) | -complication of heparin therapy
-formation of antibodies against heparin-platelet complex
s/s = decreased platelet count 4-14 days after starting therapy
MONITOR PLATELET COUNTS IF HEPARIN THERAPY |
HEPARIN INDUCED THROMBOCYTOPENIA / HIT increases risk of ... | MI, CVA, DVT, ischemic damage to extremity necessitating amputation.
fatal thrombosis risk 20-30% |
LMWH
LOW MOLECULAR WEIGHT HEPARINS | dalteparin/Fragmin
enoxaparin/Lovenox
-have more selective effects on coagulation- lower incidence of HIT but also CONTRAINDICATED IN HIT!! |
WARFARIN/COUMADIN | -anticoagulation therapy
-Vit K is antidote
-avoid Vit K foods (spinach, broccoli, lettuce)
-monitor INR (standard reporting of PT) |
nursing mgt of thrombotic disorders | -avoid circulatory stasis
-ambulate
-anti embolism stockings
-low dose aspirin therapy
-avoid tabacco/nicotine use
-avoid crossing legs
-Rx-Rx considerations (warfarin) |
therapies for blood disorders | splenectomy
therapeutic apheresis
blood component therapy
special preparatoins |
splenectomy complications, etc | -pneumonia (vaccine prior if able)
-abdominal distention
-abscess formation
-lethal infections
**see care if minor signs of infections
**predisposed to serious thrombotic/hemorrhagic problems |
apheresis | -blood is passed thru centrifuge
-components separated
-platelets / leukocytes / stem cells |
diseases transmitted by blood transfusion | -Hep B/C (viral)
-AIDS / HIV
-Cytomegalovirus (CMV)
-Graft vs. Host disease
-Creutzfeldt-Jacob disease (CJD) |
blood donor qualifications = | -health history screening
-50kg/110lbs (450mL donation)
-oral temp >99.6
-pulse reg, 50-100
-BP: 90/50-180/100
-Hgb: men 13.5 / women 12.5 |
autologous donation | -patients own blood is collected for possible future use
-4-6 weeks preop
-iron supplements
NEVER PLACED IN GEN DONOR SUPPLY
CAN BE FROZEN UP TO 10 YRS |
MOST COMMON TRANSFUSION REACTION? | febrile nonhemolytic reaction
fever / chills
antipyretics ok |
most dangerous transfusion reaction? | ACUTE HEMOLYTIC REACTION
-life threatening
-ABO mis-match |