A lot of nursing stuff
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Iron level in men | show 🗑
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| show | 65-165
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| RBC's in Men | show 🗑
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| RBC's in Women | show 🗑
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| Hgb levels in Men | show 🗑
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| show | 12-16
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| Reticulocytes in Men | show 🗑
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| show | .5-2.5
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| show | 45-54
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| show | 36-46
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| show | 81-98
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| show | low mcv, low mchc, low hgb, low hct, low serum iron, HIGH tibc
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| show | HIGH mcv, low serum B12(<.1), low hct, low hgb, NORMAL mchc
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| Folic acid deficiency lab values | show 🗑
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| show | 32-36
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| show | 150,000-400,000
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| show | 11-15 sec
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| show | 60-70 sec
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| APTT normal value | show 🗑
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| Fibrinogen normal value | show 🗑
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| show | <400-500
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| show | a. Vitamin B12 is only absorbed in the stomach
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| A patient is diagnosed with thrombocytopenia. The nurse should explain to the patient that with this condition, there could be: | show 🗑
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| show | a. Lack of production of RBC’s
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| A patient reports symptoms of fatigue and pica. Laboratory findings reveal a low serum iron level and a low ferritin level. Upon evaluation of this assessment and laboratory data, the nurse suspects that the patient will be diagnosed with: | show 🗑
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| A physican prescribes one tablet of ferrous sulfate daily experiences heavy menstral cycles. The nurse advises the patient and her mother that this over the counter medication must be taken for how long for iron replenishment to occu | show 🗑
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| show | a. Cellular blockage in small vessels
b. Decreased organ perfusion
c. Tissue ischemia
d. All of the above
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| show | _X__ Fever
_X__Ecchymosis and/or petichiea
_X__Infection
_X__Dehydration
_X___Confusion
_X___Bone pain
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| Vitamin B12 deficiency develops when your body is | show 🗑
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| Vitamin B12 deficiency can be caused by | show 🗑
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| Sometimes vitamin B12 deficiency occurs in strict vegetarians and people who eat less | show 🗑
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| show | do not make enough acidic gastric juice to release the B12
from the food you eat. This is known as achlorhydria
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| Folate deficiency is often caused by an unbalanced diet that does not include | show 🗑
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| Other common causes of folate deficiency are | show 🗑
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| With folate and vitamin B12 deficiency, anemia often causes symptoms such as | show 🗑
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| show | weakness, poor coordination, and
numbness or a “pins and needles” feeling in the hands and
feet. Mild irritability and forgetfulness are other early signs
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| show | the
nerves, spinal cord, and brain
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| show | 18 to 160 mg/dl
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| show | means the mass of the RBCs is low.
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| show | the heme, or oxygen-carrying capacity
of the RBC, is low
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| MCV: Normal 82 to 98 cmm. A value of 31.6 cmm means | show 🗑
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| RDW: Normal 11.5% to 14.5 %. RDW refl ects the size of the individual RBCs compared to one another. A value of 15.6% means | show 🗑
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| show | iron defi ciency.
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| Ferritin: Normal 18 to 160 mg/dl. Ferritin is more specifi c and sensitive than the iron level. A low level indicates | show 🗑
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| Anemia is a deficiency in | show 🗑
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| show | Impaired production of erythrocytes (Hypoproliferative)
↑ Destruction of erythrocytes (Hemolytic)
Blood Loss (acute or chronic
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| Hemoglobin (Hgb) levels are used to determine the severity of anemia | show 🗑
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| Elderly Decreased marrow response suppressed from medications Highly susceptible to anemia's | show 🗑
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| show | Pallor
↓ hemoglobin
↓ blood flow to the skin
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| anemia jaundice | show 🗑
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| show | ↑ serum and skin bile salt concentrations
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| show | Genetic
Viral pathogens
Radiation damage
Chemical exposure
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| show | suddenly
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| acute Leukocyte development is halted causing a | show 🗑
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| show | several months to years
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| show | slowly and can extend over years
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| show | Monocytes
Granulocytes
Erythrocytes
Platelets
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| AML is | show 🗑
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| show | 60
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| AML Clinical manifestations | show 🗑
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| show | Complete Blood Count (CBC)
↓ erythrocytes
↓ Platelets
Bone marrow analysis
↑ immature blast cells
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| AML COMPLICATIONS | show 🗑
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| AML Goal is to | show 🗑
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| AML treatment is | show 🗑
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| Induction therapy | show 🗑
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| AML supportive care | show 🗑
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| Tumor Lysis Syndrome | show 🗑
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| AML complication of treatment | show 🗑
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| show | Anorexia
Nausea/Vomiting
Mucositis
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| Chronic Myeloid Leukemia is... | show 🗑
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| CML Uncommon in people under | show 🗑
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| show | Asymptomatic
Increased leukocyte count
Shortness of breath
Confusion
Splenomegaly (Painful)
Hepatomegaly
Malaise
Anorexia
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| show | Chronic Stage
Gleevevc (imatinib mesylate)
Injectable chemotherapeutic agents
Roferon A (interferon alfa)
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| show | Induction therapy
Consolidation
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| show | Ensure the patient understands that there is an increased bleeding risk associated with chemotherapy due to decreased platelets.
Explain patient’s immune system is altered while receiving chemotherapy.
Patients are also vulnerable to uric acid, phosph
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| ALL is-------- | show 🗑
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| show | Most common in young children
Boys
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| All'''' | show 🗑
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| show | Menigeal involvement
Liver
Spleen
Bone marrow pain
Headache
Vomiting
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| show | Expected outcome is complete remission
Induction Therapy
Corticosteroids
Vinc Alkaloiods
Chemotherap
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| show | Malignant B lymphocytes, most of which are mature may escape apoptosis (programmed cellular death) resulting in excessive accumulation of cells in marrow and circulation
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| CLL is--------- | show 🗑
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| CLL clinical manifestations | show 🗑
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| More CLL clinical manifestations | show 🗑
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| CLL B symptoms include | show 🗑
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| show | Lymphadenopathy
Hepatomegalgy/Splenomegaly
Anemia
Thrombocytopenia
Autoimmune complications
Destruction of RBC and platelets
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| show | no treatment/ most often initiated in the later stage
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| show | Risk for infection
Risk for bleeding
Risk for impaired skin integrity r/t toxic effects of chemotherapy, alteration in nutrition and impaired mobility
Impaired gas exchange
Acute pain
Grieving
Deficient knowledge
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| show | Avoid aspirin and aspirin-containing medications or other medications known to inhibit platelet function, if possible.
Do not give intramuscular injections.
Avoid indwelling catheters if at all possible.
Take no rectal temperatures; do not give supposi
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| show | Use stool softeners, oral laxatives contraceptives
Use smallest possible needles when performing venipuncture.
Apply pressure to venipuncture sites for 5 minutes or until bleeding has stopped.
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| CLL manage bleeding by: | show 🗑
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| show | Consider using toothettes for mouth care if platelet count is <10,000/mm3, or if gums bleed.
Lubricate lips with water-soluble lubricant every 2 hours while awake
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| show | Avoid suctioning if at all possible; if unavoidable, use only gentle suctioning.
Discourage vigorous coughing or blowing of the nose.
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| show | Use only electric razor for shaving.
Pad side rails as needed.
Prevent falls by ambulating with patient as necessary
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| More CLL preventions | show 🗑
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| show | Nutritional supplements
Daily body weight with I and O is useful in monitoring fluid status
Both calorie counts and more formal nutritional assessments are useful.
Parenteral nutrition is often required to maintain adequate nutrition
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| show | Acetaminophen is typically given to decrease fever, but it does so by increasing diaphoresis
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| show | Sponging with cool water may be useful, but cold water or ice packs should be avoided because the heat cannot dissipate from constricted blood vessel
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| CLL sheets and massage | show 🗑
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| show | Physical activity is necessary to prevent physical deconditioning
Wear HEPA mask
Stationary bike
Chair
Physical Therapy
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| show | Febrile episodes, bleeding, and inadequate or overly aggressive fluid replacement can alter the patient's fluid status and persistent diarrhea, vomiting, and long-term use of certain antimicrobial agents can cause significant deficits in electrolytes
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| show | Assess for dehydration, fluid overload, with particular attention to pulmonary status and the development of dependent edema.test results, particularly electrolytes, blood urea nitrogen, creatinine, hct Replace electrolytes,particularly potassium, magnesi
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| show | Additional attempts by the heart and lungs to provide adequate O2 to the tissues
Cardiac output maintained by ↑ the heart rate and stroke volume
Complications
MI
CHF/Cardiomegaly
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| what happens in the GI during anemia | show 🗑
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| what happens nueromuscular in anemia | show 🗑
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| what are some nursing diagnos for anemia | show 🗑
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| nursing goals for anemia | show 🗑
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| facts on iron oral meds | show 🗑
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| facts on iron liquid meds | show 🗑
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| show | iron, vitamin B12, or folate deficiency, decreased erythropoietin production, cancer
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| Hemolytic: excess destruction of RBCs Due to | show 🗑
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| 3 alterations in Erythropioesis that ↓ RBC production | show 🗑
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| show | Pre-menopausal women
Pregnant women
Persons from low socioeconomic backgrounds
Older adults
Individuals experiencing blood loss
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| show | Bleeding
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| show | Pallor
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| Lab values for iron def. anemia? | show 🗑
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| positioning for bone marrrow aspiration/biopsy | show 🗑
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| show | Skin is anesthetized a sharp brief pain is experienced during the actual aspiration from the bone
Biopsy – if aspiration is done, will use a different location A small incision is made put the needle to core out the bone May feel pressure not pain
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| show | iliac crest or sternum
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| show | Apply pressure to the site for several minutes
Cover with a sterile dressing
Monitor for complications which include bleeding and infection
Warm tub baths and mild analgesics may be used
Avoid ASA
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| show | Diet teaching
Supplemental iron
Discuss diagnostic studies
Iron therapy for 6-12 months after the hemoglobin levels return to normal (sometimes lifelong)
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| megoblastic anemia is caused by | show 🗑
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| show | Large erythrocytes
Abnormal ↑ in the number of cells (Hyperplasia)
Pancytopenia (↓leukocytes and platelets)
Increased MCV due to large erythrocytes (110um3)
Majority of deficiencies from Folic Acid and Vitamin B
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| show | no, there is Absence of IF
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| show | Protein secreted by the parietal cells of the gastric mucosa (needs acidic environment)
GI surgery
Long-term users of H2-histamine receptor blockers
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| show | Cobalamin
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| pernicious anemia is caused by? | show 🗑
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| show | General symptoms of anemia
Gradual onset
Glossitis
Gastrointestinal
Anorexia
Nausea
Vomiting
Abdominal pain
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| show | Weakness
Paresthesias of the feet and hands
↓ Vibratory and position senses
Ataxia
Muscle weakness
Impaired thought process
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| show | Schillings Test
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| Schillings Test info | show 🗑
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| what is IF | show 🗑
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| show | DNA synthesis
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| show | 4 months
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| show | Folic Acid Deficiency
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| show | Poor nutrition
Malabsorption syndromes
Drugs
Alcohol abuse and anorexia
Lost during hemodialysis
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| show | Clinical manifestations are similar to those of Vitamin B12 (cobalamin) deficiency
Insidious onset
Absence of neurologic problems
Treated by replacement therapy
Encourage patient to eat foods with large amounts of folic acid
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| show | Fortified soy milk
Folic Acid is found in green leafy vegetables
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| medication for Folic Acid deficiency are? | show 🗑
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| Skin assessment for Folic acid def. is? | show 🗑
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| Nutritional counseling for folic acid def. related to eating with | show 🗑
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| for walking watch their? | show 🗑
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| Aplastic anemia definition | show 🗑
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| in aplastic anemia, T lymphocytes attack | show 🗑
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| in aplastic anemia, Bone Marrow is replaced with | show 🗑
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| fat cells in bone marrow? | show 🗑
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| aplastic anemia Acquired Idiopathic-------- | show 🗑
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| aplastic anemia can be genetic due to | show 🗑
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| clinical maifestation of aplastic anemia | show 🗑
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| show | Bone Marrow Transplant (BMT)
Peripheral Blood Stem Cell Transplant (PBSCT)
Immunosuppressant Therapy
Supportive Therapy
Packed Red Blood Cells (PRBC’s)
Palettes
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| Your blood is made of | show 🗑
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| In a bone marrow transplant, you will receive | show 🗑
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| show | is the soft, fatty tissue inside your bones. Stem cells are immature cells in the bone marrow that give rise to all of your blood cells
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| show | Autologous
Allogeneic
Umbilical cord blood transplant
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| show | Monitor patient for Pain, Chills, Fever, Hives, Chest pain, Drop in blood pressure, Shortness of breath, Nausea, Flushing, Headache, and Funny taste in the mouth
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| complications of a bone marrow transplant | show 🗑
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| show | Decreased production
Increased destruction
Seen with chemotherapy
Diagnosied with CBC
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| medical management for neutropenia | show 🗑
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| show | Hygiene
Hand
Body
Oral
Private room
Care for Neutropenic patients first (if possible)
Ensure adequate cleaning of the room
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| neutropenic precautions | show 🗑
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| show | Oral Care
Preventing Infections
Self-care
Nutrition
Photosensitivity
Monitoring for potential problems
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| what is Graft-versus-host disease (GVHD | show 🗑
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| show | Erythrocytes have a shortened life span ↓ the number present in circulation and O2 levels (related to diminished availability of erythrocyte precursors)
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| show | ↑ production of erythropoietin from the kidneys to produce more erythrocytes
Erythrocytes are released prematurely as reticulocyte
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| Causes of hemolytic anemia | show 🗑
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| show | Cardiac
Hemoglobin 7-10 g/dl
Tachycardia
Gastrointestinal
Jaundice
Enlarged liver/spleen
↑ facial bone size (widening medullary spaces)
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| show | Heart Failure
Infection
Pneumonia
Acute Chest Syndrome
Pulmonary Hypertension
Osteomylitis (infection of the bone)
Renal Failure
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| show | Signs & Symptoms
Pain
Swelling
Fever
Cold/Chills
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| medical management of sickle cell crisis | show 🗑
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| what should a nurse do for sickle cell crisis | show 🗑
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| show | Result of sudden hemorrhage
Trauma
Complications of surgery
Disruption vascular integrity
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| show | Laboratory data do not adequately assess RBC problems for 2-3 days
Patient H&P and physical assessment
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| complications of blood loss anemia | show 🗑
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| show | Identifying the source of the hemorrhage
Stopping blood loss
Replacing blood volume to prevent shock
Correcting RBC loss
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| show | Administration of Blood Products
PRBC’s
Platelets
Plasma
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| show | Neoplasm of lymph origin
Start in lymph nodes but can involve lymphoid tissue in the spleen, GI tract, liver or bone marrow
Lymphocytes undergo malignant changes and produce tumors
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| what is hodgkins | show 🗑
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| what happens to lymphnodes in hodgkins | show 🗑
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| show | Type A (no symptoms)
Type B (symptoms include fatigue, weight loss 10%, fever w/o chills, and night sweats
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| what are the type B symptoms? | show 🗑
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| diagnostic findings in hodgknis | show 🗑
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| show | Chest x-ray
Computed tomography (CT) scans of the head and neck, chest, abdomen, and pelvis
Positron emission tomography (PET) of the entire body
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| 1 stage of hodgkins | show 🗑
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| show | Stage II – involves two or more lymph node regions on the same side of the diaphragm
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| show | Stage III – involves several lymph node regions on both sides of the diaphragm
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| 4th stage of hodgkins | show 🗑
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| show | Preferable for early disease staging. May be used after aggressive chemotherapy for more advanced disease staging. Used for bulky disease types
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| show | Used in advanced stages or with reoccurrence of Hodgkin’s
Standard ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) regimen is used.
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| show | ABVD may cause infertility
Sperm abnormalities and birth defects,pregnancy prevention and sperm bank discussed.Chemo radiation increaserisk of another secondary malignancy
Breast CA in women treated before 30 Most common 2nd malignancy is lung cancer
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| NHL definition | show 🗑
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| NHL causes | show 🗑
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| show | Lymphadenopathy - Most common
Indolent (less aggressive) NHL– Early Stages
Asymptomatic
Aggressive NHL
“ B-Symptoms”
Fever
Night sweats
Unintentional weight loss
Bone pain
Anemia
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| show | Computed tomography (CT) scans of the head and neck, chest, abdomen, and pelvis
Positron emission tomography (PET) of the entire body.
Bone Marrow Biopsy
Bence-Jones protein (urine
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| what protein can be found in the urine in NHL | show 🗑
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| show | reed-sternberg cell
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| show | Fatigue
Mylosuppression
Nausea
Hair loss
Infection
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| show | YES
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| show | radiation
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| show | - Both
CHOP (cyclophosphamide, hydroxydaunomycin, oncovin, and prednisone) chemo-therapy offers 40% cure rate; CHOP-R (rituximab added) chemotherapy offers 60% cure rate; or radiation/ chemotherapy combination
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