Hematology first year summer
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| What is bone marrow biopsy used for? | ■Diagnose causes of blood disorders such as anemia, or thrombocytopenia ■Rule out diseases, such as leukemia and other cancers.
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| Nursing Actions for bone marrow biopsy | ■ Verify that clients have signed the informed consent form. ■ Position clients in a prone or side-lying position to expose the ileac crest for the procedure.
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| Client Education for bone marrow biopsy | ■ Explain the procedure to clients. ■ The biopsy site will be anesthetized with a local anesthetic ■ clients may feel pressure during the aspiration.
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| Postprocedure bone marrow biopsy Nursing Actions | ■■ Monitor for infection (fever, increased WBCs, pain, swelling at the site) and bleeding. ■■ Apply ice to the incision site if prescribed. ■■ Administer mild analgesics for discomfort. ■ Avoid aspirin and other medications that affect clotting.
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| The prothrombin time and D-dimer tests are? | D-dimers are not normally present in human blood plasma, except when the coagulation system has been activated, for instance because of the presence of thrombosis or DIC. PT measures of the extrinsic pathway of coagulation, factors I, II, V, VII, and X.
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| The iron level indicates | ■ anemia ■ hemorrhage ■ hemochromatosis ■ liver disorders.
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| MCH indicates the | weight of Hgb present in a red blood cell.
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| Altered platelets levels indicate the presence of | ■ malignancy ■ polycythemia vera ■ autoimmune disorders ■ bone marrow suppression ■ enlarged spleen.
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| A INR test is used to monitor the effects of | ■ Coumadin therapy. ■ Therapeutic is 2-3. ■ Normal is 0.7-1.8
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| An aPTT test is used to monitor the effects of | ■ heparin therapy. ■ Normal is 30-40 secs. ■ 1.5 to 2 times normal value for anticoagulation
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| Blood components: | ◯ Packed RBCs ◯ Plasma ◯ Albumin ◯ Clotting factors ◯ Prothrombin complex ◯ Cryoprecipitate ◯ Platelets
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| Excessive blood loss (Hgb 6 to 10 g/dL, depending on symptoms) transfuses with | Whole blood
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| Anemia (Hgb 6 to 10 g/dL, depending on symptoms) transfuses with | Packed RBCs
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| Chronic renal failure transfused with | Packed RBCs
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| Coagulation factor deficiencies such as hemophilia transfused with | Fresh frozen plasma
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| Thrombocytopenia/platelet dysfunction (platelets < 20,000 or < 80,000 and actively bleeding) transfused with | Platelets
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| Blood is typed based on the presence of | antigens
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| Another consideration is the Rh-factor. Blood that contains D antigen makes the | Rh factor POSITIVE.
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| Rh-positive blood given to an Rh-negative person will cause | hemolysis.
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| Packed RBCs are usually prescribed for clients with an Hgb of less than | 8 g/dL.
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| Prior to a transfusion the RN should | ■ Check clients for a history of blood-transfusion reactions. ■ Check compatibility ■ lab values and H&H. ■ Verify the prescription.
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| What type of saline is used with transfusions | ■ 0.9% sodium chloride to prime the blood administration set. ■ Never add medications to blood products.
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| Remain with clients for the first _______ to ________ min of the infusion | 15 to 30 mins. (reactions occur most often during first 15 min)
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| Complete the transfusion within a (time frame) & for what purpose | ■ 2 to 4 hr time frame ■ to avoid bacterial growth.
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| After a transfusion, Hgb levels should rise | approximately 1 g/dL with each unit transfused.
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| Immediate transfusion reaction. ■ mild or life-threatening (cardiovascular collapse, acute renal failure, disseminated intravascular coagulation, shock, death). | Acute hemolytic. ■ Chills ■ fever ■ low back pain ■tachycardia ■flushing ■ hypotension ■tachypnea ■ nausea ■ anxiety ■ hemoglobinuria.
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| Transfusion reaction occurring 30 min to 6 hr after transfusion | Febrile
■ Chills ■ fever ■ flushing ■ headache ■anxiety.
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| What type of blood should be used with a febrile reation? | • Use WBC filter. • Administer an antipyretic, such as acetaminophen(Tylenol).
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| Anaphylactic Immediate response • Findings include: | Wheezing, dyspnea, chest tightness, cyanosis, and hypotension. • Assist with emergency care (Maintain airway; administer oxygen, IV fluids,antihistamines, corticosteroids, and epinephrine.).
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| Nursing Actions transfusion reactions | ☐ Stop the transfusion immediately ☐ Maintain an infusion of 0.9% sodium chloride. (separate IV line)☐ Save the blood bag with the remaining blood and the blood tubing for testing at the laboratory following agency protocol
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| During a transfusion, clients who have impaired cardiac function can experience | circulatory overload
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| circulatory overload | Dyspnea, chest tightness, tachycardia, tachypnea, headache, hypertension, JVD, peripheral edema, orthopnea, sudden anxiety, and crackles in the base of the lungs.
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| Nursing Actions for circulatory overload | ■ Administer oxygen ■ monitor vital signs ■ slow the infusion rate ■ administer diuretics as prescribed. ■ Notify the provider immediately.
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| Sepsis and septic shock, symptoms include | Fever, nausea, vomiting, abdominal pain, chills, and Hypotension
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| Three reactions to transfusions include | ■ allergic ■ circulatory overload ■ septic shock
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| Nursing Actions for septic shock | ☐ Maintain patent airway & administer oxygen. ☐ antibiotic therapy as prescribed. ☐ samples for blood cultures. ☐ Assist with emergency care (Use vasopressors, such as dopamine, to combat vasodilation in the late phase.). ☐ Elevate the client’s feet.
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| Anemia is an abnormally low amount of circulating | ■ RBCs ■ Hgb concentration ■ Hct.
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| Anemia results in diminished | oxygen-carrying capacity and delivery to tissues and organs.
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| The goal of treatment is to | restore and maintain adequate tissue oxygenation
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| Anemias are due to | ◯ Blood loss. ◯ Inadequate RBC production (hypoproliferative). ◯ Increased RBC destruction (hemolytic). ◯ Deficiency of necessary components such as folic acid, iron, and/or vitamin B12.
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| The most common cause of anemia in children, adolescents, and pregnant women | Iron-deficiency anemia due to inadequate intake
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| The most common cause of anemia in men and women (who are postmenopausal). | ■ Iron-deficiency anemia due to blood loss (such as from a gastrointestinal ulcer) ■ Women who aremenstruating can develop anemia secondary to menorrhagia.
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| Risk Factors for anemia | ◯ blood loss ◯ Increased hemolysis ◯ Inadequate dietary intake ◯ Bone-marrow suppression ◯ Older adult clients are at risk for nutrition-deficient anemias (masks as depression in older adults) ◯ GI bleeding is a common cause in older adult
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| Defective Hgb (sickle-cell disease) | ■ RBCs become malformed during periods of hypoxia and obstruct capillaries in joints and organs
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| Vitamin B12 deficiency | Pernicious anemia due to deficiency of INTRINSIC FACTOR produced by gastric mucosa, which is necessary for absorption of vitamin B12
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| Aplastic anemia results in a | ■ decreased number of RBCs as well as decreased platelets and WBCs. ■ Bone marrow doesn't produce enough RBCs, WBCs & Platelets
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| Anemia subjective data | ◯ May be asymptomatic in mild cases ◯ Pallor ◯ Fatigue HALLMARK ◯ Irritability ◯ Numbness and tingling of extremities ◯ Dyspnea on exertion ◯ Sensitivity to cold ◯ Pain and hypoxia with sickle-cell crisis
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| Physical Assessment Findings Anemia | ■ SOB &fatigue, upon exertion ■ Tachycardia and palpitations ■ Dizziness or fainting upon standing or with exertion ■ Pallor with pale nail beds and mucous membranes ■ Nail bed deformities ■ Smooth, sore, bright red tongue (vitamin B12 deficiency)
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| Hgb transports | ■ oxygen and carbon dioxide to and from the cells ■ can be used as an index of the oxygen-carrying capacity of the blood.
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| Hct is the | percentage of RBCs in relation to the total blood volume.
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| RBC indices are used to determine | the TYPE and CAUSE of most anemias.
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| Mean corpuscular volume (MCV) | size of RBCs
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| Mean corpuscular hemoglobin (MCH) | to determine the amount of Hgb per RBC
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| Mean corpuscular hemoglobin concentration (MCHC) | to indicate Hgb amount relative to the size of the cell
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| Total iron-binding capacity (TIBC) reflects AN indirect measurement of | serum transferrin, a protein that binds with iron and transports it for storage.
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| Serum ferritin is an indicator of total | iron stores in the body.
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| Serum iron measures the amount of | iron in the blood. Low serum iron and elevated TIBC indicates iron-deficiency anemia.
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| Hgb electrophoresis separates normal Hgb from abnormal. It is used to detect | thalassemia and sickle-cell disease.
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| A Schilling test measures vitamin B12 absorption with and without intrinsic factor. It is used to | differentiate between malabsorption and pernicious anemia.
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| Bone-marrow examination is used to diagnose | aplastic anemia
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| Administer parenteral iron to clients using the | Z-track method
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| RN teaching for anemia oral meds | ■ have Hgb checked in 4 to 6 weeks to determine efficacy ■ take capsules or tablets with citrus or tomato juice (vitamin C) to increase oral iron absorption ■ take iron supplements between meals to increase absorption
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| Anemia meds | ■ Oral FE supplements ■ Erythropoietin – Epoetin alfa (Epogen, Procrit) ■ Vitamin B12 supplementation (cyanocobalamin) ■ Folic acid supplements ■ Blood transfusions
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| Vitamin B12 is necessary to | ■ convert folic acid from its inactive to its active form. ■ All cells rely on folic acid for DNA production
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| A hematopoietic growth factor (Epoetin alfa) is used to | ■ increase production of RBCs Monitor clients for cardiovascular event if Hgb increases too rapidly ●( >1 gm/dL in 2 weeks).
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| B12 must be given parenterally if | lack of intrinsic factor (produced by the parietal cells of the stomach) or malabsorption syndrome
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| Inform clients who lack intrinsic factor or have an irreversible malabsorption syndrome that this therapy must be continued for | the rest of their lives.
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| Client Education: ■ Instruct clients who are iron-deficient, but have elevated cholesterol levels, to integrate iron-rich foods that are | ■ not red or organ meats ■ USE ironfortified cereal and breads, fish and poultry, and dried peas and beans.
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| SS of a low Hct | ■ makes the heart works harder and beat faster (tachycardia, palpitations). ■ ↓the amount of oxygen carried to tissues in the body
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| The client who has decreased renal function lacks sufficient ______________, which is necessary to produce RBCs. | erythropoietin
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| What increases the absorption of iron | Vit C
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| A smooth, sore, bright red tongue is an indication of | vitamin B12 deficiency.
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| Subjective and Objective Data: Acute leukemia | ■ Bone pain ■ Joint swelling ■ Enlarged liver and spleen ■ Weight loss ■ Fever ■ Poor wound healing (infected lesions) ■ Signs of anemia (fatigue, pallor, tachycardia, dyspnea on exertion) ■ Signs of bleeding (ecchymoses, hematuria, bleeding gums)
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| SS of HL and NHL | ■ Some clients may only experience an enlarged lymph node (usually in the neck with HL). ■ Other possible findings include fever, fatigue, and infections.
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| Lab test leukemia indicate | ■ ↑ WBCs ■ ↓Hgb, Hct, and platelets ■ ↑Bleeding times
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| Identification of prolific quantities of immature leukemic blast cells and protein markers indicates the | specific type of leukemia – lymphoid or myeloid. Remission is <5% of immature leukemic blast cells
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| ID of Hodgkin’s lymphoma (HL) is | The presence of Reed-Sternberg cells (B-lymphocytes that have become cancerous) is diagnostic for Hodgkin’s disease.
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| What the types BM of donors | ☐ Autologous - client’s own cells that are collected before chemotherapy. ☐ Syngeneic cells are donated from the client’s identical twin. ☐ Allogeneic cells are obtained from an HLA-matched donor, such as a relative or from umbilical cord blood
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| An absolute neutrophil count (ANC) less than 2,000/mm3 suggests an | infection
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| An ANC of less than 500/mm3 indicates a | severe risk of infection
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| Complications of BMT | ■ Pancytopenia – Decrease in white and red blood cells and platelets ■ Thrombocytopenia ■ Anemia (hypoxemia) ■ Graft-versus-host disease ■ Phlebitis
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| Phlebitis | ■ May occur in the blood vessels of the liver ■ May occur up to one month after bone marrow transplant
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| risk with thrombocytopenia is a platelet counts | <50,000/mm3
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| Spontaneous bleeds can occur at less than | 20,000/mm3.
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