Blood Disorders Exam
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| Treatment for Pernicious Anemia | B12 Shots every 1-2 mos.for the rest of your LIFE
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| Pernicious Anemia is a deficiency of | B12 Vitamin
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| Pernicious Anemia is caused by | partial or complete removal of all of fundus of the stomache removed, Fundus is the intrinsic factor necessary for absorption of b12.
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| There is no cure for pernicious anemia but | treatments allow pts to have a normal life span
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| Labwork for pernicious anemia will show | low RBCs, decreased Hgb, jaundice, pallor, palpitations, NV, farting, indigestion
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| S/S for Pernicious Anmia | constipation, diarrhea, tongue is sore, red, beefy, decubitis ulcers, fever, infection around the teeth and gums, weakness, anorexia, difficulty swallowing, sensitivity to cold, jaundice, neurological probs, tingling hands and feet, loss of body position
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| If not treated pernicious anemia could lead to | partial or total paralysis may occur due to destruction of nerve fibers
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| Prompt treatment is needed for pernicious anemia to prevent | degenerative changes in the nervous system.
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| Treatments for pernicious anemia | diet high in protein, vitamins, minerals, VitB12 injections once every 1-2 months, PRBCs to increase the oxygen carrying power of the blood, throoguh skin assessment, daily mouth care, provide warmth, passive ROM
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| Schillings Test | 24 hour urine Sample
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| Sickle Cell Anemia is the most common | genetic disorder in the US
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| Sickle Cell is caused by | abnormal Hgb Molecule (hemoglobin S), causes cells to "sickle" or become crescent shaped.
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| Sickle Cell Crisis | Complication of sickle cell anemia when the sickle cells cannot move through a blood vessel caused by dehydration,cstress, poor nutrition, fatigue, vessel becomes cblocked or clogged. Causes tissue hypoxia.
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| Most important nursing thing during sickle cell crisis | pain management
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| Sickle cell anemia SS | severe pain in organs and bones (legs and arms), fever, anemia, clots in the lungs and spleen, spleenomegaly, decubitus ulcers, jaundice, edema, leukocytosis, chest and abdomen pain
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| Sickle Cell treatment and interventions | Screening positive for HGBS, preventive and supportive, educate pts to get immunized, reduced activity is reduced oxygen demand, rest, eat nutritiously, regular check-ups
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| During a Sickle cell crisis | pt will be hopsitalized, strickt bedrest, administer pain meds, assist with ADLS, frequent rest periods, limit ROM, push fluids to help maintain tissue perfusion,
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| During a sickle cell crisis use warm or cold compresses | warm - because cold constricts
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| SS of infection including urine | Cloudy urine, fever
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| Chronic Leukemias (CLL) COmmonly affect who | Commonly affects those older than 40 - most common type found in adults.
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| CLL Increased immature lympocytes, normal or decreased counts of granulocytes, rbcs and plts, may progress slowly or rapidly, lymph nodes throughout the body are | enlarged but painless - high incidence of infection
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| Chronic Leukemias - CML Commonly found in | those older than 20, incidence increases with age; genetic link in 95%
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| Chronic leukemias - CML Due to | slow disease growth, individual may be asymptomatic; disorder often discovered by routine physical exam. Decrease in number of myeloid cells, typically has more "normal" cells than AML
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| SS Chronic leukemias | weakness, fever, bone pain, loss of appetite, weight loss, anemia, enlargement of body organs, hemorrhage, cloudy pee
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| Treatments and interventions for chronic leukemia. Treatments are not a cure - only prolong life | depends on what type of cell is involved - CML needs to reduce WBC count, primary consideration is directed towards relief of complications, enlarged painful lymphnodes, anemia, decrease in PLTS
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| Normal platelet count | 150,000-350,000
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| Treatment and interventions for chronic leukemias drugs used | leukeran, corticosteroids, cytoxan
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| Life expectancy of chronic leukemias | 3 1/2 - 6 years with treatment
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| SS of Acute Leukemia Childern | onset often begins with a cold, low-high grade temp, HA, abdominal pain
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| SS of Acute Leukemia Infants | crying, restlessness, reluctance to move or be moved,
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| SS of Acute Leukemia Adults | onset may be traced to a cold from which recovery was slow, prostration, weakness, anemia, anorexia, pallor, skin ulcers around mouth/rectum, frequent infections, fatigue, bruising, hemorrhage, ecchymosis, petechiae, purpura
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| Mouth care for pt with mouth ulcers | provide gentle mouth care, no mouth wash, use toothettes, soft mechanical diet
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| Platelet precautions | use an electric razor, brush with soft toothbrush, wear shoes or slippers at all times, no aspirin or any other med that might increase bleed chances, eat high fiber diet to prevent constibpation, blow nose gently if at all (humidifer helps), preventinjur
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| Polycythemia Vera is a chronic disease caused by | proliferation (overgrowth) of blod cells in bone marrow. Too many RBCs, WBCs, PLTs are produced.
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| Polycythemia Vera RBC count may range from | 7-10Mill (norm is 3.6-5.4)
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| Cause of Polycythemia Vera | Idiopathic
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| Polycythemia vera blood flow rate is | slowed due to increased thickness, increases risk for clots, oxygen content of blood is diminshed due to short life span of RBCs
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| Polycythemia vera complication | HTN, CVA, CHF, hemorrhage
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| SS of polycythemia vera | angina, HA, fatigue, night sweats, pruritus, dyspnea, enlarged spleen and liver, skin bruised, bleeding mucous membranes
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| Treatment and interventions for polycythemia vera - Objective | suppress bone marrow, decrease blood cell mass, reduce number of RBCs WBCs and PLTs
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| Treatment interventions for polycythemia vera | chemo to suppress bone marrow production, phlebotomy to reduce excess volume, pts are at high risk for developing leukemia, be supportive, reduce or minimize symptoms
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| more treatment interventions for polycythemia vera | enourage lots of fluids, avoid blood flow restriction, encourage isometric exercise, if angina occurs, educate pt to rest, splenomegaly
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| Transfusion Reactions: Allergic/Anaphylactic Reaction SS: | Itching, Rash, Fever, anaphylactic shock.
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| Transfusion Reactions: Hemolytic Reactions SS: | NV, lower backpain, decreased BP, tachycardia, decreased urine output, hematuria
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| Transfusion Reactions: Pyogenic Febrile Reaction SS: | fever, chills, nausea, headache, flushing, tachycardia, palpitations
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| Transfusion Reactions: Generalized SS : | cough, chest pain, tachycardia, severe dyspnea, edema
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| Purpura | hardened bleeding under the skin (s/s of acute leukemia)
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| Hemophilia is classifed as a group of | hereditary diseases characterized by a prolonged bleeding time. All exhibit a deficiency in one or more of the factors essential for blood coagulation.
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| Most common form of hemophilia is hemophilia a... | deficiency of factor VIII, Appears only in males, transmitted in females
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| SS of hemophilia | severe bleeding in any part of the body, hemarthrosis (elbows knees wrists -limits ROM)
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| If hemophiliac pt receives a blow to the head monitor for an | intracranial bleed (drowsiness, concussion, confusion)
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| SS of Hemophilia: GI Bleed (coffee ground emesis) Observe for signs of internal bleeding: | tachycardia, pain in affected area, edema, bruising, firmness, even minor injuries may lead to fatal bleeding: watch for - hematoma, hematuria, and anemia
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| Hemophilia - monitor for side effects of treatments. Paim meds for joint or muscle pain. Avoid meds containing | aspirin. Avoid injections. Diet needs: increase iron, vit c, and protein, cool not warm compresses. ALWAYS WEAR ID, pump BP than higher systolic.
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| DIC is a syndrome of clotting cascade | overstimulation and anti-clotting process
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| DIC Generalized bleeding sets in always a complication of a | primary diagnosis: septicemia, acute hypotension, poisonous snake bites, neoplasms, ob emergencies, severe trauma, extensive surgery, hemorrhage
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| DIC Signs and symptoms | hemorrhage, hematuria, hypotension, tachycardia, dyspnea, chest pain, restlessness, cyanosis, frothy blood tinged mucous, absent peri pulses, coma
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| Treatment and interventions for DIC | identify the cause, correct immediately or condition will swiftly become fatal! blood product transfusions. Heparin - blocks the formation of multiple small emboli allowing time for clots to replenish, restrict visitors, protect pt.
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| Interventions to assess for presence of infection | take vital signs every 4 hours, 1st sign of infection is fever
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| multiple myeloma | Cause is unknown. Cancer of the plasma cells. Results in abnormal production of immunoglobulins. Abnormal plasma cells cannot protect the pt. Plasma cells destroy bone and invade lymph nodes, liver, splee, kidneys
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| SS of multiple myeloma | No symptoms in early stages, symptoms occur when kidneys are dmged or infection sets in. Pathologic fractures occur due to bone destruction. skeletal pain, destroyed bone releases extra calcum, kidney dmg, gi probs, changes in neuro status
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| Treatment and interventions for multiple myleoma | chemo - destroys abnormal plasma cells, radiation -d ecreases pain, promotes healing, keep pt well hydrated - flushes out extra calcium, prevents kidney dmg. prevent injury, focus on pain mgmt. pathological fractures.
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| Aplastic Anemia | severe life threatening anemia, very poor prognosis, results from bone marrow failure or depression of bone marrow activity / may be congenital or acquired /
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| Aplastic anemia - insufficent blod cells are produced as a result of | interference with stem cells in the bone marrow. usually occurs with a depression of all blood count levels
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| SS of Aplastic Anemia | low rbcs, pallor, weakness, dyspnea, hypoxia, lethargy, cnfusion due to lack of Oxygen, low WBCs, risk for infection, low platelets, risk for bleeding, multiple bruises
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| Agranulocytosis is caused by adverse reaction to | butazolidine, chloromycetin, penicilin and its derivities, dilantin, onocovin, diuretics, thorazine, Sulfa and it's derivitives, celebrex
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| Agranulocytosis is also caused by | neoplastic disease, chemo, radiation, bacterial and viral infections, results in bone marrow suppression thus reducing leukocyte production, number of granulocytes are severely reduced
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| SS of Agranulocytosis | HA, fever, chills, fatigue, mucous membrane ulcerations of the nose, mouth, pharynx, vagina nd rectum
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| Treatment and interventions for agranulocytosismain goals | remove cause of bone marrow suppression, prevent or treat infection, blood transfusions: provide mature leukocytes to weak system, protectivfe isolation (low WBCs), antibiotics, diet (soft, bland, high in cal, protein vitamins)
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| More treatment and interventions for agranulocytosis | balance periods of activity with periods of rest, prevent weakness - fatigue, wash hands!!!! keep surrounding environment clean, screen visitors, immediately report signs of infection, teach pt to avoid crowds, extreme temps
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| Ifnfections Mononucleousis Pathophysiology and Etiology | EEpistein Barr Viros - Direct contact secretions
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| S/S for infectious mononucleousis | fatigue, fever, sore throat, headache, cervical lymph node enlargement, oozing tonsils, pharyngeal swelling,
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| Medical Mgmt of infectious mononucleosis | tons of bed rest, antipyretic therapy, increase fluid intake, corticosteroids, antibiotics
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| nursing mgmt of infectious mononucleousis | threat inspection, offer soft bland diet, lymph node palpation, clietn teaching, rest, avoid blood donation, emotional support
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| Non Hodgkins Lymphoma | less curable, most common
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| Hodgkins Lymphoma | More curable 0 less common (reed sternburg cells)
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| Lymphoma | a group of cancers that affect the lymphatic system
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| Encourage fluid intake for all pts with | lymphoma
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