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