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nur 2038 > exam 3: anemia + clotting > Flashcards

exam 3: anemia + clotting Flashcards

1
Q

fibrin clot

A
  • last phase of blood clotting
  • completes the clotting cascade
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2
Q

as the body ages. . .

A
  • blood volume decreases
  • plasma protein levels decrease d/t diet and liver function
  • bone marrow produces less blood cells
  • hgb levels decrease after middle age
  • lymphocytes decrease d/t loss in immune function
  • antibodies decrease in response
  • WBC counts do not rise as high with infection
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3
Q

anemia

A

reduction in the number of RBCs, amount of Hgb or Hct in circulation

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4
Q

anemia is a ___ NOT a _____

A

clinical indicator
disease

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5
Q

types of anemia

A
  • iron deficiency
  • sickle cell
  • vitamin B12
  • folic acid
  • aplastic
  • glucose-6-phosphate dehydrogenase
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6
Q

most common deficiency worldwide

A

iron deficiency

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7
Q

causes of iron deficiency anemia

A
  • iron-deficient diet
  • chronic alcoholism
  • malabsorption syndromes
  • partial gastrectomy
  • menorrhagia
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8
Q

common symptoms of iron deficiency anemia

A
  • weakness
  • pallor
  • fatigue
  • reduced exercise tolderance
  • fissures at corners of mouth
  • numbness/tingling in extremities
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9
Q

ferritin

A

blood protein that contains iron

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10
Q

if ferritin levels drop. . .

A

iron levels drop

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11
Q

normal ferritin range

A

12-300 mcg/L

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12
Q

iron deficiency anemia prevention

A
  • food sources
  • supplements (PO, IV, IM)
  • balanced diet
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13
Q

eye symptoms of anemia

A

yellowing

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14
Q

skin symptoms of anemia

A
  • paleness
  • coldness
  • yellowing
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15
Q

respiratory symptoms of amemia

A

SOB

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16
Q

muscular symptoms of anemia

A

weakness

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17
Q

intestinal symptoms of anemia

A

changing of stool color

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18
Q

CNS symptoms of anemia

A
  • fatigue
  • dizziness
  • fainting
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19
Q

blood vessel symptoms of anemia

A

low BP

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20
Q

heart symptoms of anemia

A
  • palpitations
  • rapid HR
  • chest pain
  • angina
  • heart attack
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21
Q

spleen symptoms of anemia

A

enlargement

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22
Q

pernicious anemia

A

direct malabsorption of B12

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23
Q

cause of pernicious anemia

A

autoimmunity

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24
Q

causes of vitamin B12 deficiency anemia

A
  • vegan diet
  • diet lacks dairy
  • small bowel resection
  • chronic diarrhea
  • tapeworms
  • overgrowth of intestinal bacteria
  • gastric bypass surgery
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25
Q

common symptoms of vitamin B12 deficiency anemia

A
  • jaundice
  • glossitis
  • fatigue
  • weight loss
  • infertility
  • hypothyroidism
  • depression
  • cognitive decline
  • low energy
  • numbness
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26
Q

common causes of folic acid deficiency anemia

A
  • poor nutrition (lacking in green leafy vegetables, yeast, citrus fruits, dried beans, nuts; elderly)
  • Crohn’s disease
  • Celiac disease
  • anticonvulsants
  • oral contraceptives
  • alcohol consumption
  • TPN
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27
Q

aplastic anemia

A

deficiency of RBCs d/t impaired bone marrow production

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28
Q

aplastic anemia typically occurs with

A

leukopenia (increased r/f infection)
thrombocytopenia (increased r/f bleeding)

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29
Q

pancytopenia

A

reduction in RBCs, WBCs, and platelets

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30
Q

causes of aplastic anemia

A
  • toxic agents
  • ionizing radiation
  • infection
  • unknown
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31
Q

symptoms of aplastic anemia

A
  • fatigue
  • pallor
  • dyspnea
  • petechiae
  • bleeding
  • tachycardia
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32
Q

hemolytic anemia intrinsic causes

A

warm and cold antibody anemia

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33
Q

hemolytic anemia inherited causes

A
  • thalassemia (Mediterranean descent)
  • G6PD (x-linked genetic disorder)
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34
Q

hemolytic anemia extrinsic causes

A
  • drugs, chemicals
  • toxins, venom
  • infection
  • trauma, burns
  • mechanical damage
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35
Q

manifestations of thalassemia (hemolytic anemia)

A
  • splenomegaly
  • bronze skin tone
  • bone marrow hyperplasia
  • frontal bossing
  • wide set eyes with flattened nose
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36
Q

thalassemia (hemolytic anemia)

A

body produces an abnormal form of Hgb

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37
Q

thalassemia requires a pt to . . .

A

have lifelong blood transfusions

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38
Q

risk associated with thalassemia

A

over-loading the heart and other organs with iron

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39
Q

glucose-6-phosphate-dehydrogenase anemia (G6PD)

A

genetic defect in RBC metabolism
- located on the X chromosome

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40
Q

G6PD is more prominent with what group of pts

A

males, African Americans, and adults in Middle East and Asia

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41
Q

causes of G6PD

A
  • drugs
  • ASA, sulfonamides, thiazide diuretics
  • high doses of vitamin c
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42
Q

manifestations of G6PD

A
  • jaundice
  • anemia
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43
Q

sickle cell disease

A
  • formation of abnormal Hgb S chain (sensitive to O2)
  • RBCs are “sickle” shaped
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44
Q

sickle cell disease is most common in . . .

A

African Americans

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45
Q

causes of Sickle Cell crisis

A
  • low oxygen
  • dehydration
  • infection
  • venous stasis
  • pregnancy
  • alcohol
  • high altitudes
  • low/high body temp
  • strenuous exercise
  • emotional stress
  • anesthesia
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46
Q

labs to assess with sickle cell crisis

A
  • Hgb (low)
  • reticulocyte count (high)
  • bilirubin level (high)
  • WBCs (high)
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47
Q

with sickle cell disease, pain most often occurs in. . .

A
  • abdominal and long bones
  • hand-foot syndrome
  • joints
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48
Q

treatment for sickle cell disease mneumonic

A

hospital- HOP to it!
- Hydration
- Oxygenation
- Pain relief

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49
Q

risk factors for leukemia

A
  • ionizing radiation (radiation therapy)
  • viral infection
  • myelodysplastic syndrome (MDS)
  • genetic factors (down syndrome, Klinefelter syndrome)
  • immune deficiencies
  • environmental (smoking, chemicals, prev. chemo)
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50
Q

prevention for cancer

A

primary: smoking cessation, limit alcohol, exercise, wear sunscreen, avoid prolonged sun exposure, follow occupational safety protocols, healthy diets
secondary: screenings for cancer

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51
Q

priority pt education for pts with cancer

A
  • report temp over 100.4
  • high protein diet
  • avoid large crowds
  • no pets, gardening, fresh flowers
  • good oral care after meals and before bed
  • med side effects
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52
Q

diagnostic testing for cancer

A
  • bone marrow/tumor biopsy
  • PET scan
  • direct visualization (colonoscopy)
  • x-ray
  • CT/MRI
  • cytology exam (epithelial cells from PAP smear)
  • tumor marker (proteins that may indicate malignancy)
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53
Q

passive euthanasia

A

letting the pt die of their own natural disease or condition

54
Q

active euthanasia

A

killing the person before their own natural disease does (by murder)

55
Q

voluntary euthanasia

A

euthanasia with the consent of the pt (OD of opioid of choice by physician

56
Q

nonvoluntary euthanasia

A

euthanasia without the consent of the pt, but the family provides consent (“pulling the plug”)

57
Q

involuntary euthanasia

A

euthanizing a competent person against their wishes

58
Q

diagnostic screening procedure for leukemia

A

bone marrow biopsy

59
Q

types of leukemia

A
  • acute myelogenous leukemia (AML)
  • acute lymphocytic leukemia (ALL)
  • chronic myelogenous leukemia (CML)
  • chronic lymphocytic leukemia (CLL)
60
Q

s/s of oncological emergencies

A
  • sepsis
  • temp of 100.4+
  • ANC
61
Q

expected outcomes for individual with leukemia

A

remission

62
Q

s/s of impending death

A
  • disorientation
  • increased sleep
  • decreased dietary intake
  • respiratory changes (Cheyne-stokes breathing, apnea, congestion)
  • decreased temperature
  • decreased BP
  • cyanosis
  • incontinence
  • impaired muscle control
  • restlessness
63
Q

goal and priorities of palliative care

A
64
Q

types of pts in palliative care

A
65
Q

role of hospice

A
  • provides care of body, mind, spirit
  • pain relief
  • symptoms management
  • affirmation of life
  • mental, emotional, spiritual support
  • family support
  • interdisciplinary
66
Q

nursing considerations for palliative care of child

A
  • family should be provided timely and clear information
  • palliative care options implemented soon after diagnosis
  • prevent and relieve pain and suffering
  • support cognitive, emotional, and spiritual development
67
Q

AML is most common. . .

A

acute leukemia in adults

68
Q

ALL is most common. . .

A

in children

69
Q

two types of leukemia that are Philadelphia chromosome -positive

A
  • ALL
  • CML
70
Q

CLL is most common. . .

A

after age 50

71
Q

CML is most common. . .

A

chronic leukemia in adults

72
Q

systemic symptoms of leukemia

A
  • weight loss
  • fever
  • frequent infections
73
Q

respiratory symptoms of leukemia

A

SOB

74
Q

muscular symptoms of leukemia

A

weakness

75
Q

bone and joint symptoms of leukemia

A

pain or tenderness

76
Q

psychological symptoms of leukemia

A
  • fatigue
  • loss of appetite
77
Q

lymph node appearance of leukemia

A

swollen

78
Q

spleen and/or liver appearance of leukemia

A

enlarged

79
Q

clotting symptoms of leukemia

A
  • decreased platelet function
  • bruising and bleeding easily
  • heavy menstrual flow
80
Q

cardiovascular symptoms of leukemia

A
  • tachycardia
  • palpitations
  • orthostatic hypotension
81
Q

immunity symptoms of leukemia

A
  • fevers
  • night sweats
  • WBCs can be high or low
82
Q

hematological symptoms of leukemia

A
  • anemia
  • fatigue
  • weakness
  • pale skin, nail beds, conjunctivae
83
Q

GI symptoms of leukemia

A
  • anorexia
  • weight loss
  • loss of appetite
84
Q

child’s response to loss: 2-5yrs

A

do not grasp the permanence of death

85
Q

lab value results for leukemia

A
  • H&H (low)
  • platelets (low)
  • WBC can be high or low
86
Q

child’s response to loss: 5-7yrs

A
  • death is viewed as reversible
  • “magical thinking”
87
Q

child’s response to loss: 8-11yrs

A
  • understand that death is permanent
  • curious about life after death
88
Q

child’s response to loss: 12-18yrs

A

understand the abstract idea of death

89
Q

older adult’s response to loss: four multi-faceted areas

A
  • loss of family + friends
  • loss of independence
  • loss of health
  • loss of memory
90
Q

older adults are at risk for ____ as a response to loss

A

depression

91
Q

bone marrow biopsy

A
  • sample removed from posterior iliac crest
  • pressure held at puncture site and transparent dressing is applied
92
Q

three phases of chemo

A

induction
consolidation
maintenance

93
Q

induction

A
  • aggressive, combination therapy
  • 4-6 week hospitalization
94
Q

consolidation

A
  • lower doses of induction regimen
  • goal is to cure
  • given as pt can tolerate
  • transplants can be considered during this time
95
Q

maintenance

A
  • done to prevent relapse
  • lower doses (IV or oral)
  • months to years
96
Q

side effects of chemotherapy

A
  • alopecia
  • stomatitis
  • kidney, liver, cardiac toxicity
  • nadir
97
Q

precautions when chemo is adm.

A
  • assess infusing lines
  • always wear PPE
  • oral chemo = do not break, crush, chew
  • infiltration or extravasation = immediately STOP infusion
98
Q

two types of stem cell transplant

A

allogenic and autologous

99
Q

allogenic

A

bone marrow from a donor

100
Q

allogenic donor and pt details

A
  • donor must have closely matched tissue antigens
  • total body exposure to radiation possibility prior to transplant
  • pt must have little to no bone marrow prior to transplant
  • donor marrow infused via IV
101
Q

autologous

A

bone marrow from self

102
Q

autologous donor and pt details

A
  • 1 liter of bone marrow cells aspirated from iliac crest during disease remission, then frozen
  • total body radiation exposure
  • marrow is thawed and re-infused via IV
103
Q

two types of lymphoma

A

hodgkins lymphoma and non-hogkins lymphoma

104
Q

hodgkins lymphoma cell

A

Reed-Sternberg- predictable spread from one group of nodes to another

105
Q

hodgkins lymphoma details

A

one of the most treatable types of cancer

106
Q

non-hodgkins lymphoma details

A

spreads through lymphatic system in a disorderly fashion

107
Q

hodgkins lymphoma treatment

A

radiation and chemo

108
Q

non-hogkins lymphoma treatment

A
  • varies depending on extent
  • combination therapies including chemo, radiation, monoclonal antibodies
109
Q

multiple myeloma

A
  • cancer of WBCs
  • involves the B-lymphocyte secreting too many antibodies
110
Q

multiple myeloma risk factors

A
  • cause is unknown
  • radiation exposure
  • chemical exposure
  • infection certain Herpes virus
111
Q

multiple myeloma treatment

A
  • protease inhibitors
  • immunomodulating drugs
  • chemo (controls, doesn’t cure)
112
Q

what does multiple myeloma put you at risk for

A

anemia, infection, bleeding
d/t fewer RBCs, WBCs and platelets

113
Q

nursing interventions for dyspnea in dying pt

A
  • position HOB at least 30 degrees
  • oxygen
  • opioid administration to slow breathing
114
Q

nursing interventions for hypotension in dying pt

A
  • assess color, cap refill, heart rate
  • promote safety if confused and dizzy
115
Q

nursing interventions for anorexia, nausea, dehydration in dying pt

A
  • encourage favorite foods
  • antiemetics: ondansetron or promethazine
  • routine oral care to decrease oral mucosa
116
Q

nursing interventions for altered LOC in dying pt

A
  • reorient and promote safety if pt is confused and rambling
  • speak slowly and be patient if pt has poor concentration
117
Q

nursing interventions for pain in dying pt

A
  • opioid administration
  • assess at least 2x/day
  • most feared symptom
118
Q

advanced directives

A

legal documents outlining a client’s preferred treatment plan

119
Q

living will

A

describes the client’s treatment preference regarding end-of-life care (intubation, tube feeding, resuscitation)

120
Q

durable power of attorney for health care (DPOAHC)

A

empowers designated individual to make medical decisions (used only when pt cannot receive, evaluate, and/or communicate information)

121
Q

VSED

A

refusal of feesing/hydration to speed death process

122
Q

neoplasms

A

abnormal growths of new tissue that are classified as benign or malignant

123
Q

benign

A
  • localized growths
  • usually doesn’t endanger life or health
  • doesn’t invade other tissues, usually doesn’t reoccur once removed
124
Q

malignant

A
  • grows aggressively
  • uncontrolled cells
  • invades other tissues, causing inflammation, bleeding, necrosis until something stops them (surgery, radiation, chemo)
125
Q

two things that need to be present for somebody to develop cancer

A
  1. damaged DNA
  2. impaired immune system
126
Q

carcinogens

A
  • cancer-causing substances
  • chemical: tobacco, meds
  • physical: radiation, UV
  • viral: HPV
127
Q

tumor lysis syndrome (TLS)

A
  • oncologic emergency with rapid lysis of malignant cells
  • usually the result of chemo or radiation
128
Q

complications caused by TLS

A
  • hyperkalemia
  • hyperuricemia
  • hyperphosphatemia
  • cardiac arrhythmias
  • renal failure
129
Q

treatment for TLS

A
  • monitor labs
  • hydration
130
Q

syndrome of inappropriate antidiuretic hormone (SIADH)

A

too much ADH = too much water = fluid volume overload

nur 2038 (3 decks)

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