Anemia/Cancers/Lymph System

Question 1

Anemia

Answer 1

• low RBCs produced, hemolysis, blood loss
• microcytic– sm. RBCs, iron deficiency—most common, less RBCs from low hgb lvl, comes from red meat
• macrocyctic—lg RBCs, folic acid/B12 deficiency, most common macro anemia, pernicious: B12 (DNA synethesis) loss results in intrinsic factor loss= no B12 absorption, unhealthy RBCs from O2 lack
• hereditary, hemolysis

Question 2

Anemia S/S

Answer 2

• pallor, fatigue, Dyspnea, tachy (common signs from O2 & hemoglobin loss in RBCs)
• pernicious— hand/feet numb from disease nerve damage & O2 loss, glossitis, these take longer to see, B12 IM shots not PO because of absorption issue
• iron deficient— glossitis, spoon nails/oral fissures, pica, take Fe supplements PO w OJ NO MILK. Until 2 hrs after can also be IV, use straw with oral ..can stain teeth

Question 3

Anemia Labs

Answer 3

• CBC— RBC shape/sz, hgb & hct lvls(range: 12-18)
• iron profile— pherotyn, total fe capacity, will see if PT fe deficient
• marrow biopsy— posterior iliac crest
• find blood loss source—sigmoidoscopy, colonoscopy, occult tests of stool/urine

Question 4

Anemia Therapy

Answer 4

• treat causes, maybe blood transfusions, iron foods (spinach, lentils)
• correct chronic blood loss
• oral/PN (Z-track)fe therapy—increased absorption from OJ/vit. C, take when hungry, no milk or antacid until 2 hrs prior to med, oral stains teeth so use straw
• fe therapy may cause nausea , vomiting, constipation, dark/tarry stools diarrhea

Question 5

Aplastic anemia

Answer 5

• bone marrow loses clotting factors (pancytopenia), turns yellow, fatty, fibrous
• fatal if untreated
• differs from other anemias

Question 6

Anemia Nursing

Answer 6

• watch V.S., —pulse/RR increases >20%, limit activity
• conserve energy
• O2 PRN
• safety risk for falls from weakness/dizzy
• oral hygiene

Question 7

Aplastic anemia S/S

Answer 7

• varies with bone failure
• early: weakness, fatigue, pallor, SOB, headaches
• later: pancytopenia get worse from marrow cell loss, tachy (H.F.), ecchymosis/petechiae, bloody mm/injection sites, bleeding into organs, death/infection from WBC loss

Question 8

Aplastic anemia labs

Answer 8

• starts with CBC— low values: pancytopenia, WBC range 4500-11000
• RBCs may be normal from 120 day life span
• marrow biopsy—definitive, dry tap, finds fatty/yellow tissue
• iron binding capacity tests
• serum iron level test

Question 9

Aplastic anemia nursing

Answer 9

• Similar to general anemia
• low platelets= risk for bleeding: thrombocytopenia, bleeding precautions, no aspirin, no NSAIDs, low WBCs=infection risk: leukopenia, infection protection

Question 10

Sickle cell anemia

Answer 10

• recessive & from parent
• RBCs sickle-shaped, rigid/crack easily, clumps & congests vessels and organs, painful, shape change from hgb/hct body change
• normal hgb, abnormal hgs from O2 changes
• found mostly in African/asian/ Mediterranean PTs

Question 11

Sickle Cell Pathology

Answer 11

• bilirubin rises
• jaundice, gallstones, splenomegaly/hepatomegaly
• increased bile pigment
• RBC lifespan reduced from 10-20 days to

Question 12

Sickle cell S/S

Answer 12

• starts after 6 mos old
• sickling constant— cells can rt to normal if O2 improves
• can Turn into sickle cell crisis aka vasocclusive disorder

Question 13

Sickle cell crisis

Answer 13

• any O2 decreases can cause it I.e. pneumonia, cold, dehydration infection
• sickling» thick blood in capillaries/chest & abdomen veins, joints/bones
• infarction, necrosis»pain/fever/swelling

Question 14

Sickle Cell Crisis s/s

Answer 14

• severe back & joint pain, joints/elbows/knee swelling
• abdominal pain from splenomegaly
• hand-foot syndrome (toe growth), life quality impaired
• death from infection, strokes, organ failure
• O2 need»avoid exertion ..sickling

Question 15

SCC labs

Answer 15

• blood smear
• low hgb
• low cbc
• high WBCs

Question 16

SCC therapy

Answer 16

• no cure, PT education: crisis prevention
• low dose antibiotic
• acute: opioids—pain management, transfusions—replaces some RBCs, O2 therapy—help resp. Status Po fluids/IVF—flush debris from sickle cells
• WARM Compress, no tight clothes, bedrest

Question 17

Polycythemia

Answer 17

• too many RBCs
• cancer
• makes blood thick like sludge
• hgb >18 mg (12-18 is normal), hct >55%
• primary is vera…rare, genetic, secondary is from hypoxia

Question 18

Polycythemia Vera

Answer 18

• From pulmonary issue: COPD, HF, smoking, high altitude living
• not disease but compensation mechanism
• body makes more RBCs

Question 19

Polycythemia S/S

Answer 19

• HTN, vision change, headache , dizzy, vertigo, tinnitus, itching, exertional dyspnea,
• bleeding gums/nose from dysfunctional/overproduced platelets

Question 20

Polycythemia therapy

Answer 20

• pt can hemorrhage/clot to death ..incurable but manageable
• stage 1: phlebotomy, baby aspirin, hct 45%, decrease hyperviscosity tissue, stage 2: chemo/radiation for blood cell suppression, leukemia side effect

Question 21

Polycythemia nursing/ PT teaching

Answer 21

• 3 L of H2O/day, phlebotomy’s like blood donation, monitor PT for bleeding/ hypovolemia
• splenomegaly/hepatomegaly: small meals, meds: monitor CBC, platelets
• report s/s if bleeding/iron deficiency, elevate legs, bleeding precautions

Question 22

D.I.C.

Answer 22

• bleeding syndrome not disease
• vessel clotting, rapid»high mortality so prognosis dependent on condition, organ/ limb necrosis, kidneys/brain affected

Question 23

D.I.C. Bleeding S/S & Regular s/s

Answer 23

• bleeding: bruising, petechiae, Iv/venipuncture site bleed, tarry stool, hematuria, nose/gums bloody, painful joints
• regular: bleeding w/o disorder history, joint pain/enlargement, massive bleed»>muscle/back pain, organ failure, shock/coma, death

Question 24

DIC labs

Answer 24

• long PT PTT, low platelets, low hgb, high BUN and creatinine, high fibrin

Question 25

DIC Tx and Care

Answer 25

* tx: varies conditionally, fix cause, hydration, FFP for factors, platelets, cyroprecipitate mainly used * report/recognize bleeding, avoid trauma and roughness, ICU, inform family, use IDT

Question 26

Leukemia

Answer 26

* WBC Cancer/disorder * dysfunctional, immature WBCs—can’t fight infection * acute (85% of PTs) or chronic * myeloid (monos, erythros), lymphoid (lymphos..CLL&CML) * anemic and bleeding happen *MMs at risk/infection * genetic or radiation/toxin exposure * childhood cured with chemo 75%, adults 30-40%

Question 27

Leukemia AML/ALL

Answer 27

* affect blasts (immature), ALL—kids <15, abnormal lymphos growth, AML— >20 YO, bad prognosis * S/S: sudden, illness, high fever, MM bleeding, petechiae, thrombocytopenia, death, pallor, malaise

Question 28

Chronic Lymphatic/Myelogenous Leikemia

Answer 28

* CLL—affects B/T lymphos, >40 YO * CML— Philly chromosome, 40-45 YO * stages— insidious—mild bleeds, PT feels fine, accelerated/acute: takes yrs, fatal: 3-4 post onset, 3-6 mos post acute stage * S/S: low fever, pallor, weakness, SOB, malaise, fatigue, tachy, abd. Pain>>organ megaly, sternal pain/tender ribs, confusion, personality change * labs: marrow aspiration/biopsy, cbc, node biopsy, spinal tap, gene analysis * interventions: radiation, chemo, marrow transplant: autograft/autologous

Question 29

Múltiple Myeloma

Answer 29

* plasma cell cancer in bone marrow …they reproduce fast * with MM . Antibodies are useless * incurable, treatable *life expected 3-7 years * produces tissue eating tumors * with organ failure, prognosis poor

Question 30

Múltiple myeloma S/S

Answer 30

* bone pain mainly, actué/chronic renal failure, stones, anemia, fatigue/pallor, peripheral neuropathy

Question 31

Multiple Myeloma Labs

Answer 31

* CBC * MRI * 24 he urine study/Iv pyelogram * blood chemistries for Ca * marrow biopsy

Question 32

Multiple myeloma therapy and Nursing

Answer 32

* long term pain/disease management * corticos (-SONE drugs), chemo, monitor hypercalcemia, laminectomy/kidney treatment , stem cell transplant * neuro—spine compression, back pain leg weak, sensory/bladder control loss

Question 33

MM diagnosed

Answer 33

* risk of infection r/t immune function * risk for injury: fractures weak bones; immobility issues; hypercalcemia

Question 34

Hodgkin’s lymphoma

Answer 34

* lymph cancer, most curable type, enlarged nodes (cervical, inguinal etc) * AIDS, immune therapy, organ transplant PTs at risk * Begins as single malignant node * **reed-stenberg cells present**

Question 35

Hodgkins lymphoma S/S

Answer 35

* itching, night sweats, wt. loss , fever, cough, fatigue, malaise * late: no big nodes except retro peritoneal, jaundice, liver/spleen/ bones infiltration, nerve pain

Question 36

Hodgkins labs

Answer 36

* bone biopsy * marrow biopsy/aspiration * xray for cough/dysphagia * liver/spleen biopsies

Question 37

Hodgkins Tx

Answer 37

* radiation, chemo, symptom management —fatigue, infection risk, coping PT teaching * complications of chemo/radiation—bleeding

Question 38

Non Hodgkin’s lymphoma

Answer 38

* comprises all lymphomas * in lymphoid tissue * genetic * **no reed stenberg cells** * unclear cause * usually older PTs

Question 39

Non Hodgkins s/s

Answer 39

* big rubbery nodes, night sweats/fever not likely, wt loss, malaise, big tonsils * more rapid than Hodgkins

Question 40

Non Hodgkins labs

Answer 40

* lymph node/tonsil biopsy * marrow biopsy * xray * lymphangiography * pyelogram, CHV, serum level

Question 41

Non Hodgkins therapy & nursing. Care

Answer 41

* chemo/radiation * marrow transplant * Stem cell transplant * nutrition important * manage symptoms

Question 42

Hemophilia