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NURS 406 > Exam 2: Hematological Alterations > Flashcards

Exam 2: Hematological Alterations Flashcards

(58 cards)

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1
Q

What organs keep your blood in balance?

A

Spleen: destroys cells and platelet storage

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2
Q

What stimulates RBC production?

A
  • Stimulated by decreased oxygen

- Kidney then produces erythropoietin

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3
Q

How long do RBC’s live?

A

90-120 days

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4
Q

RBC Labs: Size (Cytic)

A 
MCV:
Normal 80-94
Small: microcytic
Normal: normocytic 
Large: macrocytic
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5
Q

RBC Labs: Hemoglobin (Chromic)

A

MCH:
Normal 26-24
Normal: normochromic
<26: hypochromic

*Look at these values. Especially for iron deficiency anemia.

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6
Q

WBC: Lymphocytes

A
  • Found in bone marrow, spleen, lymph glands

- Responsible for immunity

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7
Q

WBC: Neutrophils

A
  • Attack bacteria/viruses

- Elevated in acute inflammation

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8
Q

WBC: Monocytes

A
  • Macrophages

- Increased in chronic inflammation

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9
Q

WBC: Eosinophils

A
  • Kills parasites

- Increased in allergies

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10
Q

WBC: Basophils

A

-Elevated during healing

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11
Q

Platelets

A
  • Promote hemostasis
  • Produced in bone marrow
  • Stored in the spleen
  • Live 8-10 days
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12
Q

Iron Deficiency Anemia

A
  • Most common cause of anemia in infancy, childhood and adolescence.
  • Depleted Fe stores -> decreased supply of Fe needed to make hgb for RBC
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13
Q

What are risk factors for iron deficiency anemia?

A
  • Decreased iron intake
  • Increased iron or blood loss
  • Periods of increased growth
  • Fastest growth periods: 6-24 months and Adolescence
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14
Q

What are the causes of iron deficiency anemia?

A
  1. Decreased iron intake
  2. Inadequate iron stores: premature, multiple birth, anemic mother
  3. Decreased absorption: never give iron w/ milk; vitamin C enhances absorption
  4. Blood loss: hemorrhage, parasites
  5. Excessive demands: premature, pregnancy
  6. Inability to form Hgb: Lack of B12 and folic acid
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15
Q

Iron Deficiency Anemia: Decreased iron intake

A

Rare before 6 months: maternal iron stores still present

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16
Q

Increasing iron intake

A
  • Cow’s milk: whole milk after 1 year; formula/breast milk until 1 year
  • After four months: cereal/veg/fruits/meats
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17
Q

What are clinical manifestations of iron deficiency anemia?

A
  • Pallor with porcelain-like skin
  • Pale mucous membranes
  • Pale conjunctiva
  • Tachycardia
  • Tachypnea
  • Lethargy
  • Fatigue
  • Irritability
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18
Q

Children with lead poisoning often have associated

A

Iron-deficiency anemia

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19
Q

Diagnostics: Iron Deficiency Anemia

A
  1. History: emphasis on nutrition
  2. CBC:
    - Low hgb
    - Decreased MCV
    - Decreased MCH
    - Increased TIBC (total iron binding capacity)
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20
Q

Iron Deficiency Anemia: Management

A
  • Increase dietary intake

- Iron supplementation

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21
Q

Iron Deficiency Anemia Management: Increased Dietary Intake

A
  • Iron fortified
  • Limit cow’s milk to 24 oz/day or less
  • Iron rich foods
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22
Q

Iron Deficiency Anemia Management: Iron Supplementation

A
  • Daily oral preparation
  • Give with a multivitamin or fruit juice: Vitamin C increases absorption
  • Don’t give with milk or antacids: decreases absorption
  • 2 divided doses between meals
  • Can stain teeth (take through a straw and brush teeth after)
  • Causes black, tarry stools
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23
Q

Iron Rich Foods include

A
  • Carbs: bread, cereal, whole grains
  • Proteins: egg yolk, meats/liver, shellfish, tofu
  • Veggies/fruits: dark leafy greens, potatoes, dried fruits, raisins and prune juice
  • Other: kidney beans, legumes, nuts and seeds
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24
Q

Sickle Cell Disease

Study These Flashcards
A
  • Inherited
  • Autosomal recessive condition
  • Primarily affects individuals from African decent
25
Sickle Cell Disease is characterized by
- Production of sickle hemoglobin - Chronic Hemolytic Anemia - Ischemic tissue injury
26
Sickle Cell Disease Manifestations are a result of
- Obstruction caused by the sickled RBC’s and increased destruction of RBC’s. - Infants do not produce HgS until about 4 months of age (d/t maternal stores)
27
What are clinical manifestations of sickle cell disease?
- Chronic hemolytic anemia - Pallor - Jaundice - Fatigue - Cholelithiasis - Delayed growth and puberty - Avascular necrosis of the hips and shoulders - Renal dysfunction - Retinopathy
28
Sickle Cell Crisis includes
1. Vaso-Occlusive Crisis 2. Acute Sequestration Crisis 3. Apastic Crisis
29
Vaso-Occlusive Crisis: Painful Episode
- Most common - Painful episode - Precipitated by infection, cold, stress, acidosis and hypoxia
30
Vaso-Occlusive Crisis includes
- Painful episode - Acute Chest Syndrome: can be confused with pneumonia - Hand-and-foot syndrome - Priapism - CVS
31
Treatment for Vaso-Occlusive Crisis: Pain Episode
- IVF - Opioids - NSAIDs - O2
32
Acute Chest Syndrome
...
33
Treatment for Acute Chest Syndrome
- IVF - O2 - Transfusion
34
Acute Sequestration Crisis
- Blood volume pooling in the spleen | - Life-threatening condition
35
Acute Sequestration Crisis Treatment
- IVF - Blood Transfusion - Possible splenectomy
36
Apastic Crisis
- Profound anemia caused by diminished erythropoiesis | - Treat with transfusion
37
Evaluation of Sickle Cell Disease
- CBC: Elevated reticulocyte count - Hemoglobin electrophoresis - Universal screening for newborns - Prenatal diagnosis: chronic villi sampling at 8-10 weeks gestation; amniocentesis at 15 weeks gestation
38
Treatment of Sickle Cell Disease
- Vaccinations: pneumococcal and meningococcal; influenza - Spleenectomy - Prophylactic ABT: PCN V - O2 and blood transfusion: To reduce the number of circulating sickle cells - Analgesia
39
Management of Sickle Cell Disease: Monitoring
- Monitor for stroke | - Monitor for infection
40
Management of Sickle Cell Disease: Interventions
- Maintain adequate hydration and blood flow - Extend extremities to promote venous return - HOB no more than 30 degrees - Diet: high calorie, protein w/ folic acid.
41
Hemophilia
- Hereditary bleeding disorder: dysfunction or absence of specific coagulation proteins - X-linked autosomal recessive disorder - No cure
42
Hemophilia A (Classic)
Deficiency of coagulation factor VIII. | Most common.
43
Hemophilia B (Christmas)
Deficiency of factor IX
44
Hemophilia Manifestations
- Bruise easily - Epistaxis - Hematuria
45
Hemophilia: Bleeding with
- Loss of deciduous teeth - Injections - Minor lacerations
46
Hemophilia: It is common to develop
Bleeding in muscles and joints
47
Hemophilia: Labs
- PT - PTT - Fibrinogen level - Platelet count - Factor assays
48
Hemophilia Management
- Individual and depends on severity - Prevent excessive bleeding and tissue damage. - Supply the body with missing or ineffective factor: regularly scheduled, beginning in early childhood - Avoid aspirin and NSAIDs: will increase bleeding
49
How is bleeding treated in hemophilia?
RICE: Rest, Ice, Compression, Elevation
50
Treatment for Hemophilia
- Replacement of missing clotting factors - Additional meds: pain relievers and corticosteroids - Desmopressin acetate (DDAVP): vasoconstrictor action to stop bleeding
51
What are major risks associated with factor replacement therapy?
- Hepatitis - HIV - Joint Problems (prophylactic therapy to prevent)
52
Immune Thromboycytopenia
- Acquired hemorrhagic disorder | - Evolution of antibodies against multiple platelet antigens: usually follows a viral illness; an autoimmune process
53
Immune Thrombocytopenia: Characterized by
- Thrombocytopenia: platelet count <20,000** - Purpuric rash - Normal bone marrow
54
What are clinical manifestations of immune thrombocytopenic purpura?
- Sudden onset of bruising and petechiae | - Bleeding that involves the mucous membranes and gums
55
Immune Thrombocytopenic Purpura Evaluation
- History - Physical Exam - CBC - Peripheral Blood Smear
56
Immune Thrombocytopenic Purpura Management
- Frequent neurological assessment - Restore platelet count to >20,000 - Anti-D antibody administration - IV or oral steroids: blocks the autoimmune destruction of platelets - IVIG - Splenectomy - Platelet transfusion: only if active, uncontrolled bleeding.
57
Immune Thrombocytopenic Purpura Interventions
- Extra-soft bristle tooth brushes | - If splenectomy performed, administer prophylactic penicillin daily
58
What should be avoided in patients with immune thrombocytopenic purpura?
- Avoid aspirin and NSAID’s - No contact sports - Delay administration of live virus vaccines - Avoid IM injections

NURS 406 (18 decks)

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