Exam 3

Question 1

Buerger’s Disease

Answer 1

A disease that causes obstruction of the blood vessels of the hands and feet. Caused by vasculitis or inflammation of the blood vessels. Inflammation is irritation with presence of extra immune cells. Blood flow to the hands and feet can become completely blocked and cause tissue damage and lead to gangrene. Worse at night, causes ischemia (restriction of blood supply in tissues) and fibrosis (thickening or scarring of tissues) of vessels in extremities with increased sensitivity to cold; cause unknown but is associated with smoking.

Question 2

Raynaud’s Disease

Answer 2

A general term to describe a condition in which there is an increased or unusual sensitivity to cold or emotional factors, occurring primarily in the hands. Occurs between ages 17 and 50. Painful vasospasms of arteries and arterioles in extremities, especially digits, causes red-white-blue skin color changes on exposure to cold or stress.

Question 3

Lymphatic Nodes

Answer 3

Filter debris from the lymph and produces lymphocytes

Question 4

Lymphedema

Answer 4

Accumulation of lymph in soft tissue

Question 5

Lymphangitis/Lymphadentitis

Answer 5

Inflammation of lymphatic channels that usually result from acute staph or strep infection in an extremity. Symptoms: generalized edema, systemic infection, fever, chills, localized pain. Treatment: PCN, warm soak.

Question 6

Varicose veins

Answer 6

distended protruding veins that appear darkened and torturous

Question 7

Thrombophlebitis

Answer 7

refers to a thrombus that is associated with inflammation

- occurs in deep veins of the lower extremities

Question 8

Chronic venous insufficency

Answer 8

the result of prolonged venous hypertension that stretches the veins and damages the valves

Question 9

Venous stasis ulcers

Answer 9

results in people with long-term venous insufficiency which causes edema or minor injury to a limb
- occurs over the malleolus, inner and outer ankle

Question 10

Thrombocytopenia

Answer 10

low (reduction) blood platelet count

Question 11

Anemia

Answer 11

• RBC, Hemoglobin, and hematocrit levels below normal
• May be see decreased serum iron, decreased total iron binding capacity and serum ferritin.
• Insufficient oxygen supply to tissues

Question 12

Symptoms of Anemia

Answer 12

Results from decreased oxygen carrying capacity

• Fatigue
• Pallor
• Dyspnea-short of breath
• Tachycardia
• Vertigo-dizzy
• Headache
• Cardiac dilation
• Disorientation

Question 13

Hypovalemic Anemia-Early Signs

Answer 13

“Blood loss anemia”

• Anemia secondary to hemorrhage or blood loss
• Decreased blood volume
• Decreased amount of oxygen to tissues
• Usually due to an acute blood loss
• May see symptoms of hypovolemic shock
• Urine output decreases

Question 14

Treatment Hypovolemic Anemia

Answer 14

• First priority is control bleeding
• Treat for shock
• Replace lost fluid volume
• Administer oxygen to correct hypoxemia
• Change position-lay them down and elevate legs

Question 15

Pernicious Anemia

Answer 15

*Absence of intrinsic factor secreted by gastric mucosa
*Without the intrinsic factor, cannot absorb vitamin B12
It is a megaloblastic anemia-large red blood cells

Question 16

Pernicious Anemia (Etiology)

Answer 16

• Elderly- gastric mucosal atrophy-cells become smaller
• Autoimmune Component-body is fighting
• Gastric surgery/gastrectomy
• Malabsorption

Question 17

Treatment for Aplastic Anemia

Answer 17

• Find and treat underlying cause
• Platelet transfusions (HLA matched)
• Avoid all blood transfusions if possible to minimize risk of tissue rejection*
• Prepare for possible bone marrow transplant
• If untreated, aplastic anemia is fatal 75% of the time

Question 18

Types of hemophilia

Answer 18

• A: (classic) deficiency of factor VIII and accounts for 80% of hemophilia cases
• B: (christmas disease) deficiency of factor IX and accounts for 20% of cases

Question 19

Symptoms of Pernicious Anemia

Answer 19

• Red, swollen, sore tongue
• Impaired position sense (proprioception)
• Numbness and tingling of hands and feet (paresthesia)
• Disorientation

Question 20

Treatment for Pernicious Anemia

Answer 20

• Monthly B12 injections for life

* If severe, may also require blood transfusions, folic acid supplements, and iron

Question 21

Aplastic Anemia

Answer 21

• condition of decreased bone marrow function

* results in decreased erythrocytes, leukopenia, thrombocytopenia, pantocytopenia (all 3 blood elements reduced)

Question 22

Aplastic Anemia Etiology

Answer 22

• Congenital
• Autoimmune
• Viral
• Medications
• Chemicals-arsenic, benzene, alcohol, insecticides
• Radiation
• Chemotherapy-kills all rapidly increasing cells

Question 23

Treatment for Aplastic Anemia

Answer 23

• Find and treat underlying cause
• Platelet transfusions (HLA matched)
• Avoid all blood transfusions if possible to minimize risk of tissue rejection*
• Prepare for possible bone marrow transplant

Question 24

Iron Deficiency Anemia

Answer 24

RBCs contain decreased concentration of hemoglobin
Possible causes:
*Acute or chronic blood loss (menstrual bleeding or GI bleeding)
*Poor iron absorption from GI tract
*Poor dietary iron intake
*alcoholism

Question 25

Symptoms of iron deficiency

Answer 25

* Pallor * Glossitis-tongue is red, smooth, painful * Fatigue * Weakness * Shortness of breath * spoon shaped fingernails * tachycardia

Question 26

Diagnostic findings with Iron deficiency anemia

Answer 26

* Low serum iron * decreased RBC count * decreased hemoglobin * decreased hematocrit

Question 27

Treatment for iron deficiency

Answer 27

Oral iron-Ferrous sulfate * Administered in 5 daily doses * OJ enhances absorption of iron * May cause abdominal discomfort and constipation * Use z-tract method-seals medication in to muscle * Use colase-stool softener

Question 28

Thalassemia

Answer 28

Inherited blood disorder where the body produces an inadequate amount of hemoglobin(rbc that carries oxygen)

Question 29

Hemophilia A

Answer 29

affects mostly males

Question 30

S & S of hemophilia

Answer 30

- abnormal bleeding - excessive bleeding - Bruising easily - joint and muscle hemorrhages

Question 31

Sickle Cell Anemia

Answer 31

* Most common genetic disorder in US * Most predominant in African-American * Recessive gene * If heterozygous for gene, results in sickle cell trait * Development of abnormal hemoglobin S in place of normal hemoglobin A * Hemoglobin becomes crescent or sickle shaped when person is deprived of oxygen. * Red blood cells clump and are trapped in small vessels causing PAIN * Blood circulation is viscous and sluggish * Abnormal cells recognized and hemolyzed * Spleen functions to remove the RBC debris from circulation

Question 32

Sickle Cell Crisis

Answer 32

Happens due to: * Increased sickling and deoxygenation * Sickled cell clog small capillaries * Local hypoxia, thrombosis * Occurs due to anything causing hypoxia!! (dehydration, infections, altitudes, emotional/physical stress) SYMPTOMS of CRISIS: * Jaundice from excessive hemolysis (cell burst-breakdown of RBCs) * Splenic enlargement * Pain in various parts of the body * Fatigue

Question 33

Nursing interventions for Sickle Cell Crisis

Answer 33

* Bedrest * Hydration to thin blood * Blood transfusions * Analgesics * Drug-Hydroxyurea-increases fetal hemoglobin levels and reduce hemolysis

Question 34

Polycythemia Vera

Answer 34

Abnormal increase in the circulating number of red blood cells. * Blood is vicous * RBC, Hemoglobin, and hematocrit counts are elevated Two Types: Primary-all bone marrow elements are increased Secondary-due to hypoxia; only RBCs are increased Treatment: * Adequate oxygenation to prevent hypoxia. * Repeated phlebotomy to decrease blood viscosity * Myelosuppressive agents to slow bone marrow production