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nur 2038 > exam 3: anemia + clotting > Flashcards

exam 3: anemia + clotting Flashcards

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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
common symptoms of vitamin B12 deficiency anemia
- jaundice - glossitis - fatigue - weight loss - infertility - hypothyroidism - depression - cognitive decline - low energy - numbness
26
common causes of folic acid deficiency anemia
- 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
27
aplastic anemia
deficiency of RBCs d/t impaired bone marrow production
28
aplastic anemia typically occurs with
leukopenia (increased r/f infection) thrombocytopenia (increased r/f bleeding)
29
pancytopenia
reduction in RBCs, WBCs, and platelets
30
causes of aplastic anemia
- toxic agents - ionizing radiation - infection - unknown
31
symptoms of aplastic anemia
- fatigue - pallor - dyspnea - petechiae - bleeding - tachycardia
32
hemolytic anemia intrinsic causes
warm and cold antibody anemia
33
hemolytic anemia inherited causes
- thalassemia (Mediterranean descent) - G6PD (x-linked genetic disorder)
34
hemolytic anemia extrinsic causes
- drugs, chemicals - toxins, venom - infection - trauma, burns - mechanical damage
35
manifestations of thalassemia (hemolytic anemia)
- splenomegaly - bronze skin tone - bone marrow hyperplasia - frontal bossing - wide set eyes with flattened nose
36
thalassemia (hemolytic anemia)
body produces an abnormal form of Hgb
37
thalassemia requires a pt to . . .
have lifelong blood transfusions
38
risk associated with thalassemia
over-loading the heart and other organs with iron
39
glucose-6-phosphate-dehydrogenase anemia (G6PD)
genetic defect in RBC metabolism - located on the X chromosome
40
G6PD is more prominent with what group of pts
males, African Americans, and adults in Middle East and Asia
41
causes of G6PD
- drugs - ASA, sulfonamides, thiazide diuretics - high doses of vitamin c
42
manifestations of G6PD
- jaundice - anemia
43
sickle cell disease
- formation of abnormal Hgb S chain (sensitive to O2) - RBCs are "sickle" shaped
44
sickle cell disease is most common in . . .
African Americans
45
causes of Sickle Cell crisis
- low oxygen - dehydration - infection - venous stasis - pregnancy - alcohol - high altitudes - low/high body temp - strenuous exercise - emotional stress - anesthesia
46
labs to assess with sickle cell crisis
- Hgb (low) - reticulocyte count (high) - bilirubin level (high) - WBCs (high)
47
with sickle cell disease, pain most often occurs in. . .
- abdominal and long bones - hand-foot syndrome - joints
48
treatment for sickle cell disease mneumonic
hospital- HOP to it! - Hydration - Oxygenation - Pain relief
49
risk factors for leukemia
- ionizing radiation (radiation therapy) - viral infection - myelodysplastic syndrome (MDS) - genetic factors (down syndrome, Klinefelter syndrome) - immune deficiencies - environmental (smoking, chemicals, prev. chemo)
50
prevention for cancer
primary: smoking cessation, limit alcohol, exercise, wear sunscreen, avoid prolonged sun exposure, follow occupational safety protocols, healthy diets secondary: screenings for cancer
51
priority pt education for pts with cancer
- 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
52
diagnostic testing for cancer
- 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)
53
passive euthanasia
letting the pt die of their own natural disease or condition
54
active euthanasia
killing the person before their own natural disease does (by murder)
55
voluntary euthanasia
euthanasia with the consent of the pt (OD of opioid of choice by physician
56
nonvoluntary euthanasia
euthanasia without the consent of the pt, but the family provides consent ("pulling the plug")
57
involuntary euthanasia
euthanizing a competent person against their wishes
58
diagnostic screening procedure for leukemia
bone marrow biopsy
59
types of leukemia
- acute myelogenous leukemia (AML) - acute lymphocytic leukemia (ALL) - chronic myelogenous leukemia (CML) - chronic lymphocytic leukemia (CLL)
60
s/s of oncological emergencies
- sepsis - temp of 100.4+ - ANC
61
expected outcomes for individual with leukemia
remission
62
s/s of impending death
- disorientation - increased sleep - decreased dietary intake - respiratory changes (Cheyne-stokes breathing, apnea, congestion) - decreased temperature - decreased BP - cyanosis - incontinence - impaired muscle control - restlessness
63
goal and priorities of palliative care
64
types of pts in palliative care
65
role of hospice
- provides care of body, mind, spirit - pain relief - symptoms management - affirmation of life - mental, emotional, spiritual support - family support - interdisciplinary
66
nursing considerations for palliative care of child
- 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
AML is most common. . .
acute leukemia in adults
68
ALL is most common. . .
in children
69
two types of leukemia that are Philadelphia chromosome -positive
- ALL - CML
70
CLL is most common. . .
after age 50
71
CML is most common. . .
chronic leukemia in adults
72
systemic symptoms of leukemia
- weight loss - fever - frequent infections
73
respiratory symptoms of leukemia
SOB
74
muscular symptoms of leukemia
weakness
75
bone and joint symptoms of leukemia
pain or tenderness
76
psychological symptoms of leukemia
- fatigue - loss of appetite
77
lymph node appearance of leukemia
swollen
78
spleen and/or liver appearance of leukemia
enlarged
79
clotting symptoms of leukemia
- decreased platelet function - bruising and bleeding easily - heavy menstrual flow
80
cardiovascular symptoms of leukemia
- tachycardia - palpitations - orthostatic hypotension
81
immunity symptoms of leukemia
- fevers - night sweats - WBCs can be high or low
82
hematological symptoms of leukemia
- anemia - fatigue - weakness - pale skin, nail beds, conjunctivae
83
GI symptoms of leukemia
- anorexia - weight loss - loss of appetite
84
child's response to loss: 2-5yrs
do not grasp the permanence of death
85
lab value results for leukemia
- H&H (low) - platelets (low) - WBC can be high or low
86
child's response to loss: 5-7yrs
- death is viewed as reversible - "magical thinking"
87
child's response to loss: 8-11yrs
- understand that death is permanent - curious about life after death
88
child's response to loss: 12-18yrs
understand the abstract idea of death
89
older adult's response to loss: four multi-faceted areas
- loss of family + friends - loss of independence - loss of health - loss of memory
90
older adults are at risk for ____ as a response to loss
depression
91
bone marrow biopsy
- sample removed from posterior iliac crest - pressure held at puncture site and transparent dressing is applied
92
three phases of chemo
induction consolidation maintenance
93
induction
- aggressive, combination therapy - 4-6 week hospitalization
94
consolidation
- lower doses of induction regimen - goal is to cure - given as pt can tolerate - transplants can be considered during this time
95
maintenance
- done to prevent relapse - lower doses (IV or oral) - months to years
96
side effects of chemotherapy
- alopecia - stomatitis - kidney, liver, cardiac toxicity - nadir
97
precautions when chemo is adm.
- assess infusing lines - always wear PPE - oral chemo = do not break, crush, chew - infiltration or extravasation = immediately STOP infusion
98
two types of stem cell transplant
allogenic and autologous
99
allogenic
bone marrow from a donor
100
allogenic donor and pt details
- 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
autologous
bone marrow from self
102
autologous donor and pt details
- 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
two types of lymphoma
hodgkins lymphoma and non-hogkins lymphoma
104
hodgkins lymphoma cell
Reed-Sternberg- predictable spread from one group of nodes to another
105
hodgkins lymphoma details
one of the most treatable types of cancer
106
non-hodgkins lymphoma details
spreads through lymphatic system in a disorderly fashion
107
hodgkins lymphoma treatment
radiation and chemo
108
non-hogkins lymphoma treatment
- varies depending on extent - combination therapies including chemo, radiation, monoclonal antibodies
109
multiple myeloma
- cancer of WBCs - involves the B-lymphocyte secreting too many antibodies
110
multiple myeloma risk factors
- cause is unknown - radiation exposure - chemical exposure - infection certain Herpes virus
111
multiple myeloma treatment
- protease inhibitors - immunomodulating drugs - chemo (controls, doesn't cure)
112
what does multiple myeloma put you at risk for
anemia, infection, bleeding *d/t fewer RBCs, WBCs and platelets*
113
nursing interventions for dyspnea in dying pt
- position HOB at least 30 degrees - oxygen - opioid administration to slow breathing
114
nursing interventions for hypotension in dying pt
- assess color, cap refill, heart rate - promote safety if confused and dizzy
115
nursing interventions for anorexia, nausea, dehydration in dying pt
- encourage favorite foods - antiemetics: ondansetron or promethazine - routine oral care to decrease oral mucosa
116
nursing interventions for altered LOC in dying pt
- reorient and promote safety if pt is confused and rambling - speak slowly and be patient if pt has poor concentration
117
nursing interventions for pain in dying pt
- opioid administration - assess at least 2x/day - most feared symptom
118
advanced directives
legal documents outlining a client's preferred treatment plan
119
living will
describes the client's treatment preference regarding end-of-life care (intubation, tube feeding, resuscitation)
120
durable power of attorney for health care (DPOAHC)
empowers designated individual to make medical decisions (used only when pt cannot receive, evaluate, and/or communicate information)
121
VSED
refusal of feesing/hydration to speed death process
122
neoplasms
abnormal growths of new tissue that are classified as benign or malignant
123
benign
- localized growths - usually doesn't endanger life or health - doesn't invade other tissues, usually doesn't reoccur once removed
124
malignant
- grows aggressively - uncontrolled cells - invades other tissues, causing inflammation, bleeding, necrosis until something stops them (surgery, radiation, chemo)
125
two things that need to be present for somebody to develop cancer
1. damaged DNA 2. impaired immune system
126
carcinogens
- cancer-causing substances - chemical: tobacco, meds - physical: radiation, UV - viral: HPV
127
tumor lysis syndrome (TLS)
- oncologic emergency with rapid lysis of malignant cells - usually the result of chemo or radiation
128
complications caused by TLS
- hyperkalemia - hyperuricemia - hyperphosphatemia - cardiac arrhythmias - renal failure
129
treatment for TLS
- monitor labs - hydration
130
syndrome of inappropriate antidiuretic hormone (SIADH)
too much ADH = too much water = fluid volume overload

nur 2038 (3 decks)

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