Exam 4: Assessment and care of patients with hematologic problems (10 questions) Flashcards Preview

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Flashcards in Exam 4: Assessment and care of patients with hematologic problems (10 questions) Deck (28):
1

Hematologic system physical assessment

- Pain

- Cardiovascular changes
SOB, weakness, fatigue
Heart sounds
Cap refill
Pulses

- Skin changes
pallor or cyanosis
jaundice

- Renal and urinary
- Musculoskeletal
- Abdominal
- Central nervous system
- Psychosocial

2

RBC abnormal significance

Elevated > 5.4 million (females) & > 6.1 million (males)
- erythrocytosis, polycythemia vera, severe dehydration

Decreased < 4.2 million (female) & < 4.7 (males)
- anemia hemorrhage, kidney disease

3

WBC abnormal significance

Elevated > 10,000/mm3
- Infection, inflammation

Decreased < 5,000/mm3
- Immunosuppression, autoimmune disease

4

MCV abnormal significance

Elevated > 95 fL
- macrocytic (large) RBCs, megaloblastic anemia

Decreased < 80 fL
- microcytic (small) RBCs, iron deficiency anemia

5

MCH abnormal significance

Elevated > 31 pg/cell
- macrocytic (large) RBCs, megaloblastic anemia

Decreased < 27 pg/cell
- microcytic (small) RBCs, iron deficiency anemia

6

TIBC abnormal significance

Elevated > 460 mcg/dL
- Iron deficiency anemia, polycythemia vera

Decreased < 250 mcg/dL
- malnutrition, cirrhosis, pernicious anemia

7

Iron abnormal significance

Elevated > 160 mcg/dL (female) & > 180 mcg/dL (male)
- Hemochromatosis, iron excess, liver disorder, or lead toxicity

Decreased < 60 mcg/dL (females) & <80 mcg/dL (males)
- iron deficiency anemia, chronic blood loss, inadequate dietary intake of iron

8

Platelets abnormal significance

Elevated > 400,000 mm3
- malignancy, polycythemia vera, rheumatoid arthritis

Decreased < 150,000 mm3
- enlarged spleen, hemorrhage, leukemia

9

HGB abnormal significance

Elevated > 16 g/dL (females) & > 18 g/dL (males)
- erythrocytosis, COPD, severe dehydration

Decreased < 12 g/dL (female) & < 14 g/dL (male)
- anemia, hemorrhage, kidney disease

10

HCT abnormal significance

Elevated > 47% (female) & > 52% (male)
- erythrocytosis, COPD, severe dehydration

Decreased < 37% (female) & 42% (male)
- anemia, hemorrhage, kidney disease

11

APTT abnormal significance

Elevated > 40 seconds
- vitamin K deficiency, disseminated intravascular coagulation (DIC), liver disease, heparin administration

Decreased < 30 seconds
- extensive cancer

12

PT abnormal significance

Elevated > 12.5 seconds
- liver disease, warfarin therapy, disseminated intravascular coagulation (DIC)

Decreased < 11 seconds
- vitamin K excess, pulmonary embolus, thrombophlebitits

13

INR abnormal significance

Elevated > 1.1
- warfarin therapy

Decreased < 0.8
- cancer disorders

14

D-Dimer abnormal significance

Positive result > 0.4 mcg/L
- disseminated intravascular coagulation (DIC), malignancy

Negative result
- can rule out pulmonary embolus or deep vein thrmbosis

15

Fibrinogen abnormal significance

Elevated > 400 mg/dL
- acute inflammation, acute infection, heart disease

Decreased < 200 mg/dL
- liver disease, advanced cancer, malnutrition

16

Fibrin degradation abnormal significance

Elevated > 10 mcg/mL
- disseminated intravascular coagulation (DIC), massive trauma resulting in fibrinolysis

Decreased
- anticoagulation therapy

17

Bone Marrow Aspiration nursingpost op care

- apply pressure to site to prevent bleeding
- sterile dressing
- bedrest 30-60 min
- monitor signs of infection
- Ice
- mild analgesics
- avoid aspirin and anticoagulants

18

Iron deficiency anemia symptoms

- Pallor, fatigue
- Numbness of extremities
- Dyspnea on exertion
- Sensitivity to cold
- Tachycardia
- Dizziness, syncope
- Headache
- Increased somnolence

19

Iron deficiency anemia risk factors

Deficiency in components
- not enough iron in diet

20

Iron deficiency anemia treatment: diet

- Red meat, organ meat, egg yolks, kidney beans, green leafy vegetables
- Nuts, dairy products, citrus fruit

21

Iron deficiency anemia treatment: medication

- Ferrous sulfate orally
- Iron dextran parenterally
- Erythropoietin

22

Sickle cell symptoms

- Pain
- Cardiac
- Priapism
- Skin changes
- Organ damage
- Liver, kidneys, CNS
- Joint damage

23

Sickle cell diagnosis

Sickle cell test
- Evaluates the sickling of RBCs in the presence of decreased oxygen tension

24

Sickle cell management

- Hydration
- Oxygenation
- Pain control

25

Leukemia Treatment

- Chemotherapy
Induction, Consolidation, Maintenance

- Bone marrow transplant

26

Leukemia bone marrow transplant

Hemopoietic stem cell transplantation (HSCT)
- Requires chemotherapy to purge leukemia cells
- Transplant of new stem cells are infused and begin hematopoiesis

Types
- Autologous (Pt. own)
- Syngeneic (from relative)
- Allogeneic (matching donor)

27

Lymphoma: Hodgkin's

Begins in a subset of white blood cells called lymphocytes

- Reed-Sternberg cell present (usually derived from B lymphocytes, )

28

Lymphoma: Non-Hodgkin's

- Begins in a subset of white blood cells called lymphocytes

- Reed-Sternberg cell NOT present