Final: Anemia and Polycythemia (2-4) Flashcards
(114 cards)
1
Q
Characteristics/manifestations of
Anemia
A
Decreased RBCs (i.e., Lack of B12, B9, FeSo4) Blood loss (i.e., ulcer, trauma) RBC destruction (i.e., sickle cell, incompatable.blood)
2
Q
Polycythemia
opposite of anemia
A
Excess RBCs causing hyperviscosity and hypervolemia
3
Q
Clotting Disorders
Hint: (2)
A
DIC
Thrombocytopenia
Can also cause bleeding and anemia
4
Q
Neutropenia
A
Decreased WBC
specifically the neutrophils
5
Q
Which are the 3 components of the body that are determinants of tissue oxygenation?
A
Heart - good pumping in order to adequately perfuse the tissue
RBC - carry oxygen throughout our blood
Lungs - exchange of O2 and CO2
6
Q
Function of Red Blood Cells
A
Transport gases (O2 and Co2)
Hemoglobin binds with O2 and Co2
O2 attaches to iron on hemoglobin in lungs
Transported to tissues where it detaches
Co2 is picked up from the globin portion of the hemoglobin and transported to the lungs for exit
7
Q
How are RBCs made?
A
Erythropoiesis
8
Q
Erythropoiesis
Stimulated by
A
hypoxia (lack of o2)
9
Q
Controlled by erythropoietin from
A
kidney
- Erythropoietin stimulates bone marrow to make more RBCs (aka: erythrocytes)
10
Q
True or False:
A
RBCs live approximately 120 days
Requires vitamins B6 (pyridoxine), B9 (folic acid), and B12 (cyanocobalamin) and iron to make RBCs
11
Q
Which nutrients are needed for erythropoeitin?
A
: protein, iron, folate, cobalamin, riboflavin, pyridoxine, panthothenic acid, niacin, ascorbic acid, copper and vitamin E.
12
Q
Which endocrine hormones also affect RBC production?
A
thyroxine, corticosteroids, and testosterone also affect RBC production – for example – hypothyroidism is associated with anemia. In other words, low fx thyroid patients are very prone to anemia.
13
Q
T or F? Having too much testosterone can lead to too many RBC’s in the system?
A
Can lead to polycythemia condition, which is an overload of RBC’s.
14
Q
HGB - amount of oxygen carrying molecule in blood
- Male and Female values?
- What part does the oxygen molecule attach to?
- Globulin?
A
- Male = 14-18; Female = 12-16
(15 is the avg.) - O2 attaches to the heme
- CO2 to the globulin
3:1 relationship between HGB and HCT
15 hgb, hct expect to be about 45
15
Q
HCT – % RBC in blood
A
Male = 40-50%
Female = 36-44% (decreased compared to males, due to menstruation, plus men have more testosterone gives them higher RBC count)
16
Q
RBC Indice to focus on?
A
MCV
Mean Corpuscular Value
17
Q
WBC’s
A
neutrophils, lymphocytes, monocytes, eosinophils, basophils
18
Q
Platelets aka thrombocytes
A
Help with clottingform the initial platelet plug 150,000 – 450,000
19
Q
Different degrees of HGB
What happens if a patient does not have enough 02 to their bloodstream?
A
Mild = Hgb (hemoglobin) of 10 – 12 g/dL Moderate = Hbg of 6 – 10 g/dL Severe = Hgb of < 6 g/dL
Critical organs such as heart muscle and brain, kidneys
20
Q
What can occur if a patient has low Hgb?
A
Severe = Hgb of < 6 g/dL
Tissue damage/infarct can occur!
21
Q
What Ingredients Are Needed for RBCs ?
Need all these to make that perfect “cookie”
A
Protein Iron Folate (B 9 folic acid) Cobalamin (Vit B 12) Riboflavin (B 2) Pyridoxine (B 6) Other components
22
Q
If one ingredient is missing/omitted what will happen/which finding?
A
This will result in different types of anemia.
23
Q
If iron is ommitted from the RBC, which type of anemia does this result in? Hint: small
A
Microcytic anemia
24
Q
Which type of anemia will a patient have if they do not have enough Vit B12?
Hint: big RBC’s
A
Macrocytic
Do not fx well in the body
25
Hypocromic RBC's lack what? Or do not carry enough of this....
Does not contain enough iron
26
MCV (aka: Mean corpuscular volume)
What does this measure?
This measures the relative size of RBCS
Normocytic 80 – 100 femtoliter (fL) normal
Microcytic < 80 fL (think small chocolate chip cookie – not enough eggs)
Macrocytic > 100 fL (think big chocolate chip cookie – not enough flour) - does not function well just like a big chocolate chip cookie with flour missing does not taste as good.
27
```
Normocytic Anemia(this is anemia with normal size red blood cells)
Usual causes?
```
Sudden blood loss (body has not had enough time to compensate)
Prosthetic heart valves
Tumor
Long term disease
Decreased erythropoietin caused by renal failure
Blood loss can also be normocytic (gun shot wound, car accident)
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MicrocyticAnemia Usual What are the causes?
```
Biggest cause = iron deficiency
Why? Due to Chronic blood loss
Lead poisoning
Thallassemia
Inflammation
```
29
Why is this patient anemic? Which organ function are you going to look at?
What will be decreased?
```
Renal function (chronic disease of the kidneys means reduced production or erythropoietin)
Decreased stimulation of the bone marrow. Therefore, decreased mfg of RBC's
```
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MAcrocyticAnemiA
```
Usual Causes
Chemotherapy
Folate deficiency
Cobalamin (Vit B12) (Lacking Intrinsic Factor = Pernicious Anemia) Deficiency
*Alcoholism
```
31
RBC Indices
Decreased MCV, MCH, MCHC Possible causes?
<80
Iron deficiency anemia
Anemia of chronic illness
Chronic blood loss
32
Increased MCV
| Possible causes are? >80
Vitami B12 deficiency
33
Normocytic, normochromic anemia
Acute blood loss
| Sickle-cell disease
34
MCH (aka: mean corpuscular hemoglobin)
Measures mass of.....
Average mass of hemoglobin in a red blood cell – related to color of RBC
Shows how much o2 it is carrying due to amount of HGB
Normochromic 27-33 picograms (pg)/cell
Microchromic < 27 pg
Macrochromic > 33 pg
*MCH closely follows MVC values so…if one is low the other will likely be low
35
T or F? If you have a microcytic (small RBC) are you going to also have a lower MCH as well?
TRUE
36
MCHC measures.....?
The mean corpuscular hemoglobin concentration, a measure of the concentration of Hgb in a volume of packed red blood cells
Arrived at by dividing hemoglobin by hematocrit
i.e., Hgb of 7 divided by hematocrit of 21 = 33%
This value closely follows MCV and MCH…so if MCV or MCHCis low, the MCHC is usually low too! Focus on MCV values.
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How do RBC's appear when they are missing HGB?
They appear pale, and this is called hypochromic
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RDW (red cell distribution)
Measures.......?
Normal reference range?
size variation of RBCs
Normal reference range in human red blood cells is 11.5-14.5%
Greater the number means greater variation in RBC size
Lower the number means less variation in RBC size
Is used in correlation with MVC to diagnose cause of anemia – can be a complex analysis!
If there is a large variation in RDW, this can mean an acute problem (bone marrow making new RBCs)
This will likely happen when someone is actively losing blood for > than several days
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If your bone marrow is spitting out a lot of RBC's and initially they are immature bc maybe you are having blood loss, you're going to have a wider variation than if your body was in homeostasis and everything was just interchanging at the normal rate which is at 120 days. What is occurring?
larger variation in size of red blood cells signifies blood loss!
40
An anemic patient would present with?
Older adult
| Pale skin, maybe slight yellowing due to liver disease, recall that the liver is responsible for blood clotting factors
41
T or F? A decrease in the function in the liver will sometimes signify the presence of anemia concurrently with jaundice?
True
recall that the liver is responsible for blood clotting factors
42
Gerontologic Considerations
Common in older adults
Men in their 70s have decreased testosterone which inhibits erythropoiesis
Chronic disease
A hematological cancer such as colon cancer
Nutritional deficiencies
GI issues: i.e., difficult to absorb B12
Signs and symptoms may go unrecognized or may be mistaken for normal aging changes.
May be misdiagnosed as depression
43
Gerontologic Considerations
| Aging:
Decreased bone marrow –90% of bone marrow is made of hematopoietic tissue at birth,
this is reduced to 50% at age 50 and 30% at age 70.
Adults are more vulnerable to problems with clotting, transporting o2, fighting infection.
Iron deficiency, gi bleeding, renal disease, testosterone deficiency or bone marrow dysfunction can impact
Unexplained anemia in the elderly
Probable blunted response to erythropoietin.
WBC is not usually affected but older adult may only have a minimal elevation in the total WBC count
Platelets may have increased adhesiveness
44
What is the leading cause for anemia in older adults?
What would you notice in older adult men?
Decreased bone marrow
In older adult males, you will notice decreased testosterone production, due to inhibited erythropoiesis
45
Anemia Assessments
CNS: dizziness, fatigue,
fainting (in severe anemia)
Blood: Low BP
(Heart is trying by compensating: heart is working OT to get blood to circulate) In severe anemia you will see: chest pain, angina, heart attack
Palpitations, Rapid heart rate
Spleen enlargement, due to the unusual size of the RBC they can get caught in the spleen.
Muscular - weakness, due to poor oxygenation
Yellowing of the eye
Skin- pale, cold, yellow
Respiratory (SOB) as compensatory mechanism
46
What can occur if your patient presents with a HGB of <6 or under?
What will the patient experience?
It can cause a heart attack in our patient, if we are not able to replace their blood, including providing oxygenation.
Chest pain, angina, heart attack
47
Change in stool occurring in anemia describe both types
Change in stool - melena (dark tarry stools which signifies an upper GI bleed, accompanied by foul odor and hematachexia is bright red blood from lower intestinal area bc hasn't been digested yet)
48
What are some subjective assessments?
PMH – liver, kidney, pleen, organ transplant, IV drugs, ETOH, infections, blood clotting
Medications: warfarin, chemo, antiretroviral agents, antiepileptics
Surgery – splenectomy, tumors, heart valve placement, excision of duodenum, malabsorption, gastric bypass.
Usual state of health?
Jaundice, cancer, RBC disorders,
Genetic disorders: sickle cell disease, hemophilia, thalassemia, hemochromatosis, leukemia, pernicious anemia, clotting disorders
Nutritional – meat, fish, eggs, leafy greens, legumes, citrus, wholegrains.
Elimination – blood in stool – black tarry
Past radiation to chemicals or radiation
Vietnam War – agent orange –leukemia/lymphoma
49
What are the key vital signs for anemia?
Bp
Heart Rate
RR
50
How will the heart respond?
Severe anemia:Chest pain, angina, heart attack
51
How will the respiratory system respond?
RR (SOB)
Sometimes patients may be very SOB when they are anemic but after they sit down their RR decreases and gets back to normal
52
When will orthostatic BP be indicated?
It is a way of determining if there is a fluid shift or change in the homeostasis of our body.
You do not need a doctor's order to do orthostatic.
If you suspect a patient has lost a lot of blood or fluid then take an orthostatic BP.
53
What will the patient tell you about how they are feeling?
Weakness and general fatigue
54
How to take orthostatic vital signs:
1. Have patient lie flat for 5 minutes.
2. Take heart rate and BP
3. Sit them up and wait 1-3 minutes
4. Take heart rate and BP
5. Stand them up and wait 1-3 minutes
6. Take heart rate and BP
55
What is the orthostatic hypotension? (low BP)
```
If systolic drips by 20
If diastolic drops by 10
If HR increases by 20
If patient dizzy when stands
= Orthostatic v/s
```
56
Key Points in Blood Transfusions
Consent signed
Two licensed RNs must identify patient
Vitals signs before for baseline
***Remain with the patient during the first 15 minutes or 50 ml of infusion, then retake vital signs
Give between 2-4 hours in most patients
Observe for reactions: hemolytic (due to ABO incompatibility), febrile, allergic, circulatory overload, etc.
57
How will you know if patient is having a reaction during transfusion?
```
Free hemoglobin in urine or blood
Fever
SOB
Adventitious lung sounds
Any change in vital signs (i.e., hypertension, hypotension, tachycardia, tachypnea)
Nausea, weakness
Shivering or shaking
```
58
An 82-year-old male requires a blood transfusion.
You give him the first unit and are about to give him his next unit when he complains of chills and feels like “his heart is racing.”
What would you do?
1. stop the transfusion!!
2. Verify that the patient has a good IV line with NS keeping that IV open.
3. Notify blood bank
4. Recheck the identifying tags and numbers, making sure you are giving them the right units.
5. Monitor vitals, I's and O's
6. Treat symptoms per HCP order
7. Save blood bag and tubing and send to BB for examination
8. Get blood and urine specimen
9. document everything and how you kept your patient safe!
59
Does Intermittent Iron Supplementation Improve Anemia in Menstruating Women?
Intermittent iron supplementation in menstruating women is beneficial and an effective alternative when daily supplementation is not done. However, daily supplementation has best outcome.
60
General Nursing Interventions in Anemia
| What do you do as a nurse?
Administer blood products – watch for reactions
Monitor lab values - HGB and HCT
(15:45)
Oxygen therapy
Keep environment safe - monitor for falls, burns, paresthesia
Patient education (increase folic acid and iron containing foods, stop drinking!!
Alternate periods of rest with activity 9 (no Dr. order needed)
Especially after meals to decrease competition for supply to vital functions
Treat the cause
61
Assess high risk patients, which patients are susceptible to losing blood?
```
Cancer patients
Taking certain meds
Chemotherapy patients
Poor nutrition
Alcoholics (macrocytic)
```
62
Assess for improving or worsening symptoms, monitor vital signs
HR
BP
RR
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EPO therapy intervention
administer Iron therapy via IV
Medications such as erythropoietin (EPO) given as injection to stimulate production of RBC's
(athletes use this to increase their endurance)
64
How would you give patient centered care to a Jehovah’s witness refusing a blood transfusion?
Document that you witness physician teaching them the risk.
Option administer EPO, iron, fluids
Ultimately any patient can refuse anything. Treat wishes with utmose respect.
65
A nurse is caring for a patient who has an Hgb of 6.2 and an Hct of 18.4. Which of the following should the nurse include in this client’s plan of care? Select all that apply.
A. Monitor pulse rate
B. Assess color and consistency of stools
C. Encourage frequent ambulation
D. Prepare to administer packed red blood cells as ordered
E. Assess for dizziness and potential for falls
A. Monitor pulse rate
B. Assess color and consistency of stools
D. Prepare to administer packed red blood cells as ordered
E. Assess for dizziness and potential for fall
66
How will you teach your patient to take iron?
1. If it's liquid form have pt. drink through straw to avoid teeth staining.
2. Advise to take on empty stomach bc iron absorbs best in acidic environment, can take with OJ
3. Teach them about constipation, increase water intake, take fiber
4. Tarry dark stools are normal
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```
Case Studies #1 Mrs. Jones
Hgb 4.5
Hct 13
MCV 70
1. What do you think is going on here? List several possible causes.
```
2. What symptoms do you expect?
3. What is your initial treatment?
Hgb <4.5 critical anemia
Hct 13
MCV 70
1. Patient has low critical values, could either be losing blood or have an iron def. anemia
2. increased HR, pallor, pale skin, orthostatic hypotension, dizziness.
3. Establish an IV, give fluids while waiting for packed RBC's to help body with oxygenation
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```
#2 Chelsea
Hgb 11
Hct 33
MCV 95
1. What do you think is going on here? List several possible causes.
```
2. What symptoms do you expect?
3. What is your initial treatment?
1. Values are low but not as low as Mrs. Jones. (prob. moderate anemia)
MCV is w/in normal range.
2. Normocytic anemia (normal size), often due to chronic medical condition, I.e. cancer, tumor, chronic periods.
3. Tx: multivitamin, blood transfusion?
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```
#3 Mario
Hgb 8
Hct 24
MCV 110
What do you think is going on here?
```
List several possible causes.
What is your initial treatment?
```
Hgb 8 (low)
Hct 24 (low)
MCV 110 (high) macrocytic)) may be abusing alcohol or pernicious anemia which means unable to absorb the vitamin B12
```
Tx: cause....blood transfusion due to low Hgb, Hct
70
```
#4 Akemi
Taylor has been taking Dilantin for 20 years and drinks a bottle of wine each night. She is extremely pale, tired and has exertional dyspnea. When checking her conjunctiva, you cannot see any blood vessels on inside the lower lid (pale, not pink sign of anemia!). What blood indices would you expect?
Hgb
Hct
MCV
Treatment?
```
Hgb - prob. around 10 (low)
Hct - 30
MCV - macrocytic bc this is caused by medication and alcohol.
Treatment? Tx cause and consider a blood transfusion
"Banana bag" replaces Mg, all of B vits, to replace vits that are lacking due to chronic alcoholism
71
Name the 3 Coagulopathies:
Polycythemia, thrombocytopenia, neutropenia
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Polycythemia
What is it?
Type of dysfunction?
What is a main complication?
Increase production and presence of RBCs, platelets and WBC's – bone marrow dysfunction, bone marrow becomes overreactive and increases the levels of all of these things.
Causes hyper-viscosity "pancake batter" therefore, blood is not going to flow well in patient's body.
Hypervolemia - cause CHF , pulm Ed. , SOB, BP problems high, cardiac dx leads to stroke
Clotting is a complication - lack of O2 to tissues and organs. Increase in platelet counts due to increase in RBC's
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Primary: referred to as?
Polycythemia Vera
a myeloproliferative chromosomal disorder
Increased RBCs, WBCs, and platelets
Median age 60 > males
74
Secondary: referred to as?
a physiological compensation to chronic hypoxemia
pulmonary dz, heart dz
High altitudes (body thinks you don't have enough RBC's, therefore EPO will occur,
75
Signs and symptoms of Polycythemia will be related to the problems that increase RBC's such as:
```
CHF
Stroke
MI
Red flushed skin
puffy looking extremities
```
76
Collaborative Management (Treatment)
1. When a patient is bedridden in a hospital what do you do as a nurse to encourage blood flow? (Risk of having a DVT)
2. Medical interventions?
1. Ambulate, give aspirin, fluids
| 2. These pts. may also receive phlebotomy to produce blood volume (such as taking out RBC's)
77
Medications for polycythemia? To reduce amt. or RBC's (bone marrow is making)
Myelosuppressive agents (i.e., ***Hydrea, Myleran)
***Low dose ASA (prophylaxis of vascular events)
Interferon alpha
Allupurinol (reduce gouty attacks)
78
Assessment
| Subjective
```
Headache
SOB
Weakness
Double Vision (from HBP)
Sweating, particularly at night
Dizziness
Loss of weight
Pain and swelling in the joint, especially in the big toe
```
79
Diagnostic tests findings:
- elevated Hgb & RBC count
- elevated WBC count
- elevated Platelet count
- EPO levels elevated
80
Nursing Interventions
Monitor lab values
Control hypoxia to prevent secondary polycythemia vera
Perform or assist with phlebotomy
*Monitor I & O – this ensures hydration
(we don't want to make blood thicker by eliminating fluids)
Prevent thrombus formation
Ambulate patient
Give ASA (aspirin)
81
How do you control hypoxia to prevent secondary polycythemia?
Tell the patient to avoid high elevations! Can't go over 10K feet (i.e) or this will kick in EPO causing bone marrow to make too many RBC's resulting in polycythemia.
82
Thrombocytopenia
| <150,000
Reduction in platelets below 150,000/ microliter
for hemorrhage
Platelets live 10 days
Produced in bone marrow
83
Thrombocytopenia- Under 80,000/microliter indicates high risk for
hemorrhage
Worst place you can bleed is in the brain! Cranium does not expand; tissue will herniate!
Monitor that platelets do not go below 80k
84
Let’s Review Thrombocytes (AKA: platelets)
Thrombocytes
Normal blood clotting mechanisms minimize.....?
blood loss after injury
85
4 components of normal hemostasis
1. Vascular response (vasoconstriction)
2. Platelet plug formation
3. Development of fibrin clot on platelet plug by plasma clotting factors
4. Lysis of clot
86
What are the Major Types of Thrombocytopenia?
1. Hereditary
Hemophilia & Von Willebrand Disease (clotting factor abnormalities)
2. ITP (AKA: Immune thrombocytopenia)
Lifespan of platelets decreased due to autoimmune processes
3. TTP (AKA: Thrombotic thrombocytopenia)
Uncommon – caused by deficiency of plasma enzyme, meds, lupus
4. DIC (AKA: Disseminated intravascular coagulation)
Clotting and bleeding occurs at same time due to causes such as arrest, septicemia, and hemorrhage
5. HIT (AKA: Heparin induced thrombocytopenia)
87
Other Factors Causing Thrombocytopenia
Decreased production (bone marrow suppression)
Trapped in the spleen (splenomegaly)
88
Which medications cause low production of platelets? (thrombocytopenia)?
i.e., Aspirin, Quinine, Thiazides, Digoxin
Quinine is antimalarial
thiazide diuretics are an FDA-approved class of drugs that inhibit the reabsorption of 3% to 5% of luminal sodium in the distal convoluted tubule of the nephron. By doing so, thiazide diuretics promote natriuresis and diuresis. Three thiazide diuretics are the most commonly used: hydrochlorothiazide (HCTZ), chlorthalidone, and indapamide.
Digoxin (better known as Digitalis), sold under the brand name Lanoxin among others, is a medication used to treat various heart conditions. Most frequently it is used for atrial fibrillation, atrial flutter, and heart failure. Digoxin is one of the oldest medications used in the field of cardiology. It works by increasing myocardial contractility, increasing stroke volume and blood pressure ...
89
Labs
| Hereditary
Platelet - Low, everything else is Normal
Size platelets
PT*
aPTT
90
Labs
| ITP
Platelet - Low,
Size platelets - ABNormal
PT* - Normal
aPTT - Normal
91
DIC
Platelet - Low, everything else is Normal
Size platelets - Low
PT* - ***HIGH
aPTT - ***High
92
HIT
Platelet - Low, everything else is Normal
Size platelets
PT*
aPTT
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Most lab values will be similar for different thrombocytopenias, except for.....?
DIC where there are low platelets and increased bleeding times.
94
* PT – Protime: Measure of
aPTT – Activated partial thromboplastin time: How long blood takes to clot with additives.
Vitamin K dependent clotting ability. We are using mainly INR to replace the PT value now because it is more accurate.
95
aPTT – Activated partial thromboplastin time:
How long blood takes to clot with additives.
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DIC
| Disseminated Intravascular Coagulation
Bodies reaction to trauma, or severe disease. The body goes whacky, low platelets plus prolonged clotting times, therefore the patient is going to be bleeding.
97
What is a patient going to have when presenting with DIC?
Lab Findings
Low platelets and fibrinogen
Prolonged clotting times by all measures (PT, aPTT, Thrombin Time)
Elevated fibrin split products (fibrin degradation products) which cause clotting. This is a medical emergency, body is growing clots, but also bleeding at the same time. Organ failure can have DIC.
Placenta abruption, DIC can occur. (maternity)
Bleeding in brain!
98
What would be the first sign that you notice if bleeding in the brain occurs?
Altered mental status
Slower than normal, groggy, important to assess patient first thing in the morning to pick up changes throughout your shift.
99
Assessment
Petechia - tiny red dots under the skin that are a result of very small bleeds
Purpura - the purple color of the skin after blood has "leaked" under it.
Assess H & H
100
Medical Treatment of Thrombocytopenia
Depends on cause:
First step: Stop heparin and avoid future heparin (If HIT)
Avoid other anticoagulant/antiplatelet medications
Platelet infusion for severely low counts
Splenectomy
Immune suppression for autoimmune etiology
Oprelvekin (Neumega) – a platelet growth factor
Corticosteroids (decreasese immune response)
101
MEDICATIONS
| for thrombocytopenia
ITP: Corticosteroids and immunosuppressants
HIT: Anticoagulants with direct thrombin inhibitors:
argatroban, lepirudin, bivalirudin
Recall that thrombin initiates hemostasis by activating other clotting factors
DIC: Anticoagulants (heparin) can be used to decrease microclots from forming and using up clotting factors (clotting is worst so anticoagulant might be given)
102
Collaborative Care for thrombocytopenia
***Early detection is essential
Treatment of underlying cause
Replacement of missing factors for severe hemorrhage
Cryoprecipitate, FFP, Platelets
Prevent exsanguination
Drug treatments are controversial and not highly effective (heparin, amicar, lovenox)
103
Nursing Care
Protect from injury
Transfusion of platelets
*Avoid IM injections/procedures/central lines
Monitor labs, vital signs, assessments
Monitor response to and side effects from medications
Education: Soft toothbrush ok, avoid injury, pressure dressings, watch for signs bleeding (tarry stools, etc.)
104
A nurse is caring for a client who has idiopathic thrombocytopenic purpura (ITP). The nurse should notify the provider and report possible small‑vessel clotting when which of the following is assessed?
C.
A. Petechiae on the upper chest (bleeding not clotting)
B. Hypotension (bleeding not clotting)
C. Cyanotic nail beds (this is clotting! vasculature under the fingers)
D. Severe headache (large vessels in the blood)
105
Leukopenia decreased in total WBC
Low white blood cell counts <4000
**This is not a disease, this is just a syndrome.
Low white blood cell count (normal 4,000-11,000)
Neutropenia – decreased neutrophils
Leukopenia - decreased in total WBC
Varied causes – not a disease, a syndrome
Evaluation of cause may include CBC, peripheral smear and bone marrow aspiration.
Major nursing diagnosis: Risk for infection
106
Types and Functions of Leukocytes
TYPE
CELL FUNCTION
Granulocytes
Neutrophil (immature = *bands, or stabs)
* Most common. First to respond in bacterial infection. Phagocytosis, early phase of inflammation
Eosinophil
Allergic infections, parasitic infections
Basophil
Inflammatory response, allergic response, become mast cells that can release histamine and heparin.
Agranulocytes
Lymphocyte
Cellular, humoral immune response T and B cells
Monocyte
Become macrophages, Phagocytosis, cellular immune response
107
1. What are the very first WBC that are produced called?
| 2. And what does a high band count signify?
Bands = "baby neutrophils"
An acute newer infection
108
Clinical Manifestations of Leukopenic patients
At risk for infections & opportunistic pathogens
Leukopenic patients may not have typical signs: redness, heat , swelling, pus formation, high fever
Presence of low-grade fever with neutropenia is of great significance – indicates infection & leads to septic shock and death unless treated promptly
Neutropenic fever greater than 100.4 F and/or neutrophil count less than 500/uL is med emergency
*Any minor complaint or symptom should be taken seriously in a neutropenic patient
109
Neutrophils If neutrophils are low, patient will have
decreased ability to fight infection.
Most important for assessing patient’s risk of infection.
Bands = early neutrophils
bands = baby (both start with B) = new
if this value is high, it signifies a new infection
110
Diagnostic Studies
Neutropenia diagnosed by WBC & bone marrow aspiration or biopsy
WBC count less than 4000/uL (microliter) = leukopenia
Neutrophil count 1000 – 1500/uL = neutropenia
500 – 1000/uL is moderate risk of infection
Less than 500/uL is severe risk of infection
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Collaborative Treatment
Identify underlying cause
Monitor for and prevent infection
Cultures, blood cultures
If febrile, start antibiotics within 1 hr
Strict hand-washing is the most important
Early and aggressive antibiotic therapy for infection
Stop offending drugs if possible
Observe for sepsis and septic shock – this can kill patient!
***Administration of colony stimulating factors (G-CSF- Neupogen, GM-CSF)
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Nursing Care
Private room
Cultures (blood, sputum, urine, throat)
Antibiotics
Strict hand washing
Visitor restriction and screening
Medication administration
Assess for changes
Fever, lethargy, signs of infection , septic shock
Positive pressure room w/ HEPA filter or appropriate isolation – referse isolation
Patient and family education
Handwashing, signs of infection, skin care, why cultures are needed
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Patients are admitted to hospitals because
they need nursing care!
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Science + Caring = Good Patient Outcomes!
When nurses show empathy, they foster a collaborative relationship with patients
This can help in rooting out causes, symptoms or explanations that result in a proper diagnosis and appropriate treatments.
Open communication and mutual respect between nurses and their patients can result in these positive patient outcomes:
Shorter hospital stays.
Alleviation of pain.
Decreased anxiety.
Optimistic outlook about recovery.
