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NP 4- TOP 8 > HEMATOLOGIC DISEASES > Flashcards

HEMATOLOGIC DISEASES Flashcards

1
Q

Blood Components

A
  1. RBC/ Erythrocytes: ↓ RBC= ANEMIA
  2. WBC/ Leukocytes: ↓EBC= LEUKOPENIA
  3. Platelet/ Thrombocytes: ↓platelets:
    Thrombocytopenia
    4.Plasma: Liquid Portion of Blood
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2
Q

↓RBC, ↓WBC, ↓PLATELET

A

APLASTIC ANEMIA

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3
Q

2 types of Plasma

A

-Serum Plasma
-Protein Plasma

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4
Q

type of plasma which is the Liquid portion of blood

A

SERUM PLASMA

↑PLASMA
-Hemodillution
-↓ blood viscosity

↓PLASMA
-Hemoconcentration
-↑blood viscosity
-Risk for thrombus (clot formation)

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5
Q

type of plasma that is Produced by the liver

A

PLASMA PROTEIN

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6
Q

Types of plasma protein

A

-ALBUMIN
-FIBRIN
-GLOBULINS

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7
Q

Type of protein plasma that is abundant and (+) oncotic pressure, stays in the intravascular

A

ALBUMIN

↓Albumin
-Hypoalbuminemia
- (-) oncotic pressure
-Edema & Ascites

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8
Q

Type of protein plasma that is the clotting factor
Risk for: Bleeding & ecchymosis

A

FIBRIN

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9
Q

3 Types of Globulin

A

AH- BI- GA
-Alphaglobulin: transport Hormones
-Betaglobulin: transport Iron
-Gammaglobulin: transport Antibodies
:Produces in WBC (B-cells)
but scattered in plasma

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10
Q

Antibodies attack its own cells/body

A

Autoimmune disease

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11
Q

Treatment & Drug of choice for autoimmune diseases

A

Tx: Plasmapheresis: removal of antibodies on plasma

DOC: Steroids (Prednisone)

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12
Q

Complications of Plasmapheresis

A
  1. Immunosuppression
  2. Hypovolemia (Hypotension)
  3. Allergic Reaction
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13
Q

BLOOD PREPARATION

A

-Whole blood
-Packed RBC
-Platelet Concentrate
-FFP (Fresh Frozen Plasma)

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14
Q

Whole Blood

A

-Massive blood loss
-Hypovolemic shock
-Surgery: amputation

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15
Q

Packed RBC

A

-Anemia
-Fluid overload
-CHF
-Pulmonary Edema
-Renal Failure

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16
Q

Platelet concentrate

A

-Bleeding disorders
-Dengue
-Thrombocytopenia
-Hemophilia
-ITP (Idiopathic Thrombocytopenia Purpura)

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17
Q

FFP (FRESH FROZEN PLASMA)

A

-↑Blood Viscosity
-Burns: ↑hematocrit
-Polycythemia Vera

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18
Q

Whole Blood & Packed RBC must be transfused within:

A

2-4 hours; Maximum of 6 hours

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19
Q

Platelet concentrate & FFP must be transfused within:

A

10-20 minutes

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20
Q

Nursing Safety during Blood Tranfusion:

A

Blood typing, cross, matching, and transfusion orders must be checked by
“2 NURSES”

If there is only 1 available nurse
“GO TO THE NEAREST NURSING STATION”

If 2 units is received:
“TRANSFUSE ONLY 1 UNIT AND SEND THE 1 UNIT IN THE LABORATORY”

If there is an error notice in the blood details:
“RETURN TO THE BLOOD BANK”

What must be done prior to transfusion:
“CARDIOPULMONARY (CP) CLEARANCE”
-To adjust rate

Monitor for complication of blood transfusion

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21
Q

What to prepare for Blood Transfusion

A

-Blood set
-Large-Bore needle (Gauge 18)
-PNSS (Saline solution): NO D5
CONTAINING, CAUSES HEMOLYSIS
-Alternative line: For emergency meds.

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22
Q

Blood Tranfusion Complications:

A

-Pulmonary Edema
-Tranfusion Reaction

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23
Q

Blood Tranfusion Complications: Cause of Pulmonary edema

A

Rapid Infusion

Manifestation:
-Dyspnea
-(+)Rales or Crackles

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24
Q

Management for Pulmonary edema

A

-↓ Infusion Rate: don’t stop since its compatible
-POC: High backrest
-DOC: Diuretics : Eliminate excess fluid

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25
Q

Blood Tranfusion Complications: Cause transfusion reaction

A

Incompatible blood

Manifestations:
-SOB
-Tightness of throat
-Wheezing

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26
Q

Plan of care for Transfusion Reaction:

A

-Stop the infusion
-Infuse Saline solution (NSS)
-POC: High backrest
-DOC: Epinephrine (Rapid acting Bronchodilator)

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27
Q

Blood type , Destroys, Tranfuse

A

BLOOD TYPE DESTROYS TRANSFUSE
A B, AB A,O
B A, AB B,O
AB X A, B, AB, O
O AB O

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28
Q

Universal Recipient

A

AB

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29
Q

Universal Donor

A

O

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30
Q

Cross matching

A

”+” : Impure; Presence of Antigen
“-“: Pure

A+ = A+
A-= A-

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31
Q

-Microcytic Anemia
-Hypochromic Anemia

A

Iron Defeciency Anemia (IDA)

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32
Q

Manifestations of IDA

A

4F’s
-Fatigue (Tiredness)
-Fainting
-Forgetfulness
-Fallor (Pallor)
+
-Dyspnea & Tachycardia
-Pale White Tongue

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33
Q

Early sign of IDA

A

Dyspnea & Tachycardia

-Compensatory Mechanism ↓ O2

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34
Q

Late S/sx of Anemia

A

Concave Fingernails or Spoon Nails

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35
Q

PLAN OF CARE FOR IDA:

A

Diet: ↑Iron Diet
-Organ Meat: Liver =↑abundant in Iron
-Lean Meat: No fat, Full meat
-Green Leafy Vegetables: Easy Access

Iron supplement
-When: Before meal
-How: w/Orange juice or w/Vitamin C
-Black Stool: Normal, Document
-Constipation: ↑fiber diet & fluid intake
-Staining of teeth (yellow): Should be taken w/ straw

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36
Q

When is the best time to give Iron Supplement?

A

Before Meals
-↑hcl

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37
Q

How will you give Iron Supplement?

A

With Orange Juice
With Vitamin C

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38
Q

Iron IM is given via?

A

-Given via Z-track Technique or zigzag technique

R: Prevent Leakage in subq tissue, prevent staining

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39
Q

Contraindication of Iron

A

Dont’s of Iron:
CA-TS-MI-EG- A

CApe( Coffee)
TSaa (Tea)
MIlk: Breastfeeding
EGg
Antacids: ↓Iron absorption; ↓Hcl

-Coffee & Tea= Stimulants
-Milk & Egg= Calcium
↓Iron absorption

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40
Q

Why Iron must not be given along with Antacids?

A

Antacids: ↓Iron absorption; ↓Hcl

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41
Q

↓Folic Acid or B9
↓B12

A

Megaloblastic Anemia

42
Q

Common Cause of Megaloblastic Anemia

A

-Overcooking of Green Leafy Vegetables:
↓B9
-Alcoholism

43
Q

Complications of Megaloblastic Anemia:

A

-Neural Tube defects
-Macrocystic anemia
-Hyperchromic anemia
-Large RBC: Malabsoprtion Syndrome

44
Q

Manifestation of Megaloblastic Anemia

A

-IDA + “Sore Tongue”
-4F+ dyspnea & tachycardia

45
Q

PLAN OF CARE FOR MEGALOBLASTIC ANEMIA:

A

-Encourage Green Leafy Vegetables
Broccoli
Spinach
Asparagus
Broad Beans

-Folic Acid Supplement: 1mg/Day PO

46
Q

Lack of intrinsic Factor that absorbs Vitamin B12 (Cyanocobalamine)

A

PERNICIOUS ANEMIA

47
Q

Common Cause of Pernicious Anemia

A

Gastric Surgery
-Gastrectomy
-Antrectomy

Billroth 1: Gastroduodenostomy;
Gastric Ulcer
Billroth 2: Gastrojuojenostomy;
Duodenal Ulcer

Antrum: base of stomach —>
Parietal Cell: Produces HCL & Intrinsic Factor which absorbs Vit. b12

48
Q

Manifestation of Pernicious aNEMIA

A

IDA +”Beefy Red tongue”
+
“Peripheral Neuritis”

49
Q

Function of Vitamin B12

A

RBC production= IDA
Myelin Sheath Formation = Peripheral
Neuritis

50
Q

Diagnostic Test for Pernicious Anemia

A

Schilling’s Test
-Radioactive Vit. B12 (Oral
-24 hour urine collection
↑ 40% Vit B12 (urine)
= (+) Pernicious Anemia

51
Q

Management for Pernicious Anemia

A
  1. Given Vit. B12 (IM): IM Injection every month for life
    **Uncompliance: Death within 2-3 years
  2. Give Hcl solution 10ml mix with water for 1 week after vitamin B12 Administration.
52
Q

PERNICIOUS ANEMIA (↓ B9) IS PART OF MEGALOBLASTIC ANEMIA (↓B12)

A

SKL

53
Q

Sickling or Clamping of RBC
Crescent Shaped RBC

A

Sickle-cell anemia

54
Q

Normal shape of RBC

A

Spherical

55
Q

Shape of RBC with Sickle cell anemia

A

Crescent Shape

56
Q

Predisposing Factors of Sickle Cell Anemia

A

-Dehydration
-Stress
-Surgery
-↑ Altitude
-Infection

***Causes clamping of RBC
Not Rigid: Reversible
Rigid: Irreversible

57
Q

Sickle cell can’t enter the Vessel because of obstruction
-Microcirculation is obstructed by sickled RBC, causing ischemic injury to organ and resultant pain.

A

Vaso-Occlusive Crisis

58
Q

Manifestation of sickle-cell anemia

A

Splenomegaly
Anemia
Hypovolemic Shock
Joint pain
Erectile Dysfunction

59
Q

Pooling of blood in the spleen

A

Hypovolemic Shock

60
Q

Sequestration of blood in spleen

A

Splenomegaly

61
Q

Destruction of RBC, by the spleen that results to ↓ RBC

A

ANEMIA

62
Q

Plan of Care for Sickle-Cell:

A

1) PRIORITY: H-O-P
-Hydration: Oral; IV =To inflate cells
-Oxygen Administration
-Pain Management:
DOC: Morphine Sulfate (Opiod/Narcotics)

2) Blood Transfusion: Due to Anemia

3) Diet:
↑ Calories: Provide Energy
↓ Iron: Destroyed RBC leaves Iron =
Iron Toxicity
↑Folic Acid: Replacement for IRON

  1. IRON TOXICITY:
    DOC: Deferoxamine
63
Q

What is replacement of Iron for Sickle Cell Anemia?

A

Folic Acid

64
Q

Diagnostic Test for Sickle Cell Anemia:

A

1) Sickle-Turbidity Test/ Sickledex
-Blood is mix in sickledex solution
Result: Cloudy = (+) Sickle Cell Anemia

2) Hgb Electrophoresis
-Introduction of electricity in the blood that causes clamping

65
Q

Vit B1

A

Thiamine

66
Q

Vit B2

A

Riboflavin

67
Q

Vit B3

A

Niacin

68
Q

Vit B5

A

Pantothenic Acid

69
Q

Vit B6

A

Pyridoxine

70
Q

Vit B7

A

Biotin

71
Q

Vit B9

A

Folic Acid

72
Q

Vit B12

A

Cobalomin/ Cyanocobalamin

73
Q

-Hypoplasia of bone marrow
-↓Bone marrow activity
-↓RBC: Anemia; fatigue & Dyspnea
-↓WBC: Leukopenia; Prone to infection
-↓Platelet: Thrombocytopenia; Bleeding

A

Aplastic Anemia/ Pancytopenia

74
Q

Immature WBC (↑Bands)

A

Leukemia

↓RBC: Anemia
↑WBC (immature): Prone to infection
↓Platelet: Bleeding

75
Q

Two types of WBC

A

-Bands: Immature WBC

-Segs: (Segmentor) Mature WBC

76
Q

Diagnostic Test for Leukemia

A

Bone Marrow Aspiration

77
Q

Site of Bone Marrow Aspiration for Pediatric:

A

Posterior TIBIA

78
Q

Site of Bone Marrow Aspiration for ADULT:

A

Iliac Crest

79
Q

Types of Leukemia

A

AML (Acute Myelogenous Leukemia)
-AMatandaL (Matanda)
-Common in adult
-Life threatening: Poor prognosis
-Myelogenous: all WBC comes from

ALL (Acute Lymphocytic Leukemia)
-Common in Pedia

80
Q

PLAN OF CARE LEUKEMIA

A

-Bone Marrow Transplant: Precaution similar with B.T.
-Chemotherapy
-Stem cell therapy

81
Q

Hyperplasia of Bone Marrow
↑ Bone Marrow Activity

A

Polycythemia Vera

↑RBC; ↑WBC;↑PLATELET

                     ↑RBC 1.↑ Blood viscosity: Prone to Thrombus Thrombus: MI- Chestpain & Dyspnea
                CVA- Ischemic, ↓LOC, Confusion, 
                         Disorientation

2.Organ Infiltration
-Hepatomegaly
-Splenomegaly
-Joint Pain

  1. Rudy Complexion
    -Reddish Skin
  2. ↑ RBC
    -Activates immune response; (+) Pruritis
                       ↑WBC -No signs of Infection

                 ↑Platelet -Overdistention of platelet -Ruptured platelet ---> Bleeding
82
Q

Diagnostic test Polycythemia Vera

A

CBC
-reveals that all is ↑

83
Q

PLAN OF CARE

A
  1. ↑Viscosity
    -Hydrate (↑ fluids)
    -Avoid ↑ altitude
    -Monitor s/sx of thromboembolism
  2. (+) Joint Pain
    -DOC: Low dose Aspirin
  3. (+) Pruritis
    -Well-ventilated room: Sweating ↑ Itchiness
    -Starch Bath
    -Calamine Lotion (for itching)
  4. (+) Bleeding
    -monitor s/sx bleeding
    -avoid anti-coagulants
84
Q

Compensatory due to chronic hypoxia

A

Polycythemia

85
Q

Polycythemia Complications:

A
  1. Shock
  2. Blood Loss
  3. Tetralogy of Fallot: Tet Spell
    ↓
    O2 deprivation
    ↓
    ↑ Bone Marrow Activity
    ↓
    ↑RBC
    ↓
    Prone to thrombus formation
86
Q

Goal of polycythemia

A

Reverse the Hypoxia

87
Q

Plan of Care for Polycythemia:

A

-O2 Administration
-Blood transfusion

88
Q

Whose nurse is ↑ risk for HIV

A

Hemodialysis Nurse: Handling Needle

89
Q

Common Causes of HIV/AIDS

A

Cause: HIV (Retrovirus)

Common:
-Heterosexual/Homosexual: Anal Sex
-Unprotected Sex
-Blood Transfusion: Needle
-Transmitted in pregnancy

Precaution: Universal Precaution

90
Q

AIDS

A

HIV + Immunocompromise = AIDS
-TB
-Pneumonia

91
Q

Manifestation of AIDS:

A

EARLY SIGNS
-Fever -Sore Throat
-Malaise -Fatigue
-weight loss -Night sweats
-Diarrhea
-Persistent Generalized Lymph Nodes

RASHES: Kaposis Sarcoma

PNEUMONIA IN AIDS: Pneumonystis Carini
(Immunosuppression)

92
Q

Diagnostic Test for HIV/AIDS

A

CDT4 Cells
- <200 counts: Indicates AIDS
-<100 counts: Immunosuppression

ELISA TEST
-(+) HIV infection
-False (+) : Frequent or Multiple Blood Transfusion
: Pregnancy
-False (-) : Within few weeks to <3 months

***Best time for ELISA: After 3 months

WESTERN BLOT
-confirmatory test

93
Q

DRUG OF CHOICE FOR HIV/AIDS: DOC

A

AZT (Azidothymidine/ Zidovodine)
-Prevent HIV cells replication, Not cure

94
Q

Platelet is destroyed by own Platelet/ Antibody

A

ITP (Idiopathic Thrombocytopenic Purpura)

95
Q

Cause of ITP:

A

-Unknown
-R/t viral infection in children

96
Q

Lifespan of platelet with ITP:

A

1-3 Days

normal lifespan: 7-10 days

97
Q

Bleeding Manifestation

A

-Menorrhagia (Heavy Menstruation)
-Bruising
-Bleeding Nares & Gums
-Ecchymosis
-Purpura (purple skin)

98
Q

Plan of Care

A

Platelet Transfusion

DOC: ↑ Dose Steroids (Prednisone)
: Immunosuppressant (Immuvan)

Test Viral Infection
-IVIG (IV Immunoglobulin)

Chemotherapy
DOC: Plant alkaloids
(Oncovin) Plant Poison

Splenectomy
-Removal of spleen which is potential site of platelet DESTRUCTION

Plasmapheresis

99
Q

Lifespan of normal Platelet

A

7-10 days

100
Q
A

NP 4- TOP 8 (3 decks)

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