Hematologic Disorders

Question 1

Anemia

Answer 1

Not enough cells resulting in inability to carry enough O2 to the tissues

Question 2

Anemia S&S

Answer 2

Cold extremities, lightheadedness

Question 3

WBC levels

Answer 3

4,500 - 10,500

Question 4

Hgb levels

Answer 4

M: 13.5 - 17.5
F: 12 - 16

Question 5

H&H levels

Answer 5

M: 42 - 52%
F: 37 - 47%

Question 6

Platelet levels

Answer 6

150,000 - 450,000

Question 7

Neutrophil infection level

Answer 7

> 67%

Question 8

Segmented neutrophils (segs) infection level

Answer 8

> 55%

Question 9

Neutrophil band infection level

Answer 9

> 5/6%

Question 10

Iron deficiency anemia

Answer 10

Lack of iron so can’t make Hgb for RBC to carry O2

Question 11

Iron deficiency anemia clinical manifestation

Answer 11

• Fatigue, pallor
• *Tachycardia bc lack of blood
• *Tachypnea
• *SOB
• Fissures (mouth/anus)
• Glossitis (tongue: smooth, swollen, reddened)
• Spoon-shaped fingernails (not common in industrialized countries)
• Brittle hair

Question 12

Iron deficiency anemia labs

Answer 12

• Hgb/Hct: low
• MCV: low (indicate size of RBC)
• MCH: low (indicate Hgb concentration)
• MCHC: low (indicate Hgb concentration)
• Serum ferritin: low
• Serum iron: low
• TIBC: high bc body trying to compensate
• Transferrin saturation: low

Question 13

Iron deficiency anemia nursing assess

Answer 13

• VS: tachycardia, tachypnea
• Fatigue, pallor
• SOB
• LOC
• Change in hair, tongue (beefy red), nails (spoon)
• Assess for blood loss: emesis, sputum, urine, stool
• Labs: Hgb, Hct, MCV, MCH, MCHC, serum iron, ferritin, TIBC, transferrin sat

Question 14

Sickle cell disease patho

Answer 14

• Genetic disorder of Hgb –> RBC shape changed d/t lack of O2
• Sickle shaped RBC causes vasoocclusion, lack of O2, hemolysis (breaks up which causes anemia)

Question 15

Types of sickle cell crisis

Answer 15

Result of increased sickling and anything causing hypoxemia and vasoconstriction.
- Vaso-occlusive
- Aplastic
- Sequestration
- Hemolytic crisis

Question 16

Vasoocclusive crisis

Answer 16

• Most common
• Vessel obstruction by clumping, tiss hypoxia, pain

Question 17

Aplastic

Answer 17

Bone marrow ceases to make RBCs

Question 18

Sequestration

Answer 18

• Most severe
• Pooling of RBCs in spleen, shock, CV failure

Question 19

Hemolytic crisis

Answer 19

• RBC hemolysis
• Decreased Hgb
• Jaundice

Question 20

Sickle cell disease clinical manifestations (no crisis)

Answer 20

Anemia
- Fatigue
- Pallor
- SOB

Question 21

Sickle cell disease clinical manifestations (crisis)

Answer 21

Vasoocclusive
- Pain
- Swelling

Question 22

Which areas are most affected by vasoocclusion?

Answer 22

• Distal areas: joints, bones, chest, abdomen
• Wound healing in the extremities

Question 23

What happens if ischemic organ damage in SS?

Answer 23

• Cerebrovascular, pulmonary, and splenic infarcts
• Priapism: painful erection that doesn’t go away
• Liver and kidney damage

Question 24

Sickle cell anemia assess

Answer 24

• VS: tachycardia, tachypnea, fever (infection)
• Fatigue, pallor, SOB
• Pain and swelling in joints, jaundice (if hemolytic crisis)
• Psychosocial: depression, anger
• Diagnostic tests

Question 25

Sickle cell anemia diagnostic tests

Answer 25

- Hgb, serum bilirubin - Serum iron, vitamin B12, folate level - Chest x-ray

Question 26

Sickle cell anemia nursing action

Answer 26

- Administer O2 as ordered - Provide hydration/fluids esp for kidney bc need to prevent infection - Pain meds as ordered - Antipyretics as ordered - Blood transfusions as ordered - Emotional support

Question 27

Sickle cell anemia patient teaching

Answer 27

- Avoid cold temps and restrictive clothing - Patho of disease - Infection prevention (vaccines, dental hygiene, hand washing...) - Avoid high-altitudes

Question 28

Leukemia

Answer 28

Uncontrolled replication of WBCs - leukemic cells/blasts

Question 29

Leukocytosis

Answer 29

uncontrolled cloning of immature abnormal cell --> fills BM --> enters circulation

Question 30

Leukemia clinical manifestations

Answer 30

- Painful lymphadenopathy (neck, groin, armpit) d/t cells go to lymph glands - Anemia d/t lack of RBC - Infection d/t lack of neutrophil - Bleeding d/t thrombocytopenia - LUQ pain d/t splenic sequestration of blasts

Question 31

Leukemia diagnostic tests

Answer 31

- CBC shows diff types of WBCs (neutrophils, eosinophils, basophils) - Biopsy - Lumbar puncture

Question 32

Which tests diagnose leukemia?

Answer 32

- Biopsy and bone marrow aspirate: type of leukemia, chromosomal abnormalities - Lumbar puncture: CSF involvement

Question 33

Complications of pancytopenia (low levels of all three: RBC, WBC, platelet)

Answer 33

- Infection secondary to neutropenia < 1000 - Hemorrhage and bleeding secondary to thrombocytopenia < 150,000 - Anemia

Question 34

Leukemia nursing action

Answer 34

- Administer chemo as ordered - Neutropenic/bleeding precautions - Antibiotics, antivirals, antifungals (prophylactic) as ordered - Symptom management of N/V, diarrhea, stomatitis - Administer blood prods as ordered

Question 35

What's medical emergency in neutropenic pt?

Answer 35

Fever

Question 36

Hodgekins vs Non-hodgekins lymphoma

Answer 36

- H: better survival rate, Reed Steinburg cell present - N: higher in industrialized countries

Question 37

Lymphoma

Answer 37

Single stem cell in lymph develops into solid tumor and spreads to other LN or spleen

Question 38

Lymphoma diagnostic tests

Answer 38

Labs: - CBC w diff, CMP, coagulation studies, LDH Radiology: - Chest x-ray - CT scan - PET scan - MRI ...

Question 39

What does lymph node biopsy show

Answer 39

Presence of RS cells --> determine HL or NHL

Question 40

What does bone marrow biopsy/lumbar puncture show in lymphoma

Answer 40

Symptoms indicating involvement