Hematological and Immune Alterations

Question 1

Primary Site of Cell Production

Answer 1

Bone Marrow Production

Question 2

Secondary Site of Cell production

Answer 2

Spleen
Liver
Thymus
Lymphatic system

Question 3

Erythrocytes

Answer 3

RBC
stim by kidney

Question 4

Thrombocytes

Answer 4

Platelets
Clotting

Question 5

Leukocytes

Answer 5

WBC
Fight infection

Question 6

Granular Leukocytes

Answer 6

Neutrophils
Eosinophils
Basophils

Question 7

Neutrophils

Answer 7

Bacterial Infections

Question 8

Eosinophils

Answer 8

Allergens
Parasites

Question 9

Basophils

Answer 9

Allergic response
Inflammatory response

Question 10

Active immunity

Answer 10

actively produces cells to fight antigens

Question 11

Passive immunity

Answer 11

Passed on

Question 12

Humoral Immunity

Answer 12

Immunoglobins
IgG
IgM - first
IgA
IgE - allergies
IgD

Question 13

Cell medicated immunity

Answer 13

T lymphocytes
Initiated by macrophages

for viral, fungal, intracellular infections

Question 14

Intrinsic factor

Answer 14

Injury to blood factor 12

Question 15

Extrinsic factor

Answer 15

Injury to tissue factor 7

Question 16

Fibrinolysis

Answer 16

breakdown of clot
thrombin released

Question 17

cues to hematological or immunological problems

Answer 17

altered oxygenation
bleeding
infection

Question 18

Anemia causes

Answer 18

Blood loss
Impaired production
Increased RBC destruction
Combination of three

Question 19

Types of anemia (7)

Answer 19

Marrow failure – bone marrow disorder on RBC precursors
* Aplastic – disorder hematopoietic stem cells (RBC, WBC,
PLT)
* Hemolytic – extrasplenic destruction of RBC
* Sickle cell – abnormal Hbg
* B12 deficiency – decreased HCl and intrinsic factor
(pernicious anemia)
* Folic acid deficiency – malabsorption of folic acid
* Iron deficiency—(most common) decreased iron stores

Question 20

Tx of anemia

Answer 20

• Erythropoietin used to stimulate RBC production – marrow
  failure
• Bone marrow stimulants – aplastic
• Staphylococcal protein A – hemolytic
• IV fluids/oxygen – sickle cell
• Vitamin B 12 injections – B12 deficiency
• Folic acid – folic acid deficiency
• Ferrous sulfate – iron deficiency

Question 21

Immunocompromised

Answer 21

Lack of inflammatory, phagocytic, antibodies, and cytokine responses

fever may be the only sign. Pain without inflammation may be a cue.

Question 22

Neutropenia

Answer 22

• Mild – 1000 – 1500 cells/microliter
• Moderate – 500 – 1000 cells/microliter
• Severe – < 500 cells/microliter

Question 23

Neutropenia causes

Answer 23

• Overwhelming infection
• Radiation
• Inadequate production
• Exposure to chemicals and drugs

Question 24

Malignant WBC disorders

Answer 24

Leukemia - large number of immature cells
Lymphoma - affects lymphocytes
Multiple myeloma - abnormal immunoglobulins

Question 25

AIDS

Answer 25

* Infection with human immunodeficiency virus (HIV) (retrovirus) * Depletes helper T cells, CD4 cells, and macrophages * Increased risk for opportunistic infections * Transmitted via body fluids, blood, or blood products

Question 26

Bleeding Disorders

Answer 26

Abnormality in stages of clotting * Vasoconstriction * Creation of platelet plug * Development of clot * Fibrinolysis

Question 27

Nursing Management Bleeding

Answer 27

* Assess blood loss * Assess vital signs, hemodynamics, and perfusion * Assess for signs and symptoms of hypovolemia * Administer blood products and fluids * Administer topical agents as needed

Question 28

Thrombocytopenia

Answer 28

* Decreased platelets (less than 100,000 cells/microliter) * Decreased production in the bone marrow * Increased destruction of platelets * Abnormal distribution of platelets Tx: Platelet infusion RF bleeding

Question 29

Disseminated Intravascular Coagulation

Answer 29

triggered by vessel injury hemastasis lots of mini clots form no clotting factors left BLEEDING

Question 30

DIC causes

Answer 30

* Sepsis * Infection * Trauma (e.g., burns, crush) * Obstetric conditions (e.g., abruptio placentae, amniotic fluid embolus, retained dead fetus) * Hematological disorders * Oncological disorders * Other: shock and acute respiratory distress syndrome

Question 31

S/S DIC

Answer 31

Decreased perfusion to organs * Changes in mental status * Infarction of tissue in digits and nose * Overt bleeding or oozing * Occult bleeding Signs of platelet deficiency * Gingival bleeding * Petechiae * Ecchymosis

Question 32

Tx DIC

Answer 32

Adm blood - pplatelets, ffp, etc. Stop abnormal coagulation - heparin

Question 33

Myeloma

Answer 33

Cancer of plasma cells Bone pain

Question 34

Test for DIC

Answer 34

D dimer

Question 35

Primary Immuno deficency

Answer 35

Born with it

Question 36

Autoimmunity

Answer 36

Sometimes the immune system makes a mistake and attacks the body's own tissues or organs.

Question 37

humoral and cell mediated immunity

Answer 37

work together

Question 38

Increased Bleeding in Critically Ill

Answer 38

Trauma Meds - GI bleed

Question 39

Decreased Production of RBC

Answer 39

lack of nutrition chronic conditions- anemia fluid overload (dilution of RBC)

Question 40

Destruction RBC

Answer 40

genetic autoimmunity (hemolytics) DIC

Question 41

What does a shift left mean (bacterial infection)

Answer 41

Increase number of band neutrophils compared to mature neutrophils

Question 42

Bands

Answer 42

Immature neutrophils

Question 43

Decrease neutrophils causes

Answer 43

Cancer Cancer Tx Immunotherapy Viral Infection AIDS

Question 44

T cells for

Answer 44

Viral Infection

Question 45

RF for GVHD (graft versus host)

Answer 45

old age aplastic anemia prior GVHD

Question 46

GVHD priority care

Answer 46

prevent infection

Question 47

S/S GVHD - THINK TRANSPLANT

Answer 47

mucositis rash weight loss xerostomia photosensitivity joint pain