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Clinical Medicine Exam 4 > Hematology, cont. > Flashcards

Hematology, cont. Flashcards

1
Q

What 3 body systems are commonly linked?

A

Hematologic, immune, and lymphatic symptoms

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2
Q

What is edema?

A

Excess fluid in interstitial tissues or body cavities

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3
Q

What is congestion?

A

Excess blood within vessels of an organ or tissue

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4
Q

What is infarction?

A

Area of necrosis

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5
Q

What is a thrombus?

A

Solid mass of clotted blood

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6
Q

What is lymphedema?

A

A hematologic disorder, obstruction of lymph vessels or nodes

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7
Q

What is purpura?

A

A hemorrhagic condition in which there are insufficient platelets to plug leaking vessels, blood moves under the skin and through mucous membranes, producing spontaneous ecchymoses (bruises) or petechiae (small red patches)

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8
Q

What is thrombocytopenic purpura?

A

A decrease in circulating platelets, leads to bleeding from any body orifice aka the easy bleeders

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9
Q

What is shock?

A

When the cardiovascular system fails to perfuse the tissues adequately

Leads to impaired cellular metabolism (impaired oxygen and glucose use)

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10
Q

What are the manifestations of shock?

A 
Vary based on stage, but include:
hypotension
tachycardia
increased RR
cool extremities
decreased pulses and urine output
altered mental status (AMS)
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11
Q

What is cardiogenic shock?

A

Decreased cardiac output

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12
Q

What is hypovolemic shock?

A

loss of whole blood or interstitial fluid

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13
Q

What is neurogenic shock?

A

Usually trauma to spinal cord or CNS, massive parasympathetic overstimulation and sympathetic understimulation

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14
Q

What is anaphylactic shock?

A

Hypersensitivity/allergic reaction

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15
Q

What is septic shock?

A

Infection

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16
Q

What is an indication of shock?

A

Cool extremities, because they are not getting enough blood flow to the extremities

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17
Q

What is lymphadenopathy?

A

abnormal enlargement of lymph nodes

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18
Q

How should lymph nodes normally feel?

A

rubbery, mobile, small (less than or equal to 1 cm)

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19
Q

What hematologic conditions might splenomegaly be present in?

A

Infectious mononucleosis
Hodgkin’s lymphoma
Extramedullary hematopoiesis=when spleen takes over for bone marrow and produces RBCs

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20
Q

What might changes in coagulation cause?

A

Increased risk of thrombus, increased work for the heart, breathing, tissue perfusion

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21
Q

What are exercise precautions for platelet levels?

A

40,000-60,000=low platelets, keep exercise in low-load endurance (1 to 2 lb)-walk, bike, ADL

20,000-40,000=low intensity and no resistance

less than 10,000=at risk for spontaneous

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22
Q

What precautions do you follow with splenomegaly?

A

Since it is usually associated with rapid destruction of blood cells, so follow clotting precautions

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23
Q

How does exercise and sport affect blood volume and erythrocytes?

A 
Blood volume (plasma)=increases immediately
Erythrocytes=increases over time
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24
Q

What are the risky effects of blood doping through exogenous EPO?

A

Can increase blood viscosity and thrombus formation

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25
Q

What may indicate hypovolemia?

A

any time systolic drops 20 points or more, accompanied by HR increase 15 BPM

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26
Q

What are the common causes of hypovolemia?

A

Dehydration (number 1), diarrhea, slow bleed

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27
Q

What can be another cause of a drop in BP with a rise in pulse?

A
  1. normovolemic but on antihypertensives

2. orthostatic hypotension

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28
Q

What are recombinant human erythropoietin products?

A

rHuEpo, EPO, epogen=stimulates erythropoietin to elevate RBCs

reduces the need for human blood transfusions

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29
Q

What are the possible reactions to blood and blood products?

A
  1. Febrile Nonhemolytic Reaction
  2. Transfusion-Related Acute Lung Injury
  3. Adult Hemolytic Transfusion Reaction
  4. Delayed Hemolytic Transfusion Reaction
  5. Allergic Reaction to donated plasma
  6. Anaphylaxis
  7. Septic Reaction, Hep B and C
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30
Q

What is febrile nonhemolytic reaction?

A

Reaction of either the donor leukocyte cytokines or alloantibodies of recipient
Usually transient, occurs in less than 1% of RBC transfusions, 30% of platelet transfusions
Usually see a raise in temperature around a degree or 2

31
Q

How do you treat febrile nonhemolytic reaction?

A

Stop the transfusion, administer antipyretics or corticosteroids

32
Q

What are the results of transfusion-related acute lung injury? How common is it?

A

Ranges from mild SOB to Adult Respiratory Distress Syndrome (ARDS)
1 in 2000 transfusions

33
Q

What is adult hemolytic transfusion reaction?

A

occurs in 1 in 25,000 transfusions

ABO incompatibility

34
Q

What are the results of adult hemolytic transfusion reaction?

A

Can be fatal, result in DIC, renal failure, severe hypotension

35
Q

What is delayed hemolytic transfusion reaction?

A

Donated erythrocytes quickly removed by recipient’s alloantibodies, body attacks everything as an invader
May occur 1 to 4 weeks after transfusion
Often asymptomatic, just no boost from transfusion

36
Q

How do you treat an allergic reaction to donated plasma?

A

Antihistamines, corticosteroids

37
Q

How common is anaphylaxis to drug transfusions and how is it treated?

A

1 in 20,000 to 50,000

Treated as shock protocol

38
Q

What has decreased the septic reaction, hep B or C from blood transfusions? How is treated?

A

improved lab screening

treated per source of sepsis

39
Q

What are the s/s of febrile, nonhemolytic transfusion reaction?

A 
Fever, chills
HA
nausea, vomiting
hypertension
tachycardia
40
Q

What are the s/s of transfusion related acute lung injury?

A

pulmonary edema
acute respiratory distress
severe hypoxia

41
Q

What are the s/s of acute hemolytic transfusion reaction?

A 
fever, chills
N/V
flank and abdominal pain
HA
dyspnea
hypotension
tachycardia
red urine
42
Q

What are the s/s of delayed hemolytic transfusion reaction?

A

Unexplained drop in Hb=anemia
Increased bilirubin level=jaundice
Increased lactate dehydrogenase level

43
Q

What are the s/s of allergic reactions?

A

hives, rash
wheezing
mucosal edema

44
Q

What are the s/s of anaphylaxis?

A 
Abrupt hypotension
edema of the larynx
difficult breathing
neause
abdominal pain
diarrhea
shock
respiratory arrest
45
Q

What are the s/s of septic reactions?

A 
Fever, chills
Hypotension
HA
Back, chest, abdominal pain
Shortness of breath
46
Q

What are the s/s of circulatory overload?

A 
Red face
SOB
tachycardia
orthopnea
hypertension
HA
seizures
47
Q

What are examples of minimally invasive surgery?

A

Scopes
gamma knife
harmonic scalpel
argon beams

48
Q

What is normovolemic hemodilution?

A

Remove the person’s own blood and replace with intravenous crystalline/colloid solution (acts like plasma) to maintain volume, post-op, person’s own blood is returned

49
Q

What are the risks of cell salvage techniques, retransfusing own blood?

A

Can increase infection/hemolysis rates

50
Q

How should a PT treat a pt following surgery?

A

Monitor lab values when treating patient, adjust treatment and intensity accordingly

51
Q

What is hemochromatosis?

A

Autosomal recessive hereditary disorder, 1 out of 8 to 12 people is a carrier of one abnormal gene; prevalence is likely higher, because of undiagnosis

Excessive absorption of iron from small intestine

52
Q

What is the common population of hemochromatosis?

A

Onset of sx at forty to sixty

Caucasions of North European Descent

53
Q

What are the s/s of hemochromatosis?

A

Weakness, chronic fatigue, myalgia, joint pain, abnormal bronzing of the skin

54
Q

How is hemochromatosis diagnosed?

A

Blood tests and liver biopsy

55
Q

How is hemochromatosis treated?

A

By bleeding the patient, can be a blood donation

Initial treatment might be 1 pint/week, maintenance 1 pint/2-4 months for life

56
Q

What can hemochromatosis lead to?

A

Pancreatic damage and diabetes mellitus
Arthritis
Liver failure
Cardiac myopathy, CHF, arrhythmias
Thyroid Deficiency-fatigue and weight gain
Damage to the adrenal glands=immune and electrolyte regulation problems
Arthropathy
Calcium deposits, acute inflammatory arthritis

57
Q

How can we treat a pt with hemochromatosis?

A

Interventions for flexibility, strength, ADs, splints, ADLs

58
Q

How can anemia affect exercise?

A

Decreases exercise tolerance and impairs oxygenation

59
Q

What should we monitor older adults for?

A

Circulation issues, changes in cognitive function with exercise

60
Q

What may sedentary lifestyle be a result of?

A

self-imposed changes to accomodate diminished oxygenation and anemia

61
Q

What are sx of severe anemia?

A

Increased cardiac output, decreased exercise tolerance, resulting in dyspnea, tachycardia, and palpitations

62
Q

What are young female athletes at risk for?

A

Anemia and iron deficiency, may also have inadequate dietary intake

63
Q

How should you exercise pts in chronic renal failure?

A

at lower intensities, VO2 max is 20% lower than normal

64
Q

What are pts with both anemia and cardiovascular disease at greater risk of?

A

Angina

65
Q

How does anemia affect wound healing?

A

It impairs it

66
Q

What type of anemia may affect the nervous system?

A

B12 (pernicious)

67
Q

How do ASA and NSAIDs exert their effects on platelets?

A

They inactivate platelet cyclooxygenase, which is an enzyme needed for thromboxane A2 (platelet aggregation and arterial smooth muscle constrictor)

68
Q

How does ASA affect platelets?

A

A single dose of ASA can suppress normal platelet aggregation for 48 hours to up to a week. It irreversibly inhibits COX, so platelets are inactivated for the rest of their life span (they live about 8 days). Why the platelet count is reduced, they are there, but useless

69
Q

How does NSAIDs affect platelets?

A

Effects on COX are reversible, have milder effects on platelets, such as bruising and skin bleeding, still should D/C NSAIDs pre-op

70
Q

What is disseminated intravascular coagulation?

A

Overactivation of the clotting cascade, with paradoxical clotting and hemorrhage at the same time, have a wide deposition of fibrin in circulation, but it accumulates in the major organs (incl. skin)
Often in respiratory distress due to increased activity in the alveolus

71
Q

What is DIC common after?

A

shock, sepsis, OB/GYN complications, cancer, trauma

72
Q

How can you decrease the mortality rate of DIC?

A

Early recognition and treatment

73
Q

How should we treat a pt with DIC?

A

Pts will be in ICU, no PT during bleeding episodes, monitor the lab values closely to decide when to mobilize a pt, may turn them, maybe get them in sitting=a supportive role

Clinical Medicine Exam 4 (2 decks)

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