Hemo Disorders Pt 2 Flashcards
(87 cards)
1
Q
What happens with DIC?
A
clotting is altered, causing small blood clots to form in the blood vessels some of which can clog the vessels and cut off the normal blood supply to organs
2
Q
What happens during the clotting process during DIC?
A
platelets and clotting factors are consumed leaving the patient at high risk of serious bleeding even from minor injury or w/o injury
3
Q
Lab Changes w/ DIC
A
- decreased platelets
- increased PT
- increased PTT
- decreased Fibrinogen
- increased D-dimer
4
Q
S/S of DIC as Micro-clots occur are?
A
- kidney/liver failure
- stroke like symptoms
- symptoms of PE
5
Q
S/S of DIC as Clotting Factor/Platelets are depleted
A
- petechia
- oral bleeding, epistaxis, conjunctival hemorrhage
- increased bleeding from puncture sites
- hematemesis/hematuria/melena
- profuse bleeding from everywhere
- internal bleeding
6
Q
Primary Treatment for DIC
A
treat underlying cause
7
Q
Secondary Treatment for DIC
A
- treat the symptoms
- O2/IV fluids/Electrolytes
- transfusions
- heparin or lovenox to disrupt micro-clots
8
Q
Nursing Management for DIC
A
- monitor those @ risk
- early recognition and reporting is essential
- administer O2/IV fluids/electrolytes
- most will have central line
- dialysis may be needed if kidney failure
- monitor liver/neuro function
9
Q
Essential Thrombocythemia is caused by what?
A
an excessive production of platelets that leads to abnormal clotting or bleeding
10
Q
Essential Thrombocythemia occurs as a result of what?
A
acquired gene mutation or infections
11
Q
What is the average survival rate post-diagnosis for Essential Thrombocythemia?
A
20 years
12
Q
Essential Thrombocythemia is most common in who?
A
women > 50
13
Q
S/S of Essential Thrombocythemia
A
- often asymptomatic
- headaches
- dizziness
- vision probs
- burning/redness in hands and feet
- coldness/blue fingers and toes
- mildly enlarged spleen
14
Q
Goals for Thrombocythemia
A
- reduce the risk of occlusions r/t to clots
- alleviate symptoms
15
Q
Rick Factors for Essential Thrombocythemia
A
- history of clots
- PVD
- Atherosclerosis
- Obesity
- history of smoking
16
Q
Treatment for high risk patients w/ thrombocythemia
A
- hydroxyurea
- IV/sub q coagulation
17
Q
For extreme cases you would treat thrombocythemia w/ what?
A
plateletpheresis
18
Q
Aplastic Anemia results from what?
A
damage to the stem cells w/in bone marrow
19
Q
Aplastic Anemia leads to what?
A
pancytopenia-decrease in RBC’s, WBC’s, and platelets
20
Q
Causes of Aplastic Anemia
A
- most cases are idiopathic
- viral infection
- pregnancy
- meds
- chemical exposure
- chemo
21
Q
S/S of Aplastic Anemia
A
- often insidious
- fatigue
- SOB
- rapid/irregular HR
- pale skin
- frequent/prolonged infection
- easy bruising
- nose/gum bleeds
- prolonged bleeding
- skin rash
- dizziness/headache
- neutropenia/thrombocytopenia/anemia
22
Q
Treatment for Symptomatic Aplastic Anemia
A
packed RBC’s
23
Q
Treatment for Thrombocytopenia
A
platelet transfusion
24
Q
Treatment for Neutropenia
A
antibiotics
25
Treatment for Aplastic Anemia < 40 yrs old w/ matched Sibling Donor
stem cell transplant
26
Treatment for > 40 yrs old or NO matched sibling donor
immunosuppressive therapy
27
What is considered if immunosuppressive therapy is not successful?
Unmatched/unrelated stem cell donor should be considered
| -high mortality rate from rejection
28
Nursing Management for Aplastic Anemia
- infection prevention
- monitor for bleeding
- avoid ASA and aspirin products
- birth control to diminish blood loss
- educate
- close monitor BP
- educate on hirsutism and gingival hyperplasia
29
What is Leukemia?
rapid increase in the number of WBC's w/ abnormal maturation of the cells; results in suppression of other cells
30
What happens w/ Leukemia and the bone marrow?
Bone marrow begins to over fill w/ WBC's leading them to overflow into the circulatory system prematurely
31
An increase in WBC's/Leukocytes is known as what?
leukocytosis
32
Acute Leukemia
- immature leukocytes that don't function normally
- onset is rapid
- symptoms progress quickly
- death can occur w/in weeks to months w/o aggressive treatment
33
Chronic Leukemia
- most leukocytes are mature and can still function normally
- symptoms take months-years to progress
- live longer and often die of secondary conditions in late age
34
Acute Myeloid Leukemia (AML)
-affects all age groups
-grows quickly
-prognosis is directly r/t age
-most lethal form
develops w/o warning-symptoms appear over weeks-months
35
Acute Lymphocytic Leukemia (ALL)
- common in young children
- grows quickly
- 90% survival rate in kids < 5
- 60% survival rate in adolescents
- symptoms come on quickly but expected outcome w/ treatment is remission
36
Chronic Myeloid Leukemia (CML)
- Common adults > 60
- grows slowly
- symptoms progress slowly and in phases
- early detection is most common and leads to high survival rate
37
What is the survival rate like for a patient with Chronic Myeloid Leukemia?
80% 5 year survival rate w/ early detection; unless disease progresses to "blast crisis" phase (3-6 months)
38
Chronic Lymphocytic Leukemia (CLL)
- common in adults > 60
- grows slowly
- 90% 5 yr survival rate
- symptoms progress slowly-often require monitoring w/ no treatment
39
Chronic Phase of CML
- mostly asymptomatic
- incidental finding in blood work
- increased WBC's
40
Accelerated Phase of CML
- fatigue
- fever
- night sweats
- abdominal pain
- weight loss
- increased WBC's/low platelets
41
Blast Crisis of CML
- bone pain
- enlarged spleen
- bleeding
- infections
- confusion, vision changes, SOB
- very high WBC's/very low platelets
42
AML S/S
- neutropenia
- fever/infection
- anemia
- weakness/fatigue
- thrombocytopenia
- bleeding
- enlarged liver/spleen with pain/bone pain
- anorexia, N/V, diarrhea
43
ALL S/S
-pain from enlarged liver/spleen
-bone pain
-testicular swelling/pain
-visual changes
-N/V
-altered LOC
confusion
44
Nursing Management for CML
- focuses on medication
- take meds before meals
- do NOT take w/ antacids, protonix, grapefruit juice
45
Nursing Management for AML
- administer blood products/antibiotics
- infection/bleeding prevention is priority
- educate for self management and decrease anxiety
- monitor for increased potassium and phosphates
- monitor uric acid levels
- increase fluid intake
46
What is the priority nursing management for AML?
infection and bleeding prevention
47
Monitor a patient w/ AML for what?
- increased potassium and phosphates
| - uric acid levels
48
Nursing Management for ALL
- educate men on testicular exam
- prevent infection/bleeding
- discuss fertility preservation w/ young girls
49
Monitor all types of leukemia for what?
Monitor and treat side effects of chemotherapeutic treatment
- nausea
- mucositis
50
What to use for Mucositis?
- soft, bland foods
- high protein
- miracle mouthwash
- no acidic or spicy foods
51
What are the 2 types of lymphomas?
- Hodgkin's
| - Non-Hodgkin's
52
Hodgkin's Lymphoma
- rare
- high cure rate
- more common in young men
- has a specific cell that can be seen
53
Non-Hodgkin's Lymphoma
- > 70,000 cases annually
- rate of cure is lower/diagnosed at more advanced stage
- more common in older men
54
What is the treatment for Lymphomas?
chemotherapy
| radiation
55
You should monitor and treat what side effects from treatment for Lymphomas?
- nausea
- hair loss
- infection
- weight loss/anorexia
- oral ulcers
56
Blood can only be given up to how many hours?
Up to 4 hours
57
Blood Transfusions
- each unit given over 2-4 hours unless emergency
- started w/in 30 minutes after picking up
- check name, DOB, medical record #, unit #, blood type, expiration date
58
How often are vitals taken when giving a blood transfusions?
Taken prior to starting blood, 15 minutes after starting, and at completion of blood
59
What signs should you monitor for with transfusion reactions?
- back/flank pain
- dark urine
- chills, fever, skin flushing
- fainting/dizziness
- SOB/restlessness
- itching
60
What are some alternatives to blood for religious or other reasons?
- volume expanders (normal saline)
- erythropoietin
- blood salvage during surgery
- autologous donation
- artificial blood
61
Types of Donations
- directed donation
- standard donation
- autologous
- intraoperative blood salvage
62
Direct Donation
friends and family donation
63
Standard Donation
blood received from donors at community/school/occupational blood drives
64
Autologous Donations
patient donates own blood
65
Intraoperative Blood Salvage
collected in cell saver and re-transfused to patient
66
Complication of Transfusions
- infection
- iron overload
- transfusion reaction
67
Infection Risks from Blood transfusions
- hepatitis B or C
- HIV
- CMV
68
How would you treat iron overload from blood transfusion?
Chelation therapy
69
Sensitization Transfusion Reactions
- incorrect blood type and/or RH factor
- Rh- needs Rh- only
- Rh+ can have Rh- or +
- emergency or unknown type should use O
70
What is Platelet Dysfunction?
platelet numbers are WNL but function is altered
71
What is the only IV fluid that you mix with blood?
Normal Saline
72
How many nurses does it take to check blood?
2
73
If patient begins to have a reaction to transfusion you should what?
Stop blood and call doctor
74
What medications prevent platelets from clumping together and forming clots?
Aspirin
NSAIDS
Plavix
75
How long does aspirin last in the blood?
7-10 days
76
How long do NSAIDs last in the blood?
5-7 days
77
How long does Plavix last in the blood?
2-3 days
78
Blood has to ALWAYS given through what kind of IV?
20 gauge or greater with a pump
79
Liver Disease
- cirrhosis
- hepatitis
- administer fresh frozen plasma
80
Vitamin K Deficiency
- malnourishment
- alcoholism
- dietary deficiency
- administer vitamin K (Mephytom) sub q or orally
81
Fresh Frozen Plasma
- a unit is usually administered over 15-30 mins
- standard blood administration set is used
- once thawed FFP must not be re-frozen and should be used immediately
82
If a delay is unavoidable when delivering FFP you should do what with the component?
Store at ambient temperature (about 73 degrees) and used w/in 4 hours
83
Vitamin K sources take how long to reach full effect?
6-24 hours
84
What type of vitamin k works better with prolonged bleeding time w/ Coumadin administration?
Oral vitamin k
85
With Autologous donations what should be done?
- can only be given to that patient
- need to take iron supplements/erythropoietin
- donate 4-6 weeks in advance
86
What is the universal blood type recipients?
Type AB +
87
What is the universal blood type DONOR?
Type O
