Hemotology Flashcards
(97 cards)
0
Q
Hgb values
A
12-16 females
13.5-18 males
1
Q
RBC values
A
4-5 females
4.5-6 males
2
Q
Hemoglobin and anemia values
A
10-14 mild
6-10 moderate
<6 severe
3
Q
3 signs symptoms of severe anemia
A
Fatigue
Palpitations
Dyspnea
4
Q
Hct values
A
3 times the Hgb value
5
Q
If Hct is elevated then the patient is experiencing…
A
Fluid volume deficiet
6
Q
If Hct is decreased then the patient is experiencing…
A
Fluid volume overload/ excess
7
Q
WBC values
A
4000-11000
8
Q
Neutrophils should be….
A
50-78% of wBCs
9
Q
Neutropenia actions
A
Temp greater 100.4/38C report immediately and start IV antibiotic
Shift to left is high neutrophil= severe infection
10
Q
Platelet values
A
100,000-250,000
11
Q
Thrombocytopenia platelet count
A
Less than 100,000
12
Q
Thrombocytopenia critical values
A
Critical less than 50,000
Hemorrhage if less than 20,000
Need platelet transfusion if less than 10,000
13
Q
INR values for Coumadin therapy
INR values for No therapy
A
Coumadin = 2-3
No therapy= 1-2
14
Q
Antidote for Coumadin therapy
A
Intramuscular injection Vitamin K
15
Q
Coumadin is part of the ——–pathway for coagulation
A
Extrinsic
16
Q
aPTT values for heparin therapy
aPTT vales for no therapy
aPTT Heparin critical value
A
Heparin therapy 75-112
1.5-2.5 times normal
No therapy 25-35 seconds
Critical greater than 130–heparin protocol
17
Q
Antidote to heparin therapy
A
Protamine sulfate
18
Q
Heparin is part of the——–pathway
A
Intrinsic
19
Q
Patient teaching for iron liquid supplement
Where is IM iron injections given, by which method?
A
Acidic stomach, empty stomach, vitamin C increases absorption, causes black tarry stools and constipation. Stains teeth, drink with straw.
Deep gluteus with z-track
20
Q
What is hydroxyurea (Hydrea)?
A
Medications used to increase fetal hemoglobin in sickle cell and leukemia patients
21
Q
What is cyanocobalamin?
A
Medication for vitamin b12 deficient anemia. Available PO and IM.
22
Q
What is the side effects of cyanocobalamin medication?
A
Decreased K+, secondary to improved RBC production and may need supplemental K+
23
Q
What is the action of folic acid?
A
Increases production of RBCs; also prevents neural tube defects.
24
What are Epogen and Procrit used for?
Increase production of RBC in bone marrow for chemo and renal failure patients.
Watch for HTN secondary to increased Hct.
25
What are the uses of Neupogen?
Stimulate bone marrow production of neutrophils /WBC to decrease Risk of infection.
Watch for nine pain, notify mad and give Tylenol
26
What lab values are reduced in anemia?
Decreased RBC, Hgb and Hct
27
Patients with pernicious anemia lack what?
Intrinsic factor needed in the stomach to absorb vitamin b12
28
Define vitamin b12 anemia.
Decreased RBCs secondary to decreased b12. But have large RBCs.
Decreased cobalamin serum levels
Vitamin b12 is water soluble.
29
Define folic acid anemia
Decreased RBCs secondary to decreased serum folate.
30
What is the shillings test? How performed? How to interpret results?
Shillings is radioactive urine test for determining absorption of vitamin b12. 24 hour urine collection. If b12 found in urine then not absorbing it-lack intrinsic factors.
31
What are sources of dietary vitamin b 12?
Eggs, dairy, animal proteins
32
What are dietary sources of folic acid?
Fruits green leafy vegetables.
33
What are symptoms of vitamin b12 anemia
Fatigue, dyspnea, palpations
| Parathesias, swollen red tongue, confusion.
34
What are some common causes of vitamin b12 anemia?
```
Decreased diet intake
Alcoholism
Digestive disorders (chroma/celiac)
Wt loss surgery
Antacids (PPIs ⬇️acid needed to absorb iron).
```
35
HOP is used for the treatment of ------
Sickle cell anemia.
Hydration
Oxygenation
Pain
36
What are triggers for sickle cell anemia?
Anything that decreased oxygen -hypoxemia
Infection
Dehydration
Hypoxemia
37
What organs are damaged in sickle cell anemia?
Spleen-RBCs get caught up
| Liver-jaundice from hemolysis of Hgb
38
# Define polycythemia Vera.
Distinguish between primary and secondary.
Too many RBCs and WBCs and platelets
Primary: increased RBCs, WBCs, and platelets-hypercoagulability- clotting
Secondary: related to increased erythropoietin from hypoxia- body wants more 02 so kidneys secrete more.
39
What are symptoms of polycythemia?
HA, dizziness, tinnitus, itchy, thrombus
HTN secondary to increased viscosity of blood.
RBCs WBCs and platelets have shorter life span. Lysis if cells spills contents leading to---Increased Uric acid and K+
40
Define thrombocytopenia.
Decreased platelets. <100,000
41
What are some indicators of thrombocytopenia ?
Bruising
Petechia -no blanching of skin
Increased bleeding.
42
What is HITTS -thrombocytopenia
Heparin induced thrombolytic thrombocytopenia syndrome
NEVER heparin again or lovenox. Start Coumadin and thrombolytics.
Platelets decrease 50% from baseline after injection as immune system attacks platelets.
43
What changes in lab values do you see with DIC?
Platelets, clotting factors
PT/PTT, FSP, d-dimer
Platelets, clotting factors: decreased
PT/PTT, FSP, d-dimer: increased
44
Define DIC
Disseminated intravascular coaguapathy
Blood clots in small blood vessels, this ⬆️ clotting uses up platelets and clotting factors (proteins). Leads to ⬆️ bleeding.
45
# Define hemophilia.
Hemophilia A
Hemophilia B
Von will round
Deficiency in clotting factors.
Hemophilia A: factor 8
Hemophilia B: factor 9
Von will round: Von willibrond factors.
46
How does DDAVP help with hemophilia?
DDAVP desmopressin helps release factors 8 stored in lining of blood vessels.
47
What lab value changes would you see in hemophilia?
PPT
PT
Factor assay
PPT: increased. Intrinsic pathway and is slower than extrinsic
PT: normal
Factor assay: decreased
48
Define neutropenia.
Decreased WBCs. Specifically neutrophils less than 1000
49
What are precautions for neutropenic patients?
```
Strict hand washing
No fresh foods or raw or flowers
Private room
Reverse isolation
Assess temp q4 hrs
```
50
What is the sign/symptom you would watch for in neutropenic patients?
Pain
As too little WBCs to produce normal inflammatory reaction ( redness, warmth, pus, elevated WBCs)
Temp greater than 100.4/38 requires IV antibiotics within an hour.
51
# Define leukemia.
What lab value changes would you expect?
RBCs, Hgb/Hct, platelets
WBCs
Malignancy affecting blood and blood forming tissues of bone marrow, lymph system, spleen.
RBCs, Hgb/Hct, platelets: all low, body not making
WBCs: elevated at first but ineffective. Low after diagnosis.
52
What are some common manifestations of leukemia?
Acute: bone pain, anemia, bleeding, fever, weight loss, poor wound healing, enlarged liver or spleen.
53
# Define lymphoma.
Distinguish between hodgkins and non Hodgkin's lymphoma.
Malignant neoplasm in bone and lymphatic structures. Lymphoma develops when lymphocytes divide uncontrollably and crowd out healthy cells/tissues with rumors.
Hodgkins: reed sternberg cells
Non-Hodgkins: NO reed sternberg cells.
54
What are the common manifestations of lymphoma?
Painless enlargement of cervical, auxiliary, I guitar lymph nodes.
Fever, night sweats, and weight loss are late symptoms with poor prognosis.
55
# Define multiple myeloma.
What lab values would you expect? Ca++
| RBCs WBCs platelets
Neoplastic plasma cells infiltrate the bone marrow and destroy bone.
Hypercalcemia secondary to bone destruction. Give corticosteroids to secrete Ca++.
56
What lab value is assessed for intrinsic coagulation pathway?
What medication do we monitor for this value?
PTT
Heparin
Intrinsic pathway is activated via vessel damage (hemophilia)
57
What lab value is assessed for extrinsic coagulation pathway?
What medication do we monitor for this value?
PT/INR
Coumadin/warfarin
Extrinsic pathway activated via release of thromboplastin by tissues
58
What are fibrin split products?
Lab value used to measure the breakdown of clot/plug of injury to allow blood back I tot the injured area.
59
What is streptokinase?
Thrombolytic used to break up cots in MI, ischemic stroke, PE.
Increase perfusion, decrease viscosity and aggregation of RBCs
60
What is the acronym RANDI for bleeding precautions include?
```
R- razors electric
A- aspirin-NO
N- needles-small gauge
D- decrease needle sticks
I- injury- protect from
```
61
Least the sign and symptoms of transfusion reactions.
Allergic
Febrile
Hemolytic
Allergic: face flushing, hives/rash, anxiety,wheezing hypotension
Febrile: HA, tachycardia, tachypnea, fever, chills, anxiety
Hemolytic: hematuria, chest pain, low back pain, fever, tachycardia, hypotension, SOB, chills
62
```
What is the effect of stress on organs/systems?
Heart
Blood vessels
Lungs
Adrenal medulla
Liver
GI system
```
Heart: ⬆️ BP and HR= ⬆️CO
Blood vessels: peripheral vasodilation and central vasoconstriction
Lungs: increased RR with shallow breathing, bronchi dilation
Adrenal medulla: release epi and norepinephrine
Liver: gluconeogensis=⬆️BS
GI system: decreased peristalsis
63
Give an example of an emotion focused coping strategy.
Give an example of a problem focused coping strategy.
Emotion: help cope: hot bath, exercise, talking with friend
Problem: find solution: seeking advice, referral
64
What effects do corticoids ( cortisol) have during stress?
Increase breakdown proteins
Gluconeogensis--⬆️BS
Decreased lymphocytes and decreased WBCs
65
What effects does aldosterone have during stress?
Saves Na+ and H20 in kidneys
Leads to increased BV, increased BP
66
What effects does ADH have during stress?
Saves water only
Leads to water retention, increased BV, increased BP
67
What effects do catacholamines ( epi and norepinephrine) have during stress?
Flight or fight
⬆️HR, increased contractility, bronchodilation, vasoconstriction to nonessential tissues,vasodilation to periphery and essential organs. Pupil dilation, inhibit GI action, decrease insulin and increased BS
68
Hypernatremia causes.
```
Hypernatremia causes
Dehydration
Decreased renal function
HF secondary to aldosterone
Cushings (increased cortisol)
```
Na+ gain and water loss.
69
Hypernatremia signs symptoms
```
Hypernatremia symptoms
Neuro changes - altered mental status
Mild muscle twitching
Severe weakness
Dry mouth
```
70
Hypernatremia treatments
Hypotonic solutions
Diuretics
Fluids but restrict Na+
71
Hyponatremia causes
```
Hyponatremia causes
Diuretics
DKA
Addison's (decreased adrenal)
Fluid overload
Excessive sweating or GI fluid loss
```
Na+loss and water gain
72
Hyponatremia sign and symptoms
```
Hyponatremia symptoms
Neuro-confusion
General muscle weakness
Decreased reflexes
Increased GI motility
Cardiac decreased BP, weak pulse.
```
73
Hyponatremia treatments
Hyponatremia treatments
Increase oral sodium intake
IV fluids if from FVD
Diuretics if from FVE
Hypertonic soon to increase sodium
74
Hyperkalemia causes
```
Hyperkalemia causes:
Renal failure
Addison's (decreased adrenal)
DKA
K+sparing diuretics
Crush injury
```
75
Hyperkalemia symptoms
```
Hyperkalemia symptoms:
Increased excitability so:
Cardiac changes, EKG changes, v-fib, decreased BP and HR
Muscle twitching
Abdominal cramping-diarrhea
Weakness paralysis
```
76
Hyperkalemia treatment
Hyperkalemia treatment:
Decrease K+ oral intake
Diuretics, dialysis, insulin to decrease K+
IV Ca++ to decrease excitability
Kayexalate- increased GI elimination of K+
77
Hypokalemia causes
```
Hypokalemia causes:
Diuretics
Cushings ( increased cortisol)
Diarrhea vomiting
Alkalosis
Fluid overload due to increased aldosterone
Insulin
Digoxin toxicity
```
78
Hypokalemia symptoms
```
Hypokalemia symptoms: A SIC WALT. Decreased excitability
Alkalosis
Shallow reaps
Irritability
Confusion drowsiness
Weakness fatigue
Arrhythmias
Lethargy
Threads pulse
```
79
Hypokalemia treatment
```
Hypokalemia treatments:
K+ supplement
K+ sparing diuretics
Dietary K+ intake
Insulin to move K+ into cell
```
80
Hypercalcemia causes
```
Hypercalcemia causes
Hyper parathyroid
Acidosis
Renal failure
Malignancy- multiple myeloma
Prolonged immobility
```
81
Hypercalcemia symptoms
```
Hypercalcemia symptoms
Decreased excitability
Muscle weakness
Decreased reflexes
Decreased peristalsis
Blood clots
```
82
Hypercalcemia treatments
```
Hypercalcemia treatment
Loop diuretics
Isotonic fluids
Ca++ binders
Increased phosphate
Calcitonin to decreased Ca++ absorption
Dialysis
Decreased dietary Ca++
Weight bearing exercises
Cardiac monitoring
```
83
Hypocalcemia causes
```
Hypercalcemia causes:
Renal failure
Hypo parathyroid
Alkalosis
Loop diuretics
Increased phosphorus intake
```
84
Hypercalcemia symptoms
```
Hypercalcemia symptoms: muscle excitability
Parathesias around mouth/ lip tingling
Muscle cramping
Hypotension
Osteoporosis
EKG changes
Positive chovsteks and trousseaus sign
```
85
Hypercalcemia treatment
Hypercalcemia treatment:
Ca++ supplements
Oral Ca++ intake
Decrease phosphate
86
Chvotek's sign assesses for what electrolyte imbalance? How to perform.
Hypocalcemia
Tap cheek and notice muscle twitching from muscle excitability.
87
Trousseau's sign is used to asses for what electrolyte imbalance? How to perform
Hypocalcemia
BP cuff to arm and arm cramp
88
What is the effect of calcitonin on Ca++ levels?
Calcitonin causes decreased GI absorption, promotes renal secretion and deposits Ca++ to bone.
89
What effect does parathyroid hormone have on Ca++ levels?
Is released when Ca++ levels are low.
| Causes Ca++ to be released from bone, increase GI absorption and increased renal absorption
90
Acidosis causes K+ levels to------
Rise- hyperkalemia
91
Alkalosis causes K+ levels to ----
Fall- potassium enters cells and Hypokalemia in serum.
92
How much fluid is loss daily through insensible losses?
1000 cc
93
What is normal urine output?
What is the minimal urine output?
Normal = 60 cc / hour
Minimal = 30 cc/ hr
94
What affect does aldosterone have on Na+ and K+ levels?
Na + levels rise
K+ levels fall as it is excreted in urine.
95
List physical symptoms of dehydration.
```
Hypotension, orthostatic hypotension
Tachycardia
Increased RR
Decreased skin turgid
Dry mucous membranes
Confusion
Decreased urine output- high specific gravity- concentrated
Elevated Hct, BUN, osmolality.
```
96
List physical symptoms of fluid overload.
```
Pitting edema
Bounding pulses
JVD
Weight gain
Dyspnea
Crackles
Confusion
Enlarged liver
```
