lecture 11 [hematologic & immunologic dysfunctions] Flashcards
1
Q
what is the definition of hemostasis?
A
the process that stops bleeding when a blood vessel is injured
2
Q
what blood components does hemostasis require?
A
- vascular clotting factors
- plasma clotting factors
- platelets
3
Q
what is the definition of fibrinolysis?
A
clot breakdown
4
Q
what is hemophilia?
A
a group of bleeding disorders characterized by difficulty controlling bleeding due to lack of clotting factors
5
Q
what are the types of hemophilia?
A
- Hemophilia A (classic)
- Hemophilia B
- Von Willebrand Disease
6
Q
which clotting factor does Hemophilia A lack?
A
factor VIII
7
Q
which clotting factor does Hemophilia B lack?
A
factor IX
8
Q
which is the most common type of hemophilia?
A
Von Willbrand disease
9
Q
what is Von Willebrand hemophilia?
A
the inherited lack of the von willebrand factor protein characterized by inability of platelets to aggregate
10
Q
both Hemophilia A & B are male dominant (x-linked recessive)
A
true
11
Q
Von Willebrand disease affects both males & females
A
true
12
Q
how is hemophilia diagnosed?
A
- hx of bleeding episodes
- evidence of x-linked inheritance
- PTT
- factor assays
- DNA testing
13
Q
what are the medications & treatment for hemophilia?
(6)
A
- synthetic vasopressin (DDAVP)
- steroids
- factor VIII products
- pooled plasma
- recombinant products
- NSAIDs
14
Q
what is the MOA of DDAVP (Desmopressin)?
A
increases plasma factor VIII (only for Hemophilia A)
15
Q
what is the nursing care for hemophilia?
(4)
A
- monitor urine, stool, & NG fluid for occult blood
- administer Acetaminophen instead of aspirin
- administer injections via subQ only
- venipunctures are preferred for blood sampling
16
Q
what is idiopathic thrombocytopenia purpura?
A
a decrease in platelet count manifested by discoloration caused by petechia beneath the skin
17
Q
acute idiopathic thrombocytopenia purpura is most often seen after acquiring these diseases:
A
- MMR
- chickenpox
- parovirus B19 (Fifth’s disease)
18
Q
what are the clinical manifestations of ITP?
A
- easy bruising
- bleeding from mucous membranes
19
Q
what is considered a low platelet count?
A
less than 20,000
20
Q
what is the function of the spleen?
A
controls the level of blood cells (RBC, WBC, PLT, etc) by elimination
21
Q
what is often a therapeutic procedure for ITP?
A
splenectomy
22
Q
what are the medications for ITP?
A
- prednisone
- IVIG
23
Q
what are the neoplastic disorders?
A
- leukemia
- lymphoma
24
Q
what are the types of leukemia in children?
A
- acute lymphoblastic leukemia
- acute myelogenous leukemia
25
*acute lymphoblastic* ***leukemia*** is more common than *acute myelogenous*
true
26
what are the s/s of ***leukemia***?
* fever
* bone/ joint pain
* petechiae
* anemia
* bleeding
* pallor
27
what is the most common form of *childhood cancer*?
leukemia
28
what is ***leukemia***?
unrestricted proliferation of *immature* WBCs
29
what is the diagnostic procedure for ***leukemia***?
bone marrow aspiration
30
what are the stages of ***chemotherapy***?
1. induction
2. CNS prophylaxis
3. intensification
4. maintenance
31
what is the goal of ***induction***?
| stage of chemotherapy
to achieve complete remission ***or*** reduce leukemic cells in bone marrow by 5% or less
32
what is the goal of ***CNS prophylaxis***?
| stage of chemotherapy
prevents leukemic cells from invading CNS
33
what is the goal of ***intensification*** *(consolidation)*?
| stage of chemotherapy
to eradicate residual leukemia cells
34
what is the goal of ***maintenance***?
| stage of chemotherapy
maintain remission
35
what are the effects of *late stage* ***leukemia***?
* cardiomyopathy
* cognitive delays & deficits
36
what are the complications of ***myelosuppression***?
* infection
* anemia
* thrombocytopenia
37
what is considered an emergency for patients who are *immunosuppressed*?
fever
38
what are the lab tests & diagnostic procedures for immunocompromised patients?
* blood cultures
* urine cultures
* CXR
39
what are the prognostic factors for ***leukemia***?
* initial WBC count
* Karyotype analysis
* type of cell involved
40
what are common side effects of *chemotherapy*?
* nausea
* vomiting
* hemorrhagic cystitis
* alopecia
* moon face
41
what is ***lymphoma***?
a group of neoplastic diseases that arise from the *lymphoid* & *hematopoietic* system
42
what are the types of ***lymphoma***?
* Hodgkin lymphoma
* Non-hodgkin lymphoma
43
***Hodgkin lymphoma*** primarily affects which age group?
patients aged 15-19
44
***Non-Hodgkin lymphoma*** primarily affects which age group?
children younger than 14 years old
45
what are the diagnostic tests for ***lymphoma***?
| (2)
* bone scan
* lymph node biopsy
46
what are the clinical manifestations of ***lymphoma***?
* fever
* weight loss
* night sweats
* anorexia
* ***enlarged lymph nodes***
* pruritus
47
what is the therapeutic management for ***lymphoma***?
* radiation
* chemotherapy
48
what is the ***immunologic deficiency disorder*** in this lecture?
HIV/ AIDS
49
***HIV*** is usually transmitted by *lymphocytes* & *monocytes*
true
50
in which bodily fluids is ***HIV*** found?
* blood
* semen
* vaginal secretions
* breast milk
51
what is *vertical transmission* of ***HIV***?
mother passes it to infant during pregnancy
52
what is *horizontal transmission* of ***HIV***?
through sexual contact or exposure to infected body fluids
53
what are the diagnostic tests for ***HIV***?
* ELISA
* Western blot test
54
what is the treatment & prevention for ***HIV***?
* antiretroviral drugs
* immunizations
55
what are the treatments for ***hematologic*** & ***immunologic deficiencies***?
* blood transfusions
* hematopoietic stem cell transplant
56
what is the most severe reaction to a ***blood transfusion***?
hemolytic rxn
57
what are the most common rxns to a ***blood transfusion***?
* febrile
* allergic
58
what is ***intensive ablative therapy***?
deplete entire bone marrow to prevent rejection of new stem cells w/ chemo or radiation
59
what are the steps to ***hematopoietic stem cell transplant***?
1. intensive ablative therapy
2. stem cells infusion by IV
3. engrafting
60
# definition
engrafting
body accepts new bone marrow & proliferates
61
# definition
autologous
| HSCT
use of the patient's own bone marrow cells
62
# definition
allogenic
| HSCT
use of matching histocompatible donor with a recipient
63
what is the goal of treating ***WBC disorders***?
*repair or replace* damaged WBCs while *stopping the proliferation* of immature or damaged WBCs
64
what is the normal range for ***Hgb***?
11.5 - 15.5g/dL
65
what is the normal range for ***Hct***?
35 - 45%
66
what is a ***reticulocyte***?
an immature RBC
67
in which condition are ***reticulocytes*** elevated?
chronic hemolytic anemia
68
# purpose
neutrophils
primary defense of *bacterial* infection
69
# purpose
eosinophils
defends against parasites, allergies, & neoplasms
70
# purpose
basophils
increases blood flow to injured tissues
71
# purpose
lymphocytes
| (antibodies)
fights off antigens & delays hypersensitivity
72
# purpose
monocytes
large phagocytic cells involved in the early stages of inflammatory rxns
73
# definition
Mean Corpuscular Volume
* calculates svg *size & volume* of RBCs
* determines the type of ***anemia***
74
# definition
Mean Corpuscular Hemoglobin
calculates the avg amount of Hgb in (1) RBC
75
what is the normal range for ***platelets***?
150-400
76
what is the main function of ***PLT***?
helps clot blood
77
what are the types of ***anemias***?
* iron deficiency
* sickle cell
* B-Thalassemia*(Cooley)*
* aplastic
78
what are the various reasons for ***anemia***?
* decreased RBC production
* increased loss of RBC *(from bleeding)*
* increased hemolysis
79
what are common clinical manifestations of ***anemia***?
* fatigue
* pallor
* decrease in Hgb
80
what are the main reasons for *decreased* ***RBC production***?
* nutritional deficiency
* bone marrow failure
81
what are the reasons for *increased* ***hemolysis***?
* membrane deficiencies *(spherocytosis)*
* Thalassemia
* chemotherapy
* radiation
82
what are the causes for ***iron deficiency anemia***?
* decreased supply of iron
* malabsorption of iron
* change in *Hgb* synthesis
83
milk decreases absorption of iron
true
84
what does the nurse tell parents when giving their child *iron supplements*?
* give 2x a day in between meals
* give with Vit C
* iron turns stools tarry green
* it can stain teeth
* do not take with milk
85
what is the normal type of ***Hgb***?
Hgb A
86
patients with ***sickle cell anemia*** have what type of *Hgb*?
Hgb S
| predominantly; it replaces Hgb A
87
which diagnostic procedure is used for ***sickle cell anemia***?
* hemoglobin electrophoresis
* sickledex finger stick
88
***sickle cell anemia*** is an *autosomal recessive disorder*
true
89
what are the nursing actions for a ***sickle cell*** *crisis*?
* adequate oxygenation
* hydration
* transfusion
* ABX
* analgesics
* FEB
90
what are the s/s of *vasooculsive crisis* in ***sickle cell anemia***?
* pain
* priapism
* acute chest syndrome
* stroke
91
what are the s/s of *sequestration crisis* in ***sickle cell anemia***?
* spleenic sequestration
* hepatic sequestration
92
# definition
sequestration
trapping of cells and debris in the spleen, causing a decrease in Hgb
93
what is the prevention for *sepsis* in ***sickle cell anemia***?
prophylactic Penicillin
| until 5 years old
94
what are the clinical manifestations of ***Cooley anemia***?
| B-Thalassemia
* small stature
* splenomegaly
* hepatomegaly
* decreased H&H
* abnormal blood smear
95
how does the patient present with untreated ***Cooley anemia***?
* enlarged head due to prominent parietal & frontal bossing
* prominent malar eminences
* enlarged maxilla
* freckled & bronzed complexion
96
what is the therapeutic management for ***cooley anemia***?
* chronic blood transfusions
* iron chelation essential
* splenectomy
97
what are the guidelines & parameters of chronic blood transfusion for ***Cooley anemia***?
* required every 3-5 weeks
* maintain *Hgb > 9.5*
98
what is ***aplastic anemia***?
a bone marrow failure condition in which formed elements of the blood are simultaneously depressed
99
what are the conditions associated with ***aplastic anemia***?
* anemia
* leukopenia
* thrombocytopenia
100
what does ***hypoplastic anemia*** entail?
only the RBCs are decreased
101
how is ***aplastic anemia*** managed?
* Cyclosporin *(immunosuppressive therapy)*
* steroids
* HSCT
