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Exam2 NRS 202 > Nonmalignant Hematologic Disorders > Flashcards

Nonmalignant Hematologic Disorders Flashcards

1
Q

Type of anemia in which not enough erythrocytes are being produced or erythrocytes production is defective

A

hypoproliferative

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2
Q

Symptom of an underlying disorder that is characterized by lower than normal hemoglobin and erythrocytes circulating in the body

A

Anemia

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3
Q

Causes of hypoproliferative anemias

A

Deficiencies of iron, vitamin b12, or folate causing decreaased erythropoietin production, cancer, or bone marrow damage

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4
Q

Type of anemia in which there is excess destruction of erythrocytes

A

Hemolytic

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5
Q

Causes of hemolytic anemias

A

Altered erythropoiesis like sickle cell or direct injury to the erythrocytes

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6
Q

Type of anemia caused by loss of RBCs

A

Bleeding anemias

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7
Q

What do the manifestations of anemia depend on?

A

Rapidity of the development, duration, metabolic requirements of the patient, concurrent and concomitant features

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8
Q

Describe the general manifestations of anemia

A

Fatigue, weakness, malaise
Pallor, jaundice
Tongue changes - red, beefy, swollen
Nail changes - spoon nails or brittle, rigid nails
Angular cheilitis
Pica

Cardiac
GI
Neuro
Respiratory

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9
Q

What does the nurse assess for the patient with anemia?

A

H&P
Labs
Symptoms and impact of symptoms
Nutrition - are they getting vitamins?
Medications
Cardiac
GI - blood loss
Blood loss
Neuro

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10
Q

What labs are assessed for anemia?

A

Hemoglobin
Hematocrit
RBC indices
Iron levels
Vit B12
Folate
Haptoglobin and erythropoietin levels

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11
Q

How are anemias managed?

A

Correct/control cause - stop/change meds, stop bleed
Transfusion of RBCs
Dietary or vitamin supplements
Immunosuppression
Balance of activity and rest
Adequate nutrition and perfusion
Education to promote compliance
Monitor VS and pulse ox - provide O2 as needed
Monitor for complications

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12
Q

List the types of hemolytic anemias

A

Sickle cell disease
Thalassemia
Glucose-6-phosphate dehydrogenase deficiency
Immune hemolytic anemia
Hereditary hemochromatosis

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13
Q

Type of anemia in which cells ‘sickle’ and become clumped together

A

Sickle cell disease

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14
Q

Describe the signs and symptoms of sickle cell diease

A

Anemia
Jaundice
High risk for arrhythmias
Risk for thrombosis

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15
Q

What are possible complications of sickle cell disease?

A

sickle cell crisis
acute chest syndrome
stroke
pulmonary HTN
Reproductive disorders
Lung infiltrates

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16
Q

What is the cause of sickle cell crises?

A

Decreased blood flow during times of stress or cold causing ischemia and cut off circulation and severe pain

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17
Q

What does the nurse asses in the patient with SCD?

A

H&P
Pain
Lab - S shaped hgb
Presence of symptoms and impact on life
Sickle cell crises
Blood loss
CV and neuro

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18
Q

What are the nursing interventions for SCD?

A

Pain management
Manage fatigue
Infection prevention - open sores/ulcerations
Promote coping
Education on disease process
Monitor for complications

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19
Q

Anemia that is characterized by hypochromia and small erythrocytes due to cell destruction

A

Thalassemia

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20
Q

An abnormal decrease in hemoglobin content of erythrocytes

A

Hypochromia

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21
Q

What are the s/s of thalassemia?

A

severe anemia
hemolysis
ineffective erythropoiesis

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22
Q

How is thalassemia treated?

A

Regular transfusions and chelation therapy

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23
Q

What is chelation therapy?

A

A drug is used to bind a substance and excrete it from the body

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24
Q

Type of anemia caused by a mutation of the G-6-PD gene that helps to stabilize cell membranes resulting in varying degrees of hemolysis

A

glucose-6-phosphate dehydrogenase deficiency

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25
Q

What can cause G-6-PD mutation?

A

oxidant drugs, fava beans, tonic water, and Chinese herbs

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26
Q

What are the s/s of G-6-PD?

A

pallor, jaundice, and hemoglobinuria

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27
Q

How is G-6-PD managed?

A

Treated by discontinuing the offending agent and transfusing if severe

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28
Q

Type of anemia characterized by low H & H and spherocytes

A

Immune hemolytic anemia

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29
Q

What is the cause of immune hemolytic anemia?

A

Exposure of erythrocytes to antibodies or a lack of suppressor lymphocytes

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30
Q

What are the manifestations of immune hemolytic anemia?

A

Fatigue
Dizziness
Splenomegaly

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31
Q

How is immune hemolytic anemia managed?

A

Corticosteroids or transfusion if needed

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32
Q

Anemia that is characterized by a genetic increase in iron absorption from the GI tract and deposits into various organs

A

hemochromatosis

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33
Q

What are the manifestations of hemochromatosis?

A

Weakness
Weight loss
Lethargy
Bronze colored skin
Arrhythmias
Endocrine dysfunction
Cirrhosis

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34
Q

How is hemochromatosis managed?

A

Therapeutic phlebotomy
Limit iron intake

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35
Q

List the hypoproliferative anemias

A

Anemia in renal disease
Anemia of inflammation
Aplastic anemia
Megaloblastic anemia - Folic acid deficiency and Vitamin B12 deficiency
iron deficiency

36
Q

When is anemia seen in renal disease?

A

When GFR drops below <30

37
Q

When is anemia of inflammation seen?

A

In inflammatory disorders like RA

38
Q

Type of anemia caused by damage to bone marrow stem cells leading to neutropenia, thrombocytopenia and can become life-threatening if not treated?

A

Aplastic anemia

39
Q

Which anemia is characterized by a bronze skin color?

A

hereditary hemochromatosis

40
Q

How is aplastic anemia treated?

A

Stem cell transplant or immunosuppression

41
Q

Anemia that is characterized by a deficiency of iron due to lack of intake or bleeding

A

Iron deficiency anemia

42
Q

When does vitamin b12 deficiency typically occur?

A

Vegan diet or after weight loss surgery

43
Q

What are the s/s of iron deficiency anemia?

A

anemia
smooth, red tongue
brittle, rigid nails
angular cheilosis

44
Q

What foods are rich iron sources?

A

Organ meats, beans; green, leafy veggies, raisins, molasses

45
Q

How should a patient take PO iron?

A

On an empty stomach with vitamin C
Avoid calcium and antacids

46
Q

Disorder classified by the decreased production or destruction of neutrophils

A

Neutropenia

47
Q

The neutrophil count is below what to classify as neutropenia?

A

<2000

48
Q

The patient is at highest risk for infection and should be placed on neutropenic precautions when ANC is what?

A

<500

49
Q

How is neutropenia managed?

A

Close monitoring for infection
Patient education
Prevention
Management of complications

50
Q

Disorder where the lymphocyte count is <1500

A

lymphopenia

51
Q

What happens when lymphopenia is severe?

A

Increased risk of infection

52
Q

Causes of lymphpenia

A

Exposure to radiation
Long-term steroid use
Infections
Neoplasms
Alcohol abuse

53
Q

A disorder characterized by the increased volume of RBS due to the excessive production of erythropoietin

A

polycythemia

54
Q

Secondary polycythemia’s excessive production of erythropoietin is caused by what?

A

Reduced amounts of oxygen, cyanotic heart disease, and nonpathologic conditions or neoplasms

55
Q

Causes of polycythemia?

A

Lack of O2 -
Smoking
OSA
COPD
Severe heart disease
Living at high altitudes
Exposure to low levels of oxygen

56
Q

How is polycythemia managed?

A

Mild - no treatment required
Severe - treat underlying cause and therapeutic phlebotomy

57
Q

What is a myeloproliferative neoplasm disorder of the myeloid stem that causes increased erythrocytes, leukocytes, and platelets from bone marrow?

A

Polycythemia vera

58
Q

Death of polycythemia vera is usually caused by what?

A

thrombosis, hemorrhage, or AML

59
Q

Manifestations of Polycythemia Vera

A

Ruddy complexion
Splenomegaly
HA, dizzy, tinnitus, fatigue
Bone marrow fibrosis
Paresthesia
Blurred vision

60
Q

What are the goals of polycythemia vera treatment?

A

Decrease risk of thrombosis, bleeding, and AML

61
Q

How is polycythemia vera managed?

A

low dose ASA
Therapeutic phlebotomy
chemotherapy
Medications like anagrelide and interferon
Avoid iron supplements

62
Q

What do you want to tell your patient with polycythemia vera to avoid?

A

Taking iron supplements

63
Q

Causes of bleeding disorders

A

Trauma, platelet abnormalities, coagulation factor abnormalities

64
Q

How are bleeding disorders managed?

A

Specific blood products
Limiting injuries
Assessing for bleeding
Preventing bleeding

65
Q

Secondary thrombocytosis is what?

A

increased platelets

66
Q

What is thrombocytopenia?

A

Low platelets

67
Q

What is immune thromobocytopenic purpura?

A

destruction of platelets

68
Q

What does it mean when a patient has platelet ‘defects’?

A

Number is normal but the function is not

69
Q

Hemophilia means they are missing what?

A

missing clotting factor

70
Q

Deficiency of vWD leading to factor VIII problems and lack of platelet adhesion?

A

von Willebrand disease

71
Q

A significant complication of heparin-based therapy causing formation of antibodies against the heparin-platelet complex

A

Heparin induced thrombocytopenia (HIT)

72
Q

Which has a higher risk for HIT - porcine or bovine?

A

Bovine

73
Q

What are the risk factors for HIT?

A

type of heparin used, duration of therapy, surgery, women > men, bovine > porcine

74
Q

HIT stands for

A

heparin induced thrombocytopenia

75
Q

Complications of HIT

A

Venous/arterial thrombosis, ACS, stroke, or ischemic damage to extremities like DVT or PE

76
Q

How is HIT managed?

A

STOP heparin therapy
Initiate argatroban

77
Q

What is the drug of choice when HIT occurs?

A

argatroban

78
Q

What drug is NEVER used in HIT?
Why?

A

Warfarin as it can cause promotion of thrombosis in microvasculature by depleting protein C

79
Q

What is disseminated intravascular coagulation?

A

an altered hemostasis causing massive clotting in microcirculation. As clotting factors are consumed, massive bleeding occurs.

80
Q

DIC stands for

A

disseminated intravascular coagulation

81
Q

Causes of disseminated intravascular coagulation

A

sepsis, trauma, shock, cancer, abruptio placentae, toxins, and allergic reactionst

82
Q

The symptoms of DIC are related to what?

A

tissue ischemia and bleeding

83
Q

How is DIC managed?

A

Treat underlying cause
Correct tissue ischemia
Fluid replacement
Maintain BP, skin, perfusion
Replace coagulation factors
Use heparin or LMWH
Avoid trauma or increased bleeding

84
Q

What does the nurse assess in the patient with DIC?

A

Assess for s/s of bleeding and progression of thrombi and bleeding

85
Q

Complications of DIC

A

Kidney injury
Gangrene- vasculature
PE
Hemorrhage
ARDS
Stroke

86
Q

S/s of SLE

A

Fever
Malaise
Weight loss
Anorexia
Joint pain
Skin lesions

87
Q

How is SLE managed?

A

Control acute flare ups to prevent organ damage
Pain management
Meds - Benlysta, hydroxycholorquine, NSAIDS, immunosuppresants

Exam2 NRS 202 (7 decks)

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