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Exam2 NRS 202 > Nonmalignant Hematologic Disorders > Flashcards

Nonmalignant Hematologic Disorders Flashcards

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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
What can cause G-6-PD mutation?
oxidant drugs, fava beans, tonic water, and Chinese herbs
26
What are the s/s of G-6-PD?
pallor, jaundice, and hemoglobinuria
27
How is G-6-PD managed?
Treated by discontinuing the offending agent and transfusing if severe
28
Type of anemia characterized by low H & H and spherocytes
Immune hemolytic anemia
29
What is the cause of immune hemolytic anemia?
Exposure of erythrocytes to antibodies or a lack of suppressor lymphocytes
30
What are the manifestations of immune hemolytic anemia?
Fatigue Dizziness Splenomegaly
31
How is immune hemolytic anemia managed?
Corticosteroids or transfusion if needed
32
Anemia that is characterized by a genetic increase in iron absorption from the GI tract and deposits into various organs
hemochromatosis
33
What are the manifestations of hemochromatosis?
Weakness Weight loss Lethargy Bronze colored skin Arrhythmias Endocrine dysfunction Cirrhosis
34
How is hemochromatosis managed?
Therapeutic phlebotomy Limit iron intake
35
List the hypoproliferative anemias
Anemia in renal disease Anemia of inflammation Aplastic anemia Megaloblastic anemia - Folic acid deficiency and Vitamin B12 deficiency iron deficiency
36
When is anemia seen in renal disease?
When GFR drops below <30
37
When is anemia of inflammation seen?
In inflammatory disorders like RA
38
Type of anemia caused by damage to bone marrow stem cells leading to neutropenia, thrombocytopenia and can become life-threatening if not treated?
Aplastic anemia
39
Which anemia is characterized by a bronze skin color?
hereditary hemochromatosis
40
How is aplastic anemia treated?
Stem cell transplant or immunosuppression
41
Anemia that is characterized by a deficiency of iron due to lack of intake or bleeding
Iron deficiency anemia
42
When does vitamin b12 deficiency typically occur?
Vegan diet or after weight loss surgery
43
What are the s/s of iron deficiency anemia?
anemia smooth, red tongue brittle, rigid nails angular cheilosis
44
What foods are rich iron sources?
Organ meats, beans; green, leafy veggies, raisins, molasses
45
How should a patient take PO iron?
On an empty stomach with vitamin C Avoid calcium and antacids
46
Disorder classified by the decreased production or destruction of neutrophils
Neutropenia
47
The neutrophil count is below what to classify as neutropenia?
<2000
48
The patient is at highest risk for infection and should be placed on neutropenic precautions when ANC is what?
<500
49
How is neutropenia managed?
Close monitoring for infection Patient education Prevention Management of complications
50
Disorder where the lymphocyte count is <1500
lymphopenia
51
What happens when lymphopenia is severe?
Increased risk of infection
52
Causes of lymphpenia
Exposure to radiation Long-term steroid use Infections Neoplasms Alcohol abuse
53
A disorder characterized by the increased volume of RBS due to the excessive production of erythropoietin
polycythemia
54
Secondary polycythemia's excessive production of erythropoietin is caused by what?
Reduced amounts of oxygen, cyanotic heart disease, and nonpathologic conditions or neoplasms
55
Causes of polycythemia?
Lack of O2 - Smoking OSA COPD Severe heart disease Living at high altitudes Exposure to low levels of oxygen
56
How is polycythemia managed?
Mild - no treatment required Severe - treat underlying cause and therapeutic phlebotomy
57
What is a myeloproliferative neoplasm disorder of the myeloid stem that causes increased erythrocytes, leukocytes, and platelets from bone marrow?
Polycythemia vera
58
Death of polycythemia vera is usually caused by what?
thrombosis, hemorrhage, or AML
59
Manifestations of Polycythemia Vera
Ruddy complexion Splenomegaly HA, dizzy, tinnitus, fatigue Bone marrow fibrosis Paresthesia Blurred vision
60
What are the goals of polycythemia vera treatment?
Decrease risk of thrombosis, bleeding, and AML
61
How is polycythemia vera managed?
low dose ASA Therapeutic phlebotomy chemotherapy Medications like anagrelide and interferon Avoid iron supplements
62
What do you want to tell your patient with polycythemia vera to avoid?
Taking iron supplements
63
Causes of bleeding disorders
Trauma, platelet abnormalities, coagulation factor abnormalities
64
How are bleeding disorders managed?
Specific blood products Limiting injuries Assessing for bleeding Preventing bleeding
65
Secondary thrombocytosis is what?
increased platelets
66
What is thrombocytopenia?
Low platelets
67
What is immune thromobocytopenic purpura?
destruction of platelets
68
What does it mean when a patient has platelet 'defects'?
Number is normal but the function is not
69
Hemophilia means they are missing what?
missing clotting factor
70
Deficiency of vWD leading to factor VIII problems and lack of platelet adhesion?
von Willebrand disease
71
A significant complication of heparin-based therapy causing formation of antibodies against the heparin-platelet complex
Heparin induced thrombocytopenia (HIT)
72
Which has a higher risk for HIT - porcine or bovine?
Bovine
73
What are the risk factors for HIT?
type of heparin used, duration of therapy, surgery, women > men, bovine > porcine
74
HIT stands for
heparin induced thrombocytopenia
75
Complications of HIT
Venous/arterial thrombosis, ACS, stroke, or ischemic damage to extremities like DVT or PE
76
How is HIT managed?
STOP heparin therapy Initiate argatroban
77
What is the drug of choice when HIT occurs?
argatroban
78
What drug is NEVER used in HIT? Why?
Warfarin as it can cause promotion of thrombosis in microvasculature by depleting protein C
79
What is disseminated intravascular coagulation?
an altered hemostasis causing massive clotting in microcirculation. As clotting factors are consumed, massive bleeding occurs.
80
DIC stands for
disseminated intravascular coagulation
81
Causes of disseminated intravascular coagulation
sepsis, trauma, shock, cancer, abruptio placentae, toxins, and allergic reactionst
82
The symptoms of DIC are related to what?
tissue ischemia and bleeding
83
How is DIC managed?
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
What does the nurse assess in the patient with DIC?
Assess for s/s of bleeding and progression of thrombi and bleeding
85
Complications of DIC
Kidney injury Gangrene- vasculature PE Hemorrhage ARDS Stroke
86
S/s of SLE
Fever Malaise Weight loss Anorexia Joint pain Skin lesions
87
How is SLE managed?
Control acute flare ups to prevent organ damage Pain management Meds - Benlysta, hydroxycholorquine, NSAIDS, immunosuppresants

Exam2 NRS 202 (7 decks)

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