Which organ produces prothrombin and clotting factors?
Liver
Which organ regulates the growth of blood cell and stores platelets?
Spleen
How many RBCs are normal?
4.2-6.1 million/mm3
RBCs:
What products are needed to form Hgb and RBCs?
Iron
Vit B12
Folic Acid
Copper
Pyroxidine
Cobalt
Nickel
RBCs:
What is the lifespan of an RBC?
120 days
A bright red tongue is a sign of —
anemia
Tenderness of pain in sternum is a sign of —
leukemia
Lab Values:
RBCs
4.2-6.1 million/mm3
Lab Values:
WBCs
5,000-10,000
Lab Values:
Hgb
Female: 12-16
Male: 14-18
Lab Values:
Iron
Female: 60-160
Male: 80-180
Lab Values:
Platelets
150,000 - 450,000
Lab Values:
PT
11-12.5 secs
Lab Values:
If PT is high, it means –
If PT is low, it means –
clotting deciciency
vit K excess
Lab Values:
aPTT measures —
Heparin
Lab Values:
aPTT
1.5-2 x’s normal range of 30-40 secs
Lab Values:
INR measures —
warfarin
Lab Values:
INR
1 (normal)
2-3 (warfarin)
Lab Values:
D-dimer measures —
hypercoagulability of blood
Lab Values:
D-dimer
0.43-2.33 mcg/mL
or
0-250 ng/mL
Lab Values:
What does a high D-dimer indicate?
clot formation has occured
Lab Values:
Fibrinogen
170-340
Lab Values:
Fibrin Degradation Products
less than 10 mcg/mL
Lab Values:
Waht does Fibrin Degradation Products measure?
efficiency of meds for DCI
***tells us when clot dissolving activity is occurring
Bone Marrow Aspiration:
What position do we want client in?
side lying or prone position
Bone Marrow Aspiration:
Nursing care postop?
Monitor for signs of infection
Apply ice to biopsy site if prescribed
Mild analgesics for pain
Avoid ASA and other meds that affect clotting
Bone Marrow Aspiratoin:
How often should client inspect site postop?
daily
Anemia:
Signs and Symptoms
Pallor
Fatigue
Numbness of extremities
DOE
Sensitivity to cold
Tachycardia
Dizziness
Orthostatic Hypotension
Bright red tongue
Anemia:
Risk Factors
Blood Loss (ex: GI ulcer)
Inadequate RBC production
Increased RBC destruction
Deficiency in components of RBCs
Bone Marrow Suppression
CBC:
— measure the size of RBCs
— measures the amount of Hgb per RBC
MCV (Mean Corpuscular Vol.)
MCH (Mean Corpuscular Hgb)
CBC:
What will MCV be with Sickle Cell?
What will MCH be with Sickle Cell?
MCV = Normocytic
MCH = Normochromic
CBC:
What will MCV be with Iron Deficiency Anemia?
What will MCH be with Iron Deficiency Anemia?
MCV = Microcytic
MCH = Hyochromic
Anemia:
If MCV are Macrocytic, what do we suspect?
Folic Acid Deficiency
Vit B12 Deficiency
CBC:
What does MCHC measure?
Mean Corpuscular Hgb Concentration
- indication of Hgb amount in relation to size of cell
What is TIBC?
Total Iron Binding Capacity
- measure serum transferrin, a protein that binds with iron and transports it for storage
Which test detects Sickle Cell?
Hgb Electrophoresis
Which test measures ability to absorb B12?
Schilling Test
Anemia:
What type of foods should we encourage?
Red Meat
Organ Meat
Egg yolks
Kidney beans
Green leafy veggies
Nuts
Dairy products
Citrus fruits
Anemia:
When should Hgb be checked if taking iron?
4-6 wks to determine efficacy
Anemia:
What route should Iron Dextran be given?
IM (Z-track)
Anemia:
Nursing considerations for Erythropoietin?
Monitor for increased BP
Monitor Hgb and HCT twice a week
Moniotor for cardiovascular event if Hgb rises more than 1g/dL in 2 wks
Anemia:
If they take B12 shots, how often do they get them?
monthly
Anemia:
If they take B12 shots, how should they be given?
IM or deep SQ to prevent irritation
Anemia:
What will large doses of Folic Acid do?
Mask Vit B12 deficiency
Turn urine dark yellow
Leukemia:
What are the signs and symptoms?
Bone pain
Joint swelling
Enlarged Liver/Spleen
Weight loss
Fever
Poor wound healing
Fatigue, Pallor, Tachycardia, DOE
Bleeding / Bruising
Leukemia:
Is radiation used?
not typically
Leukemia:
Following BM Transplant, what is client at risk of?
infection and bleeding until the transfused stem cells being producing WBCs again
Leukemia:
What are the types of BM Transplantation?
Autologous (own cells)
Syngenec (identical twins)
Allogenec (close match)
Leukemia:
Why are we concerned with bleeding and injury postop?
they will have a low platelet count for a while
Lymphoma:
— is usually younger clients
— is usually after age 50.
Hodgkin’s
Non-Hodgkin’s
Lymphoma:
Is Chemo used?
may or may not be
Lymphoma:
What is primary form of treatment for HL?
Radiation
Lymphoma:
What are s/s?
Enlarged, PAINLESS lymph nodes
Fever
Night Sweats
Weight Loss
Fatigue
Infection
Sickle Cell:
What are s/s?
Pain
Cardiac Issues
Priapism
Skin changes
Organ damage (liver, kidney, CNS)
Joint damage
Sickle Cell:
What is treatment plan order of importance?
HOP
Hydration
Oxygenation
Pain Control
Sickle Cell:
What meds can be used but what are we concerned about
Hydroxyurea
***increases risk of leukemia
Blood Transfusion:
How often are new cross match samples obtained?
q 72 hrs
Blood Transfusion:
What can we premedicate with?
Diphenhydramine
Acetaminophen
Blood Transfusion:
What electrolyte issue do we monitor for?
hyperkalemia
Blood Transfusion:
How often do we check VS?
q 15 mins, 30 mins, then hourly
Blood Transfusion:
If they have no reaction, what rate do we want to administer?
1 unit every 1-2 hrs
Blood Transfusion:
T/F: Rh+ can receive from Rh- but cannot give to Rh-
True
Blood Transfusion:
What are s/s of an acute hemolytic reaction?
Chills
Fever
Low Back Pain
Tachycardia
Tachypnea
Hemoglobinuria
Blood Transfusion:
When would we see a Febrile reaction?
30 mins to 6 hrs after transfusion
Blood Transfusion:
What are s/s of Febrile Reaction to transfusion?
Chills
Fever
Flushing
HA
Anxiety
Blood Transfusion:
In the first 24 hrs, we may see a mild reaction to transfusion. What are the s/s?
Itching
Urticaria (Hives)
Flushing
Blood Transfusion:
What are Anaphylactic S/S of transfusion reaction?
Wheezing
Dyspnea
Chest Tightness
Cyanosis
Hypotension
Blood Transfusion:
If we overload the CV system, what s/s would we see?
HTN
Tachycardia
Tachypnea
JVD
Pulmonary Edema
Blood Transfusion:
Nursing action if they have a reaction?
Stop
NS in separate line
Save blood for testing