Test #7 - Hematological Flashcards Preview

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Flashcards in Test #7 - Hematological Deck (38):
1

What are some risk factors for Anemia?

Over 65

Heredity

Culture - African American or Mediteranean descent have ^ prevalance of Sickle Cell Anemia

2

What are the causes of Anemia?

Dec production of RBC's

Inc destruction of RBC's

Loss of blood

Dietary issues

Bone Marrow Diseases

GI Bleeds are most common blood losses

 

3

What are normal HGB/HCT levels?

Hgb 12-15 g/dl in women

Hgb 13.5-17 g/dl in men

Hct 40-54% in men

Hct 46% in women

THEY CONFIRM ANEMIA

4

What are some assessments for Anemia?

Dyspnea

Palpitations

Diaphoresis

(Those may occur with strenuous activity)

Anema may be asymptomatic related to chronic disease

Anxiety

Delayed cap refil

Cyanosis

Tachycardia

Palpitations

Murmurs (If severe)

FATIGUE (Common, 1st symptom)

5

What is Iron Deficiency Anemia?

Chronic form lack of iron in the blood

Women need 15mg daily

Men need 10mg daily

Most iron is supplied by diet which contains meat

Anemia is found in 30% of world population

6

What can cause malabsorption of iron?

Due to chronic diarrhea, celiac disease, gastrectomy and removal of the upper part of bowel

Some antacids that contain magnesium may not allow iron to be absorbed.  Give those meds about 30 min after a meal
Ie: Mylanta

Chronic Alcoholism
(Due to inadequate diet)

7

What are some assessments for the malabsorption of iron?

Severe Cases: 
Fatigue

HA

Dyspnea

Pallor in face, palm of the hands, nail beds, mucous membranes of mouth and conjunctiva

ATI:
Numbness and tingling of fingers

Low-grade fever

Smooth, bright red tongue

8

What is Pernicious Anemia?

Absence of intrinsic factor leads to malabsorption of Vit B12

Usually heredity is the culprit but GERD may be responsible also

9

What is some pharmacology for Pernicious Anemia?

Inj of 1000mcg Cobalmin every day for 2 weeks

Then 1000 mcg Cobalmin weekly until HCt returns to normal

Monthly injections are needed for lifetime

Iron may also be needed

10

What causes Folic Acid Deficiency Anemia?

Diet lacking green leafy vegetables, liver, citrus fruits, nuts, grains & yeast

Alcoholics at risk along with those haveing hemodialysis treatments

11

What are some medications and items that can cause Folic Acid Deficiency anemia?

long-term use of anticonvulsants

Use of antimetabolites in those with cancer & leukemia

Certain BC pills

Malabsorption

Some medications

Malnutrition

12

What pharmacology is needed for folic acid deficiency anemia?

Folic Acid 0.1mg-5mg daily until anemia is corrected

13

Sickle-Cell Disease is inherited, is the most common type of anemia worldwide and has the highest rate in West Africa, What are some assessments and what does it do?

Turns healthy red blood cells into a sickle shape, they are less flexible, fragile and can cause occlusions.

Can cause tissue infarcts

Abdominal/Joint Pain

Blood to become more viscious

Acute chest syndrome (Cause of death)

Low oxygen levels

Pain

RBC destruction

Fatigue

14

Iron is used for Sickle-Cell Anemia, what is the daily dose required?

If cause not from blood loss then usual dosage if 180-200mg daily on an empty stomach

Given in divided doses

15

What are some side effects of iron?

Constipation or Diarrhea

Black tarry stools

Nausea vomiting

16

What do you want to teach about iron?

Diet high in fiber

Absorption Inc when taken with Vitamin C

Tea dec absorption

17

The Blood types are A, B, AB, and O.  What is the universal donor type and the universal recipient type?

Antigens in the blood at + or -

Universal Donor Type: O-
Anyone can receive O-

Universal Recipient: AB+

18

What are some reasons for blood transfusions?

Anemia

Trauma (Hemorrhage, Blood Loss)

Surgery (Due to blood loss)

19

What do you want to do to cover your assets (Interventions) for a blood transfusion?
LOTTA LOTTA LOTS

Confirm compatibility (Must have 2 nurses to check pt is correct, blood is compatible, and dr order)
- Go to lab and Check blood bag label and requisition slip to each other (Type and cross is correct) Then initial, name, date and time on bag
-Go through process again at bedside

Check R number on band, against order, req slip and blood

Make sure it's not cloudy, no bubbles, no discoloration and the integrity of the bag

You have 30 min to initiate blood from time it is taken from the bank!!!

Assess VS again right before starting, As soon as blood hits the vein, then 15 min. 

Monitor for the first 15-30 minutes
(That's when severe reactions occur; S&S of reaction: flank pain, SOB, anxiety, itching)

Start at a slow rate, at 15 min mark we can bump up the rate if no reaction has occured

Hemolytic Transfusion Reaction Pg. 901

If life threatening STOP transfusion IMMEDIATELY and flush line

Do not shake the bag

Do not alow blood to hang for more than 4 hours

Access vein with large bore needle (20g is smallest)
Blood tubing (bc filter is present) - Prime with NS

Have informed consent

Check vital signs before transfusion (make sure stable and set a baseline)

Get proper equipment

Assess Lung sounds for crackles due to fluid volume overload (HOB up, O2, fan)

20

What is Agranulocytosis?

Failure of the bone marrow to make WBCs

Caused by autoimmune, chemo and some meds

Destruction or inadequate production of neutrophils.  

Are powerful when fighting an injury

Eat (phagocytosis) harmful bacteria

neutrophil count needs to be higher than 500/mm3

ACUTE

POTENTIALLY FATAL

@ Risk for Infection - Neutropenia Precautions

21

What are the signs and symptoms of agranulocytosis?

Fever

Sore Throat

Chills

Bleeding gums

Weakness

(Flu Like Symptoms)

22

What is considered acute blood loss and what are the signs and symptoms?

A rapid loss of 500-1000 ml due to accident, hemorrhage or surgery

Cool & moist, Inc heart rate, Low BP
Later Signs: Dec H&H

23

What are some interventions for acute blood loss?

STOP the bleeding!! Apply pressure PRN

O2

IV Fluids
LR (Fluid Volume Expander)

Rest

Transfusion

Iron Supplements

Evaluate loss stopped or shock prevented
(S&S of shock: Pallor, diaphoretic, Inc HR, Dec Bp)
Intervent for shock: Flat with legs elevated or trendelenburg

24

What is aplastic anemia?

CAN BE LIFE THREATENING OR CRITICAL
It's a reduction in RBC, WBC and platelet

Pancytopenia

D/T Bone marrow depression

50-66% of cases are idiopathic

Can be sudden or gradual onset

NURSING CARE: 
Assess for CBC, neutropenic precautions, assess RBC's and bleeding time

 

25

Bone marrow aspiration biopsy is a diagnostic done for aplastic anemia, what is it and what are some teachings?

Removal and exam of tissue from the body to detect diseases/malignancies

Most common sites are the Illiac crest or sternum

TEACHINGS: 
Removing the cause

Transfusions

Prevention of Infections

Bone marrow transplants

Need for O2 & rest

Public Education

26

What are some interventions for aplastic anemia?

Fall Risk

Bleeding Precautions

 

27

What is Erythrocytosis (Polycythemia vera)?

An abnormally Dec HCT & HGB

> 55% HCT and HGB up to 18-25

Increased RBC, WBC, platelets

S&S related to GOUT

Causes hyperkalemia

Blood is hyperviscious

Can have blood clots or bleeding tendencies (All of the platelets are attracted to clot so bleeding tendencies)

 Can be fatal in 2 years if left untreated

28

What is the primary and secondary cause of erythrocytosis (polycythemia vera)?

PRIMARY:
Neoplastic disease (Bone marrow cells will be atypical)

SECONDARY:
Compensatory reaction usually to prolonged hypoxia. Depends on erythropoietin stimulation

29

What are some assessments for pylycythemia vera?

Assess for bleeding tendencies, thrombosis, readily clots, sluggish blood flow due to viscosity

Superficial vein distention

Amost always hypertensive

Dark red or flushed face

Purple mucous membranes

HA

visual problems

Neuro symptoms

Joint pain

Splenomegaly

Tissue and organs congested with blood

30

What are some interventions for polycythemia vera?

Pheresis - Withdrawal whole blood and take out RBC's and put back in all the other stuff

Therapeutic phlebotomies (not suitable for donorship)

Push fluids

Dec Iron intake

Avoid tight fitting clothes

Elevate feet

Stop smoking

Ultimately need cytotoxic drugs/myelosuppressive agents and radiation treatment

31

What is the pathophysiology for Anemia?

Transport of O2 is decreased

therefore

Cardiac output is increased

32

How do you diagnose pernicious anemia?

Shillings Test

Measures the Vit B12 in the urine after given radioactive B12

33

What is a test for Sickle Cell Anemia?

Reticulocyte Count

Detects Cell Destruction

Want 0.5-5.0% of total blood

34

What is an autologous transfusion?

Your own blood

Taken and infused at later time

P.901

35

Thrombocytopenia, What is it?

The platelets are not being produced or there is an increase breakdown in bloodstream or spleen and liver

# of platelets are lower

Can be due to chemo, radiation or viral infection

If less than 20,000 = LIFE THREATENING

36

What are you going to assessfor thrombocytopenia?

Menorrhagia

Epistaxis

gingival bleeding

Hx of recent infections

ETOH use

Ecchymosis

Purpura 

Petechiae

37

What are you going to do (Interventions)  thrombocytopenia?

Aim at minimizing the injury

Dcument the prescense/severity of bleeding, petechiae, purpura, ecchymosis, hematuria, epistaxix

38