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NUR 120 > Unit 5 > Flashcards

Unit 5 Flashcards

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1
Q

Where does hematopoiesis occur? What is recycled? And what type of cells are made here?

A 
Bone marrow of ribs, pelvis, sternum, or vertebra.
Iron and heme.
Stem:
Myeloid-RBC, wbc, platelets
Lymphoid-t and b lymphocytes
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2
Q

Explain MCV, RDW, and MCHC values.

A

MCV-volume/size of RBC
RDW-width of RBC
MCHC-hemoglobin concentration in RBC

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3
Q

What are the iron studies used for hematology?

Explain.

A

Serum iron-(60-170)measures circulating iron bound to transferrin.
TIBC-measures transport protein (transferrin) that supplies marrow w/iron.
Percent saturation(25-35)-ratio of serum iron and total iron binding capacity
Ferritin-storage of iron

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4
Q

How can B12, folate, sed rate, and Coag studies be useful in hematology?

A

B12-Production of rbcs (intrinsic factor is req. to absorb B12, also from digestion)
Folate-makes RBCs
Sed rate-blood test that reveals inflam activity (RA, sarcoidosis)
Coag studies- if lacking clot factors. Pt, PTT, inr measures clot time.

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5
Q

Describe the Nurse duty for:
preop for bone marrow bx/aspiration.
Intra-op
Post op

A 
-Careful explanation
Anti anxiety
Signed consent
-aseptic skin cleanse
Local anesthetic
Dr insert needle, syringe attached (sharp pain)
Deep breaths/relaxation, pressure to sight for minutes, sterile dressing
-pain 1-2 days possible
Warm tub bath
Analgesic (non Asa)
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6
Q

what 3 factors are required in RBC formation in response to ________ made by the ___________? What are the norm ranges?
Where do these finish maturing and life span?

A

B12 (200-900)
Iron (60-170)
Folic acid (2-20 or 4.5-45.3)or RBC folate (140-628 or 317-1422)

Erythropoietin, kidneys

Blood system
120 days then die

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7
Q

What 2 factors will signal the bone marrow to abnormally make more rbcs?
What happens to bone in response?

A

Increased RBC death, or inc. immature rbcs released

Marrow space enlargers thinning other areas=weather bone

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8
Q

What are the terms to describe RBC size and RBC concentration of hemoglobin?
What cause changes?

A 
Size:
normocytic (normal)
Microcytic (small)
Macrocytic (large)
Concen of Hemo:
Normochromic (normal)
Hypochromic (too little Hemo)
Hyperchromic (too many Hemo/dense)
Tissue oxygenation, renal changes, and bone marrow interruptions.
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9
Q

What is anemia? And it’s causes?

A

Not a disease!
Describes quantity of circulating rbcs and an abnormally in Hemo content (or both).

D/O in RBC production (enzyme def), lack of folic acid, b12 prob, renal def (erythropoietin), production d/o, bleeding.

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10
Q

What are some s/s of RBC d/o?

A 
Tachycardia
Tachypnea
Fatigue
Pale
B12 def-tongue beefy red
Pica
Heart problems
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11
Q

What is iron def anemia? Typical causes, s/s, and diag test? Tx?

A

Dietary iron def.

Childhood, pregnancy, times of growth, nutritional interruptions, ca, heavy menstral cycle, ulcers, chronic alcoholism)

Fatigue, anemia

CBC:if bad then bone marrow endoscopy

Inc iron in diet or correct bleed

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12
Q

What is aplastic anemia? Causes, s/s, testing, and tx.

A

Dysfunction in bone marrow.

Congenital, idiopathic, infection, meds, chem/radiation.

Anemia (low Hemo), purpura. Inc WBC=infection;dec platelets=bleeding
Bone marrow testing
Hold pressure to bleed, prevent bleeding occurrences, blood transfusion/platelet, d/c meds, bm transplant, antibiotics/neupogen

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13
Q

What is pernicious anemia? S/s, test, and tx?

A

Dec. B12, intrinsic factor problem (malabsorption) pts on Metformin, Prilosec (h2protoninhib)

Neurological-motor dysfunction, beefy red tongue, GI d/o

Schillings test-definitive
Injections/po, food intake, d/c meds, alcohol

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14
Q

What are complications of sickle cell anemia? S/s? And tx?

A

Vision changes, heart attack, stroke.

Pain

Fluids, pain meds, folic acid, o2

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15
Q

What is polycythemia? Cause? Risk? S/s, tx?

A 
Inc rbcs, platelets, and granulocytes.
Idiopathic, hypoxia.
Inc risk for clotting.
Enlarged spleen.
Phlebotomy.
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16
Q

What are 3 conditions of Hemostasis/platelets?

A

Thrombocytopenia-dec platelets
At risk for bleed. Check:platelets, labs, use bleed precautions.

Thrombocytosis-inc platelets,
At risk for clot. Tx: splenectomy, Asa.

Vit K def-injections, meds destroy flora.

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17
Q

Where are WBC d/o formed? Diff granulocytes and agranulocytes.

A 
Bone marrow (immune sys)
Gran-
Neutrophil-phagocytosis 
Basophils-mast cells
Eosinophils-allergic reactions
Nongran (agranulocytes)-
Lymphocytes-immune function
Monocytes-produced faster and longer lifespan than neutrophils
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18
Q

Diff neutropenia and leukemia.

A

Neut-dec neutrophils, at risk for infection

Leuk-over production of immature wbcs, causes probs with RBCs and platelets since WBC take over bone marrow.s/s:infection, bleed, anemia.

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19
Q

What are the 2 types of irons?

A

Ferrous sulfate: constipation a

Ferrous gluconate:less GI upset(can take anytime)

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20
Q

Define and diff hodgkins and nonhodgkins lymphoma.(s/s, dx)

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A

Dz of lymph sys-ca of lymphoid tissue. Many classes to ID extent. Painless enlarged unilateral cervical lymph nodes, persistent, anemia.
Lymph node bx.
Hod-good cure rate
Non hod-spreads faster, poor cure rate, found after advanced.

21
Q

What is multiple myeloma?

Study These Flashcards
A

Bone cancer-spreads (bones are vascular)

S/s: infection, anemia, bleeding.

22
Q

What are the 3 layers of the artery?

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A

Tunica:
Intima(inner)-smooth for easy blood flow
Media(mid)-thicker, smooth muscle, elastic
adventitia(outer)-connective tissue

23
Q

What will occur if the artery develops a slow decrease in flow?

Study These Flashcards
A

Example:thrombus plaque

Outside tissue will have collateral tissue develop.

(Preferred over acute complete occlusion)

24
Q

Define capillaries.

What occurs here?

Study These Flashcards
A

Smaller vessels that connect A to V imbedded in the tissue otherwise called microcirculation.
Nutrients out to tissue by hydrostatic pressure, and waste back to vessel by osmotic pressure (protein).

25
What is flow rate? What can be auscultated with inc.?
Change in P/R Bruit-turbulent blood flow
26
What are the regulating mechanisms to peripheral vascular system?
CNS->sns(most important blood flow regulator)->norepinephrine (#1 neurotransmitter, promotes constriction) Circulating hormones/chemicals: Epi/angio I II-potent vasoconstriction Histamine/prostaglandin-potent vasodilator Thrombocytes/serotonin-damaged tissue sends more platelets (bad) and releases these causing vaso constriction (bad) dec flow, and inc risk for aggregation.
27
Diff arteriosclerosis vs atherosclerosis.
Arterio-hardening of artery | Athero-plaque formation in artery intima-this creates roughness which then can cause aortic aneurysm=turbulence.
28
What are the major modifiable risk factors for atherosclerosis and PAD?
Nicotine-causes vasoconstriction dec flow inc clots HTN-inc atherosclerotic rate inc PAD/CAD DM-abnormal blood sugars inc basement membrane thickness C-reactive protein-c/v inflammation, inc risk for vessel damage Hyperhomocysteinemia -protein promoting coagulation-thrombus Fibrinogen-activated to fibrin, makes clots form leads to PAD D-Dimer-fibrin clots break down and release this. Vein clotting.
29
Where and who is most at risk for PAD?
Men Age over 50 Lower extremities
30
What is important in assessment of intermittent claudication?
Fatigue ext. Cold/numb ext. Relieved w/ rest. (Pain at rest-bad! Severe PAD) Pain with walking and anterior foot=severe. Shouldn't see edema. Do not elevate arterial d/o. It decreases flow.
31
PAD assessments of skin.
``` Cool/pale ext. White when elevated Red-blue when down No hair, shiny Brittle thick opaque nails Atrophy Ulcerations Dec cap refill ```
32
What is ABI?
Systolic ankle/systolic brachial Increased arterial narrowing=dec sys pressure 1. 0=equal ankle to arm 0. 9-0.50=insuff
33
What are the characteristics of an arterial ulcer?
``` Typically tip of toe/webs, foot, heel Very painful Deep Circular Pale to black ulcer base Dry gangrene Minimal edema ```
34
What are the managements of PAD?
``` Ext below heart Exercise to promote flow Warmth to promote flow Stop tobacco Avoid emotional upset Avoid constrictive clothes Don't cross legs Vasodilators/adrenergic blocking agents/analgesic Sturdy, well fitting shoes, neutral soaps/lotions Pat feet dry, trim nails across. Diet intake Vit A, C, protein and zinc. Weight loss. ```
35
What are important post op nursing care interventions for surgical managements of PAD? Vascular grafting, endarterectomy, embolectomy, amputation.
Maintain circulation-c/v checks q 15 min. Keep legs uncrossed and dependent. Compression stockings, and monitor for compartment syndrome
36
What is buergers dz? (Thromboangitis obliterans)
Inflammation! And clot in small arteries/veins of ext. Thrombus forms and occluded vessel. Common in men 20-35 and heavy tobacco use.
37
What are s/s of buergers dz? TX?
``` Pain (#1 indicator) Rubor Diminished pulses Paresthesias Red/cyanosis as dz progresses (dependent position) Ischemia Skin ulceration a Gangrene *begins in hands feet then spread to larger-bilateral ``` Stop tobacco use! Improve circulation, treat ulcer/gangrene, amputation.
38
What is an aneurysm? Diff the types.
Dilated area in artery sac like,(weak point) permanent damage, and enlargens. (atherosclerosis make changes that weaken) Aorta susceptible. Typically ASYMPTOMATIC! False-outside (intima/media) layers-actual hematoma True-all three layers Fusiform-uniform dilation of entire vessel. Saccular-bulbous protrusion on one side. Dissecting-split layers of wall by hematoma.
39
What are risk factors for aneurysms? | And inc rupture risk?
``` Age HTN Smoking Hypercholesterolemia Hyperlipidemia Males Fam hx Inherited, infection, vasculitis, trauma Size:5.5 most likely ind operation-pain, dec BP, dec Hct, loud bruit ```
40
What is the pre/post operative nursing care for aneurysm?
Keep pt on bed rest with calm environment, reducing stress. No straining or holding breath.no elevation or crossing of legs. Anti hypertensives and beta blockers. BP/hemodynamics status, pain, hob elevate 45 deg., n/v checks
41
Thrombus can be caused by __________ and __________. | What are the important assessments for acute arterial embolism?
Atrial fib, Cath procedure. 6 P's: Pain, pallor, pulse lenses, paresthesia, pokilothermia (coldness), paralysis
42
What is Raynauds? Triggered by? Management?
Triggered by abnormal cold sensitivity/emotional. Intermittent arteriolar vasoconstriction to fingers/toes. Common in women 1 6-40. Usually bilateral. Avoid stimuli that provoke, CCB, sympathectomy, avoid stress, stay warm, avoid nicotine
43
Dec blood flow equals ______ venous pressure. | Edema equals _____blood flow and nutrient delivery.
Increased | Decreased
44
Explain the 3 diagnostics for venous d/o's.
Duplex:standard for lower ext thromboembolism. Flow motion-where stasis/occlusion is. Air pleth-measure leg volume for leaking of fluid to tissue. Contrast phleb-done prior to thrombolytic therapy.
45
Venous thromboembolisms typically occurs where? | Thrombus creates what?
Deeper veins, they are thinner/weaker. Edema(phlebitis) Typically seen in lower ext.
46
How are venous ulcers presented?
``` Usually medial malleoulus Pain-ache, cramp, heavy Discoloration in gainer area Mod-sev edema Superficial Very exudative Granulation tissue ```
47
What are the 3 lymphatic d/o? Explain.
Lymphangitis: inflammation/indices of lymphatic channels. Lymphadenitis: inflammation/infection of lymph nodes. Lymphedema:tissue swelling r/t obstruction of lymphatic flow.
48
What is cellulitis? And care?
Bacteria enters skin. Localized swelling, redness, pain. Antibiotics, elevation, warm moist pack q2-4 hr

NUR 120 (6 decks)

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