Week 02 Flashcards
Hematological Dysfunction/ Pharmacology (186 cards)
1
Q
functions of a healthy hematological system
A
- transports: oxygen, CO2, nutrients, waste, electrolytes
- maintains: intravascular volume, coagulates blood, combats infection
- hematopoietic system: blood, spleen, kidneys, liver, bone marrow
2
Q
components of blood
A
red blood cells, white blood cells, plasma, platelets
3
Q
red blood cells
A
largest portion of blood cells, produces hemoglobin
4
Q
white blood cells
A
functions towards inflammation and immunity
5
Q
plasma
A
liquid portion divided by three types of protein
- albumin
- globulins
- fibrinogen
6
Q
platelets
A
blood cells, formed in bone marrow and stick together to plug injured vessel wall
7
Q
albumin
A
maintains osmotic pressure of the blood (keeps plasma from leaking into tissues)
8
Q
globulins
A
transports antibodies and protects body from infection
9
Q
fibrinogen
A
critical in the blood clotting process, forms fibrin
10
Q
bone marrow
A
- functional site of blood formation in adults and produces RBC
- 2.5 billion RBC’s, 2.5 billion platelets, 1 billion WBC’s per kg are released daily from the bone marrow
- red blood stem cells are the first produced as immature and unspecialized
- committed stem cells are the next phase as a growth pathway is entered and cells specialized depending on the needs of the body
11
Q
erythropoietin (EPO)
A
- stimulates the bone marrow to increase RBC production
- hormone make and released by the kidneys to stimulate production and maintenance of RBC’s
- hypoxia stimulates EPO
- high levels of EPO cause polycythemia (too many RBC’s)
12
Q
polycythemia
A
too many RBC’s
13
Q
erythropoiesis
A
the process of RBC production
14
Q
how many days does RBC’s life cycle last
A
120 days
15
Q
which organ produces erythropoietin
A
kidneys
16
Q
what does hypoxia do to erythropoietin production
A
stimulates increased release of erythropoietin
17
Q
what does hyperoxia do to erythropoietin production
A
slows down the release of erythropoietin
18
Q
what nutrients are needed for erythropoiesis
A
protein, iron, folate, B12, niacin, vitamin C, vitamin E
19
Q
role of the spleen
A
- destroys old, imperfect RBC’s
- breaks down hemoglobin
- stores platelets
- filters antigens
20
Q
spleen is made up of
A
red pulp, white pulp, marginal pulp
21
Q
what is red pulp
A
stores RBC and platelets
22
Q
what is white pulp
A
stores WBC and antibody production
23
Q
what is marginal pulp
A
contains the end of blood vessels
24
Q
function of the liver
A
- prothrombin and clotting factor production
- assist in vitamin K formation of intestinal tract
- stores large amounts of whole blood and blood cells
- stores extra iron within the protein ferritin
25
what is vitamin K essential for
clotting factors VII, IX, X
26
hemostasis
arrest of bleeding
27
what does hemostasis do when injury occurs
starts via a multi-step process of clotting
- platelets aggregation with plug formation
- blood clotting cascade
- formation of a fibrin clot
28
clotting
cascade triggered by the formation of a platelet plug
- works like a landslide, hard to stop once started
- activated by two pathways: intrinsic and extrinsic
29
intrinsic pathway
internal vessel damage
30
extrinsic pathway
external damage to the vessel
31
when does vasoconstriction occur
after vessel injury
32
clotting cascade activation
platelet activation process > change in shape > binds to adhesive proteins (fibrinogen) > platelet recruitment
33
where are glycoproteins mostly made and responsible for
in the liver, platelet plug
34
hematological changes associated with aging
- decrease in blood volume with lower levels of plasma protein
- bone marrow produces fewer blood cells
- total RBC is lower
- platelets unaffected, but may have increased adhesiveness as clotting factors increase with age
- hemoglobin levels fall after middle-age in both male and females
- no specific cause for anemia in 30-40% of the population
35
effects of aging on hematological studies: females
- Hgb: normal
- WBC: decreased
- D-Dimer: elevated
- ESR: significantly increased
- factor V, VII, IX: may increase
- fibrinogen: may increase
- PTT: may decrease
36
effects of aging hematologic studies: males
- Hgb: slightly decreased
- WBC: decreased
- D-Dimer: elevated
- ESR: significantly increased
- factor V, VII, IX: may increase
- PTT: may decrease
37
sodium
136-145
38
potassium
3.5-5
39
calcium
9-10.5
40
magnesium
1.3-2.1
41
phosphorous
3.0-4.5
42
chloride
98-106
43
blood pH
7.35-7.45
44
PaCO2
35-45
45
PaO2
80-100
46
HCO3
22-26
47
total serum cholesterol
<200
48
LDL
<130
49
HDL
>45
50
triglycerides
<150
51
therapeutic INR
2.0-3.0
52
PT
11-12.5 seconds
53
PTT
30-40 seconds
54
INR
0.8-1.1
55
platelets
150,000-400,000
56
fasting glucose
70-105
57
glycosylated hemoglobin (HbA1c)
4%-6%
58
RBCs
- females: 4.2-5.4 million
- males: 4.7-6.1 million
59
Hgb
- females: 12-16
- males: 14-18
60
albumin
3.5-5
61
ammonia
15-45
62
total bilirubin
0.1-1.0
63
total protein (liver)
6-8
64
specific gravity
1.005-1.030
65
protein (UA)
0-8
66
glucose (UA)
less than 0.5/day
67
ketones
none
68
pH (UA)
4.6-8
69
WBC (UA)
- females: 0-5
- males: 0-3
70
serum creatinine
- females: 0.5-1.1
- males: 90-139
71
BUN
10-20
72
creatinine clearance test
- females: 80-125
- males: 90-139
73
digoxin level
0.8-2.0
74
lithium level
0.4-1.2
75
phenobarbital level
10-40
76
theophylline level
10-20
77
dilantin level
10-20
78
coombs test
used for blood typing, detects antibodies against RBC's attached to the patient's blood type
79
serum ferritin
free iron present in plasma
80
transferrin
transports iron from the intestines to cell storage site
81
low iron and low TIBC contribute to
iron deficiency anemia
82
radioisotope imaging
shows active blood cell formation and iron storage
83
standard x-ray
can show bone destruction (looks like swiss cheese)
84
bone marrow aspiration and biopsy patient care
- provide accurate information and emotional support
- explain procedure
- get informed consent
85
bone marrow aspiration and biopsy follow up care
- teach to inspect site every 2 hours for 24 hours
- avoid activity that could cause trauma
- analgesic (avoid aspirin)
ice packs
86
health promotion and maintainence
- nutritional status: food intake and diet alter cell quality and affect clotting
- anemia
- ETOH consumption alters liver functioning
- diet high in vitamin K affects clotting
87
anemias alterations
- sickle cell anemia
- thalassemia
- pancytopenia (aplastic anemia)
- iron deficiency anemia
- pernicious anemia (vitamin B12 deficiency)
- hemorrhagic anemia
- hemolytic anemia
88
anemia pathophysiology
- reduction in either the number of RBC's, amount of hemoglobin, or hematocrit
89
anemia clinical indicators
occurs with many health problems
90
common causes of anemia
- dietary problems
- genetic disorders
- bone marrow disease
- excessive bleeding
91
anemia treatment
- B12
- ferrous sulfate
- folic acid
- epoetin
92
B12 for
pernicious anemia
93
ferrous sulfate for
iron deficiency anemia
94
folic acid for
megaloblastic anemia
95
Epoetin (Epogen) for
stimulation of RBC production
96
sickle cell disease pathophysiology
- genetic hemoglobin disorder
- autosomal recessive
- formation of abnormal hemoglobin chains
- cells are distorted into sickle shape which clumps together
- clumps block blood flow then tissue becomes hypoxic
97
which ethnicity is sickle cell anemia most common among
african americans in the US
98
thalassemia pathophysiology
- inherited blood disorder
- less hemoglobin than normal
99
who is thalassemia most common in
people of mediterranean decent
100
thalassemia assessment
- fatigue
- weakness
- pallor
- slow growth
101
thalassemia treatment
- mild: may not require treatment
- severe: may require blood transfusions or donor stem-cell transplants
102
thalassemia complications
- progressive severe anemia
- heart failure arrhythmia
- hepatomegaly
- skeletal deformity
- dark skin
- poor growth
- pituitary failure
- hypothyroidism
- diabetes
- splenomegaly
- infertility
103
iron deficiency anemia pathophysiology
most common in occurrence resulting from blood loss, poor GI absorption, inadequate diet
104
iron deficiency anemia treatment
increase oral intake of iron, iron supplements
105
aplastic anemia pathophysiology
- occurs with damage to bone marrow
- causes such as chemo drugs, chemicals, radiation, viral hepatitis
106
aplastic anemia treatment
- encourage high protein, high calorie diet
- blood/ platelet transfusion
- immunosuppressive therapy
- may need splenectomy
107
pernicious anemia pathophysiology
- vitamin B12 deficiency
- caused by autoimmune disorder
- prevalent in older adults
- develops slowly
108
pernicious anemia treatment
- increase intake of foods rich in B12
- B12 injections
- oral preparations
- nasal sprays
- sublingual cobalamin
109
hemorrhagic anemia pathophysiology
characterized by sudden and acute blood loss where RBCs are destroyed faster than they are made
110
hemorrhagic anemia causes
- excessive bleeding forms a lesion or a wound leading to loss of blood, and this can lead to severe acute anemia, this kind of condition is followed by shock
- hemophilia and other bleeding disorders
- family history of anemia or blood diease
- certain medications like anti-platelets or blood thinning agents
111
hemorrhagic anemia treatments
- blood transfusion to replace lost blood
- surgery to treat an injury or to stop the internal bleeding
- intravenous supply of fluids to increase blood pressure
- supplementation of iron, if levels are low
- oxygen supply in case of inadequacy
112
coagulation alterations
- thrombocytopenia
- hemophilia
- disseminated intravascular coagulation
- heparin induced thrombocytopenia
- factor V deficiency
- von willebrand disease (VWD)
113
factors VIII, IX
hemophilia
114
desmopressin
- controls trauma induced bleeding
- diabetes insipidus
- hypernatremia
115
protamine sulfate
heparin reversal
116
aminocaproic acid
acute bleeding from elevated fibrinolytic activity (disease, surgery, drug therapy)
117
heparin
decreases the ability to clot
118
warfarin
prevents blood clots
119
lovanox
prevents blood clots in high risk patients (bedrest)
120
aspirin
- anti platelet properties
- inhibits platelet aggregation
- used for pain/ fever
121
filgrastim
increases WBC production in patients undergoing chemo or HIV
122
vitamin B12
used for healthy RBC development
123
clopidogrel
anti platelet, prevents clots from forming
124
alteplase
dissolves blood clots, high risk for bleeding
125
vitamin K
- increases blood clotting
- warfarin antidote
126
thrombocytopenic purpura pathophysiology
- destructive reduction of circulating platelets after normal platelet production
- impaired clotting occurs
- there are two types: autoimmune and thrombotic
127
autoimmune thrombocytopenia purpura (ATP)
makes antibodies against ones own platelets
128
thrombotic thrombocytopenia purpura (TTP)
autoimmune triggers platelet clumping
129
thrombocytopenic purpura assessment
- ecchymosis
- purpura
- anemia may present
130
thrombocytopenic purpura treatment
- platelet transfusion
- anticoagulants
- splenectomy
- protect from injury
131
hemophilia pathophysiology
blood does not clot properly resulting in excessive bleeding after an injury or damage
132
hemophilia assessment
- bruising
- joint pain
- swelling
- unexplained bleeding
- hematuria
- hemoccult
133
hemophilia treatment
clotting factors and plasma
134
disseminated intravascular coagulation pathophysiology
abnormal clotting in the body, all clotting factors are messed up, causes abnormal bleeding
135
disseminated intravascular coagulation assessment
clotting, bleeding
136
disseminated intravascular coagulation treatment
supportive care, fluids, blood transfusion
137
heparin induced thrombocytopenia (HIT) pathophysiology
- immune system causes patient to clot in the presence of heparin
- body forms clots instead of preventing them
- more common with unfractionated heparin
- higher incidence in female patients
138
HIT assessment
- signs of EU-DVT
- ischemic limb necrosis
- necrotic skin lesions
- abdominal tenderness
- signs of PE
- hypotension
- CNS findings (dural venous sinus thrombosis)
139
factor V leiden pathophysiology
- a mutation of one gene that controls factor V
- linked to an increase in blood clots
- inherited form parents
140
factor V leiden assessment
- easy bruising
- nose bleeds
- excessive bleeding after surgery or trauma
141
factor V Leiden treatment
- infusion of FFP, blood, platelets
- avoid contact sports or activities that cause injury
142
Von Willebrand Disease (VWD) pathophysiology
bleeding disorder caused by low levels of clotting protein in the blood, inherited but rarely may develop later in life
143
VWD assessment
- desmopressin
- replacement therapies
- oral contraceptives
- clot stabilizing meds
144
cancer alterations
- hodgkin's lymphoma
- non hodgkin's lymphoma
- multiple myeloma
- leukemia
145
hodgkins lymphoma pathophysiology
type of cancer that affects the lymphatic system, which is part of the body's germ fighting immune system
146
possible causes of hodgkin's lymphoma
- viral infections
- chemical exposure
147
reed-sternberg
cells that are also called hodgkin cells, found in people with hodgkin lymphoma
148
non hodgkin lymphoma pathophysiology
starts in white blood cells called lymphocytes, more common in males and older adults
149
possible causes of non hodgkin's lymphoma
- organ transplant
- immunosuppressive drug therapy
- HIV
150
non hodgkin's lymphoma assessment
- large painless lymph nodes
- fever, drenching night sweats
- unplanned weight loss
- some have no symptoms at the time of diagnosis
151
non hodgkin's lymphoma treatment
- external radiation of lymph nodes
- for more extensive disease, radiation and combo chemotherapy is used
- CAR-T therapy (enhances the immune system by killing cancer cells
152
multiple myeloma pathophysiology
- WBC cancer of mature B Lymphocytes
- more common in men over the age of 60
- 13,500 deaths yearly in north america
153
multiple myeloma assessment
- brain fog
- excessive thirst
- N/V
- SOA
- frequent urination
- extreme weakness and fatigue
- bone pain
- constipation
154
multiple myeloma treatment
- watch for progression
- proteasome inhibitors
- immunomodulating drugs
- hematopoietic stem cell transplant (HSCT)
155
pre leukemia and leukemia pathophysiology
- blood cancer
- uncontrolled production of WBCs (blast cells), in the bone marrow that over take the healthy cells
- acute or chronic
- classified by cell type: lymphocytic or lymphoblastic
- prevalent in down, klinefelter, and bloom syndromes
156
pre leukemia and leukemia causes
- ionizing radiation
- viral infection
- exposure to chemicals and drugs
157
pre leukemia and leukemia assessment
- SOA
- tiny red spots
- bone and joint pain or tenderness
- weakness and low energy
- lymph node swelling
- swelling of liver and spleen
- muscle aches
158
neutropenia pathophysiology
abnormally low number of neutrophils in the blood, less than 1500
159
neutrophils
subtype of white blood cells that fight off bacterial and fungal infections
160
packed red blood cells (PRBC's)
1 unit of whole blood
161
fresh frozen plasma (FFP)
- contains all factors of the soluble coagulation system
- fibrinogen, II, V, VII, VIII, and X factor
- should never be used as a plasma extender
162
most important factors
V, VIII
163
when is FFP used and with what
- in emergency bleeding problems
- with warfarin
164
where is factor V made in the body and what does it do
- liver
- coverts prothrombin into thrombin
165
what does thrombin convert fibrinogen into
fibrin which forms fibrin clots
166
platelets
- stored at room temp and cannot be frozen
- clump together to form a colt when endothelial damage occurs
167
acute hemolytic
a triad of symptoms
- fever
- flank pain
- red/brown urine
168
febrile
unexpected temp rise at initiation of blood products
169
blood transfusion allergic reaction symptoms
- fever
- chills
- itching
- hives
- all common
170
transfusion reaction treatments
- stop transfusion
- follow facility protocol
- Tylenol, Diphenhydramine per order
- document
171
Alteplase (Activase)
- thrombolytic agent
- coagulation test may be unreliable during therapy because alteplase may degrade fibrinogen in blood sample
- to dissolve blood clots that have formed in blood vessels
- will increase risk of bleeding, avoid activities that could cause bleeding
- monitor temp, limit venipuncture, assess neuro status
- bleeding and anaphylaxis, can cause headaches
172
Warfarin (Coumadin)
- anticoagulant
- for overdoes antidote is vitamin K
- to prevent clotting in people who have had a condition that can cause blood clotting (mechanical valve, clotting, A fib)
- do not double dose
- do not over eat green leafy veggies
- monitor PT/INR and for bleeding
- INR levels for a patient on warfarin are higher because we have decreased their ability to clot
173
Phytonadione (Vitamin K, Mephyton)
- fat soluble vitamin
- necessary for normal clotting of blood
- produced by the liver
- found in leafy green vegetables
- monitor PT and INR
174
Clopidogrel (Plavix)
- platelet thinner
- monitor for signs of abdominal pain and other signs of GI bleeding
- should be held 5 days before elective surgery
- PPIs, Prozac, diflucan, grapefruit juice make plavix less effective
- prevent blood clots from forming in hardened blood vessels (artherothrombosis) or platelet inhibitors
- easy bruising, prolonged bleeding
- bleeding, neutropenia, thrombolytic thrombocytopenic purpura, petechiae, weakness, vision changes, pY12 (plavix responsiveness)
175
Heparin
- anticoagulant
- hold when platelet count is 100,000/mm or lower
- to decrease the clotting ability and help prevent clots from forming by suppressing factor Xa and thrombin
- does not dissolve clots but keeps new ones from forming
- avoid OTC NSAIDS and aspirin
- avoid activity that can cause bleeding
- watch for bleeding and HIT
- can be used along with warfarin until therapeutic levels are reached
- monitor VS, bleeding, aPtt (20-30) or Xa
- used with new onset dysrhythmias to prevent clots
- antidote is Protamine Sulfate
176
Desmopressin (DDAVP, Minirin, Stimate)
- hormones
- take without eating
- to treat central cranial diabetes insipidus
- weigh daily and avoid alcohol
- adverse reactions: hyponatremia and seizures
- use precaution in patients with hypertension
177
Ferrous Sulfate (Fesol)
- transitional metal sulfate
- liquid will stain teeth, use with straw and rinse mouth after
178
Protamine (Prosulf)
- heparin antagonist
- should be administered slowly over at least 30 minutes via IV
- to counteract the effects of heparin or given before and after surgery and after dialysis
- the antidote to heparin overdose
- anaphylaxis, rapid hypotension, increased pulmonary artery pressure
179
aminocaproic acid (Amicar)
- antifibrinolytics
- to treat serious bleeding conditions, especially when bleeding occurs after surgery or dental procedues
- stop taking if you have unexplained muscle pain, sudden numbness or weakness, tingling or cold feeling in an arm or leg, trouble breathing, sudden cough or chest pain
- headache, stomach pain, N/V, diarrhea, dizziness, watery eyes, stuffy nose
180
Cyanocobalamin (vitamin B12, Nascobal)
- antianemics, water soluble vitamin
- vials should be protected from light
- used to treat pernicious anemia
- monthly injection
- know baseline levels before starting and monitor levels every 3-6 months
- adverse effects include hypokalemia, erythema, and hypertension
- report muscle weakness, nausea, palpitations, or paresthesia
181
Aspirin (Bayer)
- anti platelet agent
- can relieve pain and reduce the risk of serious problems like heart attacks and stroke
- watch for hives, tinnitus, difficulty breathing, allergic reaction, and severe headaches
182
Filgrastim (Granix)
- stimulating factor
- helps bone marrow make new WBCs
- call doctor if you develop signs of infection such as fever, chills, redness, swelling, or pain around a cut or sore
- may cause mild to moderate bone pain
183
Epoetin Alpha (Epogen)
- to treat severe anemia in patients who have CKD, on chemo, or some HIV drugs
- stimulates RBC production
- blood clots, heart attack, stroke, tumor progression, or heart failure
- contraindicated in patients with hypertension, and blood pressure should be monitored closely
- patients with CKD often have HTN and anemia and would not be able to use these medications
184
Folic Acid (Vitamin B9)
- treat or prevent folate deficiency
- folate (broke down from folic acid) is needed for the body to make RBCs
- take while trying to get pregnant and during the first 12 weeks of pregnancy
- rash
- long term use can cause colorectal or prostate cancer
185
Factor VII and IX (NovoSeven RT, Sevenfact)
- used to treat hemophilia
- helps blood clot and stop bleeding
- have epinephrine and resuscitation equipment ready
- Avoid NSAIDS
- for mild reaction avoid Benadryl
186
Enoxaparin (Lovanox)
- anticoagulant
- lower molecular weight than heparin
- Sub Q injection
- leave a bubble of air in the syringe and administer the air last
