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98 Cards in this Set

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  • Back
What is blood responsible for?
O2 and nutrition distribution, waste removal, fighting infection, and clotting
What is the consistency of blood?
45% blood cells 55% plasma (antigens and antibodies)
What is the normal volume of blood in the body?
10-12 pints (1 pint=500ml)
What is another name for RBCs?
erythrocytes
What do erythrocytes do?
transport o2 and co2
What is erythropoiesis?
the process of RBC production in the red bone marrow
What are normal Hgb and Hct levels?
Hgb 12-18 Hct 37-52%
What does Hgb provide?
ENERGY
What is another name for WBCs?
Leukocytes
What do leukocytes do?
body defenses; destroy bacteria and viruses
What is phagocytosis?
the breakdown and removal of bacteria, cellular debris, and solid particles
What is a differential WBC count?
an exam in which the different kinds of WBCs are counted and reported as % of the total examined
What is a shift to the left?
presence of excess bands in the peripheral blood (i.e. shift to immature cells) and indicates severe infection
What are the 6 types of leukocytes and how much of the blood do they make up?
Neutrophils (55-70%), Eosinophils (1-4%), Basophils (0.5-1%), Monocytes (2-8%), Lymphocytes (20-40%), and plasma cells
What are granulocytes?
WBCs that contain granules in the cytoplasm, make up greatest number of WBCs
What are the 3 types of granulocytes?
Neutrophils, Eosinophils, Basophils
What are the 2 types of agranulocytes?
Lymphocytes, Monocytes
What do neutrophils do?
useful in ingesting bacteria
What do eosinophils do?
useful in allergic reaction and parasitic infection
What do basophils do?
secrete histamine and heparin
What do monocytes do?
travel to site of invading organism and transform into macrophages
What do macrophages do?
capable of ingesting large quantities of microorganisms and damaged cells by phagocytosis; secrete interluken-1, which is a chemical signal used to tell the body which WBCs are needed
What is another name for platelets?
Thrombocytes
What do thrombocytes do?
initiate blood clotting
What happens if thrombocyte count is <20000?
spontaneous bleeding can occur
What is hemostasis?
Body process that arrests the blow of blood and prevents hemorrhage
What is the sequence of the clotting cascade?
Injury, hemorrhage, grouping platelets, thromboplastin released, converts prothrombin into thrombin, links to fibrinogen, formation of fibrin, trap RBCs and platelets, forms clot
How are blood types determined?
by presence or absence of specific antigens on the outer surface of RBC and the antibodies found in plasma
What is done before blood transfusion is administered?
assess lab values, verify order, large bore IV (20 or 18 but can use 22 if needed), Hx of blood transfusion reaction?, verify blood using institution policy
What are the timelines for hanging and transfusing blood
hanging blood w/in 30 min, transfusion complete w/in 4 hrs
What should be done during blood transfusion?
Monitor VS, rate of infusion, and respiratory status
What should be monitored after blood transfusion?
VS!
What is protocol for mixing drugs w/ blood products?
NEVER mix drugs w/ blood products. NEVER use products containing calcium (i.e. lactated ringers) b/c causes clumping
What are the 5 types of transfusion reactions?
1. Febrile nonhemolytic (most common, presents w/ fever)
2. Allergic urticarial (develops w/ skin rash w/in 1 hr)
3. Delayed hemolytic (days to weeks after transfusion, Hgb drops due to incompatibility of RBC antigens)
4. Acute hemolytic (POTENTIALLY LIFE THREATENING; usually w/in 15 minutes)
5. Anaphylactic
What are the treatments of transfusion reactions?
Depends on type of reaction: stop blood transfusion, flush w/ new bad of saline, emergency meds, notify MD and blood bank, save bag and tubing, collect blood and urine samples
What are the functions of the lymphatic system?
Maintenance of fluid balance, production of lymphocytes, absorption and transportation of lipids from intestine to bloodstream
What is lymph?
specialized fluid formed in the tissue spaces, transported by way of lymphatic vessels and reenters circulatory system
What are lymph nodes?
act as filters, keeping particulate matter such as bacteria from entering bloodstream
What do tonsils do?
produce lymphocytes and antibodies that trap bacteria
Why is the spleen useful?
it is a reservoir of blood; forms lymphocytes, monocytes, and plasma; destroys RBCs; removes bacteria by phagocytosis; holds up to 1 pint of blood for emergencies
What is the thymus for?
immune system before and a few months after birth, atrophies at puberty
What are the diagnostic tests used to id lymphatic system disorders?
CBC, red cell indices, peripheral smear, Schilling test (measures b12 absorption, used for pernicious anemia), megaloblastic anemia profile, lymphangiography, bone marrow aspiration or biopsy
What is anemia?
low count of RBC, Hgb, Hct; causes delivery of insufficient amounts of 02 to tissues and cells
What are the causes of anemia?
Blood loss, impaired production of RBCs, increased destruction of RBCs, nutritional deficiencies
What are the clinical manifestations of anemia?
Disorientation, SOB, dyspnea, pallor, tachycardia, vertigo
What is the medical management of anemia?
Depends on cause; correction of disease process may correct or lessen anemic condition; often specific to particular anemia
What is hypovalemic anemia?
Anemia caused by abnormally low circulating blood volume due to blood loss; body can tolerate losing 500ml of blood due to spleen, but 1000ml of blood loss can cause severe complications
What are the clinical manifestations of hypovalemic anemia?
Weakness, stupor, irritability, pallor, hypotension, tachycardia, hypothermia, Hgb < 10, Hct < 10%
What is the medical management of hypovolemic anemia?
control bleeding, treat shock (O2, elevate lower extremities, keep warm, Trendelenberg), replace fluid (blood transfusion, plasma, dextran, lactated ringers), monitor VS
What is pernicious anemia?
absence of intrinsic factor produced by gastric mucosa; intrinsic factor is essential for absorption of vitamin b12; deficiency of b12 affects growth and maturity of all body cells and is related to nerve myelination, may cause progressive demyelination and degeneration of nerves and white matter; Schilling's test shows malabsorption of b12
What are the clinical manifestations of pernicious anemia?
FEVER, JAUNDICE, SORE BURNING TONGUE (smooth and erythematous), extreme weakness, dyspnea, hypoxia, weight loss, pallor, GI complaints, dysphagia, neurological symptoms (tingling in hands and feet, disorientation, personality changes, behavior problems, partial or total paralysis)
What is the medical management of pernicious anemia?
Vitamin B12 (1000u, daily for 1 week, weekly for 1 month, monthly for life), folic acid supplement, iron replacement, RBC transfusion, diet (high protein, vitamins, and minerals)
What is aplastic anemia?
decrease in bone marrow function that results in decreased number or RBC/WBC and platelets; only primary if congenital; can be secondary to viral invasion, meds, chemicals, and radiation or chemo
What are the clinical manifestations of aplastic anemia?
pancytopenic (low amounts of many types of blood cells), repeated infections w/ high fevers, fatigue, weakness, malaise, dyspnea, palpitations, bleeding tendencies
What is the medical management of aplastic anemia?
id and remove cause, platelet transfusion for severe thrombocytopenia, splenectomy for hypersplenism when is the cause of destruction of platelets, steroids, androgens, bone marrow transplant
What is iron deficiency anemia?
occurs when RBCs contain decreased levels of Hgb; most common cause of anemia; due to excessive iron loss caused by chronic bleeding (intestinal, uterine, gastric)
What are the clinical manifestations of iron deficiency anemia?
pallor, fatigue, weakness, SOB, angina, s/s of HF, glossitis, pagophagia (eating lots of ice), HA, paresthesia (numbness & tingling)
What is the medical managements of iron deficiency anemia?
Ferrou sulfate 900mg po or injected (z-track) daily, ascorbic acid (vitamin C), diet high in iron
What is sickle cell anemia?
severe, chronic, incurable condition in which RBCs are an abnormal crescent shape; usually african americans; 1 in 500 have disease 1 in 10 are carriers
What are the clinical manifestations of sickle cell anemia?
precipitating factors (dehydration & change in O2 tension in body), loss of appetite, irritability, weakness, abdominal enlargement, joint and back PAIN, edema of extremities, enlarged heart, jaundice, chronic leg ulcers, tachypnea, dyspnea, arrhythmias
What is the medical management of sickle cell anemia?
ALLEVIATE SYMPTOMS, O2, fluids, rest, analgesics, bone marrow transplant
What is polycythemia?
Overproduction of RBCs; characterized by erythrocytosis (abnormal increase in # of circulating RBCs) also increased production of granulocytes and platelets
What are the s/s of polycythemia?
HA, dizziness, tinnitus, blurred vision, fatigue, weakness, pruritis, exertional dyspnea, angina, increased BP and pulse
What is the treatment of polycythemia?
Phlebotomy, meds, dietary changes
What is agranulocytosis?
severe reduction in number of granulocytes; characterized by WBC count of <200; caused by meds (PTU), chemo, radiation, neoplastic disease, viral and bacterial infections (POTENTIALLY FATAL)
What are the clinical manifestations of agranulocytosis?
symptoms of infection, ulcerations of mucous membranes, bronchial pneumonia, UTI
What is the medical management of agranulocytosis?
REMOVE CAUSE of bone marrow depression, prevent or treat infections, strict asepsis
What is leukemia?
malignant disorder of hematopoietic system; characterized by WBCs that are not functional; WBCs invade and destroy bone marrow, metastasize in liver, spleen, and lymph nodes; cause unknown
What are the 4 classifications of leukemia?
Acute lymphocytic leukemia ("ALL", usually occurs in kids younger than 15), Acute myelocytic leukemia ("AML", most common leukemia among adults, age of onset is usually 15-39), Chronic lymphocyctic leukemia ("CLL", most cases over age 60), Chronic myelocytic leukemia ("CML", most cases involve adults)
What are the clinical manifestations of leukemia?
PAIN, anemia, elevated WBCs before treatment, may develop thrombocytopenia or leukopenia, enlarged lymph nodes, splenomegaly
What is the medical management of leukemia?
CONTROL SYMPTOMS OR REMISSION, chemo radiation, bone marrow transplant, meds; pts often fail to cope due to chronic pain
What is thrombocytopenia?
condition in which number of platelets is reduced to <100000; may be caused by decreased production or decreased survival
What are the clinical manifestations of thrombocytopenia?
petechiae, ecchymosis, platelets <100000, bleeding from mucous membranes
What is the medical management of thrombocytopenia?
if platelets count continues to drop monitor changes in LOC (risk for brain hemorrhage), corticosteroid therapy, splenectomy, gamma globulin, immunosuppressive drugs, platelet transfusions, avoid trauma
What is hemophilia?
hereditary coagulation disorder seen mostly in men; characterized by disturbance of clotting factor; Hemophilia A most makes up 85% of cases; has x-linked hereditary trait
What are the clinical manifestations of hemophilia?
internal and external bleeding, excessive blood loss from small cuts and dental procedures, petechiae, ecchymosis
What is the medical management of hemophilia?
minimize bleeding (avoid trauma), relieve pain (no ASA, may apply ice for vasoconstriction and pain), transfusions (clotting factor concentrate, cryoprecipitate)
What is von Willebrand's disease?
inherited bleeding disorder characterized by abnormally slow coagulation of blood; similar to hemophilia but not limited to men
What are the clinical manifestations of von Willebrand's disease?
spontaneous episodes of GI bleeding, epistaxis, gingival bleeding
What is the medical management of von Willebrand's disease?
cryoprecipitate, desmopressin (DDAVP), minimize bleeding (avoid trauma), relieve pain (NO ASPIRIN), fibrinogen, fresh plasma
What is disseminated intravascular coagulation?
overstimulation of clotting and anti-clotting processes in response to disease or injury; alternating of clotting and hemorrhaging occurs; characterized by microclots w/ decrease in clotting factors
What are the clinical manifestations of disseminated intravascular coagulation?
bleeding, dyspnea, diaphoresis, cold mottled digits, pupura on the chest and abdomen, petechiae
What is the medical management of disseminated intravascular coagulation?
Treat underlying cause; cryoprecipitate, heparin, protect from bleeding and trauma, ADMINISTRATION OF PLATELETS AND PACK RED BLOOD CELLS
What is multiple myeloma?
malignant neoplastic immunodeficiency disease of bone marrow; characterized by bone marrow tumors
What are the clinical manifestations of multiple myeloma?
bone pain & pathological fractures (due to loss of Ca+ in the bones), infection, anemia, bleeding, hypercalcemia (bones break and release Ca+), renal failure
What is the medical management of multiple myeloma?
maintaining fluid intake of 3-4L/day to dilute Ca+; symptomatic (not curable), radiation, chemo, corticosteroids, IV fluids
What is lymphangitis?
inflammation of one or more lymphatic vessels; usually occurs from acute streptococcal or staphylococcal infection in an extremity
What are the clinical manifestations of lymphangitis?
fine red streaks from aa, edema, chills, fever, local pain, HA
What is the medical managements of lymphangitis?
penicillin, moist heat, elevate extremity
What is lymphedema?
accumulation of lymph in the soft tissue; may be primary or secondary disorder
What are the clinical manifestations of lymphedema?
massive edema and tightness of affected extremity, pain
What is the medical management of lymphedema?
diuretics, antibiotics, compression pump, elastic stocking or sleeve, restricted sodium diet, avoid constrictive clothing, meticulous skin care
What is Non-Hodgkins lymphoma?
neoplastic disorder of the lymphoid tissue; tumors usually start in lymph nodes and spread to lymphoid tissue in spleen, liver, GI tract, and bone marrow; most cases involve adults; possible causes include viral infection and exposure to chemical agents
What are the clinical manifestations of Non-Hodgkin's lymphoma?
fever, anemia, pruritis, fatigue, malaise, painless enlarged cervical lymph nodes, weight loss, anorexia
What is the medical management of Non-Hodgkin's lymphoma?
Radiation, chemo, bone marrow trasplant
What is Hodgkin's lymphoma?
inflammation of infectious process that develops into neoplasm; affects males and arises as painless swelling in lymph node and confirmed when biopsy reveals Reed-Sternberg cells
What are the clinical manifestations of Hodgkin's lymphoma?
Painless enlargement of lymph nodes, anorexia, weight loss, pruritis, low-grade fever, night sweats, anemia, leukocytosis
What is the medical management of Hodgkin's lymphoma?
Stage 1 or 2 (localized) - radiation, stage 3 or 4 (generalized) - chemo or combination of chemo and radiation