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139 Cards in this Set
- Front
- Back
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What fills the central core of bones?
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Bone Marrow
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What are the 2 types of Bone Marrow
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Red and Yellow
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What 10 bones produce Red Bone Marrow?
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Flat and irregular bones, ends of long bones, pelvic, vertabrae, sacrum, sternum, ribs, flat cranial and scapulae
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What are Stem Cells
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Nondifferentiated immature blood cells found in bone marrow
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What are the 3 jobs of the Erythrocyte cells (RBC's)
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Transport O2 and CO2
Assist in acid-base balance Flexible shape |
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(Def)
Stimulating production of RBC's |
Erythropoiesis
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When is Erythropoiesis stimulated?
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during periods of hypoxia
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What does Erythropoiesis require? (5)
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Protein, Folate, Cobalamin, Riboflavin, and Pyridoxine
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Reticulocytes are what?
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Immature RBC's (mature in 48 hours)
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Leukocytes are what?
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WBC's
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Granulocytes (Subgroup of WBC's) main purpose is?
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Phagocytosis
(eating of bacteria) |
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Granulocytes vs. Angranulocytes
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Granulocytes look like they have granules
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What Granulocyte is the most important in fighting infection and create the biggest immunity we have
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Neutrophils (50-70% of our WBC's)
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Segmented vs. Band Neutrophils
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Band are baby Neutrophils
Segmented are adult |
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Esonophils are Granulocytes and make up what % of all WBC's
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2-4%
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Basophils are Granulocytes and make up what % of all WBC's
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less than 2%
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Agranulocytes include what 3 cells?
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Lymphocytes
Monocytes Macrophages |
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Lymphocytes are broken up into what 2 groups, and what are they in response to?
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T cells
B cells They are increased during a viral infection |
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What is the difference between Monocytes and Macrophages
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Once Monocytes enter the tissues they become Macrophages.
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What's another name for Thrombocytes?
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Platelets
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What are the two main functions of Thrombocytes?
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Aid in clotting
Respond to internal damage to epithelial wall |
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What growth factor stimulates platelet production?
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Thrombopoetin
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What is the blood clotting process called?
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Hemostasis
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How many phases are there to blood clotting, and what are they?
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3
Vascular response Platelet response Plasma clotting factors |
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What takes place during the vascular response?
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Immediate local vasoconstriction
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What happens during the platelet response?
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Platelets start to stick together and form a clump
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What is formed during the plasma clotting factors?
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A fibrin clot that covers the platelet clot
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What are the two subgroups to the Plasma Clotting Factors?
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Intrinsic Pathway
Extrinsic Pathway |
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What starts the Intrinsic Pathway?
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Collagen exposure from the injury when blood vessels are damaged
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What starts the Extrinsic Pathway?
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When tissue factor is released extravacularly from injured tissues
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What breaks up the clot?
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Anticoagulants
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What natural anticoagulant is made from our liver?
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endogenous heparin
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(Def)
Process resulting in the dissolution of the fibrin clot |
Fibrnolysis
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How does Fibrinolysis work?
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Plasminogen is converted to plasmin which attaks fibrin or fibrinogen and breaks it down to FSP's or FDP's
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FSP stands for?
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Fibrin Split Products
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FDP stands for?
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Fibrin Degradation Products
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In general what is Anemia?
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Decrease in functional erythrocytes
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What are the 3 causes of Anemia?
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Blood loss
Impaired production of erythrocytes Increased destruction of erythrocytes |
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Anemia is grouped by the morphologic charateristics which is what?
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The shape, size and color of the erythrocyte
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Anemia is also grouped by what?
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Etiology
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What is the range for normal hgb?
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12-16 for women
13-18 for men |
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Mild Anemic is what range of hgb?
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10-14
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Is somebody asymptomatic or symptomatic?
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asymptomatic
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What will the person have if they are mildly anemic?
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Palpitations
Dyspnea Diaphoresis |
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Moderate Anemic is what range of hgb?
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6-10
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When would symptoms appear for moderate?
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at rest as well as active
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Severe anemic is what range of hgb?
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below 6
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how many systems are involved with severe anemia?
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multiple
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Integumentary changes are?
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Pallor
Jaundice Pruritis (itching) |
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Cardiopulmonary changes are?
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Increased HR and SV
Systolic murmurs and bruits MI, CHF, peripheral edema, ascites and cardiomegaly |
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What would be included in the nursing assesment?
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Resent blood loss
Medications Surgery Dietary history |
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Iron Deficiency Anemia's Etiology is caused by what 4 things?
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Inadequate dietary intake
Malabsorption (body can't absorb it) Blood loss (iron is loss with blood) Hemolysis (cells die) |
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Iron Deficiency Manifestations are what 7 things?
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Asymptomatic
Pallor Glossitis (inflamation of tounge) Cheilitis (inflammation of lips) Headache Paresthesias (numbness) Burning of tounge |
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Diagnostic tests for Iron Def. Anemia
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Decreased H&H
Decreased Iron Decreased Reticulocytes |
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What foods are high in Iron?
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Eggs, dried fruit, dark leafy veg., whole-grain breads, cereals, potatoes
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What type of Iron is used in treating Iron Deficiency Anemia?
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Ferrous Sulfate
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How much Iron should be given daily and with what?
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150-200mg/day an hour after eating with OJ and fiber due to constipation
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How long should Iron be taken?
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2-3 months
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Other than by mouth how can Iron be given?
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IV or IM (Z track)
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What are the two Megaloblastic Anemia's?
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Cobalamin Deficiency (Vit B12)
Folic Acid Deficiency |
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What is the most common cause of Cobalamin Deficiency?
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Pernicious Anemia
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What is the cause of Cobalamin Deficiency (B12)?
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Parietal cells can't secrete intrinsic factor and therefore can't absorb B12
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What happens if B12 isn't absorbed?
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a decrease in HCL
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What are the manifestations of Cobalamin Deficiency?
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Tissue hypoxia
sore tounge, anorexia, N&V, abdominal pain |
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What's the key difference between Cobalamin and Folic Acid?
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Cobalamin Pt's will have weakness
paresthesias impaired thought processes |
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Cobalamin Diagnostic studies will show?
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Macrocytic RBC's & abnormally shaped
Schilling test (UA) will show small amount of radioactive Cobalamin excreted |
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Collaborative and Nursing Care for Cobalamin is?
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Adequate intake of B12
Make sure B12 is in the diet Parentaeral administration of B12 Nascobal (intranasal spray or SQ) |
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What is the schedule of meds for Cobalamin?
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1000mg daily for 2 weeks, then weekly then monthly
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How long after starting medication can a person stop taking B12?
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never IT'S FOR LIFE
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Why do we protect Pt's with Cobalamin from injuries, burns and trauma?
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Paresthesias
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Folic acid deficiency is caused by?
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Poor nutrition
Malabsorption syndromes Drugs ETOH abuse & anorexia Dialysis (pulls out Folic Acid) |
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What are the manifestations for Folic Acid?
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Dyspepsia (stomach aches)
Smooth beefy tounge *normal neurologic functions* |
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what does the diagnostic studies show in Folic Acid deficiency?
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Low Serum folate levels
normal Cobalamin levels |
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Collaborative and Nursing Care for Folic Acid is?
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Replacement therapy 1mg/PO QD
Dietary supplements |
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Which Anemia has a decrease of all blood cell types?
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Aplastic Anemia
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What 2 ways a person can become Aplastic anemic?
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Congenital (chromosomal alterations)
Acquired (exposure to ionizing radiation) |
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Manifestations of Aplastic anemia are?
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Fatigue, dyspnea (low RBC's)
Susceptible to infection (low WBC's) Bleeding (low platelets) |
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Pancytopenia is?
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Decreased of all blood cell types (Aplastic Anemia)
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Morphology of Aplastic anemia is?
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Normocytic (normal size), normochromic (normal color)
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Diagnostic studies of Aplastic anemia show what?
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low Hgb, WBC's, platelets
Prolonged bleeding time |
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what is the only way to tell if a person is Aplastic anemic?
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Bone Marrow biopsy
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What Collaborative care is given to Aplastic anemic Pt's?
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Identify and remove causative agent
Supportive Care (blood transfusion) Bone Marrow transplant Immunosuppression |
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What is the purpose of immunosuppressing the Pt?
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By stopping the immune system the abnormal cells will die, so then when the immune system starts again only normal cells will grow
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Acute blood loss occurs how?
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Sudden hemorrhage
Trauma Surgery |
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Acute blood loss can lead to?
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hypovolemic shock
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10% blood loss
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No change
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20% blood loss
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tach. with exersice
slight postural hypotension |
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30% blood loss
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postural hypotension
tach. with exercise |
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40% blood loss
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Below normal BP, central venous pressure, CO, rapid thready pulse, cold clammy skin
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50% blood loss
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Shock and potential death
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Diagnostic tests show what in acute blood loss?
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Decrease RBC's and H&H
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Collaborative and Nursing Care for acute blood loss are?
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Replace vol.
Identify source of hemorrhage Stop bleeding Give Iron |
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Chronic blood loss is fast or slow?
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slow, similar to loss due to iron deficiency. Effects related to depletion of iron stores
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What is done during chronic blood loss?
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Identify source, stop bleeding
Give Iron |
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Thromboctyopenia is a platelet count below?
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150,000
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How can one have Thrombocytopenia?
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either inherited, but majority acquire it
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What does Thrombocytopenia result in?
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Decreased platelet production or Increased in platelet destruction
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What are 3 types of Thrombocytopenia?
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Immune Thrombocytopenia Purpura (ITP)
Thrombotic Thrombocytopenia Purpura (TTP) Heparin Induced Thrombocytopenia with Thrombosis Syndrome (HITTS) |
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Immune Thrombocytopenia Pupura (ITP) is what?
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Abnormal destruction of platelets
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Is ITP an autoimmune disease?
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Yes
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What's wrong with the platelets in ITP?
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They are coated with antibodies and destroyed bymacrophages in the spleen (they are seen as invaders)
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Who does ITP mainly affect?
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Women 20-40 yrs old
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Thrombotic Thrombocytopenic Purpura (TTP)causes what 5 problems?
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Hemolytic anemia
Thrombocytopenia Neuro abnormalities Fever Renal abnormalities |
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What is the key identifier with TTP?
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fever in absence of infection
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Heparin Induced Thrombocytopenia and Thrombosis Syndrome (HITTS) is also known as what?
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White Clot Syndrome
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HITTS does what to platelets?
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an immune response to heparin causes platelet destruction and vascular endothelial injury
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After platelets are destroyed then what happens?
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Platelet aggregation is promoted which decreases circulating platelets which leads to Thrombocytopenia
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Manifestations of Thrombocytopenia are?
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Pt is asymptomatic
Increased bleeding (epistaxis, gingival) Pettechiae Ecchymoses Prolonged bleeding after IM's, IV's S&S of shock |
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Diagnostic studies for Thrombocytopenia?
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Platelet count less than 150,000
less than 50,000 is prolonged bleeding less than 20,000 spontaneous hemmorrhage less than 10,000 neuro changes PT, PTT can be NORMAL Bone marrow biospy Presence of megakaryocytes (immature platelets) |
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Collaborative and Nursing Care for ITP
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Steroids
immunosuppressive thearpy splenectomy transfusion |
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nursing care for TTP
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Steroids
Plasmapheresis (plasma dialysis) splenectomy |
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Nursing care for HITTS
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D/C heparin
Plasmapheresis Protamine Sulfate Thrombolytics/surgery |
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Nursing implementations?
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no cutting, razors (electric is okay) stool softners, no ASA only Tylenol
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What causes DIC?
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an underlying condition, (tubular pregnancy is one, cancer is another)
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DIC etiology is what?
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abnormal response of clotting cascade
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Simple terms DIC is what?
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Both bleeding and clotting at the same time and at a fast rate
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Can DIC be acute, subacute or chronic?
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it can be all 3
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How does the clotting side in DIC work?
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thrombin produced, fibrinogen to fibrin, enhanced platelet aggregation, fibrin and platelet deposition in capillaries and arterioles, thrombosis
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How does the bleeding side in DIC work?
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fibrnolytic system activated, new clot breaks down, FSP, anicoagulant properties inhibit normal blood clotting, blood loses ability to clot
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DIC manifestations are?
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Pallor
pettechiae OOZING BLOOD hematomas occult hemmorrhage weakness malaise fever tachypnea hemoptysis orthopnea |
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More DIC manifestations are?
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Tachycardia
hypotension stomach distention bloody stools hematuria Neuro changes (vision change, dizziness, headache, change in mental status) |
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DIC in musculoskeletal
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bone and joint pain
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Thrombotic problems in DIC
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Cyanosis
gangrene |
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DIC diagnostic tests are
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FSP's and FDP's
D-dimer assay decreased platelets prolonged PT, PTT |
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what does the D-dimer assay show?
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if your clotting or bleeding or both, it's a percentage
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Collaborative care of DIC
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Dx quickly
resolve underlying problem supportive care (tranfusion) tranfusions: PRBCs, platletes, FFP |
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2 types of lymphomas are?
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Hodgkin's disease
Non-Hodgkin's lymphoma |
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How can a person get Hodgkins?
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infection of Epstein-Barr virus
gentic predisposition exposure to toxins |
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What happens in Hodgkins?
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Lymph nodes are destroyed by herplasia of monocytes and macrophages
occurs in a single location and spreads along adjacent lympatics infiltrates other organs |
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Manifestations of Hodgkins
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enlarged cervical, axillary or inguinal nodes
nodes aren't painful REED-STERNBERG CELLS present Wt loss, fatigue, fever, chills, night sweats, tachycardia |
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Other manifestations of Hod.
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Pruritis, cough, dyspnea, stridor, dysphagia, anemia, hepatomegaly, splenomegaly
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Diagnostic studies for Hod.
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Blood studies
Lymph biopsy Bone marrow biopsy X-rays staging |
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Collaborative care for Hod
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Stage (local or diffuse)
Classificaton A or B (B symptoms are present when disease is found) Roman numeral I-IV shows location and extent of diease |
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Stages of Hod (I and II)
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I: single lymph node or extranodal site
II: 2 or more nodes on the same side of diaphragm |
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Stages of Hod (III and IV)
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III: involvment of regions on both sides of diaphragm and divided in the upper abdomen and lower abdomen
IV: disseminated of one or more extralymphatic organs |
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Collaborative care of Hod
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Radiation
Chemo and radiation chemo with or without bone marrow transplant manage pancytopenia and effects of therapy Psychosocial issues fertility issues |
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Non Hod Etiology
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Can start outside the lymph node
spread can be unpredictable majority have widely disseminated disease of diagnosis |
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Manifestations of Non Hod
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Painless lymph nodes
symptoms depend on where disease has spread NO REED-STERNBERG CELLS |
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Non Hod collabortive care
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Radiation
watchful waiting Chemo |
