Otc Lpn Chapter 7 Care Of The Patient With Blood Or Lymphatic Disorder

Front 1

The process by which certain cells engulf and digest microorganisms and cellular debris is called:

Back 1

phagocytosis

Front 2

An examination in which the different kinds of white blood cells are counted and reported as percentages of the total examined or absolute (actual number) is called:

Back 2

differential white blood cell count

Front 3

The element that makes up 55% of the blood is:

Back 3

plasma

Front 4

anemia

Back 4

a disorder characterized by low levels of RBCs, hemoglobin, & hematocrit

Front 5

aplasia

Back 5

failure of normal process of cell generation & development; also called aplastic anemia

Front 6

pancytopenic

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all 3 major blood elements (red cells, white cells & platelets) from bone marrow are reduced or absent

Front 7

disseminated intravascular coagulation (DIC)

Back 7

aquired hemmorrhage syndrome of clotting, cascade overstimulation & anticlotting processes

Front 8

erythrocytosis

Back 8

an increase in circulating RBCs

Front 9

erythropoiesis

Back 9

process of RBC prodution; occurs in bone marrow

Front 10

hemarthrosis

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bleeding in the joint space; a hallmark of severe disease usually occurring in the knees, ankles, and elbow

Front 11

hemophilia A

Back 11

hereditary coagulation disorder; caused by lack of antihemophilic factor VIII

Front 12

heterozygous

Back 12

having two different genes

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homozygous

Back 13

having two identical genes, inherited from each parent

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leukemia

Back 14

malignant disorder; excess of leukocytes accumulates in bone marrow & lymph nodes

Front 15

leukopenia

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abnormal decrease in the number of WBC to fewer than 5000 cells/mm3 due to depression of bone marrow

Front 16

lymphangitis

Back 16

inflammation of one or more lymphatic vessels; results from strep or staph in an extremity

Front 17

lymphedema

Back 17

accumulation of lymph in soft tissue and edema

Front 18

multiple myeloma

Back 18

malignant neoplastic immunodeficiency disease of bone marrow; tumor composed of plasma cells; also called plasma cell myeloma

Front 19

myeloproliferative

Back 19

excessive bone marrow production

Front 20

pernicious

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capable of causing great injury or destruction; deadly, fatal

Front 21

Reed-Sternberg cells

Back 21

atypical histocytes; large, abnormal, multinucleated cells in lymphatic system, found in Hodgkin's lymphoma

Front 22

thrombocytopenia

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abnormal hematologic condition; platelets are less than 100,000/mm3

Front 23

Erythrocytes are also known as:

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red blood cells

Front 24

Leukocytes are also known as:

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white blood cells; have nuclei, are colorless, & live from a few days to several years

Front 25

neutrophils

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*WBCS that are the First Responders to scene*; the primary phagocytic cells; 60-70%

Front 26

A mature neutrophil is called:

Back 26

a segmental neutrophil or "seg"

Front 27

bandemia

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an increase in the number of band neutrophils

Front 28

eosinophils

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WBCs involved in inflammatory response; neutralize histamine & destroy certain parasitic worms; normal values are 1%-4%

Front 29

basophils

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WBCs that release histamine (vasodilator) during tissue damage or invasion; inhibits clot formation; normal values are 0.5% to 1%

Front 30

monocytes

Back 30

WBCs that are second on the scence to an infection; engage in phagocytosis; normal values are 2%-6%

Front 31

lymphocytes

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WBCs:
T cells-attack & destroy pathogens
B cells-produce antibodies & destroy bacteria
normal values 20-40%

Front 32

thrombocytes

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platelets; smallest cells in blood, produced in red bone marrow & assist in forming clots and hemostasis; life span of 5-9 days, 150,000-400,000 in number

Front 33

prothrombin time (PT)

Back 33

lab test determining the rapidity of blood clotting; 11-12.5 seconds

Front 34

partial thrombin time (PTT)

Back 34

lab test determining fibrin clot formation; 60-70 seconds

Front 35

lymphatic system's functions

Back 35

maintenance of fluid balnce, production of lymphocytes & absorption and transportation of lipids from intestine to bloodstream

Front 36

hematocrit

Back 36

lab test of the packed cell volume of RBCs; 42%-52% in men and 37%-47% in women

Front 37

hemoglobin

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O2 carrying portion of RBC

Front 38

renal erythropoietic factor

Back 38

an enzyme released by kidneys signaling the need for more O2 to blood, kickstarting RBC production in bone marrow

Front 39

tonsils

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protect body from invasion of foreign substances by producing lymphocytes & antibodies

Front 40

Which is a normal blood value for eosinophils?

Back 40

1% to 4%

Front 41

Which is a normal blood value for lymphocytes?

Back 41

20% to 40%

Front 42

The spleen stores how many milliliters of blood that can be released in emergencies?

Back 42

(500mL) 1 pint of blood

Front 43

Pernicious anemia results from inadequate absorption of:

Back 43

B12

Front 44

Which nursing intervention does the nurse plan for a patient who has multiple myeloma?

Back 44

Increase fluid intake to 3000 to 4000 mL/day

Front 45

When developing a care plan for a patient just diagnosed with leukemia, which two nursing diagnoses are the most appropriate to use?

Back 45

Risk for infection & ineffective coping

Front 46

The patient has a history of iron deficiency anemia. The value most indicative of iron deficiency anemia is:

Back 46

RBC count and hemoglobin and hematocrit levels to be below normal; Normal hemoglobin level is 14 to 18 g/dL for males.

Front 47

A patient is to begin taking iron supplements. The nurse evaluates the patient’s understanding of the use of this drug. Which indicates that she has an adequate knowledge base?

Back 47

An oral iron supplement may turn the stool black.

Front 48

The patient, age 35, is admitted with aplastic anemia. He asks the nurse what aplastic anemia is. An accurate response would be that:

Back 48

Aplastic anemia or aplasia (failure of the normal process of cell generation & development) is congenital & acquired. All three major blood elements (RBCs, WBCs, platelets) are reduced or absent.

Front 49

A patient, an African American, is the mother of a 9-year-old child with sickle cell anemia. She asks the nurse if sickle cell anemia occurs frequently in her race. The correct response is that:

Back 49

Approx. 1 of every 10 African Americans (81%) has sickle cell traits, and approx. 1 of every 500-600 has sickle cell anemia.

Front 50

The patient has agranulocytosis with a neutrophil count of 10%. The most important nursing intervention would be:

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Protecting the patient from infection because normal count is 60-70%

Front 51

A patient, age 24, is admitted with idiopathic thrombocytopenic purpura and a platelet count of 18,000/mm3. An appropriate nursing intervention would be to:

Back 51

Significant risk for serious bleeding occurs when the count is below 20,000/mm3.

Front 52

The nurse is caring for a 34-year-old obstetric patient who has disseminated intravascular coagulation (DIC). The nurse is aware that DIC is:

Back 52

a grave coagulopathy condition resulting from the overstimulation of clotting and anticlotting processes in response to disease or injury.

Front 53

The appropriate nursing intervention to relieve the symptom of pruritus in a patient with Hodgkin’s disease would be:

Back 53

Soothing baths with an antipruritic medication (as ordered) can be effective.

Front 54

A patient is admitted with fatigue; discomfort; enlarged, painless cervical lymph nodes; and pruritus. A lymph node biopsy yields a diagnosis of Hodgkin’s disease. The nurse is aware that the abnormal cells noted by the pathologist in Hodgkin’s disease are called:

Back 54

Reed-Sternberg cells

Front 55

Patients with pernicious anemia must receive injections of which medication for the rest of their lives?

Back 55

1,000 units of B12

Front 56

A patient, age 52, is admitted with thrombocytopenia. The most important nursing intervention to prevent hemorrhage in this patient is to:

Back 56

Instruction to patient on s/sx, as well as preventive measures (stool softner, high fiber diet, soft toothbrush, blow nose gently), and notifying physican of s/sx of bleeding

Front 57

Hematological diseases are often associated with skin impairment. Petechiae and ecchymoses are seen in:

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hemophilia A

Front 58

The typical medical treatment of polycythemia vera involves:

Back 58

Repeated phlebotomy decreases blood viscosity

Front 59

A patient, age 23, is admitted with enlarged lymph nodes, decreased production of RBCs, thrombocytopenia, and a severe increase in his WBC count. A bone-marrow aspiration shows abnormal lymphocytes present. These abnormalities are present in which disease?

Back 59

Bone marrow biopsy shows immature leukocytes. Chest radiographic examination may show mediastinal node and lung involvement and bone changes. Sickle cell anemia, hemophilia, and thrombocytopenia do not usually have elevated WBC count.

Front 60

The patient, age 44, has polycythemia vera. The nurse recognizes that the primary pathophysiologic feature of this disorder is:

Back 60

Polycythemia vera is characterized by erythrocytosis (an abnormal increase in the number of circulating red blood cells) and also increased production of granulocytes and platelets.

Front 61

Which should the nurse implement as the most important measure in preventing transmission of harmful pathogens to patients with depressed bone marrow function?

Back 61

Meticulous handwashing by medical and nursing personnel and strict asepsis are mandatory.

Front 62

The average life span of an erythrocyte is:

Back 62

129 days

Front 63

Life span of a WBC

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several days to several years

Front 64

Life span of platelets

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5-9 days

Front 65

Many older adults suffer from conditions such as colonic diverticula, hiatal hernia, and ulcerations that can cause occult bleeding. Older adults with these conditions should be observed for:

Back 65

iron deficiency

Front 66

The nurse is administering a blood transfusion to an older adult for hypovolemic shock. During the transfusion, which nursing intervention would be the most important?

Back 66

Careful assessment of cardiopulmonary function and intake and output is essential.

Front 67

If a patient is diagnosed with anemia, how are the tissues and cells affected?

Back 67

insufficient amounts of oxygen are delivered to tissues and cells.

Front 68

Donors who are less likely to be adequate bone marrow transplant would include:

Back 68

twins, siblings, or self (autologous) while in remission are preferred.

Front 69

The spleen is a highly vascularized organ located in the left upper quadrant of the abdominal cavity. The main functions of the spleen are:

Back 69

(1) to serve as a reservoir for blood;
(2) to form lymphocytes, monocytes, and plasma cells;
(3) to destroy worn-out RBCs;
(4) to remove bacteria by phagocytosis (engulfing and digesting);
(5) to produce RBCs before birth (the spleen is believed to produce RBCs after birth only in cases of extreme hemolytic anemia).

Front 70

_____________ are leukocytes which destroy and remove cellular waste, bacteria, and solid particles.

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Neutrophils

Front 71

The organ that forms lymphocytes is the __________.

Back 71

spleen

Front 72

A sudden reduction in blood volume may lead to _________ shock.

Back 72

hypovolemic

Front 73

Replaces iron stores needed for RBC development

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ferrous sulfate

Front 74

Needed for adequate nerve functioning

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B12

Front 75

Stimulates proliferation and differentiation of neutrophils

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Neupogen

Front 76

Needed for erythropoiesis

Back 76

folic acid

Front 77

Blood disorder characterized by red blood cell, hemoglobin, and hematrocrit levels below normal range

Back 77

anemia

Front 78

In hematology, a failure of the normal process of cell geneneration and development

Back 78

aplasia

Front 79

Acquired hemorrhage syndrome of clotting, cascade overstimulation, and anticlotting processes

Back 79

Disseminated intravascular coagulation (DIC)

Front 80

Hereditary coagulation disorder; caused by a lack of antihemophilic factor VIII, which is needed to convert prothrombin to trhombin through thromboplastin component

Back 80

Hemophila A

Front 81

The gland that plays a role in the development of the body's immune system is the:

Back 81

thymus

Front 82

A shift to the left on the WBC differential indicates an increase in the number of:

Back 82

bands, or immature polymorphonuclear leukocytes

Front 83

The universal recipient with regard to blood type is type:

Back 83

AB

Front 84

The preferred diagnostic test for evaluating deep lymph nodes is:

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CT

Front 85

Test used to diagnose sickle cell anemia

Back 85

peripheral smear

Front 86

Test used to diagnose pernicious anemia

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Schilling test but being replaced by megaloblastic anemia profile; older test is gastric analysis

Front 87

Your elderly patient has been diagnosed with pernicious anemia. You remember that this type of anemia results from:

Back 87

the absence of a glycoprotein intrinsic factor secreted by the gastric mucosa

Front 88

You are admitting a patient who has polycythemia to your unit. Which of the following patients best fits the profile of a patient with this disorder?

Back 88

A middle-aged male with elevated blood pressure and an erythematous appearance

Front 89

The most severe risk for a patient with agranulocytosis is that of:

Back 89

infection

Front 90

Your patient with leukemia is susceptible to hemorrhage. Which blood dyscrasia makes him susceptible to this?

Back 90

thrombocytopenia

Front 91

You are caring for a patient with hemophilia. Which of the following nursing diagnoses would you expect to see on his nursing care plan? Select all that apply.

Back 91

Ineffective tissue perfusion

Fluid volume deficit

Anxiety

Pain

Front 92

Which of the following is the main diagnostic feature of Hodgkin s disease?

Back 92

Reed-Sternberg cells

Front 93

A grave disease process in which the patient experiences both bleeding and intravascular clotting at the same time is known as:

Back 93

Disseminated intravascular coagulation (DIC)

Front 94

A CBC includes:

Back 94

1. RBC and WBC
2. hematocrit
3. hemoglobin
4. erythrocyte indexes
5. Differential WBC
6. exam of peripheral blood cells

Front 95

Common site for bone marrow aspiration or biopsy

Back 95

posterior iliac crest

Front 96

What can cause anemia?

Back 96

1. hemorrhage
2. bone marrow depression
3. long-term iron deficiency

Front 97

What can occur if there is a blood loss approaching 1000 mL?

Back 97

hypovolemic shock

Front 98

What happens at a blood loss of 1500 to 2000 mL?

Back 98

irreversible end-organ damage

Front 99

Subjective data of hypovolemic anemia

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1. thirst
2. weakness
3. irritability
4. restlessness

Front 100

cyanocobalamin

Back 100

B12

Front 101

What kind of virus is suspected to be the cause of Non-Hodgkin's Lymphoma?

Back 101

herpes-like

Front 102

What kind of patients are at greater risk of developing Non-Hodgkin's Lymphoma?

Back 102

Pts who receive immunosuppressive agents; more common in men >60, whites & Jewish ancestry

Front 103

What do they call the area that includes the chest wall, mediastinum, axillae, and neck?

Back 103

The mantle field

Front 104

Objective data of Non-Hodgkin's Lymphoma

Back 104

1. splenomegaly
2. Enlarged lymph nodes
3. fever, night sweats, and weight loss

Front 105

What is a useful system for classifying Non-Hodgkin's Lymphoma?

Back 105

The international working formulation; indolent (low grade), agressive (intermediate grade) & very aggressive (high grade)

Front 106

Hodgkin's lymphoma occurs more frequently in people who have had _________________.

Back 106

mononucleosis

Front 107

Even after a small amount of _____________, individuals with HL may complain of a rapid onset of pain at the site of the disease.

Back 107

alcohol

Front 108

What kind of diet is recommended for pernicious anemia?

Back 108

high in vitamins, iron, and protein

Front 109

To control pernicious anemia, what two things must the pt understand?

Back 109

1. disease process
2. importance of lifetime therapy of vitamin B12

Front 110

iron deficiency anemia

Back 110

a condition in which the RBCs contain decreased levels of Hgb.

Front 111

What amount of blood should be loss in the upper GI tract for stools to appear black or melenic.

Back 111

50 to 75 mL

Front 112

What two diseases result in malabsorption of iron?

Back 112

Celiac disease and sprue

Front 113

What are the two most common signs of iron deficiency anemia (in order)?

Back 113

pallor ----> glossitis

Front 114

the desire to eat ice, clay, or starches

Back 114

pagophagia

Front 115

What enhances iron absorption?

Back 115

ascorbic acid

Front 116

Should you report black tarry stools?

Back 116

No, it is expected with iron therapy

Front 117

What might a patient with polycythemia complain of b/c of engorgement of the spleen and liver?

Back 117

satiety (fullness)

Front 118

Splenomegaly occurs in only ____________ polycythemia.

Back 118

primary

Front 119

How do you prevent secondary polycythemia?

Back 119

adequate oxygenation

Front 120

What is the major cause of morbidity and mortality in polycythemia vera?

Back 120

thrombosis

Front 121

Name the three granulocytes

Back 121

B.E.N.
basophils
eosinophils
neutrophils

Front 122

What are the two primary causes of agranuloctosis?

Back 122

1. medication reaction
2. toxicity

Front 123

A potentially fatal condition of the blood characterized by a severe reduction in the number of granulocytes

Back 123

agranulocytosis

Front 124

ITP platelets are coated with _________

Back 124

antibodies

Front 125

What is the antihemophilic factor VIII for?

Back 125

conversion of prothrombin to thrombin

Front 126

Exhibits a deficiency of factor IX with an absence of plasma thromoplastin component, resulting in nonformation of thromboplastin

Back 126

Hemophilia B (Christmas disease)

Front 127

In hemophilia, who are usually the carriers?

Back 127

females (think Queen Victoria)

Front 128

How do you treat chronic leg ulcers that result from sickle cell anemia?

Back 128

Bed rest, antibiotics, warm saline soaks, mechanical or enzyme debridement and dressings

Front 129

sickle cell anemia

Back 129

an abnormal crescent-shapred RBC comtaining hemoglobin S (Hg-S), a defective hemoglobin molecule

Front 130

sickle cell trait

Back 130

Heterozygous form of sickle cell anemia whereby the individual has both hemoglobin S (Hg-S) & hemoglobin A (Hg-A) in the RBCs. Pts. don't have s/sx but pass disorder to their children

Front 131

What is the life span of an RBC affected by sickle cell disease?

Back 131

10-20 days

Front 132

What is the primary symptom associated with sickle cell disease?

Back 132

pain

Front 133

A myeloproliferative disorder with hyperplasia of bone marrow (too much); it manifests with an increase in circulating erythrocytes, granulocytes, and platelets. It develops gradually and is a chronic disease

Back 133

polycythemia vera

Front 134

When doing an assessment on someone with polycythemia vera, what might you find?

Back 134

Patient complaints of sensitivity to hot and cold. Generalized pruritis, which is related to histamine release from an increased number of basophils.

Front 135

What blood product replaces missing clotting factors in the client who has a bleeding disorder?

Back 135

Cryoprecipitate

Front 136

methotrexate (Rheumatrex)

Back 136

antimetabolite med that treats ovarian & breast cancer. Also treats RA & lupus.

Front 137

cyclophosphamide (Cytoxan)

Back 137

oldest catagory of antineoplastic meds that alter DNA's shape; may cause permanent infertility

Front 138

bleomycin (Blenoxane)

Back 138

Antitumor antibiotic class; Treats Hodgkin's lymphoma & testicular cancer; may damage lung cells

Front 139

iodine-125

Back 139

radioactive isotope that targets tumors; swallowed or implanted

Front 140

interferon alfa-2b

Back 140

treats leukemia, malignant melanoma, AIDS-related Kaposi's sarcoma & hepatitis B & C; stimulates blood cells important to immune system

Front 141

vineblastine (Velban)

Back 141

aka mitotic inhibitors by preventing formation of mitotic spindle & cells cannot complete mitosis, causing cell death; organ, blood & lymph cancers

Front 142

Nursing intervention that may benefit patient with nausea

Back 142

providing ice chips to hold in mouth

Front 143

How effectiveness of antineoplastic agents are best evaluated

Back 143

lab studies

Front 144

Healthy cells in this area of the body are commonly affected by antineoplastic agents

Back 144

gastrointestinal

Front 145

Nursing diagnosis for patient taking antineoplastic meds

Back 145

deficient fluid volume (due to N/V, no appetite)

Front 146

alopecia & bone marrow depression

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common adverse reactions associated with antineoplastic drugs

Front 147

slow growing cell growth

Back 147

chemotherapeutic agents act on this

Front 148

desmopressin acetate

Back 148

DDAVP; antidiuretic hormone in body; increases factor VIII, increasing platelet aggregation; assess pulse & BP when given SC

Front 149

antitumor antibiotics

Back 149

bleomycin & dactinomycin specific to this class; treat testicular tumors, Hodgkin's lymphoma, organ tumors & soft tissue cancers; typical S/E plus cardiotoxicity & pneumonitis