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69 Cards in this Set
- Front
- Back
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What is hemalytic anemia?
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Destruction of RBC faster than they are made. 3rd major cause of anemia.
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What organ plays a major role in recycling RBC and how long to RBC's last?
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90-100 days- SPLEEN takes damaged or used RBC with macrophages
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What is intrinsic hemolytic anemia? Examples??
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Genetic- where there is a defect with RBC ITSELF. Red blood cells do not live as long as normal RBC.
Sickle cell anemia Thalassemia |
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What is extrinsic hemolytic anemia? Examples?
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RBC are healthy, but are destroyed after production either by being trapped in the spleen, infection, or destroyed by drugs that affect RBC.
"""AQUIRED"" as in not genetic Immune-if we transfuse wrong blood type, our immune system will attack RBC. Non-immune- drugs that lysis RBC |
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Where can extrinsic hemolytic anemia occur?
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Intravascularlly or extravascular-in blood vessel or in organ
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Hemolysis causes?
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Macrophages from spleen eat RBC's, breaks down into hemoglobin and breaks down into iron and different biproducts, protiens broken down and conjugate in liver, excreted as bile. Causes buildup of biproducts, like bilirubin, can go to kidneys and cause problems.
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What biproduct buildup causes pt to be jaudiced?
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Bilirubin buildup in liver as biproduct of RBC lysis.
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If many RBC need to be removed, it can cause?
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Spleen and liver enlargement d/t biproduct overload
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Hemaglobin molecules can do what to the kidneys?
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Can obstruct renal tubules and cause tubular necrosis.
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Sickle cell disease can be grouped into? and is a chronic form of?
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Inherited, autosomial(chromosome) reccessive disorder. A chronic form of hemolytic anemia.
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What % African American community have sickle cell anemia?
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8% are heterozygous (carriers) and 1% are homozygeous. Some can have signs but not full blown sickle cell anemia.
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What is sickle cell disease?
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RBC are rigid, sticky, and shaped like sickles (crescent shaped). They clump together and cause hypoxia and bunch up in vessels.
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What causes the clumping of sickle cells?
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When oxygen is low***Cold climates causing lower body temperature, exercise, high altitudes, infections, oxygen in anesthesia, decrease plasma volume (bleeding), dehydration. HYPOXIA CAUSES SICKLE CELL CLUMPING. INCURABLE AND FATAL.
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What is the most severe sickle cell disease?
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Sickle cell anemia - homozygous for hemoglobin S (HgSS)
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What are the clinical manifestations of pt with sickle cell disease?
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Asymptomatic until hypoxic episode. Pt has pain and joint swelling.Pallow in mucous membranes, fatigue, high billirubin-jaundice, irritable, anxiety.
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Figure 31.4- effects of sickle cell anemia?
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Hemmorages, strokes, sensory deficit, pulmonary HTN, pneumonias, kidney failure, bones and joint pain, liver to enlarge, gallstones, heart failure, eye hemmorages, retinal detachment, spleen failure, extended erections, stasis ulcers in the feet.
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Look at 31.6 and lab values. What else do we do as far as tests for sickle cell pts?
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Blood smear, sickle test, electrophoresis of Hgb, DNA testing, counseling for offspring. X rays to see organ damage, MRI, CT scans.
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What is our job as nurses for pts with sickle cell anemia?
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Treat pain, provide oxygen to prevent hypoxia, hydration, ambulation and expand lungs using IS. No specific treatment for sickle cell pts. OXYGEN OXYGEN OXYGEN.
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What would our pt teaching include?
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Avoid high altitudes, crowds during holidays, treat infection, pain, hydration
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Why should you make sure there is adequate folic acid in sickle cell pts?
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Folic acid is necessary in RBC production.
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What is hydrourea?
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Antisickling agent given. If does not work, erythropoientin is given.
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What can cure some pts with sickle cell anemia? Why is this not happening as much as we'd like?
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Bone marrow transplants- b/c there are not enough african americans on the list for matches.
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What are the 3 extrinsic factors that can cause aquired hemolytic anemia?
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Physical forces, immune, or toxins/infectious agents.
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What are some examples of physical forces causing aquired hemolytic anemia?
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Dialysis, prostehtic heart valves
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Some immune reactions causing aquired hemolytic anemia?
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1. Antigen-antibody reaction-incompatible blood transfusions
2. Isoimmune reactions-antibodies developing against an antigen. This is why you want to only give blood transfusions when it is absolutely necessary b/c antigen develops and has to be matched to the next transfusions. 3. Autoimmune-develop antibodies against your own RBC. |
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What are some toxin/infectious agent reactions causing aquired hemolytic anemia?
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1. Invade RBC and cause immune system to attack them
2. Release hemolysis substance toxin 3. cause antigen antibody reaction 4. Buildup of cells cause enlargement of spleen |
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What is polycythemia?
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Increase in RBC and hemoglobin in blood
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Polycythemia is caused by?
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Stem cells (cancer) increaced RBC, granulocytes, and platelets, and increases viscosity of blood, causing congestion of blood in spleen, liver, and tissues, causing clots (thrombi) to form resulting in infarction of important body tissues
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Who gets polycythemia commonly and what age?
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Jewish -European decent , age 60
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What is the secondary cause of polycythemia?
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Increase in erythropoienten released by kidneys causing increase RBC production.
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What would cause this increase erythropoietien production?
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1. Hypoxia driven-high altitute, defective oxygen transport, smoking, cardiopulmonary diseases
2. Not d/t hypoxia-tumor or cyst on kidney |
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What are the clinical manifestations of polycythemia?
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1. "plethoria"- increase blood volume
2. H/A 3. Vertigo 4. blurred vision 5. tinnitus 6. itching not relieved by meds 7. angina 8. erythromyalgeia- finger/toe burning 9. dyspnea 10. Epitaxis- nose bleed 11. GI bleed |
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What lab levels will be increased and decrease in polycythemia?
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high hemoglobin and erythrocyte count (RBC), increased WBC, increased platelets,
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What is the nursing management of a pt with polycythemia?
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Treat COPD/hypoxia if it is leading to polycythemia.
Hydrate so blood doesn't become too viscuous. Keep hematocrit less than 45-48% Keep hydrated 3L/day Monitor I/O Give cool/tempid baths for pruitis Prevent thrombi-ambulation, passive ROM, pnumatic boots Medications- Allopurinal-for gout-high uric acid Antiplatelet agents Hep/Coumadin for clots |
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What is thrombocytopenia?
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Decrease in number of circulating platelets (less than 100-150,000)
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How long do platelets live?
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8-10 days
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If platelets go below 20 or 10,000 the pt can have?
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Bleeding problems, spontaneous bleeds
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How and when do we treat thrombocytopenia?
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When platelets go below 50,000, with steriods.
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What are the 3 ways a person can have low platelet counts (thrombocytopenia)?
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1. Decreased production
2. Increased destruction-immune system, d/t infections, drugs 3. Increased consumption |
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What are the clinical manifestations of thrombocytopenia?
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Pettachie, purpura, (thorax, arms, neck, and ankles), ecchomyses, epitaxis-nosebleed, gum bleeding, hematuria, GI bleed, signs of hemmorrage( occurs spontaniously when plts are below 10,000)
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What is the diagnostic testing for thrombocytopenia?
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Low platelets, low hematocrit and hemoglobin (could be bleeding), prolonged bleeding time, bone marrow biopsy to determine if there is a cancer present
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What are some nursing managements for a pt with thrombocytopenia?
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Soft toothbrush, electric razor, fall risk, remove speen, use immunosuppression with steriods and immunoglobins, avoid subQ or IM injections, avoid foley catheter, avoid straining on toliet, avoid, ememas or suppositories, avoid ASA.
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A group of hereditiary clotting factor disorders charcterized by a prolonged coagulation time resulting in excessive bleeding, is?
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Hemophilia
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What are the types of hemophilia?
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Type A, B, and VonWilebrand's disease **pts have tendency to bleeeeeeeeeed*
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What are the clinical manifestations of hemophilia?
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Delay of onset of bleeding after injury, subQ hematomas, prolonged bleeding, GI bleeding (guaicing stools), hematuria, pain d/t compression of hematomas, especially in joints with swelling
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What are the diagnostic tests to see if a pt has hemophilia?
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Check clotting factor that determines the type of hemophilia, APTT (activated partial thromboplastin time)will be increased
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What are the nursing managements for pts with hemophilia?
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Replace clotting factor, determining what bleeding you need to have control over, manage hemmorage complications, control topical bleeding with pressure and Ice, genetic counseling for pt thinking about having kids, monitor signs of bleeding in the brain-change in LOC, importance of wearing a medical bracelet
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What is disseminated intravascular coagulopathy? (DIC)
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Abonormal initiation and acceleration of clotting with simultaneous hemmorrage.
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How does disseminated intravascular coagualopathy happen?
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underlying disease causes body to clot, fibrolytic pathways initiates and dissolves clots, and pt hemmorrages. Caused by underlying disease or condition
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What is the mortality rate and what are the risk factors/causes?
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80% death from hemmorage. Snake bites, sepsis, trauma, neoplasms, vascular disorders, hypoxia, acute hemolysis, prosthetic devices, burns, liver disease, drug reactions, tissue damage.
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What is oliguria?
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decreased production of urine
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What diagnostic tests would we look for to determine if a pt has disseminated intravascular coagulopathy?
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Low levels of fibriginonen, decreased platelets, clotting factors reduced, prothrombin time prolonged, partial thromboplastin time prolonged, thrombin time prolonged.
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What is the nursing management for pts with disseminated intravascular coagulopathy?
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Treat underlying condition (d/t underlying condition), give blood if needed, Monitor i/o, give vasopressors,
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What are signs of complications?
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Respiratory distress, renal failure, CVA, pulmonary embolism.
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What is neutropenia?
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Decrease in neutrophil count d/t
1. decreased production 2. increased destruction |
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What is the role of neutrophills?
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Plays an important role in phagocytosis, of disease microorganisms, causing high risk of infection.
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What are the cinical manifestations of neutropenia?
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No clinical manifestations.
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What are the causes of neutropenia?
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hematolgoic disorder, drugs (chemo), autoimmune disorder, infections, sepsis, nutritional deficiencies. ***mostly seen in CA pts***
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What are the diagnostic tests of neutropenia?
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Neutrophills less than 2,000, bone marrow biopsy (determine CA or autoimmune disorder)
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What is the nursing management of pts with neutropenia?
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Limit visitors, especially small children. No flowers, no fresh fruits or veggies, give antibiotics, no invasive proceduce, strick handwashing, no undercooked meats.
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What is the malignant disorder blood forming tissues of the bone marrow, spleen, and lymph system characterized by unregulation of proliferation of WBC and their precursors?
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Leukemia
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What are the clinical manifestations of leukemia as the proliferation (growth) of abnormal cells increases, impeding the growth of normal cells?
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Fever and night sweats, bleeding problems, weakness and fatigue, weight loss, shortness of breath, activity intolerance, pallor, bone or joint pain
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What are the diagnostic tests to determine if pt has leukemia?
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**bone marrow biopsy reveals excessive blast cells***
Increased WBC in CLL and CML A normal, decreased, or increased WBC in AML and ALL |
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Look at pages 1855-1864 for reference lab values in lewis text.
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no pt or ptt values on test
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dont worry about central line lecture
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ok
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Nursing management and therapy is?
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Chemo and radiation (more from CA lecture)
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What are a group of malignant neoplasms that affect the lymphatic system that cause the proliferation of lymphocytes?
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Malignant lymphoma
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What are the two types of malignant lymphoma?
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Hodgikins-young and old age peak
NonHodgkins-older peak more common in white males |
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Magligant lymphomas have many signs and symptoms. What are we going to be dealing with as nurses?
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During treatment responses, like nausea and vomiting, obstructed bowl, weight loss.
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