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162 Cards in this Set

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What are the 3 functions of blood?
Transportation
(oxygen, nutrients, wastes)
Regulation
(fluids & electrolytes, acid base balance, body temperature)
Protection
(hemostasis- clotting, protection from pathogens/foreign substances)
The _____ produces RBCs during fetal development. After birth, bone marrow produces blood cells.
spleen
What are some functions of the adult spleen? (3 main)

Where is the spleen?
storage- stores RBC's & platelets
filtration- filters blood (old or defective RBC's) via phagocytes, filters iron for reuse, sends back to bone marrow
immunologic- rich supply of lymphocytes, monocytes, immunoglobulins

upper left quadrant
What 3 organs are involved in hemolysis?
liver
spleen
bone marrow
The lymph system consists of lymph fluid, lymphatic capillaries, ducts, and lymph nodes. What are some functions of this system?
carries fluid from the interstitial spaces back to the blood (returned to circulation)
A primary function of lymph nodes is filtration of pathogens and foreign particles that are carried by lymph to the nodes.
The lymph system returns excess interstitial fluid to the blood, which is important in preventing the development of ____. When too much interstitial fluid develops or when something interferes with the reabsorption of lymph, ____ develops. This can occur as a complication of mastectomy or lumpectomy with dissection of axillary nodes and is often caused by the obstruction of lymph flow from the removal of lymph nodes.
edema

lymphedema
A person who has had a splenectomy has higher/lower circulating levels of platelets than someone who still has his spleen.

True or False: About 30% of the platelet mass is stored in the spleen.
higher

true
Geriatrics have increased/decreased reserve capacity of blood levels. They have higher/lower blood counts than a young, healthy person. They have more/less aggressive WBC elevation with infection and inflammation. The Hb levels gradually increase/decrease, what causes this?
Geriatrics have decreased reserve capacity of blood levels. They have lower blood counts than a young, healthy person. They have less aggressive WBC elevation with infection and inflammation. The Hb levels gradually decrease due to iron deficiency and decreased hematopoeisis
Because WBC don't rise in response to infection or inflammation in older adults as well as in a healthy, young adult, they cannot fight infection as well. Are the s/s of infection the same? What should we look for?
S/S of infection aren't the same. Look for more subtle signs like confusion, which may be strong indicators of PNA or UTI.
Older adults are still capable of maintaining adequate blood cell levels, but the limited reserve capacity leaves the older adult at risk for what?
problems with clotting
problems with oxygen transport
problems fighting infection
diminished ability of older adult to compensate for an acute or chronic illness
diminished ability to produce reticulocytes in response to hemorrhage or hypoxia
Why do older adults experience iron deficiency anemia?

Is it a problem with absorption or intake?
Not a problem with absorption
but decreased nutritional intake
True or False: It is essential to assess for signs of disease processes such as GI bleeding before concluding that decreased Hb levels are caused solely by aging. Iron deficiency anemia is a diagnosis that should be made only after other causes are ruled out.
true
Are platelets effected by the aging process? Changes in vascular integrity from aging can manifest as ....
no

easy bruising
Which medications can interfere with platelet function?
antiplatelet agents
aminoglycosides (-mycin)
diuretics
histamine blocking agents (Zantax, Tagamet)
phenothiazines
salicylates (aspirin)
tricyclic antidepressants
dextran
Which medications can contribute to anemia?
NSAIDS
Antiretrovirals
Antineoplastics
Antimicrobials
Antihypertensives (hemolytic a.)
Antiseizure
Antidysrhythmics
Which medications can contribute to thrombocytopenia?
P- MEND

antidysrhythmics
antiplatelet agents

antimicrobials--
chloramphenicol
flucytosine (ancobon), trimethoprim/sulfamethoxazole (Bactrim, Septra)

antineoplastics (alkylating agents, antitumor antibiotics, platinol agents)
NSAIDS
Which medications can contribute to neutropenia?
antimicrobials--
chloramphenicol (Chloromycetin)
flucytosine (Ancobon)
isoniazid (INH)
trimethoprim/sulfamethoxazole (Bactrim, Septra)
antineoplastics (alkylating agents, antitumor antibiotics, platinol agents)
antiretrovirals
NSAIDS
allopurinol (Zyloprim)
Which medications can contribute to leukopenia?
trimethoprim/sulfamethoxazole (Bactrim, Septra)
antineoplastics (alkylating agents, antitumor antibiotics, platinol agents)
NSAIDS
What hematologic effect do corticosteroids cause?
lymphopenia
neutrophilia
What type of medication can increase clotting factors, increase fibrinogen, increase thrombin, decrease in prothrombin and PTT times, and increase coagulation and thromboemboli formation>
hormonal agents (diethylstilbestrol (DES), megestrol acetate, OC's)
A patient previously treated with chemotherapy agents, particularly _____ agents, is at a higher risk of developing what?
A patient previously treated with chemotherapy agents, particularly alkylating agents, is at a higher risk of developing a secondary malignancy of leukumia or lymphoma.
A patient on long term anticoagulant therapy such as ___ could be at risk for ______ problems.
A patient on long term anticoagulant therapy such as warfarin (Coumadin) could be at risk for bleeding problems.
Antineoplastic agents used to treat malignant disorders and antiretroviral used to treat HIV may cause what?
bone marrow depression
The following herbs: bilberry, black cohosh, chamomile, chondroitin sulfate, DHEA, feverfew, garlic, ginger, gingko balboa, ginseng, goldseal, omega 3 fatty acids, melatonin, niacin, psyllium, red yeast rice extract, saw palmetto, soy, and turmeric all may......
effect clotting
Vitamin K and C increase or decrease anticoagulant effects?
decrease
Vitamin D and E increase or decrease anticoagulant effects?
increase
Review Evolve chart about meds and how they interact with anticoagulants...
yep
In assessing a patient's hx of surgery or other treatments, why is a splenectomy relevant?
decrease immune function
more circulating platelets & RBCs
In assessing a patient's hx of surgery or other treatments, why is an excision of the duodenum relevant?
iron deficiency (this is where iron absorption occurs)
In assessing a patient's hx of surgery or other treatments, why is a gastric bypass, gastrectomy (total or partial) or ileal resection relevant?
impairs absorbtion B12 (cobalamin) deficiency
In assessing a patient's hx of surgery or other treatments, why are previous transfusions relevant?
the risk of transfusion reactions and iron overload increases with the number of blood transfusions
How does cigarette smoking effect hematological health?
increases LDL cholesterol
increases levels of CO2 (leading to hypoxia and altering anticoagulant properties of the endothelium)
increases platelet reactivity
increases plasma fibrinogen
increases HCT
increases blood viscosity
True or False- someone who has had thromboplebitis will probably never get it again.
False. Likely to recur
_____ is a caustic agent to the GI mucosa and damage to the GI tract secondary to this can cause GI bleeding, esophageal varices, and decreased absorption of cobalamin and other nutrients.
ALCOHOL
Alcohol can cause decreased absorption of what essential vitamin?
B12 (cobalamin)
_____ ____ disease is a common cause of hematemesis.
peptic ulcer
Where are clotting factors produced? What substance can have a negative effect on this organ, damaging the effect of platelet function?
liver
alcohol
What 2 nutritional deficiencies effecting hematological health can be corrected with similar foods such as liver, meat, eggs, whole grain and enriched breads and cereals, potatoes, leafy green vegetables, dried fruits, legumes, and citrus fruits.
iron and folic acid
Tender nodes usually are a result of _____, hard or fixed nodes suggest ______.
Tender nodes usually are a result of inflammation; hard or fixed nodes suggest malignancy.
What 4 aspects of the physical examination are specifically relevant to hematologic disorders?
skin
lymph nodes
spleen
liver
A smooth tongue is a sign of what 2 anemias?
iron deficiency
pernicious
Not enough blood cells in circulation will cause the body to compensate by increasing/decreasing the HR and increasing/decreasing the BP
increase HR
increase BP initially
decrease eventually (going downhill)
(compensating for low levels of RBCs, WBC, HGB, HCT)
True or False: Labs taken an hour after a blood transfusion will give an accurate result.
False- wait 2-4 h for a true reading
Normal Ranges for Hb and Hct
Hb
Female- 11.7 - 16.0 g/dl
Male- 13.2 - 17. 3 g/ dl

Hct
Female- 35-47%
Male- 39-50%
Normal Range for WBC
4,000-11,000 /microliter
_____ ____ disease is a common cause of hematemesis.
peptic ulcer
Where are clotting factors produced? What substance can have a negative effect on this organ, damaging the effect of platelet function?
liver
alcohol
What 2 nutritional deficiencies effecting hematological health can be corrected with similar foods such as liver, meat, eggs, whole grain and enriched breads and cereals, potatoes, leafy green vegetables, dried fruits, legumes, and citrus fruits.
iron and folic acid
Tender nodes usually are a result of _____, hard or fixed nodes suggest ______.
Tender nodes usually are a result of inflammation; hard or fixed nodes suggest malignancy.
What 4 aspects of the physical examination are specifically relevant to hematologic disorders?
skin
lymph nodes
spleen
liver
A smooth tongue is a sign of what 2 anemias?
iron deficiency
pernicious
Not enough blood cells in circulation will cause the body to compensate by increasing/decreasing the HR and increasing/decreasing the BP
increase HR
increase BP initially
decrease eventually (going downhill)
(compensating for low levels of RBCs, WBC, HGB, HCT)
True or False: Labs taken an hour after a blood transfusion will give an accurate result.
False- wait 2-4 h for a true reading
Normal Ranges for Hb and Hct
Hb
Female- 11.7 - 16.0 g/dl
Male- 13.2 - 17. 3 g/ dl

Hct
Female- 35-47%
Male- 39-50%
Normal Range for WBC
4,000-11,000 /microliter
What is a normal platelet count? What is it called when there is a depressed count and an excessive count? Which is more common?
normal is 150,000- 400,000 / microliter
thrombocytopenia- more common
thrombocytosis
An inexpensive lab test that measures inflammation and is a good screening test is the...
ESR
Erythrocyte Sedimentation Rate
The _____ is a standardized system used instead of PT. It detects extrinsic _____ deficiencies. This lab is always used when someone is on _______ or any type of _________ therapy.
The INR (International Normalized Ratio) is a standardized system used instead of PT. It detects extrinsic clotting deficiencies. This lab is always used when someone is on Coumadin/warfarin or any type of anticoagulant therapy.
If not taking anticoagulants (anybody else), what is the normal value? What is the normal INR, for someone on anticoagulant therapy?
If they had a heart valve replacement, which tends to clot more, what is the normal value?
1.3 - 2.0
2.0 - 3.0
2.5 - 3.5
What is the half life of Coumadin?

What is the antedote for Coumadin?
1/2 a day to 3 days
Vitamin K
What are some dietary considerations for someone on coumadin?
Advise patients not to change diet abruptly, have a moderate intake of broccoli, green leafy vegetables etc. which are high in Vitamin K
APTT stands for ___ ____ ___ ___. It is a test that detects _____ clotting deficiencies and is used to monitor ____ anticoagulant therapy. The normal range is ______
The therapeutic range is ___ to ____ times the normal range.
APTT stands for Activated Partial Thromboplastin Time. It is a test that detects intrinsic clotting deficiencies and is used to monitor heparin anticoagulant therapy. The normal range is 25-35 seconds (lewis) 30-45 seconds (lecture).
The therapeutic range is 2.5-3.5 times the normal range.
Heparin has a long or short half life? What is it?
very short
1-2 h out of their system ( IV drip- unfractionated)
Coumadin drug interactions (4)
phenytoin (Dilantin)
barbituates,
aspirin,
NSAIDS
many herbal/dietary supplements
Lovenox dose is based on _____ not ___ ___. What needs to be monitored?
Lovenox dose is based on weight not blood count. Need to monitor:
APTT
platelets (can cause to decrease)
creatinine clearance (if less than 30 ml per min. may need to adjust dose- kidneys aren't clearing as quickly as they should)
The heparin ______ is a new means to monitor heparin therapy.
Anti-Xa

Levels should be 0 if not on heparin
Heparin is given prophylactically for.... and therapeutic heparin is for an actual clot.
prophylaxis- taken after hip replacement etc, someone on bedrest, not treating an actual clot, DVT, or thrombophlebitis
In assessing the hematologic system, some diagnostic studies may include radiologic studies such as x-rays, US, PET scans, CT scans, and MRI's to see if there is ____ involvement or any ____ issues. Biopsies may also be done of the ___ ____ to see if it is producing good effective cells malignant cells. Lymph ___ biopsies may also be done.
In assessing the hematologic system, some diagnostic studies may include radiologic studies such as x-rays, US, PET scans, CT scans, and MRI's to see if there is bone involvement or any bleeding issues. Biopsies may also be done of the bone marrow to see if it is producing good effective cells or malignant cells. Lymph node biopsies may also be done.
Anemia is caused by increased RBC destruction, decreased RBC production, or blood loss. Name some examples increased RBC destruction
malaria, sickle cell, medications, G6PD enzyme deficiency, infections, incompatible blood (antibodies), cardiopulmonary bypass (trauma), prosthetic heart valves
Examples of decreased production of RBC's causing anemia
bone marrow dysfunction, aplastic anemia; iron, folic acid, and cobalamin deficiencies; leukemias, chronic diseases and disorders, medications i.e. chemo
Examples of blood loss causing anemia
acute or chronic
chronic is very insidious i.e. GI bleed, ulcers from too much NSAIDS, gastritis, menses, hemorrhoids, liver disease, colorectal cancer
acute- trauma, blood vessel rupture
The symptoms of anemia are due to what? How bad this is effects the _____ of the symptoms.
not enough oxygen to the cells

severity
Lovenox is sometimes not given to people with ____ problems, for example, because they have difficulty excreting the drug.
renal
What are 3 nursing diagnosis that relate to anemia?
fatigue r/t inadequate oxygenation of the blood as e/b (tachycardia, tachypnea, dyspnea, pallor, diaphoresis, dysrhythmias, patient statement of fatigue unrelieved by sleep)
altered nutrition: less than body requirements r/t inadequate nutritional intake and anorexia as e/b... (weight loss, nutritional deficits i.e. low serum albumin etc.)

Ineffective self- health management r/t lack of knowledge about appropriate nutrition and medication regimen as e/b.... questioning about lifestyle adjustments, diet, and medication)
What are some medications that inhibit iron absorption?
antacids
tetracyclines
soft drinks
tea
coffee
calcium
phosphorus & magnes. salts
What 3 nutrients should be encouraged in one's diet to prevent or treat anemia r/t nutritional deficiencies?
iron
Vitamin C
protein
What are some s/s of anemia in the older adult?
pallor
confusion
ataxia (uncoordinated muscle movement)
fatigue
worsening angina
heart failure
What are bruits?
abnormal sounds or murmurs
The production and presence of increased numbers or RBCs is called ________. Increased erythrocyte causes impaired ______ due to increased _____ ______ and _____. The hematocrit level in this disorder is usually greater than _____.
The production and presence of increased numbers or RBCs is called polycythmia. Increased erythrocyte causes impaired circulation due to increased blood viscosity and volume.
HCT > 55%
There are 2 types of polycythemia, primary known as ____ ___ and secondary polycythemia. What is the cause(s) of each?
There are 2 types of polycythemia, primary known as polycythemia vera and secondary polycythemia. Primary is caused by a chromosome mutation. Secondary is either hypoxia driven or hypoxia independent.
True or False: Primary polycythemia is preventable.
False. It is a chromosomal mutation. It is not preventable.
Polycythemia Vera is considered an acute/chronic myeloproliferative disorder arising from a chromosomal mutation in a single pluripotent stem cell. What other cells are also increased in this disorder? Who usually gets this disease? What are some complications?
It is chronic and insidious.

WBC & platelets also increased

Usually diagnosed after age 60, males predominance
Complications:
-hypercoagulopathies that predispose to clotting
-splenomegaly and hepatomegaly are common
-congestion of organs and tissues with blood
-morbidity/mortality r/t to thrombosis (stroke)
Of the 2 types of secondary polycythemia, hypoxia driven/independent is most common. It is seen among _____ patients, patients living at high ______, and pulmonary or cardiovascular disease. It is usually the result of a disease or disorder that causes ___ hypoxia.
Of the 2 types of secondary polycythemia, hypoxia driven is most common. It is seen among COPD patients, patients living at high altitudes, and pulmonary or cardiovascular disease. It is usually the result of a disease or disorder that causes chronic hypoxia.
In hypoxia driven polycythemia, hypoxia stimulates _______ production in the _____ which in turn stimulates ___ production.
In hypoxia driven polycythemia, hypoxia stimulates
erythropoiten (EPO) production in the kidney which in turn stimulates RBC production.
Hypoxia independent polycythemia is rarely seen. What causes it? It may cause a false high _____.
Caused by a malignancy, often a tumor that causes an increase in EPO
false high EPO
What are 2 clinical manifestations almost always seen in polycythemia vera?
What are some neurological s/s seen in all types of polycythemia?
spelonmegaly (primary)
hepatomegaly primary)


Neuro s/s
tinnitus
dizziness
h/a
visual disturbance
vertigo
What are some VS changes you might see with polycythemia?
Elevated BP, RR, and Pulse
Due to an increase in cardiac workload, what general symptom might you see with polycthemia?
fatigue/weakness
Hemorrhagic phenomena caused by either vessel rupture from overdistention or inadequate platelet function in polycythemia may result in what 4 symptoms? A ruddy complexion, known as ____ may also be present.
gi Bleeding
Ecchymoses / hematomas
Epistaxis
Petechiae

plethora (redness)
A patient with polycythemia may experience angina, HF, intermittent claudication, and thrombophlebitis, complicated by ______. These manifestons are caused by blood vessel ______, impaired blood flow, circulatory ____, thrombosis, and tissue _____ caused by hypervolemia and hyperviscosity. The most common seious acute complication is ____ secondary to thrombosis.
A patient with polycythemia may experience angina, HF, intermittent claudication, and thrombophlebitis, complicated by embolization. These manifestons are caused by blood vessel distention, impaired blood flow, circulatory stasis, thrombosis, and tissue hypoxia caused by hypervolemia and hyperviscosity. The most common seious acute complication is stroke secondary to thrombosis.
What are some complications of polycythemia?
CVA due to thrombosis
MI
Hemorrhage
GI Bleeding
Gangrene
Peptic Ulcers (increased gastric secretions)
Gout (due to build up of uric acid crystals)

GI HUGGS
What are the 3 goals of tx for polycythemia?
goals-
decrease blood volume
decrease blood viscosity
decrease bone marrow activity
What is the tx for polycythemia vera? What should be avoided?
hydration balance
phlebotomy- removal of 300-500 ml of blood until HCT level to normal levels (45-48%)

Chemotherapy or radioisotope to depress bone marrow activity (if needed)

Iron supplementation should be avoided even though repeated phlebotomies may cause iron deficiency (rarely symptomatic)

nutrition and physical activity
What is the tx for secondary polycythemia?
oxygen (main intervention)
hydration balance
low sodium diet
adequate nutrition
activity
________ is a reduction in platelets below normal range. If platelet count is less than _____ prolonged bleeding may occur and pt. needs close monitoring. At less than ____ spontaneous bleeding may occur, without even a poke. At less than _____ a platelet transfusion is necessary. At this level, an ______ hemorrhage may occur and you might see s/s like _____ and ____. If this is suspected, you need to call the MD.
Thrombocytopenia is a reduction in platelets below normal range. If platelet count is less than 50,000 prolonged bleeding may occur and pt. needs close monitoring. At less than 20,000 spontaneous bleeding may occur, without even a poke. At less than 10,000 a platelet transfusion is necessary. At this level, an intracranial hemorrhage may occur and you might see s/s like confusion and h/a. If this is suspected, you need to call the MD.
Thrombocytopenia may be inherited which is common/uncommon. It can be due to ______ when both RBCs and platelets are bled out. It can also be acquired, which is due to increased _______ of platelets. The most common type of acquired thrombocytopenia is _____, which is an _______ disorder. It can be due to shortened circulation which is caused by what 3 types? Thrombocytopenia can be caused by ______ blood flow where it's like the blood is "hitting a wall." It can also be caused by decrease production, which is acquired due to what 4 causes?
Thrombocytopenia may be inherited which is uncommon. It can be due to hemorrhage when both RBCs and platelets are bled out. It can also be acquired, which is due to increased destruction of platelets. The most common type of acquired thrombocytopenia is ITP, which is an autoimmune disorder. It can be due to shortened circulation which is caused by HIT-TS, TTP, and DIC. Thrombocytopenia can be caused by turbulent blood flow where it's like the blood is "hitting a wall." It can also be caused by decrease production, which is acquired due to bone marrow suppression, cancer, food/drugs/herbs, and by chemicals and radiation i.e. chemo.
The clinical manifestations of thrombocytopenia include ______ especially on chest, arms, neck, and oral mucous membranes; ____ ____ from gums or nostrils; e_______; _______ bleeding from incisions, IV catheter sites, and vagina (menses); and h____.
The clinical manifestations of thrombocytopenia include petechiae especially on chest, arms, neck, and oral mucous membranes; spontaneous bleeding from gums or nostrils; echymosis; prolonged bleeding from incisions, IV catheter sites, and vagina (menses); and hematuria.
ITP (Immune thrombocytopenic purpura) is an autoimmune syndrome of abnormal destruction of circulating platelets. The platelets are coated with _____ which causes them to be seen as foreign when they reach the ____ and are destroyed by macrophages in 1 to 3 days. It is now known that decreased platelet _____ and the presence of ____ infection or ____ infection may contribute to this disorder.
ITP (Immune thrombocytopenic purpura) is an autoimmune syndrome of abnormal destruction of circulating platelets. The platelets are coated with antibodies which causes them to be seen as foreign when they reach the spleen and are destroyed by macrophages. It is now known that decreased platelet production and the presence of H. pylori infection or viral infection may contribute to this disorder.
Collaborative Care for ITP includes 3 medication types and 2 procedures what are they?
meds:
corticosteroids
immunoglobulin (competes with antibodies)
immunosuppressives

procedures-
splenecotomy
and platelet transfusion (
for platelet count <10,000)
Platelet transfusions may be used to increase platelet counts in cases of life-threatening hemorrhage. Platelets should not be administered prophylactically because of the possibility of antibody production. By using _____ typing, to match HLA types of the donor and recipient, multiple platelet transfusions can be given with fewer complications. Do platelet transfusions require ABO compatibility?
Platelet transfusions may be used to increase platelet counts in cases of life-threatening hemorrhage. Platelets should not be administered prophylactically because of the possibility of antibody production. By using lymphocyte typing to match HLA types of the donor and recipient, multiple platelet transfusions can be given with fewer complications. Platelet transfusions do NOT require ABO compatibility.
In Heparin-Induced Thrombocytopenia, an immune response causes antibody production which leads to platelet destruction and later, causes thrombi (venous thrombosis and arterial infarcts). It is also known as ____ clot syndrome.
also known as white clot syndrome
True or False: HIT-TS is always caused by a medication, either unfractionated heparin or lovenox. and if it happens to a patient they can never get heparin or lovenox again.
True
If someone is on heparin, they should have a shorter/longer APTT time? If you are not seeing this, you should suspect _____.
longer
HIT-TS
What is the collaborative care for treating HIT-TS?
1. Stop Heparin
2. Thrombin inhibitor:
lepirudin (Refludan), fondaparinux (Arixtra)
3. Coumadin (when platelets have reached 150,000

If severe- most commonly used tx modalities are:
-plasmapheresis- to clear platelet-aggregating igG from blood
-protamine sulfate to interrupt circulating heparin
-thrombolytic agents to treat the thromboembolic events
-surgery to remove clots
True or False: Platelet transfusions are not effective in tx of HIT-TS because they may enhance thromboembolic events.
true
Thrombotic thrombocytopenic purpura is an uncommon syndrome characterized by h_____ a_____, thrombocytopenia, _____ and ____ abnormalities, and _____ in the absence of infection. Not all s/s are always present. TTP almost always follows ________________and is often referred to as TTP-___.
Thrombotic thrombocytopenic purpura is an uncommon syndrome characterized by hemolytic anemia, thrombocytopenia, neurological and renal abnormalities, and fever in the absence of infection. Not all s/s are always present. TTP almost always follows
hemolytic-uremic syndrome (HUS) and is often referred to as TTP-HUS
The disease is associated with enhanced agglutination of platelets which leads to ______ that deposit in arterioles and capillaries. TTP usually occurs at what age group and gender? What are some causes of TTP?
microthrombi
Usually occurs in young women

enzyme deficiency (VWF)
idiopathic
drugs
pregnancy
infection
other autoimmune disorders
What is the tx for TTP?
-treat underlying disorder
-corticosteroids
-plasmaphereis or plasma exchange (to aggressively reverse platelet consumption by supplying the appropriate vWF and enzyme and removing large vWF molecules binding with platelets)
-splenectomy
-Dextran
-Chemo/immunosuppressives
The main complication of thrombocytopenia is ______. Briefly describe the 4 types (acute/chronic, internal/external)
hemorrhage

Could be:
chronic- occult blood in stools (insidious/slow) may be due to vitamins/meds such as NSAIDS, VIt E & C
acute- like DIC
internal - abdominal pain, h/a, confusion, decreased LOC
external - obvious bleeding
For patients with thrombocytopenia, assess for potential complications in patient response to treatment. Monitor lab values such as (3), and tests (2) ; and administer platelets if indicated.
PT
WBC
H & H
coagulation tests
and renal function tests
What is the nursing dx of highest priority for a patient with thrombocytopenia (not in acute condition)?
risk for injury
What are some adverse effects of corticosteroids (tx for many blood and autoimmune disorders)
high blood sugar
increase risk of infection
delayed wound healing
moon face
larger upper body, skinnier legs
What is used first, coumadin or heparin?
Heparin used first, quicker acting
Coumadin started later, on both for 3-5 days because Coumadin takes a few days to get to a therapeutic level, then taken off heparin and continue coumadin more long term.
True or False: The goals in treating thrombocytopenia include: have no gross or occult bleeding, maintain vascular integrity, and manage home care to prevent any complications r/t an increased risk of bleeding.
true
Differentiate between chronic and acute leukemias.
Acute- increase in immature hematopoietic cells (immature cells can't function like a normal mature cell, just taking up space)
Chronic- more mature WBCs

Lymphocytic- involving lymphocytes

Myelogenous- involves proliferation of myeloblasts that interfere with the maturation of all blood cells (granulocyes)
AML- Acute Myelongenous Leukemia involves an increase in ____. Is it rare or common? Among adults or children? What's the prognosis? What often brings patients in for tx?
increase in myeloblasts
most common acute leukemia in adults
Prognosis good with tx
s/s- serious infections, abnormal bleeding from onset of disease
Acute Lymphocytic Leukemia involves an increase in immature/mature ______. Is it more common in adults or children? Prognosis? Name some s/s. Besides chemo, radiation, and stem cell transplant (tx for all leukemias) what are 2 other tx's for ALL?
immature lymphocytes
most common in children

prognosis good - 80% survival
S/S- abrupt onset of bleeding, fever (fever present in majority of patients at time of dx), CNS symptom r/t increase ICP secondary to meningeal infiltration
prophylactic intrathecal methotrexate or cytarabine is given to decrease chance of CNS involvement, also cranial radiation)
CML- Chronic Myelogenous Leukemia involves development of _______ granulocytes in the bone marrow. Usually these pts are first diagnosed with _______. It is associated with the presence of _____ chromosome (disease marker). Describe the phases.
CML- Chronic Myelogenous Leukemia involves development of neoplastic (abnormal) granulocytes in the bone marrow. Usually these pts are first diagnosed with leukocytosis. It is associated with the presence of Philadelphia chromosome (disease marker).

chronic stable phase- want to keep in this phase as long as possible, lasts about 4 years, can be well controlled w/ tx, nonspecific s/s like wt. loss

accelerated- enlarged spleen, symptoms progress rapidly, bone pain, low grade fever, night sweats, more wt loss, lasts about 6 months

terminal blast phase- more severe leukemic s/s,
more acute, aggressive phase, only a few months to live at this point
CLL- Chronic Lymphocytic Leukemia, involves active/inactive, long-lived mature ________ lymphocytes. It is the most common type of adult leukemia. What type of lymphocyte is usually involved? The lymphocytes infiltrate the ____ _____, ______, and ______. __________ is present throughout the body and there is an increased incidence of _____.
CLL- Chronic Lymphocytic Leukemia, involves inactive, long-lived mature appearing lymphocytes. It is the most common type of adult leukemia. B lymphocytes are usually involved. The lymphocytes infiltrate the bone marrow, spleen, and liver. Lymphadenopathy is present throughout the body and there is an increased incidence of infection
What are some complications of CLL? What is the tx plan?
pressure on nerves from enlarged lymph nodes can cause pain or even paralysis

mediastinal node enlargement leads to pulmonary s/s

Splenectomy is often indicated if spleen involvement.
Because CLL usually is a disease of older adults, tx decisions must be made by considering the progression of the disease and the side effects of tx
Clinical manifestations of leukemia are related to ____ _____ failure. They include (6)...
Clinical manifestations of leukemia are related to bone marrow failure.
Bleeding
Fever
Infections
Fatigue & Weakness
Bone & Joint Pain
Sternal Tenderness (AML, CML)
Philadelphia chromosome is the marker for which leukemia?
CML
Describe the 4 phases of chemotherapy and goals for each phase in treating leukemia. What is another common treatment option?
Induction- attempt to bring about remission
Intensification- same drugs at higher doses and/or other drugs
Consolidation- started after remission achieved
Maintenance- lower doses of same drug given every 3-4 weeks for prolonged period of time

Stem cell transplant- eliminate patient's hematopoietic stem cells (biggest risk-- infection)
What are the main complications of chemotherapy?
infection, fatigue, bleeding
(neutropenia, anemia, thrombocytenia)
True or False: The overall goals are that the pt with leukemia will (1) understand and cooperate with the treatment plan, (2) experience minimal side effects and complications associated with the disease and tx, and (3) feel hopeful and supported during the periods of tx, relapse, or remission.
true
Lymphomas include 2 major types: Hodgkins, which involves T/B lymphocytes, and Non-Hodgkins, which includes B/T Lymphocytes
HL-- B
NHL- B & T
________ lymphoma is more contained in lymph nodes, more localized, there is a ______ predisposition, and there is an association with ____ ____ virus. No one really knows the cause.
Hodgkin's lymphoma is more contained in lymph nodes, more localized, there is a genetic predisposition, and there is an association with Epstein Barr virus. No one really knows the cause.
________ lymphoma can originate in bone marrow (outside the lymph nodes) and is more likely to ______.
Non-Hodgkins lymphoma can originate in bone marrow (outside the lymph nodes) and is more likely to disseminate.
Hodgkin's Lymphoma is an acute/chronic disorder of unknown origin. It is characterized by ______ cells, which are ____ ______ tumor cells. These cells invade the ____ ____, and the structure of this is destroyed. It can infiltrate other organs, which 3 are most common (where these cells infiltrate)?
Hodgkin's Lymphoma is an chronic disorder of unknown origin. It is characterized by Reed-Sternberg cells, which are large atypical tumor cells. These cells invade the lymph nodes, and the structure of this is destroyed. It can infiltrate other organs, such as the liver, spleen, and lungs most commonly.
Hodgkin's Lymphoma peaks at ages 15-35 and again after age ___. Is it more common in men or women?
50
twice as likely to occur in men as in women.
What are the "B" symptoms? What do these s/s tell you?
night sweats, fever, wt. loss
These s/s tell you about prognosis, usually with these s/s prognosis is poor.
What are the s/s of Hodgkin's Lymphoma?
painless, superficial adenopathy
fatigue/weakness
B symptoms (night sweats, fever, weight loss)
Pain at site with ingestion of alcohol
In advanced stages:
hepatomegaly
splenomegaly
anemia
bone pain
nerve pain from nerve root compression
What is the clinical staging system for Hodgkin's Lymphoma? The final staging is based on clinical staging and presence of _____ _____ or not A = _____ and B = ______.
Clinical staging system for Hodgkin's Lymphoma I - IV according to lymph node involvement
The final staging is based on clinical staging and presence of B symptoms or not A = absent and B = present.
Stage I of Hodgkin's Lymphoma involves a single ___ ______ OR a single _____ ______.
Stage I of Hodgkin's Lymphoma involves a single lymph node OR single extranodal site.
Describe Stage II of Hodgkin's Lymphoma
Stage II of Hodgkin's Lymphoma:
involvement of 2 or more lymph nodes or localized extranodal region and one or more lymph node regions on the SAME SIDE OF THE DIAPHRAGM
(above or below the diaphragm)
Describe Stage III of Hodgkin's Lymphoma
Stage III of Hodgkin's Lymphoma
Involvement of lymph node regions on BOTH SIDES of diaphragm. May extend to the spleen.
Describe Stage IV (advanced stage) of Hodgkin's Lymphoma.
Stage IV of Hodgkin's Lymphoma
Diffuse involvement of one or more extralymphatic organs or tissues (hepatic, lung pleura, marrow, dermal, osseous)
Diagnosis of Hodgkin's Lymphoma involves _____ studies, _____ _____ biopsy (looking for what?), ___ Scan, ____ x-ray, and ___ ____ biopsy. These help dx, determine staging, and determine how involved or advanced it is.
Diagnosis of Hodgkin's Lymphoma involves blood studies, lymph node biopsy (looking for reed-sternberg cells) CT Scan, chest x-ray, and bone marrow biopsy. These help dx, determine staging, and determine how involved or advanced it is.
Treatment for Hodgkin's Lymphoma includes ____ and ______.(supplemental according to disease sites, and resistance of disease.) Prognosis?
Treatment for Hodgkin's Lymphoma includes chemo, radiation. (supplemental according to disease sites, and resistance of disease.) Prognosis is good if caught in early stage.
Which is more common, Hodgkin's Lymphoma or Non-Hodgkin's Lymphoma?
Non-Hodgkin's Lymphoma
Which has a more predictable spread, Hodgkin's Lymphoma or Non-Hodgkin's Lymphoma?
Hodgkin's Lymphoma
Does a patient with Hodgkin's Lymphoma or Non-Hodgkin's Lymphoma experience the side effect of pancytopenia due to their treatment?
Non-Hodgkin's
In Non-Hodgkin's Lymphoma neoplasms are primarily of B or T cells. In 90% of cases, there is more ___ cell involvement. The disease is classified according to ____ type and _____. Describe the 3 types.
In Non-Hodgkin's Lymphoma neoplasms are primarily of B or T cells. More B cell involvement. The disease is classified according to cell type and origin.

Low-Grade: Indolent
Intermediate-grade: Aggressive
High-grade: Very Aggressive
The onset of Non Hodgkin's is rising/declining due to what?
The onset of Non Hodgkin's is rising due to aging population and increase in HIV infection.
People who are immunocompromised may include.... (5)
HIV/AIDS
Cancer
Pts on immunosuppressants
transplant patients
autoimmune disorders
True or False: There are many varieties of Non-Hodgkin's
Lymphoma.

What are the clinical manifestations of Non-Hodgkin's Lymphoma?
True

Primary symptom: painless lymph node enlargement
high-grade will have B symptoms
splenomegaly
hepatomegaly
neurological s/s
Cardiac, GI, resp s/s due to spread
Treatment for Non-Hodgkin's
Lymphoma can involve chemotherapy, radiation therapy, and ___ ____ transplants. More aggressive lymphomas are more/less responsive to treatment and more/less likely to be cured. Indolent (low-grade) have a naturally long course, are easy/difficult to treat, and r_____ is uncommon. Patients with low-grade (indolent) lymphoma may live only 5 years whereas others with more aggressive lymphomas may live 30 years or more. However, most relapse several times and ____is very unlikely.
Treatment for Non-Hodgkin's
Lymphoma can involve chemotherapy, radiation therapy, and stem cell transplants. More aggressive lymphomas are more responsive to treatment and more likely to be cured. Indolent (low-grade) have a naturally long course, are difficult to treat, and remission is uncommon. Patients with low-grade (indolent) lymphoma may live only 5 years whereas others with more aggressive lymphomas may live 30 years or more. However, most relapse several times and cure is very unlikely.
Which usually has a better prognosis, Hodgkin's Lymphoma or Non-Hodgkin's Lymphoma?
Hodgkin's
The nursing care for Non-Hodgkin's Lymphoma is similar to Hodgkin's. Management of disease and treatment is more extensive because the disease involves more organs that can create complications. Treatment is often _____ based on organ involvement and addressing psychosocial needs are important for all chronic diseases cancers.
The nursing care for Non-Hodgkin's Lymphoma is similar to Hodgkin's. Management of disease and treatment is more extensive because the disease involves more organs that can create complications. Treatment is often symptomatic based on organ involvement.
Multiple Myeloma is a malignant disease caused by growth of ______ _____ cells called _______ abnormal __ cells (M ____ or____ protein)
Multiple Myeloma is a malignant disease caused by growth of neoplastic plasma cells called activated abnormal Bcells (M protein or myeloma protein)
Proliferation of malignant plasma cells and the overproduction of immunoglobulin and proteins result in the end-organ effects of Multiple Myeloma to the..... (what 6 organs/areas?)
bone marrow
lymph nodes
liver
spleen
kidney
heart
Does Multiple Myeloma develop fast or slow? More common in men or women?
slow, insidious onset
vague symptoms

2x more common in men
What are the clinical manifestations of Multiple Myeloma?
BRAT SACCI
infections
anemia
thrombocytopenia
renal failure
anorexia
confusion
seizures
coma
bone pain (plasma cells cause bone destruction depending on stage- bone pain is awful)
Another clinical manifestation of Multiple Myeloma is _____ changes which involve ______ fractures and ______ of vertebrae which can cause c_______ of the spinal cord and p_____.
Another clinical manifestation of Multiple Myeloma is skeletal changes which involve pathological fractures and destruction of vertebrae which can cause compression of the spinal cord and paralysis.
Many of the s/s involved with Multiple Myeloma are due to high levels of _____ in the blood.
calcium


(normal is around 9-11 fyi)
Diagnostic studies for Multiple Myeloma include urine studies, which look for the __-_____ protein and the ____-____protein.
Diagnostic studies for Multiple Myeloma include urine studies, which look for the M-antibody protein and the Bence-Jones protein.
Blood studies of a patient with multiple myeloma will show hyper_____, high/low creatinine, p_______, high/low albumin, high/low B2-microglobulin, presence of M-antibody protein.
Blood studies of a patient with multiple myeloma will show hypercalcemia, high creatinine, pancytopenia, low albumin, high B2-microglobulin, presence of M-antibody protein.
X-rays for a patient with multiple myeloma are done to look at bones for erosions, fractures, etc. ____ ____ biopsy is done to look for ____ cells.
X-rays for a patient with multiple myeloma are done to look at bones for erosions, fractures, etc. bone marrow biopsy is done to look for plasma cells.
Treatment for multiple myeloma is often palliative. What are 5 options?
corticosteroids
chemotherapy (to reduce number of abnormal plasma cells)
biological therapy
radiation
bone marrow transplant
Drugs used to treat complications of multiple myeloma includes what 3 types and for what purpose?


hint: bisphophonates includes 3 drugs.
Bisphophonates- Aredia, Zometa, Didronel- to inhibit bone destruction

Allopurinol to reduce uric acid levels

Lasix to promote renal excretion of calcium (need to closely monitor labs, esp. K)
_____ ____ is produced due to cell breakdown and needs to be flushed out when levels are high so that kidneys are not damaged.
uric acid
Nursing care for a patient with multiple myeloma includes _____ up to ___ to ___ liters per day (helps dilute calcium). Monitor I & O and ____ function. Encourage ______ to help strengthen bones and help with reabsorption-- do as much as possible without causing injury. Safety is very important because of the risk for fracture. Prevention of ____ is extremely important for these patient to sustain life. Pyschosocial needs are also important.
Nursing care for a patient with multiple myeloma includes hydration up to 3 - 4 liters per day (helps dilute calcium). Monitor I & O and renal function. Encourage ambulation to help strengthen bones and help with reabsorption-- do as much as possible without causing injury. Safety is very important because of the risk for fracture. Prevention of infection is extremely important for these patient to sustain life. Pyschosocial needs are also important.