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82 Cards in this Set
- Front
- Back
What does a peptic ulcer have to do with low complete blood count (CBC)?
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possible bleeding. lose blood cells
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What labs do you do prior to surgery and why?
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CBC, PT, PTT, INR - test for anemia, blood type, number of platelets for clotting factor
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Lab Values: WBC
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5,000 - 10,000
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Lab Values: Platelets
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150,000 - 450,00
(sometimes 500,000) |
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Lab Values: Hemoglobin (HGB)
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females 12 - 16
males 14 - 18 |
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Lab Values: Hematocrit (HCT)
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36% - 54% (HGBx3=HCT)
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Lab Values: pH
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7.35 - 7.45
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Lab Values: PaCO2
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35 - 45
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Lab Values: PaO2
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80 - 100
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Lab Values: HCO3
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21 - 26
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Lab Values: SaO2
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95% - 100%
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Lab Values: Sodium (Na+)
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135 - 145
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Lab Values: Albumin
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3.4 - 5.4
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Lab Values: Creatinine (CRT)
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0.5 - 1.5
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Lab Values: Blood Urea Nitrogen (BUN)
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7 - 20
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Lab Values: Magnesium (Mg+)
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1.3 - 2.1
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Lab Values: Potassium (K+)
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3.7 - 5.2
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Lab Values: Calcium (Ca+)
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8.5 - 10.2
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What happens to blood that has higher viscosity?
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slow and causes clots - possible emboli or DVT
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What are the ABC's and why is it needed?
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Airway, Breathing, Circulation. - for circulating oxygen
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What will a higher Red Blood Cell (RBC) count do?
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blood will have higher viscosity (thickness)
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What labs do you check for possible anemia, iron deficiency?
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Hemoglobin: females 12-16; males 14-18
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What does iron deficiency mean? and what lab tests are used?
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Low in iron.
need Hemoglobin and Hematocrit lab tests to determine iron deficiency |
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What foods are high in iron?
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green leafy vegetables, organ meats, red meats
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What causes iron deficiency?
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can be caused by blood loss, poor GI absorption of iron, and an inadequate diet and is common in women (menses), older adults, and people with poor diets
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What is pernicious anemia?
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caused by a deficiency of gastric acid and intrinsic factor which is required for the absorption of vitamin B12.
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What test to take for pernicious anemia?
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Schilling Test (measures the absorption of radioactive vitamin B12 as it is excreted in the urine)
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What position would you place your patient to prepare for bone marrow biopsy?
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PRONE (drilling a hole in the iliac crest)
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What is the FIRST nursing action you would do after bone marrow aspiration?
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apply pressure (stop the bleeding)
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What is phlebitis?
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irritation of a vein by chemical, bacterial, or mechanical irritation
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What are the s/s of phlebitis?
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monitor for redness, pain or burning, discomfort, warmth, edema, vein induration (hard), red streaks, slowing infusion rate, increased temperature, infection
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What does the nurse do first when a patient has phlebitis at IV site?
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remove the IV (since IV caused it, remove the cause)
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IV flow rate drop factor =
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V (mL) / T (min) x C (gtt/mL) = R (gtt/min)
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IV flow rate drop factor SHORTCUT =
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mL/h / drop factor constant = R (gtt/min)
DROP FACTOR CONSTANTS (divide by 60): 10gtt/mL = 6 15gtt/mL = 4 20gtt/mL = 3 60gtt/mL = 1 |
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What could cause a patient who has IV to have infiltration?
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infiltration is fluid leaking into surrounding subcutaneous tissue usually do to catheter displacement from inadequately taped catheter. CAUSES: improper IV insertion, improper vein selection, irritating infusions, overmanipulation of the IV catheter, improper taping, tape that is too tight
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Why should you check the glucose levels on a patient with TPN (total parental nutrition)?
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to make sure that the glucose is not elevated. check glucose every 4-6 hours the first days of administration (hyperglycemia)
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Why would a post-op patient with a splenectomy (removal of spleen) have abdominal distention?
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could have internal bleeding, complication, infection. This is a medical EMERGENCY.
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What patient teaching do you do prior to surgery?
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AERATION. turn, cough, deep breathe. Spirometer (ventilate lungs) - expand lungs
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What does eating unusual things have to do with iron deficiency anemia?
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PICA. craving ice cubes is a sign of iron deficient anemia
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What foods are high in iron?
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spinach, broccoli, asparagus, bell pepper, collared greens, mustard greens, red meats, organ meats - liver, heart, kidney, BREAST MILK
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What are the classic s/s of iron deficiency anemia?
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pallor (pale skin), pale mucous membranes - conjunctiva, fatigue, sore tongue (GLOSSITUS), spoon shaped nails, weakness, shortness of breath, PICA, pagophagia
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What are the classic s/s of pernicious anemia (B12 deficiency)?
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paresthesias (numbness, tingling - fingers, toes, mouth), pallor, jaundice, glossitus, fatigue, weight loss
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What is B12 deficiency related to?
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INTRINSIC FACTOR (a substance produced by the parietal cells of the stomach). Intrinsic factor is required for the absorpotion of vitamin B12; without B12 the body inhibits folic acid, a substance needed for RBCs to multiply properly
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Who is at risk for pernicious anemia?
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strict vegans (no organ or red meats), chrones disease (bleeding of the intestines), GI disorders, gastrectomy patients
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What is Cooley's Anemia (Beta Thalassemia)
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group of HEREDITARY homolytic (break down of RBC's) anemias characterized by a defect in the synthesis of a protein needed for production of hemoglobin and RBCs
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What group of people is Cooley's Anemia most common in?
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Mediterranean (greek, italian, turkey, portuguese, africa)
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What is sickle cell anemia?
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A congenital hemolytic (breaks down RBCs) anemia that occurs primarily in blacks. Results from a defective hemoglobin molecule that causes the RBC to become sickle shaped (moon). Cells clump together, clogging capillaries and impair circulation resulting in chronic ill health (fatigue, dyspnea on exertion, swollen joints), periodic crises, long-term complications (infarcts, ulcers) and early death
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What group of people is at risk for sickle cell anemia?
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Mediterranean and African Americans
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What is the major s/s of sickle cell anemia?
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JAUNDICE (affects major organs)
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What is the priority action for sickle cell crisis?
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PAIN management (severe abdominal, thoracic, muscular, or bone pain; cells are getting stuck and cause pain)
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What ethnic group in US has sickle cell anemia?
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African Americans (1 out of every 500 blacks have sickle cell anemia)
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Why is pushing fluids important?
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flush toxins
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What is the most common blood type?
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O
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What is the rarest blood type?
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AB
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What blood type is the universal donor?
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O
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What kind of blood can O receive?
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only O
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What blood type is the universal recipient?
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AB
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How long do you have to administer blood products?
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complete the transfusion within a 2 to 4 hour time frame to avoid bacterial growth
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Why do we prime an IV tube with normal saline prior to blood transfusion?
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to lubricate the tube. normal saline is ISOTONIC sodium chloride (NaCl) 0.9%
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What is the first thing you do when patient has a transfusion and there is a problem or reaction?
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STOP IT. then send bag and tubing to the lab. take a urine specimen, turn on saline. NOTIFY THE PRIMARY CARE PROVIDER IMMEDIATELY FOR ANY SIGNS OF REACTION
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What is polycythemia?
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chronic disorder characterized by increased red blood cell mass, erythrocytosis, leukocytosis, thrombocytosis, increased hemoglobin level, and low or normal plasma volume
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What are the treatments for Polycythemia?
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PUSH FLUIDS TO PREVENT CLOTS, therapeutic phlebotomy, myelosuppressive therapy, interferon alfa
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Why do patients have chest pain with polycythemia?
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lack of oxygen to heart muscle because the blood is too thick to carry oxygen. Secondary polycythemia is the excessive production of circulating RBCs due to HYPOXIA (smoking, high altitude, COPD), tumor, or disease
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What is phlebotomy?
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removal of blood from the vein
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How is therapeutic phlebotomy a treatment for polycythemia vera?
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(removal of blood from the vein) to reduce the RBC mass (500mL of blood) removed every other day until HCT is normal. can also push fluids to prevent clots.
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What precautions should you take when working with a patient with low neutrophils? (low on WBC)
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WASH HANDS. prevent infection. patient with low neutrophils can get infections
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Why would a patient with leukemia bruise?
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Leukemia is a group of diseases caused by malignant proliferation of WBCs; cancer of the bone marrow which lack platelets.
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What are s/s of infection when looking at urine?
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cloudy, foul smell, may be bloody, dark, concentrated
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What are s/s with low platelet count?
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BRUISING
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What is hemophelia A?
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considered the classic form of the disease, results from a congenital deficiency of clotting factor VIII (8)
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Why can't a patient with hemophelia take aspirin?
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aspirin will thin out the blood and will cause to bleed more
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What is Hemarthrosis?
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condition of bleeding in the joints
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What is DIC (dissiminated intravascular coagulation)?
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it is a SECONDARY problem. Occurs as a complication of diseases and conditions that increase rate of clotting. Risk Factors: infections, obstetric complications, cancers, necrosis, heatstroke, shock, poisonous snakebite, cirrhosis, incompatible blood transfusions, severe DVT
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What drug is given for DIC (dissiminated intravascular coagulation) patients?
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low molecular weight HEPARIN in early stages to prevent micro-clotting - used only when benefit outweighs the risk. Watch for bleeding
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a young boy fell earlier and is now complaining of abdominal pain. This boy is a hemopheliac. What is the problem?
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may have internal bleeding due to lack of clotting factor. this is a medical EMERGENCY. go to ER
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What labs should you monitor for DIC? (dissiminated intravascular coagulation)
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PLATELETS, PT, PTT, INR
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Why do multiple myeloma (cancer in bone marrow) patients need an IV?
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Hydration needed to prevent renal calculi. increase the fluids to flush out the calcium that is in the blood. Bone is breaking down and calcium is going in the blood.
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What is lymphedema?
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a build-up of lympatic fluids in soft tissue that can cause an arm or leg to swell up and become painful (commonly caused by mastectomy)
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Why should you not draw blood, take BP, or inject anything to an extremity with lymphedema?
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will make extremity worse. Apply compression pumps, elastic sleeves or stockings to protect from injury
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Who is at risk for Hodgkin's lymphoma?
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young adults 15-38, and ages 50 and older
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What lymph node is affected in the first stage of Hodgkin's disease?
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painless swelling in one of the lymph nodes (usually the cervical, neck, region) with a history of respiratory infection
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What is the treatment for Hemophilia A?
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Intravenous administration of CRYOPRECIPITATE for Hemophilia A or lyophilized FACTOR VIII (8) or IX (9) to increase clotting factor levels and permit normal hemostasis
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