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114 Cards in this Set
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3 broad categories of anemias
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1. hypoproliferative anemias
2. megaloblastic anemias 3. hemolytic anemias |
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4 types of hypoproliferative anemias
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1. iron-deficiency anemia
2. anemia of renal disease 3. anemia of chronic disease 4. aplastic anemia |
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describe megaloblastic anemias
+ give 4 types |
abnormally large RBCs.
a) folic acid deficiency b) vitamin B12 deficiency c) lack of intrinsic factor (pernicious anemia) d) myelodysplastic syndrome |
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3 types of hemolytic anemias
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1. sickle cell anemia
2. thessalemia 3. G6PD deficiency |
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how long does it take iron-deficiency anemia to develop?
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8 years
suspected cases of these should be considered bleeds until proven otherwise. |
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describe anemias in renal disease
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when creatinine exceeds 3.0 mg/dL
deficiencies in EPO and shortened lifespan of RBCs. hemodialysis pt.s are especially susceptible, as they may have folate and iron def.s from dialysis. |
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describe anemia of chronic disease
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normochromic, normocytic RBCs.
can be caused by RA, chronic infections, cancers iron stores in bone are increased. treatment of underlying disease usually resolves anemia |
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describe aplastic anemia
sources of acquired AA cure? |
rare. caused by damage to marrow stem cells and REPLACEMENT WITH FAT.
severe neutropenia, thrombocytopenia also present T cells could mediate this attack. Not sure. can be congenital or acquired (radiation, chemicals, meds, infections) can be cured with BMT |
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describe myelodysplatic syndrome
+ give 2 subtypes |
group of disorders that cause dysplasia in myeloid stem cell line.
hypercellular in marrow, but cells die before reaching system. qualitative defects in cells. primary MDS - persons > 60 YO. secondary MDS - exposure to toxins. 30% progress to AML (acute myeloid leukemia). side 3: cure? |
only cure for MDS is BMT.
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describe hemolytic anemias
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RBCs with shortened lifespans. EPO stim produces immature RBCs (reticulocytes)
all types have elevated reticulocyte counts |
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s/s sickle cell anemia
what can induce crisis? |
PAIN, ischemia, infarct. jaundice.
cold can induce crisis defective hemoglobin molecule produced. |
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3 complications of sickle cell anemia
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1. sickle cell crisis (tissue hypoxia)
2. aplastic crisis (infection with parvovirus) 3. sequestration crisis - organs pool sickled cells (e.g., splenic infarct) |
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treatment of severe sickle cell anemia
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PBSCT (peripheral blood stem cell transplant) may cure.
hydroxyurea helps increase fetal hemoglobin. transfusions for aplastic crisis. |
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how much blood in an avg adult?
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4-6 L
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who is at risk for hypoproliferative anemias?
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Kidney failure (erythropoietin), gastric resection (lack of intrinsic factor), alcoholics, vegans and vegetarians.
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definition of leukocytosis
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ANC > 7500
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how do you calculate ANC?
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(%bands + %segs)* WBC
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describe life cycle of platelets
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Circulate for 10 days and removed by macrophages primarily in the spleen
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treatment of severe hemolytic anemias?
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blood transfusions and chelation.
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describe thalassemia
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group of anemias characterized by hypochromia (decreased hemoglobin content of RBC), low MCV.
BMT possible cure. |
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treatment of anemia of chronic illness
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give epogene, iron. maybe transfusions.
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describe DIC
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disseminated intravascular coagulation.
sepsis or acute leukemia initiates intravascular clotting. treatment is controversial. some in ICU setting give heparin to dissolve clots, some give a clotting factor. |
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1 unit PRBC raises hemoglobin by how much?
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raises hemoglobin by 1 g/dL
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diagnosis of aplastic anemia?
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aspiration or bx of bone marrow.
CBC shows low platelet, low RBC, low WBC. Causes: malignancy, infections, chemo, radiation, congenital. |
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bone marrow bx and aspiration:
purposes and prevention of complications. |
Purpose?
1. Enables diagnosis by evaluating RBCs, WBCs, and platelets 2. Can stage cancers Determine different causes of infection 3. Can monitor degree of immunosuppression and effectiveness of chemotherapy (treatments) Complications? Bleeding and infection Prevention: sterile technique, apply pressure |
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pre and post bone marrow bx nursing interventions.
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Pre-procedure interventions
Informed consent, explain, anti-anxiety med possible, NPO 4 hrs before Area will be anaesthetized (superior iliac crest or rarely sternum) Evaluate ability to lie still (during and afterwards) Post-procedural Interventions: Apply pressure for several minutes, apply sterile dressing, keep dry for 24 h. Notify MD if fever, swelling, drainage |
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what measures increase oral iron absorption?
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take with vitamin C
take on an empty stomach |
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symptoms of IDA?
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pica, pagophagia (chewing ice)
fatigue, pallor, irritibility, inflamed throat. |
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tests for IDA?
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serum ferritin is the best, but don't supplement first, because replacement boosts these levels almost immediately.
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normal CBC values
RBC reticulocyte |
RBC 4.1 - 5.1
reticulocyte: 1-2%. higher usually means bleed. |
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definition of thrombocytopenia
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Thrombocytopenia: < 100,000 platelets.
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what is the schilling test?
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the test to determine if your body absorbs B12 normally.
stage I (r/o B12 def.): oral radioactive B12, then IM shot. 24 hour urine collection. if abnormal stage I, stage II is done (r/o intrinsic factor def.) - B12 with intrinsic factor. if abnormal stage II, stage III is done. 2 weeks of abx. (r/o bacterial infection) stage IV - give pancreas enzymes for 3 days, then radioactive B12 (r/o pancreas dysfunction). |
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what would a UA in a pt. with renal disease reveal?
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lower specific gravity, proteinuria, hematuria.
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how are AFAM GFRs different from other ethnic group GFRs?
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AFAM has lower GFR than norm at baseline.
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CRF diet specifications
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low protein, low potassium, low phosphorus, low Na.
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what are some high phosphorus foods?
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dairy, protein foods, dark colas, whole grain foods, fortified foods, beans and peas.
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what are some high potassium foods?
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any fish, fruits (apricots, dates, avocados, bananas, figs, esp.),
yogurt, nuts, beans, POTATOES, squash, spinach |
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normal GFR
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120 mL/min
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what's the difference b/w lower uti and upper uti?
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Lower: ureters, bladder, urethra and prostate
Upper: renal parenchyma and pelvis; typically produces symptoms of systemic toxicity -- fever, etc. |
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what is the parenchyma?
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the functional part of an organ. contrasts with structural parts (e.g., connective tissue).
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what is pyridium in tx of UTI?
what are 2 important teaching points with pyridium? |
a bladder mucosa analgesic.
turns tears and urine orange. don't wear contacts. |
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risk factors for UTI (both genders)
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Both genders
Diabetes Urinary instrumentation or catheter Urinary obstruction Neurogenic bladder Vesicoureteral reflux |
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what are the different types of incontinence?
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Stress incontinence (increased abdominal pressure)
Urge incontinence (inability to suppress urge) Functional incontinence (inability to identify need to void or reach toilet) Iatrogenic incontinence (usually medications) Mixed incontinence |
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why would you expect to see increased nitrates in the urine of a person with UTI?
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bacteria produce nitrates
and body can attempt to change pH by doing this also. |
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normal specific gravity of urine?
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1.010 - 1.024
higher numbers are more concentrated. |
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precipitating and aggravating factors for incontinence
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DIAPPERS
Delirium Infection Atrophic vaginitis (after menopause) Pharmocologic agents (diuretics, alpha blockers) Psych factors Excessive urine production Restricted activity Stool impaction |
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describe bactrim and give side effects.
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sulfamethoxazole, a bacteriostatc abx used for UTI.
side effects? n/v, other GI sx. no EtOH (will cause vomiting). possible stevens-johnson syndrome. |
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s/s PID
+ etiology |
fever, pain, vaginal discharge, dysuria, dyspareunia
usu. due to STI (chlamydia, gonorrhea) |
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describe cystocele
+ Tx |
Protrusion of bladder through vaginal wall
Weak pelvic muscles or trauma side 3 etiology? Symptoms: frequency, urgency, stress incontinence, difficulty emptying bladder, recurrent cystitis Diagnosed on pelvic exam Treatment Perineal exercises may prevent Surgical intervention to tighten muscles and support bladder Anterior colporrhaphy or anterior repair |
childbirth, pregnancy, trauma
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describe rectocele and tx
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Protrusion of the rectum through the vaginal wall due to weak pelvic muscles
Symptoms: rectal pressure, difficulty emptying rectum, hemorrhoids Diagnosed on pelvic exam or lower GI x-rays Surgical intervention Posterior colporraphy May be done with cystocele repair, then anteroposterior colporrhaphy or anteroposterior repair |
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describe uterine prolapse and tx
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Uterus collapses into the vagina and impinges on other structures
Symptoms: peritoneal wetness or urinary retention, constipation, backache, vaginal discharge, dyspareunia (pain during sex) Diagnosed on pelvic exam or ultrasound Treatment Mild: pelvic exercises Preferred: hysterectomy Pessary may be used if unable to tolerate surgical intervention |
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sxs and diagnosis of BPH
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Symptoms: urinary frequency, urgency, nocturia, hesitancy, decreased volume or force of stream, dribbling
Diagnostic studies: urinalysis (R/O UTI), DRE (digital rectal exam), PSA (prostate specific antigen – blood test), urodynamic studies may be done (measuring force, volume) |
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risk factors for BPH
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age over 50
smoker hypertension western diet heavy EtOH consumption diabetes |
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tx of BPH
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meds: alpha-adrenergic blockers, anti-androgen drugs.
surg: Goal: relieve bladder obstruction while preserving continence and erectile function Minimally invasive procedures Transurethral needle ablation (TUNA) Laser ablation Transurethral resection of prostate (TURP) |
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complications of TURP
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Bleeding may be significant. We want to prevent clots.
May require post-op irrigation with NS Risk fluid absorption with fluid and electrolyte abnormality TURP syndrome: bradycardia, tachypnea, confusion, vomiting, agitation, headache and tremor erectile dysfunction and incontinence are common after TURP. |
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what is a TRU? what information can it provide?
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transrectal ultrasound.
this can locate abnormal growths that could be prostate cancer (verified by bx.) |
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describe sxs and treatment of testicular torsion.
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Testicular torsion- trauma is most common reason. Congenital abnormalities. Sports injury. Complication: ischemia. Signs would be pain that remains for a long time. Spermatic cord is twisted. Needs to be corrected quickly or else it could become necrotic.
Treatment: surgery, manual correction. |
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describe DUB
and give 3 types |
Abnormal uterine bleeding without known cause
Most common in adolescent and perimenopausal women Must be evaluated – pregnancy, thyroid dysfunction, trauma, neoplasm, hematologic disorder Menorrhagia: prolonged or excessive bleeding at time of menses Metorrhagia: bleeding between menses (met means between). Post menopausal bleeding – any bleeding |
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risk factors for cervical cancer
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HPV 16 and 18
risky sex bxs sex with uncircumcised males Immunodeficiency or other STIs DES exposure in utero Early age of first intercourse early childbearing smoking low SES |
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tx for cervical cancer
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vaccine (prevention) - cervarix and gardasil
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pap smear schedule
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Pap smear – start at age 21 or 3 years after first intercourse
Start annually and then extend to every 2 to 3 years Discontinue screening at age 65 to 70 if regular screen and no abnormal Pap smears in previous 10 year |
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what tests are done if abnormal pap smear?
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Colposcopy (visualizes uterus) and endometrial biopsy if abnormal Pap smear
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medical tx of cervical cancer
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Preinvasive lesions:
Cryotherapy or loop electrocautery (LEEP) “Simple” hysterectomy – removal of uterus only Invasive cancer: Total hysterectomy – removal of uterus, cervix, and ovaries Pelvic exenteration – removal of pelvic organs with construction of urinary diversion, colostomy, and vagina Radical trachelectomy – removal of cervix and selected nodes Preserves childbearing ability: Radiation -Internal Radiotherapy (brachytherapy) -External Beam Radiotherapy |
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what does the prefix brachy- mean?
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short
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possible adverse events for cervical CA
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Possible adverse events:
Vaginal stenosis (if radiation)* Weight loss* Leg edema* Pelvic pain* DVT* |
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ovarian CA risk factors
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Increase risk
Age and obesity Family history Infertility Nulliparity Personal cancer history Breast, uterine or colon cancer Breast-Ovary syndrome |
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factors that decrease risk for ovarian CA
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Decrease risk
Removal of ovaries Oral contraceptives Pregnancy Breast feeding Bilateral tubal ligation or hysterectomy |
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what is breast-ovary syndrome?
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Breast-ovary syndrome: breast cancer in 30’s or 40’s followed by ovarian cancer 5 to 10 years later (related to specific BRCA genes)
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s/s ovarian CA
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95% of women report non-specific symptoms!
Pelvic pressure, bloating* (increased abd girth most common sign), urinary urgency, nausea, fatigue, dyspareunia Women with unexplained GI symptoms –> cancer work-up (spreads from ovaries). |
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describe diagnostic testing for ovarian CA
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no real screening.
can test for tumor marker CA-125 (Elevated in 80% of women with advanced ovarian cancer) BUT – normal in 50% to 75% of women with stage 1 ovarian cancer (so not a reliable screening test) |
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tx of ovarian CA
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Most women have advanced disease at time of diagnosis
Surgical staging, exploration and reduction of tumor mass TAH, BSO with omentectomy, tumor debulking, lymph node sampling and biopsies Post-op chemotherapy with platinum and taxane agents; and/or Post-op radiation TAH: total abdominal hysterectomy BSO: bilateral salpingo-oopherectomy (removal of ovaries) |
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what type of genetic testing can you do for breast cancer?
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test for BRCA mutations.
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what are 3 types of surgical intervention for breast cancer?
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Lumpectomy
Modified radical mastectomy Total mastectomy (breast removed) |
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what is a modified radical mastectomy?
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In a modified radical mastectomy, the entire breast is removed, including the skin, areola and nipple, as well as most of the lymph nodes in the armpit area.
Modified radical mastectomy is usually recommended if the tumor is large and cancer has already spread to the lymph nodes |
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risk factors for breast cancer
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Female gender
Advancing age FH of breast cancer Cumulative estrogen exposure Early menarche Late menopause Nulliparity BCP and HRT Obesity |
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protective factors for breast CA
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Physical activity
Breast feeding Full term pregnancy before age 30 years |
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PRBC transfusion nursing procedure
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1.verify order and written consent
2. explain procedure to pt. + give teaching on xfusion rxns (itching, hives, swelling, SOB, fever, chills) 3. vitals, respiratory check, JVD check 4. 20 gauge or larger needle for insertion, establish line. 5. obtain PRBCs from blood bank 6. check type and labels (ABO, Rh, MAR) with another nurse 7. check blood for gas bubbles, abnormal color, cloudiness 8. administer blood within 30 MIN of removal from refrigerator 9. first 15 min run no faster than 5 mL/ min, OBSERVE pt. for adverse effects. 10. monitor vitals closely 11. MAKE SURE infusion does not exceed 4 hrs. 12. change tubing after 2 units tranfused. |
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nursing transfusion procedure of platelets or FFP
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1. confirm order and consent signed
2. explain procedure to pt., including s/s transfusion rxn 3. baseline vitals, respiration 4. 22 gauge or larger needle in a large vein if possible, special tubing. Start line. 5. obtain platelets or FFP from blood bank 6. double-check labels with another nurse (ABO group match if compatible platelets ordered) 7. check platelets or FFP for unusual color or clumps (redness means contamination with larger amts of RBCs.) 8. infuse each unit of FFP over 30 to 60 min per pt. tolerance. Platelets as fast as pt. can tolerate to reduce plt clumping. 9. observe closely during transfusion. 10. vitals at end of transfusion. 11. flush line with saline. to remove blood component from tubing. 12. platelet count may be ordered 1 hour after plt tranfusion. |
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diseases transmitted by blood transfusion
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viral hepatits B,C
HIV HTLV (human t-cell lyphotropic virus - cancer causing) Cytomegalovirus GVHD (graft versus host disease) CJD (creuzfeldt-Jakob disease, prions in CNS) |
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when would whole blood be used for transfusions?
what's the hematocrit of whole blood? |
used in significant bleeding (>25% blood volume lost)
hematocrit 40% |
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indications for PRBCs?
hematocrit of PRBCs? |
pt has decrease in RBC mass.
hematocrit 75% |
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indications / considerations for random platelets
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indications:
-bleeding due to severe thrombocytopenia -prevent bleeds when platelets < 10,000 plt/ mm3 repeated treatments increase in mortality because of alloimmunization risk. |
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discuss platelets - single donor
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done with pt.s who are receiving repeated treatments. this decreases the chances of alloimmunization by reducing exposure to multiple donors.
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components of transfusion plasma
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plasma, including complement and clotting factors.
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when would you give an albumin transfusion?
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hypoproteinemia; burns; to expand volume; to decrease hematocrit
available in 5% or 25% |
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when would you transfuse intravenous gamma-globulin?
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contains IgG antibodies.
give in hypogammaglobulinemia (CLL, recurrent infections); ITP; primary immunodeficiency states |
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describe DIC
clinical signs |
not a disease, but a sign of an underlying condition.
- triggered by sepsis, trauma, cancer, shock, abruptio placentae, toxins, or allergic rxns - coagulation within vasculature. massive amts of tiny clots. - clotting factors are quickly used up, and bleeding can result. - clinical signs: drop in platelet count, increase in PT and aPTT, elevation in fibrin degradation products (D-dimers) - bleeding from multiple mucous membranes, venipuncture sites, GI and urinary tracts. can manifest MODS (multiple organ dysfunction syndrome). side 3: treatment |
treating the underlying cause
correcting 2ry effects: oxygenation, replacing fluids, correcting elyte imbalances, adminstering vasopressors. serious hemorrhage: replacing clotting factors and platelets. cryoprecipitate is given to replace fibrinogen and factors V and VII. |
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when would you give a cryoprecipitate transfusion?
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DIC - contains fibrinogen and factors V and VII.
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what are bleeding precautions?
what conditions would this be used for? |
conditions: thrombocytpenia due to: malingancy of marrow, marrow suppression due to chemo, hypersplenism, DIC.
assessment: check pt. for petichiae (trunk, legs), ecchymoses or hematomas, conjunctival hemorrhages, gum bleeding, puncture site bleeding. Labs: monitor CBC, platelets daily. Notify MD if platelet count is <10,000/mm3 or if pt. becomes symptomatic. Test urine, emesis, stool for occult blood. nursing: No ASA -No IMs, avoid indwelling catheters - no rectal temps, no enemas, no suppositories (use stool softeners or oral laxatives) -induce amenorrhea with oral contraceptives - no flossing, no commercial mouthwash, only soft-bristled toothbrush for care (toothettes if plt < 10,000 or if gums bleed.) - pad side rails - apply pressure to venipuncture sites for 5 minutes or until bleeding has stopped. - for epistaxis, position in high fowlers, ice packs to back of neck and pressure to nose. - notify MD if bleeding longer than 10 min. |
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what is epistaxis?
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nosebleed.
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breast CA risk factors
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female gender
increasing age personal h/o breast cancer genetic mutation (BRCA 1 and BRCA 2) obesity high-fat diet daily alcohol intake Hormonal factors: early menarche (before 12), late menopause, nulliparity, late age at first full-term preg., hormone therapy. |
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s/s breast CA
diagnostic tests for breast CA |
fixed lesions, non-tender, irregular borders.
late signs: skin dimpling, nipple retraction, skin ulceration. diagnostic tests: bx of lesion and nodes. BRCA1 and BRCA 2 genetic testing. |
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things to expect post mastectomy
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phantom sensations, tingling, numbness, tightness, etc. (these persist for several months and are normal.)
transient edema (after ALND) - resolves w/in 1 mo. elevating arm several times per day and fist-squeezing exercises can minimize this and prevent lymphedema. bloody drainage changes to serosanguinous drainage and serous drainage within several days. pt. may shower POD 2 and wash incision with soap and water. dry dressing applied each day for 7 days PO. |
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complications post surgery for breast CA
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transient edema (resolves w/in 1 mo)
lymphedema hematoma (usu w/in 12 h surgery) - gross swelling, drainage. |
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when should postop breast CA pts call dr?
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s/s infection,
sudden change in character of drainage, sudden cessation of drainage. excruciating pain |
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types of exercises post mastectomy
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wall handclimbing
rope turning pulley tugging broomstick lifting |
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lifting restrictions post breast CA surg.
driving guidelines? |
no heavy lifting 4-6 weeks postop.
can drive after drain is removed, full range of motion, no longer on opiates. |
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teaching for postop cryotherapy
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expect to have bleeding, watery discharge for a few days to several weeks after.
don't douche or use tampons or have sex for several weeks after cryotherapy. |
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surgical procedures for cervical cancer
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1. total hysterectomy (removal of uterus, cervix, ovaries)
2. radical hysterectomy (total hyst. + removal of fallopian tubes, proximal vagina, bilateral lymph nodes through abdominal incision or through vagina). 3. bilateral pelvic hymphadenectomy (common iliac, external iliac, hypogastric, obturator lymph vessels and nodes) 4. radical trachelectomy (removal of cervix and selcted nodes to preserve childbearing capacity in a woman of reproductive age with cervical cancer) |
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when is hormone replacement necessary in hysterectomy?
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only when the ovaries are removed, to prevent surgically-induced menopause.
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when is hormone replacement necessary in hysterectomy?
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only when the ovaries are removed, to prevent surgically-induced menopause.
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post-hysterectomy complications
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hemorrhage (pad count and monitor vitals)
DVT (early ambulation, leg exercises) bladder dysfunction infection (showers rather than tub baths) side 3: when to call MD |
bleeding persisting after a few days.
vaginal discharge, foul odor, excessive bleeding, leg redness or pain, elevated temp. |
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describe TURP syndrome
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TURP syndrome: bradycardia, tachypnea, confusion, vomiting, agitation, headache and tremor
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clinical manifestations of prostate cancer
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DRE, PSA, Biopsy
No early symptoms Symptoms of urinary obstruction Routine PSA (controversial) Norms affected by age and other prostate conditions |
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medical management of prostate cancer
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Watchful waiting (< 5 year life expectancy)
Radical prostatectomy – removal of prostate, seminal vesicles, tips of vas deferens and surrounding tissues Radiation therapy External beam Radioactive seeds directly into prostate |
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postop care of prostatectomy
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3-way Foley with bladder irrigation (CBI)
Assess CBI drainage Avoid kinks in tubing! Monitor color and consistency of drainage Even bright red drainage doesn’t signify major bleeding If clots, may require catheter irrigation (hospital specific). Bright red and clots is when you have to worry. CBI usually discontinued after 24 hours and catheter removed 36 to 72 hours post-operatively Bladder spasms may require anti-spasmodic medication Monitor VS and I & O closely |
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definition of oliguria?
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less than 400 ml in 24 h
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normal specific gravity of urine
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1.010 - 1.030
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categories of ARF
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Prerenal failure
Causes: volume depletion, impaired cardiac function, anaphylaxis, sepsis and vasodilator med Intrarenal failure Causes: myoglobinuria trauma, nephrotoxic substances (including contrast dye), NSAIDs, infections Intrarenal causes--- lead to interstitital, glomerular or tubular damage: Acute Tubular Necrosis (ATN) Postrenal failure Causes: obstruction (stenosis) e.g. tumors, stones, clots etc |
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s/s pyelonephritis
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S/sx: the acute form is usually symptomatic but can be asymptomatic
If Chronic s/s may be vague urgency, dysuria & cloudy, foul-smelling urine fever and chills Pain is constant in flank area or colicky if renal calculi present + CVA tenderness Tachypnea Malaise GI symptoms-nausea Muscle tenderness |
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describe nephrotic syndrome
+ clinical manifestations |
a type of renal failure characterized by increased glomerular permeability and is manifested by massive proteinuria.
incrase in protein (particularly albumin) in urine, decrease in blood albumin, diffuse edema, high serum cholesterol, hyperlipidemia. PERIORBITAL AND DEPENDENT EDEMA |
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causes of ARF
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Hypovolemia(can lead to shock)
Hypotension (can lead to shock) Reduced cardiac output and heart failure Obstruction of the kidney or lower urinary tract Obstruction of renal arteries or veins (stenosis) |
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4 ARF phases
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Acute Renal Failure Phases (4):
1. Onset—the initial phase of insult or injury begins with the problem that causes the ARF- ends with oliguria 2. Oliguric —lasts 8-14 days; decreased urinary output accompanied by increase in urea, creat, uric acid, K, Mg, and other substances that are normally excreted as waste, hypovolemia UO <400ml/24hr However, if non-oliguric ARF: output could be as much as 2L/day the longer the oliguria poorer the prognosis 3. Diuretic —lasts ~10days gradual increase in urine output as the body attempts to recover UO>1000ml/24hrs (may be up to 4-5L/day) 4. Recovery —indicates improvement of renal function & may last up to 6mos lab values slowly return to normal 3 -12 months Usually pt is left w/ some residual impairment in renal function |
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4 types of renal calculi
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1. calcium (phosphate or oxalate) - cut back on meat.
2. struvite (magnesium ammonium phosphate) - acidify urine with citrus fruits or tablets. 3. uric acid (cut back on venison, organ meats, goose) 4. cystine (lower animal protein) |
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