question

What type of anemia results from red blood cell destruction? Bleeding Hemolytic Hypoproliferative None of the above

answer

Hemolytic Bleeding results from red blood loss. Hemolytic anemia results from red blood cell destruction. Hypoproliferative anemia results from defective red blood cell production.

question

True or False Leukocytosis refers to a decreased level of leukocytes in the circulation.

answer

False Leukocytosis refers to an increased level of leukocytes in the circulation. Leukopenia refers to a decreased level of leukocytes in the circulation.

question

What should any elderly patient be evaluated for whose chief complaint is back pain and has an elevated total protein level? Anemia Leukemia Multiple myeloma Non-Hodgkin's lymphoma

answer

Multiple myeloma Any elderly patient whose chief complaint is back pain and has an elevated total protein level should be evaluated for possible myeloma.

question

Hemolysis means:

answer

(blood rupturing) the rupturing of erythrocytes (red blood cells) and the release of their contents (hemoglobin) into surrounding fluid (e.g., blood plasma).

question

When you think hemolytic, think:

answer

RBC destruction

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Leukocytosis refers to

answer

an increased level of leukocytes in the circulation.

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Leukopenia refers to

answer

a decreased level of leukocytes in the circulation.

question

Normal Lab Values: WBC

answer

4500-11,000/mm³

question

Normal Lab Values: Hemoglobin

answer

Male: 13-18 g/dL Female: 12-16 g/dL

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Normal Lab Values: Hematocrit

answer

Male: 42-52% Female: 35-47%

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Normal Lab Values: Iron

answer

Male: 75 to 175 g/dL Female: 65 to 165 g/dL

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Normal Lab Values: Platelet

answer

150,000- 450,000/mm³

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Kidneys and Blood Cell Production

answer

Think about: Renin - Angiotensin - Aldosterone System

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*Why the Renin-Angiotensin-Aldosterone System begins during heart failure:*

answer

Activation of the renin-angiotensin-aldosterone (RAA) system rapidly kicks in with heart failure. This is due to decreased renal perfusion caused by both a reduction in cardiac output and redistribution of blood away from nonessential organs --> this leads to the kidney starting to retain sodium and water in response to the perception of ineffective blood volume. The perception of decreased blood volume and the increase in sympathetic nervous activity --> stimulates renin release from the juxtaglomerular cells in the kidneys.

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Erythropoietin (EPO)

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is a hormone produced by the kidney that promotes the formation of red blood cells by the bone marrow. medication: Procrit (3 or so times/week)

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How is erythropoietin made?

answer

The kidney cells that make erythropoietin are specialized so that they are sensitive to low oxygen levels in the blood that travels through the kidney. These cells make and release erythropoietin when the oxygen level is too low. The low oxygen level may indicate anemia, a diminished number of red blood cells, or hemoglobin molecules that carry oxygen through the body.

question

What exactly does erythropoietin (EPO) do?

answer

it stimulates the bone marrow to produce more red blood cells --> this rise in red blood cells increases the oxygen-carrying capacity of the blood.

question

As the prime regulator of red cell production, erythropoietin's major functions are to:

answer

1. Promote the development of red blood cells. 2. Initiate the synthesis of hemoglobin, the molecule within red blood cells that transports oxygen.

question

What medication are dialysis patients often placed on?

answer

Procrit r/t kidney malfunction and lack of erythropoietin production

question

Damage to the kidney can lead to anemia how?

answer

it inhibits the kidney function and possibly inhibits its ability to produce erythropoietin. *medications (filtering of) and radiation can lead to kidney malfunction*

question

Lymphoid cells

answer

T cells and B cells

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Myloid cells

answer

Erythrocytes Leukocytes Platelets

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How are RBC's described?

answer

by size and by amount of hemoglobin present. Size = "-cytic" Amount of hemoglobin = "-chromic"

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Reticulocyte Count Normal Range

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0.5 - 1.5 *The reticulocyte count is used to help determine if the bone marrow is responding adequately to the body's need for red blood cells (RBCs) and to help determine the cause of and classify different types of anemia.*

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Why does anemia take a few months to recover

answer

- RBC lifespan is 120 days - can give blood transfusion (very fast recovery) - erythropoietin (EPO) (Procrit)

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Erythrocyte Dx Tests

answer

Complete Blood Count RBC Hemoglobin (this is a biggie) Hematocrit (this is a biggie) MCV (mean corpuscular volume) MCHC (mean corpuscular hemoglobin concentration)

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What is Hemoglobin test

answer

- the measure of hemoglobin in the blood - the O2 carrying ability of the blood

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What is Hematocrit test

answer

the volume percentage (%) of red blood cells in blood.

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What is MCV (mean corpuscular volume)

answer

a measure of the average red blood cell

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What is MCHC (mean corpuscular hemoglobin concentration)

answer

a measure of the concentration of hemoglobin in a given volume of packed red blood cells

question

Bone Marrow Aspiration and Biopsy

answer

Informed consent is REQUIRED! Major hazards: Bleeding and Infection

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Bone Marrow Aspiration Site

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*remember that bone marrow is a liquid and looks like blood*

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What are the Erythrocyte Disorders that we will cover?

answer

Anemia Polycythemia Vera

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What is Anemia

answer

- Decrease in quantity of RBCs and/or - an Abnormality in Hgb content - need to identify causative agent

question

Anemia Signs and Symptoms

answer

- fatigue - thirst - cold - pale - mucous membranes pale - cap refill long - cyanosis - tachycardia (heart is trying to compensate for low O2) - dizziness (think safety - slow position change) - nausea - inceased respiratory rates - clubbing with chronic anemia - hair loss in periphery

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Anemia Tx Focus

answer

- Underlying disorder or causative agent - Symptom relief - transfusion (meds given during: lasix, benadryl, tylenol) - possible fluid volume overload r/t transfusion - transfusion given over long period of time (4 or so hrs/unit) - Procrit

question

How much should the HCT increase with each unit of blood given?

answer

2-3 pts per unit *if there isn't an increase, think about a possible bleed or hemolytic disorder (spleen "eating" RBC's)*

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Anemia: Nursing Process - Assessment

answer

- Weakness, fatigue, general malaise - Pallor of skin and mucous membranes - Jaundice - Beefy red tongue - Medications (many meds, many side effects) - EtOH (hepatosplenomegaly)(hang banana bag) - Nutrition - Cardiac/GI/Neuro - Unusual cravings (PICA)(ice eating) - Females: Menstrual History (pads per day)

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Anemia: Nursing Process - Planning and Goals

answer

- Increased tolerance of normal activity - Attainment or maintenance of adequate nutrition - Maintenance of adequate tissue perfusion - Compliance with prescribed therapy - Absence of complications

question

Anemia: Nursing Process - Interventions

answer

- Manage Fatigue - Maintain Adequate Nutrition - Maintain Adequate Perfusion - Comply with Prescribed Therapy - Monitor and Manage Potential Complications

question

Types of Anemia

answer

- Aplastic - Iron Deficiency - Folic Acid Deficiency - Vitamin B12 Deficiency - Sickle Cell

question

The differences in Anemia Treatment is

answer

- Not much difference between the types - biggest difference is the medications used to tx the deficiency

question

Aplastic Anemia

answer

- Caused by decrease in or damage to marrow stem cells - toxic anemia - Neutropenia - wbc below 1500 - Thrombocytopenia - low platelets usu below 100k (can give transfusions - just platelets) - can give plasma to increase blood volume - Anemia = know relationship between HCT and Hgb (Hgb is usu 2-3 times HCT)

question

Iron Deficiency Anemia

answer

- Intake of dietary iron is inadequate for hemoglobin synthesis - think Children and Pregnant women

question

Clinical Management of Iron Deficiency Anemia

answer

- Stool specimens for occult blood - Colonoscopy or endoscopy (check for bleeding) - Iron supplementation: Dietary and Medication - usually give meds r/t not enough intake in diet

question

Iron Supplements

answer

- causes constipation - usu on supplemental bowel regiment - stool softener, miralax, lots of liquids - causes tarry stool (can through off hemoccult) - drink through a straw (if liquid) - don't drink with milk - Vit C increases absorption - take on empty stomach

question

Folic Acid Deficiency

answer

- Folic acid stored as different compounds called folates - pregnant women - multivitamins have high folic acid level - children = neural tube deficit --> spina bifida

question

Normal Range for Folic Acid

answer

2.5 - 20 ng/mL

question

Vitamin B12 Deficiency Pernicious Anemia

answer

- r/t faulty absorption in GI tract: (crohn's disease, gastrectomy, ileal resection) - dietary deficiency is rare but can develop in strict vegetarians - high cases of this in gastric bypass - probably the most common type of anemia seen - Tx: B-12 is given IM

question

What are normal B-12 Levels

answer

200-900 pg/mL

question

Sickle Cell Anemia

answer

- Hgb molecule is defective - disk shape of cell becomes deformed, rigid and sickle shaped --> can cause damage to vessel walls - pt will c/o pain in certain parts of the body

question

Sickle Cell Anemia Tx

answer

- transfusions - tx symptoms/pain if refuse blood transfusion - possible genetic therapy - protects against malaria - shortened life expectancy

question

Sickle Cell Anemia Signs/Symptoms

answer

- anemia (7-10 hgb) - jaundice - liver trying to get rid of damaged cells and build up in liver decreases fnxn - tachycardia (compensation) - cardiac murmurs - thrombosis - abn cells stick together and clot, cause pain, need blood thinner - infections - WBC might not fnxn corrctly r/t irregular WBC related to malformation - avascular necrosis (often in hip) - stroke - death

question

Sickle Cell Anemia - Sickle Cell Crisis

answer

- Sickle Cell Crisis - Acute Chest Syndrome - get fluids, O2 and pain meds - possibly blood transfusion - think dehydration --> thickens blood --> leads to crisis - affects developmental mile stones in children - Clinical Management: Bone Marrow Transplant, Hydroxyurea, RBC transfusion

question

Sickle Cell Crisis

answer

- intense pain because blood vessels can become blocked or the defective red blood cells can damage organs in the body. - assessment: determine the factor precipitating crisis - manage pain levels - all body systems must be assessed

question

Sickle Cell Crisis Interventions

answer

- manage pain - preventing and managing infection - promote coping skills monitoring for potential complications can affect developmental milestones in children - pts can be at high risk for addiction r/t medications - hydroxyurea helps relieve pain - stem cells from umbilical stem cells can help with autotransfusion

question

Sickle Cell Crisis Nursing Dx

answer

Based on the assessment data, major nursing diagnoses for the patient with sickle cell crisis may include: - Acute pain related to tissue hypoxia due to agglutina- tion of sickled cells within blood vessels - Risk for infection - Risk for powerlessness related to illness-induced helplessness - De?cient knowledge regarding sickle crisis prevention

question

Sickle Cell Crisis Collaborative Problems/Potential Complications

answer

Based on the assessment data, potential complications may include: - Hypoxia, ischemia, infection, and poor wound healing leading to skin breakdown and ulcers - Dehydration - Cerebrovascular accident (CVA, brain attack, stroke) - Anemia - Acute and chronic renal failure - Heart failure, pulmonary hypertension, and acute chest syndrome - Impotence - Poor compliance - Substance abuse related to poorly managed chronic pain

question

Hydroxyurea is

answer

- an antineoplastic drug - used to reduce the number of painful crisis in sickle cell anemia and decreased need for transfusions in adult patients with a history of recurrent moderate to severe crises -

question

Hydroxyurea SE:

answer

nausea, vomiting, diarrhea, constipation, drowsiness

question

Patient, while taking Hydroxyurea, should contact the doctor if what occurs?

answer

- rash, - purple/blue or black discoloration of the skin or nails - loss of feeling in one area of the body - sores on the skin or in the mouth - foul-smelling substance oozing from the skin - swelling of the hands/feet/ankles or lower legs

question

Acute Chest Syndrome is:

answer

a noninfectious vaso-occlusive crisis of the pulmonary vasculature commonly seen in patients with sickle cell anemia. It is characterized by a new infiltrate on a chest x-ray.

question

Acute Chest Syndrome Cause

answer

The crisis is often initiated by a lung infection, and the resulting inflammation and loss of oxygen tension leads to sickling of red cells and further vasoocclusion.

question

Acute Chest Syndrome Symptoms

answer

The crisis is a common complication in sickle-cell patients and can be associated with one or more symptoms including fever, cough, sputum production, dyspnea, or hypoxia.

question

Acute Chest Syndrome Treatment

answer

Broad spectrum antibiotics to cover common infections like strep pneumoniae and mycoplasma, Pain control, and Blood transfusion

question

Polycythemia Vera Etiology:

answer

hyper-cellular bone marrow leading to elevated RBC, WBC, and platelets

question

Polycythemia Vera Symptoms

answer

Symptoms result from increased blood volume and increased blood viscosity - headache - red faced - swollen veins - dizziness r/t too much blood

question

Polycythemia Vera Treatment

answer

relies primarily on phlebotomy to reduce hematocrit - bleed them/ drain them (usually 1 or so a week or monthly)

question

Hemostasis

answer

control of bleeding

question

Platelets

answer

essential in control of bleeding

question

Thrombocytopenia

answer

- a decrease in the number of circulating platelets - no aspirin, no blade razor shaving, no flossing, no contact sports

question

Thrombocytopenia Etiology

answer

- Decreased production in bone marrow - Increased destruction of platelets (d/t antibodies) - Increased consumption (by the spleen)

question

Vitamin K Deficiency leads to

answer

impaired synthesis of coagulation factors - can give Vit K PO or IM - IM to counter Warfarin

question

Thrombocytosis

answer

- Increased number of platelets - Usually due to a stem cell disorder - risk of blood clots - Platelets are immature - Result of contributing diseases: Chronic Inflammatory Disorder, Iron Deficiency, Malignant Disease, Splenectomy - will be on some form of blood thinner

question

White Blood Cell Disorders

answer

White blood cells are formed in the bone marrow and have as a primary function to recognize and fight micro-organisms.

question

Neutropenia is

answer

a decrease in the number of neutrophils resulting in risk of infection - Neupagen - remember precautions: no flowers or fresh fruit or kids, etc

question

Leukemia is

answer

- proliferation of one class of white blood cells - can be acute or chronic - Acute: sudden onset with poorly differentiated cells - Chronic: slow onset with well defined cells

question

Symptoms of Leukemia

answer

- Pallor - Fatigue - Frequent infections - Bleeding, bruising - Bone pain (amped up bone marrow leads to pain) - Weight loss (cancer deprives body of nutrients)

question

Leukemia Tx

answer

- chemotherapy - transfusion of bone marrow, stem cells, platelets - no radiation (can't radiate all of the body and the blood)

question

Chronic Leukemia

answer

- usually seen in older adults (60's) - Cells are fully mature - Early on there are few symptoms - Later there is splenomegaly; hepatomegaly; lymphadenopathy

question

Chronic Lymphocytic Leukemia

answer

- usually seen later in life - presents with anemia and thrombocytopenia - later it will present with fever; night sweats; and weight loss - Primary treatment is chemotherapy

question

Gleevec is

answer

- antineoplastic/enzyme inhibitor - Inhibits kinases which may be produced by malignant cell lines - Inhibits production of malignant cell lines with decreased proliferation of leukemic cells

question

Gleevec SE/AE

answer

- CNS: fatigue, headache, weakness. Resp: cough, dyspnea, epistaxis, nasopharyngitis, pneumonia. - GI: HEPATOTOXICITY, abdominal pain, anorexia, constipation, diarrhea, dyspepsia, nausea, vomiting. - Derm: petechiae, pruritus, skin rash. - F and E: edema (including pleural effusion, pericardial infusion, anasarca, superficial edema and fluid retention), hypokalemia. - Endo: hypothyroidism. - Hemat: BLEEDING, NEUTROPENIA, THROMBOCYTOPENIA. - Metabolic: weight gain. - MS: arthralgia, muscle cramps, musculoskeletal pain, myalgia. - Misc: fever, night sweats.

question

Lymph System Roles

answer

- Maintain interstitial osmotic pressures - Absorb fat from the small intestine - Fight infection - Filter

question

Lymph System Disorders

answer

- Hodgkin's Disease - Non-Hodgkin's Lymphoma - Multiple Myeloma

question

Hodgkin's Disease

answer

- Cancer of lymphoid tissue - usually lymph nodes and spleen - interferes with the body's ability to fight infection - Diagnosed by presence of Reed Sternberg cells in tissue biopsy - The stage the disease is in dictates the treatment - usually seen in young males - early stages are fairly curable - later stages have worse prognosis - think lymph nodes are everywhere

question

Hodgkin's Disease Tx:

answer

- can use born marrow transfusion - can use chemotherapy - can use radiation

question

Non- Hodgkin's Lymphoma

answer

- Diffuse cancer of the lymphoid organs - Usually involves lymph nodes, liver, spleen, and bone marrow - Classification and ability to tolerate therapy determine treatment - usually in older patients - usually diagnosed at late stage --> more profuse spreading --> poor prognosis - B Symptoms: unintentional weight loss 10% or more, night sweat and fever - can spread to other organ systems r/t lymph system is systemic

question

Non- Hodgkin's Lymphoma is classified by:

answer

the type of lymphocyte that it is affecting - B cell Lymphoma (most common) - T cell Lymphoma - described as indulent or aggressive

question

Non- Hodgkin's Lymphoma symptoms

answer

- swollen lymph nodes - night sweats - fever - chills - fatigue - unexplained weight loss - facial swelling

question

Multiple Myeloma

answer

- Disease of most mature B lymphocyte, plasma cell - Medium survival 3-5 years, no cure - Nonfunctional immunoglobulin Monoclonal or M protein - Back pain with possible lytic lesions - no cure --> mgt of symptoms - check protein levels - usually diagnosed by lytic lesions - Hypercalcemia, anemia, and renal failure

question

What is also refered to as a Myeloma protein?

answer

- immunoglobulin - M Spike - Free light chains (Bence Jones)

question

Multiple Myeloma Etiology

answer

- 3 times as common as leukemia - most common in patients around 60 or 70 - rarely see myeloma cells floating in the blood stream - usually confined to bone marrow - will show anemia r/t myeloma cells overtaking the space where RBC's are made and that leads to lower levels of RBC - causes erosion of the bone --> leads to lytic lesions and hypercalcemia - myeloma proteins fragment --> move to kidneys --> can cause renal insufficiency or failure

question

Myeloma Acronym

answer

C - Calcium problems R - Renal problems A - Anemia B - Bone disorders

question

Multiple Myeloma Tx

answer

- can be considered (for some pts) a chronic disease - treatment can sometimes consist of 6 or so lines of tx - high dose chemotherapy with bone marrow stem cell replacement - proteasome inhibitors (Bortezomib or Carfilzomib) - IMIDs (Thalidomide, Lenolidomide, Pomalidomide) - personalized medications (genomics)

question

proteasome inhibitors (Bortezomib or Carfilzomib)

answer

- IM - as initial therapy or after progression; with melphalan and prednisone) - Inhibits proteasome, a regulator of intracellular protein catabolism, resulting in disruption of various intracellular processes - Leads to the death of rapidly replicating cells, particularly malignant ones

question

IMIDs (Thalidomide, Lenolidomide, Pomalidomide)

answer

- PO - immunosuppressants - used with newly diagnosed multiple myeloma (with dexamethasone) - Inhibits secretion of pro-inflammatory cytokines and increases secretion of anti-inflammatory cytokines - Slows progression of multiple myeloma - may cause neutropenia or thrombocytpenia

AH1-Chapter 31 Nursing Management of Hematologic Problems – Flashcards

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