Medical-Surgical Nursing: Anemia and other Blood Disorders Flashcards


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cause, s/s, Tx., and nursing considerations
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1

Anemia

The decrease in the number of erythrocytes. The quantity or quality of hemoglobin, and volume of packed RBC's (hematocrit)

2

Iron Deficiency Anemia cause is...

Chronic Blood loss

3

Thalassemia

The body inherently makes an abnormal form of hemoglobin. Decrease in erythrocyte production found in ethnic groups found near the Mediterranean sea, Asia, Middle east and Africa.

4

Thalassemia Minor

Has one heterozygous gene with asymptomatic mild to moderate anemia.

5

Thalassemia Major

Has two heterozygous gene with symptoms

6

Thalassemia Minor Tx. is....

no tx. the body adapts to the reduction of normal hemoglobin.

7

Thalassemia Major Tx./ Management of symptoms are...

Blood transfusions- reduce the iron overload

No Vit-C, Splenectomy

8

Thalassemia Major symptoms

Jaundice, pallor, thickening of the cranium and maxillary cavity.

enlarged(megaly) splenomegaly, hepatomegaly, cardiomegaly

9

What are the 2 Megaloblastic Anemias?

Colalamin Deficiency(Vit. B-12)

Folic Acid

10

What is Megaloblastic Anemia

the presence of large RBC's (macrocytic)

11

Colabamin B-12 deficiency commonly caused by....

Pernicious Anemia- the absents of the intrinsic factor secreted by the parietal cells in the gastric mucosa.

12

Pernicious Anemia S/S

sore beefy tongue, weakness, parasthesias of the hands and feet, confusion, dementia, sensitive to hot/cold neuo issues.

13

Without B-12 when will pt. die?

In 1-3 yrs.

14

Labs needed for Pernicious anemia

RBC's, Folate levels, Serum test for IF antibodies

Endoscopy & Biopsy of the gastric mucosa

(increased risk for gastric cancer)

15

Pernicious anemia Tx.

Vit B-12 shot IM for life, or intrasnasal. ( cyanocobalamin blue b-12 )

16

Folic Acid deficiency is caused by

undernourishment, malabsorbtion, Hemodialysis, and ETOH alcoholism.

17

Folic Acid deficiency S/S

sore beefy tongue

18

Folic Acid Tx.

PO intake of folic Acid

peanuts,avocado, meat-liver, OJ, whole grains, green leafy veggies

19

What is Aplastic Anemia ?

Pt. has peripheral blood pancytopenia- a decrease in all blood cell types and hypocellular bone marrow.

20

Pancytopenia Tx. is....

stem cell transplant

Immunosurpressive therapy- can increase chances of infection

Blood transfusion

21

Blood Transfusion calculations are

1 to 3 for hgb to hct.

1 PRC= 1 unit of Hgb (PRC-Packed Red blood cells)

1 PRC= 3 units of Hct

Ex: Hbg-2 Hct-3 :1 unit transfusion rate= Hbg-3 and Hct-6

22

Hemolytic Anemia

The destruction of RBC's at the rate that exceeds production.Third major anemia

S/S of anemia, jaundice, the spleen is the primary site of destruction of the RBC's.

23

What is Hemochromatosis

An Iron overload due to genetic defects caused by increased intestinal iron absorption and increased tissue iron deposits.

24

Hemochromatosis S/S

early- arthriagia (pain in a joint), Fatigue and abdominal pain

Late- Bronzing of the skin, Liver enlargement, cirrhosis, and cardiomyopathy

25

Hemochromatosis Tx.

  • Reduce Iron by removing 500 ml of blood a week for 2-3 years until iron stores are depleted.
  • Chelating agents (deferoxamine)- it removes iron via the kidneys given IV or subq.
  • Dietary changes- no vit-C, uncooked seafood & iron rich foods.
26

What is Polycythemia

Increased production of RBC's impairing blood circulation due to increased blood viscosity and volume. This causes too much clotting

27

Polycythemia S/S

Thrombosis and stroke most serious

HTN, Headache, vertigo, dizziness, tinnitus (ringing or buzzing in the ears), & visual disturbances,

Paresthesias- tingling or pricking

28

Polycythemia Tx.

Phlebotomy is the mainstay,avoid iron supplements

hydration therapy to reduce blood viscosity.

Aspirin

29

Secondary Polycythemia is what?

hypoxia driven (deficiency in the amount of oxygen reaching the tissues)

due to high elevation (climbing mt. Everest)

30

Secondary Polycythemia Tx.

stay out of high altitudes

stop smoking & manage pulmonary diseases

Phelbotomy- removal of blood weekly keeping hct less than 45-48%

31

What is Thrombocytopenia

reduction of platelets less than 150k.

32

Thrombocytopenia S/S

most common bleeding

petechiae- red dots under the skin and purpura-a cluster of petechiae

if internal bleeding- confusion, headache, seizures, dizziness, cerebral bleeding and tachycardia.

33

Thrombocytopenia Tx

no blood thinners

aspirin, anti-platelets or heparin products

may need corticosteroids or splenectomy, iv immunoglobulin or plasma exchange. no needles or use smallest gauge.

34

What is Immune Thrombocytopenia (ITP)

The abnormal destruction of platelets in the spleen

(The immune system attacks the platelets in the spleen. It thinks they are foreign and destroys the platelets)

(sometimes H. pylori & infection contributes to this disease)

35

Immune Thrombocytopenia Tx.

Steroids- it alters splenic macrophages phagocytic response. (Alters the spleen recognition of the platelets which increases their lifespan)

Splenectomy may be needed

36

what is Thrombotic Thrombocytopenia (TTP)

enhanced clumping of platelets cause clots in small vessels can be due to certain drugs.

bleeding and clotting at the same time.

37

Why is TTP a medical emergency?

There's bleeding and clotting at the same time

38

Thrombotic Thrombocytopenia (TTP) Treatment

Steroids, plasma exchange, immunosuppressant on inactive immune response

splenectomy- (removal of the spleen)

39

What is Heparin induced thrombocytopenia (HIT)

platelet destruction from heparin that occurs after 5-10 days of usage leads to more platelet activation- DVT and PE with clotting

40

Heparin Induced thrombocytopenia Tx:

Stop all heparin incld. heparin flushes and lovenox

pull plasma spin it, and put back in

protamine sulfate (antidote to heparin)

Thrombolytic agents ( remove clots)

or Surgery

41

What is Neutropenia?

decrease in neutrophils less than 1000, causing little to no ability to fight infection. caused by chemo & immunosuppresants

42

Neutropnia fever is an important sign why

with decreased WBC's the ability to fight infection is very low.

a fever of 100.4 can be light threatening

43

Neutropenia S/S

fever, chills, sepsis, minor complaints of pain.

pt. own flora is the most common cause of infection

44

Neutropenia Tx:

Blood cultures STAT.

start antibiotics

hand washing, visitor restriction, private room, daily baths, soft toothbrush 4 times a day, don't' clean up after pets.

avoid, uncooked meats, seafood eggs, tap water and unpeeled fruits and veggies

45

What is Lymphoma

cancer in the bone marrow causing increased in WBC's

46

Hodgkin's Lymphoma is what?

found only in the lymph nodes

47

What are Reed-Sternberg cells

giant multinucleated cells found only with Hodgkin's lymphoma

48

S/S of Hodgkin's Lymphoma

painless movable lymph node enlargement in the neck

weight loss, fatigue, fever & night sweats

49

How to diagnose Hodgkin's Lymphoma

excisional lymph node biopsy

blood test and bone marrow exams.

50

Lymphoma B-Symptoms

worse prognosis, weight loss, fatigue, fever night sweats

51

Lymphoma staging process: Stage 1

localized to where it started in the lymph nodes

52

Lymphoma staging process: Stage 2

in lymph node and anywhere above the diaphragm

53

Lymphoma staging process: Stage 3

above and below the diaphragm and lymph node

54

Lymphoma staging process: Stage 4

all over and the organs are infected

55

Non-Hodgkin's Lymphoma is

malignant neoplasms of B or T cells

it spreads thru the lymphatic system can cause airway obstruction, kidney problems, GI prob. and pericardial tamponade (Compression of the heart caused by fluid collecting in the sac surrounding the heart.) can originate outside the lymph nodes

56

Non-Hodgkin's Lymphoma Dx test and Tx

Lymph node biopsy, MRI, LP, Bone marrow biopsy, endoscopy

tx: stem cell transplant, chemo, and radiation

NC: discuss fertility issues and tx s/s

57

Multiple Myeloma

neoplastic plasma cells infiltrate the bone marrow and destroy bone

you will have pain in the pelvis,spine and ribs, osteoporosis, fractures not caused by trauma (pathologic fractures)

58

Multiple Myeloma treatment and test

chemo, steroids, ambulation massive hydration

test- MRI, PET, CT, bone marrow analysis

59

What is Splenomegaly

enlarged spleen due to increased filtering of RBC's

Howell-jolly bodies- pocked RBC's = malfunctioning spleen

60

What do you watch for post Splenectomy

risk of infection life long, give pneumonia vaccine watch for lung expansion issues

61

Name of protein in abundance in pt. with multiple myeloma

M protein found in the blood

Bence Jones protein found in the urine

62

what electrolyte imbalance is often seen in multiple myeloma

Hypercalcemia from the destruction of the bone