Hematology NU214 Hematological Disorders

Question Answer
What is an Erythrocyte – Red Blood Cell<br/>- A non-nucleated biconcave disk which contains hemoglobin<br/>
What does hemoglobin Carry – Oxygen<br/>
How long does an eyrthrocyte live – 120 days<br/>
What is the average counts in the blood – 4.6 – 6.2 million/cu mm in males<br/> – 4.2 – 5.4 Million/cu mm in Females<br/>
How are RBCs Removed from the body – Liver<br/> – Spleen<br/> – Bone Marrow<br/>
What are some of the labs used in Hematology – Hemoglobin levels<br/> – MCV<br/> – MCHC<br/> – Hematocrit<br/> – Reticulocytes<br/>
What is a Hemoglobin test measure – Total amount of hemoglobin in the peripheral blood <br/>
What are the normal values for hemoglobin levels – Male 13 – 18 g/dL<br/> – Females 12 – 16 g/dL <br/>
What MCV measure – Mean Corpuscular Volume<br/> – measure of the average size of a single RBC<br/>- can be marcocytic or microcytic<br/>
What is Macrocytic – Larger than normal RBC<br/> – found in B12 Deficiency Anemia<br/>
What is Microcytic – Smaller than normal RBC<br/> – found in Iron Deficiency Anemia<br/>
What does MCHC measure – Mean Corpuscular Hemoglobin Concentration<br/> – Measure of the average percentage of hemoglobin within a single RBC<br/> – Hypochromic<br/>
What is Hypochromic – Lower than normal hemoglobin in a RBC<br/> – found in Iron Deficiency Anemia<br/>
What does a Hematocrit measure – Measure of the percentage of The total blood volume made up by RBCs<br/>
What are the normal values for hemoglobin – Male 40 – 52% <br/>- Female 36 – 48% <br/>
What are Reticulocytes – Immature RBCs <br/>
What are the normal values for Reticulocytes – 0.5% – 1.5% of RBCs <br/>
What is Anemia – a condition in which the hemoglobin concentration is lower than normal.<br/>- Presence of fewer than normal RBCs within circulation<br/>- Results in diminished oxygen delivery to the tissues of the body.<br/>
What are the manifestations of Anemia dependent upon – How rapid the anemia develops <br/>- Duration of the Anemia <br/>- Metabolic Requirements of the Patient<br/> – Concurrent Problems <br/>- Concomitant Features <br/>
What are some of the Manifestation of Anemia – Fatigue<br/>- Weakness <br/>- Malasie <br/>- Pallor<br/>- Jaundice <br/>- Cardiac and Respiratory Problems<br/> – Tounge Changes <br/>- Nail Changes <br/>- Angular Cheilosis <br/>- Pica <br/>
What are some of the nursing diagnosis for a patient with Anemia – Fatigue <br/>- Altered Nutrition<br/> – Altered Tissue Perfusion<br/> – Noncompliance with Prescribed Therapy <br/>
What are some of the potential complications of Anemia – Heart Failure<br/> – Angina <br/>- Parathesias in Vit B12 <br/>- Confusion in Vit B12<br/>
What should be corrected or controlled with Anemia – The Cause <br/>
What can be transfused with Anemia – Packed RBCs <br/>
What type of anemia is packed RBCs usually not given too – Macrocytic because of Fluid volume excess the body has adapted<br/>
What other treatments can be used for anemia – Dietary Therapy – Iron or vitamin supplementation – Iron – Folate – B12 – Bone Marrow Transplant – Immunosuppressive therapy
What should a nurse balance with anemia interventions – Physical activity – Exercise – Rest
What should a nurse maintain with anemia interventions – adequate nutrition
What type of education should a nurse provide with Anemia – one that promotes compliance with medications and nutrition
What should a nurse monitor with anemia interventions – Vital Signs – Pulse Oximetery – provide supplemental oxygen as needed – Potential complications
What is hypoproliferative anemia – Deficient in RBC production – due to lack of iron, B12, or folate – Decrease in eyrthropoietin production – Cancer
What is Iron Deficiency anemia – a person that lacks significant amount of iron – hypoproliferative – hypochromic – microcytic
What are the lab values with Iron deficiency anemia – Low Reticulocytes – Low Iron – Low Ferritin – Low MCV – High TIBC
What is ferritin – Aids in the storage of iron
What is TIBC – Total Iron Binding Capacity
What is the Etiology of Iron Deficiency – intake of dietary iron is inadequate
What would cause iron deficiency anemia in children – too much milk product
What would cause iron deficiency anemia in Teens – Fad Diets – Pop – Bad Diets
What would cause iron deficiency anemia in Pregnant women – extra need of iron
What would cause iron deficiency anemia in Alcoholics – Bleeding in GI Tract
What would cause iron deficiency anemia in Women – Excessive mensis
What are the two types of iron found in foods – Heme found in animal products – nonheme found in plant products – need both for best utilization
What foods are high in iron – Organ Meats – Muscle Meats – Egg Yolks – Whole Grains – Dark Green Vegetables – Legumes – Nuts
What is Ferritin – The major iron storage protein – is normally present in the serum in concentrations directly related to iron stores
What happens to the iron as the hemoglobin is destroyed – the iron is recycled
How much iron is absorbed through the digestive tract – 10% of the iron consumed
How much iron can the body store – 1/4 to 1/3 of its iron until it is depleted then anemia develops
What type of oral medication is given to a patient with iron deficient anemia – Ferrous sulfate – 300mg 2 – 4 times/day
What should be taken to help absorption – Vitamin C
What about meals and Iron Supplements – Should be taken 1 hours before and 2 hours after
what foods can decrease iron absorption – Milk – Bran – Tea
What medications can decrease iron absorption – Antacids – Histamine 2 blockers – Calcium
What precautions are needed with liquid Iron – Mix it with liquid – Stains teeth – use a straw – Rinse mouth – Brush teeth
What are the stools like with iron supplementation – Dark and green
Vitmin B12 Deficiency – normochromic – macrocytic – Hypoproliferative
What are the labs like with B12 deficiency – decreased Vitamin B12 – Increased MCV
What is the etiology of Vitamin B12 deficiency – Vegetarians who consume no meat or dairy – Faulty absorption as in Crohns disease, Gastrectomy, gastric bypass
What foods are high is Vitamin B12 – Organ meats – muscle meats – milk – cheese – eggs
Pernicious Anemia – Primarily a disorder of elderly and has a familial tendency. – the abnormality is in the gastric mucosa which fails to secrete the intrinsic factor
what are the labs like with pernicious Anemia – – Low vitamin B12 – Low Intrinsic factor
What is needed for a person with Pernicious Anemia – Injectable B12
What type of diet should a person with pernicious anemia have – soft diet because of mouth problems – May have beefy raw tounge
What are the Symptoms of B12 Deficiency anemia – Neurological – Confusion – Paresthesia in the extremities – Difficulty maintaining balance due to damage of the spinal cord – Loss of position sense
What can happen if B12 deficiency anemia goes on too long – the Neurological symptoms can be permanent
What is the Schilling test – Used in pernicious anemia – Evaluates the bodys ability to absorb vit B12 by testing urinary excretion of radioactive vit b12 with or without the intrinsic factor
Folate Deficiency – Normochromic – Macrocytic
What are the lab values like with folate Deficiency – Decrease Folate levels – Increased MCV
What is the etiology of Folate Deficiency Anemia – Rarely eat uncooked vegetables or fruits – Over cooked Vegetables
Who are affected by Folate Deficiency Anemia – Alcoholics – Pregnant Women – Patients with hemolytic anemia – Each have increased needs
What foods are high in Folic acid – green leafy vegetables – Organ meats – Whole Grains – Enriched Cereals
Aplastic Anemia – normochromic – normocytic – decrease in percursor cells in the bone marrown
What is the Etiology of Aplastic Anemia – Idiopathic
What Medications are related to the cause of aplastic anemia – Anticonvulsants – Cytotoxic Agents(Chemo)- Anti-Thyroid meds – Antimicrobials – Hypoglycemic agents
What 2 hypoglycemic agents are related to aplastic anemia – Actos causes slight anemia – Avandia causes bad anemia
What Chemicals are related to Aplastic Anemia – Organic Arsenic – Benzene – Pesticides
How does Aplastic Anemia manifest itself – Gradual onset – Weakness – Pallor – Dyspnea on exertion – Abnormal bleeding in about 1/3 of patients – Sepsis
How is Aplastic Anemia managed medically – Bone marrow transplant – Immunosuppressive therapy
Why is a bone marrow transplant given with aplastic anemia – Because the marrow is replaced with fat
What are Hemolytic Anemias – Excessive destruction of RBCs
What are some of the causes of Hemolytic Anemias – Altered erythropoiesis – Hypersplenism – Drug induced autoimmune response – Mechanical Heart Valve
What are the types of Hemolytic Anemias – Inherited- Acquired
What are the Inherited types of Hemolytic Anemias – Sickle Cell Anemia – Thalassemia – Sherocytosis – Glucose-6-Phosphate Dehydrogenase Deficiency
What are the acquired types of Hemolytic Anemias – Autoimmune Process – Drug induced – Heyperslenism – Mechanical Heart valve
What is Sickle Cell Anemia – An acquired hemolytic anemia where the person inherits hemoglobin S HbS that causes sickling of the RBCs – Genetic implications
What causes the sickling for the cells in Sickle Cell Anemia – The lack of O2 tension in the cell
Who is Sickle Cell Anemia found in – African Defense – lesser in Middle East and Mediterranean
How can you change the sickle trait – by administering Fluids and O2
What percentage of the Hemoglobin sickle in Sickle Cell Anemia – less than 50%
What are some of the Manifestations of sickle cell anemia – Anemia 7 – 10 g/dL- Jaundice due to hemolytic anemia – bone marrow expands – Dysrhythmias
What is a Sickle Cell Crisis in Sickle Cell Anemia – Painful episode due to tissue hypoxia and necrosis
What should you so for a person in Sickle Cell Crisis – Keep them hydrated.
What are the patterns of Sickle Cell Crisis/Vaso-occlusive Crisis – Acute Chest Crisis – Abdominal Crisis – Joint Crisis
What is an Acute Chest Crisis in Sickle Cell Crisis – Sudden chest pain- Low-grade fever – Shortness of Breath
What is an Abdominal Crisis in Sickle Cell Crisis – Pain is constant and sudden – May be localized – Nausea – Vomiting – Diarrhea
What is a Joint Crisis in Sickle Cell Crisis – May develop without significant traumatic history – Single of Multiple joints
How long does a Sickle Cell Crisis Last – 5 – 7 Days – Frequency, Severity and duration vary considerably
What are the treatments for Sickle Cell Crisis – Hydration – Analgesics
How can a Sickle Cell Crisis be managed in the ER – Fluids and Pain Meds
What can happen if there is a delay in the treatment of a Sickle Cell Crisis – the condition may become worse – May require hospitalization
When should a person do to the hospital when having a Sickle Cell Crisis – Uncontrolled pain even with use of narcotics – Uncontrolled Fever – Continued fluid Loss – Chest Pain – Shortness of Breath – Severe Abdominal Pain
What is a Complication of the Spleen in a Sickle Cell Crisis – Abdominal Pain – Signs of Infection
What is a Complication of the Lungs in a Sickle Cell Crisis – Chest Pain – Dyspnea
What is a Complication of the CNS in a Sickle Cell Crisis – Weakness- Learning Difficulties
What is a Complication of the Kidney in a Sickle Cell Crisis – Dehydration
What is a Complication of the Heart in a Sickle Cell Crisis – fatigue – Dyspnea
What is a Complication of the Bone in a Sickle Cell Crisis – Hip Pain – Joint Pain
What is a Complication of the Liver in a Sickle Cell Crisis – Abdominal Pain
What is a Complication of the Eye in a Sickle Cell Crisis – Blindness
What is a Complication of the Penis in a Sickle Cell Crisis – Impotence
Where are the common sites for pain with Sickle Cell Crisis – Joints – Extremities – Chest – Abdomen
What situations should be avoided that may precipitate a Sickle Cell Crisis – Infection – Dehydration – Strenuous Physical activity – Hypoxia – Exposure to Cold – Pregnancy
How can infection be prevented in Sickle Cell Crisis – Encourage Early Ambulation – Promote adequate Nutrition – Promote Adequate fluid Intake
What should there be an absence of with Sickle Cell Crisis – Hypoxia – Ischemia
What is Thalassemia – A group of hereditary disorders associated with defective hemoglobin chain synthesis
What is the Severity dependent upon with thalassemia – the amount of hemoglobin chains involved
What are the 2 Major groups of Thalassemia – Alpha – Beta
What is Alpha-thalassemia – Milder form – occurs mainly in people from Asia and the Middle East
What is Beta-Thalassemia – Thalassemia Major – Cooley's Anemia – occur mainly in people from the Mediterrean regions – may also occur in those from the middle east or Asia
What can happen if Beta-Thalassemia is left untreated – the person can only live a few years and with blood transfusions
What is Hereditary Spherocytosis – Relatively common – Characterized by large round RBCs – Abnormal permeability of the membrane – Hemolysis maybe mild – Can hold O2
What is the treatment for Hereditary Spherocytosis – removal of the spleen
What is Glucose-6-Phospahte Dehydrogenase Deficiency – Hemolysis occurs when the RBCs are stressed – can be caused by medications or foods
What is Glucose-6-Phosphate Dehydrogenase – an enzyme within the RBC that is essential for membrane stability
What medications can cause Glucose-6-Phosphate Dehydrogenase Deficiency – Antimalarial Agents – Vitamin K – Sulfonamides – Aspirin in High Doses – Oral Hypoglycemics agents – Thiazide Diuretics
What foods can cause Glucose-6-Phosphate Dehydrogenase Deficiency – Fava Beans
What are some of causes of Acquired Hemolytic Anemia – Autoimmune Process – Drug Induced
What are some of the Autoimmune conditions that cause hemolytic anemia – the most common results from a hemolytic transfusion reaction or ABO incompatability – Infections – neoplasm – connective tissue conditions
What are some of the Drug induced conditions that cause hemolytic anemia – Methyldopa – High Dose penicillin – Streptomycin – quinine – quindine
How can hypersplenism cause hemolytic anemia – by destroying RBCs
How can a mechanical heart valve cause hemolytic anemia – Friction from the valves
What are some of the disorders that cause Polycythemia – Polycythemia vera – Secondary Polycythemia
What is Polycythemia Vera – a proliferative disorder- the myeloid stem cells become hyperactive especially RBCs
What is the cause of Polycythemia Vera – Unknown
What are the manifestation of Polycythemia Vera – Ruddy Complexion – Splenomegaly – Increased Blood Volume – Increased Blood Viscosity – Pruritis
what are some of the complications of increased Blood Volume in Polycythemia Vera – Headache – Dizziness – Tinnitus – Fatigue – Paresthesia – Blurred Vision
What are some of the complications of increased Blood Viscosity in Polycythemia Vera – Angina – Claudication – Dyspnea – Thrombophlebitis
What some of the complications of Polycythemia Vera – Thrombosis – Bleeding
What can be done in the management of Polycythemia Vera – Phlebotomy – Avoid Iron Supplements – Allopurinol may be given because of increased uric acid from breakdown of RBCs – Chemotherapy(hydroyurea)
What is secondary polycythemia – occurs as compensatory response to tissue hypoxia associated with prolonged exposure to high altitude, chronic lung disease(smoking) and heart disease
What are some of the bleeding disorders – Primary thrombocythemia – Thrombocytopenia – Idiopathic Thrombocytopenia Purpura – Hemophilia – Von Willebrand Disease – Disseminated Intravascular Coagulation
What is Primary Thrombocythemia – Stem cell disorder within the bone marrow that causes a platelet count that is greater than 600,000/mm(normal 150,000-400,000), abnormal size, survival is normal of 7 – 10 days.
What are some of the manifestations of Thrombocythemia – Asymptomatic – If they occur thrombosis in microcirculation, hemorrhage.
What is done in the management of Thrombocythemia – Low Dose aspirin which is controversial – Chemotherapy if other risk factors such asPVD, Smoking, Athereosclerosis
What is Thrombocytopenia – Low Platelet count in the blood
What are the types of Thrombocytopenia – Decreased Production – Increased Destruction – Increased Consumption
What are some of causes of decreased production in Thrombocytopenia – Hemorrhagic Malignancy – Myelodysplastic syndrome – Aplastic anemia – Megaloblastic anemia – Toxins- Medications – Alcohol – Chemotherapy
What are some of the causes of increased destruction in Thrombocytopenia – Due to Antibodies – Due to infection – Sequestration of platelets
What are some of the antibody dysfunctions that cause an increased destruction in Thrombocytopenia – ITP Idiopathic Thrombocytopenia purpura- Lupus Eyrthematosus/Maglignant Lymphoma – Chronic lymphocytic leukemia – Medications
What are some of the infections that cause an increased destruction in Thrombocytopenia – Bacteremia – Post viral Infection
What are some of the Sequestration dysfunctions that cause an increased destruction in Thrombocytopenia – an enlarged spleen
What are some of the causes of increased consumption in Thrombocytopenia – DIC- Disseminated Intravascular coagulation
What are some of the substances that impair platelet function – Anesthetic agents – Anticoagulation agents – NSAIDS – Antineoplastic agents – Antibiotics – Cardiovascular Drugs
What are some of the antibiotics that can impair platelet function – Penicillins – Cephalosporins
What are some of the Cardiovascular drugs that can impair platelet function – Beta-Blockers – Calcium channel Blockers – Nitroglycerine
What are some of the substances that can impair platelet function – Caffeine – Ethanol – Vitamin E – Fish Oils – Garlic – Onion Extract – Herbal Supplements
What are some of the herbal Supplements that can impair platelet function – Feverfew – Ginger – Gingko – Ginseng – Kava Kava
What is Idiopathic Thrombocytopenia Purpura – It is an increased destruction of Platelets
Who does ITP usually affect – More common in children and young women
When does ITP usually appear – Often appears 1 – 6 weeks after an infection
When does remission occur in ITP – Spontaneously within 6 months
When does the bleeding usually occur with ITP – when platelets are less than 10,000/mm
What are some of the manifestation of ITP – Easy bruising – Heavy Menses – Petechiae – Hematuria – Wet Purpura
What is Wet Purpura – Bleeding from mucosal surfaces (GI and Pulmonary)
What can be done for the management of ITP – Stop medications that is known to cause ITP(quinine, sulfa drugs) – Immunosuppressive agents – IV immune globulin – Splenectomy – Chemotherapy
What is a Splenectomy – Removal of the spleen
Why would the spleen be remove – Rupture – Acquired hemolytic anemia – Trauma – Tumor – ITP
What should a nurse observe for with a splenectomy – signs of hemorrhage – Bleeding tendency with thrombocytopenia
What should a nurse recognize as a normal temperature with a splenectomy – A temp of 101 is normal for 10 days
What should a nurse teach with a splenectomy – Increased risk of infection – Call HCP if any bleeding – SOB – increased swelling in abdomen – yearly flu vaccine important
What is Hemophilia – Hereditary Bleeding disorder that are X-linked
What are the 2 types of Hemophilia – Hemophilia A – Hemophilia B
What is Hemophilia A – Deficient in factor VII
What is Hemophilia B – Deficient in factor IX – called Christmas Disease
Who does Hemophilia Affect – Almost all affected persons are males – Mothers and sisters can be carriers but they remain asymptomatic
What are some of the manifestations of Hemophilia – large spreading bruises and bleeding into muscles, joints, and soft tissue after even minimal trauma. – Intracranial Bleeding- Spontaneous Hematuria – GI Bleeding
What happens with the Joints in Hemophilia – Recurrent joint hemorrhages can result in damage so severe that chronic pain or ankylosis(fixation) of the joint occurs
What happens with the peripheral nerves in Hemophilia – Peripheral nerves are compressed resulting in decreased sensation, weakness and atrophy.
What was done in the past in the management of Hemophilia – Fresh Frozen Plasma
What is done with the management of Hemophilia – Blood By-Products of recombinant forms of Factor VII and IX. – Amicar – Avoid agents that interfere with platelet aggregation – Rest Joints during active bleeding
What is Amicar – A fibrinolytic enzyme inhibitor that can slow the dissolution of bloods clots
What is Von Willebrand Disease – Most common hereditary bleeding disorder – Inherited at birth- may not manifest itself until later in life- affects both males and females
What are some of the manifestation of Von Willebrands Disease – Heavy bleeding after surgery – Postpartum hemorrhage – Severe menstrual bleeding – Bruising – Epistaxis – bleeding following tooth extractions ares clues to this disorder
What is the treatment of Von Willebrands Disease – Mild treatment with decompression – Severe: replacement of vWF and factor VII
What medication should be avoided with bleeding disorders – Avoid Aspirin or other medications known to inhibit platelet functions
What dont you give to a patient with a bleeding disorder – NO IM injections – NO indwelling catheters – No rectal temps – No Suppositories – No Enemas
What should be used for constipation in a person with a bleeding disorder – Stool softeners – Oral laxatives
What should be done with oral care in a patient with a bleeding disorder – NO Flossing – No Commericial Mouth washes – Use only soft bristle toothbrushes – only toothettes if platelet count is below 10,000 or if gums are bleeding
What should be done with a venipuncture site in a patient with a bleeding disorder – Apply pressure for 5 minutes or until bleeding is stopped
What should be done with a person with a cold and a bleeding disorder – Discourage vigorous coughing of blowing of the nose.
What should be done with respiratory issues and a person with a bleeding disorder – Avoid Suctioning at all possible
What is Disseminated intravascular coagulation – altered homeostasis mechanism causes massive clotting in microcirculation- as the clotting factors are consumed bleeding occurs – also called DIC
What are the symptoms of DIC – related to tissue ischemia and bleeding
What may trigger DIC – sepsis – Trauma – Shock – Cancer – abruptio placentae – toxins – allergic reactions
What is the treatment of DIC – treat the underlying cause – correct the tissue ischemia – replace fluids and electrolytes – replace coagulation factors – use heparin
How is the platelet count in DIC – Low- Normal 150,000 – 450,000/mm
How is the Prothrombin time in DIC – High – Normal 11.12.5 seconds
How is the Partial thromboplastin time in DIC – High – Normal 23 – 35 seconds
How is the Thrombin Time in DIC – High – Normal 8 – 11 seconds
How is the Fibrinogen in DIC – Low – Normal 170 – 340 mg/dL
How is the Fibrin degradation products in DIC – High- Normal 0 – 5 mcg/ml
How is the D-dimer in DIC – High – 0 – 250 ng/ml
What are some of the complications of DIC – Renal Failure – Gangrene – Pulmonary Embolism – Acute Respiratory distress – Stroke – Hemorrhage
What are some of the nursing interventions for DIC – Should target potential sites of organ damage- Monitor and assess carefully – Avoid Trauma and procedures that increase the risk of bleeding, including activities that increase intracranial pressure
What can be some of the nursing diagnosis for DIC – Risk for Fluid Volume deficit – Risk for impaired skin integrity
What should be done before a blood transfusion is given – Review the patients history including history of transfusions and transfusion reactions- note concurrent health problems and obtain baseline assessment and vital Signs – patient teaching and obtain consent
What equipment is use for a blood transfusion – IV – 20 gauge or greater needle for PRBCs – Appropriate tubing – normal saline solution
How long should it take to infuse PRBCs – 4 hours
What should be monitored during the transfusion – vital Signs
How much are the RBCs raise with each unit of PRBCs – 1 g/dL for each unit
What should you check the Platelets or FFP for before tranfusing – Unusual color or clumps
When does the transfusion have to take place with Platelets or FFP – Immediately after being obtained
How long should you infuse FPP or Platelts – 30 – 60 minutes
What should you observe for with infusion of FPP or Platelets – Adverse reactions
What are some of the complications of Transfusions – Febrile nonhemolytic reaction- Acute hemolytic reaction – Allergic reaction – Circulatory reaction – bacterial contamination – Transfusion related acute lung injury – Delayed hemolytic reaction – Disease acquisition
What is Febrile Nonhemolytic reaction

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