Blood & Lymph Systems - Med/Surg (Christiensen Ch. 47)

5 Written Questions

1. Measured in the Erythrocyte Index, the MCV measures the size and volume of a single RBC
2. Loss of 1000 mL is severe (complications include hypovolemic shock). Usually related to internal or external hemorrhage. Loss of volume causes decrease of oxygen to tissues and cells. Average total volume = (6000 mL (6 L or 12 pints), most can tolerate a loss of up to 500 mL.
   S & S - restlessness, subtle rise in respiratory rate, weakness, stupor, irritability, and pale, cool, mosit skin.
3. aka DIC, a grave disease process in which the patient experiences both bleeding and intravascular clotting at the same time. It results from the overstimulation of clotting and anticlotting processes in response to disease or injury, including septicemia, obstetrical complications, malignancies, tissue trauma, transfusion reactions, burns, shock, or snake bites.
4. Stop blood loss. Treat for shock and lost volume (IV of normal saline, a 2 L bolus can be used in extreme cases). Mechanical ventilation may be needed (oxygen therapy restores oxygen that is decreased because of decreased hemoglobin in blood). Packed RBC infusion if hemoglobin is less than 6 or hypovolemia continues. Monitor hemoglobin. 1 unit of packed
   RBCs should raise hemoglobin by 1 g/dL. Iron may be given because it boosts bone marrow production of RBCs.
5. Is replacing the Schilling Test, it is a serum test that measures Vit B12 methylmalonic acid, and homocysteine levels.

5 Matching Questions

1. Pernicious Anemia - Diagnostic Tests
2. Peripheral Smear
3. Pernicious Anemia
4. Hypovolemic Anemia Diagnostic Test
5. Aplastic Anemia - Medical Management

1. a Extreme weakness with dyspnea, fever, hypoxia. With progression weight loss, slight icterus (jaundice) with pallor. Skin may be a pale lemon-yellow because of the excessive destruction of the RBCs which causes the bile pigments to increase in the blood serum. Edema of the legs, intermittent constipation and diarrhea.
2. b Diagnose cause and remove if possible, e.g.: related to a med or radiation therapy, avoid blood transfusions if possible to prevent iron overloading and the development of antibodies to tissue antigens, platelet transfusions to treat serious thrombocytopenia, bone marrow transfusions, spleenectomy, steriods and androgens are sometimes used to stimulate bone marrow. Immunosuppressive therapy with antithymocyte globulin and cyclosporine or Cytoxan has become important for patients who are not candidates for bone marrow transplantation or hematopoietic stem cell transplant(treatments of choice for patients under 45)
3. c The most informative of all the hematological tests. All 3 blood cell lines can be examined. Allong with the WBC differential, allows examination of the size, shape and structure of individual RBCs and platelets, differentiates between various forms of anemias and blood dyscrasias (pathologic condition or disorder such as leukemia or hemophilia in which the constituents of the blood are abnormal or are present in abnormal quantity).
4. d Because when blood loss is sudden plasma volume might not yet have had a chance to increase, the loss of RBCs is not reflected in laboratory data and therefore lab values may seem normal or even high for 2-3 days. However, once the plasma is replaced the RBC mass is less concentrated and then the H & H levels are severely decreased, often to half the normal values.
5. e Schilling test shows malabsorption of Vit B12. Serum Megablastic Anemia Profile is replacing Schilling test, it reveals serum methylmalonic acid and homocysteine. Bone marrow aspiration reveals abnormal RBC development. RBCs are too large and odd shaped and the B12 levels are reduced. Gastric analysis may be done and will show a decrease in hydrochloric acid (an acidic environment is required for the secretion of intrinsic factor).

5 Multiple Choice Questions

1. Infection. Agranulocytosis is a potentially fatal condition of the blood characterized by a severe reduction in the number of granulocytes. Both the WBC count and the differential neutrophil counts are extremely low. The patient with this disorder is highly susceptible to a life-threatening infection.
   1. Hypovolemic Anemia Diagnostic Test
   2. The most severe risk for a patient with agranulocytosis is...
   3. Pernicious anemia results from:
   4. Aplastic Anemia - Diagnostic Tests
2. May have acute onset or develop over several weeks or months. With suppression of all 3 types of blood cells, patient may develop signs and symptoms of all 3 - e.g.: suppression of WBCs may result in infection, suppression of RBCs may lead to anemia, suppression of thrombocytes may cause petechiae. Repeated infection with high fever, fatigue, weakness, general malaise, dyspnea, palpitations. Mortality is high from complications of infection and hemorrhage. Bleeding tendencies can be petechiae, ecchymoses, bleeding gums, epistaxis, GI & genitourinary system bleeding
   1. Aplastic Anemia - Diagnostic Tests
   2. Aplastic Anemia - Prognosis
   3. Aplastic Anemia - Manifestations
   4. Aplastic Anemia - Assessment
3. Subjective - thirst, weakness, irritability, restlessness
   Objective - decreased bp; rapid, weak, thready pulse; rapid respirations; cold & clammy skin with pallor; oliguria (inability to produce uria sufficient to support metabolic waste elimination, less than 30 mL/hr); mental disorientation; physical collapse with prostration (exhaustion)
   1. Hypovolemic Shock
   2. Pernicious Anemia
   3. Iron Deficient Anemia
   4. Hypovolemic Anemia
4. To diagnose pernicious anemia. Gastric secretions are minimal and pH remains elevated even after injections of histamine.
   1. Pancytopenic
   2. Gastric Analysis
   3. Hemostasis
   4. Epistaxis
5. Below normal range levels of RBCs, hemoglobin and/or hematocrit, causes an insufficient amount of oxygen to be delivered to cells and tissues.
   1. Epistaxis
   2. Pancytopenic
   3. Hemostasis
   4. Anemia

5 True/False Questions

1. Erythrocyte Index → Measures the size and hemoglobin content, provides info about the average volume or size of a single RBC (MCV - Mean Corpuscular Volume)

   True        False

2. Pernicious Anemia - Nursing Interventions → V/S q4h. Mouth care several times a day. Diet high in protein, vitamins & minerals. Add lightweight blankets (anemia patients are sensitive to cold). Interventions should conserve energy and prevent injury (due to nerve myelination).

   True        False

3. Aplastic Anemia - Assessment → Subjective - includes history of exposure to chemicals such as insecticides and drugs in addition to family history of aplastic anemia.
   Objective - monitor for pallor, signs of infection and bleeding tendencies, also dypsnea and tachycardia

   True        False

4. Lymphangiography → To diagnose metastatic involvement of the lymph nodes. Raidological exam, contrast medium is injected into the lymph vessel of the hand or foot, followed by visulization of the lympatic system. (Note: CT is now the preferred method of examination)

   True        False

5. Intrinsic Factor → Cause unknown as in Idiopathic Aplastic Anemia

   True        False