Blood & Lymph Systems - Med/Surg (Christiensen Ch. 47)
5 Written Questions
5 Matching Questions
- Pernicious Anemia - Diagnostic Tests
- Peripheral Smear
- Pernicious Anemia
- Hypovolemic Anemia Diagnostic Test
- Aplastic Anemia - Medical Management
- 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.
- 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)
- 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).
- 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.
- 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
- 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.
- 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
- 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)
- To diagnose pernicious anemia. Gastric secretions are minimal and pH remains elevated even after injections of histamine.
- Below normal range levels of RBCs, hemoglobin and/or hematocrit, causes an insufficient amount of oxygen to be delivered to cells and tissues.
5 True/False Questions
Erythrocyte Index → Measures the size and hemoglobin content, provides info about the average volume or size of a single RBC (MCV - Mean Corpuscular Volume)
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).
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
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)
Intrinsic Factor → Cause unknown as in Idiopathic Aplastic Anemia