Scheduled maintenance: Thursday, January 26 from 6PM to 7PM PST
Upgrade to remove ads
Only $35.99/year

Med-Surg Hematology

Terms in this set (132)

What are the three components of blood
Erythrocytes (RBC), Leukocytes (WBC) & Thrombocytes (Platelets)
Why is iron an vital component of blood circulation and hemoglobin
The reason iron is a vital component of blood circulation and hemoglobin is because it takes iron to attach 4 oxygen molecules for proper perfusion
True or False: iron is essential to part of hemoglobin
True
What is the origin of hemoglobin
Erythrocytes (RBC)
What is a small drop in tissue oxygenation "hypoxia" result in increase transfer of oxygen from hemoglobin to tissue and that is "why" hemoglobin MUST combine "loosely" with oxygen
Oxygen Dissociation
What is the composition of hemoglobin
IRON, B12, folic acid, nickel, copper, etc.
What is the selective growth of stem cells into mature erythrocytes that includes RBC production, control erythropoietin and stimulated by hypoxia
Erythorpoiesis
What is a multi-step process to control blood clotting
Hemostatsis
True or False: platelet plugs are NOT clots and last only a few hours. Thus, they cannot complete hemostatsis but only start the process
True
What is a soft substance in core of bones that result in blood cell production (Hematopoiesis):The production of all types of blood cells generated by a remarkable self-regulated system that is responsive to the demands put upon it.
Bone Marrow
What is produced by the Kidney in respond to hypoxia and is considered a growth factor for Erythrocytes
Erythropoietin
Which organ receives 24% of cardiac output (1500mL each minute) and the hematologic function includes synthesis plasma protein including CLOTTING FACTORS and ALBUMIN. Another function of this organ is to clear the body of damaged and non-functional RBCs/erythrocytes from circulation
Liver
Which organ is in the upper left quadrant of the abdomen that has a hematopoietic function of filtering/reuse certain cells, immune function, lymphocytes, monocytes and storage 30% of platelets while recycling IRON.
Spleen
When assessing the patient as a nurse through lab results there is a decrease in hemoglobin, decrease in respond to infection, consistent platelet count but decrease in coagulation confirmed by PTT/PT lab testing and bone marrow produce less cells
Aging
True or False: due to AGING, it is recommended as a nurse to educate the patient on limiting their IRON diet
True
Which physical assessment involves checking for pallor, jaundice that indicate poor tissue perfusion. This physical assessment also involves gums for active bleeding to light pressure "brushing teeth," and signs of Petechiae which is a reflects of hemorrhagic lesions.
Skin Assessment
What is the best place to assess Pallor
Conjunctiva
Which physical assessment involves documenting any enlarged lymph node that is sensitive to PAIN, check the tongue, iron deficiency anemia, oral mucosa.
Head and Neck Assessment
When performing this physical assessment for Kidney and Urine, what is a vital indication of underlining Hemotaologic condition
Protein in urine
True or False: an adult spleen is NOT palpable
True
What is a sign of hematologic issue during a abdominal assessment
ENLARGED but usually performed by provider because an enlarged spleen is tender and easily ruptures
When assessing the abdominal area, if the stool is BLACK "Melena" which part of the GI region is bleeding
Upper GI Tract
When assessing the abdominal area, if the stool is BRIGHT red, which part of the GI regiion is bleeding
The areas of the anus, rectum, and the sigmoid colon
When assessing the abdominal area, if the stool is dark red or maroon color, which part of the GI regiion is bleeding
The areas of the transverse colon and the right colon
True or False: Cloudy urine may be indicative of infection.
True
Which WBC's condition is caused by bacterial infection inflammation, trauma, stress, steroids and malignancies
Leukocytosis
Which WBC's condition is caused by viral infection, chemotherapy, immunosuppression, radiation therapy, disease of immune system and malignancies
Leukopenia
When a nurse is assessing Hemoglobin (Hbg), what is the normal range for a male patient
13.8-18g/dL
When a nurse is assessing Hemoglobin (Hbg), what is the normal range for a female patient
12-16g/dL
When a nurse is assessing Hemocrit (Hct), what is the normal range for a male patient
37-49%
When a nurse is assessing Hemocrit (Hct), what is the normal range for a female patient
36-46%
Does polycythemia and dehydration (e.g. burns) increase hemoglobin levels
Yes
Does blood loss, anemias and overhydration decrease hemoglobin levels
Yes
What the normal range of Platelets in an adult
150,000 to 350,000mm^3
What is called "Thrombocytes" and assist in the formation of blood clots
Platelets
Does bone marrow suppression, leukemia, HIV, viral infections, chemotherapy, pregnancy, ITP, autoimmune disease, medications (e.g. Heparin and Antibiotic) cause Thrombocytopenia
Yes
Does Splenectomy, Rheumatoid arthritis (RA) and Irony Deficit Anemia cause Thrombocytosis
Yes
What is a decrease level in RBC's, WBC's and Platelets
Pancytopenia
What is the normal range for Leukocytes (WBC's)
4,500-11,000mm or 4.5-11mm
What is the formula for ANC
WBC * Percentage of Neutrophil = ANC
True or False ANC is a more accurate laboratory testing method
True
What is Neutropenia from a ANC Laboratory Test
ANC < 1500mm
What Mild Neutropenia from ANC Laboratory Test
ANC 1000-1500mm
What is Moderate Neutropenia from ANC Laboratory Test
ANC 500-999
What is Severe Neutropenia from ANC Laboratory Test
ANC < 500
What are the diagnosis tools for Hematologic System
CT/MRI for Lymph Tissues; Bone Marrow Examination and Lymph Biopsies
What are the principle requirement for Blood Transfusion
It is required when patient(s) is symptomatic in which young people may tolerate HCT < 20 and older/CAD maybe symptomatic at HCT < 30
It is expected with Blood Transfusion that Hgb increase by 1g/dL and HCT increase by 3-4.
Yes
The result of a blood transfusion is volume expansion, correct anemia and improve oxygenation capacity
Yes
Which type of blood transfusion is RARELY used due to induce reaction. It is used for extreme cases of ACUTE HEMORRHAGE that increase red cell mass and plasma volume. It also increase oxygen carrying capacity of blood and 1 unit is estimated at 500 cc or mL
Whole Blood Transfusion
Which blood transfusion is COMMON to treat anemia, restore oxygen carrying capacity of blood.
Packed Red Blood Cell Transfusion
During a Packed Red Blood Cell Transfusion, the nursing should infuse in what time frame and HOW long should the infusion run?
The Infuse within 1 hour receiving and run over 2 hours normally
Normal volume of infusion is 250-350 ml
When the Packed Red Blood Transfusion is completed, when should the nurse check the blood work
1-6 hours after the Red Blood Transfusion is completed
How much should the HCT & Hbg improve after the Red Blood Transfusion
3-4% POINTS for HCT and 1g/dL for Hgb
True or False: A patient with Rh-positive can receive Rh-negative blood but a patient with Rh-negative blood CANNOT receive Rh-postive blood during a transfusion
True
Which Packed Red Blood Cell Transfusion is used to prevent recurrent or SEVERE allergic reaction(s), remove nearly all plasma, decrease concentration of leukocytes, remove platelets and cellar debris. It also require third generation filter
WASHED Packed Red Blood Cell
Which Packed Red Blood Cell Transfusion is used to filter removal of leukocyte antibodies, decrease non-hemolytic febrile reaction, CMV transmission, Esptein Barr virus, requires third generation leukocyte reduction filter and MUST specify CMV negative blood applicable
Leukocyte Reduced Packed Red Blood Cell Transfusion
Which transfusion contains ALL coagulation factors & complements but NOT platelets sued in treatment of coagulation deficiency (liver disease, malabsorption and DIC). This transfusion can also be used to correct Coumadin (e.g. Warfarin) induced coagulopathy while waiting for Vitamin K to work.
Fresh Frozen Plasma (FFP)
Which transfusion DOES NOT require Type & Cross
Fresh Frozen Plasma (FFP)
Which transfusion is VERY expensive but used to treat Thrombocytopenia and bleeding disorders
Platelet Transfusion
Post Platelet Transfusion, how much should the platelet count rise per unit
500-800 per unit
Which test is done by a nursing in order to prevent or avoid transfusion incompatible red blood cells.
Blood Typing & Cross Matching
What is done to determine the ABO blood group and Rh factor status
Typing
What is is done prior to transfusion to identify possible interactions of minor antigens with their corresponding antibodies
Cross-Matching
These are the requirements for which procedure listed:
Need large bore IV access - 16 or 18 G ideal
Unit of blood
Normal saline 250 ml bag
IV pole and pump
Gloves
Appropriate tubing with filter
Saline flush
Blood Administration for Transfusion
What is the order for a Blood Transfusion
Verify ORDER
Verify that the patient has signed CONSENT
Verify that patient has current Type/Cross Match within 72 HOURS
Verify IV ACCESS
EDUCATE the patient
2 LICENSED PERSONS must identify recipient and verify correct blood product
True or False:

Before blood transfusion, a check of the blood bag label and requisition form is done:
Lab
second licensed person
patient
Pre-medicate if needed
True
How many minutes should a nurse start a blood transfusion once received from the blood bank
30 minutes
What is started first before the blood transfusions
Normal Saline (NS) in order prime the tubing
True or False: when priming the line with NS before transfusion, the nurse should flush the line based on the consideration of the patient's age, blood volume, hemodynatics, and cardiac status
True
Is it recommended to complete a blood transfusion slower on an older patient
Yes
How long should a nurse observe a patient when the blood transfusion starts
15 minutes
If there are no signs of reaction, the nurse can start regular flow of blood transfusion
Yes
After regular flow is started how often should the nurse check the vital signs
every 30 minutes
What is the MAX time should a transfusion last
4 hours or less
Which blood Transfusion reaction is due to sensitivity to the blood transfusion in which the patient develop chills, tachycardia, fever and hypotension. This is also the most COMMON reaction to a blood transfusion
Febrile Reaction
Which blood transfusion reaction is due to incompatibility between the patient and donors blood that includes headaches, chest pain, lower back pain, tachycardia, hypotension and hemoglobinuria. This is a result of Rh-incompatibility
Hemolytic Transfusion Reaction
Which blood transfusion reaction is a result of blood transfused too quickly that results in hypertension, dyspnea, confusion, DJV and bounding pulse
Circulatory Overload
What is the major condition a nurse should watch for after a blood transfusion
Hyperkalemia
What assessments are perform after a patient states they are prolong weight loss with reason, night sweats, general malaise and shortness of breath
Spleen, Skin, Lymp and Neuro Status
What are the lab results after assessing a patient having issues after a blood transfusion reaction
Elevated WBC
Low Hgb
Low Plts
Elevated LDH "Tissue Damage"
For a Bone Marrow Aspiration, how should the nurse prepare the patient for this procedure?
Educate, explain the procedure, discuss the "position" and can they get in that position due to lung cancer or bleeding risk
For a Bone Marrow Aspiration, what nursing care is necessary during the procedure?
Help keep the patient calm, vital signs, access diaphoresis and emotional support
For a Bone Marrow Aspiration,
How will the nurse care for the patient after the procedure.
Pain Management, medications and hold pressure for 5-10 minutes. Sterile dressing, position of comfort, lay on side w/pillow and prevent pulling hip
For a Bone Marrow Aspiration,
What follow-up care is necessary?
Wound care, assessing the site, pain control and appointment set-up
What condition is a malignant proliferation of lymphocytes either of B or T. The growth occurs in solid tumors instead of stem cells
Lymphoma
A nursing performing an assessment can find swollen growing lymph glands, nodal disease, tumors in other organs. The patient is asymptomatic but may present with Common B Symptoms of fever, drenching night sweats, loss of 10% body weight without reason, pruritis (sever itching)
Lymphoma
Which stage of Lymphoma involvement of a single lymph node region or single extranodal organ or site
Stage I
Which stage of Lymphom involvement limited to one side of the diaphragm with 2 or more lymph node regions
Stage II
Which stage of Lymphoma involvement of lymph node regions on both sides of the diaphragm
Stage III
Which state of Lymphoma is diffuse or disseminated involvement of one or more extralymphatic organs
Stage IV
What is the primary treatment for Lymphoma
Chemotherapy
Why is radiation and surgery rarely used in Lymphoma
The majority of lymphomas present in multiple areas of the Body
Which a patient does not respond to primary treatment (e.g. Chemotherapy) for Lymphoma, what would be the recommended treatment
Bone Marrow Transplantation
Which condition is characterized by an abnormal proliferation of immature white blood cells, called blasts or progenitor cells.
Leukemia
Which type of Leukemia occurs in younger patients and the earlier stages of lymphocyte maturation
Acute Lymphoblastic Leukemia (ALL)
Which type of Leukemia occurs in adults usually a malignancy of the myeloblast
Acute Melogenous Leukemia (AML)
What is the condition during a nursing assessment the patient present with low Hgb (anemia), decreased/increased white blood cells, infection, fever and low platelet count (thrombocytopenia) with bleeding
Leukemia
Which condition present with red blood cell transfusion to correct anemia, treatments for infections caused by lack of mature white blood cells, platelet transfusion to stop any bleeding and start chemotherapy to kill leukemia cells.
Leukemia
True or False: Once chemotherapy stops, tumor cells die, the normal stem cells in the marrow that are resistant to chemotherapy divide, and their progeny cells mature and repopulate the marrow over the next 3 weeks
True
What condition is a result of Hgb < 7b/dL and increased Cardiac Output
Anemia
These are the three causes for which condition, blood loss, inadequate production of red blood cells and excessive destruction of red blood cells
Anemia
What is the condition If a patient present with Pallor, Fatigue, weakness, dyspnea, palpitations, tachycardia, hypotension, headaches, dizziness, restlessness, slowing of thought, paresthesia and feeling cold
Anemia
These are the common signs/symptoms for which condition listed: Orthostatic hypotension
Tachycardia (increasing with activity, after meals)
Murmurs and gallops
Decreased pulse pressure
Anemia
What is the most common sign/symptom of Iron Deficiency Anemia
Pallor
What condition does the patient have if they present during a nursing assessment a patient present with Pallor, Glossists, Cheilitis, sensitive to cold, weak and fatigue.
Iron Deficiency Anemia
What condition is a result of nursing intervention that involves treating underline conditions, REPLACEMENT of IRON, diet, drug therapy of iron supplements WITH Vitamin C
Iron Deficiency Anemia
Which condition result in nursing management of cardio/respiratory status, monitor vital signs, recognize bleeding (e.g. urine or stool "occult blood"), diet teaching on IRON, provide rest, diagnostic studies, compliance
Iron Deficiency Anemia
How long is iron therapy after a patient has Iron Deficinecy Anemia
2-3 months after the hemoglobin levels return to normal
Which anemia is a result of Vitamin B12 & Folic Acid Deficiency
Megaloblastic Anemias
Which anemia is a result of Cobalamin Deficiency "Pernicious Anemia." Intrinsic Factors require cobalamin for absorption.
Megaloblastic Anemias
Which anemia condition present with sore tongue, anorexia, weakness and parathesisas with altered thought process from confusion to dementia
Megaloblastic Anemia
What test is used fro Megalobalstic Anemia in which multiple tests are done after a patient intake Vitamin B12
Schilling Test
With Megalobalsitc Anemia, a patient loss gastric mucosa because H1 receptors are block due to atrophy with the lack of intrinsic factors deficiency
Yes
What is a reduction in ALL blood cell type that is acquired due to exposure to ionizing radiation, chemical agents, viral and bacterial infection, congenital and chromosomal alteration
Aplastic Anemia
What is managed with erythropoietin and blood transfusion
Aplastic Anemia
Which anemia condition is a result of homozygous for abnormal gene in which both parents are heterozygous for abnormal gene. This patient will present with anemia, vascular occlusion resulting in necrosis and increase susceptibility to infections "pneumococcal/pneumonia"
Sickle Cell Disease
What is the MOST common manifestation of Sickle Cell Disease (SCD)
PAIN
Do these conditions of INFECTION, hypoxia, dehydration, venous stasis, alcohol, high altitude, low/high environment or body temperature, acidosis, strenuous exercise, emotional stress and anesthesia play a role in Sickle Cell Disease (SCD)
Yes
True or False:
If a painful crisis persists or there is infection of a major organ (brain, lung, or heart), exchange transfusion is performed to remove some of the sickle red cells - the effect is temporary
True
It is advise for a child to take daily penicillin until age six to prevent serious infection if they have Sickle Cell Disease (SCD)
Yes
What is the number one nursing priority for Sickle Cell Disease
Fluids
What are considered a crises for Sickle Cell Disease
Infection (fxnal asplenia)
Dehydration
What is the initial nursing priority for Sickle Cell Disease
Fluid
What are the nursing priorities for Sickle Cell Disease
Fluid, Oxygen, Pain Management and potential cure: bone marrow and cell transplantation
True or False: Does hydration "fluid" with Sickle Cell Disease reduce the duration of pain episodes
True
Which drug that is given with Sickle Cell Disease may reduce the number of sickle cell, pain episodes by increase Hbg production. The potential risk of this drug is Leukemia
Hydroxyurea
What condition has the laboratory results of Increase Bilirubin, increase WBC's (chronic inflammation), decrease Hgb/HCT, and decrease Plts & HbS increased
Sickle Cell Disease
What is the normal range for Bilirubin
0.5-1mL
True or False: Morphine and hydromorphone (Dilaudid) are given IV route schedule or by infusion pump using PCA. Once relief is obtained, the IV does con be tapered and the drug given orally. AVOID PRN schedule drugs because they do not provide adequate relief. Moderate pain may be managed with oral doses o opioids or NSAID's.
True
Which condition present with nose bleeding, bruising and Petechia due to reducing in Platelets below 150,000
Thrombocytopenia
Which condition is a result of agglutination of platelets that form micro thrombi
Thrombotic Thrombocytopenic Purpura
Students also viewed