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COTAC Ch 30: Hematologic
Terms in this set (95)
What is anemia?
-Deficiency in number of RBC's
-Deficiency in quantity or quality of hemoglobin
-Deficiency in volume of packed RBC's
What are the causes of anemia?
-Decreased RBC production
-Blood loss chronic/acute
-Increased RBC destruction
What are the s/s of anemia due to?
What are the classic symptoms of anemia?
What vital sign changes can be expected with anemia?
-BP dependent on cause
Why are the s/s of anemia variable?
Based on severity and bodies ability to compensate
What is the best way to diagnose anemia?
What are the teaching goals with anemia?
What populations are more prone to iron deficiency anemia?
What is the most common cause of iron deficiency anemia in children, adolescents and pregnant women?
What is the most common cause of iron deficiency anemia in postmenopausal women and men?
What foods should patients with iron deficiency anemia increase in their diet?
What should iron supplements be taken with?
When should oral iron supplements be taken?
1 hour prior to meals
What are common side effects the patient should be made aware of prior to taking iron supplements?
-GI effects common (*constipation)
-Stools turn black
What can patients do to combat constipation caused by iron supplements?
Increase fluids and fiber
What nursing actions should be taken when administering the injectable form of Iron?
-Give Z-track method
-May stain skin
-Watch for allergic reaction
What are the results of chronic iron-deficiency?
-Spoon shaped nails
-Red beefy tongue (glossitis)
What is thalassemia?
Group of genetic diseases that causes an inadequate production of normal hemoglobin
What number of gene abnormalities would cause thalassemia minor?
What number of gene abnormalities would cause thalassemia major?
What ethic groups is thalassemia more common?
-Live near the equator in Asia, Middle East and Africa
What are the manifestations of thalassemia minor?
-May be asymptomatic
-May have mild form of microcytic, hypochromic anemia
What is thalassemia major?
-Life threatening disease
-Retardation of physical and mental growth
-Hemolysis causes jaundice
What does the collaborative care include in the treatment of thalassemia?
-Maintain Hgb level
What do repeated transfusions lead to?
What is the optimal hemoglobin level for patients with thalassemia major?
Why do we want to keep the hemoglobin at a slight anemic level when treating thalaessmia major?
Higher hemoglobin results in enlarged spleen due to increase hemolysis
What is the cure for thalaessemia major?
Stem cell transplant
What is pernicious anemia?
Deficiency of intrinsic factors which is necessary for vitamin B12 absorption
What procedure can lead to pernicious anemia?
Why can pernicious anemia occur with gastric surgery?
Patient unable to absorb B12 or part of the bowel removed was secreting intrinsic factor
What is the Schilling test?
Measures Vitamin B12 absorption with and without instrinsic factor
Why is the Schillings test used?
Differentiates between malabsorption and pernicious anemia
What is the treatment for pernicious anemia?
Monthly vitamin B12 injections
In treating pernicious anemia which is easier, replacing intrinsic factor or replacing B12?
What is aplastic anemia?
Decreased RBC's, WBC's and platelets
What patients are at risk for aplastic anemia?
-Bone marrow failure
What are the priorities for patients with aplastic anemia?
How is aplastic anemia diagnosed?
Bone marrow biopsy
What are the nursing priorities following a bone marrow biopsy?
-Watch for bleeding and infection
-Ice to site
What is the management of aplastic anemia?
-Identify and remove cause if possible
What is the management of aplastic anemia for those having an autoimmune response?
Give immunosuppressant therapy
What is the management for aplastic anemia for patients under 55?
Consider stem cell transplant if they have HLA-matched donor
When are stem cell transplants more successful for patients with aplastic anemia?
If they have NOT received multiple transfusions
What is sickle cell anemia?
Autosomal recessive condition, RBCs become malformed during periods of hypoxia and obstruct capillaries of joints and organs
What ethnic group is more prone to get sickle cell anemia?
What is chronic pain associated with sickle-cell anemia due to?
Repeated episodes that have caused damage
What are the nursing priorities with sickle cell anemia?
What are the predisposing factors for sickle crisis?
What is thrombocytopenia?
Reduction of platelets below 150,000, can be inherited or acquired.
What is the most common acquired thrombocytopenia?
Idopathic Thrombocytopenic Purpura (ITP)
What is ITP?
Autoimmune disease, body destroys its own platelets
What is the most often cause of thrombocytopenia?
What are the manifestations of thrombocytopenia?
-May be asymptomatic
-Prolonged bleeding following procedures
-Hemorrhage (internal or external)
What are the skin manifestations of thrombocytopenia?
What is the treatment for ITP?
When are platelets transfused to treat ITP?
Platelet count less than 10,000
What is the treatment for heparin induced thrombocytopenia?
-Patient should never receive heparin or enoxoparin
What is hemophilia?
-Usually factor VIII deficiency
What is Von Willebrand disease
-Genetic, girls can have it
-Deficiency of VW factor needed for clotting cascade
What is the management for hemophilia and Von Willebrand disease?
-Watch for hemorrhage
-Prevent and treat bleeding
-Replacement of missing factor as prophylaxis and treatment
What is the purpose of Desmopression (DDAVP)?
Stimulates production of needed clotting factors
What is disseminated intravascular coagulation (DIC)?
Abnormal response of the clotting cascade, causes both abnormal clotting and abnormal bleeding
What are the manifestations of DIC?
What diagnostic studies are used to identify DIC?
-Prolonged PT, PTT
What is involved in collaborative care for DIC?
-Recognize signs early
-May administer heparin (EARLY)
-May transfuse FFP, cryoprecipitate, and platelets in severe acute DIC
What is neutropenia?
Decreased amount of neutrophils
What does neutropenia predispose a patient to?
What is considered a medical emergency in patients with neutropenia?
What is the major concern with blood transfusions?
What does an Rh factor reaction cause?
Who is the universal donor?
Who is the universal receiver?
What is an acute hemolytic reaction?
When does an acute hemolytic reaction occur?
First 15 minutes
What are the signs and symptoms of an acute hemolytic reaction?
-Low back pain
What can an acute hemolytic reaction lead to?
When does an anaphylactic reaction occur with a blood transfusion?
What are the signs and symptoms of an anaphylactic reaction?
What are the nursing actions for an acute hemolytic or anaphylactic transfusion reaction?
-Run saline in separate line
-Send blood bag and tubing to lab
When does a febrile reaction occur with a blood transfusion?
30 min - 6 hrs after transfusion
What causes a febrile reaction to a blood transfusion?
What are the signs and symptoms of a febrile reaction to a blood transfusion?
How can a febrile reaction be prevented?
When does a mild allergic reaction occur with blood transfusions?
Up to 24 hours after
What causes a mild allergic reaction with blood transfusions?
Plasma protein reaction
What are the signs and symptoms of a mild allergic reaction to a blood transfusion?
What is the treatment for a mild allergic reaction to a blood transfusion?
What causes circulatory overload during a blood transfusion?
Impaired cardiac function
What are the signs and symptoms of circulatory overload?
-Crackles in lungs
How can circulatory overload be prevented?
Blood blank can split unit into two
What is the treatment for circulatory overload?
-Slow infusion rate
If DIC occurs with blood transfusions what treatment is effective if given early?
If DIC occurs with blood transfusions what treatment is effective if given later?
Clotting factors and blood products
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