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high folate foods for anemiaspinach, lentils, bananas, juicesepoetin alfaErythropoiesis-Stimulating Agent (ESA)folate deficiency anemia is related to macrocytic anemiaRBC are larger and oval shaped due to lack of folate and related to GI issue, metabolic change, and hemodialysisfolate deficiency anemialack of folate leading to premature RBC death... caused by dietary deficiencymacrocytic anemiaA form of anemia characterized by large, immature red blood cellssigns of folate deficiency anemia- beefy red tongue - pallor - dyspepsia - tinnitus - tachycardiaB-thalassemiaReduced production of globin chains that make the hemoglovin Common in Mediterranean descent, (Italians, greeks, Syrians)assessment findings of b-thalassemia•Frontal bossing •Maxillary prominence •Wide set eyes •Greenish yellow skin tone •Severe anemia •Microcytic, hypochromic blood cellstreatment of b-thalassemia- blood transfusion - bone marrow transplant - splenectomythalassemia minorasymptomatic silent carrierb thalassemia traitmild microcytic anemiab thalassemia intermediaThere is some normal B-globin production and, therefore, milder symptoms compared with Cooley anemia. These patients usually do not require transfusions. Decreased production of P-globin leads to increased delta gamma chains. Therefore, HbA2 (a2d2) and HbF (a2g2) may be increased. This is of use diagnostically because quantitative Hb electrophoresis measures the levels of these hemoglobins.sickle cell anemiaa genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shapevaso-occlusive crisisIschemia and pain caused by sickle-shaped red blood cells that obstruct blood flow to a portion of the bodysplenic sequestration• Life threatening—death can occur within hours • Blood pools in the spleen • Signs • Profound anemia, hypovolemia , and shockhyperhemolytic crisisIncreased rate of RBC destruction leading to anemia, jaundice, and/or reticulocytosisaplastic crisisA condition in which the body stops producing red blood cells; typically caused by infection.interventions for sickle cell anemia- hydration - oxygen - blood transfusion - analgesics - high CALORIE & PROTEIN - folic acid supplement - prn abxcomplications of sickle cell anemia- HTN - stroke - osteomyelitis - HRepithelial tissuescarcinomasglandular organsadenocarcinomasmesenchymal tissuesarcomasbloodleukemialymphlymphomaplasmamyelomasgrading of cancersGrade 1: Closely resembles the normal cells from which they come from Grade II: Moderately differentiated Grade III: Poorly differentiated Grade IV: Undifferentiated (No normal characteristics) This is important for prognosis and appropriate therapy plancancer preventiondiet low fat, high fruit/veggies; regular exercise, low stress, avoid alcohol and smoking, other environmental hazards, Avoid excessive sun exposurecancer riskEnvironmental carcinogens, physical carcinogens, and viral carcinogens. Obesity, genetics, age (older adults have higher incidence of CA occurrence), Immunosuppressionchemopreventionthe use of natural or synthetic substances such as drugs or vitamins to reduce the risk of developing cancer, or to reduce the chance that cancer will recurtamoxifen-used to treat breast cancer -increased risk of endometrial cancer -causes endometrial thickening with subendometrial cysts and POLYPSimmunization to prevent cancerHPV vaccine & cervical cancerCAUTION•C - change in bowel, bladder habits •A - sore that does not heal •U - Unusual bleeding or discharge •T - Thickening or a lump in the breast or elsewere •I - Indigestion or difficulty swallowing •O - obvious change in wart or mole •N - nagging cough or hoarseness.most common cancers in caucasianlung breast colorectal prostatemost common cancers in african americanlung prostate breast colorectal and uterinemost common cancers in asainbreast colorectal prostate lung stomachmost common cancers in hispanicprostate breast colorectal lungbreast cancer screening - mammogramevery year 45 - 54; every other year 55 - 74colon cancer screeningfecal occult blood test every year age 50 - colonoscopy every 10 yearsprostate cancer screeningdigital rectal exam, prostate specific antigen testcervical cancer screeningpap smear between 21-65 every 3 years. Women ages 30-65 can screen every 5 years with pap smear AND HPV test.ABCDEasymmetry, border, color, diameter, evolvingtumor, node, metastasisTNMcancer staging•TNM (Tumor Node Metastasis) •T UMOR ( T1, 2, 3, 4) •Node ( N0, 1, 2, 3) •Metastasis ( M 0, 1) • •GRADING - •Differentiation of cells Grade I - IVcommon sites of metastasis1) Breast- bone, lung, and brain 2) lung- brain, liver, and bone 3) prostate- bone, spine, lung, kidney, liver 4) colorectal- liver and lungsPost-op mastectomy care-check ABCs, LOCs, and vitals -elevate affected arm above level of heart -no constrictive clothing -limb alert (no labs/BP in this arm)primary prevention breast cancer-Lifestyle changes - Reduce fat in diet - Weight reduction - Reduce alcohol - Tamoxifen for high-risk women - Reduces breast cancer risk by 50%primary prevention prostate cancer-circumcise male children -avoid exposure to cadmium, dioxin, agent orange, -avoid high risk occupation: tire/ rubber manufacture, farmers, mechanics, sheet metal workers -2 drinks of ETOH a day -sleep hygiene (only sleep and sex) -low fat dietcancer diagnostics-Biopsy -Radiographs -PET(shows metastasis of cancer cells)/CT/MRI (Shows tissue damage) -Certain cancers have serum markers (PSA, BRCA)labs for cancerCBC is critical; LFTs, tumor marker assays (CEA - colon, PSA - prostate; AFP - liver; B2M - multiple myeloma,chemotherapycancer treatment that destroys rapidly diving cells but also normal cellsside effects of chemofatigue, n/v, hair loss, nuetropenia, anemia, infertility, neuropathy and thrombocytopeniachemo risksimmunosuppression, N/V/D; Alopecia; Mucositis/Stomatitis; anemia, and thrombocytopenia, neuropathychemo precautions48 hours post administration; flush toilet 3 times, keep lid down, disposing of items in a specialty bag, sleep in different beds, wash linen separately, protective barrier between sheet and mattress; nurses wear PPEchemo precautions and nursing interventions:•Monitor WBCs, blood counts, electrolytes •Thrombocytopenia (i.e. platelet count < 50,000) bleeding precautions •Neutropenia - s/s of infection •Nutrition •Psychologicalradiation•destruction to cells where radiation is targeted •Wash site with mild soap and water only •Do not irritate site •Do not remove radiation markers •No powders creams, ointments, unless prescribed •Wear soft clothing to avoid irritation •Avoid sun to area •Avoid heatradiation therapy educationfocused around cleaning and care of site, no lotions, creams, or ointments to skin at radiation site unless prescribed, avoid sun and heat, also need to limit exposure to children and pregnant women especially if radiation implants are used.radiation side effectsside effects include local skin damage, fatigue, and altered tasteleukemia signsanorexia, fatigue, weakness, anemia, bruising/bleeding, elevated temp, enlarged lymph nodes, pain, decreased H&H; headaches; pain; decreased platelet ctleukemia treatmentchemo along with antibiotic, antifungal, antiviral drugs to offset complicationsleukemias•Acute Lymphocytic Leukemia •Acute Myelogenous leukemia •Chronic Myelogenous leukemia •Chronic lymphocytic leukemialymphomas•Fever •Malaise •Night sweats •Loss of appetite, anorexia, wt loss •Enlarged lymph nodes •Presence of Reed-Sternberg cellsHodgkin's lymphomadistinguished from other lymphomas by the presence of large, cancerous lymphocytes known as Reed-Sternberg cellsNon-Hodgkin's Lymphomathe term used to describe all lymphomas other than Hodgkin's lymphomamultiple myeloma findings•Bone pain; weakness/fatigue •Anemia •Osteoporosis •Thrombocytopenia and leukopeniamultiple myeloma•Proliferation of plasma cells within the bone •Presence of Bence Jones proteintreatment of multiple myeloma- chemo - symptom management - bisphosphonate medications to slow bone damageHIV diagnostics1) ELISA - may be negative early 2) Repeat ELISA if positive 3) Western Blotnucleic acid test (NAT)can usually tell you if you have HIV infection 10 to 33 days after an exposure.antigen/antibody testperformed by a laboratory on blood from a vein can usually detect HIV infection 18 to 45 days after an exposure. Antigen/ antibody tests done with blood from a finger prick can take longer to detect HIV (18 to 90 days after an exposure).antibody testscan take 23 to 90 days to detect HIV infection after an exposure. Most rapid tests and self-tests are antibody tests. In general, antibody tests that use blood from a vein can detect HIV sooner after infection than tests done with blood from a finger prick or with oral fluid.CD4 counts normal limits500-1600When CD4 drops below 200severe immune compromisedHIVA virus that attacks and destroys the human immune system.AIDSacquired immune deficiency syndromeHow does HIV turn into AIDS?T-Helper cells run outtransmission of HIVblood, semen, vaginal secretions, breast milkprevention of HIV- counseling - safe sex education - condoms - alternatives to breast feeding - safe drug injection equipment - PREPPre-exposure prophylaxis (PrEP)a pill containing antiretroviral drugs taken before someone is exposed to the virus to prevent HIV acquisitionstage 1 HIV- acute infection - 2-4 weeks after exposure - flu like illness for several weeks - high viral, low CD4, high CD8HIV Stage 1 symptomsfever, chills, joint pain, muscle aches, sore throat, night sweats, enlarged glands, red rash, fatigue, wt loss, thrushstage 2 HIV• Clinical latency or Asymptomatic HIV •Usually asymptomatic •Without treatment with ART may last about 10 yrs; with treatment decades •low viral load, CD4 200-499Stage 3- AIDS•CD4 <200; high viral loads •AIDS defining condition r/t severe immunosuppression •Without treatment survival about 3-5 yrsstage 3 aids symptomsblurred vision, diarrhea, dry cough, fever, night sweats, fatigue/exhaustion, dyspnea, swollen glands, wt loss, candidiasiscommon opportunistic infection in Aidscandidiasis of trachea, bronchi, esophagus, or lungs; Chronic Herpes Simplex; HIV encephalopathy; Kaposi's sarcoma; Mycobacterium TB; Pneumocystis carinii pneumonia (PCP); recurrent salmonella; wasting syndrome due to HIVaids treatment•Fusion inhibitors (Enfuvirtide) •Entry inhibitors (Maraviroc) •Nucleoside reverse transcriptase inhibitors (Zidovudine) •Non-nucleoside reverse transcriptase inhibitors (Delavidine and Efavirenz) •Protease inhibitors - (Atazanavir, nelfinavir, saquinavir, and indinavir) •Integrase inhibitor (Raltegravir) •Antineoplastic medication - (Interleukin- used to treat Kaposi's sarcoma )