Nursing 202 > Hematologics 2 > Flashcards

Hematologics 2 Flashcards

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1
Q

Hemoglobin:

A

Female 12-16g/dL

Male 14-18 g/dL

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2
Q

Hematocrit:

A

Female 37% - 47%

Male 42% - 52%

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3
Q

Erythropoietin –

A

kidney produces at same rate of RBC destruction

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4
Q

White blood cells (leukocytes)

A

5,000-10,000
-Formed in bone marrow
-Provide protection through inflammation & immunity
Neutrophil & Macrophage: Destroy and eliminate foreign invaders
Monocyte: Destruction of bacteria & matures into macrophage
Eosinophil & Basophil: Release chemicals that act on blood vessels to cause tissue level response

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5
Q

Platelets:

A

50,000-400,000

Form plugs to stop flow of blood at injured site

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6
Q

Spleen

A

White pulp

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7
Q

Liver

A

Prothrombin

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8
Q

3 sequential process of controlled blood clotting

A
  1. Platelet aggregation with platelet plug formation
  2. Blood clotting cascade
  3. Formation of a complete fibrin clot
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9
Q
  1. Blood clotting cascade
A

Intrinsic factors

Extrinsic factors

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10
Q
  1. Formation of a complete fibrin clot
A

Fibrinogen inactive protein made in liver
Active enzyme thrombin removes portions of fibrinogen converting into fibrin
Form into fibrin threads (meshlike base) making blood clot

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11
Q

Hematologic- Aging:

A

Decreased blood volume
Lower levels of plasma proteins
Bone marrow produces fewer blood cells

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12
Q

Hematologic- Aging: Abnormal findings

A

Nails beds (capillary refill)
Hair distribution
Skin moisture
Skin color

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13
Q

Patient history

A

Age, gender, known liver function, hematologic and immunologic disorders
Ask about jaundice, anemia, gallstones may indicate liver problems
Previous radiation therapy may impair hematologic function
Hobbies, occupation exposure to agents affecting bone marrow etc.

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14
Q

Assessment methods:

A 
Patient history 
Nutritional status
Family history
Generic risk
Current health problems
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15
Q

Nutritional status:

A

Fats, carbohydrates, protein, iron & vitamins
Vitamin K
Alcohol
Finances

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16
Q

Family history:

A

Blood/ blood clotting issues inherited

Hemophilia, Sickle Cell Disease

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17
Q

Genetic risk

A

Sickle Cell trait

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18
Q

Current health problems:

A
  • Lymph nodes swelling, excessive bruising/ bleeding

- Shortness of breath on exertion, palpitations, frequent infections, fever

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19
Q

Medications

A 
Blood “thinners” & NSAIDS
Anticoagulants 
Vitamin K antagonists 
Fibrinolytics 
Platelet inhibitors
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20
Q

Blood “thinners” & NSAIDS –

A

change clotting activity, not viscosity

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21
Q

Anticoagulants:

A
  • nterfere with one or more steps in the clotting cascade
  • prevent new clots and limit extension of previous clots
  • Classified as direct and indirect thrombin inhibitors and Vit K antagonists
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22
Q

Direct – thrombin inhibitors

A

Reduces amount of fibrinogen converted into active fibrin
Parenteral & oral
Rivaroxaban (Xarelto), apixaban (Eliquis)

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23
Q

Indirect – thrombin inhibitors

A

by activating antithrombin III, thrombin is indirectly inhibited
Parenteral
Enoxaparin (Lovenox)

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24
Q

Vitamin K antagonists –

A

decreases synthesis of Vit K in intestinal tract
Oral
Warfarin (Coumadin)

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25
Fibrinolytics –
“clot busters” , break down fibrin threads Intravenous Alteplase (Activase)
26
Platelet inhibitors –
prevent platelet aggregation or activations Oral and parentally clopidogrel (Plavix) Complementary medications
27
Skin assessment
petechiae
28
Head and neck
Pallor/ ulceration oral mucosa; inspect lymph nodes
29
Respiratory
Fatigue; shortness of breath
30
Cardiovascular
Pulse weak and thread, systolic B/P lower with anemia, higher with excessive RBC
31
Kidney and urinary
Hematuria; hormone
32
Musculoskeletal
Rib/ sternal tenderness (leukemia) marrow overproduces cells, increasing pressure
33
Abdominal
Palpable spleen; GI bleed
34
Central nervous system
Vit B12 deficiency impairs nerve function; head trauma
35
CBC
Hematocrit (HCT)– percentage of red blood cells in total blood volume Hemoglobin (HGB)– oxygen carrying capacity Mean corpuscular volume (MCV) – average volume/ size of RBC’s Mean corpuscular hemoglobin (MCH) – average amount of HGB by weight in a single RBC Mean corpuscular hemoglobin concentration (MCHC) – average amount by percentage
36
Reticulocyte count
Determines bone marrow function; normally 2% are circulating
37
Platelet Count
Reflects number of platelets in circulation | Thrombocytopenia
38
Hemoglobin electrophoresis
Detects abnormal forms of hemoglobin (sickle cell)
39
Coombs’ tests (direct and indirect)
Used for blood typing (antibodies & antiglobulins)
40
Iron Studies:
1. Serum ferritin – measures amount of free iron in plasma; represents 1% 2. Transferrin – protein that transports dietary iron from the intestines to cell storage sites 3. TIBC (total iron binding capacity) – measuring the amount of iron bound to serum transferrin
41
Prothrombin time (Protime/PT)
measures how long blood takes to clot; value 11-12.5
42
International normalized ratio (INR)
Same as PT by Establishing a normal mean or standard; value 0.7-1.8 Warfarin therapy – usually therapeutic level 2-3; also individualized for patients
43
Partial thromboplastin time (PTT)
- Assesses the intrinsic clotting cascade - Prolonged when deficient - Uses with heparin
44
Anemia manifestations:
``` Pallor Cool to touch, intolerance to cold Nails Tachycardia, murmurs/ gallops (severe) Orthostatic hypotension Dyspnea on exertion Fatigue, headache ```
45
Sickle cell disease (sickle cell anemia)
Autosomal recessive inheritance, HbS Chronic anemia Pain Increase risk for infection Early death 40% of total hemoglobin is composed of hemoglobin S (sensitive to low oxygen content) Sickle shape = hypoxia – reduces oxygen supply – more sickles – blood vessel obstruction and ischemia Conditions – hypoxia, dehydration, infection, venous stasis, environmental extremes, pregnancy, alcohol, strenuous exercise Hemolytic anemia
46
Clinical Manifestations - SCD
-Pain – most common manifestation -Cardiovascular Heart failure – murmur, JVD Slow capillary refill – distal, cool Heart rate rapid, B/P normal to low -Priapism – cannot urinate -Skin pallor/ cyanosis; jaundice; ulcers lower legs -Abdomen Liver and spleen feel firm -Kidney Decreased urine output, protein present -Musculoskeletal Joint necrotic degeneration; pain with movement -CNS Low grade fever, seizures
47
Management - SCD
-Pain control -Infection control -Oxygen -Hydroxyurea (Droxia) – stimulating fetal hemoglobin production -Hydration – intravenous as well as oral -Check circulation -Complementary therapies Warm room Distraction Relaxation
48
Prevention - SCD
``` Socks & gloves Planes Healthcare professionals- knowledge of disease Genetic counseling Physical activity Low impact exercise Hydration Alcohol Smoking Contact HCP Flu shot ? Pneumonia vaccine Temperature extremes ```
49
Iron deficiency anemia
Blood loss, poor GI absorption of iron, inadequate diet Manifestations Food sources
50
Vitamin B12 deficiency anemia (Pernicious anemia)
Failure to activate enzyme that moves folic acid into RBC cells so cell division and growth into to functional RBC Causes Manifestations Foods rich in B12
51
Aplastic anemia
Deficiency of circulating red blood cells because of failure of bone marrow to produce these cells Causes – exposure to toxic agents/ drugs, radiation, infection
52
Polycythemia Vera
``` # of RBC’s greater than normal Hyperviscous ```
53
3 major hallmarks of Polycythemia Vera
Massive production RBC’s Excessive leukocyte production Excessive production platelets
54
Manifestations of Polycythemia Vera
Skin/ mucous membrane – dark purple Flushed appearance Itching, poor perfusion (heart, spleen & kidneys), thrombosis
55
Treatment of Polycythemia Vera
Apheresis (2-5 times per week) | Hydration
56
Autoimmune Thrombocytopenia Purpura (idiopathic) ITP
Amount of circulating platelets reduced, production normal Antibody against surface of their own platelets Destruction exceeds production, clotting impaired Suspect viral infection Women 20-50 and people with autoimmune disorders Manifestations: ecchymosis, petechial rash, mucosal bleeding Treatment: corticosteroids, drugs to suppress immune function, platelet transfusion Safe environment, splenectomy
57
Thrombotic Thrombocytopenia Purpura (TTP)
Platelets clump together abnormally in capillaries Occurs in trauma; tissue becomes ischemic Fresh Frozen Plasma, aspirin
58
Coagulation Disorders- Hemophilia
Hereditary bleeding disorder Form platelet plug but impairs formation of stable fibrin clot Excessive bleeding cuts, bruised, joints Treatment: synthetic factor VIII
59
Pretransfusion Transfusion Responsibilities
Verify prescription with another RN Test donor’s/recipient’s blood for compatibility Verify patient’s identity with another RN Examine blood bag label, attached tag, and requisition slip for ABO and Rh compatibility with the patient with another RN Check expiration date with another RN Inspect blood for discoloration, gas bubbles, cloudiness
60
During transfusion responsibilities:
Provide patient education Assess vital signs immediately before starting infusion Begin transfusion slowly, stay with patient first 15 to 30 minutes Ask patient to report unusual sensations (for example, chills, shortness of breath, hives, itching) Administer blood product per protocol Assess for hyperkalemia
61
RBC transfusions –
Given to replace cells lost from trauma or surgery
62
Platelet transfusions –
Given for low platelet counts, active bleeding, scheduled for invasive procedure
63
Plasma transfusions –
Given to replace blood volume and clotting factors
64
Granulocyte (WBC) transfusions –
Given (rarely) to neutropenic patients
65
Acute Transfusion Reactions
Bacterial Circulatory overload Transfusion-associated graft-versus-host disease (GVHD)
Nursing 202
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