chapter-20 hematologic disorders hi

polycythemia vera is?

"to many cells in the blood" -when to many RBC are produced, blood becomes thick, hindering its passage through smaller blood vessels.

______ is used to TX ITP

-IVIG & immunosuppressives

nsg management/pt education?

-avoid Fe, dont cross legs/impede circulation, if p. dysfunction - dizzy, falls, bruises

in DIC, the clots in the microcirculation can trigger bleeding this causes a INCREASE or DECREASE in platelets? an INCREASE or DECREASE in PT/PTT or thrombin time

-decrease in platelets -INCREASE in pt/ptt/thrombin time

DIC can be triggered by?

-trauma -cancer -sepsis -shock -allergic reactions

thromboCYTOpenia is a result of _____?

-v decreased production in b. marrow -^ destruction in spleen -^ consumption of platelets

The nurse is caring for a pt diagnosed with ALL receiving initial treatment. The pt has been complaining of a dry cough. She also has diminished breath sounds upon auscultation. Which of the following should the nurse monitor as priority with regards to potential complications in this pt? A. hemoglobin B. ANC C. hematocrit D. urine

B. ANC

pts affected by primary thrombocythemia are at risk for thrombosis? or bleeding?

BOTH thrombosis because of abundance of cells bleeding - platelet dysfunction

What gauge angiocatheter is used most frequently for a stable patient receiving blood products? A. 22 gauge B. 24 gauge C. 20 gauge D. no preference

C. 20 gauge

When providing care for a patient who has a diagnosis of AML, the nurse should prioritize which of the following actions? A. Early ambulation B. Education about deep breathing and coughing C. Vigilant hand washing D. Integumentary assessment

C. Vigilant hand washing

which type of cancer is the most common type of secondary malignancy in patients with Hodgkin's Disease A. bone B. colon C. lung D. breast

C. lung

complications of P. Vera?

CVA MI, BLEEDING, & THROMBOSIS. platelet dysfunction

which type of lymphocyte is responsible for cell mediated immunity A basophil B. b lymphocyte C. plasma cell D. t lymphocyte

D. t lymphocyte

the normal hemostatic mechanisms are altered in ____ and results in tiny clots forming in the ____?

DIC; microcirculation

HCT in polycythemia vera?

>55% males >50% females

When providing care for a patient who has a diagnosis of AML, the nurse should anticipate which of the following interventions? Select all that apply. A. Early ambulation B. Education about deep breathing and coughing C. Vigilant hand washing D. Integumentary assessment

A, B, C, D

nsg mgmt for multiple myeloma?

NO CURE- nsg care=symptom relief pain- NSAIDS/opioids wt lifting restrictions no more than 10lbs othotic- check skin integrity s/s hypercalcemia pt education on ideal body weight (limit wt on frame)

Standard donation

blood bank

assessments in P. vera?

check for clots/ decrease in perfusion to a system ex-v output/ hypotension/tachycardia hematuria

TX options for leukemia?

chemo

medical mgmt for NHL?

chemo, radiation

iron deficient anemia

chronic blood loss, nutrition

treatment for multiple myeloma?

corticosteroids & chemo, NO CURE

what is the most common symptom and complication of anemia?

fatigue

what is thrombocytOpenia?

low platelets

manifestations of NON-hodgkins lymphomas?

lymphadenopathy most common

allogenic stem cells transplantation is the only curative treatment for CML? true or false

true

risk factors of hodgkins lymphoma?

-men > women 2 peaks - early 20s, after 50yrs old -agent orange -pts getting chronic immunosuppressive TX

ABX that can impair platelet function?

-penicillins -cephalosporins -sulfonamides

medical management/ treatments of P. Vera?

-therapeutic phlebotomy -ASA if NO p, dysfunction

what 3 conditions place a pt at risk for both bleeding AND thrombosis

1-DIC 2-polycythemia vera 3-primary thrombocythemia

medical mgmt of p. thrombocythemia

>60yrs-chemo less than 60yrs- low dose asa to tx abundance of platelets

A patient's recent fatigue has been attributed to anemia. You are aware that this health problem is a result of: (select all that apply) A. Inadequate RBC production B. Active bleeding C. Damage to the circulating RBCs D. Distortions in the shape of WBCs

A, B, C

The RN is explaining the potential signs and symptoms of a transfusion reaction to a pt who is receiving his first blood transfusion. The nurse explains that she will do which of the following to ensure safe blood product admin? Select all that apply A.) check ABO compatibilty by comparing the blood product label to the pt's medical record B.) use 2 pt identifiers, such as the pt's date of birth, and name to verify the blood product C.) admin the blood product slowly for the first 15 minutes D.) admin acetaminophen and diphenhydramine, which are standard premed. used in all transfused pts

A, B, C

When assessing a patient who has a diagnosis of thrombocytopenia, the nurse should understand that the patient may present with what sign or symptom of the disease? A. Petechiae B. Cherry angiomas C. Alopecia D. Pruritus

A, Petechiae

The nurse provides pt education r/t the management of iron deficiency anemia. Which of the following statements made by the pt signifies understanding of the education provided? A. "I should take my iron pills with a glass of oj" B. "I should take my iron pills with breakfast to decrease stomach upset" C. "Iron pills often cause constipation, so I should decrease my fluid and fiber intake" D. "I will only need to take these pills for a few days and then my problem will be fixed"

A. "I should take my iron pills with a glass of oj"

the most common cause of iron deficiency anemia in men and postmenopausal women is which of the following A. bleeding B. iron malabsorption C. chronic alcoholism D. menorrhagia

A. bleeding

thalassemias are a group of hereditary anemia is characterized by which of the following select all that apply A. hemolysis B. thrombocytopenia C. extreme macrocytosis D. anemia E. hyperchromia

A. hemolysis C. extreme macrocytosis D. anemia E. hyperchromia

which of the following is the major function of neutrophils A. phagocytosis B. destruction of tumor cells C. rejection of foreign tissue D. production of antibodies called immunoglobulin

A. phagocytosis

a nurse is reviewing the daily lab results for a female client with acute leukemia. which of the following is an expected finding? A) Hgb 14 g/dL B) WBC count 21,000/mm3 C) Hct 40% D) Platelets 170,000/mm3

B) WBC count 21,000/mm3

A pt's 18 yr old son would like to donate blood. The nurse educates him regarding eligibility requirements for blood donation. Which of the following statements demonstrates that he does not understand the education provided? A. "I am so glad that I am old enough to donate." B. "Because I just got a tattoo a week ago, I am unable to donate." C. "Because I live with a friend with HIV, I cannot donate" D. "Because my girlfriend has hepatitis, and we are sexually active, I cannot donate"

B. "Because I just got a tattoo a week ago, I am unable to donate."

Mrs. Jones is being treated for sepsis. On the second day caring for her, she experiences epistaxis and persistent bleeding from a venipuncture site. The nurse suspects DIC. Which of the following lab results supports the nurse's suspicion? A.) increased fibrinogen, decreased PTT, decreased platelets B.) decreased fibrinogen, increased PTT, increased platelets C.) decreased fibrinogen, increased PTT, decreased platelets D.) increased fibrinogen, increased PTT, increased platelets

C. decreased fibrinogen, increased PTT, decreased platelets

when assessing a female patient with a disorder of the hematopoietic or the lymphatic system which of the following assessments is the most essential A. menstrual history B. age and gender C. health history such as bleeding fatigue or fainting D. lifestyle assessment such as exercise routines

C. health history such as bleeding fatigue or fainting

which of the following is accurate regarding the use of corticosteroids for immune hemolytic anemia select all that apply A. corticosteroids are not effective in the treatment of immune hemolytic anemia B. the treatment consist of low doses of corticosteroids C. if the hemoglobin returns to normal the corticosteroid those can be lowered D. they produce lasting effects and E. they decrease the macrophages ability to clear the antibiotic coated erythrocytes

C. if the hemoglobin returns to normal the corticosteroid those can be lowered E. they decrease the macrophages ability to clear the antibiotic coated erythrocytes

which of the following is the percentage of blood volume consists of erythrocytes A. differentiation B. erythrocyte sedimentation rate C. hemoglobin D. hematocrit

D. hematocrit

which of the following terma refer to an abnormal decrease in WBCs, RBC's and platelets? A. anemia B. leukopenia C. thrombocytopenia D. pancytopenia

D. pancytopenia

which one of the following statements best describes the function of pluripotent stem cells in the bone marrow A. they are active against hypersensitivity reactions B. they defend against bacterial infection C.they produce antibodies against foreign antigens D. they produce all blood cells

D. they produce all blood cells

diagnosis of polycythemia vera requires hgb of?

Hgb >18.5 male or >16.5 females

Patient with renal disease are susceptible to anemia because of a deficiency of erythropoietin. True or False

TRUE

When providing care for a patient who has DIC, the nurse should pay particular attention to the patient's levels of RBCs, hematocrit, and hemoglobin when reviewing laboratory results. True or False

TRUE

consolidation therapy is

after induction is achieved -goal to keep pt in remission

manifestations of platelet defects/dysfunction

all s/s that may indicate bleeding

medications that can interfere with platelet function

anticoagulate garlic LOCAL ANESTHETICS caffeine

signs/symptoms of ITP

bleeding bruising heavy menses petechiae

pts with leukemia at risk for?

bleeding due to thrombocytopenia (low platelets) infection

_____ is used to dx thromboCYTOpenia?

bone marrow biopsy

leukemia diagnosed by?

bone marrow biopsy

what is the most common symptom of Multiple myeloma?

bone pain w/movement that subsides with rest -back/ribs

therapeutic phlebotomy is done to?

decrease volume by removing excess RBC ex-in polycythemia vera.

in ITP the platelet level is Increased or decreased?

decreased

Directed donation

donor can direct it to specific person

what is thrombocythemia?

excess platelts -^ in platelet production >600,000

lymphomas are classified into what 2 categories?

hodgkins or non-hodgkins

in multiple myeloma, the malignant plasma cells produce an increased amount of ____ that is non-functional?

immunoglobin

hodgkins lymphoma spreads by continous extension along the ______ system

lymphatic

multiple myeloma is a disease of?

malignancy of plasma cell -ineffective immunoglobin

primary thrombocythemia affects _____ more than ___. and occurs at what age? symptoms?

men>women late/middle age many pts asymptomatic, find out @ physical/ER

leukemia is a term used to describe _____ proliferation of one particular hematopoietic cell type?

neoplastic

manifestations of hodgkins lymphoma?

painless enlargement, enlarged cervical lymph nodes

multiple myeloma affects ______?

people 70yrs+, 2x more common in black population than white

PBSCT?

peripheral blood stem cell transplant -graft vs host disease

____ is given when there is coagulation factor deficiencies

plasma

SECONDARY THROMBOCYTHEMIA

platelet level > 1 million

if pt is actively bleeding provider may order a ______?

platelet transfusion- to stop bleeding by replacing clotting factors

ASA should NOT be used when _____

platelets are dysfunctional

_____ refers to an increased volume of erythrocytes?

polycythemia

what condition may be treated with therapeutic phlebotomy?

polycythemia vera

_________ is a stem cell disorder within the bone marrow that results in a platelet count >600,000

primary thrombocythemia

antidote for heparin toxicity

protamine sulfate

Autologous donation

pts own blood

what is the malignant cell of hodgkins lymphoma?

reed stenberg cell

medical mgmt of hodgkins lymphoma?

regardless of stage, focus is CURE. chemo radiation stem cell transplant

therapeutic apheresis is done to?

removes excess platelets from the blood

decreased EPO anemia

renal disease

_____ & acute promyelocytic leukemia are the most common causes of DIC?

sepsis

if underlying cause of bleeding disorder is due to INCREASED consumption what would the tx be?

splenectomy

what is the hallmark symptom of polycythemia vera?

splenomeagly

manifestations of Polycythemia vera?

splenomegaly & PRURITIS (h2o)= hallmark sign HA, dizziness, blurred vision, dyspnea, ^B/P

leukemia is classified by ?

stem cell line involved, either lymphoid or myeloid. and then acute or chronic

induction therapy is

the first round of chemotherapy -trying to achieve remission

durring the chronic phase of CML, pts have few symptoms and complications from the disease itself true or false

true

inmultiple myeloma, the maignant plasma cells produce an increased amount of a specific immunoglobin that is non functional true or false

true

tx of thrombocytopenia

tx underlying cause if due to ^ in consumption= splenectomy if active bleeding-platelet transfusion

pernicious anemia is

vit b12 deficient

antidote for coumadin toxicity

vitamin K

whole blood is given for _____

volume replacement