EXAM 1 AH 1 Study Guide

BUN levels

7-18

pH normal range

7.35-7.45

calcium normal values

8.5-10.5 mg/dL

chloride normal values

95-105 mEq/L

The most dangerous, and potentially life-threatening, type of transfusion reaction occurs when the donor blood is incompatible with that of the recipient

Acute hemolytic reaction

The nurse is caring for a patient with acute myeloid leukemia (AML) with high uric acid levels. What medication does the nurse anticipate administering that will prevent crystallization of uric acid and stone formation?

Allopurinol

A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action?

Assess renal function

b12 and folic is required for

B12= synthesis of dna, folaic is absorbed in intestine and b12 is from animals

The nurse cares for a client with acute myeloid leukemia with severe bone pain. What pathophysiological concept does the nurse understand is the reason for the client's pain?

Bone marrow expands.

neutropenia causes and nursing interventions:

Causes can include: aplastic anemia, chemotherapy, metastatic cancer, lymphoma, leukemia, radiation therapy (these are all decreased production) bacterial infection, hypersplenism, immunologic disorders, medication induced, viral disease (increased destruction) Nursing management: patients who have cancer are more at risk, patients need to be informed when they need to seek medical attention. At risk patients should have blood drawn for a CBC with a differential.

venipuncture phlebitis:

Characterized by a reddened, warm area around the insertion site or along the path of the vein, pain or tenderness at the site or along the vein, and swelling.

what therapy is administered to reduce the chance of leukemia recurrence.?

Consolidation therapy

A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia?

Dyspnea, tachycardia, and pallor

what Ig is the immediate reaction response of body to allergy/allergen

IgE

opportunistic complications

Illness caused by various organisms (especially normal flora, which is normally found in body but with immunosuppression can become an issue), some of which do not cause disease in people w/ normal immune systems) CD4+ count serves as major lab indicator of immune function and prophylaxis for opportunistic infections and strongest predictor of subsequent disease progression and survival Patients in stage 3 or AIDS are severely immune depressed and can develop opportunistic infections Are they getting thrust, constant yeast infections, overgrowth of fungi What causes infections: Pneumocystic jiroved pneumonia (PCP) Prophylaxis w/ TMP-SMZ for T4 ct<200 Most common manifestations are subacute onset of progressive dyspnea, fever, nonproductive cough, chest discomfort Mild cases - pulmonary examination normal at rest w/ exertion, tachypnea, tachycardia, and diffuse dry (cellophane) rales may be auscultated fever apparent hypoxemia - most characteristic lab abnormality, along w/ elevated lactate dehydrogenase levels Taxoplasmosis encephalitis - onset at age >1 mo Crptosporidiosis, chronic intestinal (>1 mo duration) Candida albicans Crptococcosis, extrapulmonary Histoplasmosis, disseminated or extrapulmonary isosporiasis, chronic intestinal (>1 mo duration) Mycobacterium Avium complex (MAC) Occurs w/ CD4+ T-lymphocyte (CD4+) cell counts less 50 cells/mm3 Caused by infection by different mycobacterium Mycobacterium avium, Mycobacterium intracellulare, or Mycobacterium kansasii Early symptoms minimal and can precede detectable mycobacteria by several weeks and include fever, night sweats, weight loss, fatigue, diarrhea, abdominal pain Confirmed diagnosis of disseminated MAC based on clinical signs/symptoms w/ isolation of MAC from cultures of blood, lymph node, bone marrow, or other normally sterile tissue or body fluids Tuberculosis Possible reactivation of TB among those w/ untreated HIV infection Disease can occur at CD4+ T-lymphocyte (CD4+ cell) count; risk increases w/ progressive immune deficiency Testing for latent TB should be routine during HIV diagnosis, regardless of risk of TB exposure Those w/ negative diagnostic tests for latent TB who have stage 3 HIV infection should have CD4+ retested when count increases due to ART Anergy Disseminated Multidrug resistant Bacterial pneumonia Cytomegalovirus Herpes simplex: chronic ulcers (>1 mo duration) or bronchitis, pneumonitis, or espophagitis (onset at age >1 mo) Varicella zoster

Nursing intervention after given a med to allergic reaction

Intervention: wait 30 min to see if the meds cause a reaction

organ that regulates sodium

Kidney

Leukemia (immature cell proliferation, interventions)

Leukocytosis increase of leukocytes (WBCs) in circulation Normal response to increased need (in acute infection), elevation of leukocytes should decrease as physiologic need decreases Types of leukocytes: eosinophils, basophils, monocytes any other type of leukocyte can elevate total leukocyte count, esp neutrophils or lymphocytes common feature of leukemia is unregulated proliferation of leukocytes in bone marrow acute forms (or late stages of chronic forms) proliferation of leukemic cells leave little room for normal cell production can be proliferation of cells in liver and spleen (extramedullary hematopoiesis) w/ acute forms, infiltration of leukemic cells in other organs, meninges, lymph nodes, gums, and skin bone marrow damage from pelvic radiation or certain types of chemo can cause acute leukemia Cause not fully known: Exposure to radiation or chemicals, certain genetic disorders and viral infections are risk factors for certain types of leukemia classified according to stem cell line lymphoid (stem cells that produce lymphocytes) myeloid (stem cells that produce nonlymphoid blood cells) classified as either acute or chronic, based on time it takes for symptoms to evolve and phase of cell development is halted (w/ few leukocytes differentiating beyond that phase) Interventions: Chemotherapy Neutropenic precautions Bleeding precautions Bone marrow transplant Blood transfusions Adequate nutrition Temperature monitoring Bone marrow aspiration provides definitive diagnosis

Thrombocytopenia

Low platelet level, can result from reduced production of platelets in the bone marrow, increased destruction of platelets, or increased consumption of platelets (like when they're needed for making clots) Clinical manifestations: Platelet count greater than 50,000/mm3, no bleeding or petechiae Platelet count below 20,000/mm3 or less, petechiae may occur (nasal and gingival bleeding, excessive menstrual bleeding, and excessive bleeding from surgery or dental extractions can occur) Platelet count less than 5,000/mm3, spontaneous and potentially fatal bleeding in the CNS or GI tract can occur If less than 1,000 we initiate bleeding precautions (soft bristle, minimize punctures, fall precautions, no rectal exams) - Assessment/Diagnostic findings Bone marrow aspiration and biopsy are used to identify platelet deficiency associated with decreased Genetic causes include: autosomal dominant, autosomal recessive, x-linked mutations If cause of thrombocytopenia is platelet destruction, the bone marrow will show increased megakaryocytes and normal or increased platelet production to compensate There should be a screening for hepatitis B or C Pseudothrombocytopenia should be ruled out. Platelets aggregate and clump in the presence of EDTA, which is the anticoagulant present in the tube for CBC collection. If this happens, use citrate instead of EDTA Manual examination of the peripheral smear can easily detect platelet clumping as the cause of thrombocytopenia Treatment Platelet transfusion, if platelet production is impaired If excessive platelet destruction occurs, transfused platelets may be destroyed Most common cause of increased platelet destruction is immune thrombocytopenia purpura (ITP) Bone marrow transplant Platelets made in bone marrow Splenectomy, may be therapeutic intervention, not always feasible For those unresponsive to medical therapy Secondary thrombocytopenia managed w/ treatment of underlying disease Patient education Educate they will need to follow bleeding precautions Use electric razors Use small needle gauges No aspirin Decrease needle sticks Protect from injury

Multiple Myeloma

Malignant disease of the most mature form of B lymphocyte- the plasma cell. Plasma cells secrete immunoglobulins, which are proteins necessary for antibody production to fight infection. -Etiology is unknown -Risk factors include: age about 70, african americans, exposure to radiation, petroleum products, benzenes, and Agent Orange, family history (especially first-degree relatives), men have slightly higher risk than women, obesity/overweight, plasma cell disease history (monoclonal gammopathy of undetermined significance and plasmacytoma) -It can evolve from a premalignant stage, known as gammopathy of undetermined significance (MGUS). Although they have the M protein, they do not have signs and symptoms of multiple myeloma. MGUS can progress to multiple myeloma at rate 0.5% to 1% per year -Clinical manifestation: hyperCalcemia, Renal dysfunction, Anemia, Bone destruction (CRAB) Bone pain is considered to be a classic presenting symptom, pain increases with activity and decreases with rest -A substance secreted by the malignant plasma, osteoclast activating factor, and other substances, such as interleukin-6 stimulate osteoclasts, which break down bone matrix -Bone breakdown can be severe enough to cause spinal cord compression, spinal fractures, kyphosis is common -Hypercalcemia may therefore develop and may be manifested by excessive thirst, dehydration, constipation, altered mental status, confusion, and perhaps coma Assessment/Diagnostic findings: All suspected patients should have a CBC with differential BUN, serum creatinine, creatinine clearance, serum electrolytes (especially calcium and albumin) = renal dysfunction LDH, and beta-2 microglobulin = measure degree of tumor burden Radiographic evaluation (CT scan, MRI, and PET scan) for presence lytic bone lesion Bone marrow aspiration and biopsy = evaluate bone marrow plasma cell abnormalities Serum protein electrophoresis (free light chain assay) = detect M protein which will tell you how bad the disease is and how they will respond to treatment

Treatment depending on etiology for neutropenia:

Medication induced = discontinue Immunological disorder = corticosteroids (anti-inflammatory drug/steroid) Reduced cell production = granulocyte colony stimulating factor destruction of neutrophils= splenectomy

Anaphylaxis

Most severe. Its an unanticipated severe allergic reaction. Accompanied by hypotension, bronchospasm, and cardiovascular collapse- use epipen (epinephrin) This is a type 1 reaction hypersensitivity

Neutropenia definition and ANC (absolute neutrophil count)

Neutropenia: occurs when a patient has a neutrophil count less than 2,000 mm3 because of decreased production/increased destruction. With this, comes increased risk for infection from both exogenous (outside the body) and endogenous (inside the body) )sources. ANC: an estimate of the body's ability to fight infections, especially bacterial infections normal: <1500/μL. mild: between 1000 and 1500/μL moderate: 500 and 1000/μL severe: <500/μL

A client with chronic anemia has received multiple transfusions. Which client action would the nurse be concerned about relative to the client's condition?

OTC Iron supplements

central line purpose

Placement of central lines is to administer fluids or medications for a long time. Individuals who need frequent blood draws may have a central line placed. Dialysis patients also may get central line placed. (provide adequate hemodialysis). If you need a continuous infusion of chemotherapy through a portable pump at home, you'll need a central line. peripherally inserted central catheter (PICC) is for continuous treatment of weeks to months.

The nurse is performing an assessment on a patient with acute myeloid leukemia (AML) and observes multiple areas of ecchymosis and petechiae. What laboratory study should the nurse be concerned about?

Platelet count, Major hemorrhages also may develop when the platelet count drops to less than 10,000/mm3.

polycythemia

Refers to increased volume of RBCs. Used when hematocrit is elevated 55% in males and 50% in females. Sometimes dehydration can cause elevated hematocrit, but not usually to the extreme that polycythemia does. Primary polycythemia (vera): a myeloproliferative neoplasm, which is a group of diseases where the bone marrow makes too many red blood cells, white blood cells, and platelets. Secondary polycythemia: caused by an excessive production of erythropoietin (a glycoprotein hormone, naturally produced by the peritubular cells of the kidney, that stimulates red blood cell production. This can occur as a response to a reduced amount of oxygen because that is a stimulus for production. Causes: heavy smoking, obstructive sleep apnea, chronic obstructive pulmonary disease, severe heart disease, or conditions such as living at high altitudes or exposure to low levels of carbon monoxide. Hemoglobin chesapeake causes the hemoglobin to have a high affinity for oxygen. It can also be caused from certain neoplasms that stimulate erythropoietin production Nursing Management: when polycythemia is mild, treatment might not be necessary. When treatment is needed, you treat the primary condition. If this does not work, therapeutic phlebotomy may be needed for symptom management and to reduce blood viscosity and volume. It is not indicated when the cause for elevated RBC count is an appropriate response to tissue hypoxia

venipuncture steps :

Tunicate, palpate vein in order to find, clean 30 second, no fan no blowing, reassure process to patient, insert, no fishing for vein. (No tourniquet on older people)

Polycythemia vera definition and interventions:

a lot of RBC produced interventions: 1. take out blood, You'll get this treatment once a week or month until your hematocrit goes down to around 45%. 2. monitor hematocrit 3. monitor hemoglobin

ph <7.35

acidic (acidosis)

PH >7.45

alkalosis

how to check Fluid & electrolytes, how fluid is lost, and what is normal output:

best way to check: weigh client daily -30ml output/hr sensible fluid loss: urination (something that you are aware of losing fluids) Urine: 1500 mL insensible fluid loss: when you are outside in the heat you loss moisture from your skin that evaporates directly from your skin, also when you exhale moisture comes out, like when the glass fogs up in the shower or when you breath out in the cold (since this is not seen it is insensible because you are unaware of it) lungs 300ml skin 500ml feces 200ml

a signed consent form is needed for

bone marrow aspiration or bone biopsy.

Assessment of venipuncture

check for Round, firm, elastic, and engorged. Not hard, bumpy, or flat.

when it is on the higher/lower end of the range, like pH of 7.45

compensated

multiple myeloma

destruction

Symptoms reflective of thrombocytopenia

ecchymoses (bruises), petechiae (pinpoint red or purple hemorrhagic spots on the skin), epistaxis (nosebleeds), and gingival bleeding.

Pharmacological treatment to allergies

epinephrine, benadryl, aminophyllin, corticosteroids

Symptoms due to neutropenia

fever and infection.

Allergic response:

hives, itching, swelling, shortness of breath (SOB)

Education on allergic reaction

how to administer Epipen and to go to ER after using it

low RBC or eopoetic could mean

kidney dysfunction as the kidneys make RBC

eopoetic= is located in the _______and makes RBC

kidneys

Neutrophil definition:

make up 40% to 70% of all white blood cells in humans. They form an essential part of the innate immune system. They have long been regarded as the first line of defense against infection and one of the main cell types involved in initiation of the inflammatory response.

Hemoglobin (Hgb) meaning and values for women and men

men 13.2-16.6 g/dL women 11.6-15 g/dL (is the iron-containing oxygen-transport metalloprotein in red blood cells)

Hematocrit (Hct) meaning and men and women values:

men 41-50% women 36-44% ( measures how much of a person's blood is made up of red blood cells.)

if PH is high with PaCO2 or HCO3 it is

metabolic

if PH is low with PaCO2 or HCO3 it is

metabolic

The nurse cares for an older adult client with unprovoked back pain and increased serum protein. Which hematologic neoplasm does the nurse suspect the client has?

multi myeledoma

What pathophysiological process does the nurse recognize is the cause of the client's fever?

neutropenia

WBC normal values and values for risk of infection and severe infection:

normal: 4,500 to 11,000 microliter <1000= risk for infection <500 = risk for severe infection

Symptoms related to anemia

pallor, fatigue, weakness, dyspnea on exertion, and dizziness

everything is abnormal

partially compensated

Venipuncture Insertion Considerations:

patient's medical history, age and general condition, condition of veins, type of IV fluid and medications, expected duration of therapy, your skill (novice nurse gets one try and expert two), use non dominant hand or forearm, avoid antecubital fossa and above, start distal and make subsequent puncture proximal, avoid veins of the palmar side of wrist, veins of legs, feet, and ankles are not recommended in adults patients. Avoid arms affected by a radical mastectomy, edema, blood clot, paralysis or infection, and or an arm with an arteriovenous shunt or fistula

The nurse is discussing disorders of the hematopoietic system when a client asked about erythrocytosis. What disease will the nurse mention with a primary characteristic of erythrocytosis?

polycythemia vera

if if PH is high and PaCO2 or HCO3 is low or vice versa it is

respiratory

Venipuncture Extravasation:

similar to infiltration, with an inadvertent administration of vesicant or irritant solution or medication into the surrounding tissue. Blistering, inflammation, and necrosis of tissues can occur. Older patients, comatose, patients with diabetes, patients with peripheral vascular or cardiovascular disease are at great risk for extravasation. complications of an extravasation may include blister formation, skin sloughing and tissue necrosis, functional or sensory loss in the injured area, and disfigurement or loss of limb

The nurse is assessing a client admitted with a deep vein thrombosis with an elevated red blood cell count. The admitting diagnosis is polycythemia vera. What is the hallmark clinical sign of PV?

splenomegaly

with bronchospasm, laryngeal edema, and shock. These reactions are managed with epinephrine, corticosteroids, and vasopressor support, if necessary.

symptoms of severe allergic reaction and treatment are

multiple myeloma and leukemia are cancerous?

true

if one of the PaCO2 or HCO3 is normal it is considered

uncompensated

Venipuncture Infiltration

unintentional administration of a nonvesicant or medication into surrounding tissue. Can occur when IV cannula dislodges or perforates the wall of the vein. Characterized by edema around the insertion site, leakage of IV fluid from the insertion site, discomfort and coolness, and significant decrease in flow rate. If solution is irritating, slough of tissue may result. A way to determine if an IV is infiltrated is if you tourniquet the area above enough to cause venous obstruction, and infusion continues to drip, it's infiltrated. Infiltration of any amount of blood product, irritant, or vesicant is considered the most severe.

Which statement indicates the client understands teaching about induction therapy for leukemia?

"I will be in the hospital for several weeks."

A client with pernicious anemia is receiving parenteral vitamin B12 therapy. Which client statement indicates effective teaching about this therapy?

"I will receive parenteral vitamin B12 therapy for the rest of my life."

Assessment for phlebitis: scale from 0-4 explain and what is the treatment?

(treatment is to discontinue the IV, restart, and apply a warm, moist compress to affected site) 0 being no clinical symptoms 1 being erythema at access site with or without pain 2 being pain, erythema, edema, or both 3 being pain, erythema, edema, or both, with streak formation, and palpable venous cord 4 being pain with erythema, streak formation, palpable venous cord (longer than an inch), and purulent drainage

HIV prevention

- Educating patient how to eliminate or reduce risks of low CD4 count that causes opportunistic infection. Standard precautions: hand hygiene, PPE, soiled PT equipment, DO NOT recap needles and other sharps instead use a hard surface for the needle protector to clip on. -HIV is transmitted through exchange of body fluids -Behavioral interventions have been effective (ensuring people have the info, motivation and the skills to reduce their risk) - HIV testing (change behaviors to protect partners if they know they are infected with HIV) -Latex condoms are highly effective in preventing the secual transmsion of HIV

Megaloblastic Anemias

-Associated w/ vitamin B12 or folic acid deficiency. Ability of bone marrow to respond to decrease in erythrocytes by producing reticulocytes Degree to which immature erythrocytes proliferate in bone marrow and their ability to mature Presence or absence of end products of erythrocyte destruction in circulation Diagnostics: Hemoglobin (Hgb)/ RBC Hematocrit Reticulocyte count (slightly immature red blood cells- tells you if they are being produced at good rate or if they are dying early) MCV (mean corpuscular volume) Red cell distribution width (RDW) CBC values- indicates the counts of white blood cells, red blood cells and platelets, the concentration of hemoglobin, and the hematocrit. Other studies include iron studies (serum iron level, total iron-binding capacity [TIBC], percent saturation, and ferritin), serum vitamin B12, folate levels, haptoglobin, and erythropoietin levels Bone marrow aspiration can be used to assess for cellular abnormalities Pathophysiology: Decreased number of erythrocytes associated with hypoproliferation (decreased production), hemolysis (increased destruction), or loss of cells through bleeding Decreased erythrocytes= less red blood cells/low normal reticulocyte (immature RBC) count) = less SPO2= fatigue cause: -may include bone marrow damage from chemicals (benzene) or medication (chloramphenicol), -lack of important factors that promote erythrocyte production or erythropoietin, -lack of nutrients, including iron, vitamin B12, and folic acid -Hemolytic anemias= premature destruction of erythrocytes = liberation of hemoglobin from erythrocytes into plasma, released hemoglobin converted to bilirubin and bilirubin rises. -Increased erythrocyte destruction leads to tissue hypoxia= stimulates erythropoietin production but doesnt work. -can result from abnormality within erythrocyte, within plasma, or from direct injury to erythrocyte Causes: -Administer blood products and hematopoietic medications as prescribed, which are used to treat anemia related to acute and chronic conditions by introducing bone marrow, which naturally has growth factor for stem cells= WBC, RBC, platelets -Control and address source of bleeding if anemia is caused by acute blood loss and assess client for sources of frank and occult bleeding. -Contact PCHP and prepare replacement therapy if acute blood loss occurs. Complications: Heart failure, paresthesias, delirium Diet: Encourage diet rich in deficient nutrient if anemia is caused by malnutrition such as iron (helps RBC carry O2), folate (important for pregnant women= decrease neural tube defects), or vitamin B12 supplementation ( helps prevent megaloblastic anemia, a blood condition that makes people tired and weak.)

aplastic anemia causes, assessment, interventions:

-Deficiency in circulating erythrocytes and all other formed elements of blood, resulting from arrested development of cells within bone marrow -Hemoglobin is the part of blood that carries oxygen through your body. Having fewer white blood cells makes you more likely to get an infection -is a life-threatening bone marrow failure syndrome in which the hematopoietic stem cells are destroyed, leading to pancytopenia. Although the exact biological process leading to AA remains largely unknown, bone marrow destruction is thought to be mediated by an autologous T cell response. .-Therapeutic management focuses on restoring function to bone marrow and involves immunosuppressive therapy and bone marrow transplantation Assessment: Pancytopenia (deficiency of erythrocytes, leukocytes, thrombocytes) Petechiae, purpura (bruising), bleeding, pallor, weakness, tachycardia, fatigue Interventions: Monitoring side effects of therapy, including hypersensitivity reactions while administering ATG (antihymocyte globulin) At risk for problems associated w/ deficiencies of erythrocytes, leukocytes, and platelets

A client with heart failure is prescribed to receive 2 units of packed red blood cells. Which actions will the nurse take to decrease the client's risk of developing transfusion-associated circulatory overload? Select all that apply.

-Elevate the head of the bed-Place feet in a dependent position-Reduce the rate of transfusion to 100 mL/hr-Provide furosemide as prescribed before the transfusion

Most common anemia deficiency? assessment, causes, and interventions

-Iron stores depleted, resulting in decreased iron supply of hemoglobin in blood Causes: from blood loss, increased metabolic demands, syndromes of gastrointestinal malabsorption, dietary inadequacy Assessment: Pallor Weakness and fatigue Low hemoglobin, hematocrit, mean cellular volume (MCV) levels Interventions Increase oral intake and instruct client in food choices high in iron Interventions: -Administer supplements, Have to take iron supplements 6-12 months to build up iron stores in bone marrow -Intramuscular injections of iron or IV administration of iron may be prescribed in severe cases -Instruct client about side effects of iron (black stools, constipation, foul aftertaste) -Liquid iron prep stains teeth. Teach client that liquid iron should be taken through a straw and that teeth should be brushed after administration

Folate deficiency anemia definition, causes, assessment, treatment

-RBC larger than normal and due to lack of folate (vitamin B6) -folate is Required for DNA synthesis required for RBC formation and maturation Common causes include: dietary deficiency; malabsorption syndromes (Celiac disease, Crohn's); medications (such as antiseizure meds) that decrease absorption of folic acid; requirement during pregnancy; chronic alcoholism; chronic hemodialysis Assessment: Dyspepsia ***Smooth, beefy red tongue Pallor, fatigue and weakness ***Tinnitus Tachycardia Interventions: Encourage client to eat foods rich in folic acid (green leafy veggies, meat, liver, fish, legumes, peanuts, orange juice, avocado) Administer folic acid as prescribed

blood transfusion

-Safety: check vitals at 5 min and 15 min - give Oxygen -Monitoring/Signs of a reaction: Fever, chills, low back pain, nausea, chest tightness, dyspnea, anxiety, Cardiovascular overload and signs of difficulty breathing (transfusion-associated circulatory overload)---look for crackles in lung sounds, Transfusion-related acute lung injury may occur and is characterized by pulmonary edema, hypoxia, respiratory distress, and pulmonary infiltrates Acute coronary syndrome is also a possible complication of excessive fluid resuscitation and may initially present with respiratory symptoms and decreased urine output, Hemodynamic pressure monitoring, arterial blood gases, serum lactate levels, hemoglobin and hematocrit levels, temperature, bladder pressure monitoring, and fluid intake and output need to be monitored, Jugular venous pressure is low in hypovolemic shock, Observe for jugular vein distention and monitoring jugular venous pressure Nurse must monitor cardiac and respiratory status closely and report changes in BP, pulse pressure, CVP, heart rate and rhythm, and lung sounds (15 and 30 minutes after transfusion begins)

HIV stages

-Stages: 5 stages of HIV infection (0, 1, 2, 3, or unknown) Stage 0: Primary infection (acute HIV infection) window period: period from infection with HIV development to the HIV-specific antibodies. Acute HIV infection is the interval between the appearance of detectable HIV RNA and the first detection of antibodies. test negative on the HIV antibody blood test, although they are not only infected, but also highly contagious. Stage 1: Amount of virus in the body depends on viral set point which reflects between HIV levels and immune response. Untreated will last for years. Stage 2:occurs when CD4+ T-lymphocyte cells decrease to between 200 and 499 cells/mm3 and had previously been referred to as the symptomatic stage Stage 3: an opportunistic illness has been diagnosed

pernicious anemia is due to

-Vitamin B12 deficiency. -It is a Macrocytic anemia that results from inadequate intake of vitamin B12 or lack of absorption of ingested vitamin B12 from intestinal tract. Pernicious anemia results from deficiency of intrinsic factor, necessary for intestinal absorption of vitamin B12; gastric disease or surgery can result. A special protein, called intrinsic factor (IF), binds vitamin B12 so that it can be absorbed in the intestines. The body needs vitamin B12 to make red blood cells. Assessment: Severe pallor Fatigue Weight loss ***Smooth, beefy red tongue Slight jaundice Paresthesias of hand and feet Disturbances w/ gait and balance

manifestations of hypokalemia (potassium)

-apnea -hypotonic bowel sounds -prolonged pr wave -muscle fatigue -flattened t wave and large u wave after t wave

The nurse cares for several clients with hematological conditions. Which assessment needs will the nurse prioritize for the client with aplastic anemia? Select all that apply.

-bleeding-infection

A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply.

-blood loss-abnormal erythrocyte production- destruction of normally formed RBC

anemia definition and signs/symptoms:

-condition in which blood lacks adequate healthy red blood cells or hemoglobin, with most common causes being acute blood loss, decreased or faulty red blood cell production, or the destruction of red blood cells. (page 885). Less oxygen in tissues causing variety of signs and symptoms Assessment Findings: Fatigue Weakness Pallor or slight jaundice if red blood cell destruction occurs Shortness of breath Dysrhythmias Chest pain Tachycardia Cool extremities Lesions in GI tract including ulcers, polyps, or tumors may be source of blood loss

hyperphosphatemia manifestations

-tetany-hypotension-ECG with shortened QT interval

Assessment for infiltration: scale from 0-4 explain

0 no clinical symptoms 1 skin blanched, edema less than 1 inch in any direction, cool to touch, with or without pain 2 skin blanched, edema 1 to 6 inches in any direction, cool to touch, with or without pain 3 skin blanched, translucent, gross edema greater than 6 inches in any direction, cool to touch, mild to moderate pain, possible numbness 4 skin blanched, translucent, skin tight, leaking, skin discolored, bruised, swollen, gross edema greater than 6 inches in any direction, deep pitting edema, circulatory impairment, moderate to severe pain, infiltration of any amount of blood products, irritant, or vesicant

creatinine normal values

0.5-1.5mg/dL

HIV pharm treatment

1. =PrEP: 1 pill containing 2 HIV medications ((tenofovir disoproxil fumarate 300 mg and emtricitabine 200 mg) Does not prevent STIs 2.-ART (anti-retro viral therapy) as prescribed and achieving and maintaining viral suppression, there is no risk of transmitting HIV through sex. 3.Post-exposure prophylaxis (PEP)( for health care providers)includes taking antiretroviral medicines as soon as possible, but no more than 72 hours (3 days) after possible HIV exposure;

explain Types of immunity

1. Acquired Immunity: develops due to prior exposure to an antigen through immunization or by contracting a disease, both of which generate a protective immune response. This form of immunity relies on the recognition of specific foreign antigens. Divided into two mechanisms: the cell-mediated response, involving T-cell activation and the effector mechanism, involving B-cell maturation and production of antibodies. This type of immunity can last many years or even a lifetime 2. Passive Immunity: temporary immunity transmitted from a source that has developed immunity through previous disease or immunization. Examples: immunity resulting from the transfer of antibodies from the mother to an infant in utero or through breast-feeding or receiving injections of immune globulin.

phlebitis inflammation of a vein, can be categorized as chemical, mechanical or bacterial. explain them:

1. Chemical phlebitis-occurs from an irritating medication or solution, rapid infusion rates, and medication incompatibilities. 2. Mechanical phlebitis- results from long periods of cannulation, catheters in flexed areas, catheter gauges larger than vein lumen, and poorly secured catheters 3. Bacterial phlebitis- can occur with poor hand hygiene, lack of aseptic technique, failure to check all equipment before use, and failure to recognize early signs and symptoms of phlebitis.

types of IV solutions with examples and indications:

1. Hypotonic: purpose is to replace fluid and to provide free water. At times, can be used to treat hypernatremia and other hyperosmolar conditions Half strength saline (0.45% sodium chloride) solution 2. Hypertonic: include 3% NaCl and IV mannitol. If a patient's sodium is depleted, a hypertonic sodium IV solution might be used. If a patient is experiencing acute cerebral edema, IV mannitol is often used. Hypertonic solutions pull water from the interstitial and intracellular compartments into the bloodstream (cellular dehydrated). Pulls fluids from vascular space to cells; used to treat hypernatremia Monitor patients for altered mental status, confusion D5W for hypovolemia NaCl and IV mannitol 3. Isotonic: total osmolality close to that of the EFC and do not cause cells to shrink or swell. One liter of isotonic fluid expands the ECF by 1 L; however, isotonic solution expands the plasma component of ECF by only 0.25 L. Patients with heart failure or hypertension who receive isotonic solutions should be carefully monitored for signs of fluid overload. ***Normal saline and lactated Ringer's solutions (can be hypertonic when added dextrose)***

Medication administration: IV push, bolus, infusion explain

1. IV Push: medication is pushed through a syringe connected to the IV catheter. Make sure to flush before and after the medication administration and be mindful if it can be pushed quickly or if you must take time pushing it through or in a pulse motion. Choose injection port closest to iv, cleanse the injection port with alcohol swab, ***remove needle** and attach the hub of the syringe (maintain sterile technique), kink the tube while administering push, administer medication in appropriate time frame, unking the tubing and assess iv rate. 2. Bolus: Same as push however medications are pushed slower. While IV push takes seconds to deliver medications IV bolus takes minutes. IV push is used in emergencies and bolus is used in less high-stakes situations. 3. IV infusion:Takes longer to reach the bloodstream as it relies on gravity, although the dosage rate can be controlled more minutely by monitoring the drops per minute.

magneseum normal values

1.5-2.5 mg/dL

Sodium normal values

135-145 mEq/L

platelet normal count

150,000 to 450,000 microliter

phosphorus normal values

2.5-4.5 mg/dL

HCO3 normal range

22-26

Gauges (sizes) and what they are for 26-14

24 to 26 gauge for infants, small children and elderly 22 gauge for medical patients (IV therapy) 20 gauge for surgical and for blood transfussion 18 gauge preferred size for surgery. Needs to be in a large vein 14-16 gauge for trama (those requiring large volume of fluid rapidly)

potassium normal values

3.5-5.0 mEq/L

PaCO2 normal range

35-45