NUR 426 - Exam 1 Study Set

consequences of sickle cell anemia

- CVA - paralysis - death - retinopathy - hemorrhage - hepatomegaly - gallstones - splenomegaly - splenic sequestration - autpsplenectomy - hematuria - hyposthenuria (dilute urine) - abdominal pain - osteomyelitis - dactylitis (hand-foot syndrome)

acute chest syndrome

- a form of vaso-occlusive crisis that occurs in the pulmonary tissue - can cause pulmonary emboli - cause of 1/4 of death for those with SCD

skin reactions to cancer

- alopecia - infections - radiation treatment field skin reactions

cachexia

- also called wasting syndrome - due to anorexia and/or unintended loss of weight/appetite - general tissue wasting, skeletal muscle atrophy, immune dysfunction, and metabolic abnormalities

when to give fresh frozen plasma

- bleeding due to deficiency of clotting factors - DIC - hemorrhage - liver disease - vitamin K deficiency

myelosuppression

- bone marrow suppression - low WBC, RBC, and plt counts - increases risk for infection, anemia, bleeding, and fatigue

carcinoma & adenocarcinoma

- cancer originating from the skin, glands, and mucous membrane lining of the respiratory, GI, or GU tracts - examples: prostate cancer, lung cancer, colon cancer

when to give platelets

- cancer patients and BMT patients - burn patients - extremely low platelet counts or patients with platelet dysfunction - patients at high risk of bleeding

sarcoma

- cancer that originates from muscle, bone, or connective tissues - examples: osteosarcoma, fibrosarcoma

leukemia and myeloma

- cancer that originates from the hematopoietic system - examples: acute lymphocytic leukemia, chronic myeloid leukemia

lymphoma

- cancer that originates from the lymphatic system - examples: Hodgkin's lymphoma & Non-Hodgkin's lymphoma

warning signs of cancer

- change in bowel or bladder habits - a sore that does not heal - unusual bleeding or discharge - thickening or lump in tissue - indigestion or dysphagia - obvious change in a wart or mole - nagging cough or hoarseness

clotting manifestations of DIC

- cyanosis, ischemic tissue necrosis - dyspnea, pulmonary emboli - ECG changes and venous distention - abdominal pain and paralytic ileus - kidney damage and oliguria, leading to organ failure

vascular effects of hydroxyurea

- decreased WBC and platelets - decreased endothelial activation and adhesion - decreased thrombosis and microparticles - decreased vasoconstriction

folic acid

- given in pregnancy to prevent neural tube defects in the developing fetus - treats alcoholism and megaloblastic anemia - this therapy can mask the symptoms of B12 deficiency

desmopressin

- given to treat mild forms of hemophilia A - can also be given to control trauma-induced bleeding and help to maintain hemostasis during surgery - antidiuretic that also stimulates the body to release factor VIII - interactions do not affect the drug's use for hemophilia, only the use for diabetes insipidus - NSAIDs, SSRIs, and thiazide diuretics can increase the risk of hyponatremia as well as fluid retention

when to give albumin

- hypovolemic shock - hypoalbuminemia - after a large volume paracentesis

RBC effects of hydroxyurea

- increased fetal hemoglobin - decreased HbS polymerization - decreased RBC membrane damage - decreased hemolysis increased hemoglobin

stressors that can cause sickling

- infection - low O2 in the blood - decreased blood pH - dehydration - hypovolemia - vasoconstriction - emotional stress - high altitudes

clopidogrel (Plavix)

- inhibition of platelet aggregation - causes platelets to be "less sticky" - anticoagulants, NSAIDs, glucocorticoids, and alcohol all increase bleeding risk - monitor for thrombotic thrombocytopenia purpura in the first two weeks of therapy - irreversible; lasts 7-10 days

late effects of radiation and chemo

- lymphedema - cardiac toxicity - cataracts - arthralgia - renal insufficiency - hepatitis - osteoporosis - neurocognitive problems

DIC - diffuse coagulation

- microclots - caused by an underlying condition triggering wide-spread coagulation

benign

- normal differentiation - not capable of spreading to other locations

Laboratory findings with DIC

- platelets low - shistocytes (fragmented RBCs) - fibrinogen low - bleeding/coagulation times often prolonged - d-dimer high

malignant

- poor differentiation - ability to infiltrate and spread to other sites (metastasize)

sickle cell anemia

- presence of abnormal hemoglobin (HbS) in the RBCs - malformation causes the cells to become sticky, viscous, and inflexible

sequestration

- sickled cells that are hemolyzed in the spleen - can cause life threatening pooling of blood in the spleen and possibly in the liver

manifestations of hemophilia

- slow, prolonged bleeding from minor trauma - delayed bleeding, hours to days, from minor trauma - uncontrollable bleeding - GI bleeding - hematuria - hemarthrosis (bleeding into a joint)

heparin and lovenox

- treatment of DIC - decreases the clotting ability of the blood - activates antithrombin in the blood - NSAIDs, ASA, and antiplatelet drugs increase bleeding risk - Heparin -> hospital only - Lovenox -> can take shots at home - reversal agent is protamine

factor VIII and factor IX concentrate

- treatment of hemophilia A and B - can cause the patient to develop creutzfeldt-jakob disease - ASA can cause GI ulceration and bleeding - NSAIDs should not be given but celecoxib (Celebrex) is the safest if necessary

ferrous sulfate

- treats iron deficiency anemia and prevention of iron deficiency anemia for those at risk - can cause a metallic taste in the mouth - antacids REDUCE absorption - vitamin c INCREASES absorption

montelukast

- used as adjunctive therapy in the treatment of allergic rhinitis, asthma, and exercise induced bronchospasm - given once daily in the evening

alteplase

- used for AMIs, DVTs, CVAs, and for reestablishing patency of occluded central lines - AMIs within two hours and CVAs within 3-4.5 hours - drugs that enhance bleeding (such as NSAIDs, warfarin, and heparin) increase the patient's risk for bleeding

theophylline

- used for long-term management of chronic asthma - caffeine can increase the risk of toxicity - phenobarbital, dilantin, and nicotine can increase the metabolism of theophylline

beclomethasone/prednisone/fluticasone

- used for long-term management of chronic asthma and short-term management of post-exacerbation symptoms - NSAIDs increase the risk of GI bleeding - decreases effects of insulin and oral hypoglycemics

cromolyn

- used for long-term treatment of allergy-related asthma, prophylaxis of exercise-induced bronchospasm and seasonal allergy symptoms, as well as management of allergic rhinitis - to be used with a nebulizer or metered-dose inhaler

ipratropium

- used for relief of bronchoconstriction and decrease secretions in clients who have COPD - beta2-adrenergic agonists enhance bronchodilation

warfarin

- used to treat current blood clots and/or to prevent new clots from forming in the body - disrupts the role of vitamin K in the body - heparin, ASA, acetaminophen, and glucocorticoids increase anticoagulation - excessive consumption of foods rich in vitamin K decreases anticoagulation - reversal is vitamin k

vitamin b12 (cyanocobalamin)

- used to treat pernicious anemia and vitamin deficiencies - folic acid can mask the symptoms of vitamin deficiency - alcohol can reduce the absorption

bleeding manifestations of DIC

- venipuncture site bleeding - hematoma and petechiae - occult hemorrhage - pallor - purpura - tachypnea - upper and lower GI bleeds - abdominal distension - bloody stools and hematuria - bone and joint pain - vision changes, dizziness, headache, changes in mental status

when to give IVIG

- when a patient is immunodeficient and cannot make their own antibodies - when a patient's immune system has started attacking its own cells

INR normal range

0.8-1.1

platelet normal range

150,000-400,000

ANC normal range

2200-7700

aPTT normal range

30-40 seconds

WBCs normal range

5,000-10,000

DIC definition

a serious bleeding and thrombotic disorder that results from abnormally initiated and accelerated clotting

neoplasia

abnormal and progressive multiplication of cells

differentiation

acquisition of a specific cell function (less specialized cell becomes more specialized)

hyper-hemolytic crisis

an acceleration of RBC destruction in the bloodstream

DIC - profuse bleeding

caused by the depletion of clotting factors and platelets

Hemoglobin normal range

female: 12-16 male: 14-18

Hematocrit normal range

female: 37-47% male: 42-52%

when to give granulocytes

given for BMT patients who develop a bacterial or fungal infection not responsive to antibiotics

when to give clotting factors

given just before a procedure to prevent bleeding

RBCs normal range

male: 4.7-6.1 female:4.2-5.4

neoplasm

new but abnormal tissue growth that is uncontrolled and progressive

aplastic crisis

occurs when the bone marrow stops making RBCs, causing severe and potentially life threatening anemia

proliferation

reproduction of new cells through cell growth and cell division

albuterol

used for long-term management of asthma, the prevention of exercise-induced bronchospasm, and the treatment of ongoing asthma exacerbations

when to give pRBCs

used for treatment of anemia usually when Hgb levels are less than 7-8

when to give cyroprecipitates

used in hemophilia, DIC, liver disease, or a massive transfusion

vaso-occlusive crisis

when sickled cells clump together which can result in ischemia, infarction, fever, pain, swelling, and CVA