PATHOPHYSIOLOGY CHAPTER 11
infectious mononucleosis/clinical manifestations
-4 to 8 weeks of incubaiton -several days of prodromal period: malaise, anorexia, chills -fever, pharyngitis, and lymphadenopathy -most recover without incident: 2 to 3 weeks of acute illness or 2 to 3 months
White blood cell count
-White blood cell counts vary between species. -The more dense the population, the more neutrophils. -The more sexual partners, the more eosinophils
Granulocytes: Granular leukocytes are created in the bone marrow; eosinophils, basophils, and neutrophils are all granular leukocytes
-a group of leukocytes containing granules in their cytoplasm -lobed nucleus, multilobar nuclei -phagocytic
-common myeloid stem cells
-erythrocyte/megakaryocytic -nd granulocyte monocyte
basophils
-stain blue Account for 0-1% of WBC's in the blood. They carry histamines to be released in case of an allergic reaction.
eosinophils: 1 to 4 % -detoxify agents during allergic reactions and parasitic infections
-stain red
Neoplastic disorders of hematopoietic and lymphoid origin:
2 types depending on the origin of the tumor: -lymphoid neoplasm -myeloid neoplasm Features are determined by the site of origin and the malignant development
Which of the following types of white blood cells are related to the connective tissue mast cells and respond in allergic and hypersensitivity reactions? a) Granulocytes b) Basophils c) Neutrophils d) B lymphocytes
Basophils Explanation: The basophil is related to connective tissue mast cell because they contain similar granules and are believed to be involved in allergic and hypersensitivity reactions. Neutrophils, granulocytes, and B lymphocytes are not identified as being similar to mast cells. (
Plasma cell dyscrasias
Causes of decreased anion gap metabolic acidosis A pre-neoplastic condition with an increase in plasma cell with monoclonal Ig production, but without the presence of a tumor is known as ___________. Multiple myeloma
When a white blood cell with differential count reveals an acute infection, which of the following is correct regarding the client's neutrophils? You selected: Neutrophils are the first white blood cell to elevate in an acute infection. Incorrect
Correct response: There are fewer neutrophils in the blood than other white blood cells. Explanation: Neutrophils constitute 55% to 65% of the total numbers of white blood cells and are primarily responsible for maintaining normal host defenses against invading fever producing bacteria and fungi, cell debris, and a variety of foreign substances. Eosinophils are white blood cells that are responsive in an allergic or parasitic infection. (less)
Which of the following colony-stimulating factors (CSFs) is given to ESRD patients to help with their chronic anemia? a) Neupogen. b) Interleukin. c) Erythropoietin (EPO). d) Thrombopoietin (TPO)
Erythropoietin (EPO). Correct Explanation: The CSFs that act on committed progenitor cells include erythropoietin (EPO) which stimulates RBC production. TPO stimulates platelets. Neupogen is for white blood cell production. Interleukin is a cytokine utilized as a immune response agent. (less)
lymphoid tissue -the alimentary canal, respiratory passages, and genitourinary systems are guarded of lymphoid tissues that are not enclosed in a capsule
Houses and provides a proliferation site for lymphocytes - lymph nodes, tonsils, spleen, thymu
CFUs colony forming units
Several levels of differentiation lead to the development of committed unipotential cells, which are the progenitors of the the blood cell types
Drug-induced neutropenia is a disease that has significantly increased in incidence over the last several decades. What is the attributing factor in the increased incidence of drug-induced neutropenia? a) The decrease in the use of street drugs b) The destruction of tissue cells by cocaine c) Treatment of cancer by chemotherapeutic drugs d) The new drugs developed to treat autoimmune diseases
Treatment of cancer by chemotherapeutic drugs Correct Explanation: The incidence of drug-induced neutropenia has increased significantly over the last several decades and is attributed primarily to a wider use of drugs in general and more specifically to the use of chemotherapeutic drugs in the treatment of cancer. (less)
Define the terms leukopenia, neutropenia, granulocytopenia, and aplastic anemia.
WBC's deficiencies: leukopenia, neutropenia, granulocytopenia, and aplastic anemia, infectious mononucleosis, HIV
A patient diagnosed with systemic lupus erythematosus (SLE) has been experiencing a low neutrophil count. How would this type of neutropenia be classified?
You selected: Acquired, autoimmune secondary neutropenia Correct Explanation: A person with SLE (an autoimmune disease) with neutropenia would be considered to have acquired (not born with), autoimmune secondary neutropenia. Chronic refers to long-term conditions. (less)
Which of the following is the main job of lymphocytes?
You selected: Immune reaction Correct Explanation: Immune reaction is the main job of lymphocytes.
A high school teenager comes to the emergency room with symptoms that include the abrupt onset of severe pharyngitis and a high fever. The teenager reports that in the previous four days he has "just not felt well." The nurse anticipates orders to include which of the following?
You selected: White blood cell count Correct Explanation: The nurse should anticipate orders that include white blood cell count as this teenager is experiencing symptoms of possible mononucleosis, including severe pharyngitis, a fever, and prodromal period that includes maliase. Typically, the peripheral blood of those with mononucleosis includes increase in number of leukocytees with a white blood cell count of 10,000 cells/uL, 30 percent of which are leukocytes. (less)
he nursing caring for a 62-year-old client with diffuse large B-cell lymphoma plans care based on the knowledge that this client's lymphoma is:
You selected: aggressive. Correct Explanation: Diffuse large B-cell lymphomas are a heterogenous group of aggressive germinal or postgeminal center noeplasms. They evolve rapidly, are multifocal, nodal and extranodal. They are rapidly fatal if left untreated
myeloid neoplasm arise from hematopoietic stem cells and give rise to monoclonal proliferations that replace normal bone marrow cells
abnoraml proliferation of myeloid tissue or myeloid precursor cells often associated with cancerous transformation
neutropenia
abnormal low number of neutrophils
Leukemia types
according to its predominant cell type: lymphocytic or myelocytic, and whether the condition is acute or chronic
infectious mononucleosis
an infection caused by the Epstein-Barr virus (EBV) that is characterized by fever, a sore throat, and enlarged lymph nodes. -oral contact is contagious
Kostman syndrome
autosomal recessive congenital neutropenia severe congenital neutropenia -almost all patients died in earlier childhood
The nurse reading a client's history and physical notes that the client has a history of leukopenia. The nurse interprets this to mean that the client has which of the following? a) Decreased hematocrit b) Decreased leukocytes c) Anemia d) Leukemia
b
A nurse is caring for a newborn that has developed a low platelet count. Which of the following could be the cause? a) Decreased spleen function b) Decreased thrombopoietin (TPO) c) Increased megakaryocytes d) Increased pluripotent stem cell division
b Decreased thrombopoietin (TPO) Correct Explanation: TPO stimulates the differentiation of platelets.
The nurse's plan of care for a client with multiple myeloma should include interventions to prevent which of the following? a) Urinary tract infections b) Fractures c) Diarhhea d) GI bleed
b Fractures Correct Explanation: In multiple myeloma there is abnormal proliferation of marrow plasma cells, which leads to bone resorption and destruction, predisposing the person to fractures.
Which is the reason why bed rest and analgesics are expected treatments for infectious mononucleosis? a) To increase the white blood count b) To relive fever, headache, and sore throat c) To decrease the risk of neutropenia d) To eliminate the causative organism
b To relive fever, headache, and sore throat Correct Explanation: Rationale: The typical treatment will consist of bed rest and analgesics to keep the patient comfortable. Antivirals, transfusions and antibiotics are not required.
The nurse evaluating a client's bloodwork determines that a client has an increased risk for infection based on which of the following lab results? a) Absoulute neutrophil count of 1000/uL b) Absolute neutrophil count of 1100/uL c) Absoulute neutrophil count of 800/uL d) Absolute neutrophil count of 1200/uL
c The absolute neutrophil count is supposed to be 1000/uL and neutropenia or a low neutrophil count is less than 1000/uL, placing the client at risk for infection, as nuetrophils play a critical role in fighting infection. (
Leukocytes (WBC's)
classify in 2 groups: granulocytes: neutrophils, eosinophils, basophils agranulocytes: lymphocytes and monocytes
Cite two general causes of neutropenia.
congenital or acquired
A nurse sends a blood sample to the lab for analysis. Assuming the sample is normal, the nurse anticipates which of the following white blood cells (WBCs) will account for the highest percentage? a) Monocytes b) Eosinophils c) Lymphocytes d) Neutrophils
d
granulocytopenia
deficiency of granulocytes in the blood
-common limphoid
develops into two lineage-specific precursor cells: -T Lymphocytes (T cells) -B Lymphocytes (B cells) -and natural killer NK
neutrophils: 60 -65% -maintain normal host defense
do not stain Most abundant white blood cell., The most abundant type of white blood cell. Phagocytic and tend to self-destruct as they destroy foreign invaders, limiting their life span to a few days.
The pediatrician knows that the most common cause of cancer in children is which of the following? a) Multiple myeloma b) Leukemia c) Infectious mononucleosis d) Non-Hodgkin lymphomas
Leukemia Correct Explanation: Leukemia is the most common cause of cancer in children and adolescents. Multiple myeloma occurs most frequently in people older than 60 years of age. Children are not as likely as adults to be diagnosed with non-Hodgkin lymphomas. Infectious mononucleosis does not cause cancer in children. (less)
Leukemia ppt...
Malignant neoplasms of hematopoietic stem cells Create abnormal white blood cells Lymphocytic (ALL, CLL) Myelocytic (AML, CML) Biphenotypic
Lymphoid neoplasms
Mutation of the lymphoid cell line Overproduction of abnormal immune cells Lymphocytic (B- and T-cell) leukemia Hodgkin and non-Hodgkin lymphomas
myeloid neoplasm ppt...
Mutation of the myeloid cell line Overproduction of abnormal monocytes or granulocytes Replace normal bone marrow cells Acute and chronic myelocytic leukemia
Lymphoma ppt...
Non-Hodgkin lymphoma B cell T cell Hodgkin lymphoma Malignant B cells invade lymphoid organs.
A group of nursing students were studying for their pathophysiology exam by quizzing each other about disorders of WBCs and lymphoid tissue. When asked what the first chromosomal abnormality that identified cancer was, one student correctly answered: a) BRCA-1. b) Interleukin cells. c) Philadelphia. d) PSA.
Philadelphia. Explanation: One of the more studied translocations is the Philadelphia chromosome, which was the first chromosomal abnormality identified in cancer. Cytokines or chemical messengers, such as interleukin (IL)-1, IL-4, IL-6, and interferon, act synergistically to support the functions of the growth factors. BRCA is a genetic test for breast cancer testing. BRCA mutations place the female at risk for developing cancers of the breast and ovary; PSA stands for prostate-specific antigen. It is a protein produced by prostate cells and is utilized to screen for prostate cancer. (less)
The nurse is admitting a client who is documented to be in the terminal blast crisis phase of chronic myelogenous leukemia (CML). The nurse interprets this to mean that: a) the CML is indolent. b) the CML has evolved to acute leukemia. c) the CML has evolved to chronic lymphocytic leukemia. d) the CML is in remission.
the CML has evolved to acute leukemia. Correct Explanation: The terminal blast crisis phase of CML represents evolution to acute leukemia and is characterized by an increasing number of myeloid precursors, especially blast cells.
infectious mononucleosis/tx
tx is isymthomatic and supportive: bed rest, and analgesics like acetaminophen and non-steroidal anti-inflammatory drugs to relaeav fever, headache and sorethroat -splenic rupture is rare, avoidance of contact sports 3 weeks after diagnosis
leukopenia
Abnormally low white blood cell count -most often affects the neutrophils
(see full question) A lymph node biopsy pathology report notes the presence of Reed-Sternberg cells on a patient suspected of having a lymphoma. The nurse interprets the report as indicating which of the following? You selected: Non-Hodgkin's lymphoma Incorrect Correct response: Hodgkin's lymphoma Explanation: Hodgkin's lymphoma is a specialized form of lymphoma that features the presence of an abnormal cell called a Reed-Sternberg cell. Therefore the nurse should interpret the pathology report as indicating Hodgkin's lymphoma.
A 30 year-old male's blood work and biopsies indicate that he has proliferating osteoclasts that are producing large amounts of IgG. What is the man's most likely diagnosis? You selected: Acute lymphocytic leukemia Incorrect Correct response: Multiple myeloma Explanation: One of the characteristics resulting from the proliferating osteoclasts in multiple myeloma is the unregulated production of a monoclonal antibody referred to as the M protein. In most cases the M protein is either IgG or IgA. This phenomenon is not present in cases of CML, ALL or Hodgkin lymphoma. (less)
Following an injury resulting in a small cut from a knife, the first cells to go to the area of the cut would be the: You selected: Neutrophils. Correct Explanation: Neutrophils are very mobile and are the first cells to go to an area of tissue damage. Erythrocytes (RBCs) contain O2-carrying protein that functions in the transport of oxygen. Albumin, a plasma protein does not pass through the pores in the capillary wall to enter the interstitial fluid and therefore contributes to the plasma osmotic pressure and maintenance of blood volume. Basophil granules contain heparin, an anticoagulant; histamine, a vasodilator; and other mediators of inflammation. (less)
A client's bone marrow study report reveals the findings of blast cells in the bone marrow. What does the nurse interpret this as indicating? You selected: Hodgkin's disease Incorrect Correct response: Luekemia Explanation: The finding of blast cells in the bone marrow is indicative of leukemia.
Myeloma ppt...
Abnormal B cells -Can form tumors Produce abnormal antibodies -Immune depression -Proteins increase blood viscosity -Infiltrate organs Proliferation of osteoclasts -Break down bone a type of cancer that occurs in blood-making cells found in the red bone marrow
A 16-year-old male client who has been diagnosed with infectious mononucleosis asks the health care provider what caused the condition. The best response would be: a) Non-Hodgkin lymphoma b) Abnormal cell nucleus development c) Human immunodeficiency virus (HIV) d) Epstein-Barr virus (EBV)
Epstein-Barr virus (EBV) Correct Explanation: EBV is the usual causative factor that results in the development of infectious mononucleosis. People with HIV may be at more risk for contacting mononucleosis. EBV may contribute to lymphoproliferative disorders, such as non-Hodgkin lymphoma. (less)
List the three types of cells of the hematopoietic system.
Pluripotent stem cells multipotent stem cells committed progenitor cells
Some cytokines stimulate the growth and production of new blood cells. Other cytokines support the proliferation of stem cells in the human body. Which cytokines support the proliferation of stem cells in the human body? a) Interleukins, interferons, and tumor necrosis factor b) Transforming growth factor, interferons, and tumor necrosis factor c) Interleukins, T-cell growth factor, and colony-stimulating factors d) Granulocytes, B-cell growth factor, and interferons
Some cytokines stimulate the growth and production of new blood cells. Other cytokines support the proliferation of stem cells in the human body. Which cytokines support the proliferation of stem cells in the human body? You selected: Interleukins, interferons, and tumor necrosis factor Correct Explanation: Cytokines, such as the interleukins, interferons, and tumor necrosis factor, support the proliferation of stem cells and the development of lymphocytes, and act synergistically to aid the multiple functions of the colony-stimulating factors. B-cell growth factor, T-cell growth factor, colony-stimulating factors, and transforming growth factor are all cytokines that stimulate the growth and production of new blood cells. (
mast cells
Tissue cells; release heparin, histamine, and other inflammatory mediators; involved in allergic reactions
A 20-year-old client has presented for care because she has a cervical lymph node on the right side of her neck that is firm and enlarged, and has been so for several weeks. Palpation of the node is painless. The nurse should document this assessment finding and anticipate: a) the need for watchful waiting and close monitoring of the node over the following weeks. b) facilitating the client's lymph node biopsy. c) preparing the client for the induction phase of treatment. d) preparing the client for a bone marrow transplant (BMT).
facilitating the client's lymph node biopsy. Correct Explanation: Lymph node biopsy provides the definitive diagnosis of Hodgkin lymphoma, which is the client's most likely medical diagnosis. BMT would be premature at this stage in care. An induction phase is used in the treatment of acute leukemias. Monitoring the client without further testing or treatment would be unsafe. (less)
aplastic anemia
failure of blood cell production in the bone marrow -all of the myeloid stem cells are affected resulting in anemia, thrombocytopenia, and agranulocytosis
acquired neutropenia: many cases are drug related
from aplastic anemia and treatment with cancer chemotherapeutic drugs and irradiation may cause suppression of bone marrow stem cells with decreased production of of al blood cell types. autoimmune disorders or idiosyncratic drug reactions may cause increased and premature destruction of neutrophils
pluripotent stem cells
give rise to two types of multipotential stem cells: -common limphoid -common myeloid stem cells
Leukemia type/byphenotipic
if both lymphoid and myeloid lineages
Describe the mechanism of symptom production in neutropenia.
if hereditaty, -starts in infancy and last decades -periodic neutropenia that lasts every 21 days and lasts 2 to 3 days
Granulocytes types:
neutrophils, eosinophils, basophils
infectious mononucleosis/pathogenesis
orally transmitted by contact with EBV-contaminated saliva. The virus penetrates the nasopharyngeal, oropharyngeal, and salivary epithelial cells, and then spreads down oropharyngeal lymphoid tissue and more specifically related to B lymphocytes where it could spread or die
lymph nodes
organized collecting of limphoid tissue along the lymphatic vessels -1mm to 2cm range -malignant B and T cells home to particular nodal sites
