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