HEMATOLOGY/IMMUNOLOGY (Medical Surgical) 3
Platelet
(Thrombocytes) Function in blood clotting.
What are the clinical manifestations of Sickle Cell?
*Brain:* 🔺Thrombosis or hemorrhage. *Lung* 🔺Pulmonary HTN, Pneumonia, Acute Chest Syndrome. *Liver & Gallbladder:* 🔺Hepatomegaly & Gallstones. *Kidney:* 🔺Hematuria & Renal Failure. *Bones & Joints:* 🔺Hand-Foot Syndrome & Osteonecrosis. *Eye:* 🔺Hemorrhage, retinal detachment, blindness, retinopathy. *Heart:* 🔺HF *Speen:* 🔺Speen atrophy. *Penis:* 🔺Priapism *Skin:* 🔺Statsis ulcers of hands, ankles, and feet.
What are the clinical manifestations of Anemia?
*D/T Hypoxia* *CV*: Tachycardia, Angina, HF, MI. *Respiratory*: Tachypnea, Dyspnea at Rest, Orthopnea. *Neurologic*: HA, Vertigo, Impaired Thought Process. *GI*: Anorexia, Hepatomegaly, Splenomegaly. *MS*: Bone Pain. *General*: Fatigue. *Integumentary*: Pallor, Jaundice
What are the clinical manifestations of Pernicious Anemia?
*GI:* 🔺Sore tongue 🔺Anorexia 🔺N/V 🔺Abdominal pain. *Neuro:* 🔺Paresthesia feet/hands. 🔺Muscle weakness. 🔺Impaired thought process.
What are the 4 stages of Leukemia Chemotherapy?
*Induction:* aggressive treatment that destroy leukemic cells. *Intensification:* higher doses of medication. *Consolidation:* started after remission (usually same meds). *Maintenance:* lower doses of same drugs, given every 3-4 weeks.
How might you anticipate therapeutically managing Sickle Cell Anemia?
*Supportive Care* 🔺Bedrest 🔺O2 therapy 🔺Fluids 🔺Analgesics 🔺Antibiotics 🔺Antisickling agents
What is Hodgkin's disease?
A Lymphoma that causes abnormal histiocytes (macrophage) which are known as Reed-Sternbergs.
Lymphocyte
A type of white blood cell that make antibodies to fight off infections.
Granulocytes
AKA: WBC or Leukocyte *Granulocytes: (polymorphonuclear leukocytes, PMNs).* 🔺Neutrophils (polys, segs): strong phagocytic activity. 🔺Eosinophils: allergic response. 🔺Basophils: granules - heparin, serotonin and histamine.
Lymphocytes
AKA: WBC or Leukocyte *Lymphocytes: cellular and humoral responses.* 🔺B cells: stimulated by antigens to produce antibodies. 🔺T cells: involved in cellular immune response against viruses.
Monocytes
AKA: WBC or Leukocyte *Monocytes: large slow moving potent phagocytes. (macrophages)*
What is happening with Sickle Cell Anemia?
Abnormal hemoglobin (HgS) replaces normal hemoglobin (HgA). RBC is deprived of O2, resulting in sickle shape. *Erythrostasis occurs, sickle cell gets trapped, ➡️ more sickling.*
What is Leukemia?
Accumulation of abnormal cells due to loss of cell division regulation. Abnormal cells infiltrate and damage bone marrow, lymph nodes, spleen, and other organs➡️suppress bone marrow.
What are some nursing diagnoses for Iron Deficiency Anemia?
Activity intolerance rt fatigue Altered nutrition: less than req. rt lack of knowledge of adequate nutrition Self-care deficit rt weakness and fatigue High risk for injury:falls rt weakness, dizziness
What are the 4 types of Leukemia?
Acute myeloblastic leukemia (AML) Acute lymphoblastic leukemia (ALL) Chronic myelogenous leukemia (CML) Chronic lymphocytic leukemia (CLL)
Antineoplastic drugs
Agents that prevent the development, maturation, or spread of cancer cells
What are some Nurisng Diagnosis that can be applied to Leukemia?
Altered Nutrition less than rt n/v, loss of appetite. High-risk for infection rt dec immune response. Ineffective coping rt effects of illness. Body image disturbance rt effects of change in body function/structure.
AIDS Dementia Complex
An AIDS-related syndrome involving memory loss, confusion, and personality changes.
Acute myeloblastic leukemia (AML)
An uncontrolled growth of myeloblast of bone marrow and spleen. AML = any age MC acute leukemia in adults (85% of cases are in adults) and it has the worst prognosis.
Hypochromic
Anemic condition due to a deficiency of hemoglobin in the red blood cells.
What are the GI clinical manifestations of Anemia?
Anorexia Hepatomegaly Splenomegaly. *D/T Hypoxia*
What are some nursing diagnosis related to HIV/AIDS?
Anticipatory grieving rt effects of chronic illness. Social Isolation rt effects of illness. Altered Role performance rt changes in role function. Ineffective coping/Altered family process rt change in health status.q
What is the etiology of Sickle Cell Anemia?
Autosomal homozygous recessive.
What produces blood cells, erythrocytes, leukocytes, & platelets.
Bone Marrow
What are the MS clinical manifestations of Anemia?
Bone Pain. *D/T Hypoxia*
Myelocyte
Bone marrow or spinal cord cell.
Lymph System
Carries fluid from interstitial spaces to blood and returns excess fluid to prevent edema. Also transports protein and fat from GI tract to blood and certain hormones.
What are the 3 modalities that are employed to combat Leukemia?
Chemotherapy in four stages Radiation therapy may be used for chronic leukemia. Bone marrow/stem cell transplant.
Define Anemia
Decrease in RBCs, decrease in Hemoglobin and Hematocrit caused by blood loss, impaired production or increased destruction of RBCs. *Result➡️Hypoxia*
How is Hodgkin's Disease therapeutically managed?
Depends on stage. Radiation and/or chemotherapy.
Erythrocytes
Erythropoiesis - stimulated by hypoxia and erythropoietin. *Fx: transport O2.* Life span - about 120 days. (Red Blood Cells)
What happens when a Sickle Cell gets trapped in a blood vessel?
Erythrostasis occurs, sickle cell gets trapped, ➡️ more sickling.
Chronic myelogenous leukemia (CML)/(CGL)
Excessive growth, spread of neoplastic granulocytes in bone marrow. Malignant, but relatively mature granulocytic leukocytes multiply in the bloodstream.
What are the General clinical manifestations of Anemia?
Fatigue *D/T Hypoxia*
What are the 4 types of anemias that we cover?
Folic Acid Deficiency Anemia Sickle Cell Anemia Pernicious Anemia Iron deficiency anemia
What are the clinical manifestations of Folic Acid Deficiency Anemia?
GI: sore tongue, anorexia, n/v, abdominal pain.
How might you treat Cytomegalovirus?
Ganciclovir (Foscarnet if opportunistic infection progresses or intolerant). *T-Cell <100*
Reed-Sternberg
Giant multi-nucleated cells found in Hodgkins Lymphoma.
What are the Neurologic clinical manifestations of Anemia?
HA Vertigo Impaired Thought Process. *D/T Hypoxia*
What is the pathology of AIDS/HIV?
HIV infects T-helper cells, macrophages, B cells, brain cells - risk infection.
At what point might you see Pneumocystis carinii pneumonia (PCP)?
HIV/AIDS *T-Cell 200*
At what point might you see Cryptosporidiosis?
HIV/AIDS *T-Cell less than 100*
At what point might you see Cytomegalovirus?
HIV/AIDS *T-Cell less than 100*
How might you treat Cryptosporidiosis?
Humatin 2-4x/day x 7-10 days. Treat symptoms with Immodium, Sandostatin, MS Contin.
Cheilitis
Inflammation of the lips, red, scaling, shallow, painful fissures at corners of mouth. *Clinical Manifestation of Iron Deficiency Anemia*
Glossitis
Inflammation of tongue *Clinical Manifestation of Iron Deficiency Anemia*
How might you anticipate managing Iron Deficiency Anemia?
Iron Preparations
What is a Sickle Cell Crisis?
It develops suddenly, painful because of inc rate of sickling of cells.
HIV/AIDS Early Infection clinical manifestations.
It is asymptomatic with vague symptoms.
What are the clinical manifestations of Cryptosporidiosis?
Large volumes of watery diarrhea, cramping, pain and fever. *T-Cell <100*
Cytomegalovirus Retinitis
Lesions develop in retina, dec visual acuity, blurry vision. *T-Cell <100*
What is the primary manifestation of Non-Hodgkin's Lymphoma?
Lymph node enlargement
Lymphoma
Malignant tumor of lymph nodes and lymph tissue
Acute lymphoblastic leukemia (ALL)
Most common type of childhood cancer and the most common presentation of lymphoblastic leukemia/lymphoma. *Children*
Non-Hodgkin's Lymphoma
No Reed-Sternberg Cells and 12 B/T cell types. This is a group of different types of lymphomas that originate outside the lymph nodes.
What are the clinical manifestations of Iron Deficiency Anemia?
Pallor Glossitis Cheilitis
What are the Integumentary clinical manifestations of Anemia?
Pallor Jaundice *D/T Hypoxia*
Microcytic
Pertaining to a small red blood cell.
HIV Wasting Syndrome
Progressive weight loss.
How might you treat Pneumocystis carinii pneumonia (PCP)?
Prophylactically, if T-Cells are 200, with Septra DS QD or 3x/week. If ill or pO2< 60: Septra IV 3-4x/day for 21 days with prednisone. *T-Cell 200*
Macrocytic
RBCs are larger in size.
What kind of therapy is used for Chronic Leukemia?
Radiation Therapy
Lets discuss Radiation therapy 2/2 Leukemia.
Radiation therapy may be used for chronic leukemia.
Reticulocyte
Reticulocytes are immature erythrocytes.
What are the clinical manifestations of Cytomegalovirus?
Retinitis: retinal lesions, blurred vision, loss of vision. Esophagitis, stomatitis: difficulty swallowing; colitis or gastritis: bloody diarrhea, pain, weight loss. Pneumonitis: respiratory symptoms. Neurologic disease: CNS manifestations. *T-Cell <100*
HIV/AIDS Acute Retroviral Syndrome
Seroconversion, flu-like symptoms.
How is Hodgkin's Disease managed in relation to nursing?
Similar to leukemia, manage side effects of chemo, manage pancytopenia, skin care for radiation therapy.
AIDS threshold
T cell <200 ➡️ opportunistic infections.
HIV/AIDS Early Symptomatic Disease clinical manifestations.
T cells < 500, symptoms start...
What are some Nurisng management interventions for the Chronic Phase of Leukemia?
T/L Psychosocial Support
What are the Cardiovascular clinical manifestations of Anemia?
Tachycardia Angina HF MI. *D/T Hypoxia*
What are the Respiratory clinical manifestations of Anemia?
Tachypnea Dyspnea at Rest Orthopnea. *D/T Hypoxia*
What are some nursing management components of Folic Acid Deficient Anemia?
Teaching/Learning activities focused on diet and medications.
What is the pathophysiology of Hodgkin's disease?
The cause is unknown. Nodes are destroyed by hyperplasia of macrophages. Majority - starts in cervical nodes and then spread to the lung, spleen and liver.
Chronic lymphocytic leukemia (CLL)
The production and accumulation of mature appearing lymphocytes. Rarely strikes before age 45; most victims are over 65.
What is occurring to cause Pernicious Anemia?
There is impaired Vitamin B12 absorption.
How might Folic Acid Deficient Anemia be therapeutically managed?
Through replacement therapy.
Schilling Test
Used to determine the cause of Vitamin B12 deficiency, which leads to pernicious anemia. The Schilling test (no longer offered in most laboratories) indirectly evaluated vitamin B12 absorption by administering radioactive B12 and measuring excretion in the urine. Low urinary excretion was significant for PA. The Schilling test has been replaced with serologic studies that measure methylmalonic acid and homocysteine levels, which are elevated early in PA; and this test is more sensitive.
What are the clinical manifestations of Leukemia?
Varies but in general: 🔺Pancytopenia 🔺Anemia 🔺Neutropenia 🔺Thrombocytopenia. Also fatigue, weakness, HA
How would you therapeutically manage Pernicious Anemia?
Vitamin B12 IM
Leukocytes
WBCs *Granulocytes: (polymorphonuclear leukocytes, PMNs).* 🔺Neutrophils (polys, segs): strong phagocytic activity. 🔺Eosinophils: allergic response. 🔺Basophils: granules - heparin, serotonin and histamine. *Lymphocytes: cellular and humoral responses.* 🔺B cells: stimulated by antigens to produce antibodies. 🔺T cells: involved in cellular immune response against viruses. *Monocytes: large slow moving potent phagocytes. (macrophages)*
What are the classifications of Leukemia?
🔺Acute 🔺Chronic 🔺Leukocyte identification: 🔹Myelocyte 🔹Lymphocyte
What diagnostic studies are performed to detect Hodgkin's Disease?
🔺Blood analysis 🔺Lymph node biopsy 🔺Radiological studies
What is the etiology of Leukemia?
🔺Chemicals 🔺Genetic 🔺Viruses 🔺Immunological Disorders. 🔺Prior use of antineoplastic drugs. 🔺Large doses of radiation.
What are the clinical manifestations of Hodgkin's Disease?
🔺Enlarged cervical, axillary, or inguinal lymph nodes. 🔺Weight loss. 🔺Fatigue, weakness. 🔺Fever, chills. 🔺Tachycardia. 🔺Night sweats. 🔺Pruritus.
What are the clinical manifestations of Pneumocystis carinii pneumonia (PCP)?
🔺Fever. 🔺Night Sweats. 🔺Non-productive cough. 🔺Progressive SOB. *T-Cell 200*
How might Nurisng management be geared towards dealing with Sickle Cell Anemia?
🔺Genetic counseling *Acute:* 🔺Pain management 🔺I&O 🔺Monitor O2 🔺Energy management 🔺Emotional support *Long-term management:* T/L, pain control.
What are 4 functions of the Spleen?
🔺Hematopoietic function. 🔺Filter function. 🔺Immune function. 🔺Storage function.
Lets discuss Nurisng management and Pernicious Anemia.
🔺ID p/c at risk (family history). 🔺Protect against injury. 🔺Follow up care.
What would nursing management look like for Iron Deficiency Anemia?
🔺Identify p/c at risk 🔺Diet and medication teaching 🔺Energy management
What is the etiology of Iron Deficiency Anemia?
🔺Inadequate Intake of Iron 🔺Malabsorption 🔺Blood Loss 🔺Pregnancy 🔺Chronic Hemodialysis
How is HIV/AIDS medically managed?
🔺Monitoring 🔺Medications for HIV: block reverse transcriptase and/or protease inhibitors. 🔺Medications for opportunistic infections.
What are some Nurisng management interventions for the Acute Phase of Leukemia?
🔺Physical assessment 🔺Infection protection 🔺Bleeding precautions 🔺Energy management 🔺Pain management 🔺Nutrition management 🔺Psychosocial support
What is the Etiology of Folic Acid Deficiency Anemia?
🔺Poor nutrition 🔺Malabsorption syndrome 🔺Medications 🔺Alcohol abuse 🔺Chronic hemodialysis
What are some priority nursing interventions for HIV/AIDS?
🔺Prevent infection 🔺Medication management/education. 🔺Energy management. 🔺Pain control/comfort measures. 🔺Nutrition/dietary interventions. 🔺Psychosocial support
What are 3 compensatory mechanisms for Anemia?
🔺Redistribution of blood. 🔺Increased cardiac output. 🔺Increased rate of RBC production.
What is the etiology of Pernicious Anemia?
🔺Surgery 🔺Malabsorption Syndrome 🔺Autoimmune Reaction
What are some diagnostic tests for Pernicious Anemia?
🔽HCT, HB, RBC. ⬆️MCV-Macrocytic 🔽 Serum B12 Schillings test
What are the diagnostic studies for Folic Acid Deficiency Anemia?
🔽HCT, HB, RBC. ⬆️MCV-Macrocytic 🔽 Serum Folic Acid
What are diagnostic studies for Iron Deficiency Anemia?
🔽Hb, Hct, RBC, serum Fe 🔽MCV-Microcytic 🔽MCHC-Hypochromic
