NUR118 hematology

myelodysplastic syndrome (MDS)

"pre leukemia" -myeloid stem cell disorder manifestations: -fatigue -risk for pneumonia and infections -altered platelets (causing bleeding) *usually in elderly treatment: -HSCT is only 'CURE' -blood transfusions -immunosuppressive therapy -chelation therapy

hematologic studies

-CBC labs -bleeding time test -d-dimer -PTT/PT or INR

plasma and plasma proteins in blood

-albumin: help with fluid balance in body -globulins: help with clotting factors

why would a patient get a splenectomy to treat a hematologic disorder

-an enlarged spleen may be the site of excessive destruction of blood cells -pts with enlarged spleens develop severe thrombocytopenia

acute chest syndrome

-blood flow to lungs is impaired; lung condition associated with sickle cell manifestations: -fever -respiratory distress -tachypnea -cough and wheeze *common cause of death causes: influenza, chlamydia, fat emboli, bone marrow emboli, pulmonary infarction management: -antibiotics -incentive spirometer

apheresis

-blood is taken from the pt, a specific component is removed from the blood, and then the blood is put back into the pt *used to harvest stem cells *basically donating blood but its put back into you

bone marrow biopsy

-bone marrow is aspirated from posterior iliac crest on body -used to diagnose many disorders -must hold pressure for 5-7 minutes after complications: -infection risk -bleeding (more bleeding risk if platelets are low) -site covered with sterile dressing after the pressure if held

polycythemia vera

-bone marrow is hypercellular and wbc/rbs/platelets are elevated manifestations: -headaches, dizzy, risk for stroke -abdominal symptoms -cardiac symptoms complication: -stroke risk -bleeding treatment: -chemo

graft vs host

-can be from getting marrow from an outside source -own body is attacking the new cells symptoms: -rash, diarrhea -abdominal pain, hepatomegaly (give immunosuppressants: cyclosporine)

leukemia

-cancer of bone marrow; causes overgrowth of cancerous WBCs -a neoplastic proliferation of particular WBC cells -this proliferation leads to an overcrowding in the bone marrow, resulting in impaired function *Unregulated accumulation of white cells in the bone marrow, which replace normal marrow elements -types: AML, CML,ALL, CLL

multiple myeloma

-cancer that causes overgrowth of plasma cell in bone marrow; results in excess antibodies (prevents growth of platelets/rbcs/wbcs) -malignant disease of plasma cells (ineffective immune system) risk factors: -older age (older than 35) -radiation exposure -family history -obesity manifestations: -BONE PAIN (back and ribs) -hypercalcemia (treat with bisphosphates) -renal impairment -anemia (treat with high protein diet) -increased protein in serum treatment: -HSCT -chemo/radiation -corticosteroids *vulnerable to spinal suppression *CRAB ACRONYM C: hyperCalcemiq R: renal dysfunction A: anemia B: bone destruction

thrombocytapenia

-decreased platelet counts (increased risk for bleeding) -avoid injections if possible -monitor for blood in stool -avoid blowing nose -avoid NSAIDS

anemia

-decreased rbc count -med: epoetin alfa (increase RBCs), ferrous sulfate (iron supplement) -encourage pt to take extra rest, eat/drink enough iron

Reticuloendothelial System (RES)

-defend body against foreign matter -remove old or damaged cells -stimulate inflammatory process *spleen

B symptoms

-fever -night sweats -unintentional weight loss *Affect multiple systems

stem cell transplant (HSCT)

-for auto, stem cells are taken from the pt, the pt gets chemo or radiation, then the stem sells are placed back into pt -for allo, the stem cells are from an outside source (monitor for graft vs host disease; the pt receiving the stem cells reject them)

factor IX

-it helps the blood form clots to stop bleeding -pt most likely has hemophilia is gets these transfusions

Non Hodkins lymphoma (NHL)

-lymphoid tissues become infiltrated with malignant cells; spread is unpredictable and localized disease is rare risk factors: -pts with autoimmune diseases -organ transplants -on immunosuppressants -has had viral infections -exposed to pesticides manifestations: -starts as swollen lymph nodes -b symptoms -organ compression treatment: -chemo/radiation -

Chronic Lymphocytic Leukemia (CLL)

-malignant clone of B lymphocytes -common in ELDERLY -have greater risk for developing other cancers -immature lymphocytes, decreased granulocytes, normal erythrocytes manifestations: -B symptoms -splenomegaly treatment: -"watch and wait period" -chemo, HSCT

sickle cell crisis

-most common: acute vaso-occlusive crisis -painful accumulation of RBCs and WBCs, resulting in restricted blood flow to tissue, causing hypoxia, inflammation, necrosis (treat with opiods) -aplastic crisis: severe anemia, results from infection of human parovirus -sequestration crisis: when sickled cells are pooled in organs (most common organ is spleen)

chronic myeloid leukemia (CML)

-mutation in myeloid stem cell, uncontrolled cell proliferation -cells get into blood stream, enlarging organs *PHILADELPHIA CHROMOSOME manifestations: -asymptomatic at first -worsened blood counts -fatigue, anemia, splenomegaly, dyspnea -confusion because of decreased profusion to lungs -anorexia, wt loss treatment: -TKI's -Gleevec (med that makes phil. chrom. negative) -HSCT -chemo

aplastic anemia

-rare -caused by decrease or damage to bone marrow stem cells (bone marrow damage) -deficiency of erythrocytes *severe anemia and neutropenia occurs manifestations: -fatigue, pallor, dyspnea, bruising

Hodgkin disease (HD)

-rare malignancy unknown cause, but likely from viral infection (mono) *REED-STENBURG CELL (large cells) -unicentric- originates from singular node manifestations: -enlarged lymph nodes on neck -compression of organs -B symptoms -itchy -non painful enlarged cervical lymph nodes complications: -puts pt at risk for ineffective airway/ unclear gas exchange *sitting pt in high fowlers position promotes lung expansion treatment: -possible chemo/radiation -HSCT for advanced cases *treatment is linked to where nodes are

iron deficiency anema

-results when intake of dietary iron is inadequate *most common *the erythrocytes produced by the marrow are small and low in hemoglobin manifestations: -smooth red tongue -brittle ridged nails -angular cheilosis (cracks in corner of mouth) -fatigue/pallor/SOB -best way to diagnose: marrow aspiration -management: -iron supplement -eating foods rich in iron (organ meats, meats, beans,leafy veggies, rasins, peaches) -liquid iron (drink with straw, don't take antacid with) -orange juice promotes iron absorption *iron makes stool black, green *first test that discovers iron deficient: Serum ferritin (would be decreased with anemia)

acute myeloid leukemia (AML)

-series of genetic mutations in myeloid HSC that leads to the development of abnormal blasts - bone pain is caused when the bone marrow expands. -usually seen in older population -most common leukemias and most common cause of death risk factors: -exposure to chemicals ( benzene, pesticides) -history of chemo drugs -ionizing radiation -smoking tobacco -other blood disorders manifestations: -fever and infection (due to low neutrophils) -pallor, fatigue, weakness -bruising, petechiae, nose bleeds -bone pain, enlarged liver or spleen -HIGH CALCIUM (calcium is released when bone is destroyed) treatment: -aggressive chemo (induction chemo destroys healthy AND impaired cells) -HSCT (stem cell transplant) *pt will be VERY fragile (there are no WBC/RBC/platelets) complications: -bleeding (platelet deficiency) -infection -tumor lysis syndrome (excess purine) (allopurinol can lower uric levels) (MONITOR RENAL SYSTEM)

tumor lysis syndrome

-the release of tumor cells into the bloodstream

Acute Lymphocytic Leukemia (ALL)

-uncontrolled proliferation of immature cells from lymphoid stem cell *SEEN IN KIDS manifestations: -asymptomatic first -high leukocytes -pain form enlarged liver, bone pain -CNS (cranial nerve palsies, headaches, vomiting) treatment: -chemo/radiation -HSCT -lumbar puncture (treats spinal fluid) -corticosteroids

Intrathecal chemotherapy

-used primarily as preventive therapy -multiple drugs, with many side effects -goal of therapy is remission

Bone Marrow Biopsy and Aspiration

-used when additional info is needed to assess how the pts blood cells are being formed to assess the quantity and quality -potential complication: bleeding, infection

Normal INR range

.9-1.1 *if its higher means bleeding *if low means possible clots

normal hgb

12-18

normal platelet

150,000-400,000

normal hct

35-50%

normal RBC

4-6

The nurse cares for a client with a coagulation factor deficiency who is actively bleeding. Which blood component replacement does the nurse anticipate administering?

FFP *Fresh frozen plasma has all the coagulation factors in it and is the blood component replacement therapy that will be used to replace blood from a client who is actively bleeding with a coagulation factor deficiency

normal PT/PTT

PT: 11.7-13.8 PTT: 22.4-35.9

febrile nonhemolytic reaction

The signs and symptoms of a febrile nonhemolytic transfusion reaction are chills, fever, -usually within 2 hrs of transfusion

von Willebrand disease

a bleeding disorder -characterized by mucosa associated bleeding

What is DIC (disseminated intravascular coagulation)?

a systemic syndrome that is characterized by microthromboses and bleeding -headache, tachypnea, and abdominal distention -DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs." *pt who has DIC is at high risk for fluid deficit triggers: -sepsis, trauma, shock, cancer treatment: *must treat underlying cause, replace fluids, use heparin if needed -monitor organ function organs become ischemic form microthrombi complications: -kidney injury -gangrene -pulm embolism -stroke -acute resp. distress -organ failure

what does a left shift mean

an increased number of band cells -may be developing an infection -

sickle cell disease/anemia

autosomal recessive genetic disorder -RBC becomes rigid and sickle shaped, causing them to stick to vessel walls, decreasing blood flow to organs (can lead to ischemia or infarction) -low hematocrit causes: pain, organ damage manifestations: -chronic hemolysis/ thrombosis -jaundice -arrhythmias or heart failure -tachycardia, cardiomegaly, murmurs -SOB, pain complications: -acute chest syndrome -stroke -anemia -hypoxia, infection, ischemia -CKD -heart failure management: -HSCT -analgesics -antibiotics if infection -administer IV fluids (helps thin the blood) -hydroxyurea (chemo med that prevents the cells from sickling) *pt needs to avoid infections AND get enough fluids

erythrocytes (RBCS)

carry oxygen to tissues and removes CO2

thrombocytes (platelets)

clots blood

anemia

decreased RBC count can be from: -decreased production (hypoproliferative) -increased destruction (hemolytic) -bleeding manifestations: -tachycardia -dyspnea/SOB -muscle pain, weakness, fatigue -pallor -tongue changes (beefy red tongue) -pica complications: -heart failure -paresthesia -delirium *people with history of alcohol consumption are at risk

megaloblastic anemia (b12/folic acid deficiency)

folic acid: inadequate intake (found in leafy vegetables and liver) b12 :inadequate dietary intake, impaired absorption, no intrinsic factor (pernicious anemia) *B12 is produced in stomach *B12 IV for life, no intrinsic factor, so can't be taken orally *B12 can causes numbness and tingling, and frequent stumbles when walking -pallor, tachycardia, sore tongue manifestations: •in b12: neuro symptoms (confusion, paresthesia in extremities, difficulty with balance, lost position sense) •in both: weakness, fatigue

chemo phases

induction: high doses of chemo meds, destroys all cells, consolidation: given to eliminate any residual leukemic cells maintenance:

neutropenia

insufficient numbers of neutrophils -wbc count is down; higher risk for infection *implement neutropenic precautions (reverse iso) -monitor pts temps, no fresh flowers, no sick visitors *med: filgrastim

leukocytes (WBCS)

part of immune system -protect and fight off pathogens -attack foreign material *med: filgrastim helps body make more WBCs

major function of neutrophils

phagocytosis

therapeutic phlebotomy

removal of certain amount of blood under controlled conditions

chelation therapy

removes excess iron from blood side effects: -abdominal camping -diarrhea

lymphoma

solid tumor in lymphoid tissue -causes overgrowth of lymphocytes ex: hodgkins and nonhodgkins

how is erythropoieten given

subcut injection or IV *stimulates erythropoiesis -side effects are rare (HTN)

transfusion

transfer of blood or a blood component from donor to recipient symptoms to monitor for: fever, chills, nausea, back pain, heart rate changes, respiratory changes complications: •febrile non-hemolytic reaction •allergic reaction •fluid over load (TACO) •bacterial contamination *if anything happens during transfusions, STOP blood, assess pt and notify Dr

packed RBC's

usually given in emergency situations -unmatched O negative is given

fresh frozen plasma

usually given to replace clotting factors

what do type 2 diabetics have to watch out for if they are also at risk for anemia?

vitamin B12 deficiency *metformin (the oral med taken to lower sugar) increases risk for vit. b12 deficiency

bone marrow

where blood cells are formed -stem cells are formed here too *stem cells: stem cells can self-replicate and form into lymphocytes