Heme

lymphocyte

monocytes

Eosinophils

Basophils

Neutrophils

WBC

RBC

Spleen

Polycythemia Vera

Macrocytic-normochromic

Microcytic-hypochromic

Normocytic normochromic

Most common type of anemia-in third world countries, -may cause mental issues
-cells will look like pale, microcymic hypochromic, heme is missingFatigue, SOB, HR up, pale skin, look at mucuous membrane around the eyeballs, pale tongue

cracked fissures around the mouth

CLASSIC SIGN, spoon-shaped nails

Preventive education
Nutritional counseling
Oral supplement (ferrous sulfate)
Understand difference between pill form and IM
Pill-can stain teeth=use straw or drop it at the back of the throat,
take on empty stomach,
follow up with OJ or vitamin C which will increase absorption
For Ims use a Z-track
Expect stool to be black and tarryIf stool is green= too much iron!

It is genetic among african american women, also with gastric bypass pts.
-A form of Vitamin B12 Deficiency(treated by diet and supplements)-Large Cell Anemias

Lack of Intrinsic factor which is required for absorption of B12 Diet

Diagnosed by the Schilling Test

Gastric issues/pancrease

Red beefy tongue & neuro=CLASSIC SIGN

Drug to give for this disorder is Cyanocobalamin

Tell your pt. with Pernicious Anemia that they will have to receive treatment _____

THIS PT will usually receive an IM injection for the rest of their lives. Not PO because they cannot process it.

(same signs and symptoms w/o nerve tissues problems), it is RARE, give supplements

Folate essential for formation and maturation of RBC’s
Folate orally (vitamin B9)
Common in bread

pt. Not forming Red blood cells, usually caused by renal failure or cancer

common with patients who have undergone chemo, also with autoimmune disorder, also renal failure where kidneys are not forming erythropoeitin (lack of signal to produce RBC)

drug to give: Epogen=given to make bone marrow produce RBC

Side effect of this drug: too much RBC or polycythemia=high BP, clotting (due to vascular damage, because blood is to thick!), bone marrow suppresion (myelosuppresion)

blood cell is lysed/ or broken=they release bilirubin: jaundince color-yellow sclera

Blood Transfusion Reaction, Infection, Drugs, Sickle Cell, G6PD enzyme deficiencyJaundice/ecteric (same meaning)-Not because of liver failure but because of high bilirubin level

Hemorrhage
Trauma, Complications of surgery, Disruption vascular integrityStop / replace blood loss

Erythropoietin (EPO) ↑ Number of stem cells committed to RBC productionShortens the time to mature RBCs

what is HOP treatment

symptoms; pain
abdominal and long bones
hand foot syndrome
joint pain

complications:
infections
stroke
URIs
leg ulcers
splenomegaly

proliferative disorder in which myeloid stem cells escape normal control mechanisms

caused by excessive production of erythropoietin from chronic hypoxia

Medical management is removal of cause or therapeutic phlebotomy

Manifestations: Thick, sticky blood which causes tissue ischemia and infarction, Increased BP and angina

Treatment: Remove cause (tumor), Phlebotomy, Hydration to minimize complications

excess RBC

Platelet count < 150,000

severe bledding platelet count

Can result from: Decreased production of platelets within the bone marrow
Increased destruction of platelets
Increased consumption of platelets

thrombocytopenic purpura (rare), chronic, takes time

more common among women

acquired from chemo or radiation

increased level of WBCs

uncontrolled neoplastic proliferation of leukocytes

lots of baby WBC that dont work right

Bone marrow is highjacked; will have many many babies of one kind only-that doesnt work right.
Early arrest of cell maturationBlock of cell production precursor
Many blast cells

Mature or near-mature cells that dont work right

No single causative agent
Combination of genetic and environmental influences
Chemical agentsChemotherapeutic agents
VirusesRadiation Immunologic deficiencies

Symptoms include:
Anemia, Bleeding, Infection, Weight Loss, Bone pain, Liver/ Spleen enlargement, Elevated Uric Acid (by-product of protein metabolism)

Bone marrow overproduces ONE type of WBC that doesnt work. Will also not produce platelets which makes pt. At risk for bleeding.=pt. Will complain of bone pain

DX:
Blood tests, Bone Marrow Biopsy
Very deficeint reds and platelets
Infection or bleeding problem

Treatment:
Bone Marrow Transplantation-wipe out existing one that makes dysfunctional WBCsStem cell transplantCombination Chemotherapy

This cancer stays in the bone marrowMature B-cells produce abnormal antibodies (called M-protein, found in the bloodstream)=forms tumorsCytokines and IL-6 help sick cells to survive
Tumor masses of plasma cells form in the skeletal and soft tissues

Diffuse Bone Lesions

Diffuse bone lesions, Pain, bone is very porous or brittle.

Pathological Fractures (they didnt trip or fall, they just snapped and fell)-this is when doctors find out what the problem is., Hypercalcemia=bone destruction=

M-proteins, Bence Jones proteins.Common in african american males

Treatment:
Plasmapheresis, chemotherapy, pain, biphosphonate

Types:
Hodgkin’sNon-Hodgkin’s

Malignancies characterized by a proliferation of committed lymphocytes rather than stem cell precursors

Solid tumors- particularly affecting lymph nodes and spleen

Presence of Reed-Sternberg (RS) cellsarises from a single node and spreads (definitive diagnosis)

Lymphadenopathy (enlargement), Night Sweats, swelling of extremities? Genetic (maybe). younger people

Early Dx (Fever of unknown origin) is important.CXR, Lymphagiography, Biopsy75% cure, 20 year survival

Wide spectrum of disordersvariety of causes ( exposure to infection, immune, genetic, environmental, H. Pylori (bacteria common in ulcer disease)

No RS cells presentS/S: Similar to HD. generalized Lymphadenopathy

Patient ages 50+ more common

Many physical and psychological needs:Evokes great fear
Equated with death
Family may need help
Patient empowered by knowledge of disease and treatment can have a more positive outlook and improved quality of life

anemia caused by deficiency in intrinsic factor

patients with sickle cell has periodic episodes of extensive cellular sickling, called:

most common symptom of sickle cell crisis

jaundice often causes intense

drug used to reduce number of sickling and pain episodes

Drugs given for pain management of sickle cell pain

lack of ___ is the main cause of sickling cells

teaching pts to avoid activities that lead to hypoxia and hypoxemia, stress, are ways to avoid ______

anemia that requires IM using Z track method

Vegan diets and poor intake of foods containg B12 leads to

Glossitis is__

B12 is need for normal ____ function

Test given to diagnose pernicious anemia:

Folic acid deficiency may present same symptom as B12 deficiency but the difference is it does not affect ____ function

poor nutrition
malabsorption
drugs

Deficiency of circulating RBCs becaue of failure of bone marrow to produce these cells:

______ is common in Aplastic anemia, where all three cell types are deficient.

Mainstay management for patiets with aplastic anemia:q

long term exposure to toxic agents, drugs, infection

removal of the spleen

hyperviscous

cancer of RBC that has these three major hallmarks:
1. massive production of RBCs
2. Excessive leukocyte production
3. Excessive production of platelets

this disorder presents the ff symptoms:
1. mucous membranes have dark flushed cyanotic appearance
2. intense itching caused by dilated blood vessels and poor tissue oxygenation.
3. thrombosis (clot formation)
4. sludging of the blood
5. results in increased uric acid and potassium which leads to gout and hyperkalemia
6. patients have poor oxygenation with severe hypoxia

Phlebotomy or blood drawing is a treatment used in pts. with

hydration
increasing venus return, and
using anticoagulants are treatments used for:

Type of cancer with uncontrolled production of immature WBCs in the bone marrow

WBC disorder that makes excessive abnormal WBCs. Also leads to anemia, thrombocytopenia, and leukopenia.

Cause of Leukemia is:

The heart makes adjustments when tissue perfusion with oxygen is reduced because of Leukemia. Because of this, expect, the heart rate to be _________, and the blood pressure ___________.

Because of the anemia that results from Leukemia, expect the respiration to be:

Intestinal changes from Leukemia include increased bleeding tendency and fatigue. Expect patient to also have engorgement of the ____ and ____

lab results show: decreased Hgb and Hct levels, low platelet count, abnormal WBC count. WBC may be low, normal, or elevated. Which disorder is this?

2 definitive tests for diagnosing Leukemia:

____ is the major cause of death among pts. with Leukemia

Actions for this type of disorder includes:
monitoritng pts. daily CBC with differential WBC count and absolute neutrophil count. Inspect mouth for lesions and mucosa breakdown. Assess lungs q8hrs for crackels, wheezes, and reduces breath sounds.

the standards treatment for pts. with Leukemia

patient care for those with Thrombocytopenia ultimately involves minimizing the risk for :

Patient care for those with Leukemia ultimately involves minimizing the risk for:

This is a cancer of the lymphoid tissues. they are the abnormal growth of one type of leukocyte, the lymphocytes. Affected organs are usually the liver and spleen. They are also solid tumors.

Hodgkin Lymphoma affects two age groups:

Hodgkins Lymphoma has nodes that contain a specific cancer cell type: a marker called ___

this type of lymphoma generally spreads in an orderly fashion: from one group of lymph node to the next.

B symptoms that occur with HL

In HL, the affected lymph nodes are enlarged but ___

Hodgkins Lymphoma is one of the most treatable types of cancer. true or false?
True False

Infections from H. Pylori, Epstein Barr viral infection, and Burkitts lymphoma has been associated to cause:

This WBC cancer involves overpduction of antibodies and thus making fewer functioning RBCs, WBCs, and platelets. It also produces excess cytokenes that increase the cancer cell growth and destroy bone.

The pt. with _____ presents the following symptoms:
bone fracture
hypertension
infection
hypercalcemia
presence of Bence Jones Protein

Protein found in Multiple Myeloma

A rare platelet disorder in which platelets clump together abnormally in the capillaries and too few platelets remain in circulation.

An autoimmune disorder where the total number of circulating platelets is greatly decreased, even though platelet production in the bone marrow is normal.

a nurse taking care of a client with DIC (Disseminated Intravascular Coagulation) has which priority nursing diagnosis?

A pt. is getting blood transfusion to treat severe anemia. he suddenly develops chills and low back pain. What shoudl the nurse do first?
A. slow transfusion and monitor pt. closely
B. Administer Benadryl
C. stop transfusion and call Dr. immediately
D. Take vitals

The earliest symptom of Hodgkins disease is usually:

Name this drug:

Toxicity:green, then tarry stools
do not give with antacids or milk
avoid reclining for 15-30 mins to avoid esophageal erosion

Ferrous Fumarate does what?

Name this drug:
Common side effects: hypertension, long
bone pain, cough
Seizure, CHF, DVT

Name this drug:
used to prevent low platelet counts
side effects: pain, red
eyes, dizziness, bone pain, HTN, vision changes

name this drug:
-stimulates proliferation and differentiation of neutrophils
side effects:
Nausea, alopecia
thrombocytopenia, ARDS, wheezing

-give mild analgesia for bone pain

Name this drug:
Vit B12 replacement-needed for nerve functioning
Side effects: Diarrhea, optic nerve atrophy,CHF, pvd, pulmonary edema, anaphylactic shock

-tell pts. Treatment
for life for pernicious anemia

name this drug:
-needed for erythropoesis, increase, RBC, WBC, platelets

side effect: flushing and bronchospasm
urine will turn bright yellow

Platelet count

What does creatinine measure?
give the normal value:

This genetic disorder results in chronic anemia, pain, organ damage, increased risk for infection, and early death.The main problem is the formation of abnormal hemoglobin chains where SICKLED RBCs form masses that block blood flow and further leads to HYPOXIA

Hydroxyurea works by stimulating fetal hemoglobin which does not sickle. It is the treatment of choice for:

The problem of this disorder is decreased iron supply for the developing RBC

Type of anemia that result from failure to absorb Vit. B12 and is caused by a deficieny of Intrinsic Factor

Substance normally secreted by the gastric mucosa and is needed for intestinal absorption of vit. B12

Anemia that is a deficiency of circulating RBCs because of failure of the bone marrow to produce these cells

symptoms of gout and hyperkalemia are present in:

Cancer that involves uncontrolled production of immature WBCs in the bone marrow.

WBC cancer that involves a more mature lymphocyte called a plasma cell. B-lymphocyte plasma cells (needed to make antibodies) overproduce, and when this happens, it produces excess cytokenes and destroys bone.

Epogen is a subq injection used to treat______ and people with ____ _____ _______.

Drug used for low platelet counts (thrombocytopenia). It helps your body may more platelets. Used mostly by chemo patients.

This drug is used to prevent infectious complications associated with a decrease in the number of neutrophils in the body (neutropenia). Neutropenia may develop in cancer patients receivingchemotherapy or undergoing bone marrow transplantation

_______, one of the B vitamins that is a key factor in the synthesis (the making) of nucleic acid (DNA and RNA).

Caused by an out of control inflammatory response like sepsis, major trauma, and bleeding.
-clotting and bleeding at the same time.
-so look for symptoms of bleeding (petechiae), and symptoms of clotting (MI, CVA, stroke, ischemia)
-look at platelet count, D-Dimer

Treatment for DIC
1.
2.

An RN from pediatrics has floated to the medical-surgical unit. Which of these patients is best to assign to the float nurse?

A) a. A 42-year-old with sickle cell disease who is receiving a transfusion of packed red blood cells

B) b. A 50-year-old with pancytopenia who needs assessment of risk factors for aplastic anemia

C) c. A 55-year-old with folic acid deficiency anemia caused by alcohol abuse who needs counseling

D) d. A 60-year-old with newly diagnosed polycythemia vera who needs teaching about the disease

An increase in abdominal girth in a thrombocytic patient indicates possible _____.

the only proven lifestyle-related risk factor for leukemia is ______.

name some Vit. B12-rich foods

Induction Therapy is not a cure for Leukemia. It is a _____.

An elevated temperature would indicate an infection, not ______.

The nurse is providing genetic counseling to the client with sickle cell disease and the client's healthy spouse. Which information does the
nurse include?

_____ and ________ in the neutropenic client may be the first symptom of infection.

The nurse is caring for the client with neutropenia with a suspected infection. Which intervention does the nurse implement first?

Red blood cell (RBC) indices are part of the complete blood count (CBC) test. They are used to help diagnose the cause of anemia, a
condition in which there are too few red blood cells.

adverse side effect of anti-platelet meds:

The nurse is caring for a 32-year-old client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?

1Pallor, bradycardia, and reduced pulse pressure

2. Pallor, tachycardia, and a sore tongue

3. Sore tongue, dyspnea, and weight gain

4. Angina, double vision, and anorexia

A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to:.

signs of ___ ____ include:
abnormal bleeding
petechiae
easy bruising

Care for pts. with ___ includes the ff:
1. placing the pt. in a private room and imposing reverse isolation if necessary
2. avoid using indwelling catheters and giving IM injections
3. screening visitors and staff for contagious diseases

do not give aspirins, taking rectal temps, or performing digital rectal temps for pts. with

large nucleated rbcs found in Pernicious Anemias and Vit. B12 Deficiencies:

most serious hazard of bone marrow aspiration and biopsy

ferrous fumarate must be taken _____ to _____ months for iron replenishment to occur?

Absence of Intrinsic factor is associated with B12 Deficiency, because the vitamin cannot bind to be transported for absorption in the :

a patient with sickle cell trait would have:

bone pain in the back of the ribs is a classic symptom of

petechiae and bruising are common early signs of:

Decreasing intake of fresh fruits and vegetables is recommended for patients who have:

petechia, purpura, epistaxis (nose bleeds), and bleeding gums are common signs of:

Should you give aspiring to a a pt. with thrombocytopenia?

A neutropenic patient is admitted with a diagnosis of possible sepsis (infection).Which one should the nurse accomplish first?

Which assessment information about a patient who is receiving oprelvekin (Neumega) requires immediate action by the nurse?