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Lymphatic vessels
move fluid / proteins from interstitial spaces to venous circulation preventing edema
reabsorb fats from small intestine
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Lymph Nodes
cerviofacial
supraclavicular
axillary
epitrochlear
inguinal
femoral
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Lymph
composed - water / end product of cell metabolism
fluid in interstitial spaces
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Tonsils
lymphatic tissue producing lymphocytes that fight off pathogens
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Spleen
lymphatic organ
destroys - bacteria
filters - blood
reservoir - blood
forms - lymphocytes / monocytes
traps - formed particles
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Bone Marrow
Red - hematopoiesis - production - erythrocytes, leukocytes, and trombocytes
Yellow - red bone marrow that turned into fat
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Stem cells
evolve - lymphocytes and may become B cells or T cells, phagocytes
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Erythrocytes
-red blood cells
formed in bone marrow containing hemoglobin, oxygen combines with it and circulates thoughout body
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Thrombocytes
-platelets
function - coagulation of blood
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Leukocytes
-white blood cells
provide - immunity / protection from infection by
phagocytes (engulfing, digesting, destroying microorganisms
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Plasma
liquid portion of blood
water , protein, albumin, globuin, glucose, electrolytes
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Blood Types
A
B
AB
O
O - has no A / B used for emergency
AB - can recieve any kind of blood
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Acquired immunodeficiency syndrome
-defect in Tcell mediated immunity
exposure to HIV
anorexia, disorientation, night sweats, opportunistic infections
less than 200 tcell
transfusions / antibiotics
assess respiratory, maintain diet, standard precautions
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Anaphylaxis
-acute atopic reaction that rapidly produces urticaria / respiratory distress
chemicals, enymes, food
cardiovascular / physical / respiratory distress
CPR, epinephrine subq
massage injection site to increase circulation, maintain airway, monitor blood pressure / urine output
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Ankylosing spondylits
-inflammation of the spine and adjacent soft tissue between the sacrum and ileum
lower back pain, stiffness of lumbar spine, symptoms progress unpredictably
xray family history
good posture, strectching
anti-inflammatory meds
offer support, heat therapy
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Aplastic anemia
-suppression, destruction, apalasia of bone marrow, marrow is unable to produce erythrocytes, leukocytes, platelets
dyspnea, epistaxis, melena, palpitations
transfusion
monitor infection, bleeding, bruising, monitor o2 sats, and no injections
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Calcium imbalance
-imbalance leads to tetany, seizures, cardiac arrhythmias and coma
- HYPO -
- cardia arrhythmias, tetany
- HYPER -
- muscle weakness/tone, anorexia, polydipsia, polyuria
serum calcium 4.5 -5.5
diet with calcium, vitamin D, protein
monitor serum calcium levels
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Chloride imbalance
-an acid medium conducive to digestion and activation of enymes
- HYPO-
- shallow breathing, twitching, loss of gastric secretions
- HYPER-
- deep rapid breating, hypertension, tachycardia
Serum Chloride level 98 meq/l - 108 meq/l
hypo - salty broth, saline solution
monitor serum chloride levels
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Disseminated intravascular coagulation
-accelrated clotting in small vessels, organ necrosis, which can provoke hemorrhage
abnormal bleeding, petechiae, hematomas, ecchymosis
Prolonged PT <15sec PTT <60sec
bedrest, transfusion
check iv sites for bleeding, apply 10min pressure for sites, monitor HCT, Hb, coagulation times
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Hemophilia
-mild to severe bleeding
hematuria (bloody urine) tarry stools, joint tenderness
monitor bleeding
follow orders for treatment
elevate joints to control bleeding
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Iron deficiency anemia
- decrease iron affects formation of hemoglobin and RBCs, and decreases oxygen in the blood
pallor, sensitivity to cold, weakness
hematology shows decreases
iron supplements
assess cardio / respiratory, stool, urine, vomit for occuly blood
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Kaposis sarcoma
-cancer of the lymphatic cell wall
lesions on the skin, pain
high calorie / protein, radiation therapy
inspect skin qshift, pain meds, monitor effects of radiation therapy
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Leukemia
-uncontrolled proliferation of WBC prescursors that fail to mature
enlarged lymph nodes spleen, liver
drug therapy
monitor bleeding, pt with epistaxis in upright position leaning slightly forward to reduce vascular pressure and prevent aspiration
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Lymphoma
-tumors that travel from one lymph node through the entire system
enlarged lymph node in cervical region
radiation therapy
monitor bleeding, jaundice, infection
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Magnesium imbalance
- affects muscle / bone movement,
- HYPO-
- arrhytmias, neuromuscular irritability, confusion
- HYPER-
- diminished deep tendon reflexes, heart block, weakness
Serum Magnesium 1.5meq - 2.5meq
hypo - diet / iv fluid
hyper - lasix, diet
monitor serum mag levels, intake and outputs, LOC
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Metabolic acidosis
-lungs, kidneys, cells affected by excess acid accumulation
- CNS depression, lethargy
- kussmauls respirations
- Arterial Blood Gas >7.35
- Bicarbonate > 24meq
sodium bicarbonate iv
keep sodium bicarbonat ampules available, monitor LOC, VS, labs
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Metabolic alkalosis
-loss of acid and increase of base bicarbonate causing metabolic , respiratory, and renal response, hypoventilation
atrial tachycardia, hypoventilation, twitching
- ABG pH <7.45
- Bicarbonate <29meq
monitor ammonium chloride infusion avoid giving to pts with hepatic or renal disease because of toxicity
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Multiple myeloma
-abnormal proliferation of plasma cells, they invade bone marrow, lymph nodes, liver, spleen, kidneys triggering osteoblasctic activity leading to bone destruction
severe bone pain, fractures, deformities, height loss
orthopedic devices
drug therapy
assess renal, bone pain, iv fluids
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Pernicious anemia
-vitamin B12 cannot be absorbed by ileum resulting in defective maturation of RBCs
paresthesia of hands / feet
vitamins
assess cardiovascular
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Phosphorus imbalance
-metabolic functions are changed
- HYPO-
- tremor, parasthesia, muscle weakness
Serum Phosphorus level 1.7meq - 2.6meq
diet, supplements
record intake and outputs
hyper- below 600ml per day notify dr
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Polycythemia vera
-increase RBC mass, leukocytosis, thrombocytosis and Hb concentration with increased or normal plasma levels
clubbing of digits, dizziness, thrombosis, hypertension, visual disturbance
removal of blood 350ml-500ml a day
drug therapy
check vs monitor tachycardia, clamminess, or vertigo
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Rheumatoid arthritis
-autoimmune disorder, affecting synovial lining of the joints eventually tendons and ligaments are affected
painful swollen joints, crepitus, symmetrical joint swelling
cold / heat therapy
drug therapy
check joints for swelling, spling inflammed joints
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Scleroderma
-a diffuse connective tissue disease, inflammation and degenerative and fibrotic changes in the skin, vessels, membranes, muscles, internal organs
pain, blue fingers, swelling, tight inelastic facial skin, renal problems followed my hypertension
physical therapy, no cure exist
drug therapy
assess vs bp output
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Septic shock
-bacterial infection, causes inadequate blood perfusion and circulatory collapse
chills, oliguria, fever <101
altered LOC, hyperventilation, hypotension, hypothermia, tachycardia, tachypnea
decrease - platelet count, leukocytosis, creatinine levels
increase - BUN, creatinine
replace iv and foley tubes, o2 therapy, diuretics
drug therapy
normal saline infusion, systolic <80 increase o2 call dr
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Sickel cell anemia
-RBC cells become rigid affecting circulation
aching bones, jaundice, unexplained dyspnea
- low RBC count, ESR
- high WBC, serum iron
iron and folic acid to treat anemia, iv fluid for hydration
pain meds
warm compresses, bedrest, fluid intake
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Sodium imbalance
-major cation, positively charged ion
- HYPO-
- abd cramps, cyanosis, seizures, hypotension
- HYPER-
- hypertentsion, flushed skin, pitting edema, thirst, rough dry tongue
Serum Sodium Levels 135meq - 145meq
- HYPO-
- saline infusion, potassium supplement
- HYPER-
- sodium restricitons
watch levels, monitor q6, record intake and output
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Systemic Lupus erythematosus
-autoimmune disorder, tcell drop antibody increase, immune responds to veins / arteries causing pain, swelling and tissue damage
butterly rash on face, fatigue, pain, joint stiffness
drug therapy
asswss musculoskeletal, minimize environmental stress
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Vasculits
-inflammation and necrosis of blood vessels
- wegeners granulomatosis
- (respiratory tract and kidneys)
- cough, fever, malaise
- temporal arteritis
- (carotid artery)
- headache, jaw claudication, myalgia
- takayasus arteritis
- (aortic arch)
- bruits, loss of distal pulse, paresthesia distal to the affected area
diet, removing environmental antigen
regulate room temp, vs, intake and outputs
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Systemic lupus erythematosus, should monitor there body temp when discharged
Epistaxis
sit up right leaning slightly forward
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Pernicious anemia
teach pt importance of receiving monthly vitamin b12 injections for the rest of their life
Lymphoma ( Hodgkins disease )
stage 1 single lymph node / organ
stage 2 two nodes on one side of diaphragm or organ
stage 3 both sides fo diaphragm and organ, spleen or both
stage 4 diesase dessemninates
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