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What makes up the blood?
- 45% formed elements (RBC, WBC, platelets)
- 55% plasma (fluid that formed elements floats around in) mostly water and 7% protien
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What is albumin?
- made by liver
- maintains fluid balance
- low levels in liver failure patients or malnutrition
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What is a RBC (erythrocytes)?
- bioconcave cell
- more broad that capillaries so it can fold to get through
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What is Platelets (thrombocytes)?
aide in formation of clots
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What are WBC?
- Neutrophils
- Lymphocytes
- monosytes
- eosinophils
- basophils
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What are neutrophils?
- componant of WBC
- aka-segs and bands
- elevate in response to injury, infection, inflammation
- first responders
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Whay are lymphocytes?
- componant of wbc
- natural killers
- B cells and T cells
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What are monocytes?
- componant of wbc
- when stimulates can ecome macrophages (phagocytic cells that engulf the invader)
- assist T cells
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What are eosinophils?
- componant of wbc
- react in allergic response
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What does hemaglobin do?
- enables blood to carry O2 through body
- patients with low hemaglobin have compromised O2 saturations
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What is a normal hemaglobin?
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What is a normal hematocrit?
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What is a normal INR?
- healthy person less than 1
- Theraputic 2-3
- mechanical valve 2.5-3.5
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What medication would we give if we need to monitor INR?
Warafrin (Coumidin)
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What is normal PTT and APTT?
- PTT- 60-70 seconds
- Appt- 30-45 seconds
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What medication has us monitor PTT and APTT?
Heparin
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What are modifiable risk factors for bleeding?
- exposure to chemicals, enviroment
- sexual patterns
- aspirin use
- alcohol use
- drug toxicity
- diet
- occupational radiation
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What are NON-modifiable risk factors for bleeding?
- ethnic background
- age
- malabsorption syndrom
- history of liver disease
- history of malignancy
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What is blood dysccrasias?
something abnormal about the blood
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What are some types of RBC disorders?
- HYPOproliferation- (anemia)
- HYPERproliferation- (polycythemia)
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What is the result of anemias?
decreased production, or distruction of RBC or blood loss
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What is polychethemia?
increase in production RBC r/t hypoxia, erythropietin secreating tumors, kidney disease, genetic defects
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Why do people living in a higher elevation have a higher H and H?
less O2 is available so they need more hemaglobin to carry o2
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What is hypochromic anemia?
Iron or vitamin definciency
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Who is at risk for iron defiency amenia?
- women of child bearing age
- pregnant or lactating women
- infants/children/ adolescents in rapid growth phases
- poor diet
- blood loss
- PUD
- long term aspirin use
- colon cancer
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What are signs and symptoms of anemia?
- pallor
- fatigue
- weakness
- dyspnea
- brittle nails
- headache
- PICA (craving unusual substances)
- low iron
- low hgb and hct
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What will a nurse do for a patient with anemia?
- assess patient (determine energy level, head to toe exam)
- identify problems
- set goals with patient
- educate patient on diet
- monitor lab work
- educate patient on replacement
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what are some dietary sources for iron?
- dark leafy veggies
- lamb
- dried beans and fruits
- eggs
- lean meats
- nuts
- wheat germ
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How should iron supplement meds be taken?
- empty stomach is the best for absorption
- Orange juce aides in absorption
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If diet does not increase iron levels what else can be done?
- PO supplements
- IV replacement
- Im replacement- use z-track (this medication is staining)
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What is Epogen (Epoetin)?
- medication given IM
- stimulates production of RBC
- worried about impaired thinking
- It is man made erythropoietin
- store in fridge
- warm in hands
- do not shake
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What is the sgnificance of a CBC with differntial?
It breaks down the blood cells to determine the types and number of cells in blood.
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What is the difference between segs and bands?
segs are more mature neutrophils than bands
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What are the norms for a differential blood count
- out of 100 cells
- neutrophils - 50-70%
- lymphocytes 25-35%
- monocytes 4-6%
- eosinophils 1-3%
- basophils less than 1%
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What is pernicious anemia?
- chronic progressive anemia
- caused by lack of intrinsic factor
- hinders ability to absorb vit B12
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Where does intrinsic factor come from?
a protien secreted by the stomach
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What are causes of pernicious anemia?
- not enough secreted by stomach
- atrophic gastric mucousa
- auto immune disease against gastric cells
- autoimmunity to IF
- absence of IF (most common)
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Whata re risk factors for Pernicious anemia?
- family hx
- northern europe decent
- scandinavian
- history of autoimmune endocrine disease
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What are signs and symptoms of pernicious anemia?
- sensory and motor never issues
- anoxeia
- sortness of breath
- diarrhea
- megaloblastic madness (looks like dementia)
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How do we treat pernicious anemia?
- vitamin B 12 injections
- increase dairy products and meat intake
life long therapy
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Where can you assess a patient to look for s/s of anemia?
- conjuctiva should be bright pink
- if not bright pink patient may have anemia
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What is hemophilla?
- clotting disorder
- lack of factor 8 and 9
- body fails to clot
- more common in men
- caried by mom (sex linked trait)
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What is Leukopenia?
- a drecrease n circulating WBC
- less than 5000
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What is neutropenia?
decrease in neutorphils
precautions should be implemented with patients who have a ANC of 1000 or less per physicians order
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What is a ANC?
absolute neutrophil count
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How do caluculate ANC?
Total WBC (%segs +% bands)
We want patient to be above 1500
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What is pancytopenia?
- a decrease in all cell numbers
- (WBC, RBC, platelets)
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What are causes of leukopenia?
- infections
- HIV
- viruses
- autoimmune disorders (lupus)
- radiation
- bone marrow diseases
- (leukemia, myelodysplastic syndrome)
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What is leukemia?
bone marrow produces an abundance of immature blood cells called stem cells and blast
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What is the differnce between chronic and acute leukemia?
- Chronic leukemia is slow and develops over time with a gradual increase in cells
- Acute leukemia has very abnormal rapidly rising blood cells
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How is leukemia grouped?
- Chronic or acute
- and type of cell effected
- Lymphocytic= lymphnoid cells
- Myelocytic = myeloid cells
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What are the four comon types of leukemia?
- CLL chronic lymphocytic leukemia
- CML chronic myloecytic leukemia
- ALL acute lymphocytic leukemia
- ALM acute myelocytic leukemia
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Who most commonly has CLL?
people over 65
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Who most commonly has CML?
adults
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Who most commonly has ALL?
- most common in children
- most CURABLE
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Who most commonly has AML?
adults and kids with downs syndrome
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What are risk factors for developing leukemia?
- radiation exposure
- Chemicals such as benzene, formaldhyde
- chemo
- downs syndrome
- human T cell leukemia virus
- myelodysplastic syndrome
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What are s/s of leukemia?
- fever
- night sweats
- frequent infections
- weak/ tired
- headaches
- bleeding bruising
- bone and joint pain
- abdominal sweeling
- swollen lymph nodes
- weight loss
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What does the nurse do for leukemia?
- assess patient
- get work hx
- s/s
- assess for swollen lymph nodes
- CBC with differential
- before and after care for bone marrow biopsy
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what should nurse do for bonemarroe biopsy
?
- comfort patient during procedure
- monitor for s/s of bleeding after
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What are nursing Dx for leukemia?
- risk for infections
- fatigue
- fear
- anxiety
- altered nutrition
- anxiety
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What are nurisng interventions for leukemia?
- educate pt on disease process, infection prevention, radiation, chemo
- be truthful with patient
- offer emotional support
- handwashing
- administer meds as ordered
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What are treatments for leukemia?
- chemo
- radiation
- bone marrow transplant
- biological therapy
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What is the goal for treating leukemia?
remission
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What is colony stimulating factor?
medications uses to stimulate production of WBC
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What are examples of colony stimulating factors?
- Filgrastim (Neupogen)
- Pegfilgrastim (Neulasta)
- Sargramostim (Leukotine)
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What is the action of colony stimultaing factors?
stimulate production of granulocytes and macrophages
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What are indications for colony stimulating factors?
- aplastic anemia r/t chemo
- acceleration of bone marrow recovery in malignant lyphoma and hodgkins
- delayed or failed bone marrow transplant
- Increase wbc in patients taking a antiviral (zidovudine, used in HIV patients)
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What are contraindications for patients taking colony stimulating factors Filgrastim (Neupogen) and Pegfilgrastim (Neulasta)?
- hypersensitivity to ecoli derived protiens
- because it is grown in ecoli
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What are adverse reactions to colony stimulating factors?
- respiratory problems
- supraventricular arrythemias
- bone pain
- arthralgia / myalgia (muscle and joint pain)
- N/V/D
- anorexia
- stomatitis
- fluid retention
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Colony stimulating factor can interact and cause problems with what meds?
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What does a nurse do when a patient is taking colony stimulating factors?
- monitor WBC
- monitor s/s of infection
- D/C when ANL in with in normal limits
- teach patient about diet
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How can chemotherapy be administered?
- Oral
- IV- perpipheal or central line
- Into CSF if cancourous cells are found in csf
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What is multiple myeloma?
- to many B cells (abnormal plasma cells)
- affects bones, immune system, kidneys and RBC
- cause unknown
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What are s/s of multiple myeloma?
- they vary from person to person
- bone pain (back, pelvis, ribs, skull)
- pathological fractures
- frequent infections
- weight loss
- abnormal protien in blood (M protiens)
- protiens in urine (bence jones)
- hypercalcemia
- polydipsia, polyuria, constipation, N/V/ anorexia confusion
- anemia
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What are tumor makers in multiple myeloma?
- bence jones protien in urine
- M protiens in blood
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What are risk factors in multiple myeloma?
- Age
- sex (more common in men)
- Race (more common in african americans)
- history of monoclonal gammopathy of indetermined significance
- obestiy
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What are complications of multiple myeloma?
- immpaired immuntiy (increase risk for infection)
- bone problems (pathological fractures)
- impaired renal function (r/t high calcium)
- anemia
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What is the treatment for multiple myeloma?
- When patient is assymptomatic continue to monitor
- chemo
- corticosteriods
- radiation to spleen, and brain..if doesnt work then stem cell transplant
- stem cell transplant
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Where can stem cells be obtained from for transplant?
- umbilical stem cell
- bone marrow stem cells
- peripheral stem cells
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What are side effects to a bone (stemcell) marrow transplant?
- increased risk for infection
- bleeding
- s/s from high does of chemo and radiation
- transplant reactions
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What is Hodgkins Lymphoma?
- reed-sternburg cells
- more curable than non hodgkin's
- enlarged lymph nodes
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What is treatment for lymphoma?
- radiation
- chemo if radiation unsuccessful or advanced stage
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What is thrombocytopenia?
- low platelet count less than 150,000
- decreases patients ability to clot
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What are s/s of thrombocytopenia?
- sudden onset of petechiae
- signs and symptoms of bleeding such as bruising
- fatigue
- weakness
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