FINAL EXAM EXAM REVIEW
Hematology
Anemia
A decrease in the number of red blood cells (RBCs)
Types
● Iron deficiency anemia
● Anemia in renal disease
● Anemia of chronic disease
● Aplastic anemia (suppression of bone marrow)
● Megaloblastic anemias:
● Caused by deficiencies of either vitamin B12 or folic acid
● Immune hemolytic anemia
● Thalassemia
Numbness and tingling and beefy red tongue in B12
Treatment
● Vitamin B12
● Folic acid
● Iron
● Oxygen therapy
LABS
CBC (hemoglobin specifically)
Mean Corpuscular volume - less than 80 in iron deficiency anemia)
Nursing interventions
, ● Packed RBC if hemoglobin lower than 9
● Epogen if bone marrow suppression or kidney failure
● Iron deficiency
● Direct general management toward addressing the cause of anemia and replacing
blood loss as needed to sustain adequate oxygenation.
● Promote optimal activity and protect from injury.
● Reduce activities and stimuli that cause tachycardia and increase cardiac output.
● Provide nutritional needs.
● Administer any prescribed nutritional supplements
● Patient and family education
Patient Education
● Receive B12 injections on a monthly basis (lifetime if lacking intrinsic
factor)
● Eat foods rich in iron (beans, leafy green vegetables, fish, nuts, poultry)
● Take iron on EMPTY stomach
● Don’t take iron with any milk products, antacid, calcium
● Black stool while on iron supplements=normal finding
Thrombocytopenia
Condition that causes low platelet count
Causes
Alcohol, viral infections (HIV), bone marrow infiltration (leukemia, tumors),
radiation, chemotherapy, drug induced, hereditary, nutrient deficiencies (B12,
folate, iron), DIC, portal hypertension
Nursing interventions
● Nursing care prioritizes the risks of hemorrhage and thrombosis
● Management focuses on correction or treatment of the underlying cause
● Assess for signs of bleeding (blood in stool, bleeding gums, bruising)
,Patient Education
● Educate to look out for signs of bleeding
● Avoid NSAIDS (increased risk of bleeding)
● Initiate bleeding precautions (electric razors, soft toothbrush)
● Increase intake of leafy greens
● Avoid activities that could cause injury like sports
● Avoid alcohol
Bleeding/Clotting Disorders
Hemophilia
Hemophilia is a rare disorder in which the blood doesn't clot in the typical way because
it doesn't have enough blood-clotting proteins (clotting factors)
Desmopressin drug of choice to help stop bleeding
Disseminated Intravascular Coagulation (DIC)
Clot formation followed by bleeding
● Not a disease but a sign of an underlying condition
● Normal hemostatic mechanisms are altered so that a massive amount of
tiny clots forms in the microcirculation
● Treatment focuses on the underlying cause
● Nursing care prioritizes monitoring and management potential
complications
Procedures: Bone Marrow Aspiration
● Used to diagnose causes of blood disorders, leukemia, or stage other forms
of cancer
● Before procedure: check baseline CBC
● Ensure client has INFORMED CONSENT
, ● Place patient in a prone or side-lying position to expose the iliac crest for
the procedure
● Make sure patient is educated on procedure
● Done under sedation or local anesthesia
● Apply pressure after procedure to stop from bleeding
● Place sterile dressing over site
● Avoid heavy activity
● Apply ice to minimize bleeding
● Avoid aspirin or other medications that affect clotting
Immune/Oncology
Hypersensitivity Reactions:
- Overactive functioning of immune response
◦ body cells or an aggressive response immune response to a
Atacks
normally non-toxic pathogen
◦ after an individual is sensitized to substance (already exposed)-
Occurs
second or more exposure
◦ response is generally asymptomatic
First
◦
If a person is symptomatic at first exposure it is a non-allergic
hypersensitivity reaction.
- Causes allergies and autoimmune disorders
- Common causes:
◦Foods
◦
Peanuts, tree nuts, seafood, milk, eggs, soy, wheat
◦
Medications
◦
Antibiotics, vaccines, allopurinol, radioactive isotopes/contrast, anesthesia,
hormones, aspirin, NSAIDs
◦
Animal Serum
◦
Snakes, bees, wasps, ants
Hematology
Anemia
A decrease in the number of red blood cells (RBCs)
Types
● Iron deficiency anemia
● Anemia in renal disease
● Anemia of chronic disease
● Aplastic anemia (suppression of bone marrow)
● Megaloblastic anemias:
● Caused by deficiencies of either vitamin B12 or folic acid
● Immune hemolytic anemia
● Thalassemia
Numbness and tingling and beefy red tongue in B12
Treatment
● Vitamin B12
● Folic acid
● Iron
● Oxygen therapy
LABS
CBC (hemoglobin specifically)
Mean Corpuscular volume - less than 80 in iron deficiency anemia)
Nursing interventions
, ● Packed RBC if hemoglobin lower than 9
● Epogen if bone marrow suppression or kidney failure
● Iron deficiency
● Direct general management toward addressing the cause of anemia and replacing
blood loss as needed to sustain adequate oxygenation.
● Promote optimal activity and protect from injury.
● Reduce activities and stimuli that cause tachycardia and increase cardiac output.
● Provide nutritional needs.
● Administer any prescribed nutritional supplements
● Patient and family education
Patient Education
● Receive B12 injections on a monthly basis (lifetime if lacking intrinsic
factor)
● Eat foods rich in iron (beans, leafy green vegetables, fish, nuts, poultry)
● Take iron on EMPTY stomach
● Don’t take iron with any milk products, antacid, calcium
● Black stool while on iron supplements=normal finding
Thrombocytopenia
Condition that causes low platelet count
Causes
Alcohol, viral infections (HIV), bone marrow infiltration (leukemia, tumors),
radiation, chemotherapy, drug induced, hereditary, nutrient deficiencies (B12,
folate, iron), DIC, portal hypertension
Nursing interventions
● Nursing care prioritizes the risks of hemorrhage and thrombosis
● Management focuses on correction or treatment of the underlying cause
● Assess for signs of bleeding (blood in stool, bleeding gums, bruising)
,Patient Education
● Educate to look out for signs of bleeding
● Avoid NSAIDS (increased risk of bleeding)
● Initiate bleeding precautions (electric razors, soft toothbrush)
● Increase intake of leafy greens
● Avoid activities that could cause injury like sports
● Avoid alcohol
Bleeding/Clotting Disorders
Hemophilia
Hemophilia is a rare disorder in which the blood doesn't clot in the typical way because
it doesn't have enough blood-clotting proteins (clotting factors)
Desmopressin drug of choice to help stop bleeding
Disseminated Intravascular Coagulation (DIC)
Clot formation followed by bleeding
● Not a disease but a sign of an underlying condition
● Normal hemostatic mechanisms are altered so that a massive amount of
tiny clots forms in the microcirculation
● Treatment focuses on the underlying cause
● Nursing care prioritizes monitoring and management potential
complications
Procedures: Bone Marrow Aspiration
● Used to diagnose causes of blood disorders, leukemia, or stage other forms
of cancer
● Before procedure: check baseline CBC
● Ensure client has INFORMED CONSENT
, ● Place patient in a prone or side-lying position to expose the iliac crest for
the procedure
● Make sure patient is educated on procedure
● Done under sedation or local anesthesia
● Apply pressure after procedure to stop from bleeding
● Place sterile dressing over site
● Avoid heavy activity
● Apply ice to minimize bleeding
● Avoid aspirin or other medications that affect clotting
Immune/Oncology
Hypersensitivity Reactions:
- Overactive functioning of immune response
◦ body cells or an aggressive response immune response to a
Atacks
normally non-toxic pathogen
◦ after an individual is sensitized to substance (already exposed)-
Occurs
second or more exposure
◦ response is generally asymptomatic
First
◦
If a person is symptomatic at first exposure it is a non-allergic
hypersensitivity reaction.
- Causes allergies and autoimmune disorders
- Common causes:
◦Foods
◦
Peanuts, tree nuts, seafood, milk, eggs, soy, wheat
◦
Medications
◦
Antibiotics, vaccines, allopurinol, radioactive isotopes/contrast, anesthesia,
hormones, aspirin, NSAIDs
◦
Animal Serum
◦
Snakes, bees, wasps, ants
