Thyroid
Your patient is post thyroidectomy. You notice they are swallowing a lot and have begun to feel nauseous. What should you check for?
Hemorrhage- bleeding
When calcium____ in the cell Phosphate secretion_____
Increases; decreases
A patient just has a Transsphenoidal Hypophysectomy. He asks you for a Benadryl because he thinks his allergies are acting up. He wipes his nose and there is blood with a ring of a clear, yellow tinged liquid around it. It is a very thin liquid. He complains that his throat hurt too after his nap. What is this fluid?
CSF
Your patient is an African American male who has just been turned away from the urgent care as a “drug seeker”. He tells you he is in severe pain all over. He is guarding and grimacing. He is jaundice and tells you he is in renal failure. He takes spironolactone and metoprolol on a daily basis. What condition might you suspect?
Sickle Cell Anemia
A X-linked recessive, Inherited blood disorder where there is defective or deficient clotting factor. The only Romanov male successor the Tsar Nicholas II’s throne was born with this condition. These pts experience hemarthrosis, extended bleeding, and bruise easily.
Hemophelia
What turns a platelet plug into a clot
Fibrin
Universal Blood donor
O-
phagocytosis & release antimicrobial chemicals, First responders! ↑: Bacterial infections
Neutrophils
Your patient has lupus and is on reverse isolation in Private room, HEPA filtration. Orders include screen visitors and to call a doctor for a low grade temp. Why might these precautions be put in place?
Neutropenia Defined as < 2000 mm3
Most common kids; peak 4 yo; boys > girls; again age 45, Immature lymphocyte proliferation, Prognosis good in kids
Acute Lymphocytic Leukemia – ALL
You work in a dermatology office. Your patient is in to see you about her course, oily skin. She is telling you how the bag under her eyes is because she never sleeps well due to her snoring. She has a deeper voice and she tells you that she can barely feel her fingers, its so cold out (its 75 degrees). What condition might contribute to these features.
Acromegaly
Your patient has had “a frog in his throat” for a few months now and it just doesn’t seem to go away. He’s had pain in his throat and his voice has been throat. You palpate to the sides of his trachea and it is enlarged and hard. What do you suspect? What is the only was to be sure your intuition is correct?
Thyroid cancer, fine needle biopsy
Your patient has come in for his yearly checkup. He has had 5 kidney stones in the past 3 months, he has constant pains that he says occur “in his bone”. Before this past December he had never broken a bone. After he tripped on a walking path a month ago, he broke his wrist. What might cause these changes?
Hyperparathyroidism High calcium, low phosphorus
A resident at the Cedar Crest assisted living is complaining of a pounding headache. His blood pressure is 196/98, he’s having heart palpitations in his blood sugar was 300. What is causing this?
Hypersecretion of catecholamines- Adrenal medulla hyper secretion Pheochromocytoma
Which statement shows your patient with Hemochromatosis has a better understanding of their condition?
I can’t wait to have a few beers after work like I normally do
I should avoid Fe and Vit C
I should eat a lot of spinach to make sure I keep my iron levels up
If I have kids they will have this condition as well
I should avoid Fe and Vit C
What Patient teaching would be important for a pt with thrombocytopenia?
Avoid ASA, NSAIDS
Neuro Assessments
Watch: stools, urine, sputum
Avoid IMs; If SubQ unavoidable, use small-gauge needle, apply pressure/ice
Watch Labs: platelet count, coagulation studies, Hgb & Hct
Manage blood loss from excessive menstrual bleeding-use OCs
Teach avoidance of causative agents, trauma, and injury;
Use electric razor, soft toothbrush; no tattoos or piercings; stool softeners
Caution dental work, Pedi/manicure
Teach S&S of bleeding; direct pressure &/or ice
Report headache, changes in vision, sudden weakness in arm/leg
Transfuse platelets
Black tarry stool indicates.
Lower GI bleed- sneaky bleed.
Universal recipient
AB+
↑ Fungal infections and viruses ↓: Corticosteroid use Tissue macrophages Activated by cytokines Remove debris & phagocytize bacteria within tissues
Monocytes
What is the goal of MDS - Myelodysplatic Syndrome treatment
Goal-delay progression to leukemia
Multiple Myeloma CRAB (S&S)
C – calcium ↑
R – renal failure
A – anemia
B - bone pain
Your pt came in with bone and back pain with a cough. Labs indicate renal failure and the patient’s sputum culture indicates pneumonia. Calcium is 13.2 and there is beta-2-microglobulin and monoclonal proteins. What is wrong with this pt?
Multiple Myeloma
Your patient is a 45 yof diagnosed with hyperthyroidism. She takes propylthiouracil (PTU), Atorvastatin, Metoprolol, a multivitamin, and a new biotin supplement. She started the supplement because her nails and hair felt very brittle and dry. She also tells you she has felt so tired recently that she’s been having to have a few cups of coffee a day and that’s why she thinks shes put on a few pounds. What would you the nurse tell her.
May be over correcting the Hyperthyroidism, may have low now
A male patient came in through the ER for numbness in his limbs, odd behavior and dysphagia. Triage did not suspect stroke but did a CT to be safe. It showed no signs of a CVA. You note a carpopedal spasm when taking his BP. What labs would you suggest and expect to be abnormal?
Hypoparathyroidism low calcium high phosphorus
Your patient is newly diagnosed with Addison's disease. What teaching might be necessary
Limit environmental stress
High Na diet
S&S corticosteroid excess
At risk for hyperkalemia
***Steroids need to be adjusted for stressful events!
Adrenocortical Insufficiency
This condition causes Hyperviscosity & Hypervolemiain the circulation which causes hypercoagulation & impaired circulation.
Polycythemia
What is the risk of bovine heparin
Heparin Induced Thrombocytopenia (HIT)
What type of patient is more likely to get Heparin Induced Thrombocytopenia (HIT)
duration of therapy (4-14 days), surgery (especially if on cardiopulmonary bypass).
Your patient is receiving a blood transfusion. You notice they begin coughing up pink frothy sputum. What do you suspect?
Transfusion Related Acute Lung Injury (TRALI)
Donor blood has HLA or HNA → interstital & intraalveolar edema
Inactivates inflammatory chemicals released in an inflammatory response (neutralizes histamine) Ex. Allergic reactions ↑: Allergies, collagen diseases, diseases of spleen and CNS
Eosinophils
Most common leukemia & cause of leukemia deaths Nonspecific complaints occur abruptly, gradually worsen Uncontrolled proliferation of myleoblasts BM analysis- > 20% immature leukocytes (blasts)**hallmark of dx Major cause death - Bleeding & Infection
acute Myeloid Leukemia – AML
All NHLs involve lymphocytes arrested in various stages of development. Unpredictable growth. Patients who survived have an increased risk of a secondary form of cancer.
Non-Hodgkin’s Lymphoma
WBC w Differential (Diff) purpose
determines % of each type of leukocyte
You are helping a patient with their radioactive iodine treatment. She is telling you how she can’t wait to be a grandmother. Her daughter’s baby shower is next week. What should you tell her? Select all that apply
She must wear a mask to attend
She can only go If she goes virtually
She should stand 3-6 feet away from anyone
She should use a separate toilet and avoid sharing drinks
Nothing she can attend as normal
She should stand 3-6 feet away from anyone
She should use a separate toilet and avoid sharing drinks
You are getting lunch with a friend. She has gone to the bathroom 4 times in the past 20 minutes. She has been losing weight. She is telling you how the last time she went to the DR her BP was low (90/60) and her heart rate was high. She is a little upset because she thought she had been watching her salt, but her routine labs came back with her Sodium at 156. What might be causing these results?
Diabetes insipidus
Symptoms of Cushing disease (select all the apply)
Truncal Obesity
Weight loss
Large tongue
Buffalo Hump
Sun face
Moon face
Truncal Obesity
Buffalo Hump
Moon face
What is the most common X-Linked genetic blood disorder in world? The gene makes an enzyme needed to stabilize RBC membrane. This causes hemolysis.
Glucose-6-Phosphate Dehydrogenase (G-6-PD)
Your patient with Von Willebrand Disease is going to the dentist next week. Why may this be a concern?
Needs Desmopressin (DDAVP) to prevent w dental/surgical procedures
Provides transient ↑ in Factor VIII
Systemic syndrome with Microthrombi & Bleeding that presents with Petechiae → uncontrollable hemorrhage.
Disseminated Intravascular Coagulation (DIC)
It’s 5 hours after your patient received a blood transfusion. BP is 175/82, the patient has SOB, crackles and JVD. What happened? How do you fix it?
Prevent or Treat ~ IV diuretics
Transfusion Related Circulatory Overload (TACO)
B: derived from BM; Humoral Immunity ; Produce antibodies or immunoglobulins (Igs) ; Attack & neutralize antigens in bacterial infections
B-Lymphocyte (B Cells)
Chronic Myeloid Leukemia – CML Genetic link-
Philadelphia Chromosome
Reed-Sternberg cells in lymph node bx is indictive of
Hodgkin’s lymphoma Goal is CURE! 90% in early stage
Sign of bleeding from upper GI
Coffee Ground Emisis
Your patient has come into the office for a follow up appointment. When taking her vitals you notice she is fanning herself and seems nervous and diaphoretic. When doing your head to two you feel the gland in her anterior throat. It feels soft enlarged. In her record you see her labs came back with T3 and T4 elevated and TSH is low. What would you suspect this patient has contributing to all of these symptoms?
Hyperthyroidism
Signs of Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Select all
Concentrated urine
Dilute Urine
Fluid retention
Na Deficiency
Na Excess
↓ reflexes
Concentrated urine
Fluid retention
Na Deficiency
↓ reflexes
A patient comes into the ER with a GCS of 10. When assessing orientation you ask her the president, she says its Joe Burrow. She Has a blood pressure of 82/ 46 and BS of 56. Upon getting labs back her Potassium level is at a 6. What is she experiencing
Addisonian Crisis
Your patient has a disease that impairs her ability to produce hemoglobin. She was telling you when she was younger she grew up in Vietnam , where her family Is from. Her treatments of her condition are HSCT, Blood transfusion, Chelation therapy, Splenectomy. What is the condition?
Thalassemia
Acute Blood Loss Sudden hemorrhage Nursing
Stop bleeding
Replace blood volume
IVF
PO/Parenteral Fe
Volume expanders
Blood Transfusion-PRBCs
Identify hemorrhage source*****
Your patient had come In with a femoral bleed and lost 2 liters of blood. His RBC count is 4.9 x 10*12/L(within normal range). Why?
Lab data do not adequately reflect RBC levels for 2 – 3 days
You are just arriving at the hospital and the new travel nurse who is supposed to be giving you report is scrolling through tiktok on her phone. You go in to your pt’s room and see blood transfusing, the bag is mostly full. Your patient is shivering and flushed. The Patient’s hr is in the 100s and BP is 80/40. What do you suspect and what do you do?
Wrong type of blood- stop transfusion and flush. REPORT IT
derived from thymus; Cell mediated Immunity; Surveillance: recognizes foreign material ; Delayed allergic reactions ;transplant rejection, tumor cell destruction ↑: infections & immune responses
T-Lymphocyte (T Cells)
Who is most likely to get Chronic Lymphocytic Leukemia – CLL
Veterans exposed to Agent Orange
You are an oncology charge nurse what teaching might be important for your pt with leukemia as well as the staff taking care of him.
Blood &/or platelet transfusions
Frequent rest periods
Reverse isolation
Nutritional support
Granulocyte colony-stimulating factors admin
Stimulate BM to make neutrophils
Filgrastim (short acting) Neupogen
Pegfilgrastim (long acting) Neulasta
Bone marrow transplant (only possible cure)
Radiation side effect Mgt
Chemo admin & side effect Mgt
Monoclonal Ab admin & side effect Mgt
Fun endocrine fact: The ancient Greek physician Hippocrates tested for diabetes by
tasting his patients' urine for a distinct sweetness.