Caught in Cold Blood
List 5 clinical manifestations of general anemia:
Decreased RBCs, decreased HgB, decreased O2, hypoxia, weakness, SOB, fatigue, pallor, yellowing of eyes, pale cold skin, changes in stool color, spleen enlargement, chest pain, angina, heart attack, palpitations, fainting, dizziness
List 3 lymphatic structures:
Lymphatic vessels, lymphoid tissue, tonsils, lymph nodes, spleen, thymus gland, red bone marrow
iron-deficiency anemia
microcytic-hypochromic
Define polycythemia
overproduction of red blood cells (due to abnormality of stem cells in bone marrow - vera)
What is the rationale for administering injections of vitamin B12 to patients with pernicious anemia?
a. The patient's body does not normally manufacture enough vitamin B12.
b. B12 apsorption is impaired due to a loss of plasma proteins.
c. The patient may lack the intrinsic factor necessary for vitamin B12 absorption.C. The patient may lack the intrinsic factor necessary for vitamin B12 absorption.
What is hematopoesis?
The process of blood cell production. Should occur in the bone marrow of pelvic bones, vertebrae, cranium and mandible, sternum and ribs, humerus, and femur.
Describe lymph, including its location and function.
Lymph is a clear, watery, isotonic fluid that circulates in lymph vessels. It returns excess interstitial fluid to the cardiovascular system. Lymphatic organs filter and destroy foreign material and initiate the immune response. They also absorb lipids from the GI tract.
sickle cell anemia
abnormal elongated sickle shape hemoglobin (due to deoxygenation and dehydration)
Explain the left-shift phenomenon - when does it occur?
Mature cells are not released, instead precursor cells serve as the final product. Occurs in acute leukemia.
What should be a major focus in a teaching plan for a teenager with sickle cell anemia?
a. Limit tobacco use to no more than two cigarettes a day.
b. Eat foods high in iron and vitamin B.
c. Maintain environmental temperature at 65° F to 68° F.
d. Maintain adequate hydration.
ANS: D
Maintaining adequate fluid intake (4-6 L/day) prevents hemoconcentration. The use of alcohol and tobacco are contraindicated for the patient with sickle cell anemia as the cause of vasoconstriction. Warm environments are more therapeutic as warm environments do not cause vasoconstriction.
Normocytic-normochromic anemia. Impacts bone marrow, so all cell types are decreased. Caused by autoimmune processes, chemotherapy, parvo, drugs, AIDS. Initial symptoms include fatigue, weakness, and pallor. Symptoms associated with leuko/thrombocytopenia also occur.
List the cause and two symptoms of elephantiasis:
Lymphedema caused by blockage d/t a parasitic infection. S/S include extreme swelling of legs, breast, or genitalia, thickening of subcutaneous tissue, frequent infections, skin ulcerations, fever
normocytic-normochromic
Define a vasoocculsive crisis
Sickled cells cause obstructed blood flow in microcirculation. Very painful and can last days to weeks.
When a client is diagnosed with aplastic anemia, the nurse monitors for changes in which of the following physiological functions?
a. Bleeding tendencies
b. Intake and output
c. Peripheral sensation
d. Bowel function
Explain the effects of DIC:
Clotting and hemorrhage simultaneously occur. Typically caused by endothelial damage and sepsis. Small and midsize vessels clot, leading to organ necrosis in the kidneys and lungs. (Platelets and clotting factors are all used in one place, leaving others without any.) S/S: widespread hemorrhage, petechiae, altered LOC, confusion to coma, malaise, abdominal distension, hematuria, oliguria, renal failure.
What is the difference between Hodgkin's and Non-Hodgkin's lymphomas?
Hodgkin lymphoma: Initially involves a single lymph node, T lymphocytes are defective, Reed-Sternberg cells are present
Non-Hodgkin lymphoma: Multiple node involvement, nonorganized, with widespread involvement, rarely localized
Contrast the s/s of acute and chronic pain:
Acute: sudden and severe (indicates tissue damage), increased BP, temp, RR, diaphoresis, skeletal muscle tension, dilated pupils, increased BG levels, decreased gastric acid secretion, induces fear and anxiety
Chronic: occurs over an extended time, more challenging to treat, sleep disturbances are common, weight gain/loss, affects ADLs, reduces tolerance to additional pain
Explain the mechanism of multiple myeloma.
B cell cancer. Malignant cells originate in teh bone marrow and move via lymph throughout the body. Progressively invades and destroyes cortical bone. Leads to hypercalcemia due to calcium release. Bence-Jones proteins are evident in urine.
When performing a physical assessment of the client in the early stages of Hodgkin's disease, which is the most likely finding when the nurse palpates the client's lymph nodes?
A. The lymph nodes are fixed and hard.
B. The lymph nodes are enlarged and painless.
C. The lymph nodes are small and firm.
D. The lymph nodes are swollen and tender.
ANS: B. The lymph nodes are enlarged and painless.
Compare and contrast acute leukemias (ALL & AML) and chronic leukemias (CML & CLL); include causes and s/s:
Acute: the presence of undifferentiated or immature cells, usually blast cells; ALL = too many lymphoblasts (kids), AML = too many myeloblasts (adults), sudden onset, symptoms are related to depressed bone marrow function; s/s = anemia, thrombocytopenia, bleeding gums, bruising, petechiae, high fevers, anorexia, rapid weight loss, lymph enlargement, bone pain, elevated uric acid
Chronic: cells are mature but do not function normally; CML = too many blood cells made in bone marrow, CLL = too many immature lymphocytes (most common adult); progresses slowly, asymptomatic for a long time; s/s = pancytopenia, fatigue, lymphadenopathy, petechiae, night sweats, more gradual weight loss, low-grade fevers
List the correct order of lymphatic circulation:
Capillaries in tissues > larger vessels > (lymph nodes) > lymphatic ducts
R lymphatic duct > R subclavian vein
Thoracic duct > L subclavian vein
thalessemia
microcytic-hypochromic
List 4 complications of sickle cell anemia
CVA (stroke), paralysis, death, retinopathy, blindness, hemorrhage, avascular necrosis, hepatomegaly, splenomegaly, hematuria, abdominal pain, osteomyelitis, pain, chronic ulcers
"After a client with a potential diagnosis of leukemia is admitted to the
hospital, the nurse should assess for which of the following? (Select
all that apply.)" "
A. Reports of fatigue and weakness
B. An elevation in the leukocytes
especially neutrophils
C. Signs of bruising easily
D. Recent weight gain"
ANS: A & C. Reports of fatigue and weakness Signs of bruising easily
Rationale: General manifestations of leukemia
result from anemia, infection, and bleeding. The client would complain
of fatigue and weakness and show signs of bruising. Leukemic cells
replace normal hematopoietic elements preventing the formation of mature
leukocytes. Neutrophil count would be decreased. Because of an
increased metabolism, weight loss may occur.