NURS-202 Exam 5 - Hematology and Neuro 2022
what is a left shift?
***need to know per lecture*** Correct Answer: increased number of immature
... [Show More] neutrophils AKA band cells
what are bands in relation to a CBC? Correct Answer: young neutrophils
what does "more band building" mean? Correct Answer: more shift to the left, more young neutrophils
what is the first clue that an infection is starting? Correct Answer: shift to the left
what could cause a left shift?
***need to know per lecture*** Correct Answer: infection
physical stress
(ex: surgery)
inflammation
when reading labs, what does SEGS represent? Correct Answer: mature neutrophils
"segmental neutrophils"
what are thrombocytes? Correct Answer: platelets
what percentage of blood is plasma vs RBCs? Correct Answer: RBC 45%
plasma 55%
what are the three types of protein found in plasma? Correct Answer: albumin
(maintains blood volume and binds to substances)
globulins
(main proteins of antibodies)
fibrinogen
(activated by thrombin, forms fibrin clots)
what can happen if a patient has low albumin? Correct Answer: leads to leaky vessels which can lead to third spacing, edema
what can cause low albumin? Correct Answer: AKI
malnutrition
hemorrhage
burns
liver disease
hemoglobin vs hematocrit per lecture
***need to know per lecture*** Correct Answer: hematocrit measures the percentage of blood that is RBCs
hemoglobin measures how many RBCs you have
hemoglobin protein carries oxygen - without sufficient hemoglobin, won't have enough oxygen
function and anatomy of the spleen Correct Answer: vascular and lymph tissues, located in ULQ of abdomen
functions:
filters blood
stores blood and platelets
aids in antigen production
aids in initiation of B&T lymphocytes
white pulp: where immune functions occur
red pulp: where filtration occurs
can you live without your spleen? Correct Answer: yes, but will be at higher risk of infection
why do we need to assess/palpate the spleen for patients with sickle cell anemia? Correct Answer: sickle cells can get stuck in the spleen and cause it to rupture - will have lots of pain with palpation
how long do normal RBCs live?
which organ removes them from the blood? Correct Answer: 120 days
the spleen
the primary function of erythrocytes is __________
***need to know per lecture*** Correct Answer: respiration
what are the two pathways in the clotting cascade?
which one is faster? Correct Answer: intrinsic
(blood or vessel injury)
&
extrinsic
(external tissue damage)
extrinsic is faster, skips some steps in the clotting cascade
PT or PTT - which goes with intrinsic or extrinsic clotting cascade? Correct Answer: extrinsic monitored by PT
intrinsic monitored by PTT
PT vs INR vs PTT
***need to know per lecture*** Correct Answer: PT measures how long it takes a clot to form
(we use to monitor oral anticoag therapy - warfarin/coumadin)
INR is used to standardize PT lab results
PTT evaluates all clotting factors of intrinsic pathway except platelets
(we use to monitor response to anticoag therapies - heparin)
what could increased INR indicate? Correct Answer: DIC
taking salicylates
cirrhosis
hepatitis
vitamin K deficiency
what does high vs low INR mean? Correct Answer: high INR = takes a long time to clot = bleeding risk
low INR = clots fast = clot risk
what is a normal INR?
what do we want INR at for someone taking warfarin/coumadin? Correct Answer: normal is 1.1 or less
if on warfarin/coumadin, we want to be at 2-3
how long do platelets live? Correct Answer: 4-7 days
how long does aspirin affect blood clotting for? Correct Answer: it irreversibly inhibits platelet aggregation for the entirety of a platelet's life, which is 4-7 days
what do we use bone marrow biopsy for vs a bone marrow aspiration?
***need to know per lecture*** Correct Answer: biopsy - diagnosis of leukemia
aspiration - check if treatment is working and/or look for bone marrow suppression
how can drinking alcohol cause/affect hematological issues? Correct Answer: 90% of alcohol is metabolized in the liver and damage to the liver increases the risk for hematological problems
assessment considerations for hematological assessment Correct Answer: history:
nutrition
past medical hx
chronic disease
medications and herbs:
--- goldenseal and green tea can reduce the effect of anticoags
--- aspirin inhibits platelet aggregation
--- penicillins, cephalosporins, vancomycin may cause neutropenia
physical assessment
lab profile
examination of bone marrow
what are the best sites to use for bone marrow aspiration or biopsy?
what is something to remember about this procedure?
***need to know per lecture*** Correct Answer: iliac crest is best
can also use sternum
it is very painful!
risk for osteomyelitis!
nursing management for bone marrow aspiration
***need to know per lecture*** Correct Answer: watch for signs of infection - can get osteomyelitis
(bone pain, fever, purulent drainage)
apply pressure to the site for 5-10 minutes after
assess VS frequently
apply a sterile pressure dressing
instruct patient to rest for several hours
monitor for sx of bleeding and infx for 24 hours
reinforce dressing if needed, do not remove for 24 hours
assess for pain
specimens labeled and brought to lab - not tubed, usually in person
age related changes to the hematological system
***need to know per lecture*** Correct Answer: blood volume decrease
lower levels of plasma
number of cells is gradually reduced
lean body mass decreases
fat tissue increases until around age 60
bone mass and intracellular fluids decrease
nutrition needs change
(ex: after menopause iron requirements are the same for men and women)
decrease in total body water
is there a change in platelets with aging?
is there a change in hematocrit with aging?
***need to know per lecture*** Correct Answer: no and no
what is the protein that stores iron? Correct Answer: ferritin
what does a decrease in ferritin indicate? Correct Answer: iron deficiency
teaching points for iron supplementation
***need to know per lecture*** Correct Answer: don't take with calcium or dairy
vitamin c can increase absorption
don't lay down for 30 mins after taking
expect black stools
may cause nausea, constipation, abdominal discomfort
normal H&H Correct Answer: Hemoglobin
14-18 male
12-16 female
Hematocrit
42-51 male
38-44 female
why is iron so important? Correct Answer: it is essential to the formation and function of hemoglobin
dietary teaching for iron
***need to know per lecture*** Correct Answer: Good sources:
red meat
green leafy veggies
dried fruits
dried beans
fortified cereals
eggs
oatmeal
sweet potatoes
beets
cook w/ cast iron skillets
Avoid:
alcohol
coffee
tea
(increase GI motility and decrease absorption of iron)
The nurse correlates which clinical manifestations with a diagnosis of iron-deficiency anemia? (Select all that apply.)
A. Decreased temperature
B. Decreased heart rate
C. Increased blood pressure
D. Increased heart rate
E. Increased respiratory rate Correct Answer: D, E
what is the most common type of anemia? Correct Answer: iron deficiency anemia
2. During an assessment, which finding does the nurse correlate with iron-deficiency anemia?
A. Red, beefy gums
B. Loss of teeth
C. Red, swollen, tender tongue
D. Xerostomia Correct Answer: C
symptoms of iron deficiency anemia
***need to know per lecture*** Correct Answer: fatigue
pallor
tachycardia
tachypnea
SOB
pale gums
pale conjunctiva
difficulty focusing
sore muscles
pink/red urine
red, swollen, smooth, shiny, painful tongue
(glossitis)
spoon-shaped nails
(koilonychias)
growth issues in children
(cognitive impairment)
The nurse assesses for which clinical manifestation as a compensatory mechanism for iron-deficiency anemia?
A.Increased respiratory rate
B.Increased blood pressure
C.Decreased temperature
D.Decreased pulse rate Correct Answer: A
A patient is scheduled to have a serum iron level in 1 month. The nurse includes which instructions about this test?
A. "You will need to fast for 12 hours before the test."
B. "This sample needs to be drawn in the morning."
C. "Continue to take your iron supplements."
D. "This test will require three different samples taken at hourly intervals." Correct Answer: B
iron levels vary throughout the day, usually lower in the evening so we draw them in the morning
we want them to stop taking iron 24hr before the test
there is no need to fast
what is the cause of B12 anemia?
risk factors?
***need to know per lecture*** Correct Answer: B12 deficiency - either due to lack of intake or inability to absorb it
risk factors
lack of intrinsic factor
vegan/vegetarian diet
older adults
low socioeconomic status
chronic alcohol use
autoimmune disorders
(AIDS, thyroiditis, graves)
long term use gastric meds
GI resection
crohn's disease
celiac disease
what is pernicious anemia?
treatment?
***need to know per lecture*** Correct Answer: anemia caused by B12 deficiency due to lack of intrinsic factor which is necessary for absorption of B12.
autoimmune disease
***prevention is key! gets worse the longer they are deficient***
treatment - B12 injections
daily x1 week
then weekly x5-6 weeks
then monthly for life
(SubQ or IM)
complications of pernicious anemia / B12 deficiency
***need to know per lecture*** Correct Answer: anemia
(pallor, fatigue, SOB, tachycardia, tachypnea)
GI disorders
dysfunction of peripheral nerves, spinal cord, brain
-peripheral neuropathy
-spinal cord degeneration
-paresthesia hands/feet
-Lhermitte's sign
-confusion
-depression, mood swings
-impaired taste, stinging on tongue
-impaired balance
-visual disturbances
-dementia
-tinnitis
What is Lhermitte's sign? Correct Answer: flexion of neck causes electric shock sensation
can be seen in B12 deficiency / pernicious anemia
what age does sickle cell usually appear? why?
***need to know per lecture*** Correct Answer: 6 months
this is when they change over from fetal hemoglobin
management of sickle cell anemia
***need to know per lecture*** Correct Answer: no cure - treatment is prevention and symptom management
pain management and hydration are key!
hydration can prevent sickle crisis but can also open up vessels during a crisis and help to decrease pain
opioids for pain during a crisis
transfusions
avoid high altitudes, avoid dehydration
what is the most common inherited blood disorder? Correct Answer: sickle cell anemia
clinical manifestations of sickle cell anemia?
***need to know per lecture*** Correct Answer: fatigue
pallor
SOB
tachycardia
tachypnea
SOB
pain in joints, chest, abd
fever
delayed wound healing
hand-foot syndrome
jaundice
pain and swelling with vaso-occlusion of blood vessels
s/sx of sickle cell crisis
***need to know per lecture*** Correct Answer: changes in LOC
headache
dizziness
sensorimotor deficits
seizures
neuro changes
A patient with sickle cell disease is admitted with splenic sequestration. The blood pressure is 86/40 mm Hg, and heart rate is 124 beats/min. Which of these actions will the nurse take first?
1.Complete a head-to-toe assessment
2.Draw blood for type and cross-match
3.Infuse normal saline at 250 mL/hr
4.Ask the patient about vaccination history. Correct Answer: 3 - rehydration is the priority
patients with sickle cell are at an increased risk for _ [Show Less]