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Question
Is the following statement True or False? Hematopoiesis is the complex process of the formation and maturation of blood cells.
Answer
True Hematopoiesis is the complex process of the formation and maturation of blood cells.
Hematologic System
The blood and the blood forming sites, including the bone marrow and the reticuloendothelial system Blood
Plasma
Blood cells Hematopoiesis
Blood Cells
ErythrocyteRBC LeukocyteWBC Neutrophil Monocyte Eosinophil Basophil LymphocyteT lymphocyte and B lymphocyte Thrombocyteplatelet
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Hematopoiesis
Hemostasis
Refer to fig. 33-3
Question
What type of anemia results from red blood cell destruction? A.Bleeding
B.Hemolytic
C.Hypoproliferative D.None of the above
Answer
B Bleeding results from red blood loss. Hemolytic anemia results from red blood cell destruction. Hypoproliferative anemia results from defective red blood cell production.
Anemias
Lower than normal hemoglobin and fewer than normal circulating erythrocytes. A sign of an underlying disorder Hypoproliferative: defect in production of RBCs Due to iron, vitamin B12, or folate deficiency, decreased erythropoietin production, cancer Hemolytic: excess destruction of RBCs
Due to altered erythropoiesis, or other causes such as hypersplenism, drug-induced or autoimmune processes, mechanical heart valves
May also be due to blood loss
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Manifestations
Depend upon the rapidity of the development of the anemia, duration of the anemia, metabolic requirements of the patient, concurrent problems Fatigue, weakness, malaise Pallor or jaundice Cardiac and respiratory symptoms
Tongue changes
Nail changes Angular cheilosis
Pica
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Medical Management
Correct or control the cause Transfusion of packed RBCs Treatment specific to the type of anemia Dietary therapy Iron or vitamin supplementationiron, folate, B12 Transfusions Immunosuppressive therapy Other
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Laboratory data
Presence of symptoms and impact of those symptoms on patients life; fatigue, weakness, malaise, pain Nutritional assessment Medications Cardiac and GI assessment
Interventions Balance physical activity, exercise, and rest. Maintain adequate nutrition.
Question
Is the following statement True or False? Leukocytosis refers to a decreased level of leukocytes in the circulation.
Answer
False Leukocytosis refers to an increased level of leukocytes in the circulation. Leukopenia refers to a decreased level of leukocytes in the circulation.
Leukemia
Hematopoietic malignancy with unregulated proliferation of leukocytes Types:
Stages:
1. chronic phase, life expectancy >5 yrs 2. transformational phase
Treatment
Imatinib mestylate (Gleevec) 3 Chemotherapy, BMT or PBSCT
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Treatment - complex
Chemotherapy Corticosteroids
Self-care deficit
Anxiety Disturbed body image Potential for spiritual distress Grieving diagnoses Deficient knowledge
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Depression
Interventions
Interventions related to risk of infection and bleeding Mucositis Frequent, gentle oral hygiene Soft toothbrush, or if counts are low, sponge-tipped applicators Rinse only with NS, NS and baking soda, or prescribed solutions Perineal and rectal care
Improving Nutrition
Oral care before and after meals Administer analgesics before meals Appropriate treatment of nausea Small, frequent feedings Soft foods that are moderate in temperature Low-microbial diet Nutritional supplements
Lymphoma
Neoplasms of lymph origin Hodgkins lymphoma Non-Hodgkins lymphoma
Hodgkin Lymphoma
Relatively rare More men than women, Two peaks 20s and 50s, familial pattern
Hodgkin Lymphoma
Manifestations
1. Tobacco use
2. Alcohol use 3. Exposure to carcinogens
4. Exposure to sunlight
Screening for effects of treatment Provide education regarding self care strategies Provide education regarding disease management
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Treatment
Determined by type and stage of disease 2 May include interferon, chemotherapy, and/or radiation therapy.
Copyright 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
What should any elderly patient be evaluated for whose chief complaint is back pain and has an elevated total protein level? A. Anemia B. Leukemia C. Multiple myeloma D. Non-Hodgkins lymphoma
Answer
C Any elderly patient whose chief complaint is back pain and has an elevated total protein level should be evaluated for possible myeloma.
Multiple Myeloma
Malignant disease of plasma cells in the bone marrow with destruction of bone
Prognosis based on markers 1. Serum albumin
Multiple Myeloma
Manifestations Bone pain (back or ribs) Osteoporosis & spinal fractures
Hypercalcemia 1
Renal failure Anemia 2, so fatigue , weakness
Bleeding Disorders
Disseminated Intravascular Coagulation (DIC) Primary Thrombocythemia Thrombocytopenia Idiopathic Thrombocytopenia Purpura (ITP)
Hemophilia
Acquired Coagulation disorders: liver disease, anticoagulants, vitamin K deficiency Bleeding precautions
Question
Is the following statement True or False? Disseminated intravascular coagulation is not a disease but a sign of an underlying condition.
Answer
True Disseminated intravascular coagulation is not a disease but a sign of an underlying condition.
DIC
Severity is variable; may be life-threatening -80% mortality rate
Triggers may include sepsis, trauma, shock, cancer, abruptio placenta, toxins, and allergic reactions.
Hemostasic mechanism is altered causing massive clotting. As clotting factors are consumed, bleeding occurs. Symptoms are related to tissue ischemia and bleeding. 1 Laboratory tests. Treatment: treat underlying cause, correct tissue ischemia, replace fluids and electrolytes, maintain blood pressure, replace coagulation factors, use heparin.
DIC
Manifestations Organ failure (or compromised function) Low platelet and fibrinogen levels 1
Interventions
Assessment and interventions should target potential sites of organ damage. Monitor and assess carefully
Avoid trauma and procedures which increase risk of bleeding, including activities which would increase intracranial pressure.
Complications of Transfusions
Febrile nonhemolytic reaction Acute hemolytic reaction Allergic reaction Circulatory overload Bacterial contamination Transfusion related acute lung injury Delayed hemolytic reaction Disease acquisition Complications of long-term transfusion therapy
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