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BLOOD DISORDERS - MEDSURG

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Most common cause of DIC Potential complications of DIC


Bleeding characteriz ed by low platelet and fibrinogen levels, prolonged PT PTT and thrombin time and elevated fibrin degradation products (Ddimers)

sepsis, promyelocytic leukemia Renal failure, Gangrene, PE, ALOC, ARDS, Stroke

DIC DIC
IRON DEFICIENCY ANEMIA IRON DEFICIENCY ANEMIA IRON DEFICIENCY ANEMIA FOLIC ACID DEFICIENCY ANEMIA

Characterized by massive amounts of microthrombi with bleeding

Most common form of anemia Anemia with a sore tongue (GLOSSITIS) Involves admin of z-track injection of iron
Megaloblastic anemia with pallor due to lack of folic acid

BLOOD DISORDERS - MEDSURG

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Lack of intrinsic factor PERNICIOUS ANEMIA


Bone marrow depressed due to drugs or fever with bleeding from mucous membranes

APLASTIC
HEMOLYTIC ANEMIAS

Thalassemia, G6PD, sickle cell


Antibodies make the platelets susceptible to phagocytosis

ITP
POLYCYTHEMIA VERA
PALLOR JAUNDICE AND PRURITIS
increased HR AND STROKE VOLUME, ANGINA AND MI

Increased Hgb levels with purple red complexion Integumentary changes to anemia Cardio changes to anemia

RBC indices MCV, RDW

BLOOD DISORDERS - MEDSURG

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Nsg Dx to anemia
Patient teaching to anemia PTs Diagnosis iron deficiency anemia
A genetic disorder of inadequate production of normal HgB

Acivity intolerance, ImBALANCED NUTRITION LESS THAN BODY REQUIREMENTS

NUTRITIONAL INTAKE, DRUG THERAPY COMPLIANCE


GUIAC TEST, ENDOSCOPY, COLONOSCOPY, LABS ret count, TIBC

THALASSEMIA

T or F with hemolytic anemia platelet is normal to high

true
THALASSEMIA MINOR
THALASSEMIA MAJOR
MEGALOBLASTIC ANEMIA

With this anemia Body adapts to decreased HgB


With this anemia Blood transfusions are combined with desferal

Characterized by large RBCs with impaired DNA synthesis

BLOOD DISORDERS - MEDSURG

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Protein secreted by parietal cells of the gastric mucosa


Is required for cobalamin absorption in the small intestine
Decreased vibratory and position senses, ataxia, weakness, paresthesias, ALOC

INTRINSIC FACTOR INTRINSIC FACTOR


COBALAMIN DEFICIENCY

Is diagnosed by means of the schilling test


Treatment is parenteral (injections) admin of cobalamin injections

COBALAMIN DEFICIENCY

COBALAMIN DEFICIENCY
POOR DIET, MALABSORPTION, DRUGS, DIALYSIS, ETOH

Causes of Folic acid deficiency Megaloblastic anemia with no neuro deficits Anemias of chronic disease

FOLIC ACID DEFICIENCY

ESRD, LIVER DISEASE, CHRONIC INFLAMMATION, TUMORS, DM

BLOOD DISORDERS - MEDSURG

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Anemia thats either congenital or idiopathic Normocytic normochromic anemia


Destruction or hemolysis of RBCs at a rate that exceeds production

APLASTIC APLASTIC
HEMOLYTIC ANEMIA HEMOLYTIC ANEMIA
JAUNDICE, SPLENOMEGALY, HEPTOMEGALY, TUBULAR NECROSIS

Third major cause of anemia

s/s of hemolytic anemia


A genetic disorder with presence of Hbs causing RBC to stiffen and elongate

SICKLE CELL DISEASE


PAIN AND SWELLING, PALLOR, FATIGUE
ACUTE SPLENIC SEQUESTRATION CRISIS, STROKE, ACUTE CHEST SYNDROME, PRIAPISM, IRON OVERLOAD DUE TO TRANSFUSIONS

Primary s/s of sickle cell crisis Complications of sickle cell disease

BLOOD DISORDERS - MEDSURG

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Dx of sickle cell
Patient teaching for sickle cell

SMEARS, SICKLING TEST, ELECTROPHORESIS OF HGB, DNA, XRAY, MRI AVOID HIGH ALTITUDES, FLUID INTAKE, TREAT INFECTIONS AND PAIN O2 ADMIN, PAIN MGMT, FOLIC ACID, TRANSFUSIONS, HYROXYUREA, BMT

Care of sickle cell


Bleeding disorder by lack of clotting factor VIII or factor IX

HEMOPHILIA
ID, CONSENT, PROCEDURE, VS, ORDER, TRIPLE CHECK
MATCH PT WITH BLOOD, EXPIRY DATE, 2nd RN verify, SIGN SLIP, ORDERS

What to check before transfusion When picking up blood When prepping for transfusing

STERILE TECHNIQUE, 18/20 G IV CATH, Y-TUBING C NS, VITALS

To start transfusion..

check PT ID, FLUSH IV, HANG AND CHECK FILTER, TITRATE SLOW, VITALS

BLOOD DISORDERS - MEDSURG

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After transfusion.
Two major components of blood

VITALS, FLUSH, ASSESSMENT, OBTAIN LABS,"", DOCUMENT

plasma 55% , cells 45%


granulocytes and agranulocytes
EOSINOPHILS, BASOPHILS, NEUTROPHILS

Types of leukocytes
Types of granulocytes
Types of agranulocytes
Most common form of leukocyte with phagocytic function

LYMPHOCYTE AND MONOCYTE

NEUTROPHIL
PRESENCE OF SEGMENTED NUCLEUS (seg)

How do you know if neutrophil is mature How do you know if neutrophil is immature

PRESENCE OF BANDS IN NUCLEUS

BLOOD DISORDERS - MEDSURG

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Life span of neutrophils


Defends against parasite, contains histamine
Does phagocytosis with histamine, serotonin and heparin

3days
EOSINOPHILS

BASOPHILS
LYMPHOCYTES

Combats viral infections


Phagocytize and become macrophages
How much seniors have anemia; how much in senior homes?

MONOCYTES

2% 40% 5-9 days


MEGAKARYOCYTES from bone marrow

Life span of platelets


Cells that release thrombocytes into circulation

BLOOD DISORDERS - MEDSURG

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Four components of normal hemostasis


Able to produce RBC during fetal devt; next to kidney
Removes old RBCs, removes HgB, filters bacteria, stores immunoglobulins, RBCs

VASCULAR RESPONSE, REFORMATION of PLATELET, DEVELOPMENT OF CLOTTING, LYSIS OF CLOT

SPLEEN SPLEEN
POSTERIOR ILIAC CREST
Blood hemolysis, AGGLUTINATION AND CLUMPING

Site of BM aspiration
What happens during transfusion rxn?

Universal recipient

ab thymus
ERYTHROPOEITIN

Origin of T-Cells
Whats deficient in Renal Dialysis PTs?

BLOOD DISORDERS - MEDSURG

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Chronic, microcytic, hypochromic anemia, may be asymptomatic

IRON DEFICIENCY ANEMIA PANCYTOPENIA in aplastic anemia Radioactive b12 is injected with oral b12 HEREDITARY SPHEROCYTOSIS

Decrease in myeloid stem cells What happens during a schilling test? Anemia with spherical RBCs BMT offers cure before liver damage occurs
Anemia with hypochromia and microcytosis, hemolysis
Treatment of B-thalassemia due to long term transfusion

thalassemiA thalassemia DESFERAL DESFERAL

Treatment for acute iron toxicity

BLOOD DISORDERS - MEDSURG

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Management of Inherited Hemolytic Anemias Common cause of sickle cell crisis pain

SPLENECTOMY, O2 ADMIN, BLOOD TRANSFUSION

occlusion OF MICROCIRCULATION HGB ELECTROPHORESIS

Dx of sickle cell
WHAT to do during iron overload?
What you call degraded HgB? (seen with G6PD anemia)
Anemia caused by genetic dysfunction and RBC membrane instability Decreased HGB/HCT, increased RET count, positive Coombs test, antibodies A proliferative disorder in which myeloid stem cells escape normal control mechanisms

CHELATION
Heinz BODIES

G6PD anemia
ACQUIRED HEMOLYTIC ANEMIA

POLYCYTHEMIA

BLOOD DISORDERS - MEDSURG

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Burning fingers and toes characterized by Polycythemia Vera

ERYTHROMELALGIA
POLYCYTHEMIA VERA

Blood disorder when HCT is 60%, splenomegaly, clots, tinnitus

Results from neutropenia or lymphopenia Nsg management of Neutropenia

lymphocytes
ID causing agent, CORTICOSTEROIDS, G-CSF, CBC, ANC

Formula for ANC


Another term for neutrophils
What renal patients get due to lack of erythropoietin?

WBC x (% neutro + % bands) over 100

POLYS/BANDS

EPOGEN
When HCT is <25

When to do blood transfusions?