COPY QUIZLET Clinical Management of Hematological and Oncological Systems — Cardiopulmonary

Hemoglobin

main component of RBCs that transports oxygen and CO2

Blood plasma

The pale yellow fluid portion of whole blood that consists of water and its dissolved constituents: sugars, lipids, metabolic waste products, amino acids, hormones, and vitamins.

Hematocrit (Hct)

percentage of RBCs comprising blood

Anemia and polycythemia are related to what component of whole blood?

Hematocrit

- anemia: low hct

- polycythemia: elevated hct

Polycythemia S/S

thicker blood = inc thrombus risk

- Fatigue

- Visual Changes

- Headache

- Dizziness

- Dysrhythmia

- Bleeding, bruising

- TIA

Anemia S/S

- pallor

- tachycardia

- tachypnea

- OH

- impaired endurance, activity tolerance

Hematocrit norms: female

37-47%

Hematocrit norms: male

42-52%

Hematocrit critical values

Hemoglobin norms: male

14-18

Hemoglobin norms: female

12-16

Hemoglobin critical values

Hematocrit and hemoglobin typically follow which normal ratio?

3:1 [hct to hgb]

- may be referenced in chart as H&H ratio

Leukocytes (WBC): critical values

< 2,500 or > 30,000

Neutrophils

Most abundant WBC, first responders to infection

- kill bacteria, fungi, foreign debris

Monocytes

WBC that cleans up damaged cells

Eosinophils

WBC that kills parasites, cancer cells; involved in allergic response

- "E" eliminates parasites

Lymphocytes

WBC that makes antibodies to fight off viruses

Basophils

WBC that produces histamine during allergic responses

- "B" blasts histamine

Albumin

protein in blood that maintains adequate blood pressure and volume

- synthesized by the liver; seen to decrease with liver disease

Which blood types are considered the universal donor and universal recipient?

Donor: O -

Recipient: AB +

Systemic inflammatory response syndrome [SIRS]

exaggerated inflammatory response that occurs in the body after a stressor

- may precede the development of sepsis

Sepsis

Systemic inflammatory response syndrome [SIRS] caused by infection

Septicemia

bloodstream infection

Septic shock

sepsis with uncontrollable, persisting hypotension [requiring the use of vasopressors] and serum lactate level >2

Anemia

reduction in circulatory RBCs due to decreased production, increased destruction, and/or abnormal maturation

- also nutrient related: iron, B12, folic acid

Posthemorrhagic anemia

rapid loss of RBCs due to bleeding, vascular injury, surgery

- 20-30% blood volume loss = dizziness, hypotension, tachycardia, exertion intolerance

- 30-40% = thirst, dyspnea, diaphoresis, dec urine output, altered mentation, LoC

- 40-50% = severe shock. death possible

Aplastic anemia

failure of RBC production in the bone marrow due to damage caused by toxins, infection, cancer, autoimmune dz

S/S and management of aplastic anemia

- bleeding [mucosal, easy bruising, petechiae], fatigue, sore throat, pallor

- management: immunospuuression, marrow transplant, transfusion, supplemental O2

Hemolytic anemia

destruction/removal of RBCs prior to completing their normal lifespan of 120 days

- congenital: Sickle Cell, Thalassemia

- acquired: circulatory damage (immune response, mechanical heart valve), enzyme deficit, overactive spleen

S/S and management of hemolytic anemia

- fatigue/weakness, chills, fever, N/V, janudice, dec urine, pain associated with splenomegaly

- management: corticosteroids, transfusion, splenectomy

sickle cell anemia

a genetic disorder in which RBCs take on a curved/ "sickle" shape when deoxygenated, become rigid and occlude blood flow over time

- increases risk of CVA, MI, ischemia

Sickle cell crisis

condition in sickle cell anemia in which the sickled cells interfere with oxygen transport, obstruct capillary blood flow, and cause fever and severe pain in the joints and abdomen

- may be triggered by infection, dehydration, hypoxia, cold exposure

- super painful, usually treated with opioids

- can last days to weeks

S/S of sickle cell anemia

- jaundice

- nocturia

- hematuria

- organ failure

- retinopathy

- nonhealing ulcers

- systolic murmur

- cardiomegaly

When working with a pt who has sickle cell anemia, what should be monitored closely?

Oxygen supply/demand

Neutropenia

Absolute neutrophil count (ANC) < 1500

Neutropenic precautions

- Universal precautions plus mask

- no one enters room who has any suspected infection

- no fresh flowers or potted plants

Hemophilia

Excessive and spontaneous hemorrhaging into joints, mm, cranium, and mucus membranes due to hereditary clotting deficiency

- severe cases could turn into hematomas

- modift MSK exam d/t bleeding risk

Hemarthrosis

Spontaneous hemorrhaging into a joint [see hemophilia]

S/S of hemophilia

- petechiae

- ecchymosis

- hematoma

- tachycardia/pnea

- hypotension

- pain

Thrombocytopenia

Acute or chronic platelet count < 150,000 d/t destruction, decreased production, or drug suppression

- educate on fall risk, modify MSK exam and therex d/t risk of bleeding

S/S of thrombocytopenia

- petechiae (or pupura, larger)

- ecchymosis

- hematoma

- tachycardia/pnea

- renal failure

- bleeding mucosal membrane

Heparin-induced thrombocytopenia [HIT]

The body mistakenly binds antibodies to heparin/platelet complex, leading to platelet activation and a hypercoagulable state

- macrophages wipe out tagged platelets, overall count drops

- 20% mortality rate

- most common type of drug induced thrombocytopenia

S&S of heparin induced thrombocytopenia

- DVT

- pulmonary emobolism

- skin lesions, necrosis

- limb ischemia

- weakness, painful movement

- erythema [rash]

- edema

Magament of heparin induced thrombocytopenia

immediate discontinuation of heparin, followed by an alternative anticoagulant, plasmapheresis, and/or immunoglobulin therapy

- defer PT until hemodynamically stable and properly anticoagulated

Heparin-induced thrombocytopenia most likely occurs with the adbimistration of which thrombolytics?

Unfractionated heparin

Metastatic disease

tumor that spreads away from the original/primary organ

- spine and pelvis most common sites of metastasis

- increases risk of pathological fx

Which primary tumors commonly metastisize to bone?

BLT Kosher Pickle: breast, lung, thyroid, kidney, prostate

Leukemia

malignancies of stem cells originating in bone marrow, causing anemia, thrombocytopenia, and leukopenia

- tx with chemo and bone marrow transplants

What is the most aggressive form of leukemia? What age group is it typically seen in?

Acute myeloid leukemia; 60+ age group

Lymphoma

malignant tumor of lymph tissue (and therefore lymphocytes of B-, T-, or NK cell origin)

- visible by painless enlargement of tissue [lymphadenopathy]

- Tx: chemo, stem cell transplants, immunotherapy

Multiple myeloma

Malignancy of plasma cells in the bone marrow, which decreases the production of all whole-blood components

- creates the highest risk of a pathological fx

S/S of multiple myeloma

- bone pain

- decreased RBCs, WBCs, platelets

- lesions cause osteoporosis, patho fx, hypercalcemia [due to malignant bone destruction], and AKI assoc.

Side effects and PT considerations of radiation therapy

- skin reactions/burns, fatigue, bone marrow suppression

- site specific administration may impact contractile tissue and therefore ROM

What precautions are important for treating a patient on chemo?

Extra precautions for managing body fluids due to toxins [i.e. flush toilets twice, be careful of saliva and vomit]

PT considerations for pts on chemo

chemotherapy-induced peripheral neuropathy may occur

- bilateral in the feet and hands, usually lifelong

Cancer related fatigue [CRF]

Physical, emotional, and mental feeling of tiredness or exhaustion, unassociated with exertion and not alleviated by rest

- reported as the most distressing cancer sx

- all pts should be screened for this

Acute adverse blood reactions: febrile

Antileukocyte antibodies in the pt's blood are sensitive to transfused plasma protein, platelets, or WBCs

- occurs during or up to 24 hrs after transfusion

- chills followed by low fever, HA, N/V, flushing, mm pain, anxiety

- low BP, tachycardia/pnea, cough [severe]

Acute adverse blood reactions: allergic

Pt's blood [IgE, IgG, or both] is sensitive to transfused plasma protein

- occurs within minutes of starting transfusion

- hives, flushed or itchy skin, mild bronchial wheezing

- tachypnea, angina, cardiac arrest [severe]

Acute adverse blood reactions: septic

Caused by transfused blood components being contaminated with bacteria

- occurs within minutes to 30 mins after transfusion

- rapid onset of high fever, low BP, chills, emesis, diarrhea, renal failure, shock, ab cramps

Acute adverse blood reactions: acute hemolytic

Patient's blood and transfused blood are not compatible, resulting in RBC destruction

- occurs within minutes to hours after transfusion

- most common manifestation is fever w/ or w/o chills

- tachycardia/pnea, cyanosis, chest pain, HA or back ache, ARF, cardiac arrest

Acute adverse blood reactions: anaphylactic

Caused by the development of IgA antibodies to transfused components

[if pt is deficient in IgA to begin with]

- OCCURS WITHIN SECONDS of starting transfusion

- mild hives, wheezing or bronchospasm, cyanosis, emesis, bloody diarrhea, shock

Acute adverse blood reactions: transfusion-related acute lung injury

Caused by the reaction of antibodies in donor plasma with the recipient granulocytes

- occurs within several hours after transfusion

- imaging shows pulm edema

- chills, fever, chest pain, hypotension, cyanosis