LRTI & Hematologic disorders

What is anemia?

A condition resulting from an insufficient supply of healthy RBCs, packed RBC volume, or hemoglobin, indicating an underlying disorder.

What are common assessments for diagnosing anemia?

Erythropoietin levels, hemoglobin, iron studies, bone marrow aspiration, hematocrit, reticulocyte count, RBC indices, and MCV.

What does MCV stand for and what does it measure?

Mean corpuscular volume; it measures the average size and volume of RBCs.

What are the normal ranges for MCV?

76 - 100 um³.

What is Total Iron Binding Capacity (TIBC) and its normal range?

A measure of the blood's capacity to bind iron with a normal range of 240-450 mcg/dl.

How can anemia be classified?

Anemia can be classified as hypoproliferative, bleeding, or hemolytic.

What is Iron Deficiency Anemia?

A type of anemia resulting from inadequate dietary iron intake, leading to decreased RBC formation.

What are common causes of Iron Deficiency Anemia?

Inadequate dietary intake, increased internal demands, bleeding, and malabsorption syndromes.

What are clinical manifestations of Iron Deficiency Anemia?

Pallor, weakness, fatigue, smooth sore tongue, brittle nails, angular cheilosis.

What is the significance of Schilling's Test?

It detects the lack of intrinsic factor by measuring the absorption of radioactive Vitamin B12.

What is Sickle Cell Anemia?

A severe hemolytic anemia caused by the inheritance of the sickle cell hemoglobin gene, leading to deformed RBCs.

What are common clinical manifestations of Sickle Cell Anemia?

Jaundice, fatigue, shortness of breath, dizziness, and pain during sickle crisis.

What are the three types of Sickle Cell Crisis?

Sickle Crisis, Aplastic Crisis, and Sequestration Crisis.

What is Thalassemia?

A group of hereditary anemias characterized by hypochromia, microcytosis, hemolysis, and variable degrees of anemia.

What are the two major classifications of Thalassemia?

Alpha-thalassemia and Beta-thalassemia, classified based on which hemoglobin chain is diminished.

What is the typical lifespan of RBCs in Sickle Cell Anemia?

Reduced to 10-12 days.

What are common nursing management strategies for Iron Deficiency Anemia?

Monitor for bleeding, instruct on iron-rich foods, and enhance iron absorption with vitamin C.

What is the role of Hydroxyurea in Sickle Cell Anemia management?

It increases Hemoglobin F, allowing RBCs to remain round and flexible.

What are the risks associated with Sickle Cell Anemia?

Risk for infection, acute pain related to tissue hypoxia, and powerlessness related to illness.

What dietary sources are high in iron?

Organ meats, other meats, beans, leafy green vegetables, raisins, and molasses.

What is the relationship between anemia and oxygen delivery to tissues?

Anemia diminishes the amount of oxygen delivered to body tissues.

What is the significance of reticulocyte count in anemia diagnosis?

It helps assess the bone marrow's response to anemia and RBC production.

What are common complications of Sickle Cell Anemia?

Thrombosis, cardiac murmurs, dysrhythmias, and heart failure.

What is the impact of Vitamin B12 and folate levels in anemia?

They are important in diagnosing types of anemia and assessing nutritional status.

What is hypersplenism in the context of hemolytic anemia?

A condition where the spleen is overactive, leading to excessive destruction of RBCs.

What are common diagnostic findings in Sickle Cell Anemia?

Sickled cells on blood smear and low hematocrit.

What is the primary cause of Aplastic Crisis in Sickle Cell Anemia?

Infection with the human parvovirus leading to a rapid drop in hemoglobin levels.

What are alpha-thalassemias primarily associated with?

People from Asia and the Middle East.

What happens to the alpha globin protein in alpha-thalassemias?

A gene or genes related to the alpha globin protein are missing or changed.

How severe is alpha-thalassemia typically?

It is milder and often occurs without symptoms.

What is the primary population affected by beta-thalassemias?

People from Mediterranean regions, as well as those from the Middle East and Asia.

What is a potential outcome of untreated severe beta-thalassemia?

It can be fatal within the first few years of life.

What are the two forms of thalassemia?

Thalassemia minor and thalassemia major.

What are the characteristic symptoms of thalassemia major?

Severe anemia, marked hemolysis, and ineffective erythropoiesis.

What is the treatment for thalassemia major?

Regular blood transfusions and PBSCT (Peripheral Blood Stem Cell Transplantation).

What complication can arise from excessive iron in multiple PRBC transfusions?

Organ dysfunction due to iron overload.

What is G6PD deficiency?

A hereditary condition where red blood cells break down when exposed to certain drugs or stress.

What populations are most at risk for G6PD deficiency?

Italian, Greek, and African Americans.

What are common clinical manifestations of G6PD deficiency after exposure to triggers?

Pallor, jaundice, hemoglobinuria, increased reticulocyte count, and hemolysis.

What is spherocytosis?

A disorder characterized by an abnormal permeability of the RBC membrane leading to spherical red blood cells.

What are the symptoms of spherocytosis?

Fatigue, irritability, shortness of breath, and weakness.

What is hereditary hemochromatosis?

A genetic condition where iron is excessively absorbed from the gastrointestinal tract.

What organs are primarily affected by iron overload in hereditary hemochromatosis?

Liver, myocardium, testes, thyroid, and pancreas.

What are some clinical manifestations of hereditary hemochromatosis?

Cardiac dysrhythmias, endocrine dysfunction, cirrhosis, weakness, and hyperpigmentation.

What is polycythemia vera?

A proliferative disorder where myeloid stem cells escape normal control, leading to increased blood cell production.

What are common symptoms of polycythemia vera?

Dizziness, headache, fatigue, angina, and dyspnea.

What complications can arise from polycythemia vera?

Increased risk for thromboses, bleeding, and potential cardiovascular events.

What diagnostic findings are associated with polycythemia vera?

Elevated erythrocyte mass, normal O2 saturation, and splenomegaly.

What is leukemia?

Malignant neoplasms characterized by increased production of immature white blood cells (WBCs) from the bone marrow and other blood-forming organs.

What are the two major classifications of leukemia?

Acute and Chronic.

What are the two classifications of leukemia by cell origin?

Myeloid and Lymphoid.

What is the primary goal of leukemia treatment?

To reduce blood thickness and prevent bleeding.

What is phlebotomy used for in leukemia treatment?

To decrease blood thickness.

What nursing management is recommended to reduce the likelihood of DVT?

Avoidance of tight clothing, crossing legs, and sedentary behavior.

What is Acute Lymphoblastic Leukemia (ALL)?

A cancer of lymphoblasts and the most common form of leukemia in children under 19 years of age.

What are common clinical manifestations of Acute Lymphoblastic Leukemia?

Malaise, fatigue, bony pain, diaphoresis, bleeding, splenomegaly, hepatomegaly, lymphadenopathy, petechiae, and echymoses.

What is Acute Myelogenous Leukemia (AML)?

Characterized by the accumulation of myeloid progenitor cells in the blood, bone marrow, liver, and spleen.

What are common clinical manifestations of Acute Myelogenous Leukemia?

Bone marrow failure, hepatosplenomegaly, bone pain, pallor, ecchymosis, signs of infection, anemia, neutropenia, thrombocytopenia, fatigue, and weight loss.

What is Chronic Lymphocytic Leukemia?

A malignant chronic lymphoproliferative disorder characterized by the proliferation and accumulation of functionally incompetent lymphocytes.

What are common clinical manifestations of Chronic Lymphocytic Leukemia?

Fatigue, exertional dyspnea, weight loss, night sweats, splenomegaly, lymphadenopathy, and ecchymosis.

What is Chronic Myelogenous Leukemia?

Cancer of granulocytes and monocytes, often diagnosed in older patients.

What are common clinical manifestations of Chronic Myelogenous Leukemia?

Fatigue, malaise, fever, weight loss, night sweats, ecchymosis, lymphadenopathy, and splenomegaly.

What laboratory tests are used for diagnosing leukemia?

CBC, platelet count, bone marrow aspiration with biopsy, and bone marrow smear.

What is Idiopathic Thrombocytopenic Purpura?

An autoimmune disorder characterized by a platelet count less than 100,000/ml leading to bleeding due to lack of platelet aggregation.

What are common clinical manifestations of Idiopathic Thrombocytopenic Purpura?

Bruising without trauma, bleeding gums, black and tarry stools, and hematemesis.

What is the significance of Colony Stimulating Factors in hematopoiesis?

They mediate the proliferation of hematopoietic stem cells.

What is the role of stem cells in hematopoiesis?

All circulating blood cells arise from a small pool of hematopoietic stem cells (HSCs).

What are the common risk factors for Acute Lymphoblastic Leukemia?

High-dose radiation, chemicals, drugs, viruses (EBV, HIV), and genetics.

What are the common risk factors for Acute Myelogenous Leukemia?

Genetics (e.g., Down Syndrome), cigarette smoking, exposure to certain chemicals, and ionizing radiation.

What is the role of the nurse in managing patients with leukemia?

Primarily an educator, encouraging behavior that reduces risks and managing symptoms.

What is the recommended nursing intervention for patients with pruritus?

Tepid or cool bathing and avoidance of vigorous toweling.

What is the treatment for severe bleeding in patients with clotting factor deficiencies?

Transfusion of clotting factors, such as FX VIII or IX, FFP, or cryoprecipitate.

What is the importance of genetic counseling in bleeding disorders?

To provide information about hereditary conditions and risks to family members.

What are the clinical manifestations of Disseminated Intravascular Coagulation (DIC)?

Petechiae, ecchymosis, oozing of blood from puncture sites, and severe bleeding during childbirth.

What is the treatment for DIC?

Identify and control the cause, blood transfusions, and heparin in the early phase.

What is oxygenation?

The process of delivering oxygen through arterial blood from the alveoli to the body tissues through gas exchange for sustenance of cellular activity.

What are the main components of the oxygenation process?

Blood and blood vessels.

What is the significance of oxygenation for cells?

Without oxygenation, cells cannot survive.

What does the hematologic system consist of?

The blood and the sites where blood is produced, including the bone marrow and the reticuloendothelial system.

What is blood often referred to as?

The 'river of life' that transports oxygen, nutrients, wastes, and body heat within the body.

What are the two main components of blood?

Plasma and various types of cells (RBC, WBC, and platelets).

How much of the body weight does blood make up?

Approximately 7% to 10%.

What is the volume of blood in an average adult?

5 to 6 liters.

What percentage of blood is plasma?

55%.

What are the primary functions of blood?

Delivers oxygen and nutrients to tissues, removes wastes, and transports gases, immune cells, antibodies, and hormones.

What is the function of WBC (Leukocytes)?

To fight infection.

What is the role of Neutrophils?

Essential in preventing or limiting bacterial infection via phagocytosis.

What do Monocytes become when they enter tissues?

Macrophages, which are highly phagocytic, especially against fungus.

What is the function of Eosinophils?

Involved in allergic reactions and digesting foreign proteins.

What is the role of Basophils?

Contains histamine and is integral to hypersensitivity reactions.

What is the function of T-Lymphocytes?

Responsible for cell-mediated immunity and recognizing foreign materials.

What do B-Lymphocytes mature into?

Plasma cells that secrete immunoglobulin (antibodies).

What is the average lifespan of RBCs (Erythrocytes)?

120 days.

What is the role of Platelets (Thrombocytes)?

Provides the basis for coagulation and maintains hemostasis; average lifespan is 10 days.

What is hemostasis?

The process of preventing blood loss from intact vessels and stopping bleeding from a severed vessel.

What mechanisms does the body have to prevent excessive clotting?

The fibrinolytic mechanism that dissolves thrombi formed within blood vessels.

What are the general functions of the hematologic system?

Transportation of oxygen, nutrients, cellular waste products, regulation of body temperature, pH, fluid balance, and production of protective cells.

What should be included in history taking for oxygenation assessment?

Integumentary history, surgical history, allergies, reason for seeking care, family history, diet, medications/supplements, occupations/exposure, fatigue, bleeding tendencies, and respiratory history.

What is the recommended technique for physical examination in nursing?

Utilization of cephalocaudal examination of body systems.