Blood, lymph and immune (test 9)

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Production of blood cells

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Production of blood cells

Developed from stem cells located in the bone marrow through erythropoiesis

Kidney makes most of bodies erythropoietin stimulating factor that then

stimulates liver to release erythropoietin to then produce the RBC's.

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Normal range of RBC's

4.2-6.2 million

Live for about 120 days

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Normal Hemoglobin

12-18

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Is sickle cell genetic? True or false?

True, inherited from both parents

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Sickle cell patho

-composed of an abnormality of hemoglobin S that forms clumps in the red cells causing the "sickle shape".

Sickle shaped cells block BV, forming thrombi. The body destroys the cells, causing anemia

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Treatment for sickle cell

No specific tx, but:

  • taking folic acid and eating protein to help build red cells

  • infection prevention including vaccines

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Pt teaching for sickle cell

  • Avoid high altitudes

  • Avoid vigorous exercise

  • Avoid iced liquids

  • No alc

  • Obtain tx for any infections quickly

  • O2 in case of inadequate oxygenation during a sickle crisis

  • Push fluids to help stop/slow clumping

  • Warm blankets to vasodilate

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Iron deficiency anemia s/s

  • Thin, concave (spoon-shaped) nails with raised edges

  • dizziness

  • headache

  • palor (too little RBC's)

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Iron deficiency anemia patho

  • not enough iron to produce adequate RBC

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Disseminated Intravascular Coagulation (DIC)

DEATH IS COMING

  • occurs with tissue damage (childbirth, trauma, sepsis)

  • excessive clotting, depletes the body's clotting factors causing the pt to hemorrhage

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S/S of disseminated intravascular coagulation

  • bleeding at IV site, oral, vaginal, rectal bleeding.

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tx of disseminated intravascular coagulation

Fresh frozen plasma and packed RBCs to restore blood volume and control clotting

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Aplastic Anemia patho

Bone marrow suppression/failure

  • can be caused by some meds such as chemo and antiarthritics.

EMERGENCY SITUATION

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Aplastic Anemia symptoms

  • anemia s/s

  • ecchymosis

  • peticia

  • hemorrhage

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Aplastic Anemia tx

  • bone marrow transplant common in pts under 45 prevention of hemorrhage and infection are important

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Pernicious anemia tx

Vitamin b12 injections.

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When should iron supplements be taken?

1 hr before or 2 hours after a meal

  • antacids may interfere.

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polycythemia vera patho

too many RBCs

  • causing blood to be too thick

  • blood flow is slowed

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Polycythemia vera s/s

  • reddish face

  • purple lips

  • fatigue

  • blood clots Genetic mutation of JAK2V617F is + in 95% of cases

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Treatment of polycythemia vera

Phlebotomy (removal of blood q 2-3 months) Increased fluid intake Aspirin

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Leukemia patho

Too many immature or abnormal WBC's. Type of cancer

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S/S and dx of leukemia

  • usually no s/s but sometimes severe, persistent infections can occur as a result of abnormal WBC's.

-dx by CBC

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Multiple Myeloma patho

calcium leaking out of bones

  • leads to osteoporosis

-Type of cancer

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Multiple myeloma s/s

similar to that of osteoporosis

  • easily broken bones

  • bone pain

  • hypercalcemia

treated with chemo

  • pain control

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How is iron best absorbed?

With vitamin c

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What is the most common cause of death from sickle cell anemia?

Acute chest syndrome (damage to lungs)

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In pt's who are prone to excessive bleeding, what should the nurse do after giving an IM injection?

Hold pressure for 10 minutes

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What is classified as thrombocytopenia

Platelet count <150

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Hemophilia

Bleeding into the joints

  • NO ASPRIN

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Needle gauge for blood transfusions

18 or bigger 22 for older adults

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Ab blood type

universal recipient

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O blood type

Universal donor

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Blood admin best practice

Y shaped IV line, one side with blood other side with 250 mL of NS.

  • if reaction occurs shut off blood and run saline

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How soon must blood be started after arriving on scene?

30 minutes

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Can blood be left at room temp?

Not for more than 4 hours

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How long does blood take to infuse?

1.5-4 hours

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function of lymph vessels

drain lymph fluid into large veins

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Lymph fluid

waste after plasma has delivered nutrients to the cells

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Tonsils and adrenals function

Lymph tissue

  • guards airway

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Spleen function

filters blood:

  • filtering out damaged rbc

  • recycling hemoglobin

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B lymphocytes

formed in the bone marrow and releases antibodies that fight bacterial infections

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T lymphocytes

Formed in thymus (located behind breastbone)

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Capillaries vs lymphatic system

Capillaries absorb about 80% of fluid

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Inflammatory response

Reaction to tissue damage caused by injury or infection:

  • histamine

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Immune response

The body's defensive reaction to invasion by bacteria

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Specific immunity

Invader is marked for later if it comes back (part of immune response)

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Passive immunity

the short-term immunity that results from the introduction of antibodies from another person or animal.

  • ex. ebola "vaccine" where bone marrow from survivors is injected into sick

  • Infants who breastfeed have temporary immunity to lots of diseases

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natural active immunity

When body makes own antibodies and T cells.

Example when you get a cold

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artificial active immunity

vaccination: exposure of a controlled dose of a weakened/dead virus to induce formation of antibodies

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innate immunity

present at birth

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cell-mediated immunity

type of immunity produced by T cells that attack infected or abnormal body cells

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primary humoral immune response

Antibodies mark the cells to kill later

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Fat soluble vitamins

ADEK

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Conditions to postpone vaccine

  • fever

  • immune deficiency disease or immunosuppressive therapy

  • blood transfusion 6-8 weeks before

  • live vaccine before and during pregnancy

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Influenza vaccine recommended for:

All persons 6 months and older

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Anemia

a deficiency of red blood cells

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Thrombocytopenia

low platelet count

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Neutropenia

deficiency of white blood cells

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Nursing management for fever

Increase nutrition to meet demands of increased metabolic rate

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Steroids can cause immunosuppression (true or false)

True

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Anorexia can cause lowered immune system (true or false)

True

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C-reactice protein (CRP)

a protein whose level in the blood increases with inflammation

Normal below 8mcg/mL

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Rules for patient on neutropenic precautions

  • no fresh fruits or flowers

  • No visitors with infectious diseases

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immune deficiency

Body does not make enough antibodies

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autoimmune disorder

Antigen in body cannot tell self from invader (body is attacking its own cells)

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HIV

human immunodeficiency virus

HIV 1 most common in US

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AIDS

Caused by HIV

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Pre-exposure prophylaxis

  • Truvada: approved for pt's of high risk (msm relationships)... works by suppressing HIV replication

  • Emtricitabine: for patients of high risk

  • Safer sexual practices

  • Screening of blood products

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HIV Patho

A retroviral virus that inserts its RNA into a healthy cell

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Why no HIV/AIDS vaccine?

Constant mutation

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HIV Transmission

HIV infected blood

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S/S of HIV

Often no obvious symptoms... in the early stages flu like symptoms

Later in the disease evidence of the immune system failing

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such as s/s of frequent infections (thrush

swollen lymph nodes

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Treatment of HIV/AIDS

No cure

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Wasting syndrome

Losing more than 10% of weight longside at least 30 days of diarrhea or weakness accompanied by fever

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Needle stick injury

Wash with soap and water

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Treatment of autoimmune disorders

Replacement or support of lost body function

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systemic lupus erythematosus (SLE)

Body creates antibodies that attack own cells

Appears after puberty

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Symptoms of systemic lupus erythematosus (SLE)

  • Butterfly rash under eyes

  • Painful/swollen joints

  • Loss of hair

  • Light sensitivity

  • Swollen glands

  • Weakness

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What can make systemic lupus erythematosus worse?

  • Sun exposure

  • Birth control pills

  • Penicillins

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Diagnosis of SLE

Must meet 4/11 criteria given by ruematologist

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Symptom management of SLE

  • Sunblock and clothing

  • Gulcorticosterious to lower s/s

  • NSAIDS to lower inflammation

  • B-lymphocyte protein inhibitor

  • Corticosteroids

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Lymphoma

Cancer of lymphocytes (type of WBC)

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Hodgkin's lymphoma

More curable! Rarer

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