Term
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Definition
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Definition
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Definition
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Term
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Definition
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Definition
| (size of RBC)82-98 fL/cell |
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Term
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Definition
| (weight of Hgb) 27-33 g/dL |
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Term
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Definition
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Definition
| (size variation) 11-14.5% |
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Definition
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Definition
Blood loss
Nutritional
Iron deficiency
Vitamin B12 deficiency
Folic acid deficiency
Hemolytic
Sickle cell
Thalassemia
Bone marrow depression
Aplastic anemia |
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Term
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Definition
Primary
Idiopathic
Secondary
Erythropoietin-secreting tumors
Renal diseases
Cushing’s syndrome
Prolonged hypoxemia |
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Term
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Definition
Hgb 10-14 g/dl
Palpitations, dyspnea on exertion |
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Term
Severity of Anemia
Moderate |
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Definition
Hgb 6-10 g/dl
Increased symptoms, “roaring” in ears |
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Term
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Definition
Hgb <6 g/dl
Pallor, blurred vision, tachycardia, systolic murmur, headache, dyspnea at rest, organomegaly, sore mouth, difficulty swallowing, bone pain, sensitivity to cold, weight loss, lethargy |
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Term
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Definition
| Total amt of Hgb and volume of RBCs |
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Term
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Definition
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Term
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Definition
| Immature RBCs--measures bone marrow ability to make RBCs |
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Term
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Definition
| 70% of iron in body is found in RBCs |
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Term
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Definition
| Measures proteins available for binding Fe |
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Term
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Definition
| Reactant protein—has inverse relationship to inflammation or chronic disease, malignancy |
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Term
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Definition
| 30% of body’s iron that is stored |
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Term
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Definition
| Measures liver’s ability to metabolize RBC breakdown |
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Term
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Definition
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Term
| Blood loss 20-30% symptoms |
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Definition
| tachycardia with exercise, sl postural hypotension |
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Term
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Definition
| hypotension, cardiac output down, rapid & thready pulse, cool & clammy skin |
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Term
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Definition
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Term
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Definition
Dietary deficiency, malabsorption
Blood loss
Hemolysis |
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Term
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Definition
Pallor
Glossitis or burning sensation of tongue
Cheilitis
Headache
Paresthesis |
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Term
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Definition
Autosomal recessive gene causing inadequate production of normal Hgb
Heterozygous—thalassemia minor (trait, mild form)
Homozygous—thalassemia major (severe disease)
is a problem with the globin protein |
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Term
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Definition
Vitamin is needed for DNA synthesis, especially in proliferating RBCs
deficiency produces RBCs that are macrocytic, have thin membranes, are oval shaped
Causes
malabsorption from gut (pernicious anemia) is most common cause
lack of intrinsic factor
gastrectomy
dietary deficiency |
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Term
| Vitamin B12 Deficiency sxs |
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Definition
Symptoms (develop gradually)
pallor or slight jaundice
weakness
paresthesia in extremities
smooth, red, sore tongue
diarrhea |
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Term
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Definition
Needed for DNA synthesis
Most likely to occur in people who are chronically undernourished or those whose metabolic requirements are increased
older adults, alcoholics, drug addicts, TPN
pregnant women, infants, teens
Characterized by fragile megaloblastic cells |
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Term
| Folic Acid Deficiency sxs |
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Definition
pallor
progressive weakness and fatigue
SOB
palpitations
glossitis and cheilosis
diarrhea
paresthesias and altered proprioception |
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Term
| Anemia of Chronic Disease |
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Definition
Due to chronic inflammatory, autoimmune, infectious, or malignant disease
Underproduction of RBCs and a shortening of the RBC lifespan
Distinguished from iron deficiency anemia by elevated serum ferritin and increased iron stores
Treatment aimed at underlying cause |
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Term
| Anemia of Chronic Disease Dx |
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Definition
| Elevated serum ferritin and increased iron stores in macrophages distinguish this type of anemia from iron-deficiency anemia; normal folate and cobalamin levels |
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Term
| Anemia of Chronic Disease Tx |
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Definition
Correction of underlying problem
Erythropoietin in the presence of chronic renal disease
If severe, blood transfusion |
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Term
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Definition
Bone marrow fails to produce RBCs
Causes
genetic or idiopathic
exposure to certain chemical substances
some antibiotics and chemotherapy drugs
viral infections
mono, HIV, hepatitis C
Characterized by pancytopenia
RBCs are normocytic and normochromic |
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Term
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Definition
Symptoms can occur at any age
fatigue, exertional dyspnea
pallor of skin and mucous membranes
progressive weakness
headache
tachycardia and CHF
platelet deficiency may cause bleeding problem |
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Term
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Definition
Treatment
Remove the underlying cause
Blood transfusion therapy
Bone marrow transplant
Complete recovery may take months |
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Term
|
Definition
Symptoms
Pain
Fatigue
Grayish color
Jaundice
Gallstones
Priapism |
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Term
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Definition
Treatment (symptomatic)
Pain management
Oxygen
Vasodilators
Rest
Fluids & lytes
Hydroxyureia (anti-sickling agent)
Bone marrow transplant is only tx available that can cure some patients |
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Term
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Definition
Two types
Primary, also called polycythemia vera, a neoplastic stem cell disorder
Secondary, hypoxia-driven or hypoxia-independ. r/t renal tumors
Excessive number of circulating RBCs
Relatively rare but most common in Caucasian men of European Jewish ancestry
Gradual onset, begins between age 40-60 yr |
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Term
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Definition
Often asymptomatic
hypervolemia, hypertension, hypermetabolism, distended blood vessels, splenomegaly
HA, blurred vision
tinnitus, dizziness
bruising, GI bleeding, ulcers, epistaxis
severe pruritus
pain in fingers and toes |
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Term
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Definition
focus is on reducing blood viscosity and volume
initial phlebotomy of 300-500 ml blood 2-5 x/wk to keep Hct <45%
may need Fe supplement
symptomatic relief
for PV, radioactive phosphorus or chemotherapy can be used to suppress bone marrow function, however the danger is risk of developing leukemia |
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
Malignant condition of WBCs and blood-forming tissues
Characterized by replacement of bone marrow with malignant immature WBCs
Most often diagnosed in children but growing problem in adults
number of adults is 10 times that of children |
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Term
| Acute Manifestations of Leukemia |
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Definition
Integument
ecchymosis, petechiae
open lesion
pallor of conjunctiva, nail beds, palmar creases, around mouth
GI
bleeding gums
anorexia, wt loss
organomegaly
Renal
hematuria
CV
tachycardia, palpitations
orthostatic hypotension
Respiratory
exertional SOB
Neuro
fatigue, HA, fever
MSK
joint swelling, bone pain |
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Term
|
Definition
Named according to the predominant type of abnormal cell involved and according to the acuity or chronicity of the condition
Terms acute and chronic r/t cell maturity and nature of disease onset |
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Term
| Most common types of leukemia in adults |
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Definition
acute myelogenous leukemia (85%)
chronic lymphocytic leukemia |
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Term
| Acute Myelogenous Leukemia |
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Definition
Uncontrolled proliferation of myeloblasts (granulocyte precursors) with hyperplasia of spleen and bone marrow
Onset abrupt and dramatic
Sx:
fatigue, headache, pallor, exertional dyspnea, fever, mouth sores, infection, bleeding
lab findings: myeloblasts in marrow; low RBCs & platelets, H&H
Tx is chemotherapy, possible bone marrow transplant |
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Term
| Chronic Lymphocytic Leukemia |
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Definition
Proliferation of abnormal B-lymphocytes in the bone marrow; infiltrate spleen, liver, bone marrow
Slow onset, often diagnosed on routine PE
Sx are vague
weakness, malaise, enlarged lymph nodes, infection
lab findings: anemia, reduced platelet and erythrocyte counts, total WBCs >100,000, lymphocytes in marrow
Tx
chemo, radiation (survival rate ~7 yr) |
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Term
|
Definition
lymphatic cancer
occurs ages 15-35 and over 50, men>women 2:1
high cure rate if discovered early
malignant cells attack any body area, sx vary
characteristic finding is Reed-Sternberg cells from node biopsy or bone marrow
secrete cytokines, tumor necrosis factor-alpha, colony-stimulating factor that attract inflammatory cells to tumor site |
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Term
| Manifestations of Hodgkin’s |
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Definition
Early
enlarged lymph nodes
persistent fever
night sweats
fatigue
weight loss
malaise
pruritus
anemia
Later
edema of face and neck
jaundice
nerve pain
enlargement of retroperitoneal nodes
nodular infiltration of spleen, bones, liver
bone pain |
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Term
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Definition
Stage I
single node region
Stage II
two or more regions on same side of diaphragm
Stage III
regions on both sides of diaphragm
Stage IV
disseminated disease |
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Term
|
Definition
Malignant disorder of lymph tissues but no hallmark diagnostic feature, can originate outside the lymph nodes
Cause unknown
suspect viral illnesses, ionizing radiation, toxic chemicals, immunosuppressive medications
Begins as single node and spreads throughout lymphatic system, unpredictable
can involve bone, CNS, GI tract |
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Term
| Manifestations of Lymphoma |
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Definition
Early sign may be enlarged lymph node
Other
GI symptoms, jaundice, abdominal cramping, bowel obstruction
compression of the spinal cord
hemolytic anemia (late)
Diagnosis made by node biopsy
Staging
Low-grade, intermediate (aggressive), high-grade (very aggressive) |
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Term
|
Definition
Neoplastic plasma cells infiltrate bone marrow and destroy bone
Men 2:1 women, develops after age 40
Afr Amer more common than whites
Prognosis—2 year survival |
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Term
|
Definition
Slow onset so sx not initially noticed
Diffuse osteoporosis develops, pathologic fractures
Skeletal pain
Hypercalcemia
Renal, GI, neuro, cardiac problems
Anemia, thrombocytopenia, granulocytopenia |
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Term
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Definition
is a decrease in total WBCs
Total count <4000/μl |
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Term
| Neutropenia is a decrease in neutrophils |
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Definition
| Defined as a count of <1000-1500/μl (nl 4000-11,000) |
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Term
| Most common cause of neutropenia |
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Definition
is iatrogenic
Chemo, immunosuppressants, autoimmune diseases |
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Term
|
Definition
Diagnostics
WBC count w/diff
If neutrophil count 500-1000, pt at moderate risk for infection. If <500, risk is severe.
Peripheral blood smear
Hct
Platelet count
Bone marrow aspiration |
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Term
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Definition
ID cause
Antibiotic therapy
Hematopoietic growth factors
Isolation, HEPA filtration
Monitor for S/S infection |
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Term
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Definition
Formed in the bone marrow, controlled by thrombopoietin
30-40% stored in spleen before release into circulation
Life span 8-10 days
Role in clot formation |
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Term
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Definition
Defined as platelet count <150,000/µl
Condition is generally acquired rather than inherited
Antibodies attack platelets destroying them
Usual mechanism is drug-dependent antibodies that bind to platelet surface protein
Causes
Foods, herbs, drugs, bone marrow suppression or failure |
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Term
| Immune thrombocytopenic purpura (ITP) |
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Definition
Autoimmune condition destroying platelets
Platelets coated with antibodies, have normal function but when they reach the spleen they are recognized as “foreign” and are destroyed
Survive only 1-3 days |
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Term
| Thrombotic thrombocytopenic purpura (TTP) |
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Definition
Combo of hemolytic anemia, thrombocytopenia, fever w/o infection, neuro and renal abnormalities
Platelet agglutination, forms microthrombi |
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Term
|
Definition
Extravasation of blood into tissues
Many may be asymptomatic
Most common sx is bleeding
Multiple sites possible
Petechiae, purpura, ecchymoses
Does not blanch
Major complication is hemorrhage |
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Term
|
Definition
Diagnostics
Platelet count low
If below 20,000 /μl is life-threatening
PT, aPTT
H & H
Fibrin products
Bone marrow biopsy
Treatment
Steroids
Danazol
may increase CD4 T cells
Immunoglobulin
Immunosuppressants
Platelet transfusion for life-threatening hemorrhage
Splenectomy |
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Term
| Sex-linked recessive genetic disorder causing defective coagulation |
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Definition
Hemophilia A most common (80%)
Factor VIII deficiency
Hemophilia B (Christmas disease)
Factor IX deficiency |
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Term
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Definition
| Deficiency in VonWillebrand coagulation protein (vWF) |
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Term
|
Definition
Diagnosis
Factor assays
deficiencies in VIII, IX, XI, XII, or vWF
PT, thrombin time, platelet count not involved
PTT and bleeding prolonged
Treatment
Stop bleeding
Replace clotting factors
Desmopressin (DDAVP) to stimulate increases in factor VIII and vWF
Antifibrinolytics to stabilize clots
Treat symptoms
Gene therapy is experimental
Cell removal and modification |
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Term
| Disseminated Intravascular Coagulation (DIC) |
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Definition
Is not a disease but rather an abnormal clotting cascade response from a disease or other condition
is a generalized response to injury or sepsis
injury to blood cells, leads to platelet aggregation and decreased blood flow
fibrin clots form throughout microcirculation, slows circulation further and stimulates excess fibrinolysis
simultaneous bleeding and clotting, eventually clotting factors are depleted, result is generalized hemorrhage
often have MODS |
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Term
| Conditions That May Cause DIC |
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Definition
Widespread tissue damage
trauma
OB complications
neoplasms
Hemolysis
drugs, toxins
transfusion reactions
uremic syndrome
acute pancreatitis
Hypotension
hypovolemic shock
sepsis
Hypoxia and circulatory stasis
sickle cell
MI, cardiac arrest
PE, ARDS, near drowning (fresh water)
Metabolic acidosis |
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Term
|
Definition
CV
hypotension
tachycardia
Respiratory
tachypnea
decreased breath sounds
ARDS
Urinary
oliguria or anuria
hematuria
GI
occult blood
abdominal distention
CNS
increased ICP
anxiety, confusion to stupor and coma
seizures
Integument
petechiae, purpura, ecchymosis, bleeding
cyanosis, gangrene |
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Term
|
Definition
Increased bleeding time, platelet count, fibrinogen levels, PT, PTT, aPTT
Increased fibrin degradation products
Elevated D-dimer
Decreased clotting factors
II, V, VII, X |
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Term
|
Definition
ID underlying problem
IVs
FFP, cryo, platelet concentrates
Heparin (controversial) and antithrombin III
Monitor VS, pulse ox, mental status
Maintain urine output
Pain management
Bedrest, position change q2h, TCDB
Emotional support |
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Term
| Nursing Care for Bleeding Disorders |
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Definition
Assess for and control topical bleeding
Administer coag factors
Rest bleeding joints, apply ice
Analgesics (no ASA) for pain
Teaching safety and recognition of disease-related problems
Oral hygiene without trauma |
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Term
| Nursing diagnoses for Bleeding Disorders |
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Definition
activity intolerance
altered oral mucous membranes
self-care deficit
risk for insufficient cardiac output |
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Term
|
Definition
Circulating endotoxins from gram negative or gram positive microorganisms (septicemia) leads to inflammatory response
bacteria gain entry, rapid growth, damages body by a combination of factors
bacterial endotoxins leaking into plasma that damage endothelial linings of blood vessels
increased vessel permeability, fluid shifts
altered oxygenation of tissues and cellular death
leads to systemic shock
60% mortality rate despite treatment |
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Term
|
Definition
Oxygen and respiratory support
Fluid replacement, vasodilators
Hemodynamic monitoring
Blood cultures
Broad spectrum antibiotics
Vasopressors if BP not maintained by IVs
Enteral nutrition
Environmental controls, skin care |
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Term
|
Definition
Hypodynamic (“cold shock”, sudden deterioration)—compensation failing
clotting factors are used up so hypovolemic, MODS
dramatic decrease in CO and BP, tachycardia, may have dysrhythmia
respirations rapid, shallow, dyspneic
subnormal temperature, cold clammy skin, pale
oliguric to anuric
altered mentation
sx resemble late stages of shock |
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Term
| Compensatory staeg of sepsis |
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Definition
Hyperdynamic (“warm shock”, hrs to days)
vasodilation, increased CO, normal or elevated BP
thready pulse
respirations rapid and deep (Kussmaul)
normal urine output
n/v/d, impaired GI motility
dry skin, tissue hypoxia (change to anaerobic metabolism ) but color normal, fever/chills
peripheral edema, weakness
platelet aggregation, DIC, inflammatory reaction
alert, oriented, anxious |
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Term
|
Definition
May have no outward signs
Metabolism changes from aerobic to anaerobic, lactic acid begins to accumulate
Lactic acid needs to be removed but process requires oxygen which is unavailable to tissues |
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Term
|
Definition
LV loses ability to generate pressure to eject blood into aorta
Hallmark is decreased EF |
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Term
|
Definition
Inability of ventricles to fill during diastole
Result is venous engorgement in pulmonary and systemic circulation |
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Term
| Mixed (biventricular) failure |
|
Definition
| Poor CO further compromised by enlarged heart |
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Term
|
Definition
Pump failure leads to fall in cardiac output
Decrease SV and EF stimulates baroreceptors which stimulate sympathetic nervous system
Increased HR increases workload of compromised myocardium
Decreased renal perfusion activates renin-angiotensin-aldosterone system
Result is vasoconstriction, water retention, increase in vascular volume and venous return |
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Term
|
Definition
Ht chambers and muscle adapts to increased volume and incomplete emptying
Hypertrophy of cells in myocardium
Overstretching and loss of effective contraction
Contributes to deterioration of ht function
Eventual thinning and degeneration of myocardium
Less coronary blood flow results in ischemia |
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Term
|
Definition
LV often affected because of high workload and oxygen demand
Results from muscle damage or volume overloading
Increased ventricular pressures due to overfilling and incomplete emptying
Increased pressure results in higher pressures in pulmonary vasculature
Fluid moves from blood vessels into interstitial tissues and alveoli |
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Term
| Effects of Left-Sided Failure |
|
Definition
Pulmonary congestion
Dyspnea, SOB, dry cough, orthopnea
Cyanosis
Inspiratory crackles
S3 and S4 gallop
Tachycardia, palpitations
Fatigue, activity intolerance
decreased PaO2 and increased PaCO2
Decreased urine output, nocturia |
|
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Term
|
Definition
Primary cause is L ventricular failure
Also caused by pulmonary hypertension, cor pulmonale, or R ventricular infarct
Distention of RA and RV
Blood accumulates in venous system resulting in engorgement and anasarca |
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Term
| Effects of Right-Sided Failure |
|
Definition
Elevated central venous pressure, JVD
Peripheral edema
Congestion in abdominal organs
Liver engorgement, hepato-jugular reflux
Splenomegaly
Ascites, abdominal distention
Anorexia, nausea
Fatigue
Dysrhythmias, murmurs, RV heaves |
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Term
|
Definition
Both ventricles affected
Symptoms of both R and L failure
Paroxysmal nocturnal dyspnea
S3 and S4 present
Heart’s compensatory mechanisms fail
Can lead to impaired organ function
Risk of sudden death is high |
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|
Term
| New York Heart Association Functional Classification of Persons with Cardiac Disease |
|
Definition
Class 1
No limitation of physical activities, activity does not cause fatigue, dyspnea, palpitations, or angina
Class 2
Slight limitation of activity, no sx at rest
Class 3
Marked limitation of activity, uncomfortable at rest
Class 4
Inability to carry on any activity without discomfort, sx of angina present even at rest |
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|
Term
|
Definition
Lab
Electrolytes
Serum osmolarity
LFTs
ABGs
BNP
MI markers
CPK
CK-MB
LDH
Troponins
CRP
Diagnostic Imaging
CXR
EKG
Echocardiography
Cardiac cath
Nuclear imaging |
|
|
Term
|
Definition
Improve LV function
Decrease intravascular volume
Decrease preload and afterload
Improve gas exchange and oxygenation
Increase CO
Reduce anxiety |
|
|
Term
|
Definition
ACE inhibitors (-pril drugs)
Diuretics
Inotropes
Sympathomimetic agents
Phosphodiesterase inhibitors
Direct vasodilators
Beta-blockers
Antidysrhythmic drugs |
|
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Term
|
Definition
Monitor VS, heart and lung sounds, hemodynamic pressures, gas exchange
Rest—physical and emotional
Plan activities to preserve energy
Elevate HOB to 45o
Strict I&O, weigh daily, measure abd girth
Med administration, watch for SEs
Patient and family teaching |
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|
Term
|
Definition
Decreased CO with evidence of tissue hypoxia
in the presence of adequate circulating volume
Precipitating factors (see table p. 1797)
MI most common cause
Hemodynamic parameters: BP < 90 for at
least 30 min and reduced cardiac index <2.2
L/min |
|
|
Term
| Signs/Symptoms cardiogenic shock |
|
Definition
Hypotension, narrowed pulse pressure
Tachycardia, thready pulse, JVD
Tachypnea, labored respirations, crackles, wheezes, pulmonary edema
Skin pale, peripheral cyanosis, clammy
Oliguria to anuria
Dependent edema
Dysrhythmias
Anxiety, confusion, agitation |
|
|
Term
| Cardiogenic shock Diagnosis: |
|
Definition
Early
RBCs, H & H normal
Cardiac enzymes may be elevated if MI
BUN/Cr increased
Lytes– glu Na, K increased
Urine sp gr increased
Respiratory alkalosis
Other tests include CXR, CT, EKG, echocardiogram
Late
RBCs, H & H decreased if hemorrhage
LFTs increased
Lytes—glu, Na, K decreased
Urine sp gr fixed at 1.010 if renal failure
Metabolic acidosis |
|
|
Term
| Treatment for cardiogenic shock |
|
Definition
Life-threatening emergency
Oxygen therapy
PASG contraindicated
Fluid replacement—judicious
Pharmacology
Vasoactive drugs, diuretics
Antidysrhythmic agents
Digitalis |
|
|
Term
| Nursing Care cardiogenic shock |
|
Definition
Oxygenation
Monitor cardiovascular function
BP, HR, rhythm, pulse ox, peripheral pulses, hemodynamic monitoring
Strict I & O
Monitor urine output (keep >30 ml/hr)
Monitor for CP, cyanosis, dyspnea, restlessness, anxiety
Bedrest, provide calm environment
Emotional support |
|
|
Term
|
Definition
Accumulation of fluid in lung—pt is “drowning”
Cardiac causes
Volume overload, valvular disease, MI
Noncardiac causes
ARDS, trauma, sepsis, drug OD, neuro |
|
|
Term
|
Definition
Cardiogenic
Inadequate LV contractility
Rise in end-diastolic volume and pressure
Hydrostatic pressure in pulm vessels>osmotic pressure, fluid leaks into alveoli
S/S
Dyspnea, SOB
Cough, frothy, pink sputum
Tachypnea, orthopnea
Hypotension
Cyanosis
Hypoxemia
Restlessness, anxiety
Feeling of doom |
|
|
Term
|
Definition
Focus on improving oxygenation, reducing fluid volume, and emotional support
Airway management, oxygen by CPAP, pulse ox
Monitor heart and lung sounds
Strict I & O, foley, IV
Rotating tourniquets may be ordered
Reassurance, explain all procedures, maintain contact with family |
|
|
Term
|
Definition
Most common type
Cause: idiopathic but most often follows myocarditis
Dilated chambers, impairs LV function
Can present with sx R and L sided failure
S3 and S4 present
Dysrhythmias common
Poor prognosis—most die within 2 yr of sx onset
Tx rhythm control |
|
|
Term
| Hypertrophic cardiomyopathy |
|
Definition
Cause: hereditary, may be due to chronic hypertension, men > women
LVH, impaired relaxation, aortic outflow obstructed
Sx associated with increased oxygen demand and increased contractility, double apical pulse, S4 present
Ventricular or atrial dysrhythmias common
Often asymptomatic, sudden cardiac death may be first sign |
|
|
Term
| Restrictive cardiomyopathy |
|
Definition
Cause: fibrotic rigidity of ventricular walls, least common type
Decreased ventricular compliance, decreased size of ventricular chambers, elevated pressures
Contractility unaffected
Sx biventricular failure
S3 and S4 present
Prognosis poor—most die in 3 years |
|
|
Term
|
Definition
EKG
Echo
CXR shows cardiomegaly, pulmonary congestion
Nuclear scans
Cardiac cath
Endomyocardial biopsy |
|
|
Term
|
Definition
Pharmacology
ACE inhibitors, diuretics, dig, vasodilators, anticoagulants, antidysrhythmics
Beta-blockers to reduce anginal symptoms
Surgery
Transplant
Ventricular assist devices in the interim
Dual chamber pacing, AICD
Myotomy and/or myectomy |
|
|
Term
|
Definition
50% are patients with cardiomyopathy, 40% are those with inoperable CAD
Indications and contraindications
(see table, p. 857)
Donor and recipient tissue must match
Once heart harvested, must transplant within 4-6 hr
Lifelong immunosuppressive drugs |
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|
