-deficiency of RBCs, Hg, or both

-↓ ability to deliver O2 to tissues

 -causes weakness, SOB

-is a symptom, not a diagnosis

-fissures at corners of mouth, glossitis, spoon-shaped nails

1) impaired production of RBCs (aplastic anemia)

2) ↑ destruction of RBCs (hemolytic/sickle cell anemia)

3) chronic blood loss (hemorrhage)

iron

folic acid

vitamin B12

destruction of RBCs

(hemolytic anemia)

pallor

 tachycardia

 tachypnea

 irritability

 fatigue

 SOB

red meat

dark green leafy veggies

dried fruits

whole-grain products

liver

green leafy veggies

legumes

enriched grains

meat

fish/shellfish

poultry

milk

-lack of intrinsic factor in stomach (absorption of B12)

-numbness of hands and feet

-sore, beefy red tongue

-vegetarians have ↑ risk

-larger-than-normal RBCs

 -↓ gastric acid

-bone marrow is fatty and "incapable of producing enough RBCs" (pancytopenia)

-always fatal if left untreated

-causes: congenital, exposure to toxins, chemo meds, bacterial/viral infections (TB, hepatitis)

-most definitive test is a bone marrow biopsy

-if pts platelet count is low, put on bleeding precautions

-if pts WBC count is low, put on infection protection

weakness/fatigue 

pallor

 SOB

 headaches

 tachycardia

 HF

 ecchymoses

 petechiae

-treatment: bone marrow transplant (most effective), steroids, immunosuppressants, hormones

-inherited

-Hg is very sensitive to O2 changes

-a ↓ in O2 causes cells to change into a sickle shape

-sickled cells are fragile and get tangled in vessels and organs easily (congestion, clumping, clotting)

-normal RBC live 120 days, sickled cells live 10-20 days

-when the sickled cells bust, they cause:

*↑ bilirubin=jaundice

*↑ bile pigments=gallstones

*spleen/liver enlargement

 -most definitive test is a blood smear that shows the mutated RBCs; sickledex test

-symptoms don't appear in infants until 6 months old

sluggish blood

↓ blood flow

infarction (tissue necrosis)

fever

pain

swelling

abdominal pain

hypoxia

tachypnea

priapism

renal failure

-treatment: frequent blood transfusions

-avoid tight clothes that restrict circulation

-avoid strenuous exercise

-avoid cold temps

-no smoking

-no alcohol

-encourage vaccines

-blood becomes sludge (↑ RBC=↑ viscosity)

-tests: CBC and bone marrow aspiration

-primary polycythemia: unknown cause; congested organs; plethoric appearance, thrombosis; pts over 50 are most at risk

-secondary polycythemia: caused by long-term hypoxia, COPD, HF, high altitudes, smoking

HTN

changes in vision

headache

vertigo

dizziness

tinnitus

panmyelosis

nose-bleeds

bleeding gums

chest pain

retinal hemorrhages

flushing

intense itching

feeling of fullness

abdominal pain

↓ viscosity (phlebotomy)

chemo drugs

radiation therapy

-no bedrest=stay active and ambulatory

-bedrest= passive and active ROM exercises

-eat small meals

-drink at least 3L of water daily to thin blood volume

-stop smoking

-avoid tight clothing

-elevate feet when resting

-wear support hose

-accelerated clotting throughout the peripheral blood vessels

-all clotting factors/platelets are used up and clots can't be formed

-can develop after any condition that causes the body to have trauma (severe blood loss)

-tests: PT, PTT, BUN

-abnormal bleeding without a history of a bleeding disorder is a cardinal sign

petechiae

ecchymoses

bleeding from venipuncture sites

-treatment: blood/blood products administration

-↑ platelet destruction by immune system

-acute: affects children, ages2-6; usually occurs after viral infection (rubella, chickenpox)

-chronic: affects adults over 60

-test: platelet count <20,000/mm3

petechiae

ecchymoses

bleeding from mouth/nose/GI tract/brain

-treatment: usually resolved without treatment, steroids, immune globulin, chemo meds, splenectomy

-a group of hereditary bleeding disorders caused by a lack of clotting factors

-test: prolonged PTT

-inherited:

*daughters born with gene are carriers

*sons bore with gene have hemophilia

*it is possible for daughters to have hemophilia, but very rare

-hemophilia A:

*most common (80%)

*deficiency of factor 8

-hemophilia B:

*deficiency of factor 9

*least common (15%)

bleeding

hemarthrosis

joint deformities

-treatment: not curable, administer missing clotting factors, desmopressin (mild cases)

-"white blood"

-malignant disease of WBCs that affects all age groups

-immature WBCs are produced in abundance (abnormal and unable to fight infection)

-lymphoid leukemia: affect lymphocytes

-myeloid leukemia: originate in cells in bone marrow that develop into monocytes, erythrocytes, granulocytes, platelets

-unknown cause

-persons with down syndrome have ↑ risk

 -test: bone marrow aspiration

-most common cancer in children

-abnormal growth of lymphoblasts

-usually affects people over 60

-poor prognosis

-mostly affects B and T cells

-usually occurs in adults

-characterized by Philadelphia chromosome

-most often in older adults

fever

pallor

weakness

lethargy

SOB

malaise

fatigue

tachycardia

palpitations

abdominal/sternal pain

rib tenderness

confusion

headache

personality changes

ecchymoses

petechiae

-chemotherapy: goal is to get pt to a state of remission (bone marrow can produce normal cells)

-4 phases (each stage must be completed to move on to the next):

*induction: attempt to get pt into remission; high doses of chemo

*intensification: higher doses of chemo

*consolidation: ensure all leukemia cells are gone

*maintenance: pt kept free of leukemia cells and hopefully in remission forever; chemo on a monthly basis; possibly radiation

-bone marrow transplant

-lymphoma (cancer of lymph system)

-more commen in men, mostly ages 15-40 and 55 and older

-most curable lymphoma

-begins as a single changed lymph node, then spreads

-cause is unknown, but possibly a virus (more common in people who have had mono/AIDS/immunosuppressed), possibly a genetic link

-test: lymph node biopsy

painless swelling in lymph nodes

pruritus

alcohol-induced pain

obstruction (cough, dysphagia, stridor)

fever

night sweats

fatigue

weight loss

malaise

neck edema

jaundice

nerve pain

-elderly: enlarged lymph nodes might not be visible, so only secondary symptoms present 

-radiation

-chemotherapy

LPN responsibilities:

anemia

sickle cell anemia

polycythemia

DIC

-anemia: reduce pts activity level if BP/R ↓ by >10%, conserve energy, administer O2, administer IM iron injections by z-track method

-sickle cell anemia: assess circulation q2h, avoid cold compresses, avoid giving aspirin (↑ acidosis)

-polycythemia: reassure pt that phlebotomy will relieve symptoms, keep pt active and ambulatory (prevent clots), passive/active ROM (bed rest), offer small meals

-DIC: bleeding precautions

LPN responsibilities:

hemophilia

leukemia

hodgkin's disease

-hemophilia: bleeding precautions, avoid giving IM injections, apply ice/pressure to any bleeding spots

-leukemia: protect pt from infection, monitor for bleeding (tarry stools, petechiae, ecchymoses), allow rest between activities

-hodgkin's disease: symptom management, encourage rest between activities, protect pt from infection

-injection of dye into lymphatic vessels of hands and feet

-various xray views are taken to look for lymph flow and/or blockages

-xrays are repeated in 24 hours to assess how the lymph nodes are working

-post procedure: dr might order pressure dressing and immobilization of injected limb

-LPN responsibilities: monitor limb for swelling, circulation, changes in sensation; warn pt that urine may be blue from the dye for 2 days

-WBCs:

*normal: 4,500 to 11,000/mm3

*↑ during infections

-hemoglobin:

*normal: 13.2 to 17.3 g/100 ml (male); 11.7 to 15.5 g/100 ml (female)

*↑ in chronic hypoxia

*↓ in blood loss or anemia

-cardiac glycoside

-↓ HR

-↑ contractility

-↑ CO

-side effects: fatigue, bradycardia, anorexia

-check apical pulse for 60 seconds before administering

-if HR <60, hold dose

-hypokalemia ↑ risk of toxicity

-contraindicated for pregnancy/breastfeeding

-elderly are more sensitive, able to become toxic easier

-loop diuretic

-slow down/turn off Na+ pumps

-↑ Na+/K+/water excretion

-↑ urine output

-↓ BP

-side effects: light headedness, dizziness, hypokalemia, hyponatremia

-check K+ level before administering

-frequently check/record urine output

-opioid

-side effects: constipation, nausea, vomitting, drowsiness, orthostatic hypotension

-monitor R and O2 sat q1h

-given for relief of chest pain

-usually given IV (2-8 mg) every 5-15 mins until pain is gone

-monitor for hypotension, respiratory distress, oversedation, morphine sensitivity

-helps ↓ anxiety, opens bronchioles, ↓ preload and afterload

-opioid

-side effects: constipation, nausea, vomitting, drowsiness, orthostatic hypotension

-monitor R and O2 sat q1h

-given for relief of chest pain

-↓ workload of heart

-↓ heart's O2 demand

-potassium

-prescribed to maintain normal K+ levels when diurectics are prescribed

-side effects: nausea, vomiting, diarrhea, gas, abdominal discomfort

-normal K+ levels: 3.5 to 5.0 mEq/L

-continually monitor K+ levels

-monitor for hypermagnesemia

-administer with food or juice, can cause upset stomach otherwise

-be careful to not ↑ dietary K+ intake

-contraindicated for pregnancy

-anticoagulant

-↓ production of clotting factors in liver

-↑ clotting time

-↓ clot formation

-side effects: bleeding, hematuria, fatigue, fever, chills, sore throat, stomach pain, headaches

-check INR results before administering

-avoid foods rich in vitamin K

-contraindicated for pregnancy

-elderly are more sensitive, may require lower doses

-HTN is a major cause

-other causes: aortic stenosis, cardiomyopathy, heart muscle infection, MI, mitral regurgitation

-↑ pressure in aorta→L ventricle works harder→eventually, L ventricle weakens and fails

-blood backs up from L ventricle→L atrium→pulmonary veins→lungs

-major cause is left-sided HF

-other causes: cor pulmonale, HTN, valve stenosis

-L side fails→fluid backs up in lungs→pulmonary pressure ↑→R ventricle pumps harder and eventually fails→blood builds up in systemic vessels→edema in peripheral tissues and organs

-right sided:

JVD

anorexia

nausea

abdominal pain

hepatomegaly

splenomegaly

-left sided:

alveolar edema

SOB

cyanosis

pulmonary edema

tachypnea

rales/crackles

-tests: xray, ECG, exercise stress test, cardiac magnetic imaging, angiography, sleep studies

-ACEIs

-dietary modification

-exercise

-↓ heart's workload

-maintain Na+ and water balance

-pacemaker

-CABG

-valve replacement

-administer O2

-encourage rest

-fluid management

-restrict Na+ in pts diet

-encourage weight control

-monitor daily weights

the forces impeding blood flow out of the heart

*vascular pressure

*aortic compliance

*blood mass

*viscosity

-end-diastolic stretch of cardiac muscle fibers

-equals end-diastolic volume

-measure of the pumping ability of heart

-amount of blood pumped/minute

-performed by forcibly exhaling while holding mouth and nose closed

-↓ preload to heart

-↑ workload of heart

-↑ venous return to heart

-should not be performed by pts with CAD or who have had a recent MI

-prevent constipation with stool softeners

-baseline data collection: assess VS, hx of transfusions or reactions

-identification: check/double-check pts id, 2 nurses must ask pt name and DOB/check id band/make sure pt info and blood info match/check expiration date  (DO NOT ADMINISTER BLOOD IF ANYTHING DOES NOT MATCH)

-filtering: prevents harmful particles from entering pt

-guildelines: use correct needle gauge (18-20), use NS to dilute blood, flush tubing before and after infusing, must transfuse all blood in 2-4 hours

-monitoring: stay with pt for first 15 mins, check VS before infusing/after infusion starts/every 15 mins for first hour/after infusion is complete, assess for s/s of reaction

-fever

-most common reaction to transfusion

-s/s: fever, shaking chills, back pain, headache

-stop infusion and call doctor

-aspirin might be prescribed

-hives

-s/s: hive-like rash, fever

-stop infusion and call doctor

-antihistamine will be prescribed (Benadryl)

-hemolysis of RBCs

-most fatal/most rare

-mismatched blood type

-s/s: back pain, chest pain, chills, fever, SOB, nausea, vomiting, feeling of impending doom

-stop infusion immediately and stay with pt, activate emergency procedures

-keep tubing open with NS so that emergency drugs can be administered

-↑ volumes of fluids are ordered to flush vessels

-allergic reaction

-causes respiratory/cardiovascular collapse

-s/s: GI cramping, vomiting, diarrhea

-stop infusion immediately and stay with pt, activate emergency procedures

-rapid transfusion in a short period of time

-s/s: chest pain, cough, frothy sputum, JVD, crackles/wheezes, ↑ HR

-stop transfusion and call doctor

-diuretics may be administered

-has no plasma

-can ↓ risk of febrile reaction

-may have no WBCs

-warmed to body temp (98.6*)

-helps prevent hypothermia that can cause dysrhythmias and shivering (destroys blood cells and platelets)

-uses:

*transportation of O2, nutrients, and waste products

*temp regulation

*pH and fluid balance

-human body has 4-6 L; majority is plasma

-RBCs, WBCs, platelets are all formed by red bone marrow

-normal ph: 7.35-7.45 (slightly alkaline)

-91% water

-transports nutrients, wastes, hormones, enzymes, electrolytes, gases

-biconcave discs with nuclei

-carry O2 bonded to iron in Hgb

-rate of RBC production is most influenced by blood O2 level:

hypoxia→stimulates kidneys to secrete erythropoeitin→↑ RBC production→↑ O2 carrying capacity

-reticulocyte becomes mature RBC when it ejects nucleus (biconcave shape); remain in red bone marrow until mature

-folic acid and B12 are needed for RBC production

live for 120 days→phagocytized by macrophages in liver/spleen/red bone marrow→iron returned to red bone marrow or stored in liver→heme is converted to bilirubin and excreted in feces

-larger than RBCs

-have nuclei when mature

-granular WBCs produced in red bone marrow (neutrophils, eosinophils, basophils)

-agranular WBCs produced in red bone marrow, but T lymphocytes become mature in thymus (lymphocytes, monocytes)

-T and B lymphocytes activate, proliferate, differentiate in lymph nodes and spleen

-for immunity and/or inflammatory response

-formed in red bone marrow

-fragments of cells

-involved in hemostasis and clotting