PNP Review: Blood Disorders
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Questions and Answers

What is the result of osteoclasts breaking down bone cells in multiple myeloma?

  • Bone marrow expansion
  • A decrease in bone density
  • An increase in platelet production
  • An increase in blood calcium levels (correct)

    • Which of the following is NOT a symptom of agranulocytosis?

  • Headache
  • Fatigue
  • Nosebleeds
  • Joint pain (correct)

    • What is the term for a decrease in the production of all blood cells, including red blood cells, white blood cells, and platelets?

  • Thrombocytopenia
  • Agranulocytosis
  • Pancytopenia (correct)
  • Leukopenia

    • What is the primary goal of medical management in disseminated intravascular coagulation (DIC)?

    <p>Correct the underlying cause</p> Signup and view all the answers

    Which of the following is a nursing management intervention for a patient with thrombocytopenia?

    <p>Applying pressure to bleeding sites</p> Signup and view all the answers

    What is the term for a condition where the bone marrow produces abnormal plasma cells, leading to bone destruction and anemia?

    <p>Multiple myeloma</p> Signup and view all the answers

    Which of the following is a diagnostic finding for aplastic anemia?

    <p>Bone marrow aspiration</p> Signup and view all the answers

    What is the primary goal of nursing management for a patient with hemophilia?

    <p>Minimizing bleeding</p> Signup and view all the answers

    What is the term for a condition where the spleen destroys platelets, leading to a decrease in platelet count?

    <p>Thrombocytopenia</p> Signup and view all the answers

    Which of the following is a medical management intervention for disseminated intravascular coagulation (DIC)?

    <p>Heparin therapy</p> Signup and view all the answers

    Which of the following is NOT a compensatory mechanism for the lost red blood cell (RBC) function in anemia?

    <p>Orthostatic hypotension</p> Signup and view all the answers

    What is the cause of sickle cell anemia?

    <p>Hemoglobin A is replaced by Hemoglobin S</p> Signup and view all the answers

    Which of the following symptoms is most indicative of iron deficiency anemia?

    <p>Reduced energy and feeling cold all the time</p> Signup and view all the answers

    Which diagnostic test is used specifically for diagnosing sickle cell anemia?

    <p>Sickledex test</p> Signup and view all the answers

    Which of the following is not an intervention for a client with hypovolemic anemia?

    <p>Administer prescribed analgesics</p> Signup and view all the answers

    What is the primary cause of hypovolemic anemia?

    <p>Sudden loss of large volume of blood or chronic loss of small amounts of blood</p> Signup and view all the answers

    Which management strategy is specifically for treating iron deficiency anemia?

    <p>Foods high in iron</p> Signup and view all the answers

    What symptom is a common finding in clients with chronic hemolytic anemia related to sickle cell disease?

    <p>Jaundice</p> Signup and view all the answers

    Which assessment finding would most likely indicate inadequate RBC volume?

    <p>Oliguria</p> Signup and view all the answers

    Which of the following is an appropriate nursing diagnosis for a patient with hypovolemic anemia?

    <p>Imbalanced Body Temperature</p> Signup and view all the answers

    Which diagnostic test is used to differentiate Pernicious Anemia?

    <p>Schilling test</p> Signup and view all the answers

    What medical management is appropriate for a patient with Cooley’s anemia?

    <p>Iron chelation therapy</p> Signup and view all the answers

    Which nursing management technique is recommended for a patient experiencing Permanent neurologic deficit due to Pernicious Anemia?

    <p>Encourage and assist with ambulation</p> Signup and view all the answers

    What is the primary medical intervention for managing Erythrocytosis in Polycythemia Vera?

    <p>Phlebotomy</p> Signup and view all the answers

    Which clinical finding is associated with hemolytic anemia?

    <p>Jaundice</p> Signup and view all the answers

    Which of the following is NOT a finding in Folic Acid Deficiency Anemia?

    <p>Jaundice</p> Signup and view all the answers

    What assessment finding is expected in a patient with chronic premature erythrocyte destruction?

    <p>Enlarged spleen</p> Signup and view all the answers

    What specific symptom is associated with Thalassemia?

    <p>Bronzing of the skin</p> Signup and view all the answers

    Which symptom is common in patients with Pernicious Anemia?

    <p>Numbness and tingling in arms and legs</p> Signup and view all the answers

    Which diagnostic finding is typical in Polycythemia Vera?

    <p>Elevated blood cell count</p> Signup and view all the answers

    What is a common medical management strategy for Thalassemia?

    <p>Frequent blood transfusions</p> Signup and view all the answers

    Which diagnostic test is specifically used to diagnose Pernicious Anemia?

    <p>Schilling test</p> Signup and view all the answers

    Which of the following is a significant finding for a patient with Polycythemia Vera?

    <p>Reddish-purple face and lips</p> Signup and view all the answers

    What is a critical nursing management strategy for a patient diagnosed with Leukocytosis?

    <p>Monitor platelet counts</p> Signup and view all the answers

    Which medical management approach is appropriate for Hemolytic Anemia?

    <p>Corticosteroids</p> Signup and view all the answers

    What intervention is crucial for managing Pernicious Anemia with neurologic deficits?

    <p>Administering vitamin B12 injections</p> Signup and view all the answers

    Which assessment finding would most likely be seen in a client with Chronic Premature Erythrocyte Destruction?

    <p>Enlarged spleen</p> Signup and view all the answers

    What is a primary nursing management strategy for a patient with Folic Acid Deficiency Anemia?

    <p>Teaching: diet and rest promotion</p> Signup and view all the answers

    What medical management technique is used to handle rapid blood cell proliferation in Polycythemia Vera?

    <p>Phlebotomy</p> Signup and view all the answers

    What is a common assessment finding for Pernicious Anemia?

    <p>Dyspnea with minimal exertion</p> Signup and view all the answers

    Which symptom would most likely be indicative of decreased red blood cell function?

    <p>headache</p> Signup and view all the answers

    What is a common compensatory mechanism for anemia?

    <p>amenorrhea</p> Signup and view all the answers

    Which medical management option is most appropriate for hypovolemic anemia resulting from chronic blood loss?

    <p>Iron supplementation</p> Signup and view all the answers

    What is a significant nursing intervention for a client with hypovolemic anemia?

    <p>Monitoring intake and output</p> Signup and view all the answers

    Which symptom is less likely to be observed in cases of iron deficiency anemia?

    <p>Increased energy</p> Signup and view all the answers

    In the context of sickle cell anemia, which diagnostic test is used to detect the presence of hemoglobin S?

    <p>Hemoglobin electrophoresis</p> Signup and view all the answers

    What is an appropriate nursing diagnosis for a patient experiencing a sickle cell crisis?

    <p>Risk for infection</p> Signup and view all the answers

    Which of the following is specifically a medical intervention for managing a sickle cell crisis?

    <p>Narcotic analgesia</p> Signup and view all the answers

    Which of these findings is not typical in the assessment of iron deficiency anemia?

    <p>High hemoglobin levels</p> Signup and view all the answers

    What is a primary cause of hypovolemic anemia?

    <p>Sudden large blood loss</p> Signup and view all the answers

    What is the distinguishing appearance of osteolytic tumors in bones caused by multiple myeloma?

    <p>Punched-out or honeycombed appearance</p> Signup and view all the answers

    Which initial medical management is suggested for agranulocytosis?

    <p>Human granulocyte colony-stimulating factor</p> Signup and view all the answers

    What is a common clinical sign of thrombocytopenia?

    <p>Purpura</p> Signup and view all the answers

    What precaution should be taken for a patient with agranulocytosis?

    <p>Protective isolation with visitor restrictions</p> Signup and view all the answers

    Which symptom is NOT typically associated with aplastic anemia?

    <p>Hypertension</p> Signup and view all the answers

    In the management of Disseminated Intravascular Coagulation (DIC), which treatment is used to control severe bleeding?

    <p>Platelet replacement and cryoprecipitate</p> Signup and view all the answers

    What is the primary nursing management goal for a patient with hemophilia?

    <p>Preventing trauma and minimizing bleeding</p> Signup and view all the answers

    What is a typical diagnostic finding in a patient with coagulopathies caused by thrombocytopenia?

    <p>Purple or reddish skin spots (purpura)</p> Signup and view all the answers

    Which intervention is NOT commonly associated with nursing management of multiple myeloma?

    <p>Encouraging daily jogging</p> Signup and view all the answers

    Which symptom is a major indicator of Disseminated Intravascular Coagulation (DIC) in a patient?

    <p>Tachycardia and petechiae</p> Signup and view all the answers

    What is the primary goal of medical management in Hemolytic Anemia?

    <p>Removing the cause of anemia</p> Signup and view all the answers

    What is the characteristic of Thalassemia?

    <p>Hereditary hemolytic anemia</p> Signup and view all the answers

    What is the primary nursing management strategy for a patient with Folic Acid Deficiency Anemia?

    <p>Teaching oral hygiene and promoting rest</p> Signup and view all the answers

    What is the characteristic of Erythrocytosis in Polycythemia Vera?

    <p>Rapid proliferation of blood cells</p> Signup and view all the answers

    What is the primary medical management strategy for Leukocytosis?

    <p>Administering antineoplastic drugs</p> Signup and view all the answers

    What is the primary consequence of osteoclasts breaking down bone cells in multiple myeloma?

    <p>Hypercalcemia and bone lesions</p> Signup and view all the answers

    What is the primary goal of medical management in aplastic anemia?

    <p>To eliminate the causative agent and promote bone marrow recovery</p> Signup and view all the answers

    Which of the following is a characteristic of disseminated intravascular coagulation (DIC)?

    <p>Depletion of clotting factors</p> Signup and view all the answers

    What is the primary goal of nursing management in hemophilia?

    <p>To prevent bleeding and manage pain</p> Signup and view all the answers

    What is the primary cause of thrombocytopenia?

    <p>Increased platelet destruction by the spleen</p> Signup and view all the answers

    Which intervention is crucial in managing pain for a patient with sickle cell anemia during a crisis?

    <p>Providing narcotic analgesia</p> Signup and view all the answers

    A patient with iron deficiency anemia is most likely to experience which of the following symptoms?

    <p>Fatigue and a rapid heart rate even at rest</p> Signup and view all the answers

    What is a significant assessment finding in a patient with hypovolemic anemia?

    <p>Extreme pallor and chills</p> Signup and view all the answers

    Which diagnostic test is used to confirm the presence of sickle-shaped erythrocytes in a patient suspected of having sickle cell anemia?

    <p>Hemoglobin electrophoresis</p> Signup and view all the answers

    Which assessment finding is specifically associated with the compensatory mechanisms for lost RBC function in anemia?

    <p>Cool, clammy skin</p> Signup and view all the answers

    Study Notes

    Anemia

    • Anemia: a deficiency of erythrocytes or hemoglobin
    • Causes: blood loss, inadequate erythrocyte production, destruction of formed RBCs
    • Assessment Findings:
      • Inadequate RBC volume: orthostatic hypotension, thready pulses, oliguria, heart murmur
      • Compensatory mechanisms for lost RBC function: tachycardia, tachypnea, cool, clammy skin, amenorrhea
      • Decreased RBC function: dyspnea, chest discomfort, acidosis, headache, vertigo, pallor

    Hypovolemic Anemia

    • Causes: sudden loss of large volume, chronic loss of small amounts of blood
    • Assessment Findings:
      • Extreme pallor, tachycardia, hypotension, reduced urine output, altered consciousness, fatigue, chills, rapid respiratory rate
    • Medical Management:
      • Blood transfusions: treating underlying condition or chronic blood loss
      • Administration of oral, IV, or IM iron: restore hemoglobin

    Iron Deficiency Anemia

    • Iron Deficiency Anemia: insufficient iron to produce hemoglobin
    • Assessment Findings:
      • Reduced energy, feel cold all the time, fatigue and dyspnea with minor physical exertion, rapid heart rate even at rest, decreased hemoglobin, hematocrit, and serum iron levels
    • Medical Management:
      • Foods high in iron, Blood transfusion
    • Nursing Management:
      • Increase iron intake, collaborate with dietitian, administer iron supplement (IM Z-track)

    Sickle Cell Anemia

    • Sickle Cell Anemia: Hemoglobin A is replaced by Hemoglobin S; sickle- or crescent-shaped erythrocytes from inadequate oxygen supply to blood
    • Hereditary; sickle cell crisis
    • Chronic hemolytic anemia
    • Assessment Findings:
      • Jaundice, tachycardia, dyspnea, cardiomegaly, and dysrhythmias; stroke, acute chest syndrome
    • Diagnostic Findings:
      • Sickledex test; hemoglobin electrophoresis
    • Medical Management:
      • Supportive treatment: regular blood transfusions; bone marrow transplantation; prophylactic antibiotic therapy
      • Sickle cell crisis: narcotic analgesia, O2, bed rest, IV fluids, meds

    Other Anemias

    • Hemolytic Anemia: Chronic premature erythrocyte destruction
    • Assessment Findings:
      • Jaundice, enlarged spleen, shock
    • Medical Management:
      • Removing the cause; corticosteroids; blood transfusions
    • Surgical Management:
      • Splenectomy
    • Nursing Management:
      • Health history, supportive care, medication, teaching measures of self-care, arrange follow-up evaluations

    Thalassemias

    • Thalassemias: hereditary hemolytic anemia
    • Types: alpha-thalassemias, beta-thalassemias
    • Assessment Findings:
      • Cooley's anemia: bronzing of the skin
    • Medical Management:
      • Symptomatic, frequent transfusions, iron chelation therapy
    • Nursing Management:
      • Bed rest, protect from infection, closely monitor blood transfusion

    Pernicious Anemia

    • Pernicious Anemia: lack of intrinsic factor necessary for absorption of vitamin B12
    • Degenerative changes in nervous system
    • Secondary to surgical removal of stomach or small bowel resection
    • Assessment Findings:
      • Stomatitis, glossitis, digestive disturbances; diarrhea; dyspnea with minimal exertion, jaundice, irritability, confusion, depression, numbness and tingling in arms and legs, ataxia
    • Diagnostic Findings:
      • Blood and bone marrow studies; Schilling test, blood smear
    • Medical Management:
      • IM vitamin B12
      • Physical therapy for permanent neurologic deficits
    • Nursing Management:
      • Glossitis and stomatitis: soft, bland diet; small, frequent meals; oral care
      • Permanent neurologic deficit: encourage and assist with ambulation, supervision
      • Teaching: administration of vitamin B12; diet

    Folic Acid Deficiency Anemia

    • Folic Acid Deficiency Anemia: immature erythrocytes; insufficient dietary intake of foods rich in folic acid
    • Assessment Findings:
      • Severe fatigue, sore and beefy-red tongue, dyspnea, nausea, anorexia, headaches, weakness, light-headedness
    • Diagnostic Findings:
      • Schilling test
    • Medical Management:
      • Folic acid supplements; balanced diet
    • Nursing Management:
      • Teaching: diet, oral hygiene, rest promotion

    Erythrocytosis

    • Polycythemia vera: increase in circulating erythrocytes and leukocytes
    • Rapid proliferation of blood cells produced by the bone marrow; cause is unknown
    • Assessment Findings:
      • Reddish-purple face and lips, fatigue, weakness, exertional dyspnea
    • Diagnostic Findings:
      • Elevated blood cell count, platelets and WBC counts elevated, abnormal serum K+ and uric acid
    • Medical Management:
      • Phlebotomy, radio phosphorus, and radiotherapy

    Leukocytosis

    • Leukocytosis: proliferation of leukocytes, usually in immature form
    • Four types according to dysfunctional bone marrow stem cell line (Acute and Chronic forms of lymphocytic and myelogenous leukemia)
    • Precipitating factors: genetic correlation
    • Assessment Findings:
      • Severe anemia, infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes, internal or external bleeding
    • Medical Management:
      • Antineoplastic drugs, transfusions, Transplantation: bone marrow; stem cell
    • Nursing Process:
      • Assessment: history of symptoms; physical assessment, laboratory results; assess neutrophil
      • Diagnosis and Planning:
        • Risks: infection, hemorrhage, activity intolerance, disturbed body image, anxiety, and fear
      • Interventions:
        • Monitor platelet counts, assess for signs of bruising and petechiae; report hematuria or epistaxis (nosebleed)
        • Acknowledge client's anxieties and fears, reassure PT

    Multiple Myeloma

    • Multiple Myeloma: malignancy involving plasma cells
    • Osteoclasts break down bone cells, resulting in increased blood calcium and pathologic fractures
    • Osteolytic tumors: "punched-out" or "honeycombed" appearance in bones
    • Assessment Findings:
      • Bone Pain, infection, symptoms of anemia, bruising, nosebleeds, renal calculi
    • Diagnostic Findings:
      • Skeletal radiographic studies: bone lesions; increased serum calcium levels, bone marrow aspiration
    • Medical Management:
      • Steroids, anticancer drugs, antibiotics
      • Analgesics, blood transfusions
      • Back braces, body casts
      • Surgical Management: transplantation: bone marrow; stem cell
    • Nursing Management:
      • Assess pain, signs of infection (increased WBC, Fever), fatigue, bleeding, thrombus formation, urine
      • Analgesics, ambulation (caution-fracture), fluid intake I&O, safety, Prevent infection

    Agranulocytosis

    • Agranulocytosis: decrease in production of granulocytes
    • Neutrophils, Basophils, Eosinophils
    • Assessment Findings:
      • Fatigue, fever, chills, headache, opportunistic infections
    • Medical Management:
      • Remove cause; drugs: human granulocyte colony-stimulating factor
    • Nursing Management:
      • Drug assessment, protective isolation (neutropenic); visitor restriction–NO flowers, fruit

    Aplastic Anemia

    • Pancytopenia: Aplastic Anemia: pancytopenia: numbers of all cells reduced
    • Causes: autoimmune, exposure to toxic chemicals, radiation, drug therapy
    • Assessment Findings:
      • Weakness, fatigue, opportunistic infections, Unusual bleeding, petechiae, ecchymosis
      • Enlarged spleen/abdominal pain
    • Diagnostic Findings:
      • CBC- blood cell count; bone marrow aspiration
    • Medical Management:
      • Withdrawal of causative agent, Transfusions, antibiotics, corticosteroids, Transplantations: bone marrow; autologous stem cell
    • Nursing Management:
      • History, physical assessment, symptoms, Infection prevention measures/isolation
      • Nutrition; modify oral hygiene, Monitoring of blood transfusion

    Coagulopathies

    • Thrombocytopenia: platelet manufacture by bone marrow is decreased or platelet destruction by the spleen is increased (Splenomegaly)
    • Causes: leukemia; malignant blood diseases, severe infections
    • Assessment Findings:
      • Purpura (purple/reddish), bleeding, internal hemorrhage (GI)
    • Medical Management:
      • Eliminate cause; corticosteroids, transfusions
      • Surgical Management: splenectomy
    • Nursing Management:
      • Manage/minimize bleeding: Apply pressure/tourniquet, ADR; taper corticosteroid dosage/frequency

    Hemophilia

    • Hemophilia: clotting factor; inherited: mother to son
    • Assessment Findings:
      • Oozing; severe bleeding, bleeding in joints

    Anemia

    • Anemia: a deficiency of erythrocytes or hemoglobin
    • Causes: blood loss, inadequate erythrocyte production, destruction of formed RBCs
    • Assessment Findings:
      • Inadequate RBC volume: orthostatic hypotension, thready pulses, oliguria, heart murmur
      • Compensatory mechanisms for lost RBC function: tachycardia, tachypnea, cool, clammy skin, amenorrhea
      • Decreased RBC function: dyspnea, chest discomfort, acidosis, headache, vertigo, pallor

    Hypovolemic Anemia

    • Causes: sudden loss of large volume, chronic loss of small amounts of blood
    • Assessment Findings:
      • Extreme pallor, tachycardia, hypotension, reduced urine output, altered consciousness, fatigue, chills, rapid respiratory rate
    • Medical Management:
      • Blood transfusions: treating underlying condition or chronic blood loss
      • Administration of oral, IV, or IM iron: restore hemoglobin

    Iron Deficiency Anemia

    • Iron Deficiency Anemia: insufficient iron to produce hemoglobin
    • Assessment Findings:
      • Reduced energy, feel cold all the time, fatigue and dyspnea with minor physical exertion, rapid heart rate even at rest, decreased hemoglobin, hematocrit, and serum iron levels
    • Medical Management:
      • Foods high in iron, Blood transfusion
    • Nursing Management:
      • Increase iron intake, collaborate with dietitian, administer iron supplement (IM Z-track)

    Sickle Cell Anemia

    • Sickle Cell Anemia: Hemoglobin A is replaced by Hemoglobin S; sickle- or crescent-shaped erythrocytes from inadequate oxygen supply to blood
    • Hereditary; sickle cell crisis
    • Chronic hemolytic anemia
    • Assessment Findings:
      • Jaundice, tachycardia, dyspnea, cardiomegaly, and dysrhythmias; stroke, acute chest syndrome
    • Diagnostic Findings:
      • Sickledex test; hemoglobin electrophoresis
    • Medical Management:
      • Supportive treatment: regular blood transfusions; bone marrow transplantation; prophylactic antibiotic therapy
      • Sickle cell crisis: narcotic analgesia, O2, bed rest, IV fluids, meds

    Other Anemias

    • Hemolytic Anemia: Chronic premature erythrocyte destruction
    • Assessment Findings:
      • Jaundice, enlarged spleen, shock
    • Medical Management:
      • Removing the cause; corticosteroids; blood transfusions
    • Surgical Management:
      • Splenectomy
    • Nursing Management:
      • Health history, supportive care, medication, teaching measures of self-care, arrange follow-up evaluations

    Thalassemias

    • Thalassemias: hereditary hemolytic anemia
    • Types: alpha-thalassemias, beta-thalassemias
    • Assessment Findings:
      • Cooley's anemia: bronzing of the skin
    • Medical Management:
      • Symptomatic, frequent transfusions, iron chelation therapy
    • Nursing Management:
      • Bed rest, protect from infection, closely monitor blood transfusion

    Pernicious Anemia

    • Pernicious Anemia: lack of intrinsic factor necessary for absorption of vitamin B12
    • Degenerative changes in nervous system
    • Secondary to surgical removal of stomach or small bowel resection
    • Assessment Findings:
      • Stomatitis, glossitis, digestive disturbances; diarrhea; dyspnea with minimal exertion, jaundice, irritability, confusion, depression, numbness and tingling in arms and legs, ataxia
    • Diagnostic Findings:
      • Blood and bone marrow studies; Schilling test, blood smear
    • Medical Management:
      • IM vitamin B12
      • Physical therapy for permanent neurologic deficits
    • Nursing Management:
      • Glossitis and stomatitis: soft, bland diet; small, frequent meals; oral care
      • Permanent neurologic deficit: encourage and assist with ambulation, supervision
      • Teaching: administration of vitamin B12; diet

    Folic Acid Deficiency Anemia

    • Folic Acid Deficiency Anemia: immature erythrocytes; insufficient dietary intake of foods rich in folic acid
    • Assessment Findings:
      • Severe fatigue, sore and beefy-red tongue, dyspnea, nausea, anorexia, headaches, weakness, light-headedness
    • Diagnostic Findings:
      • Schilling test
    • Medical Management:
      • Folic acid supplements; balanced diet
    • Nursing Management:
      • Teaching: diet, oral hygiene, rest promotion

    Erythrocytosis

    • Polycythemia vera: increase in circulating erythrocytes and leukocytes
    • Rapid proliferation of blood cells produced by the bone marrow; cause is unknown
    • Assessment Findings:
      • Reddish-purple face and lips, fatigue, weakness, exertional dyspnea
    • Diagnostic Findings:
      • Elevated blood cell count, platelets and WBC counts elevated, abnormal serum K+ and uric acid
    • Medical Management:
      • Phlebotomy, radio phosphorus, and radiotherapy

    Leukocytosis

    • Leukocytosis: proliferation of leukocytes, usually in immature form
    • Four types according to dysfunctional bone marrow stem cell line (Acute and Chronic forms of lymphocytic and myelogenous leukemia)
    • Precipitating factors: genetic correlation
    • Assessment Findings:
      • Severe anemia, infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes, internal or external bleeding
    • Medical Management:
      • Antineoplastic drugs, transfusions, Transplantation: bone marrow; stem cell
    • Nursing Process:
      • Assessment: history of symptoms; physical assessment, laboratory results; assess neutrophil
      • Diagnosis and Planning:
        • Risks: infection, hemorrhage, activity intolerance, disturbed body image, anxiety, and fear
      • Interventions:
        • Monitor platelet counts, assess for signs of bruising and petechiae; report hematuria or epistaxis (nosebleed)
        • Acknowledge client's anxieties and fears, reassure PT

    Multiple Myeloma

    • Multiple Myeloma: malignancy involving plasma cells
    • Osteoclasts break down bone cells, resulting in increased blood calcium and pathologic fractures
    • Osteolytic tumors: "punched-out" or "honeycombed" appearance in bones
    • Assessment Findings:
      • Bone Pain, infection, symptoms of anemia, bruising, nosebleeds, renal calculi
    • Diagnostic Findings:
      • Skeletal radiographic studies: bone lesions; increased serum calcium levels, bone marrow aspiration
    • Medical Management:
      • Steroids, anticancer drugs, antibiotics
      • Analgesics, blood transfusions
      • Back braces, body casts
      • Surgical Management: transplantation: bone marrow; stem cell
    • Nursing Management:
      • Assess pain, signs of infection (increased WBC, Fever), fatigue, bleeding, thrombus formation, urine
      • Analgesics, ambulation (caution-fracture), fluid intake I&O, safety, Prevent infection

    Agranulocytosis

    • Agranulocytosis: decrease in production of granulocytes
    • Neutrophils, Basophils, Eosinophils
    • Assessment Findings:
      • Fatigue, fever, chills, headache, opportunistic infections
    • Medical Management:
      • Remove cause; drugs: human granulocyte colony-stimulating factor
    • Nursing Management:
      • Drug assessment, protective isolation (neutropenic); visitor restriction–NO flowers, fruit

    Aplastic Anemia

    • Pancytopenia: Aplastic Anemia: pancytopenia: numbers of all cells reduced
    • Causes: autoimmune, exposure to toxic chemicals, radiation, drug therapy
    • Assessment Findings:
      • Weakness, fatigue, opportunistic infections, Unusual bleeding, petechiae, ecchymosis
      • Enlarged spleen/abdominal pain
    • Diagnostic Findings:
      • CBC- blood cell count; bone marrow aspiration
    • Medical Management:
      • Withdrawal of causative agent, Transfusions, antibiotics, corticosteroids, Transplantations: bone marrow; autologous stem cell
    • Nursing Management:
      • History, physical assessment, symptoms, Infection prevention measures/isolation
      • Nutrition; modify oral hygiene, Monitoring of blood transfusion

    Coagulopathies

    • Thrombocytopenia: platelet manufacture by bone marrow is decreased or platelet destruction by the spleen is increased (Splenomegaly)
    • Causes: leukemia; malignant blood diseases, severe infections
    • Assessment Findings:
      • Purpura (purple/reddish), bleeding, internal hemorrhage (GI)
    • Medical Management:
      • Eliminate cause; corticosteroids, transfusions
      • Surgical Management: splenectomy
    • Nursing Management:
      • Manage/minimize bleeding: Apply pressure/tourniquet, ADR; taper corticosteroid dosage/frequency

    Hemophilia

    • Hemophilia: clotting factor; inherited: mother to son
    • Assessment Findings:
      • Oozing; severe bleeding, bleeding in joints

    Anemia

    • Anemia: a deficiency of erythrocytes or hemoglobin
    • Causes: blood loss, inadequate erythrocyte production, destruction of formed RBCs
    • Assessment Findings:
      • Inadequate RBC volume: orthostatic hypotension, thready pulses, oliguria, heart murmur
      • Compensatory mechanisms for lost RBC function: tachycardia, tachypnea, cool, clammy skin, amenorrhea
      • Decreased RBC function: dyspnea, chest discomfort, acidosis, headache, vertigo, pallor

    Hypovolemic Anemia

    • Causes: sudden loss of large volume, chronic loss of small amounts of blood
    • Assessment Findings:
      • Extreme pallor, tachycardia, hypotension, reduced urine output, altered consciousness, fatigue, chills, rapid respiratory rate
    • Medical Management:
      • Blood transfusions: treating underlying condition or chronic blood loss
      • Administration of oral, IV, or IM iron: restore hemoglobin

    Iron Deficiency Anemia

    • Iron Deficiency Anemia: insufficient iron to produce hemoglobin
    • Assessment Findings:
      • Reduced energy, feel cold all the time, fatigue and dyspnea with minor physical exertion, rapid heart rate even at rest, decreased hemoglobin, hematocrit, and serum iron levels
    • Medical Management:
      • Foods high in iron, Blood transfusion
    • Nursing Management:
      • Increase iron intake, collaborate with dietitian, administer iron supplement (IM Z-track)

    Sickle Cell Anemia

    • Sickle Cell Anemia: Hemoglobin A is replaced by Hemoglobin S; sickle- or crescent-shaped erythrocytes from inadequate oxygen supply to blood
    • Hereditary; sickle cell crisis
    • Chronic hemolytic anemia
    • Assessment Findings:
      • Jaundice, tachycardia, dyspnea, cardiomegaly, and dysrhythmias; stroke, acute chest syndrome
    • Diagnostic Findings:
      • Sickledex test; hemoglobin electrophoresis
    • Medical Management:
      • Supportive treatment: regular blood transfusions; bone marrow transplantation; prophylactic antibiotic therapy
      • Sickle cell crisis: narcotic analgesia, O2, bed rest, IV fluids, meds

    Other Anemias

    • Hemolytic Anemia: Chronic premature erythrocyte destruction
    • Assessment Findings:
      • Jaundice, enlarged spleen, shock
    • Medical Management:
      • Removing the cause; corticosteroids; blood transfusions
    • Surgical Management:
      • Splenectomy
    • Nursing Management:
      • Health history, supportive care, medication, teaching measures of self-care, arrange follow-up evaluations

    Thalassemias

    • Thalassemias: hereditary hemolytic anemia
    • Types: alpha-thalassemias, beta-thalassemias
    • Assessment Findings:
      • Cooley's anemia: bronzing of the skin
    • Medical Management:
      • Symptomatic, frequent transfusions, iron chelation therapy
    • Nursing Management:
      • Bed rest, protect from infection, closely monitor blood transfusion

    Pernicious Anemia

    • Pernicious Anemia: lack of intrinsic factor necessary for absorption of vitamin B12
    • Degenerative changes in nervous system
    • Secondary to surgical removal of stomach or small bowel resection
    • Assessment Findings:
      • Stomatitis, glossitis, digestive disturbances; diarrhea; dyspnea with minimal exertion, jaundice, irritability, confusion, depression, numbness and tingling in arms and legs, ataxia
    • Diagnostic Findings:
      • Blood and bone marrow studies; Schilling test, blood smear
    • Medical Management:
      • IM vitamin B12
      • Physical therapy for permanent neurologic deficits
    • Nursing Management:
      • Glossitis and stomatitis: soft, bland diet; small, frequent meals; oral care
      • Permanent neurologic deficit: encourage and assist with ambulation, supervision
      • Teaching: administration of vitamin B12; diet

    Folic Acid Deficiency Anemia

    • Folic Acid Deficiency Anemia: immature erythrocytes; insufficient dietary intake of foods rich in folic acid
    • Assessment Findings:
      • Severe fatigue, sore and beefy-red tongue, dyspnea, nausea, anorexia, headaches, weakness, light-headedness
    • Diagnostic Findings:
      • Schilling test
    • Medical Management:
      • Folic acid supplements; balanced diet
    • Nursing Management:
      • Teaching: diet, oral hygiene, rest promotion

    Erythrocytosis

    • Polycythemia vera: increase in circulating erythrocytes and leukocytes
    • Rapid proliferation of blood cells produced by the bone marrow; cause is unknown
    • Assessment Findings:
      • Reddish-purple face and lips, fatigue, weakness, exertional dyspnea
    • Diagnostic Findings:
      • Elevated blood cell count, platelets and WBC counts elevated, abnormal serum K+ and uric acid
    • Medical Management:
      • Phlebotomy, radio phosphorus, and radiotherapy

    Leukocytosis

    • Leukocytosis: proliferation of leukocytes, usually in immature form
    • Four types according to dysfunctional bone marrow stem cell line (Acute and Chronic forms of lymphocytic and myelogenous leukemia)
    • Precipitating factors: genetic correlation
    • Assessment Findings:
      • Severe anemia, infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes, internal or external bleeding
    • Medical Management:
      • Antineoplastic drugs, transfusions, Transplantation: bone marrow; stem cell
    • Nursing Process:
      • Assessment: history of symptoms; physical assessment, laboratory results; assess neutrophil
      • Diagnosis and Planning:
        • Risks: infection, hemorrhage, activity intolerance, disturbed body image, anxiety, and fear
      • Interventions:
        • Monitor platelet counts, assess for signs of bruising and petechiae; report hematuria or epistaxis (nosebleed)
        • Acknowledge client's anxieties and fears, reassure PT

    Multiple Myeloma

    • Multiple Myeloma: malignancy involving plasma cells
    • Osteoclasts break down bone cells, resulting in increased blood calcium and pathologic fractures
    • Osteolytic tumors: "punched-out" or "honeycombed" appearance in bones
    • Assessment Findings:
      • Bone Pain, infection, symptoms of anemia, bruising, nosebleeds, renal calculi
    • Diagnostic Findings:
      • Skeletal radiographic studies: bone lesions; increased serum calcium levels, bone marrow aspiration
    • Medical Management:
      • Steroids, anticancer drugs, antibiotics
      • Analgesics, blood transfusions
      • Back braces, body casts
      • Surgical Management: transplantation: bone marrow; stem cell
    • Nursing Management:
      • Assess pain, signs of infection (increased WBC, Fever), fatigue, bleeding, thrombus formation, urine
      • Analgesics, ambulation (caution-fracture), fluid intake I&O, safety, Prevent infection

    Agranulocytosis

    • Agranulocytosis: decrease in production of granulocytes
    • Neutrophils, Basophils, Eosinophils
    • Assessment Findings:
      • Fatigue, fever, chills, headache, opportunistic infections
    • Medical Management:
      • Remove cause; drugs: human granulocyte colony-stimulating factor
    • Nursing Management:
      • Drug assessment, protective isolation (neutropenic); visitor restriction–NO flowers, fruit

    Aplastic Anemia

    • Pancytopenia: Aplastic Anemia: pancytopenia: numbers of all cells reduced
    • Causes: autoimmune, exposure to toxic chemicals, radiation, drug therapy
    • Assessment Findings:
      • Weakness, fatigue, opportunistic infections, Unusual bleeding, petechiae, ecchymosis
      • Enlarged spleen/abdominal pain
    • Diagnostic Findings:
      • CBC- blood cell count; bone marrow aspiration
    • Medical Management:
      • Withdrawal of causative agent, Transfusions, antibiotics, corticosteroids, Transplantations: bone marrow; autologous stem cell
    • Nursing Management:
      • History, physical assessment, symptoms, Infection prevention measures/isolation
      • Nutrition; modify oral hygiene, Monitoring of blood transfusion

    Coagulopathies

    • Thrombocytopenia: platelet manufacture by bone marrow is decreased or platelet destruction by the spleen is increased (Splenomegaly)
    • Causes: leukemia; malignant blood diseases, severe infections
    • Assessment Findings:
      • Purpura (purple/reddish), bleeding, internal hemorrhage (GI)
    • Medical Management:
      • Eliminate cause; corticosteroids, transfusions
      • Surgical Management: splenectomy
    • Nursing Management:
      • Manage/minimize bleeding: Apply pressure/tourniquet, ADR; taper corticosteroid dosage/frequency

    Hemophilia

    • Hemophilia: clotting factor; inherited: mother to son
    • Assessment Findings:
      • Oozing; severe bleeding, bleeding in joints

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    Description

    This quiz covers the medical-surgical aspects of anemia, including its causes, assessment findings, and compensatory mechanisms. It also touches on the symptoms of anemia and its effects on the body.

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