Podcast
Questions and Answers
What is the main purpose of bone marrow aspiration and biopsy?
What is the main purpose of bone marrow aspiration and biopsy?
Which of the following is a potential complication of a bone marrow biopsy?
Which of the following is a potential complication of a bone marrow biopsy?
In which condition is a splenectomy indicated?
In which condition is a splenectomy indicated?
What type of transplant involves using the patient’s own stem cells?
What type of transplant involves using the patient’s own stem cells?
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Which therapeutic approach is specifically used for conditions like myasthenia gravis and sickle cell disease?
Which therapeutic approach is specifically used for conditions like myasthenia gravis and sickle cell disease?
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Which analgesic agent should be avoided immediately after a bone marrow aspiration due to potential bleeding issues?
Which analgesic agent should be avoided immediately after a bone marrow aspiration due to potential bleeding issues?
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During a bone marrow procedure, what is a suggested nursing intervention to help the patient?
During a bone marrow procedure, what is a suggested nursing intervention to help the patient?
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What does therapeutic phlebotomy involve?
What does therapeutic phlebotomy involve?
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What is a common dietary recommendation for managing iron deficiency anemia?
What is a common dietary recommendation for managing iron deficiency anemia?
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What are typical laboratory findings in a patient with iron deficiency anemia?
What are typical laboratory findings in a patient with iron deficiency anemia?
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Which condition is least likely to result in fatigue and increased feelings of depression in a 50-year-old woman?
Which condition is least likely to result in fatigue and increased feelings of depression in a 50-year-old woman?
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The presence of brittle nails in a patient should raise suspicion for which condition?
The presence of brittle nails in a patient should raise suspicion for which condition?
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Which of the following would most likely indicate a nursing diagnosis of imbalanced nutrition related to iron deficiency anemia?
Which of the following would most likely indicate a nursing diagnosis of imbalanced nutrition related to iron deficiency anemia?
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What is the primary reason for transfusion therapy in cases of iron deficiency anemia?
What is the primary reason for transfusion therapy in cases of iron deficiency anemia?
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Which vitamin is commonly prescribed to enhance iron absorption in patients with iron deficiency anemia?
Which vitamin is commonly prescribed to enhance iron absorption in patients with iron deficiency anemia?
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A patient is diagnosed with iron deficiency anemia. Which symptom would least likely be associated with this condition?
A patient is diagnosed with iron deficiency anemia. Which symptom would least likely be associated with this condition?
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Which of the following medications is NOT typically used to treat iron deficiency anemia?
Which of the following medications is NOT typically used to treat iron deficiency anemia?
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What could be a non-dietary contributing factor to the development of iron deficiency anemia?
What could be a non-dietary contributing factor to the development of iron deficiency anemia?
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What role does erythropoietin play in response to red blood cell destruction?
What role does erythropoietin play in response to red blood cell destruction?
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Which statement about sickle hemoglobin (HbS) is true?
Which statement about sickle hemoglobin (HbS) is true?
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What is the approximate lifespan of sickled erythrocytes?
What is the approximate lifespan of sickled erythrocytes?
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How does cold exposure affect sickle cell disease?
How does cold exposure affect sickle cell disease?
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What is the carrier status referred to as sickle cell trait?
What is the carrier status referred to as sickle cell trait?
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What are the potential complications that arise from sickle cell disease?
What are the potential complications that arise from sickle cell disease?
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What happens to erythrocytes containing HbS when there is decreased oxygen in venous blood?
What happens to erythrocytes containing HbS when there is decreased oxygen in venous blood?
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What process leads to the formation of bilirubin from hemoglobin?
What process leads to the formation of bilirubin from hemoglobin?
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What are the clinical manifestations of sickle cell disease primarily caused by?
What are the clinical manifestations of sickle cell disease primarily caused by?
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Which statement about the sickling episodes in sickle cell disease is accurate?
Which statement about the sickling episodes in sickle cell disease is accurate?
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What is a characteristic of chronic leukemia?
What is a characteristic of chronic leukemia?
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Which symptom would most likely indicate thrombocytopenia?
Which symptom would most likely indicate thrombocytopenia?
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Which of the following symptoms is not commonly associated with leukemia?
Which of the following symptoms is not commonly associated with leukemia?
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Which clinical finding suggests the presence of anemia?
Which clinical finding suggests the presence of anemia?
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What specifically characterizes the bleeding associated with leukemia?
What specifically characterizes the bleeding associated with leukemia?
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What is a common non-bleeding symptom experienced in patients with leukemia?
What is a common non-bleeding symptom experienced in patients with leukemia?
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What does the presence of ecchymosis and petechiae indicate in a patient?
What does the presence of ecchymosis and petechiae indicate in a patient?
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What is the most common cause of an aplastic crisis in sickle cell patients?
What is the most common cause of an aplastic crisis in sickle cell patients?
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Which of the following is NOT a complication commonly associated with chronic anemia in sickle cell disease?
Which of the following is NOT a complication commonly associated with chronic anemia in sickle cell disease?
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In sickle cell disease, what is the term used to describe the abnormal accumulation of red blood cells in an organ?
In sickle cell disease, what is the term used to describe the abnormal accumulation of red blood cells in an organ?
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What is a typical hemoglobin value range for a patient with sickle cell disease?
What is a typical hemoglobin value range for a patient with sickle cell disease?
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Which organ is most commonly involved in sequestration crisis in children with sickle cell anemia?
Which organ is most commonly involved in sequestration crisis in children with sickle cell anemia?
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What is a potential long-term consequence of repeated splenic sequestration in children with sickle cell disease?
What is a potential long-term consequence of repeated splenic sequestration in children with sickle cell disease?
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Which condition is characterized by painful acute vaso-occlusive crisis due to tissue hypoxia in sickle cell patients?
Which condition is characterized by painful acute vaso-occlusive crisis due to tissue hypoxia in sickle cell patients?
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What is the most effective potential cure for sickle cell disease?
What is the most effective potential cure for sickle cell disease?
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Which of the following symptoms is NOT associated with chronic anemia in sickle cell disease?
Which of the following symptoms is NOT associated with chronic anemia in sickle cell disease?
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What is a common primary site affected by thrombosis in sickle cell patients?
What is a common primary site affected by thrombosis in sickle cell patients?
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Study Notes
Management of Patients with Hematologic Disorders
- Hematologic disorders affect the blood and its production sites, including bone marrow and the reticuloendothelial system (RES).
- Blood is a specialized fluid organ, distinct from other organs in its liquid state.
- Blood is composed of plasma (55% of volume) and cells.
- Plasma contains proteins (albumin, globulin, fibrinogen), electrolytes, waste products, and nutrients.
- The cellular component of blood includes erythrocytes (red blood cells), leukocytes (white blood cells), and thrombocytes (platelets).
- These cells generally comprise 40%-45% of blood volume.
- Hematopoiesis (blood cell formation) primarily occurs in bone marrow.
Objectives
- Describe hematopoiesis and hemostasis.
- Discuss the significance of patient history for hematologic health assessment.
- Detail techniques for a comprehensive physical assessment of hematologic function.
- Explain diagnostic tests and related nursing implications used in hematologic function evaluation.
- Identify blood disorder therapies and nursing implications for blood component administration.
Hemostasis
- Hemostasis is the process of preventing blood loss in intact vessels and stopping bleeding from a severed vessel.
- This process, requiring sufficient functional platelets, involves three phases:
- Vascular phase (spasm in damaged muscle).
- Platelet phase (aggregation and adhesion).
- Coagulation phase (clot formation, retraction, and destruction).
Assessment
- Health history includes:
- Nutritional history.
- Use of medications (prescription, OTC, herbal).
- Past medical history (frequent infections, bleeding disorders, and others).
- Surgical history, recent trauma, and others.
- Onset, severity, and contributing factors of symptoms.
Physical Examination
- Include thorough assessment of skin, oral cavity, lymph nodes, and spleen.
- Assess signs like:
- Pallor (anemia).
- Jaundice (hemolytic anemia).
- Bruising.
- Palmar creases (anemia).
- Tachycardia (anemia).
- Character of pulse.
Diagnostic Evaluation
- Complete blood count (CBC) measures blood cells (leukocytes, erythrocytes, and platelets), hemoglobin, hematocrit (percentage of blood volume consisting of erythrocytes), and RBC indices.
- Peripheral blood smear examines erythrocytes and platelets, along with the appearance of leukocytes, to identify hematologic conditions.
Bone Marrow Aspiration and Biopsy
- Used to assess the quantity and quality of cells produced by the bone marrow.
- In adults, typically performed from the iliac crest or occasionally the sternum.
- Nursing interventions primarily center around:
- Procedure explanation and consent.
- Comfort measures and relaxation for patient.
- Post-procedure monitoring with analgesia (if required).
Therapeutic Approaches to Hematologic Disorders
- Splenectomy: surgical spleen removal.
- Therapeutic Apheresis: the removal of specific components (such as platelets or leukocytes or plasma) from a patient's blood, followed by return of the remaining blood to the patient.
- Hematopoietic Stem Cell Transplant (HSCT): transplantation of stem cells from a donor or the patient to restore healthy blood cell production.
- Therapeutic Phlebotomy the removal of a certain amount of blood to control conditions.
Blood Transfusion
- Procedure details, including transfusion preparation, patient and blood compatibility verification, transfusion start procedures, observation for adverse reactions, and management of potential complications (overload and others).
- Postprocedure monitoring, including vital signs and assessing for complications.
Anemia
Defined as lower-than-normal hemoglobin concentration or fewer-than-normal erythrocytes. It's a symptom, not a diagnosis.
Iron Deficiency Anemia
- Characterized by insufficient body iron content that impacts hemoglobin synthesis.
- Common causes include chronic blood loss (GI bleeding).
- Findings: pallor, glossitis, headache, irritability, depression, impairment of thought processes, weakness, fatigue, sensitivity to cold.
- Assessment findings include pica (cravings for non-nutritive substances), pallor, glossitis (inflammation of the tongue), and angular cheilosis (inflammation of the corners of the mouth).
- Treatment involves iron-rich diet, supplements, and stopping of unnecessary blood loss.
Megaloblastic Anemias
- Caused by vitamin B12 or folic acid deficiencies.
- The erythrocytes produced are abnormally large and termed megaloblasts.
- Folic acid is present in green vegetables and liver; deficiency, common in those with liver disease, pregnancy, or poor diet.
- Treatment centers on supplements; patients need to work with a nutritionist to provide a proper diet that enables adequate absorption and intake of folic acid.
Pernicious Anemia
- Type of megaloblastic anemia, specifically due to vitamin B12 deficiency.
- The body needs intrinsic factor—a substance secreted by the stomach—for vitamin B12 absorption from the ileum.
- Lack or impaired function of intrinsic factor causes vitamin B12 malabsorption, leading to pernicious anemia.
- Findings include a sore tongue, mild diarrhea, confusion, paresthesias (tingling) and balance issues.
- Treatment includes supplemental vitamin B12 to achieve normal blood counts.
Hemolytic Anemias
- Marked by shortened erythrocyte lifespan and reduced blood cell count.
- Causes vary, including genetic defects and other factors.
- Reduced erythrocyte count leads to decreased oxygen transport to tissues; these patients often require transfusions.
Sickle Cell Disease
- Severe hemolytic anemia caused by inheritance of the sickle hemoglobin gene.
- Results in misshapen (sickled) red blood cells.
- Episodes of sickling can block blood vessels, causing pain and organ damage.
Aplastic Anemia
- Rare bone marrow failure characterized by the insufficient production of all blood cell types.
- Factors causing destruction or damage of bone marrow stem cells range from genetic predisposition to environmental factors.
- Treatment primarily focuses on supportive care (transfusions) until a stem cell transplant is possible.
Leukemia
- A group of malignant hematological disorders.
- Characterized by abnormal white blood cell production and often immature cells in the bone marrow.
- Leukemias are classified as acute or chronic, based on the time it takes for symptoms to appear and the type of leukemia cell that starts to increase in the blood.
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Description
Test your knowledge on bone marrow aspiration and biopsy procedures, complications, and related medical conditions. This quiz covers various aspects of hematology including therapies and diagnostic measures for iron deficiency anemia and related disorders.
