NUR 529 Exam 2 Blueprint PDF

The University of Alabama Capstone College of Nursing NUR 529 Exam 2 Blueprint ----------------------------------------------------------------------------------...

The University of Alabama Capstone College of Nursing NUR 529 Exam 2 Blueprint --------------------------------------------------------------------------------------------------------------------- Unit 7. Disorders of the Hematopoietic System. Chapters 22, 23, and 24. There are 6 questions from this unit. 1. Chapter 22. Could talk a client through the Mechanisms of Hemostasis. See page 623 Understanding hemostasis, three stages.  Hemostasis is the stoppage of blood flow  Stage 1: vessel vasoconstriction o Vascular smooth muscle contraction occurs and Local nervous reflexes + local humoral factors (TXA2) are released from platelets and contribute to vasoconstriction  Stage 2: Formation of the platelet plug o vWF (Von Willebrand factor) is released from the endothelium, binds to platelet receptors and causes adhesion of the platelets to the exposed collagen fibers (inset) o platelet adhesion to the collagen fibers become activated and release ADP + TXA2 which attract additional platelets = platelet aggregation.  Stage 3: Development of a blood clot as a result of the coagulation process (blood coagulation) – activation of several factors through 2 coagulation pathways: o Intrinsic pathway – begins in circulation, activated by factor XII o Extrinsic pathway – activated by tissue factor (a cellular lipoprotein that becomes exposed when tissues are injured) o Both pathways activate factor X which converts prothrombin  thrombin and fibrinogen  insoluble fibrin threads that hold the clot together  Clot retraction o Pulls the edges of the injured vessel together  Clot dissolution/ Lysis o Plasmin dissolves the clot and allows blood flow to be reestablished and tissue healing to take place (t-PA is released slowly) 2. Chapter 22. Bleeding Disorders: Bleeding Associated with Platelet Disorders (p 629).  Disorders result from a decrease in # of platelets from either: decreased platelet production, increased destruction, or impaired function.  Spontaneous bleeding often involve small vessels of mucous membranes & skin ( mouth, nose, GI tract, uterine cavity)  Cutaneous bleeding = pinpoint hemorrhages (petechiae) and bruising (purpura)  Petechiae indicates platelet deficiency (not dysfunction)  Thrombocytopenia o Reduced platelets < 150,000/uL (the lower the platelets the higher the bleeding risk) Severe is 100 fL from impaired maturation & division o Commonly caused by folic acid and vitamin B12 deficiencies  Sickle cell disease – abnormally shaped RBCs from deoxygenation (becomes sickled) this increases red cell adhesiveness and adherence to vessel wall (hemolysis, occlusion, ischemia)  Normal – normocytic & normochromic (normal size and color) 4. Chapter 23. Anemia: Anemias of Deficient Red Cell Production. (p. 654) Iron deficiency anemia (IDA). Compare causes of IDA in adults and children. What are the most common causes in each group?  4 causes of anemia o Loss of RBCs from bleeding – iron loss/deficiency i.e. GI bleeds & menstrual cycle disorders o Destruction (hemolysis) of RBCs – iron is retained i.e. sickle cell  Increased erythropoiesis (Bone marrow is working overtime to produce more RBCs which means there are more circulating reticulocytes)  Shortened RBC lifespan o Defective RBC production or Inadequate RBC production from bone marrow failure  Decreased production of erythrocytes  Deficiency in nutrients for production (folic acid and cobalamin)  Cause of IDA in adults: o Chronic blood loss o In men and postmenopausal women GI bleeds from peptic ulcer, vascular lesions, intestinal polyps, hemorrhoids, or cancer o Child bearing age women require have an increased iron demand because of loss through menstrual cycle  Cause of IDA in Children: o Child growth = increased demand o Iron requirements are highest in infancy (3-24 months) and deficiency is usually caused by low iron levels at birth because of the mom’s deficiency and a diet consisting of cows milk  Anemia manifestation: fatigue, irritability, PICA (cravings for things without nutritional value), dyspnea, tachycardia, angina, palpitations  Diagnosis: decreased MCHC, MCV 5. Chapter 24. Nonneoplastic Disorders of White Blood Cells: Infectious Mononucleosis. Clinical course, most common complication, and laboratory diagnostics.   Neutropenia (Agranolucytosis) o Leukopenia: decrease of leukocytes in blood and often affects the neutrophils (which engulf, digest, and destroy microorganisms) o Neutrophils are the granulocytes most responsinle for defense against bacteria o Higher risk for infection, proportional to the ANC (absolute neutrophil count), if