Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
141 Cards in this Set
- Front
- Back
These types of cells have a role in phagocytosis of foreign microbes |
White blood cells |
|
What is a normal neutrophil count |
4000 to 11,000 |
|
When neutrophils Reach This level it is considered neutropenia |
Below 2000 |
|
Two reasons for low neutrophil levels |
Marrow unable to replace as fast as being used They are being destroyed too quickly |
|
How long after chemotherapy do patients neutrophil counts often drop too low |
10 to 12 days |
|
Neutropenia leads to this |
Higher risk for infection |
|
Signs and symptoms of infection are often masked |
Neutropenia, due to lack of available neutrophils |
|
Signs and symptoms of inflammation may not occur |
Neutropenia, due to lack of neutrophils |
|
In neutropenia even with infection pus formation is absent. This is because white blood cells are absent. |
True |
|
What is the most important thing to Monitor and recognized in patients with neutropenia |
Changes in temperature, even low-grade fever demands immediate attention |
|
With this condition signs and symptoms of infection often occur in the mouth, throat, perianal area, pulmonary system. All are entry points to the body |
Neutropenia |
|
This is not considered a disease but instead A syndrome or a side effect |
Neutropenia |
|
This condition can be a intentional or unintentional side effect |
Neutropenia |
|
In this condition the patient is more prone to infections even just from their own normal flora |
Neutropenia |
|
These patients are unable to fight even minor things on their own. We must recognize infection early and get on antibiotics within an hour if possible |
neutropenia |
|
CBC with differential as well as bone marrow aspiration may be utilized in this condition |
Neutropenia |
|
Tuberculosis can cause neutropenia |
True |
|
Blood cultures are one way to identify the organism that may cause problems with this condition. Blood cultures are preferably taken when there is a temperature and are always taken from two different sites |
True |
|
It is important to always get the culture before beginning antibiotic therapy |
True |
|
With complications occurring from this condition broad-spectrum coverage is used until cultures come back. May use multiple antibiotics in combination |
Neutropenia |
|
Two types of medication used in neutropenia |
Antibiotics and hematopoietic growth factors such as neupogen and neulasta |
|
What is GCSF |
Granulocyte colony-stimulating Factor, used in neutropenia. Neupogen and neulasta |
|
What are the side effects of medications like neupogen and neulasta |
Bone pain |
|
These stimulate bone marrow production helping to build more neutrophils. They are available by Sub-Q injection, IV, and you may give an analgesic before to help decrease bone pain |
Neupogen and neulasta |
|
In this condition the patient's own common Flora is the most common cause of infection in these patients. They can get very sick very fast |
neutropenia |
|
What is a normal platelet count |
150,000 to 450,000 |
|
What is thrombocytopenia |
Platelet count less than 150,000 |
|
Prolonged bleeding with minor injury |
Thrombocytopenia |
|
Spontaneous bleeding without injury |
Thrombocytopenia |
|
Four main reasons for acquired thrombocytopenia |
Decreased platelet production Increased platelet destruction Increased consumption of platelets Abnormal platelet function |
|
Thrombocytopenia can be either acquired or genetic |
True |
|
An example of genetic thrombocytopenia |
Fanconi syndrome, these patients have pancytopenia which is low in all blood levels including red blood cells, white blood cells and platelets |
|
Average lifespan of platelets |
7 to 10 days |
|
Myelosuppression, viral infection and chronic alcoholism can lead to this |
Decreased platelet production |
|
May occur during pregnancy, from severe burns, HIV, spleen problems |
Increased platelet destruction, associated with thrombocytopenia |
|
May be caused by DIC |
Increased consumption of platelets |
|
May be caused by medications such as diuretics, estrogen, aspirin, heparin, ginger, garlic, cloves |
Abnormal platelet function |
|
Autoimmune disease in which platelets are produced normally and function normally but are coated with antibodies so the spleen sees them as foreign and they are destroyed by phagocytosis. |
Idiopathic thrombocytopenic purpura, ITP |
|
Life of platelets drops from 7 to 10 days down to only 1 to 3 days |
Idiopathic thrombocytopenic purpura |
|
Thrombocytopenia in which abnormal destruction of circulating platelets occurs |
Idiopathic thrombocytopenic purpura |
|
What is the most common type of thrombocytopenia |
Idiopathic thrombocytopenic purpura |
|
This type of thrombocytopenia occurs usually in women 20 to 40 years of age and children |
Idiopathic thrombocytopenic purpura |
|
This type of thrombocytopenia has a gradual onset with recurrent episodes |
Idiopathic thrombocytopenic purpura |
|
There is a possible correlation between this type of thrombocytopenia and H pylori but it has not been proven why yet |
Idiopathic thrombocytopenic purpura |
|
It is unknown why we get this type of thrombocytopenia however there is enhanced agglutination, meaning sticking together, of platelets which leads to microthrombi |
Thrombotic thrombocytopenic purpura, TTP |
|
In this thrombocytopenia microthrombi can deposit in arterioles and capillaries |
Thrombotic thrombocytopenic purpura |
|
This is a type of thrombocytopenia that occurs over time due to immune responses to heparin |
Heparin induced thrombocytopenia and thrombosis, HITTS |
|
Many with this condition are asymptomatic |
Thrombocytopenia |
|
Four signs and symptoms that may be seen for internal bleeding with thrombocytopenia |
Hypotension, tachycardia, pain and dizziness |
|
What is the major complication of thrombocytopenia |
Hemorrhage |
|
When platelets get below 20,000 we may see these three external signs and symptoms of thrombocytopenia |
Mucosal bleeding, cutaneous such as bruising and petechiae, prolonged bleeding |
|
These two things are usually seen when platelet counts get below 50,000 |
Petechiae and ecchymosis |
|
Small flat pinpoint microhemorrhages |
Petechiae |
|
Bruising |
ecchymosis |
|
When platelets reach below this level we start to see spontaneous bleeding which may be internal and fatal |
Below 5000 |
|
Platelet count, PT, PTT, H&H, bone marrow biopsy |
Diagnostics used in thrombocytopenia |
|
In this condition PT and PTT will be normal because they assess coagulation factors and not platelets |
Thrombocytopenia |
|
Avoid aspirin, no IM injections, avoid suctioning, soft-bristled toothbrush, stool softeners |
Thrombocytopenia nursing care |
|
No rectal temperature or enemas, electric razor only, prevent Falls |
Nursing care thrombocytopenia |
|
Use the smallest needle possible if IV is required |
Thrombocytopenia |
|
When platelet levels reach around the 20,000 range this is often given |
Platelets |
|
Given as close to blood type as possible but we don't worry quite as much about compatibility unless they have had many transfusions overtime and may have developed antibodies |
Platelets |
|
One unit of donor blood is about this many milliliters This is spun down to create one unit of platelets which is about this many milliliters |
450 to 500 ml 30 to 50 Ml |
|
Platelets often come in six pack and eight packs. This means platelets from six different to eight different patients and units of blood |
True |
|
Phoresis |
A unit of platelets that has all come from the same donor |
|
Many premedicate with this medication before administering platelets |
Antihistamine such as Benadryl |
|
Four types of medical care for thrombocytopenia |
Corticosteroids, prednisone or Solu-Medrol Immunosuppressive meds Splenectomy Platelet transfusion |
|
Used in thrombocytopenia because they suppress the phagocytic response of the spleen |
Corticosteroids |
|
This may lead to a partial or complete remission of thrombocytopenia |
Splenectomy |
|
Prolonged clotting time and abnormal bleeding time |
Hemophilia |
|
Sex-linked hereditary disorder caused by defective or deficient coagulation factors. Transmitted by women but most often displayed by men |
Hemophilia |
|
The classic form of hemophilia, it is the most common type with 80% of patients having it |
Hemophilia a |
|
Also known as Christmas disease named after Stephen Christmas |
Hemophilia B |
|
Deficiency of factor 8 in the coagulation Cascade |
Hemophilia a |
|
Deficiency of factor 9 in the coagulation Cascade |
Hemophilia B |
|
Condition that may be mild to severe |
Hemophilia |
|
This Is A congenital bleeding disorder characterized by a deficiency in Von Willebrand's coagulation protein which should circulate with coagulation factor 8 |
Von Willebrand's disease |
|
This is the most common congenital bleeding disorder occurring more than even hemophilia |
Von Willebrand's disease |
|
Characterized by abnormal bleeding time it is seen equally in both sexes |
Von Willebrand's disease |
|
Children are usually diagnosed around six to eight months when they become more mobile and have teeth coming in. It may not be diagnosed until adulthood in some cases |
Von Willebrand's disease |
|
Any bleeding can lead to life-threatening Hemorrhage in these patients |
Hemophilia and Von Willebrand's disease |
|
Slow persistent bleeding Delayed bleeding uncontrollable hemorrhage Epistaxis GI bleed Hematuria Ecchymosis |
Hemophilia and Von Willebrand's disease |
|
Bleeding into the joints. It is important to completely rest the joint! |
Hemarthrosis, associated with hemophilia and von Willebrand's disease |
|
Replaces coagulation factor 8 and fibrinogen it is made from whole blood |
Cryoprecipitate |
|
A treatment for hemophilia B |
Transfusion of factor-9 |
|
The main treatment for these conditions is replacing clotting factors |
Hemophilia and Von Willebrand's disease |
|
Eventually patients may be taught to administer their own clotting factors at some point as this is a chronic condition |
Hemophilia and Von Willebrand's disease |
|
Avoid medications that interfere with platelet aggregation such as alcohol, some herbs and aspirin |
Hemophilia and Von Willebrand's disease |
|
Disorder and acceleration of the clotting Cascade. This is a very serious coagulation disorder! |
Disseminated intravascular coagulation |
|
Depletion of clotting factors and platelets leaving patients at risk of severe hemorrhage. All of them are used up in a big thrombosis throughout the body |
Disseminated intravascular coagulation |
|
This is usually a side effect of some other disease process. Often seen in very sick ICU patients who may be septic, had significant trauma, shock and advanced cancer |
Disseminated intravascular coagulation |
|
Initial phase of disseminated intravascular coagulation |
Abnormal clotting occurs throughout the body not localized. Enhanced platelet aggregation happens forming thrombi |
|
Secondary phase of disseminated intravascular coagulation |
Thrombi formation activates the fibrinolytic system which then goes through breaking clots down. This produces anticoagulant effects causing blood to lose ability to clot |
|
Bleeding is the first symptom |
Disseminated intravascular coagulation |
|
Cyanosis, tissue necrosis from clots blocking areas, pulmonary emboli, ards, EKG changes, oliguria from blocking of urine outflow |
Thrombosis related to disseminated intravascular coagulation |
|
Prolonged PT and PTT, platelet counts decreased, D-dimer elevated |
Disseminated intravascular coagulation |
|
Specific to fibrin breakdown, blood should not normally have detectable levels of this it shows fibrinolysis occurring |
D-dimer |
|
This is essential to reversal of disseminated intravascular coagulation |
Treat the underlying cause |
|
Blood products used for treatment of disseminated intravascular coagulation |
Platelets for thrombocytopenia Cryoprecipitate fresh frozen plasma for clotting factors |
|
What medications may be used in treatment of disseminated intravascular coagulation |
Anticoagulants such as Heparin and Lovenox to prevent new clots from forming |
|
Three pharmacologic therapies for disorders of hemostasis |
Anticoagulants Anti platelets Hematopoietic growth factors |
|
Disrupt the clotting Cascade and in doing so supresses the production of fibrin. Enhances activity of antithrombin which then inactivates thrombin and factor 10 |
Heparin |
|
Not given PO due to molecules being too large to pass through membranes |
Heparin and Lovenox |
|
Rapid acting and available in subcutaneous or IV methods |
Heparin |
|
Uses include pulmonary emboli, dialysis, after a stroke, prophylactic from surgery , DVT |
Heparin |
|
What must be monitored with Heparin therapy |
PTT |
|
What is a normal PTT |
30 to 40 |
|
With Heparin therapy how do we want PTT |
1 1/2 to 2 1/2 times normal |
|
What is the antidote for heparin |
Protamine sulfate |
|
Loading dose calculation for heparin |
80u/kg IV push |
|
Rate for maintenance dose of Heparin |
18u / kg / HR |
|
How is heparin dosed |
In units per kilogram per hour |
|
In calculating Heparin drip dosing the pharmacist uses what |
adjusted body weight |
|
Made of shorter molecules but just as effective as heparin |
Lovenox |
|
Half-Life is longer so it can be given on a fixed dose schedule |
Lovenox |
|
You do not have to monitor PTT with this medication |
Lovenox |
|
Can be given at home |
Lovenox |
|
Given subcutaneously dosed per patient wait |
Lovenox |
|
Prevention and treatment of DVT is frequently used post-op. It is now the first line therapy in prevention of DVT |
Lovenox |
|
What is the antidote for Lovenox |
Protamine sulfate |
|
Only given po, take several days to develop Peak effects |
Warfarin |
|
Good for long-term prophylaxis of clot formation |
Warfarin |
|
This medication antagonizes vitamin K there by suppressing coagulation |
Warfarin |
|
What must be monitored with Warfarin treatment |
PT and INR, monthly if stable |
|
What is the antidote for Warfarin |
Vitamin-k |
|
International normalization ratio |
INR |
|
An order for Coumadin is usually only good for 24 hours in the hospital |
True |
|
Usually given around 5 p.m. in the hospital to give time for labs, orders and pharmacy |
Coumadin |
|
It is important to know that some foods such as leafy dark greens interact with this medication |
Warfarin |
|
What is a normal PT |
11 to 12.5 |
|
Therapeutic range for PT with Warfarin use |
One and a half to two times normal |
|
What is a normal INR |
1.3 to 2.0 |
|
Therapeutic range for Warfarin therapy of an INR |
2 to 3 |
|
List two newer anticoagulants on the market |
Pradaxa and Xarelto |
|
As effective as Coumadin without the need to monitor INR or adjust the dose |
Pradaxa |
|
Very expensive medication, must remain in original package until use! |
Pradaxa |
|
No antidote available |
Pradaxa |
|
No INR monitoring required with these two newer anticoagulant |
Pradaxa and Xarelto |
|
Both these medications inhibit platelet aggregation and are used for Peripheral arterial disease |
Plavix, pletal |
|
Take 30 minutes before or two hours after meals |
Pletal |
|
Avoid grapefruit juice |
Pletal |