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men: 13.5- 18 g/dl
women: 12-16 g/dl
men: 4.5-6.0 million/cubic
women: 4.0-5.0 million/cubic
<100,000 indicate thrombocytopenia
<20,000 may result in spontaneous hemorrhage
<5,000 usually indicates massive hemorrhage
weakened stomach lininc (atrophic gastritis);
An autoimmune condition in which the body's immune system attacks intrinsic factor protein or the cells that make it.
-cardiopulmonary changes (resting or activity): result from additional attempts by the heart and lungs to provide adequate amounts of O2 to the tissues.
-increased HR and stroke volume
-low viscosity of blood >> systolic murmurs and bruits
-extreme cases: angina pectoris, MI may occur if MI O2 needs cannot be met
-HF, ascites, peripheral edema (if heart is overworked for extended period of time).
-integumentary changes: pallor, jaundice, pruritus
pallor: due to reduced amounts of HGB and reduced blood flow to skin.
Jaudice: hemolysis of RBCs results in an increased concentration of bilirubin
Pruritus (itching): due to increased serum and skin bile salt concentrations.
-iron is best absorbed in the duodenum and proximal jejunum, therefore coated or sustained release capsules (which are digested further down in the GI tract) are counterproductive and expensive.
-should be taken 1hr before meals b/c iron is best absorbed in an acidic environment.
-iron is best absorbed as ferrous sulfate in an acidic environment. taking with vit-C or Orange juice can enhance iron absorption.
-undiluted liquid iron may stain pts teeth (should be diluted and given through straw).
-daily dosage should provide 150-200 mg of elemental iron (this can be ingested 3 or 4 daily doses).
GI s/e may occur: heartburn, constipation, diarrhea.
-black tarry stool, may need to use laxative or stool softener to relieve constipation.
-elevated hgb and RBC count with microcytosis
-low to normal EPO level (2dary will have high level)
-elevated WBC count with basophilia
-elevated platelet count (thrombocytosis) and platelet dysfunction
-elevated leukocyte alkaline phosphate, uric acid and combalamin levels
-elevated histamine levels
-directed towards reducing blood volume and viscosity and bone marrow activity.
-phlebotomy is the mainstay of treatment; reduce hct <45-45% at time of diagnosis 300-500mL blood may be removed every other day until hct reduced to normal levels.
-hydration therapy, myelosuppressive agents (hydrea, myleran, alkeran, gleevec)
-new target therapies
-interferon (a women child bearing age)
anagrelide may be used to reduce platelet count and inhibit aggregation.
-major component of the RBC
-contains heme (iron and porphyrin) which gives blood its color when O2 attached
-contains globin (a protein)
-measurements help to indicate severity of anemia or polycythemia
-low: anemia, hemorrhage
-low RBC: anemia, fluid overload, recurrent hemorrhage, leukemia
-high RBC: dehydration, polycythemia, acute poisoning
-low WBC: indicates bone marrow depression
-high WBC: indicates infection, leukemia or tissue necrosis
-platelets: <100K indicates thrombocytopenia, <20k indicates possible spontaneous hemorrhage, <5k indicates massive hemorrhage, low: risk for bleeding and HIT antibody
-tests measure quantity, not quality
perform a thorough history and physical assessment. because atherosclerosis is a systemic disease, look for signs of coexisting cardiac, pulmonary, cerebral, and/or lower extremity vascular problems.
Monitor the pt. for signs of aneurysm rupture, such as diaphoresis, pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain; changes in LOC, or pulsating abdominal mass.
-tenderness to pressure over involved vein.
-induration of overlying muscle.
-may have mild to moderate pain
-deep reddish color to area due to venous congestion; warmth.
-localized platelet aggregation and fibrin entrap RBCs, WBCs, and more platelets to form a thrombus.
-frequent locations include valve cusps of veins where venous stasis occurs.
-as the thrombus gets bigger more blood cells and fibrin collect behind it, producing a larger clot with a "tail" that eventually occludes the lumen of the vein.
-if a thrombus only partially occludes vein, endothelial cells cover the thrombus and stop the thrombotic process.
-if the thrombus does not become detached, it undergoes lysis or becomes firmly organized and adherent within 5-7 days.
-blood components are usually administered with at least a 19 gauge needle
-verify venous patency before
-do not use give any additives (including meds) via the same tubing as the blood unless the tubing is cleared with saline solution
-positive identification of the donor blood and recipient must be made (some hospitals require dual-checking system)
-follow the policy and procedure at your place of employment
-make sure the patient understands the procedure and the s, sx. to report, and that he/she agrees witht he treatment plan.
-take pt's VS before and beginning transfusion so you have a baseline measure (if abnormal VS:fever, call doctor to clarify when the blood can be administered)
-blood should be administered as soon as its brought in unit (dont refrigerate)
-if blood is not used within 30 minutes, it should be returned to the blood bank
-during 1st 15 min. or 50ml you should remain with the patient (in case of reactions)
-rate of infusion should be no more than 2ml/min (PRBCs should not be infused quickly unless there is an emergency)
-after the first 15min. retake VS
-med given via injection into a vein or under the skin (SQ) as directed by doctor. do not inject med into a muscle b/c of increased risk of hematoma.
-HIT: heparin induced thrombocytopenia
-most important risk factor is smoking
-s/sx: intermittent claudication (when pt. exercises).
-stop smoking, drug therapy, exercise, nutritional therapy, goes undiagnosed in DM.
-most common in femoral and femoral popliteal
-buerger's sign: leg elevation pallor, rubor on dependent position
-complications: delayed wound healing, wound infection, tissue necrosis, non-healing ulcers and gangrene.
progressive narrowing and degeneration of peripheral arteries
-chronic PAD is primarily caused by atherosclerosis
-classic sx: intermittent claudication, ischemic muscle pain precipitated by consistent level of exercise, resolves with rest; reproductible
-attributed to lactic acid accumulation
-paresthesia, impotence, decrease in pulses, hair loss on legs, buerger's sign, leg elevation pallor, rubor on dependent position, pain at rest is a sign of severe ischemia and is present as the atherosclerosis progresses.
force of blood against the walls of blood vessels, created by circulating blood through arteries, veins, and the chambers of the heart.
increase HR (chronotropic); increase contractility (inotropic); increase speed of conduction (dromotropic).
controls sodium excretion and fluid volume.
epinephrine and norepinephrine secreted by the adrenal glands.
-maintain adequate anti-coagulation
-goal of coumadin is to mantain adequate anti-coagulation to prevent thrombotic complications. Started prior to discontinuing heparin so adequate levels are achieved before heparin is stopped.
-vitamin K is the antidote for warfarin.
a calculated value which accounts for the sensitivity between reagents and instruments. Goal depends on reason for anticoagulation; is usually an INR of 2-3
-weekly lab tests needed.
-eyebrows and eyelashes: graying of eyebrows, eyelashes
-eyelids: excessive upper lid skin
-conjunctiva: pinguecla (small yellow spot on medial aspect of conjunctiva).
-sclera: color, yellowish.
-cornea: decreased corneal sensitivity and corneal reflex, blurring vision, loss of corneal luster.
-lacrimal apparatus: dryness, tearing, irritated eyes.
-iris: decreased pupil size, slower pupil recovery, iris color change, decrease in near vision and accomodation.
-lens: cataracts, presbyopia, glare, noc vision impaired, yellow color of lens.
retina: loss of central vision, decreased visual acuity.
-vitreous: increase floaters.
characterized by IOP and the consequences of elevated pressure, optic nerve atrophy, and peripheral visual field loss. largely preventable with early detection and treatment; increased risk with age.
-balance between rate of aqueous production (inflow) and rate of aqueous reabsorption (outflow); place where outflow occurs is the "angle".
-history and physical examination
-visual acuity measurement
-slit lamp microscopy
-visual field perimetry
-IOP is elevated in glaucoma (10-21 mm Hg).
correct aplication of antibiotic and steroid eye drops. importance of avoiding activities that increase intraocular pressure. the principles of hand hygiene when cleaning eye. Eye shield at night may improve comfort.
-notify surgeon for increased redness or drainage, or intense pain.
painless loss of peripheral or central vision
-bleeding (internal/external), nose bleeding, oral bleeding.
-petechia, purpura, ecchymosis
-weakness, fainting, dizziness
-evaluate 6 p's
-normal lymph structure is destroyed by hyperplasia of monocytes and macrophages.
-an increase in malignant, large, multinucleated cells called reed-sternberg cells occurs.
-believed to arise in the lymph nodes (90% of patients) and then spread to adjacent tissues; eventually infiltrates other organs (lung, spleen, liver).
-2/3 patients cervical lymph nodes are the first to be affected .
-infection with Epstein-Barr virus (EBV)
-exposure to occupational toxins
-increased incidence with HIV patients ( it is not considered an AIDS neoplasm/abnormal growth)
this occurs in people age 15-35 and 50 years and older.
-men have twice the incidence as women.
lymph tissue (spleen, bone marrow); mostly lymph node tissue. 90% originate from B cells; either B-cells or T-cells are involved.
-results from abnormal gene mutations during production, maturation or action of lymphocyte.
-no hallmark signs, however can mimic leukemia; cause unknown
-85% of all malignant lymphomas are NHLs
-age increased risk
-immunosuppressive meds (organ rejection, autoimmune disorders).
-epstein barr-virus is associated with Burkett's lymphoma.
-NHL is five times as common as Hodgkin's lymphoma.
-white have a higher risk than african american or asian; incidence is higher in men than women (1.4-1)
-average age > 50 years old.
-vaccination: annual influenza; pneumovax
-decreased exposure in high risk areas (grocery store)
ACE, ARBs, Thiazides, Ca+ channel blockers, beta blockers.
-DASH diet: grains, veggies, fruits, low fat dairy, meat poultry fish, nuts, seeds, beans, fats, and oils.
hodgkin's: peripheral blood analysis (presence of Reed sternberger cells, increased platelet count, hypoferremia, microcytic hypochronic anemia), lymph node biopsy, bone marrow biopsy, MRI, CT, PET.
-nonhodgkin's: similar to hodgkin's lymphoma, blood tests (lactate dehydrogenase- LDH ), MRI, CT, PET, lymph node biopsy, bone marrow biopsy, lumbar puncture.
-assess for pressure ulcer risk initially on admission and reassess patient every 24 hrs.
-reposition every 2 hrs.
-use devices to reduce pressure and shearing force (special mattress, foam boots, wheelchair cushions, padded commode seats, lift sheets).
-collaboration with wound care specialist, plastic surgeon, dietitian, PT, and OT.
-assess for signs of bleeding and hemorrhage (bleeding gums, nosebleed, unusual bruising, black tarry stools, hematuria, fall in hct, fall in BP).
-assess for evidence of additional or increased thrombosis.
-monitor for hypersenstivity reactions
-monitor aPTT and hct prior and periodically during therapy.
-monitor platelet count every 2 days (for HIT)
-HIT may develop on 8th day of therapy
-may cause hyperkalemia
-protamine sulfate is antidote
-most common skin cancer; least deadly
-locally invasive malignancy from epidermal basal cells
-tiddue biopsy needed to confirm diagnosis
-rarely spreads beyond the skin
-may invade surrounding tissues and be destructive
-malignant neoplasm of keratinizing epidermal cells
-pipe, cigar, and cigarette smoking are risk factors.
-biopsy performed when a lesion is suspected of SCC
-can be very aggressive, potential to metastasize
-treatment generally surgical removal
-a tumor arising in melanocytes
-melanomas can metastasize to any organ
-the most deadly skin cancer
-consult HCP if moles or lesions show any of the ABCDE signs
-risk factors include UV radiation; skin sensitivity; high number of moles; genetic, hormonal, and immunologic factors; and sun exposure.
-clinical manifestations: 1/4 occur in existing nevi or moles.
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