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Go to www.khanacademy.org
Then click on "Science", then "Health & Medicine".
"What is Anemia?" 4:14
"Anemia Pathophysiology" 10:19
"Microcytic, Macrocytic, & Normocytic Anemia" 5:57
"Anemia of Chronic Disease" 6:19
"Chronic Disease vs Iron Deficiency" 5:29
"Iron Deficiency and Anemia of Chronic Disease "Treatment" 6:13
White White blood cells are also called what ?
What are WBC important for?
Increased levels are associated with infection, inflammation, auto immune disorders & leukemia
Decreased levels may indicate prolonged infection or bone marrow supression
WBCs are broken down into different %'s .... neutrophils 50-70% (largest % of WBC) active phagocytes that eats infection, 1st on scene; what is lifespan and why is it important?
~ 10hr —
important for cancer treatment side effects & nadirs.
lifespan ~ 10 days
Unique RBC shape increases surface area of cells which allows them to pass through very small capillaries without disrupting the cell membrane.
Body normally recycles amino acids and heme after RBC breakdown for re-use in new RBC production.
If increased lysis (abnormal breakdown) or impaired liver function, heme is converted to bilirubin & can accumulate in serum, causing what?
or altered Hgb content or structure what happens?
How long is the duration of the erythropoiesis process (RBC production) from pluripotent stem cell to mature erythrocyte?
1. What is a reticulocyte ?
2. Why would the #'s be ↑ ?
What do you think happens to folks Hgb levels with COPD or other perfusion problems?
What happens to folks with kidney disease or renal failure?
inadequate RBC production
or ↑ RBC destruction
Table 42-1, Iggy, p. 870 - Common Causes of Anemia.
Chart 42-1, p. 871 - Manifestations of Anemia
Acute blood loss—If there is enough stored iron, recovery of RBC, Hgb, Hct within 3-4 wks. Circulating RBC’s are normal size and shape (normocytic)
Chronic blood loss—RBC’s become microcytic (small) and hypochromic (pale), due to depletion of iron stores.
Excessive iron loss resulting from chronic bleeding is the usual cause of iron deficiency anemia in adults.
What are some chronic bleeding reasons?
pregnancy and lactation
2/3 of adult iron is stored where?
1/3 is stored where?
When Iron is low, Iron stores depleted first, then what next?
Signs & Symptoms of Iron Anemia—
1.What will the skin look like?
3. Mouth ?
5. How will the pt feel?
1. ↑HR and ↑RR - in attempt to ↑cardiac output and tissue perfusion.
2. Angina (chest pain d/t ↓ perfusion of O₂ to myocardium
3. exercise intolerance; fatigue, dyspnea on exertion (DOE), and night cramps
1. bone pain. (marrow gets packed with RBCs until released)
2. Cerebral hypoxia can cause H/A, dizziness, and dim vision.
*Heart failure can develop in severe anemia.
Iron absorption is enhanced by what ?
inhibited by what ?
2. cook in iron skillet
Only 5-10% of dietary iron is absorbed.
FeSO4 (Iron) supplements commonly used. When should you take Iron supplements?
1. Intrinsic factor
a substance secreted by gastric mucosa to facilitate absorption of B12 in ileum. W/O intrinsic factor, B12 cannot be absorbed.
2. resection of stomach or ileum, chronic gastritis, or loss of pancreatic secretions, diverticula, chronic diarrhea, tapeworm, overgrowth of intestinal bacteria
These cells undergo improper DNA synthesis and increase in size. This type of anemia is called megaloblastic or macrocytic anemia bc of the large size of these abnormal cells.
Note: Also become misshapen (oval, not concave) & have thin, fragile membranes that shorten their lifespan & make them unable to carry adequate oxygen to tissues.
smooth, sore, beefy red tongue (Glossitis)
Pallor & jaundice
fatigue and weight loss
nasal spray (Calomist)
Green leafy vegetables,fruits,
cereals and meats, liver, yeast, dried beans, nuts—absorbed from the intestines.
* Also a supplemental replacement if needed
Pregnant women are at high risk for folic acid anemia due to the increased need for baby.... What are some things that can go wrong?
Fractures of long bones, ribs, and vertebrae can occur from marrow expansion and thinning from ↑ erythropoiesis
Bone marrow transplant
2.Acquired; could be from longterm exposure to toxic agents, ionizing radiation, or infection.
Immunosuppressive drug therapy
Bone marrow transplant
—See Table 41-3 (Iggy pg862)—
jaundice; causing large amounts of bilirubin to release into the blood
Symphony of science on cellular regulation :
it will take you to YOU TUBE
Symphony of Science, “The Unbroken Thread”
“Every cell is a triumph of natural selection…..We are each of us--a multitude.”
2. Nucleolus inside nucleus
1)Limited cell division,
2)Apoptosis—Programmed death; cells are “mortal”,
3)Small nucleus (less)/cytoplasmic Ratio (more)
4)Specific Differentiated Funcs.—specific purpose
5)Tight adherence to neighbor Cells Fibroconectin
7)Well-regulated and orderly growth
8)Contact Inhibition - ”Don’t getclose to my bubble.”
9)Euploidy—”eu” means “easy”, or “good”, (opposite of “dys”); normally 23 pairs of chromosomes (46 total)—22 pairs of autosomes and 2 sex chromosomes (X,Y). Autosomes are all chromosomes not involved in sex determination.
1. What is enlargement of cells, which increases tissue size, as BPH, or increase in functional activity, as muscle cells in athletes?
2. What is an increase in number or density of normal cells, in response to metabolic demands, ↑ hormonal levels, or stress. Normal DNA control; reversible. (like gingival hyperplasia—side effect of some meds)
Invasive is the key word!
Cancer is uncontrolled growth and spread of abnormal cells.
Can affect any body tissue.
Serve NO useful purpose
What are the number 1 & 2 causes of death in the US?
KNOW THE 3 TOP CANCERS IN INCIDENCE (New Cases)
IN BOTH MEN & WOMEN IN ORDER!
KNOW THE TOP 3 CAUSES OF CANCER DEATH IN BOTH
MEN & WOMEN IN ORDER!
Approximately how many women in the U.S. will develop cancer over her lifetime.?
KNOW THIS ....
WHO has LESS INCIDENCE OF BREAST CANCER, BUT ARE ~28% MORE LIKELY TO DIE FROM IT?
The first step in carcinogenesis where proto-oncogenes are turned back on to encourage uncontrolled growth & apoptosis (which was normal activity for embryonic cells)—damage to genes that was not repaired or had defective repair—suppressor genes turned off and genes that should stay quiet are turned on (expressed).... What is this step and what is the most important thing to remember?
**Ectopic hormone production—ADH, ACTH, insulin, PTH
**Angiogenesis—creation of their own blood supply
**Vascular permeability—enzymes destroy basement membranes to eliminate physical barriers to invasion by “lysing” blood and lymph vessels & normal tissues
Formation of secondary tumors
Extension into surrounding tissues
Blood vessel penetration
Release of tumor cells
Invasion—ability to overtake adjacent tissue
Local seeding—shed into cavity, as ovarian to peritoneum; possibly from surgical instruments as malignant tumors are resected.
(See Table 23-3, Iggy) Only about 1 in 1000 cells escapes immune detection, but tumor the size of the end of your little finger (~ 1 cm) can contain 10 billion cancer cells. Impaired immunity can play a major role in development of metastatic disease
1. 5-10%; hereditary component
2. #1 Risk Factor! 76% of cancer cases in those >55. P. 405, Iggy. Children account for < 1%
3. breast ↑in women, prostate & bladder ↑ men.
4. Inadequate access to healthcare could be controllable, but often is not w/o interventions
5. epinephrine & cortisol exposure in the longterm can impair immune surveillance. Depression that is chronic / associated with multiple continuous losses can lead to hopelessness which can eventually depress immune responses.
6. Some food genotoxic (nitrates in preserved meats and pickled, salted foods.) High fat, low fiber diet associated with colon, breast, and sex hormone-dependent tumors. Fish and meat fried excessively or charred can lead to breast, colon, liver, pancreas, and bladder cancers. Red food dyes, saccharin sweeteners, and coffee may increase risks. (For coffee, jury still out. New studies are showing that coffee has multiple antioxidants, and so does tea!)
—Chart 23-1, Iggy, p. 404.
11. Tobacco -Length and intensity of exposure are key, including second-hand smoke. Weak initiator, but strong promoter. All forms of tobacco are carcinogenic. (Table 23-7, Iggy)
12. Alcohol Use—Cancer promoter by enhancing contact between cells and carcinogens to which they are exposed. People who both smoke and drink excessively have an even higher risk for oral, esophageal and laryngeal cancers.
13. Recreational Drug Use—May promote unhealthy lifestyle nutritionally and may act as promoters due to suppression of immune system. Marijuana causes chromosomal damage which over time may result in cancer-causing mutations. Also more injurious to lung tissue when smoked.
Some viruses, which damage cells and induce hyperplastic cell growth have been associated with certain types of cancers. Most people’s bodies can suppress progression to malignant cells.
What virus is associated with cervical, penile, anal/rectal, head & neck cancers?
KNOW THIS! Primary prevention—keeping cancer from occurring at all!
*Avoidance of known carcinogens—sun, tobacco, asbestos, alcohol, high fat and/or low fiber diet, multiple sexual partners.
*Removal of at risk tissues
Cells and tissues--samples from needle or excisional biopsy, exfoliated cells (cervical smear or bronchial washings), collections of secretions (sputum), aspiration of fluid from body cavities (pleural, CSF), or blood analysis can only be examined for differences from the parent tissue, How?
(Table 23-4, Iggy. Don’t need to memorize, but know prefixes and meanings in this slide.)
1. This classifies solid tumors and refers to size of tumor and extent of disease. The higher the # the more extensive the disease. What is this called?
2. This determines the level of functional maturity (differentiation)—how malignant or aggressive the tumor is—how close it is to the tissue of origin. The higher the # the worse the prognosis and the more difficult to treat. What is this called?
1. What is Doubling Time ?
2. What is the Mitotic Index?
the larger the %, the more aggressively the tumor is dividing and the greater the growth rate of the tumor / small (or oat) cell carcinoma of the lung and some lymphomas and leukemias divide very rapidly.
Once in the blood, How many will escape immune detection?
But that can be enough. Undetected cells move out of the blood, again secreting enzymes & cutting through the vessel wall into new tissue. Tissue selected for establishing a new tumor may be downstream from the original tumor, or a chemical attraction may cause the malignant cells to target a specific site (chemotaxis).The malignant cells multiply & establish a new site metastatic tumor.
The only factor where it’s good to be “high” is in the level of what?
undifferentiated (unlike tissue of origin, low or nonexistent functional maturity), which is high grade; rapid doubling time, and high mitotic index. WORST CASE SCENARIO
Complementary Health Practices
Regular developmental assessment of children during treatment for cancer (standardized tool, as Denver Developmental Screening Test if <6.) Observe for developmental milestones and signs of regression. Refer to neuropsychologist if problems develop.
In childhood cancers, child and family support needs to include siblings.
Goal of cancer therapy ?
Three major treatment approaches...
What are they?
3. Chemotherapy (More appropriate to call it Pharmacotherapy, to include biologic, targeted, and hormonal therapies as well as cytotoxic meds)
Surgery to remove diseased tissue is oldest form of cancer treatment—sometimes curative.
1. What does Prophylactic mean?
2. What does Diagnostic mean?
3. What does Curative—
~ 50% of cancer patients receive radiation therapy (RT)
Localized treatment—aimed directly at tumor and confined to that area.
Modern equipment minimizes “scatter” to other regions and organs.
May follow surgery to kill any cancer cells left behind after excision of tumor.
exposes cancer cells to tremendous energy, resulting in cell destruction or interference with cell division?
Intensity of radiation exposure decreases with the distance from the source.
If 4 ft away from source, intensity is 1/16 of intensity at 1 ft from source. Important if any sort of radiation leakage accident (with radioactive cargo during transport) RT or X-ray accident, or trauma to facility or damage to its safety mechanisms)
“Fibrosis” on CXR. Acute phase, may use steroids, as with COPD, to ↓ inflammation, then taper. Nursing Diagnosis: Impaired Gas Exchange if ABG available & pH abnormal, or if O2 sats below ~90-92%, usually.
Three general purposes of chemo
1. Cure or increased survival
2. Palliation - explain?
3. Prophylaxis - explain?
Nitrogen Mustard (Mechlorethamine), as a result of hematologic side effects from use as chemical warfare agent in WWI. A toxic effect was to decrease or arrest cell proliferation in bone marrow, where blood cells are produced. Led scientists to research whether it would decrease abnormal cell proliferation in cancer patients. Took 32 years for approval, after first used as weapon in 1917.
Nursing interventions for flu-like syndrome
Remember what 4 words when planning interventions for biologic therapy-induced flu-like syndrome! (Interferons)
CYTOTOXIC THERAPY -
DAMAGES DNA IN SOME WAY, DIRECTLY CAUSING CELL DEATH / INTERFERING WITH CELL DIVISION—CELLS THAT ARE DIVIDING ARE MUCH MORE SENSITIVE TO CYTOTOXIC EFFECTS OF CHEMO. NORMAL CELLS THAT ARE MOST SENSITIVE TO CHEMO ARE THOSE THAT UNDERGO FREQUENT OR RAPID CELL DIVISION (HEMATOPOIETIC CELLS IN BONE MARROW, SKIN, MUCOUS MEMBRANCES, GI TRACT, HAIR, REPRODUCTIVE CELLS).
When does this become an ethical issue?
Do know the concept that multi-drug (combination) therapy is often necessary for what?
This involves the client regaining strength; recovering from surgery, radiation therapy, or chemotherapy, learning to live with an altered body part or appliance, and recovery from associated psychologic and emotional issues. May involve PT, OT, speech therapy, job retraining, direct nursing care and teaching. What is it ?
1.What is the most common cancer among children ages 0-14 years and comprises approximately 30% of all childhood cancers?
2.What is the most common form?
3. What is the second most common incident of cancer in both boys and girls?
Leukemia also accounts for the most cancer deaths in children, comprising roughly a third of cancer deaths among boys and girls 0-14 years. Cancers of the brain/other nervous system are the second leading cause of cancer death in children 0-14.
What is the #1 cause of death in children?
NAME THE AGE GROUP:
1)—unaware of severity; must deal with issues such as pain, separation from home, family
2) —beginning to understand; may believe they caused illness by “bad” behavior; may wonder why parents can’t/won’t make it go away.
3) can understand cancer diagnosis.
4) find peer contact reassuring, supportive.
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