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Thrombocytopenia is a decrease in the number of platelets. Peptic ulcers and hemorrhoids are Higher risk r / t bleeding. Give Iron pills (don't give with calcium), teach how to eat with iron, anemia abnormally low circulating RBC or hemoglobin.
Thrombocytopenia is a decrease in the number of platelets. Peptic ulcers and hemorrhoids are Higher risk r / t bleeding. Give Iron pills (don't give with calcium), teach how to eat with iron, anemia abnormally low circulating RBC or hemoglobin.
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Thrombocytopenia is a decrease in the number of platelets. Peptic ulcers and hemorrhoids are Higher risk r / t bleeding. Give Iron pills (don't give with calcium), teach how to eat with iron, anemia abnormally low circulating RBC or hemoglobin.
Copyright:
Attribution Non-Commercial (BY-NC)
Formati disponibili
Scarica in formato DOCX, PDF, TXT o leggi online su Scribd
○ N145 renal failure, fever, and neuro • Case #1 abnormalities. May result from platelet- ○ Mr. Jones has been on Heparin therapy as a aggregating substances (molecular result of his recent atrial fibrillation substances that naturally occur). ○ For your info: Test - Platelet count, episode. He develops purple discolorations of the skin. anticipate an order to stop heparin and get ○ What might be causing this? a bag o' platelets. May give lovenox. Avoid needlesticks, leaving BP cuff on. Initiate • Bleeding into skin tissue, not clotting falls precautions, avoid injury. well, therefore thrombocytopenia • Case Study 2 • Thrombocytopenia ○ Mr. Larson has a history of peptic ulcers ○ A decrease in the number of platelets ○ The greater the decrease the bigger the and hemorrhoids. He is a new vegetarian (9 months) and he complains of fatigue and risk of bleeding dyspnea. He also states he has periods ○ Three causes: where he feels his heart racing. • decreased production • Fatigue and dyspnea, r/t decreased O2 • increased sequestration of platelets in from lack of iron. the spleen. • Higher risk r/t bleeding - peptic ulcers, • decreased platelet survival hemorrhoids. • Other types of thrombocytopenia ○ Give Iron pills (don't give with calcium), ○ Drug-induced thrombocytopenia teach how to eat with iron, • Produce and antigen-antibody response • Anemia (quinine, quinidine, some sulfa drugs) ○ abnormally low circulating RBC or ○ Heparin-induced thrombocytopenia hemoglobin, or both (common in hospital) ○ results in diminished oxygen-carrying • Immune reaction, antibody-platelet capacity complexes are made, activation of ○ Related to: other platelets, thrombosis. • excessive bleeding ○ Immune thrombocyticytopenic purpura • destruction of RBC’s • Autoimmune platelet antibody • deficient production of RBC’s formation and excess destruction of platelets. • Types of Anemia’s ○ thrombotic thrombocytopenic purpura ○ Blood Loss Anemia • Acute (not tolerated as well) or Chronic • Chemo can alter RBC, WBC (don't want ○ Hemolytic Anemias: premature destruction infex) of RBC's. • Considerations: Neutropenic diet (no • Transfusion reactions fresh fruits/vegies, must be cooked • Mechanical injury well, pasteurized), no flowers, stimulate • Sickle Cell Disease WBC, universal precautions for nurses, visitors, doctors, gowns. • Types of Anemias ○ Iron-Deficiency Anemia: • Neutropenia ○ decrease in the absolute number of • Dietary deficiency, loss of iron in leukocytes in the blood bleeding, or increased demands. Iron is ○ usually a decrease in the number of component in heme, low levels neutrophils decrease hemoglobin synthesis, impair ○ Causes: O2 delivery. ○ Megaloblastic Anemias: • decreased neutrophil production • Vitamin B-12 Anemia • accelerated utilization or destruction B12 is essential for RBC • shift from the blood to the tissue maturation; deficiency leads to compartments large, immature RBC's with a short • Acquired Neutropenia life span. ○ Autoimmune Neutropenia • Folic Acid-Deficiency Anemia • Antibodies against the neutrophils or Folic acid is essential for RBC the bone marrow. Can be primary maturation; deficiency leads to (childhood) or secondary (related to large, immature RBC's with a short other autoimmune process, RA, lupis). life span. ○ Infection-Related Neutropenia ○ Aplastic Anemia • Affect either auto-antibody production • A disorder of the stem cells in the bone or infects bone marrow and marrow. Bone marrow can't replace the splenomegaly. Common in AIDS. RBC's. ○ Drug-Related Neutropenia • Case 3 • Mostly seen with chemotherapy- ○ Ms. Sally is receiving radiation and induced neutropenia. chemotherapy for her Stage IV breast CA. • Clinical Course ○ She has a CBC, why are these lab results ○ Mild to Moderate important? • Mild Skin Lesions • Stomatitis (mouth sores) •Pharyngitis (inflammation of pharynx) • intermediate or fast growing: also have • Diarrhea constitutional symptoms of fever, night ○ Severe sweats, or weight loss. • malaise • Hodgkin Lymphoma • fever ○ Reed-Sternberg cells multiplying in affected
• chills lymph node
○ Usually arises in a single node or chain • weakness ○ cause is unknown, generally poor • fatigue prognosis. ○ painless enlargement of a node or group of Cancers nodes • Lymphoma ○ Usually occur above waist, often picked up ○ malignancies that arise from the peripheral on Xray lymph tissues ○ other symptoms (fatigue, anemia) indicate ○ Both forms involve: disease spread • uncontrolled lymph node and tissue • HIV growth ○ A retrovirus that destroys the body’s • bone marrow involvement immune cells, takes over and destroys the • constitutional symptoms (fever, CD4 T-cells (Thelper cells) fatigue, weight loss) ○ Transmission: sexual contact, blood-to- • Non-Hodgkin Lymphoma blood contact, pregnancy perinatally. ○ cause is unknown ○ HIV infected person is infectious even when ○ Either a T cell or B cell neoplasm no symptoms are present. (window period) • Within each it is either fast growing • Phases of HIV Infections (notice lymph node enlargement, fever, ○ Primary Infection Phase: night sweats) or slow growing • An acute mono like illness. (fever, (insidious, not noticed) fatigue, malaise, myalgias, sore throat, ○ usually originates in the lymph nodes but night sweats, GI problems, can originate in the lymph tissue lymphadenopathy, maculopapular rash, ○ clinical manifestations depend on the type HA). of lymphoma • Increased viral replication decreased • slow growing: painless CD4 T-cell count. Appears 1-4 weeks lymphadenopathy after exposure; lasts 7-10 days. Then CD4 count drops to lower level and • HIV associated neurocognitive maintains for years. disorders • Try to catch at this point for more Impaired attention and chances to address illness. concentration, slow mental speed ○ Chronic Asymptomatic or latent phase: and agility, slow motor speed, • CD4 count drops gradually. Some apathetic behavior. people have lymphadenopathy. This • Toxoplasmosis (not as common now, phase lasts for about 10 years. once was) ○ AIDS phase: Parasitic infection (opportunistic), • CD4 count very low or the development affects the CNS. (fever, HA, of an AIDS-defining illness. Without confusion, lethargy, visual treatment this phase will lead to death disturbances, and seizures) in 2-3 years. High risk for opportunistic • Progressive Multifocal infections. Leukoencephalopathy Demyelinating disease of the white • Clinical Course ○ Opportunistic Infections: matter of the brain. Caused by a virus. (progressive limb weakness, • May be fungal, bacterial, parasitic, subtle changes in mental status, viral, etc. hemiparesis, ataxia, diplopia, and ○ Respiratory Manifestations seizures) • P. jiroveci pneumonia (aka • Clinical Manifestations Pneumocystic carinii pneumonia) ○ Cancers and Malignancies Inhaled pathogen from soil, opportunistic (normally not an • Kaposi Sarcoma issue with healthy individuals) Malignancy of the endothelial lining • Mycobacterium tuberculosis of the small blood vessels. Lesions This is the leading cause of death in the skin, lungs, and GI tract in HIV patients worldwide. • Non-Hodgkin Lymphoma Becoming resistant to treatment. • Noninvasive cervical and anal • Clinical Course carcinoma: HPV ○ Gastrointestinal Manifestations ○ Wasting Syndrome • Esophageal candidiasis, CMV infection, • Involuntary weight loss >10%, diarrhea herpes simplex virus. Also diarrhea and >2x's a day, chronic weakness, fatigue. gastroenteritis. ○ Nervous System Manifestations