NUR 405 EXAM 3
- Polycythemia
-Increased RBCs (hyperviscosity) Causes
-JAK-2 mutation (primary) -Hypoxia (secondary) -s/s SOB, fatigue, dizziness, HA, pruritis, facial flushing, nosebleeds, gum bleeds, abdominal fullness (blood clogged in liver/spleen), thrombosis
- Primary Polycythemia
-Results from JAK-2 mutation
-Increase in RBCs, WBCs, and platelets
- Secondary Polycythemia
-Hypoxia
-RBCs increased (WBCs and platelets normal)
-Appropriate response
high altitudes, COPD, HF, heavy smoke inhalation 1 / 4
-Inappropriate response Answer
excess erythropoietin (kidney disease, tumor)
- Polycythemia Dx
-CBC (RBCs greater than 6,000), HCT (greater than 48% in F and 52% in M), Hgb (Greater than 16.5 in M and 16 in F), bone marrow bx, genetic tests
- Polycythemia management
-Main goal
reduce hyperviscosity
-Tx
-Primary
therapeutic phlebotomy, chemo/radiation (bone marrow suppressants), antiplatelets (low dose aspirin) 2 / 4
tx cause
- Therapeutic phlebotomy
-Treatment for polycythemia (removes RBCs, not WBCs or platelets)
-1 unit of blood is removed weekly until HCT is less than 45% -Provides immediate relief/improvement -MONITOR IRON (can cause anemia and may need supplements)
- Polycythemia teaching
•s/s of thromboembolic events (PE, MI, CVA), bleeding precautions (soft toothbrush, electric razor), exercise, elevate legs, avoid tight cloth- ing, increase fluids (3L/day unless contraindicated), small, frequent meals
- Polycythemia complications
-MI, CVA, PE, GI hemorrhage
- Thrombocytopenia
-Low platelets (less than 150,000) 3 / 4
-3 types Answer
SUBSCRIBE
ITP, DIC, HIT
-s/s
bruising, petechiae, bleeding from nose and gums, GI bleeding, hematuria
- Idiopathic Thrombocytopenic Purpura (ITP)
-antiplatelet antibodies
-Causes
infection, cancer, sulfa meds, autoimmune conditions (lupus)
-Decreased bone marrow production or increased destruction
-RF
African, obesity, F (15-40)
- Disseminated intravascular coagulation
- / 4