test 1

• Hemoglobin(hgb) levels:

  • Male 14-18 (g/dl)
  • Female 12-16 (g/dl)
  • Low< 6.0
  • High > 20.0
• Iron Deficiency Anemia Etiology:

  • Inadequate dietary intake
  • Menstruation/pregnancy increase
  • Malabsorption
  • Diseases or surgery that alter, destroy, or remove absorption surface of this area of intestine cause anemia
  • Blood Loss
  • Chronic blood loss common in GI and GU systems
  • Postmenopausal bleeding, chronic kidney disease, and dialysis may contribute
• General manifestations of anemia:

  • Dyspnea
  • fatigue
  • pallor
  • palpitations
  • dizziness
  • Pallor(most common sign)
  • Glossitis(second most common sign)
  • Cheilitis
• Glossitis: Inflammation of the tongue
• Cheilitis: Inflammation of lips
• Iron-Deficiency Anemia Diagnostic Studies

  • Stool occult blood test
  • Lab findings: Hgb, ferritin, serum iron
  • Endoscopy and colonoscopy
  • Bone marrow biopsy
• Interprofessional and Nursing Management(iron deficiency anemia):

  • Replace Iron
  • Nutritional therapy
  • oral iron supplements
  • transfusion of packed RBC's
• Oral Iron:

  • Factors to be considered
  • best absorbed
  • Acidic environment (empty stomach/ source of vitamin C)
• Undiluted liquid iron may stain teeth and Should be diluted and drank through a straw
• Side effects of oral Iron:

  • heartburn
  • Constipation
  • Diarrhea
• Causes of Cobalamin (Vitamin B12)deficiency:

  • Surgery or chronic disease of GI tract
  • Excess alcohol / hot tea ingestion
  • Smoking
  • Strict vegetarian
  • Proton pump inhibitors/ H2 histamine receptor blockers
• Cobalamin (B12) Deficiency Clinical Manifestations:

  • GI problems
  • Sore, red, beefy and shiny tongue, anorexia, nausea, vomiting,  and abdominal pain
  • Neuromuscular problems
  • Weakness, paresthesias of feet and hands, decreased vibratory and position senses, ataxia, muscle weakness, and impaired thought processes
• Cobalamin Deficiency Diagnostic Studies

  • Macrocytic RBCs have abnormal shapes and fragile cell membranes
  • Serum cobalamin levels are low (Less than 200pg/mL)
  • Check upper GI endoscopy with biopsy of gastric mucosa to rule our gastric cancer
• Normal serum folate levels and low cobalamin levels suggest megaloblastic anemia is due to cobalamin deficiency
• Interprofessional and Nursing Management of Cobalamin (B12 ) deficiency:

  • Parenteral administration of cobalamin is treatment of choice
  • Patients will die in 1 to 3 years without treatment
  • Anemia can be reversed with ongoing treatment but long-standing neuromuscular complications may not be reversible
• Folic Acid Deficiency:

  • Serum folate level is low
  • Encourage patient to eat foods with large amounts of folic acid
  • Common causes: Alcohol use, dietary deficiency
• Serum folate level:

  • •Normal is 5 to 25 ng/mL (11 to 57 nmol/L)
• Thrombocytopenia clinical manifestations: common symptom is mucosal or cutaneous bleeding

  • Petechiae: microhemorrages
  • Purpura: bruise from numerous petechiaeEcchymoses: larger lesions from hemorrhage
  • Ecchymoses: larger lesions from hemorrhage
• Thrombocytopenia manifestations:

  • Hemorrhage may be insidious or acute
  • Internal bleeding may manifest as weakness, fainting, dizziness, tachycardia, abdominal pain, or hypotension
  • Cerebral hemorrhage may be fatal
• • Decreased Platelet count< 150,000/μL
  • Prolonged bleeding < 50,000/μL
  • Spontaneous bleeding < 20,000/μL
• Thrombocytopenia Nursing Management:

  • Discourage the use of OTC medications, especially aspirin products
  • Prevent or control hemorrhage
  • electric razor
  • Soft-bristle toothbrush
  • Avoid IM injections
  • If subcutaneous injection is unavoidable, use small-gauge needles and apply direct pressure or ice packs after
• Neutropenia Causes

  • Autoimmune disorders ex. Lupus
  • Hematologic Disorders ex. Leukemia / aplastic anemia
  • Medications ex. Chemotherapy
  • Infections ex. Viral (influenza, HIV)
• Neutropenia Nursing interventions:

  • Isolation Precautions
  • No fresh flowers or plants
  • Strict hand hygiene
  • Screen visitors (No children)
  • Monitor for s/s of infection (fever > or = 100.4 F)
  • Avoid uncooked foods
  • Good oral hygiene
• Aplastic Anemia

  • Pancytopenia (decrease in all blood cell types. WBCs, RBCs, & PLTs)
  • Fatigue, dyspnea, palpatations
  • Neutropenia & thrombocytopenia
  • Can be potentially fatal
• Acute Lymphocytic Leukemia 


  The bone marrow is making more lymphocytes than needed. Too many stem cells turn into B or T lymphocytes. As these types of lymphocytes increase in the blood and bone marrow, the healthy WBCs, RBCs, and platelets are outnumbered.
• What is a risk factor for Acute Lymphoblastic Leukemia?

  Genetic predisposition and exposure to radiation or chemotherapy
• What are the comorbidities for Acute Lymphoblastic Leukemia?


  Down syndrome, Li-Fraumeni syndrome, neurofibromatosis type 1, Bloom syndrome, ataxia-telangiectasia.
• What are the clinical presentations of Acute Lymphoblastic Leukemia?

   Fatigue, bruising easily, and fevers. Other manifestations include weight loss, night sweats, SOB, stomach or bone pain, frequent infections, and petechiae.
• Chronic Myelogenous Leukemia (CML)

  Caused by a shortened chromosome 22 and is called the Philadelphia gene
• What are leukemia's clinical Manifestations? 


  Inadequate marrow elements predispose pt to anemia, thrombocytopenia, & neutropenia
• Hodgkin Lymphoma 


  • Enlargement of cervical, axillary, or inguinal lymph nodes

  • The second most common location is a mediastinal node mass

  • Nodes are movable and non-tender

  • Not painful unless nodes exert pressure on adjacent nerves
• Non-Hodgkin’s Lymphoma Clinical Manifestations

  •Widespread disease usually present at time of diagnosis: Painless lymph node enlargement (Primary clinical manifestation and Lymphadenopathy can wax and wane)

  •Other symptoms depending on where disease is present

  •Resemble those used for Hodgkin’s lymphoma

  •Since NHL is more often extranodal: MRI, Lumbar puncture, Bone marrow biopsy, & Barium enema or upper endoscopy
• Multiple Myeloma

  • Condition in which cancerous plasma cells proliferate in bone marrow and destroy bone
  • Involves excess production of plasma cells
  • Normal plasma cells make immunoglobulins to protect the body
  • In multiple myeloma, plasma cells make monoclonal antibodies that are ineffective and even harmful
• Multiple Myeloma Nursing interventions

  • Pain control
  • Adequate Hydration
  • Prevent dehydration & M proteins from causing renal damage (Maintain urine output of 1.5-2L/day)
  • Ambulation & weight bearing
  • Reabsorb calcium
• Multiple Myeloma Clinical Manifestations & Labs

  • Skeletal pain is major manifestation
  • Pelvis, spine, and ribs
  • Diffuse osteoporosis develops: Osteolytic lesions seen in the skull, vertebrae, long bones, ribs
  • Compression of spinal cord, pathologic fractures
  • Calcium loss from bones causes hypercalcemia:
  • Leads to renal, GI, neurologic manifestations
  • Laboratory:
  • M protein found in blood
  • Pancytopenia
  • Hypercalcemia
• Anemia Nursing intervention:

  • Alternate rest and activities
  • Maximize O2 supply for vital functions
• What dietary food are high in iron? (red meats)

  Tofu, Pumpkin seeds, Fruits, Dark chocolate, Broccoli, Whole grain, Legumes, Leafy Greens
• Neutropenia infection risk:

  • ANC=1500-2000 not significant
  • ANC=1000-1500 minimal risk
  • ANC=500-1000 moderate risk
  • ANC=<500 severe risk
• HIV


  Can be transmitted through contact with certain body fluids
• Body fluids that can transmit HIV

  • Blood
  • Semen
  • Vaginal secretions
  • Rectal secretions
  • Breast milk