Exam 1 Study Guide
Blood Components
Differentiate normal and abnormal lab results. Know, RBC, HGB, HCT, WBC and differential, and platelet
values.
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Can lose 500mLs of blood without having complications
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RBC: 4.2-6.2
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Largest number of blood cells
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Lives up to 120 days
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Develop from the myeloid stem cell
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Reticulocyte= immature RBC; stay in bone marrow until mature
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Protein, iron B12, folic acid are needed to make
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HGB: 12-16g/dL; 13-17g/dL
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Direct measurement of HgB in a volume
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To form HgB must have RBC, iron, Vitamin B12, Folic Acid
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HCT: 37-48%; 45-52%
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% of blood that consists of RBC
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WBC/Leukocytes: 4,000-10,000 cells/mcL
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Protect the body from infection
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Innate and adaptive parts of immune system
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Innate: need to mature; Neutrophils, Eosinophils, Basophils, Natural Killers
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Adaptive: remember and attack in future; B-lymphocytes, T-lymphocytes
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Differential: measures the percentage of each type of WBC that is in you blood
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Shift to left
Increase in neutrophils, early and immature cells
Bandemia (increase number in immature cells)
Bone marrow is not able to keep up with demand of infection and is releasing immature cells
into circulation
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Platelet: 150,000-450,000
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Controlled by growth factor thrombopoietin
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Smallest of blood cells
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Developed in bone marrow from megakaryocytes (immature cell)
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Stored in spleen; 80% circulate; 20% stored
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Thrombocytosis >750,000= risk for clots
Identify changes in WBC, RBC, and differentials. Know signs & symptoms, pathophysiology, and
treatment associated with abnormalities of each blood component.
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Increased level of WBC; infection, inflammation, stress, neoplasms (cancer), bone marrow
disorder
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Decreased level of WBC; destruction of WBC
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Tx: Filgrastim (Neupogen)- helps stimulate bone marrow to produce more WBC
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Increased level of Platelets; leukemias, splenectomy, anemias, trauma, surgery, epinephrine,
polycythemia vera (increase in RBCs and platelets)
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Decreased level of Platelets; meds (Heparin), viral/bacterial infections, ITP, bleeding, acute
leukemia, Hemolytic anemia, malignancies, anticancer drugs
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Precautions with Thrombocytopenia when level is <100,000
No rectal meds, no NG tube
Soft bristle brush, electric razor
No IM injections
Types of WBCS
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Neutrophils
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1ST Responder to an infection, stressful stimulus, or inflammatory response
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Epinephrine, antigens, and corticosteroids stimulate neutrophils to be released
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40-80% of WBC
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1–2-day life span
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Mature neutrophils= segs, polys, PMNs
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Increased: Bacterial infection, fungal infections, inflammation, physical. Stress, tissue necrosis,
granulocytic leukemia
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Decreased: Typhoid, Tb, Viral infections, indicator of sepsis in newborn
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Immature neutrophils= bands
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Released when mature neutrophils (segs) are depleted
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Increased in bands= bone marrow is working to make WBC for the infectious or inflammation
process
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Basophils
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0.5-1% of WBCs
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Released in response to inflammatory responses
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Surface covered with IgE
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Contains Granules of
Histamine; constricts small veins and resp smooth muscle
Bradykinin; dilate arterioles and increase cap permeability
Serotonin
Heparin; prevent blood and protein clotting
Activation of basophils release the chemicals above
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Involved in immune and inflammatory responses
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Increase; inflammation, allergy, leukemia
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Decrease; stress and steroid therapy
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Eosinophils
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1-4% of total WBC
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Increase in number during allergic reactions or parasitic infections
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Contain vasoactive chemicals
Histamine, eosinophil peroxidase, lipase, ribonuclease, plasminogen
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Attach to parasites and release hydrolytic enzymes that kill parasites.
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FX: phagocytosis, help control inflammatory process and may. Participate in hypersensitive
reactions
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Increased: allergic reaction, meds, toxins, parasitic disease, Addison disease, Tumors, Chronic
skin conditions, Polycythemia, GI (ulcerative colitis and chrons) and autoimmune diseases
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Decreased: increased in adrenal steroids, Mono, CHF, Cushing’s disease, infection with
neutrophilia
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Monocytes and macrophages (mature cells)
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2-8% of WBC
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Monocytes are immature cells
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Functions
Phagocytosis-primary function
Immunological response to an antigen.
Enhance inflammation and stimulate other WBCs
Present antigens to T-cells
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Circulate in blood for 3 days
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Increase: inflammation, chronic infection, malignancy, autoimmune disease, cirrhosis, SLE,
Hemolytic anemias, Hodgkins disease, ulcerative colitis
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Lymphocytes (T and B cell)
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20-40% of WBCs
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Three types
Natural killer cells
B Cells
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Plasma cell: immunoglobulins memory cell
T cells
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CD4 or helper t cell
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CD8 or cytotoxic t cell
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Suppressor t cells
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Recognize target and remember the antigen
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Increase; viral infections, leukemia, ulcerative colitis, Addison’s disease, leukemia
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Decrease; immune deficiency disease, Hodgkin’s disease, aplastic anemia, bone marrow failure
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ANC (Absolute neutrophil count).
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Neutrophil count and band count = ANC
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If percent
Multiply Percent of neutrophils X total WBC count
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Example: neutrophils are 30% and WBC count is 3000
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3000 X .30 = ANC of 900
Neutropenia
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Mild ANC of < 1500
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Moderate ANC of <1000
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Severe ANC < 500
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Precautions: Mask, no kids, no fresh fruit/flowers, WASH HANDS
Familiarize the drugs that alter bleeding and platelet function. (fibrinolytics, antiplatelets,
anticoagulants)
Genetics
Apply genetics principles regarding patterns of inheritance (dominant and recessive).
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Dominant: genes are expressed with one gene (A)
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These 2 parents have dominant traits.
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It is possible that 2 heterozygous parents have an unaffected child
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75% chance of a child having the disease with heterozygous parents
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Recessive: needs to be homozygous to be expressed (aa)
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These 2 parents are carriers of a recessive trait
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25% chance that heterozygous parents will have an affected child
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Males and females are equally affected
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Carriers: person has the gene, is phenotypically normal (Aa)
Discuss the role of a med surge nurse in relation to genetics.
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Identify a patient at genetic risk
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Be aware when a patient may want genetic testing
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Communicate and educate
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Maintain privacy and confidentiality
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Be accurate with information
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Provide support
HIV/AIDS
Analyze the pathophysiology of HIV/AIDS.
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HIV revere transcriptase converts HIV RNA into DNA. The enzyme HIV integrase is used to get the
DNA into the nucleus of the hosts CD4 + T cell and insert it into the hosts DNA
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Chronic illness that requires long-term medical management to obtain optimal health and
reduce the spread of infection
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Transmission
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Sexual contact, blood, contaminated needles, mother to infant (intrapartum, birthing process,
breast milk)
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S/S
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OI
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Dry skin, lesions, Poor wound healing, night sweats
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Cough, shortness of breath
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Diarrhea, N/V, weight loss
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Confusion, headache, fever, vision changes, seizures
Discuss and analyze labs related to HIV/AIDs (viral load, CD4 count, antibody test, WBC)
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Lymphocyte Count
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WBC < 3,500
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Lymphocyte count <1500
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CD4 + T cell and CD8
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CD4+ T-cell- low
Falling CD4+ levels (< 500 cells/mcL) = progression of disease
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CD8 – normal
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CD4 to CD8 ratio is 1:2
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HIV/AIDS ratio is 2:1
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Antibody-Antigen Tests
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Measure the response to the virus (antigen) and are indirect tests for HIV.
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Does not indicate the severity of the disease if positive
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Pt makes antibodies within the first 3 weeks to 3 months
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Some adults may not have detectable antibodies up to 36 weeks
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Good but don’t tell us the severity of disease
Enzyme-linked immunosorbent assay (ELISA)
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Negative: negative for HIV
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Positive: take western blot analysis
Western blot analysis
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Highly sensitive to virus
3rd generation tests for HIV IgG antibodies
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4th generation (recommended by the CDC)
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Detects HIV- IgM and IgG
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Lowered the amount of false negatives
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Detect positive result in 21 days
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Viral Load Testing
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Measures actual HIV viral RNA particles
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A positive viral load can measure as few as 20 particles/mL
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Viral Suppression = < 500 copies/mL
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Rising viral loads indicate disease progression= 5,000-10,000 copies/mL
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Higher viral load = greater risk for developing HIV/AIDS
Develop a comprehensive plan for a patient with HIV. Include lifestyle and pharmacological
considerations.
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Complications
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Endocrine problems
Men-low testosterone levels
Women-irregular menstrual cycles
Body shape changes from fat redistribution
Buffalo humps
Loss of subcutaneous fat (lipoatrophy)
Adrenal function decreased
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AIDS Wasting Syndrome
Diarrhea, malabsorption, anorexia, oral and esophageal lesions, weight loss
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Kidney problems
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Skin Changes
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CV- leading cause of death
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Treatment
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There is no curative treatment for AIDS
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Many people are living long lives with HIV
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Treatment focuses on:
Antiretroviral therapy (ART)
Reduces viral load
Does not kill the virus
3 or more synergistic drugs from different classes are combined
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Opportunistic infection treatment
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Malignancies
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Complications
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Prophylaxis for opportunistic infections
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Combination Antiretroviral therapy
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Reduces viral load
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Improves CD4 T-cell counts
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Slows disease progression
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Drug resistant mutations can form
viral loads no longer suppressed
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Teach patient:
Medication has to be taken on time
Missed doses lead to drug resistant mutations.
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Drawbacks:
Expensive
Timing with food requirements
Number of daily drugs
Significant side effects and drug interactions
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Medications
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Nucleoside Reverse Transcriptase Inhibitors (NRTIs) and Non-Nucleoside Reverse Transcriptase
Inhibitors (NNRTIs)
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Work to prevent viral replication where the HIV enzyme reverse transcriptase converts HIVs RNA
into DNA.
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NRTIs
Can cause peripheral neuropathy
Avoid fatty and fried foods-pancreatitis
NNRTIs
Can cause anemia and liver toxicity
Take 1 hr before or 2 hr after antacids
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Protease Inhibitors (PIs)
Don’t take St. John’s wort-reduces effectiveness of all Pis
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Integrase Inhibitors
Can cause rhabdomyolysis
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Fusion Inhibitors/CCR5 Antagonists
Change positions slowly-hypotension
Can cause liver toxicity
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Combination Products
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Interventions
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Prevent Infection
Monitor for opportunistic diseases and other infections
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Enhance Gas Exchange
Respiratory support, comfort, and rest
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Manage Pain
Drug therapy
Basic comfort measures
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Nutrition
Nutrition Therapy
Drug Therapy
Mouth Care
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Manage Diarrhea
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Skin Integrity
Discuss the different stages of HIV/AIDS- including cues, treatment, and education.
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Acute Viral Syndrome (Primary Phase)
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2-4 weeks of exposure
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Increase in viral replication
Viral loads > 1,000,000 copies/mL
Decrease in CD4 + T cell count
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Cues
Normal flu like symptoms
Swollen glands, fever, rash, joint, muscle pain, and fatigue
HIV test would be positive
Antibody test would be negative
CD4 LOW Viral Load HIGH
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Latency Period
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Initial infection to development of symptoms
Swollen lymph nodes
Persistent generalized lymphadenopathy
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Development of antibodies
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Asymptomatic phase
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Untreated this lasts about 10 years
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Treatment lasts much longer
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CD4 + Count falls to < 200=severe immune dysfunction (NORMAL CD4 + T CELL 800-1000)
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Overt AIDS
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CDC defines AIDS as
Seropositive HIV infection with
CD4 +T cell count less than 200 or
The presence of at least on AIDS-defining illness (regardless of CD4 + count)
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Death will occur in 2-3 years without therapy
Discuss opportunistic infections the importance of their diagnoses with HIV/AIDs.
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Caused by an overgrowth of a patient’s normal flora= Means disease is worsening moving to
AIDS category
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Usual s/s; fever, night sweats, weight loss (common)
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When immunity is depressed, these organisms can cause infection; CD4 is less than or equal to
200= opportunistic infections are contracted
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Usually protozoan, fungal, bacteria, or viral
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Pneumocystis jiroveci pneumonia (PCP)- most common or PJP (respiratory symptoms)
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Toxoplasmosis Encephalitis
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Cryptosporidiosis
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Candida albicans
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Cryptococcosis
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Histoplasmosis (respiratory symptoms)
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Tuberculosis (TB)
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Cytomegalovirus (CMV)
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Herpes Simplex Virus (HSV)
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Varicella-zoster virus (shingles)
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Kaposi sarcoma
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Small purple brow lesion on mucous membrane
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Tumor lining blood vessels
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Not painful
Prevention of Opportunistic Infections
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Pneumonia and influenza vaccines are high priority
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Live virus vaccines are contraindicated in HIV/AIDS (MMR & Varicella zoster)
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Neupogen may be given to counteract the neutropenia from the antiretroviral therapy or to HIV
itself
Prevention Education
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Avoid IV recreational IV drug use
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High risk people should be tested at least annually for HIV infection
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Safe sex practices
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Abstinence
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Condoms
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Monogamous relationships