NURS 611 > Exam 2 > Flashcards

Exam 2 Flashcards

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1
Q

Iron deficiency anemia

A

Decreased iron stores the oxygen carrying ability of the RBC due to inability to form adequate hemoglobin.

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2
Q

Iron deficiency anemia symptoms

A

Brittle nails, smooth, red tongue, angular cheilitis, SOB, fatigue, tachycardia, pallor, dizziness/syncope.

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3
Q

Iron deficiency anemia diagnosis

A

CBC, MCV, MCH, iron studies: TIBC, ferritin.

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4
Q

Iron deficiency anemia treatment

A

Treat underlying cause, nutrition education, iron supplements, epoetin alfa (monitor Hgb, Hct, and iron studies to ensure therapeutic effects, monitor BP and K+ as common side effects can be hypertension and hyperkalemia).

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5
Q

Pernicious Anemia

A

Decrease in vitamin B12 that is required to convert folic acid to its active form. Could be due to lack of intrinsic factor in the gut.

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6
Q

Pernicious Anemia symptoms

A

Pallor, sore, cracked, red tongue, anorexia, nausea/vomiting, weakness, paresthesias, ataxia, cognitive issues.

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7
Q

Pernicious Anemia diagnosis

A

CBC, MCV, Schilling test, serum B12 levels.

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8
Q

Pernicious Anemia treatment

A

B12 supplements.

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9
Q

Folic acid anemia

A

Decrease in folic acid alters the process of DNA synthesis and differentiation of RBC precursors.

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10
Q

Folic acid anemia symptoms

A

Fatigue, pallor, weakness, SOB, sore tongue, neural tube defects in pregnant women.

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11
Q

Folic acid anemia diagnosis

A

CBC, MCV.

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12
Q

Folic acid anemia treatment

A

Folic-acid supplements, diet.

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13
Q

Aplastic anemia

A

A lack of cells produced by the bone marrow.

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14
Q

Aplastic anemia symptoms

A

Fatigue, pallor, weakness, SOB, frequent infections, easy bleeding and bruising.

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15
Q

Aplastic anemia diagnosis

A

CBC, Bone marrow biopsy.

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16
Q

Aplastic anemia treatment

A

Immunosuppressants, colony stimulating factors, blood products transfusions.

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17
Q

Sickle cell anemia

A

Normal hemoglobin is replaced by abnormal hemoglobin which cause RBCs to sickle and stick together more easily.

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18
Q

Sickle cell anemia symptoms

A

Fatigue, SOB, fever, swelling, tenderness, hypertension, jaundice, pain, end-organ damage.

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19
Q

Sickle cell anemia diagnosis

A

CBC, hemoglobin electrophoresis, sickle cell turbidity test.

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20
Q

Sickle cell anemia treatment

A

IV fluids, supplemental O2, hydroxyurea, blood transfusions, analgesics (only cured by bone marrow stem cell transplant).

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21
Q

Erythropoiesis

A

Process of red blood cell formation occurring in the red bone marrow, stimulated by erythropoietin from kidneys, triggered by hypoxia.

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22
Q

Nutrients needed for erythropoiesis

A

Iron, B12, folate, protein.

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23
Q

Complications from anemia

A

Cardiovascular strain, neurologic and cognitive effects, respiratory changes, hypoxia organs, impaired healing and immunity.

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24
Q

Role of the spleen in anemia

A

Acts as a quality-control organ for RBCs—filtering, destroying, and storing them.

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25
Iron supplement administration teaching
Vitamin C, empty stomach - Dairy, antacids, tea/coffee, calcium.
26
B12 supplement administration teaching
Any time of day (if oral) - No major food interactions.
27
Types of blood products
PRBCs, Platelets, FFP, Cryoprecipitate, Albumin, Whole blood, Granulocytes.
28
PRBCs
Used for acute blood loss, increases Hgb/Hct.
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Platelets
Used for thrombocytopenia or platelet dysfunction, 1 unit increases platelet count by 10k.
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FFP
Contains all clotting factors besides platelets, must be ABO compatible.
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Cryoprecipitate
Used for DIC, hemophilia, von Willebrand, low fibrinogen.
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Albumin
Plasma protein, expands intravascular volume.
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Whole blood
Used for massive hemorrhage.
34
Granulocytes
WBCs, used for severe neutropenia.
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Volume of PRBCs
300 ml, max time of administration = 4 hours.
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Platelets administration time
No infusion pump, over 15-30 minutes.
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FFP administration time
Infuse as soon as possible after thawing, give over 30-60 minutes, use pump.
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Albumin administration time
Administer over 15-20 minutes.
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Equipment needed for transfusion
Type and cross match blood, IV access, blood filter tubing, infusion pump, emergency oxygen and epinephrine if reaction occurs.
40
Pre-medication for transfusion
Give Tylenol for hx of nonhemolytic reactions, diphenhydramine for hx of mild allergic reactions, steroids used to suppress immune reactions, diuretics for pts at risk of fluid overload.
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Risks for transfusion reactions
Hx of prior transfusion reaction, multiple prior transfusions, hx of pregnancy, ABO or Rh incompatibility, immunocompromised status, elderly, HF, renal impairment.
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Steps to manage a transfusion reaction
Stop the transfusion, assess the patient, notify provider and implement prescribed treatments, continue to monitor patient, return blood, document the event, keep line open but replace tubing, stay with the patient, monitor VS Q5 minutes.
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Febrile nonhemolytic reaction
Fever greater than 1C/2F, occurs within 2 hrs, use of Tylenol, more common.
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Acute hemolytic reaction
ABO incompatibility, mild or life threatening (DIC or circulatory collapse), S/S: chills, fever, lower back pain, tachycardia, flushing, hypotension, chest tightness, tachypnea, hemoglobinuria.
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Circulatory overload
Occurs from giving too fast, S/S of HF, lasix to treat, O2.
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Allergic reaction
Common reaction with plasma proteins, S/S: rash(urticaria), itching, flushing, use of Benadryl or epi/steroids(more severe).
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WBC normal range
5-19 K mm3.
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Hematocrit normal range
37%-47% in women/ 42%-52% in men.
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Platelets normal range
150-400K mm3.
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RBCs normal range
4.2-5.4 M in women / 4.7 - 6.1 in males.
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Hemoglobin normal range
12-16 g/dL in women / 14-18 g/dL in men.
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High platelet counts suggest
More clotting.
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Low platelet counts suggest
Less clotting.
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High RBC counts suggest
Dehydration, chronic hypoxia, polycythemia vera.
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Low RBC counts suggest
Iron deficiency, B12/folate deficiency, chronic kidney disease (↓ EPO), bone marrow failure, hemorrhage, hemolysis.
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MCV (mean corpuscular volume)
Sizes of RBCs.
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MCH/MCHC
Hemoglobin content & concentration in RBCs.
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RDW
Variation in RBC size.
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Low MCV and Low MCHC indicate
Microcytic (iron deficiency).
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Normal MCV indicates
Normocytic anemia (acute blood loss, anemia of chronic diseases).
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High MCV indicates
Macrocytic (B12/folate deficiency, alcohol use, liver disease).
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High RDW indicates
Early iron deficiency or mixed deficiency.
63
Low WBC (leukopenia) suggests
Bone marrow suppression, chemo, aplastic anemia, viral infections, autoimmune diseases.
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High WBC (leukocytosis) suggests
Infection, inflammation, stress, trauma, steroid, hematologic malignancies.
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Neutrophils indicate
Bacterial infection, acute inflammation.
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Bands (left shift) indicate
Early infection/sepsis.
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Lymphocytes indicate
Viral infection.
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Monocytes indicate
Chronic infection, recovery phase.
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Eosinophils indicate
Allergies, asthma, parasites.
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Basophils indicate
Rarely ↑, chronic inflammation or myeloproliferative disorders.
71
Warfarin therapy
Used for monitoring INR in patients.
72
INR
Used for Warfarin monitoring.
73
aPTT
Used for Heparin therapy and clotting factor deficiencies (e.g., hemophilia).
74
Platelet count
Indicates thrombocytopenia (bleeding risk) or thrombocytosis (clot risk).
75
Fibrinogen
Associated with DIC and liver disease.
76
D-dimer
Used for DVT/PE rule-out, DIC, and major clot breakdown.
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Hemophilia A
Characterized by deficient or defective factor VIII.
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Hemophilia B
Characterized by deficient or defective factor IX.
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von Willebrand disease
Affects both sexes, causes mild clotting defect, primarily a platelet problem, and leads to mucosal bleeding.
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Hemophilia
Mostly a clotting factor problem, causing severe bleeding into joints and muscles; primarily affects males.
81
Treatments for hemophilia
Includes plasma, cryoprecipitate, Factor VIII or IX, and platelets for active bleeding.
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Treatments for von Willebrand disease
Includes vWF, platelets for active bleeding, and cryoprecipitate.
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Neutropenic precautions
Infection prevention measures for patients with neutropenia.
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Absolute neutrophil count
= (#WBCs x Neutrophil %)/100.
85
Neutropenia classification
1500-2000: not significant; 1000-1500: minimal risk; 500-1000: moderate risk; <500: severe risk.
86
Treatments for neutropenia
Start on broad spectrum antibiotics and narrow down; Neupogen (filgrastim).
87
Chemotherapy precautions
Double glove and long sleeve gown, goggles if handling bodily fluids, consider all body fluids contaminated for 48 hours after administration, double flush toilet, place all soiled linens in special hamper.
88
Bone marrow biopsy
Performed to diagnose or rule out malignancy or diagnose blood disorder.
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Risks of bone marrow biopsy
Includes infection and bleeding.
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Lymphoma
Malignancies of lymphoid tissue, usually derived from the B lymphocyte.
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Hodgkin's lymphoma
Initiated in a single nodule and characterized by Reed-Sternberg cells.
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Non-Hodgkin's lymphoma
Lower cure rates and does not have Reed-Sternberg cells.
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Lymphoma staging
Stage 1: single node on one side of diaphragm; Stage 2: 2+ nodes on one side of diaphragm; Stage 3: nodes above and below diaphragm; Stage 4: involvement of bone marrow.
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Risks associated with lymphoma
Includes anemia, enlarged liver, and spleen.
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Leukemia
Characterized by overproduction of immature WBCs, decreasing production of RBCs, platelets, and mature leukocytes.
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Treatments for leukemia
Includes chemotherapy, radiation, hematopoietic stem cell transplant (bone marrow), and symptom management.
97
Risks associated with leukemia treatment
Includes bone pain, frequent infections, bruising/bleeding easily, anemia, fever, weight loss, night sweats, enlarged liver & spleen, lymphadenopathy, poor healing wounds, fatigue, and weakness.
98
Multiple myeloma
Involves malignant plasma cells that secrete abnormal antibodies, taking over the bone marrow and decreasing the ability to fight infection/secrete normal antibodies.
99
Hypercalcemia
A condition characterized by elevated calcium levels in the blood.
100
Severe bone pain
Intense discomfort in the bones, often associated with various medical conditions.
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Osteoporosis
A medical condition where bones become weak and brittle.
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Pathologic fractures
Fractures that occur in bones weakened by disease.
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Renal impairment & failure
A decline in kidney function, leading to the inability to filter waste from the blood.
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Anemia
A condition characterized by a deficiency of red blood cells or hemoglobin.
105
Immune system failure
A condition where the immune system is unable to function properly.
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DIC (Disseminated Intravascular Coagulation)
A serious condition resulting from the overactivation of the coagulation system, leading to severe bleeding.
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Causes of DIC
Often caused by sepsis, trauma, transfusion reactions, vascular/organ injuries.
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Best treatment for DIC
Treat underlying cause, oxygen, fluids, vasopressors, coagulation factors, heparin; avoid NSAIDs.
109
Blood products for DIC
Platelets, FFP, Cryoprecipitate, PRBCs.
110
Signs of worsening Peripheral Artery Disease (PAD)
Claudication, numbness/burning of feet, decreased cap refill, loss of hair on legs, dry skin, thick toenails, pallor with elevation, dependent rubor, gangrene.
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Claudication
Extremity pain caused by insufficient blood flow during exercise.
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Improvement of Claudication
Walking helps to improve vascular health, preventing future claudication.
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Risks associated with Claudication
Formation of non-healing skin lesions, death of muscle and skin tissues, possible amputation.
114
Ankle-brachial index
Ankle systolic pressure divided by brachial systolic pressure; used to assess arterial disease.
115
Medications for PAD
Anticoagulants, pentoxifylline, cilostazol, risk factor modification, percutaneous transluminal angioplasty, mechanical abrasive atherectomy, arterial revascularization surgery.
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Nursing considerations for Claudication medications
Monitor for bleeding, increased extremity pain, assess the 6Ps.
117
Symptoms of DVT
Unilateral swelling, warmth, redness, pain, engorged superficial veins.
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Risk factors for DVT
Prolonged immobility, surgery, increased coagulation, dehydration, smoking, age >60, history of DVT/PE.
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Strategies to prevent DVT
Early ambulation, leg exercises, SCDs, compression stockings, anticoagulants, hydration, smoking cessation.
120
Severe complications of DVT
Pulmonary embolism (PE) and recurrence.
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Diagnostics for DVT
Doppler ultrasound, D-dimer, CT, V/Q scan, ABG.
122
Difference between venous and arterial ulcers
Venous ulcers: pooling blood, red appearance, heavy drainage, mild pain. Arterial ulcers: poor perfusion, pale/necrotic, minimal drainage, pain worsens with elevation.
NURS 611
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