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adult 1 med surg > anemia > Flashcards

anemia Flashcards

1
Q

4 parts of anemia etiology

A
  1. problems with RBC production
  2. increased RBC destruction
  3. RBC malfunction
  4. blood loss
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2
Q

how long is the normal life span of an RBC

A

120 days

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3
Q

diet requirements for a pt with anemia

A

iron, vit b12, vit b6, folic acid, copper, protein

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4
Q

explain the roles of the following dietary requirements:
- protein (amino acids)
- vit b12 (cobalamin)
- copper
- folic acid
- iron
- niacin
- vit c
- vit e

A

protein (amino acids): heme/plasma membrane synthesis + structure
vit b12 (cobalamin): DNA synthesis, RBC maturation
copper: moves iron from tissues –> plasma
folic acid: DNA and RBC synthesis
iron: Hgb synthesis
niacin: RBC maturation
vit c: iron abs, keeps it in ferrous form
vit e: protects RBCs from oxidative damage

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5
Q

2 ways to classify anemia

A

quantity and quality

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6
Q

3 words to describe RBC size (quality)

A

microcytic, macrocytic, normocytic

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7
Q

3 words to describe Hgb concentration (quality)

A

hypochromic, hyperchromic, normochromic

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8
Q

tissue perfusion in a pt with anemia

A

sluggish cap refill, weak pulse, pale/cool skin

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9
Q

cardiac assessment in a pt with anemia

A

inc HR (tachycardia), heart murmur

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10
Q

respiratory assessment in a pt with anemia

A

increased RR

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11
Q

neurological assessment in a pt with anemia
- vit b12 deficiency?

A

vit b12 deficiency = paresthesia, tingling, glossy tongue (glossitis)

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12
Q

integumentary assessment in a pt with anemia

A

spooning of nails (iron deficiency), jaundice, petechiae, ecchymosis

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13
Q

GI assessment in a pt with anemia

A

heme postive stools (bloody)

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14
Q

musculoskeletal assessment in a pt with anemia

A

joint pain = sickle cell or hemolytic anemia

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15
Q

explain Hgb levels for each level and symptoms a pt could exhibit:
- mild anemia
- moderate anemia
- severe anemia

A

mild anemia
- Hgb 10-12; asymptomatic OR palpitations with dyspnea with activity

moderate anemia
- Hgb 6-10; roaring in the ear, fatigue, SOB, palpitations at rest or during activity

severe anemia
- Hgb <6; multiple body systems affected: vertigo, dyspnea at rest, tachypnea, jaundice, pruritus, glossitis, smooth tongue

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16
Q

what are foods that can encourage RBC maturation (from adaptive quizzing)

A

niacin high foods: avocados and red meat

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17
Q

why can a pt with anemia have yellowing of the eyes

A

if anemia is RBC destruction (lysing)

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18
Q

what do pale stools symbolize

A

RBC destruction and lack of bilirubin destruction

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19
Q

medications that can increase the risk of anemia

A

glyburide, methyldopa, ASA, NSAIDs
antibx, sulfanomides, anticoags, immunosuppressants
herbals

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20
Q

explain the normal range levels for these labs:
- RBCs
- Hgb
- HCT
- PLT
- folic acid

A

RBCs: 35-45
Hgb: 12-17
HCT: 35%-45%
PLT: 150,000 to 450,000
folic acid: 5-25

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21
Q

what is peripheral blood smear morphology and what can it dx?

A

test looks at the shape of the cell
- can dx sickle cell anemia

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22
Q

what is total iron binding capacity (TIBC) and what can it dx?

A

test the measures ability of iron to bind with hemoglobin
- can dx iron deficiency anemia

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23
Q

what is ferritin vs serum iron

A

the iron found in liver vs iron in circulation

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24
Q

what is the shilling’s test and what can it dx?
- explain the procedure

A

test that measures B12 deficiency
- can dx pernicious anemia

pt ingests radioactive b12 –> looking for non abs b12
intrinsic factors are supposed to bind to b12 for abs
no intrinsic factor –> no abs –> b12 deficiency
24 hr urine collection = measure b12 in urine not being absorbed

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25
Q

iron deficiency anemia
- physiology
- etiology
- risk factors
- dx
- tx

A

PHYS: iron is needed to form heme (found in hgb and RBCs)
E: dietary/chronic blood loss
RF: dec iron intake, slow/chronic blood los

Dx: microcytic, hypochromic, inc TIBC, dec ferritin

Tx: ferrous sulfate 325 mg PO TID, ferrous gluconate 300 mg PO BID, iron dextran IM, IV iron

26
Q

s/s of iron deficiency anemia (book)

A

pallor, glossitis, burning sensation on tongue, chelitis

27
Q

ferrous sulfate 325 mg PO TID
ferrous gluconate 300 mg PO BID
- take with ____
- avoid ____
- when to take
- SE of iron supplements

A

take with citrus fruits to inc absorption
avoid milk/dairy
take 1hr before meals
SE: black stools, constipation, heartburn

28
Q

pernicious anemia
- physiology
- etiology
- dx
-tx

A

PHYS: need intrinsic factor to abs vit b12
E: lack intrinsic factor = b12 deficiency

Dx: macrocytic, normochromic, postive shillings

Tx: B12 injections, IM or PO if there’s little IF

29
Q

s/s of pernicious anemia

A

red, beefy tongue, anorexia, weak, paresthesia, ataxia

30
Q

folic acid deficiency
- etiology
- dx
- tx

A

E: dietary deficiency, dec intake/abs, medications (Bactrim, Dilantin, BC)

Dx: macrocytic, normochromic, low folic acid levels

Tx: folic acid 1mg PO/day, green leafy veggies, fruits

31
Q

chronic disease anemia
- etiology
- dx
- tx

A

E: underlying disease, chronic inflammation/infection, cancer, CKD

Dx: normocytic, normochromic, dec Hgb, HCT, FE, ferritin

32
Q

polycythemia vera
- physiology
- dx
- tx

A

PHYS: erythrocyte excess bc excess bone marrow prod of RBCs, leukocytes, PLTs
–> inc blood viscosity and blood vol

Dx: increased HCT, HTN – dx with bone marrow biopsy

Tx: phlebotomy, myelosuppressive drug, radiation therapy

33
Q

s/s of polycythemia vera

A

ruddy complexion, hypervolemia, dizzy, HA, heart failure, peripheral gangrene, stroke from clot

34
Q

ID the blood disorder: microcytic, hypochromic, inc TIBC, dec ferritin

A

iron deficiency anemia

35
Q

ID the blood disorder: macrocytic, normochromic, positive shillings

A

pernicious anemia

36
Q

ID the blood disorder: macrocytic, normochromic, low folic acid levels

A

folic acid deficiency anemia

37
Q

ID the blood disorder: normocytic, normochromic, dec Hgb, HCT, FE, ferritin

A

chronic disease anemia

38
Q

what is Epogen

A

erythrocyte growth fact; used to stimulate production of RBCs with erythropoietin

39
Q

whole blood product
- what does it have?

A

plasma, proteins, clotting factors, everything basically

40
Q

packed RBCs

A

blood replacement used during blood transfusions

41
Q

PLT solutions

A

yellow solution; for low PLT or for pts needing help with clotting

42
Q

what blood products to use for pts with severe blood loss?

A

packed RBCs and PLT solutions

43
Q

fresh frozen plasma

A

used to reverse warfarin and help clotting factors

44
Q

cryoprecipitate

A

rich in clotting factors

45
Q

granulocytes

A

for infections unresponsive to antibx

46
Q

albumin

A

protein, for 3rd spacing or burn patients

47
Q

factor VIII, IX blood products

A

for hemophiliacs and pts who need these factors specifically

48
Q

autologous

A

client donates + banks OWN blood for later
- typically for procedures where lots of blood can be lost

49
Q

blood salvage

A

blood drained during surgical procedure thru closed vacuum system is re-infused back into the patient during the procedure

50
Q

donor

A

must match ABO/Rh compatibility

51
Q

at what Hgb level do we usually start doing a blood transfusion
is this different with a pt with CAD and anemia?
is this different with a pt who has sickle cell?

A

Hgb at 7 = start transfusion

CAD + anemia = start transfusion at hgb 8

sickle cell = start transfusion at hgb <7

52
Q

explain the steps of doing a blood transfusion

A
  1. type and screen
  2. vitals from pt
  3. call blood bank
  4. double verification with nurse: patient matches blood
    –> 30min to begin transfusing
  5. have special tubing, prime ONLY SALINE first, then blood
  6. start rate (no more than 1-2mL/min)
  7. wait 15min (where most rxns can occur), get another set of vitals
  8. if not rxn after 15min, raise rate
  9. at 30min another set of vitals
  10. 4 hrs to infuse
53
Q

explain the steps if the pt gets a rxn from a blood transfusion

A
  1. stop infusion
  2. get different tubing and different saline
  3. flush saline
  4. call Dr and blood bank
  5. IDs, monitor, benadryl, Tylenol
  6. send info to blood bank
  7. blood gets retesting for correct labeling
54
Q

acute hemolytic reaction
- what is it
- s/s

A

immediate transfusion rxn within first 15-30min

s/s: chills, fever, flank/back/abd/chest pain, hypotension, tachycardia, SOB, circulatory collapse

55
Q

anaphylactic/severe allergic reaction
- what is it
- s/s

A

sensitivity to donor proteins

s/s: urticaria, dyspnea, wheezing, b.spasms, shock, cardiac arrest

56
Q

mild allergic reaction
- what is it
- s/s

A

sensitivity to donor proteins

s/s: flushing, pruritus, itching, hives

57
Q

transfusion-associated circulatory overload (TACO)

A

reaction in which pulmonary edema and respiratory distress occur due to volume excess

58
Q

febrile, non hemolytic reaction
- what is it
- s/s

A

sensitization to donor’s WBCs, PLTs, plasma proteins

s/s: chills, rigors, fever, HA, vomiting

59
Q

transfusion related lung injury
- what is it
- s/s

A

rxn with donor’s anti leukocyte antibodies vs recipient leukocytes

s/s: pulmonary inflammation, capillary leak

60
Q

massive blood transfusion reaction

A

happens when 10+ RBC units are given within 24 hrs

adult 1 med surg (5 decks)

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