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N3 Ex1: Cellular Regulation/Hematology > Anemia > Flashcards

Anemia Flashcards

CRITICAL THINKING: 1. Be familiar c components of labs & diagnostic studies 2. Track values over time 3. Prioritize significant manifestations for further investigation 4. Distinguish normal from abnormal and benign from serious 5. Evaluate the whole pt

1
Q

What is Anemia?

A
  1. Decrease in Total Body RBC(erythrocyte) Volume
  2. Decreased Hgb Protein
  3. Decreased Hct & RBC count
  4. Most Common Blood Disorder
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2
Q

Anemia Compensatory Mechanism:

Acute Blood Loss Anemia

A
  1. @ the detection of Hypoxia the body tries to get back to homeostasis by compensation.
  2. Circulating blood volume decreases which leads to decreased Cardiac Output
  3. Comp Mech activates resulting in:
    Increased HR
    Increased BP
    Increased RR
    Peripheral vessels & Liver constrict which increases circulating volume
    Fluid shift Interstitial–>Vascular: Diluting blood & reducing blood viscosity
  4. Increased erythropoietin
  5. If hemorrhage persists Comp Mech is less effective & this increases risk for Shock & Circulatory Failure.
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3
Q

Risk Factors: Anemia

A 
Poor Health Maintenance:
1. Smoking     
2. Excessive Alcohol Intake
3. Poor Dietary Pattern      
4. Sedentary Lifestyle
Alterations in Hematologic System:
1. Medications
2. Diseases
3. Behavioral Patterns
4. Family Hx
5. Surgical Interventions
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4
Q

Transfusion Therapy

A
  1. Severe reactions occur during 1st 50 mL
  2. Stay c pt for 1st 15–30 minutes
  3. Whole Blood
  4. Packed RBC’s (PRBC’s)
  5. Platelets
  6. Fresh Frozen Plasma (FFP)
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5
Q

Whole Blood & PRBC’s Transfusion

A
  1. Infuse c Normal Saline Only
  2. Complete Transfusion in 4 Hours
  3. Never add Drugs to blood
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6
Q

Platelet Transfusion

A
  1. Client c Platelet count less than 20,000 or 80,000 is actively bleeding
  2. Filter can be used
  3. Infuse in 15–30 Minutes
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7
Q

Fresh Frozen Plasma Transfusion

A
  1. INDICATION:
    a. Clotting Factor Deficiency
    b. Liver Disease
    c. DIC
    d. PT or PTT greater than 1.5 times normal
  2. Infuse over 20–30 minutes
  3. Use filter for infusion
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8
Q

Physical Assessment:

A 
SUBJECTIVE DATA:
1. Presenting symptoms
2. Chief complaint
3. Family Hx
OBJECTIVE DATA:
1. Physical exam (H-->T)
2. Vital Signs
3. Labs
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9
Q

How to document chief complaint

A

In pt’s own words:

  1. Elimination pattern
  2. Activity–exercise pattern
  3. Sleep–rest pattern
  4. Cognitive–perceptual pattern
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10
Q

What type of presenting symptoms of anemia?

A
  1. FATIGUE & weakness #1 common
  2. SOB also common
  3. Increasing illness
  4. Fevers & decreased WBC
  5. Unusual bleeding
    a. Problems c platelet
    b. Thrombocytes
    c. Clotting Mechanism
  6. Pallor
  7. Tachycardia & Tachypnea c Dyspnea
  8. Vertigo/Dizziness especially when standing
  9. Headache & Irritability
  10. Decreased Hgb, Hct, & RBC
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11
Q

Labs & Diagnostics

A
  1. CBC
    a. Hgb b. Hct c. Total RBC’s d. Reticulocyte count
  2. Serum Vitamin B12 & Folate Levels
  3. Iron
  4. Hgb Electrophoresis Analysis
  5. Schilling Test
  6. Bone Marrow Aspiration
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12
Q

Severity of Anemia

A

Based on Hgb
1. Normal = 12–16 g/dL

  1. Mild Anemia = 10–12
  2. Moderate Anemia = 7–11
  3. Severe Anemia = HtC <25%
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13
Q

Care Interventions for Anemia

A
  1. Resolve Hypoxemia
  2. Replace Blood Volume
  3. Determine Underlying Cause

RESOLVE–>REPLACE–>DETERMINE

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14
Q

Nursing Role for Anemia pt

A
  1. PREVENT complications secondary to decreased O2 carrying capacity.
  2. ASSESS/Identify underlying causes
  3. MONITOR: Symptoms, Lab changes, Physical changes
  4. INITIATE Interventions unique to Dx
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15
Q

Patient Teaching & DC Priorities for pt c Anemia

A
  1. Dietary restrictions
  2. Fatigue management
  3. Medications
  4. Disease prevention
  5. Safety
  6. Reportable clinical manifestations
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16
Q

Pharmacological Therapy

A
  1. Vitamin B12 (Cyanocobalamin)
  2. Ferrous Sulfate (Femiron, Imferon)
  3. Epogen
17
Q

Gerontological Considerations: Anemia

A
  1. Amount of Red Marrow & # of stem cells DECREASE c age.
  2. Hgb levels DECREASE p middle age; Mainly men
  3. Anemic older adult usually due to processes in other systems
18
Q

Anemia Care Plan

A

Priority Depends On Type of Anemia & Active Problem

  1. Imbalance Nutrition: Less than body requirements R/T inadequate intake of Iron
  2. Activity Intolerance R/T decrease O2-carrying capacity of the blood
  3. Ineffective Tissue Perfusion R/T Decreased O2 Carrying capacity of the blood
19
Q

Quick Example of Anemia Care Plan

A

ASSESSMENT: Fatigue, SOB, Dyspnea
RN Dx: Activity intolerance r/t decreased O2-carrying capacity of blood 2nd to Fe deficiency anemia
EXPECTED OUTCOMES: Correction of Fe deficiency by end of week.
RN INTERVENTIONS: Admin Fe as ordered & teach pt foods high in Fe.
RATIONALES: Corrects Fe deficiency.
EVAL OF EXPECTED OUTCOMES: Goal met, pt incorporates several foods high in Fe into diet, takes prescribed supplements as ordered.

20
Q

What is Vitamin B12 (Cyanocobalamin) Action?

A
  1. Required for RBC Formation

2. Treats Pernicious Anemia

21
Q

What are Vitamin B12 (Cyanocobalamin) Side Effects?

A
  1. Diarrhea
  2. Itching
  3. Rash
  4. Hypokalemia
  5. Anaphylaxis
22
Q

What are Vitamin B12 (Cyanocobalamin) Teaching?

A 
1. Food high in Vitamin B12
Meats
Sea Food
Egg Yolk
Cheese
23
Q

What is the Action of Ferrous Sulfate (Femiron & Imferon)?

A

Prevents & Treats Iron Deficiency

24
Q

What are some side effects r/t Ferous Sulfate (Femiron & Imferon)?

A
  1. Dizziness
  2. Seizures
  3. Tachycardia
  4. Hypotension
    With IM - Skin Staining
    PO - Constipation
    Dark Stools
    Stained teeth
25
Q

What are some teaching points r/t Ferous Sulfate (Femiron & Imferon)?

A 
1. Monitor for over dose
   Stomach pain
   N/V
   Blue lips, fingernails
   Seizures
   Tachycardia
2. Teach that Vitamin Enhances Aabsorption
26
Q

What is the Action of Epogen?

A

Increases Production of RBC in Blood Marrow

27
Q

What are some Side Effects R/T Epogen?

A
  1. Bone Pain
28
Q

What are some Teaching Points R/T Epogen?

A
  1. Give to pt. with Kidney Failure on Weekly Basis.

N3 Ex1: Cellular Regulation/Hematology (8 decks)

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