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Week 7 Med Surg B3 > Anemia > Flashcards

Anemia Flashcards

1
Q

Anemia is a deficiency in…

A
  • Number of RBCs
  • Quantity/quality of hemoglobin
  • Volume of packed RBCs
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2
Q

What is hematocrit?

A

Volume of packed RBCs.

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3
Q

Causes of anemia…

A
  • Decreased RBC production
  • Blood loss
  • Increased RBC destruction
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4
Q

Causes for decreased RBC production

A
  • Deficient nutrients (iron, folic acid, cobalamin)
  • Decreased erythropoietin
  • Decreased iron availability
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5
Q

Causes for blood loss

A

-Chronic hemorrhage like bleeding duodenal ulcer, colorectal cancer, liver disease, acute trauma, ruptured aortic aneurysm, GI Bleeding

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6
Q

Increased RBC destruction

A

-Hemolysis like sickle cell disease, medication, incompatible blood, trauma

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7
Q

Clinical manifestations of anemia

A

-Caused by the body’s response to tissue hypoxia

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8
Q

Hemoglobin levels are used to determine

A

-The severity of anemia
-Mild: Hb: 10-12 g/dL
-Moderate: Hb: 6-10 g/dL
Severe: Hb: <6 g/dL

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9
Q

Mild Anemia

A
  • Hb 10-12 g/dL
  • May exist w/o causing symptoms
  • If symptoms develop it is bc pt has underlying condition or experiencing compensation
  • Symptoms include palpitations, dyspnea, mild fatigue
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10
Q

Moderate Anemia

A
  • Hb 6-10 g/dL
  • Cardiopulmonary symptoms increased
  • Pt may experience them while resting as well as w/ activity
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11
Q

Severe Anemia

A
  • Hb < 6 g/dL

- Pt has many clinical manifestations involving multiple body systems

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12
Q

Integumentary manifestations of anemia

A
  • Pallor (Hbg & blood flow to skin decreased)
  • Jaundice (increased concentration of bilirubin)
  • Pruritus (increased serum & skin bile salt concentrations)
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13
Q

Cardiopulmonary manifestations of severe anemia

A
  • Result from additional attempts by heart & lungs to provide adequate O2 to tissues
  • Cardiac output maintained by increasing HR & stroke volume
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14
Q

Subjective data, nursing assessment anemia

A
  • Past health history
  • Medications
  • Surgery or other treatments
  • Dietary Health
  • Functional health patterns (family, nutritional, elimination, activity, cognitive, sexuality)
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15
Q

Objective data, nursing assessment anemia

A
  • General
  • Integumentary
  • Respiratory
  • Cardiovascular
  • Gastrointestinal
  • Neurologic
  • Diagnostic findings
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16
Q

Anemia nursing diagnoses

A
  • Fatigue
  • Imbalanced nutrition: less tahn body requirements
  • Ineffective self-health management
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17
Q

Anemia gerontologic considerations

A
  • Common in older adults (chronic disease, nutritional deficiencies)
  • S/Sx may go unrecognized or may be mistaken for normal aging changes
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18
Q

Iron-deficiency anemia

A
  • 1 of the most common chronic hematologic disorders
  • Fe is present in all RBCs as heme in hemoglobin & in stored form
  • Heme accounts for 2/3 of body’s iron
19
Q

Etiology of iron-deficiency anemia

A
  • Inadequate dietary intake (5-10% of ingested iron is absorbed)
  • Malabsorption
  • Blood loss
  • Hemolysis
  • Pregnancy
20
Q

Iron absorption occurs where?

A

Duodenum (diseases or surgery that alter, destroy, or remove absorption surface area of intestine alter absorption)

21
Q

Clinical manifestations of iron-deficiency anemia

A
  • General manifestations of anemia
  • Pallor (most common finding)
  • Glossitis (second most common finding)
  • Cheilitis
22
Q

Cheilitis

A

Inflammation of the lips

23
Q

Glossitis

A

Inflammation of the tongue

24
Q

Iron-deficiency anemia diagnostic studies

A
  • Lab findings
  • Stool guaiac test
  • Endoscopy
  • Colonoscopy
  • Bone marrow biopsy
25
Q

Collaborative care iron-deficiency anemia

A
  • Goal is to treat underlying disease

- Efforts aimed at replacing iron

26
Q

Efforts aimed at replacing iron

A
  • Nutritional therapy
  • Oral or occasional parenteral iron supplements
  • Transfusion of packed RBCs
27
Q

Drug therapy for iron-deficiency anemia

A
  • Oral iron (inexpensive, convenient)

- Parenteral iron

28
Q

Oral iron

A
  • Daily dose is 150-200mg
  • Enteric-coated or sustained-released capsules are counterproductive
  • Best absorbed as ferrous sulfate in acidic environment
  • Liquid iron should be diluted & ingested via straw
  • S/E: heartburn, constipation, diarrhea
29
Q

Parenteral Iron

A
  • Indicated for oral iron intolerance, malapsorption, need for iron beyond normal limits, poor patient compliance
  • Can be given IM or IV (IM may stain skin)
30
Q

At risk groups for iron-deficiency anemia

A
  • Premenopausal women
  • Pregnant women
  • Persons from low socioeconomic backgrounds
  • Older adults
  • Individuals experiencing blood loss
31
Q

Management of iron-deficiency anemia

A
  • Diet teaching
  • Supplemental iron
  • Discuss diagnostic studies
  • Emphasize compliance
  • Continue therapy 2-3 months after hbg return to normal
32
Q

Megaloblastic anemias

A

Group of disorders caused by impaired DNA synthesis & characterized by presence of large RBCs (megaloblasts)

33
Q

Megaloblastic anemias result primarily from deficiencies in

A
  • Cobalamin

- Folic Acid

34
Q

Cobalamin deficiency

A

-Intrinsic factor is required for absorption in distal ileum (IF: protein secreted by parietal cells of gastric mucosa)

35
Q

Pernicious anemia

A
  • Caused by absence of IF
  • Insidious onset
  • Begins in middle age or later
  • Predominant in Scandinavians & African Americans
36
Q

Cobalamin deficiency etiology

A
  • Caused most commonly by pernicious anemia
  • GI surgery
  • Chronic diseases of GI tract
  • Chronic alcoholics
  • Long-term uses of H2-Histamin receptor blockers & proton pump inhibitors
  • Strict vegetarians
37
Q

Clinical manifestations of cobalamin deficiency

A
  • GI (sore tongue, anorexia, N/V, abdominal pain)
  • Neuromuscular (weakness, paresthesia of feet & hands, decreased vibratory & position senses, ataxia, muscle weakness, impaired thought process)
38
Q

Cobalamin deficiency diagnostic studies

A
  • Macrocytic RBCs have abnormal shapes & fragile cell membranes
  • serum level decreased
  • Upper GI endoscopy w/ biopsy of gastric mucosa
  • Normal serum folate levels & low cobalamin levels suggest megaloblastic anemia
39
Q

Treatment for cobalamin deficiency

A

-Parenteral or intranasal administration of cobalamin is treatment of choice (pt will die in 1-3 years w/o treatment)

40
Q

Folic Acid Deficiency

A
  • Cause of megaloblastic anemia
  • Folic acid is required for DNA synthesis
  • Clinical manifestations similar to cobalamin deficiency but absence of neuro problems!
41
Q

Common causes of folic acid deficiency

A
  • Dietary
  • Malabsorption syndromes
  • Increased requirement
  • Alcohol abuse & anorexia
  • Loss during hemodialysis
42
Q

Diagnosis and treatment of folic acid deficiency

A
  • Serum folate level is low
  • Serum cobalamin level is normal
  • Treated by replacement therapy (1mg PO daily)
  • Encourage pt to eat foods w/ large amounts of folic acid
43
Q

Management of megaloblastic anemia

A
  • Early detection & treatment
  • Ensure safety
  • Focus on compliance w/ treatment
  • Regular screening for gastric cancer

Week 7 Med Surg B3 (2 decks)

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