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Anemia Flashcards

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1
Q

What is anemia?

A

deficiency in the number of erythrocytes, the quantity or quality of hemoglobin, and/or volume of packed RBCs.

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2
Q

What causes decreased production of RBCs leading to anemia?

A

Decreased erythropoietin, deficiency in nutrients - iron, cobalamin, folic acid, and decreased iron availability

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3
Q

What causes blood loss leading to anemia?

A

Acute: acute trauma, ruptured aortic aneurysm, and GI bleeding.
Chronic: bleeding duodenal ulcer, colorectal cancer, and liver disease.

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4
Q

What causes increased destruction of RBCs leading to anemia?

A

sickle cell disease, medication such as methyldopa, incompatible blood, trauma such as cardiopulmonary bypass

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5
Q

Mild anemia Hgb __ to __ g/dL

A

10 to 12 g/dL

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6
Q

Moderate anemia Hgb __ to __ g/dL

A

6 to 10 g/dL

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7
Q

Severe anemia Hgb < __ g/dL

A

less than 6 g/dL

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8
Q

What are the mild to moderate clinical manifestations of anemia?

A

Fatigue, palpitations, exertional dyspnea to dyspnea, roaring in the ears

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9
Q

What are the severe clinical manifestations of anemia (exacerbation of anemia)?

A

Pallor, blurred vision, tachycardia, angina, heart failure, MI, tachypnea, orthopnea, dyspnea at rest, headache, vertigo, irritability, impaired thought process, hepatomegaly, splenomegaly, sensitive to cold, weight loss, lethargy

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10
Q

What is the main cause of anemia by acute blood loss?

A

sudden hemorrhage

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11
Q

What are some of the causes of sudden hemorrhage?

A

trauma, complications of surgery, and conditions or diseases that disrupt vascular integrity

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12
Q

What is the major complication of acute blood loss?

A

shock

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13
Q

What occurs when there is sudden reduction in the total blood volume in acute blood loss?

A

hypovolemic shock

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14
Q

What occurs when there is gradual reduction in the total blood volume in acute blood loss?

A

Body slowly increases plasma volume to maintain the blood volume at homeostasis but circulating RBCs available to carry O2 are still low

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15
Q

How long does it take for acute blood loss to reflect on Hgb and Hct?

A

36 to 48 hrs

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16
Q

What assessment is important in patient with acute blood loss?

A

pain

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17
Q

What are the clinical manifestations of retroperitoneal bleeding?

A

Numbness and pain in a lower extremity, lower back pain.

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18
Q

What are nursing management of acute blood loss?

A

Prevent blood loss if possible. For post-op patient monitor drains and dressings for excess bloody output. Anticipate administration of blood products.

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19
Q

What is the long term treatment of anemia due to acute blood loss?

A

None. Anemia should resolve once the blood loss is stopped and blood volume and fluid status returns to normal.

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20
Q

What are the two important steps in care of acute blood loss?

A

First, replace blood volume to prevent shock.

Second, identify the source of the hemorrhage and stop the blood loss.

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21
Q

What IV fluids replacement can be given in emergencies in acute blood loss?

A

Dextran, hetastarch, albumin, and crystalloid electrolyte solutions such as lactated Ringer’s solution.

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22
Q

Why is blood transfusion of packed RBCs needed in significant blood loss?

A

Body takes 2 to 5 days to manufacture more RBCs in response to increased erythropoietin.

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23
Q

Why do patients need supplemental iron replacement after acute blood loss?

A

Availability of iron affects the marrow production of erythrocytes.

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24
Q

What are some of the causes of chronic blood loss?

A

Chronic inflammation, autoimmune disease, infection, HIV, kidney failure, heart failure, cancer, blood pressure.

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25
Q

Food rich in iron are —

A

Red meat, organ meat such as liver, egg yolk, kidney beans, green leafy vegetables, raisins

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26
Q

Who are most susceptible to iron-deficiency anemia?

A

very young, older adults, poor diet, women in reproductive years, and pregnant women

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27
Q

What is the major cause of iron deficiency in adults?

A

blood loss

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28
Q

What is the clinical manifestation of iron-deficiency anemia?

A

Mild anemia is often asymptomatic.
Pallor, glossitis (smooth shiny red swollen tongue), cheilitis (inflammation of the lips), headache, paresthesia, burning sensation of the tongue

29
Q

What is the normal daily loss of iron from the body?

A

1 mg; lost in urine, bile, sweat, sloughing of epithelial cells from the skin and intestinal mucosa, and minor bleeding

30
Q

What is the main goal of treatment of iron-deficiency anemia?

A

treat the underlying cause

31
Q

How do you care for iron-deficiency anemia?

A
  1. Identify and treat the underlying cause
  2. Drug therapy to replace iron such as ferrous sulfate
  3. Educate patient to increase dietary iron
  4. If caused by acute blood loss, then transfusion of packed RBCs.
32
Q

True or False: Enteric-coated or sustained-release capsules are the best method to supplement iron.

A

False. Iron is absorbed best from the duodenum and proximal jejunum. So enteric-coated or sustained-release capsules, which release iron farther down in the GI tract, are not best absorbed and can be expensive.

33
Q

True or False: Iron is best absorbed in acidic environment.

A

True. Iron should be taken about an hour before meals or between meals (when the duodenal mucosa is most acidic)

34
Q

What helps in the absorption of iron?

A

Vitamin C or orange juice

35
Q

When is the parenteral use of iron indicated?

A

For malabsorption, intolerance of oral iron, a need for iron beyond oral limits, or poor patient adherence to oral iron supplements.

36
Q

What patient teaching is needed for taking undiluted liquid iron?

A

Use a straw, it may stain the teeth

37
Q

What are the GI side effects of iron administration?

A

heartburn, constipation, and diarrhea

38
Q

What can patient take for constipation caused by iron administration?

A

stool softeners such as Colace, and laxatives

39
Q

True or False: To replenish the body’s iron stores, the patient needs to take iron therapy for 2 to 3 months after the hemoglobin level returns to normal.

A

True

40
Q

What are the nursing considerations of IM iron administration?

A

Because IM iron solutions may stain the skin, separate needles should be used for withdrawing the solution and for injecting the medication. Use a Z-track injection technique.

41
Q

Who are at risk for developing iron-deficiency anemia?

A

Premenopausal and pregnant women, persons from low socioeconomic backgrounds, older adults, and individuals experiencing blood loss.

42
Q

What are the routes of administration of Vitamin B12?

A

oral, sublingual, intranasal, IM, SubQ. NEVER given IV.

43
Q

What are the causes of Vitamin B12 (cobalamin) deficiency anemia?

A

dietary deficiency such as strict vegetarians, small bowel resection, chronic diarrhea, diverticula, tape worm, or overgrown intestinal bacteria, long term use of H2 blockers like Zantac and PPIs like Protonix, smoking, deficiency in intrinsic factor (IF) known as pernicious anemia, helicobacter pylori, celiac disease, pregnancy, chronic alcoholism

44
Q

What test is done mainly to check for Vitamin B12 deficiency?

A

Schilling test

45
Q

What is the typical treatment schedule for IM shot of cobalamin administration?

A

1000 mcg/day of cobalamin IM for 2 weeks and then weekly until the hemoglobin is normal, and then monthly for life.

46
Q

What are the clinical manifestations of anemia related to cobalamin deficiency?

A

glossitis (sore, red, beefy, and shiny tongue), anorexia, nausea, and vomiting; and abdominal pain. Neurological problems such as weakness, paresthesias of the feet and hands (pins and needles feeling), reduced core balance, ataxia, muscle weakness, and impaired thought processes ranging from confusion to dementia.

47
Q

Risk for which type of cancer is increased in pernicious anemia?

A

gastric

48
Q

What are some diagnostic tests done for cobalamin deficiency anemia?

A

Schilling test, serum folate levels, serum test for anti-IF antibodies, upper GI endoscopy and biopsy of the gastric mucosa, serum methylmalonic acid (MMA), serum homocysteine

49
Q

What symptoms differentiates folic acid deficiency anemia from cobalamin deficiency anemia?

A

neurological problems (B12 affects nerve function)

50
Q

Which electrolyte must be monitored for vitamin B12 deficiency anemia?

A

Potassium (it can cause hypokalemia)

51
Q

What are the causes of folic acid deficiency?

A

Dietary deficiency of folic acid, celiac disease, Crohn’s disease, small bowel resection, medications (such as methotrexate, phenobarbital, phenytoin), pregnancy, chronic alcoholism, chronic hemodialysis, elderly

52
Q

Diet rich in folic acid are…?

A

Red meat, liver, fish, green leafy vegetables, legumes, whole grains, orange juice, peanuts, avocado

53
Q

What is aplastic anemia?

A

Deficiency of circulating RBCs

54
Q

A patient with petechiae, bruising, pancytopenia (decreased RBC, WBC, platelets) has ____ anemia

A

aplastic anemia

55
Q

What are some of the causes of aplastic anemia?

A

Idiopathic or autoimmune, chemical agents and toxins (e.g., benzene, insecticides, arsenic, alcohol), medications (e.g., antiseizures, antimetabolites, antimicrobials, gold, NSAIDs, antithyroids, allopurinol), radiation, viral and bacterial infections

56
Q

True or false: For aplastic anemia patients, even a low-grade fever (above 100.4° F [38° C]) should be considered a medical emergency.

A

True. Due to decreased WBC count these patients are susceptible to infection.

57
Q

In aplastic anemia, bone marrow has increased ____ marrow (fat content) and decreased ____ marrow.

A

yellow, red

58
Q

What are the diagnostic tests done in aplastic anemia?

A

CBC, iron studies such as serum iron and total iron-binding capacity (TIBC), bone marrow biopsy, aspiration, and pathologic examination

59
Q

What is hemolytic anemia?

A

It is a condition caused by the destruction or hemolysis of RBCs at a rate that exceeds production.

60
Q

What are the causes of hemolytic anemia?

A

Intrinsic (hereditary): abnormal Hgb.
Extrinsic: trauma, prosthetic heart valves, DIC, TTP, viral and bacterial infections such as malaria, toxins, antibody reactions

61
Q

What are specific clinical manifestations related to hemolytic anemia?

A

jaundice, enlarged spleen and liver (due to hyperactivity)

62
Q

What is the specific focus of treatment of hemolytic anemia?

A

maintain renal function

63
Q

What are some of the care provided for hemolytic anemia?

A

Treat the cause, supportive therapy, steroid therapy, splenectomy, immunosuppressive therapy, plasmapheresis, aggressive hydration and electrolyte replacement

64
Q

Normal range Hgb: men __ to __ g/dL; women __ to __ g/dL

A

Men: 13.5 to 17.5 g/dL
Women: 12 to 15.5 g/dL

65
Q

What are the causes of iron-deficiency anemia?

A

inadequate dietary intake, malabsorption, blood loss, hemolysis.

66
Q

____ mL of whole blood contains __ mg of iron

A

2 mL; 1 mg

67
Q

Monitor ____ for patients on long term iron supplements.

A

Liver

68
Q

Without cobalamin administration, individuals will die in ___ years.

A

1 to 3 years

Anemia (1 decks)

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