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Med Surg 2 > anemias > Flashcards

anemias Flashcards

1
Q

anemia

A

a reduction in the number of RBCs, the quantity of hemoglobin, or the volume of RBCs.

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2
Q

anemia caused by

A
  • Blood loss
  • Inadequate RBC production (hypoproliferative)
  • Increased RBC destruction (hemolytic)
  • Deficiency of necessary components such as folic acid, iron, erythropoietin, and/or vitamin B12
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3
Q

contributing factors

A

Acute/chronic blood loss (GI bleed)
Abnormal bone marrow (chemotherapy)
Decreased erythropoietin (renal failure)
Inadequate maturation of RBCs (cancer)
Nutritional deficiencies

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4
Q

Diagnostic Tests

A

CBC Count
Iron Studies
Sickle-cell test
Schilling Test

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5
Q

Sickle-cell test

A

Evaluates the sickling of RBCs in the presence of decreased oxygen tension.

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6
Q

Schilling Test

A
  • Measures vitamin B12 absorption
  • Used to differentiate between malabsorption and pernicious anemia.
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7
Q

causes of acute or chronic blood loss

A
  • Trauma
  • Menorrhagia
  • Gastrointestinal bleed (ulcers, tumor)
  • Intra or postsurgical blood loss or hemorrhage
  • Chemical or radiation exposure
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8
Q

Increased Hemolysis cause

A
  • Defective Hgb (sickle-cell disease): RBCs become malformed during periods of hypoxia and obstruct capillaries in joints and organs
  • Immune disorder or destruction (transfusion reactions, autoimmune diseases)
  • Mechanical trauma to RBCs (mechanical heart valve, cardiopulmonary bypass)
  • acute chest: deprived of 02
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9
Q

Inadequate dietary intake or malabsorption cause

A
  • Iron deficiency
  • Vitamin B12 deficiency
  • Folic acid deficiency: complex grains (wheat), prenatal vitamins have it
  • Pica, or a persistent eating of substances not normally considered food ( clay, dirit, chewing ice)
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10
Q

clinical manifestations anemia

A
  • Possibly asymptomatic in mild cases
  • Pallor
  • Fatigue
  • Irritability
  • Numbness and tingling of extremities
  • Dyspnea on exertion
  • Sensitivity to cold
  • Pain and hypoxia with sickle-cell crisis
  • Shortness of breath/fatigue, especially upon exertion
  • Tachycardia and palpitations
  • Dizziness or syncope upon standing or with exertion
  • Pallor with pale nail beds and mucous membranes
  • Nail bed deformities (spoon-shaped nails)
  • Smooth, sore, bright-red tongue (vitamin B12 deficiency)
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11
Q

Nursing Care for Anemia

A
  • Encourage increased dietary intake of the deficient nutrient
  • Monitor oxygen saturation to determine a need for oxygen therapy.
  • Administer medications.
  • Teach the client and family about energy conservation in the client and the risk of the client experiencing dizziness upon standing.
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12
Q

Total iron-binding capacity (TIBC) reflects

A

an indirect measurement of serum transferrin, a protein that binds with iron and transports it for storage.

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13
Q

Serum ferritin is an indicator of

A

total iron stores in the body.

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14
Q

Serum iron measures the

A

amount of iron in the blood. Low serum iron and elevated TIBC indicates iron-deficiency anemia.

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15
Q

medications for anemias

A
  • Iron supplements
  • Ferrous sulfate, ferrous fumarate, ferrous gluconate
  • Oral iron supplements are used to replenish serum iron and iron stores.
  • Parenteral iron supplements (iron dextran) are only given for severe anemia.
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16
Q

educations on medication

A
  • Instruct to have hemoglobin checked in 4 to 6 weeks to determine efficacy.
  • Vitamin C can increase oral iron absorption.
  • Instruct the client to take iron supplements between meals to increase absorption, if tolerated.
  • Inform the client stools can appear green to black in color while taking iron.
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17
Q

Erythropoietin: epoetin alfa (prokrit)

A

A hematopoietic growth factor used to increase production of RBCs

18
Q

Erythropoietin: epoetin alfa nursing considerations

A
  • Monitor for an increase in blood pressure.
  • Monitor Hgb and Hct twice per week.
  • Monitor for a cardiovascular event if Hgb increases too rapidly (greater than 1 g/dL in 2 weeks).
19
Q

vitamin b12 supplementation

A

Can be given orally if the deficit is due to inadequate dietary intake.
- Administer vitamin B12 according to appropriate route related to cause of vitamin B12 anemia (parenteral vs. oral).
- Administer parenteral forms of vitamin B12 IM or deep subcutaneous to decrease irritation.
- A client should receive vitamin B12 injections on a monthly basis.

20
Q

folic acid

A
  • Folic acid supplements.
  • Folic acid is a water-soluble, B-complex vitamin. It is necessary for the production of new RBCs.
  • Folic acid can be given orally or parenterally.
  • Large doses of folic acid can mask vitamin B12 deficiency.
  • Large doses of folic acid will turn the client’s urine dark yellow.
21
Q

blood transfusions for anemias

A
  • Blood transfusions lead to an immediate improvement in blood-cell counts and manifestations of anemia.
  • Typically only used when the client has significant manifestations of anemia, because of the risk of blood-borne infections.
22
Q

what is Aplastic Anemia and what is it caused by

A
  • Bone marrow suppression of new RBC production.
  • Deficiency of circulating WBCs, platelets, and RBCs.
  • Caused by medications, viruses, toxins, and radiation.
  • starts in bone marrow and included wbc
23
Q

Nursing Care for Aplastic Anemia

A
  • Monitor labs.
  • Put in isolation room= big risk for infection
  • Monitor for infection.
  • Implement barrier precautions
24
Q

meds for aplastic anemia

A

Immunosuppressive therapy (resets bone marrow)
- Prednisone, cyclosporine

Chemotherapy
- Ctyoxan, Procytox

25
Q

therapeutic measures for aplastic anemia

A

Stem Cell Transplant
Splenectomy

26
Q

Hemolytic Anemia

A

A group of anemias that occur when the bone marrow is unable to increase production to make up for premature destruction of red blood cells.
- Sickle Cell
- Thalassemia

27
Q

contributing factors of hemolytic anemia

A
  • Trauma
  • Lead poisoning
  • Tubercululosis
  • Infections
  • Transfusion reactions
  • Toxic agents
28
Q

manifestations for hemolytic anemia

A

Chills
Dark urine
Enlarged spleen
Shortness of breath
Jaundice

29
Q

Coagulation Disorders

A
  • Occur secondary to an alteration in platelets, clotting factors, or both
  • Coagulopathy is the term for any condition that affects an individual’s ability to coagulate
  • Suspected when usual measures to stop bleeding fail
  • Can occur secondary to autoimmune disorder, extensive blood loss
  • Platelets and clotting factors are lost
30
Q

DIC

A

In some cases, the development of microemboli in the circulatory system paradoxically uses up the clotting factors that cause hemorrhages to occur at the same time intravascular clotting occurs.

31
Q

dic is a complication of

A
  • Septic shock
  • Cardiopulmonary arrest
  • Trauma (hemorrhage, burns, crush injuries)
  • Obstetric complications (toxemia, amniotic fluid embolus, placental abruption
  • Cancer
32
Q

what happens in DIC

A
  • A life threatening coagulopathy in which clotting and anticlotting mechanisms occur at the same time.
  • The client in DIC is at risk for both internal and external bleeding, as well as damage to organs resulting from ischemia caused by microclots.
  • Thousands of microemboli form within organ capillaries ( liver, kidney, heart, brain)
  • This causes hypoxemia and anaerobic metabolism.
  • As a result of massive, multiple clot formation, platelets and other clotting factors are depleted and the client is at increased risk for hemorrhage.
33
Q

nursing actions for DIC

A

Assess client preferences related to blood products
- Religion
- Fear of contamination

  • Administer platelets, clotting factors, and other blood products as prescribed
  • Monitor lab results
    PT, PTT
  • Assess for blood product reactions
  • Assess for further indications of bleeding
  • Apply pressure to leading IV/central line/arterial line sites
34
Q

Heparin Induced Thrombocytopenia (HIT)

A

An immunity-mediated clotting disorder that causes unexplained low blood platelet count as a result of treatment with heparin.

35
Q

Heparin Induced Thrombocytopenia (HIT) risk factors

A
  • Female
  • Receiving heparin longer than 1 week
  • Exposure to unfractionated heparin
  • Post-surgical thromboprophylaxis
    Lovenox
    Heparin
36
Q

Clinical Findings in Coagulation Disorders

A
  • Unusual spontaneous bleeding from gums and nose (epistaxis)
  • Oozing, trickling, or flow of blood from incisions or lacerations
  • Petechiae and ecchymoses
  • Hematuria
  • Excessive bleeding from venipuncture, injection sites, or slight traumas
  • Tachycardia
  • Hypotension
  • Diaphoresis
  • Organ failure secondary to microemboli
  • Respiratory distress
  • Redness, pain of lower extremities (HIT)
37
Q

coag disorder: Hemoglobin

A

(decreased with DIC and ITP)
Male 14-18
Female 12-16

38
Q

coag disorder: platelets

A

(140,000-400,000)
Thrombocytopenia: decreased with DIC, HIT, ITP

39
Q

coag disorder: fibrinogen

A

(60-100)
Decreased with DIC

40
Q

coag disorder: prothrombin

A

(PT)(11-12.5 seconds)
Increased with DIC

41
Q

coag disorder: partial prothrombin

A

(PTT) (60-70 seconds)
Increased with DIC

Med Surg 2 (35 decks)

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