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Anemias Flashcards

1
Q

Pathophysiology of Fe (iron) deficiency

A
  1. Amount of iron (Fe) in body is ADEQUATE
  2. INADEQUATE amt of Fe is delivered to ‘erythroid precursor cells’
  3. RBCs can’t be made
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2
Q

Causes or risks for Fe deficiency

A

+ Diet low in iron
+ blood loss
+ malabsorption from Crohn’s, celiac, etc.
+ pregnancy

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3
Q

Diagnostic tests for iron deficiency, anemia

A

CBC
+ ⬇️ MCV (molecular corpuscular volume)
+ ⬇️ reticulocytes (immature RBCs)
OTHER
+ decreased iron
+ % saturation
+ ferritin (protein found in spleen/liver/skeletal muscle/bone marrow) that controls store & release of Fe
+ ⬆️ TIBC (total iron-binding capacity of blood) — if high, low amts of Fe in 🩸

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4
Q

Medical treatments for iron deficiency, anemia

A

+ Oral iron – ferrous sulfate, ferrous glutamate, etc.
+ Venofer IVF — if oral Fe is poorly tolerated
+ Treat underlying causes — G.I. bleed, ulcers, cancer, fibroids

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5
Q

considerations when giving patient ORAL Fe

A

+ Do not take with antacid, dairy, pantoprazole
+ take on empty stomach OR with orange juice

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6
Q

Nursing assessments for Fe deficiency anemia

A

S/S:
+ fatigue, dizziness, headache
+ pins and needles and fingers/toes
+ SOB on exertion

SEVERE S/S:
+ pounding pulse, low blood pressure
+ hematuria, bloody stool

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7
Q

Nursing care & interventions for iron deficient anemia

A

+ Cluster activities — don’t wear out patient
+ O2 if needed
+ fall precautions
+ ⬇️ Pt anxiety
+ increase dietary greens/red meat and poultry/dried yellow apricots

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8
Q

What B9/Folic acid, and B12 deficiency anemia have in common

A

+ Increased MCV — RBC’s are large, inefficient, and fewer RBCs circulating
+ ⬇️ folate or B12

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9
Q

Another name for folic acid, or a vitamin B12 deficient anemia

A

Megaloblastic anemia (a type of pernicious anemia)

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10
Q

Causes of folic acid deficiency

A

+ Malabsorption — Crohn’s, celiac
+ ETOH
+ medications — dilantin
+ poor quality diet
+ kidney dialysis
+ pregnancy

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11
Q

Causes of vitamin B 12 deficiency

A

+ inadequate intake: vegan diets, not eating animal products
+ impaired GI tract absorption
+ age-related decreased acid secretion
+ autoimmune gastritis
+ meds
+ malabsorption
+ absence of Intrinsic Factor (pernicious anemia)

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12
Q

Diagnostic tests or labs for Folic acid in vitamin B 12 deficiency

A

+ ⬇️ folate or B12

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13
Q

Treatment for Folic acid, or B12 deficient anemia

A

+ treat underlying problems related to deficiency
+ folic acid — PO/IV supplement
+ B 12 — PO/IM supplementd

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14
Q

Assessment for Folic acid and/or B12 deficient anemia

A

+ fatigue, dizziness, headache, paresthesia in fingers/toes
+ pallor
+ palpitations
+ SOB on exertion
+ sore red tongue, mouth ulcers (B12, pernicious)
+ muscle weakness
+ vision disturbances
+ depression, confusion

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15
Q

Interventions for folate or B12 deficient anemia

A

+ supplementation (if vegetarian/vegan)
+ diet rich in folate: greens, green veggies, enriched breads/grains
+ diet rich in B12: red meat, liver, sardines, lamb, wild caught salmon, feta, eggs

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16
Q

What is B12 needed for

A

+ RBC production
+ DNA synthesis
+ support healthy functioning nerves 

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17
Q

What is pernicious anemia?

A

When the body can’t absorb enough B12, due to lack of intrinsic factor, autoimmune syndrome or weak stomach lining

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18
Q

What is neutropenia?

A

+ neutrophil count < 2000/mm3
+ When the level of neutrophils circulating on blood is lower than expected/normal

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19
Q

How is neutropenia related to anemia?

A

Nutritional deficiency:
- Production of blood cells requires vitamin B12, folate, and copper
- Severe deficiency of these vitamins results in neutropenia, as well as low levels of other cells such as red blood cells (anemia). Vitamin deficiency can be caused by low dietary intake of nutrients or from poor absorption, such as after bypass surgery.

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20
Q

What is intrinsic factor?
Why is it important to anemia?

A

+ substance found in the stomach that is needed to absorb B12
+ lack of intrinsic factor ➡️ B12 cannot be absorbed ➡️ pernicious anemia

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21
Q

Causes of neutropenia

A

+ Sepsis
+ TB
+ cancers
+ autoimmune dz

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22
Q

How to diagnose neutropenia

A

+ CBC w/differential
+ absolute neutrophil count — ANC

23
Q

Medical tests/Tx for neutropenia

A

+ If associated w/fever ➡️ assumed to be infection
- cultures taken: blood, urine, sputum — ALSO chest x-ray
- broad-spectrum antibiotics initiated immediately
- After culture results identified – correct antibiotic regimen initiated

TREAT THE CAUSE
+ filgrastim/Neupogen
- colony-stimulating factors: prevention of febrile neutropenia assoc. w/infection in patients with bone marrow, depressing treatments, reduces time for neutrophil, recovery and sequela of neutropenia and patients
- binds to/stimulates immature neutrophils to divide/differentiate

24
Q

Signs and symptoms of neutropenia

A

+ No defined S/S till patient develops infection
+ routine CBC w/differential can show neutropenia before onset of infection symptoms

25
Neutropenia interventions
+ Monitor ANC + neutropenic precaution – reverse isolation ➡️ no flowers, no raw veggies/fruit, no yogurt
26
Thrombocytopenia Relation to anemia
+ Platelet level below 140,000 + iron deficiency & aplastic anemia can both cause ITP
27
What is aplastic anemia?
Bone marrow fails to make enough RBCs, WBCs & platelets
28
Causes of ITP
+ decreased production in bone marrow + increased destruction/consumption by antibodies and spleen + severe dehydration + leukemia + alcoholism/alcohol consumption + decreased thrombosis Iatan production in the liver + hereditary + cancer, HIV, hepatitis, H. pylori, autoimmune diseases + antiplatelet meds
29
Medical treatment for Thrombocytopenia
+ Find the cause + platelet transfusion + IVIG — blocks Plt interaction w/antibody-coated Plts — ⬆️ # of circulating Plts + steroids — shuts down immune response in body
30
Thrombocytopenia S/S
+ Bruising bilaterally + petechiae plus song, prolonged, bleeding + bleeding gum/nose + hematuria + dark or bloody stool + fatigue + heavy menstrual flow
31
Thrombocytopenia teaching/interventions
+ ⬆️ vitamin C: broccoli, spinach, brussels sprouts, kiwi, strawberries + avoid ETOH, avoid people sick w/viruses
32
What are platelet defects in the blood?
+ Platelet count **within normal range** + platelet function **not within normal range**
33
Example of platelet dysfunction
+ platelets lack a substance that sticks to the walls of blood vessels ➡️ *Bernard-Soulier syndrome (don’t need to know name)*
34
Causes of platelets defects/dysfunction
+ Cancer + meds: aspirin, aces, beta blockers, calcium, channel, blockers, fish oil + OTC herbs: garlic, ginkgo, ginseng, ginger
35
Labs/tests for platelet defects
+ CBC + PT/PTT + platelet function analyzer ➡️ measures platelet ability to aggregate
36
Treatment for platelet defects
+ Find cause + platelet transfusion
37
Platelet defect S/S Platelet defect interventions
+ Bleeding + Avoid substances that interfere with platelet function: meds/herbals + notify HCP‘s, including dentists of condition before invasive procedures — allows for risk measured to be in place for procedures + maintain good oral hygiene
38
What is sickle cell anemia?
+ Fewer RBC in blood + RBCs sickle shaped – don’t move through vessels properly - stick to sides and build up causing blocks
39
Sickle cell anemia, Patho
+ Inheritance of both HbS genes - 1 from ea/parent — *hemoglobin S* + Arterial blood – ⬆️ O2 — HbS has biconcave disc shape + venous blood – ⬇️O2 — HbS becomes dehydrated, rigid + sickle-shaped ➡️ die early + body has ⬇️ RBCs in circulation + sickle cells stick in endothelium of small vessels ➡️ ischemia/infarction ➡️ pain, swelling, fever (SCC crisis) + sickling happens over time ➡️ precipitated by stressors, cold, infection, severe physical exertion, dehydration
40
What is sickle cell trait?
Receiving only one HbS genes — only 1 parent passes gene
41
Sickle cell etiology /risk factors
**Certain descents:** + African + Mediterranean + Middle Eastern + Indian
42
Diagnostic test for sickle cell disease – anemia
+ Low Hct + sickle shaped RBCs on observation + WBC/Plt often ⬆️ than normal + **Dx tests confirmed by hemoglobin electrophoresis**
43
Symptoms of sickle cell disease/anemia
+ Anemia + episodes of pain: chest, abdomen, joints – often chronic + swelling: hands and feet + frequent infections – potentially life-threatening ➡️ pneumonia + delayed growth/puberty + vision/eye problems
44
Medical treatment for sickle cell disease/anemia
+ Aggressive management signs/complications + hematopoietic stem cell transplant + hydroxyurea – chemo agent to ⬆️ fetal Hgb + folic acid, hydration w 1/2NS, steroids + PRBC transfusion + pain management: narcotics + anti-depressants, PCA pump for **SCC – pain management, IV, transfusion** + Oxygen therapy + erythrocytapheresis: automated red cell exchange — removes blood w/HbS from Pt ➡️ replaces w/ same volume PACKED w/red cells FREE of HbS
45
What causes Sickle Cell Crisis — SCC
+ illness + changes in temperature + stress + dehydration + high altitudes
46
What is sickle cell crisis — SCC?
+ pain that can begin suddenly and last several hours to several days + happens when sickled red blood cells block small blood vessels that carry blood to your bones — causes pain in back, knees, legs, arms, chest, stomach
47
Six types of sickle cell crisis - SCC
+ vaso-occlusive - most common + sequestration + infarctive + aplastic + haemolytic - least common + bone pain
48
Why are antidepressants prescribed for sickle cell anemia
The complications from chronic disease causes depression
49
Why does sickle cell disease cause jaundice?
+ sickled RBCs die faster than liver can filter them out + Bilirubin from broken down cells builds up in system causing jaundice
50
Nsg care: Clinical manifestations of SCD?
+ Hemoglobin at 5 to 11(LOW) — should be 12-24 depending on sex + short stature, stubby fingers and toes (children have growth set-back) + jaundice + hypoxic damage or ischemic necrosis in tissues/organs + ⬆️ susceptibility to infection — pneumonia, osteomyelitis + pain, fatigue, depression **chronic SCD associated with:** + tachycardia + cardiac murmurs, cardiomegaly + dysrhythmias, heart failure
51
Nsg interventions/actions for sickle cell disease
+ Identify factors that precipitate previous crisis + identify measures taken to prevent/manage crisis + maintain hydration status Dash PO/IV + provide comfort + pain management – opioids + oxygen therapy – tissue perfusion + know Pts Hx of SCD treatments + monitor CBC + Promote coping skills + minimize deficient knowledge to prevent sickle cell crisis + educate patient - self care - how to prevent exacerbation & crisis
52
Medical management for anemia – – general sense
+ Correct and/or control the cause of anemia + May include transfusions of PRBCs + understanding each type of anemia and how to control it (deficient iron, folate, B12, etc) + **Understanding gerontologic considerations:** - physical performance - ⬇️ mobility - ⬆️ frailty - ⬆️ depression - ⬆️ risk of falls - delirium - MORE fatigue, dyspnea, confusion (much lower cardiac reserve)
53
Difference between hypoproliferative and hemolytic anemias
+**Hypoproliferative:** anemias that are deficient in red blood cells due to iron/Folate/B 12, renal disease, inflammation, aplastic anemia, megaloblastic anemia + **Hemolytic anemias:** “lysis” — erythrocytes have shorten lifespan, their number in circulation is reduced, oxygen is much more decreased — sickle cell disease

_NS 124 (4 decks)

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