ATI (chp 30) Flashcards
Potassium and magnesium regulate
body fluid volume
Iron preparations –> select prototype medications
◯ Oral: Ferrous sulfate (Feosol, FeroSul, Slow FE)
◯ Parenteral: Iron dextran (INFeD, DexFerrum)
Iron preparations provide
iron needed for RBC development and oxygen transport to cells.
treat iron-deficiency anemia
When is iron in high demand
times of increased growth (children and pregnancy) and after blood loss
poorly absorbed by the body
Ferumoxytol is limited to clients
with chronic kidney disease
requires only 2 doses every 3 to 8 days
■ Ferumoxytol requires only two doses over 3 to 8 days
compared with SFGC and iron sucrose,
which requires 3 to 10 doses over several weeks.
Iron sucrose and SFGC are used solely for clients
undergoing long-term hemodialysis (most common way to treat advanced kidney failure)
Adverse effects of Iron
-GI distress
-teeth staining (liquid form)
-anaphylaxis risk w/ iron dextran
-Hypotension, which may progress to
circulatory collapse
-fatal iron toxicity in children may offer with overdose (2 - 10 g)
What can be used parenthetically to treat toxicity from iron in children?
chelating agent deferoxamine
Desferal
Iron Preparations are contraindications for:
Hemolytic anemia
peptic ulcer disease
severe liver disease
Coadministration of ___________ and _____________
reduces absorption of iron.
antacids or tetracyclines
separate by atleast 2 hours
Vitamin C increases absorption, but also increases ____________
incidence of GI complications
Avoid taking Vitamin C while taking iron
Patient-Centered Care w/ iron
-eat on empty stomach to maximize absorption
-Instruct clients to space doses at approximately equal intervals throughout day to most efficiently
increase red blood cell production. Inform clients to anticipate a harmless dark green or black color
of stool.
Foods full of iron
(liver, egg yolks, muscle
meats, yeast, grains, green leafy vegetables)
Nursing evaluation on Iron EFFECTIVENESS:
Increased reticulocyte count is expected at least 1 week after beginning iron therapy
Increase in hemoglobin of 2 g/dL is expected 1 month after beginning therapy.
Fatigue and pallor (skin, mucous membranes) have subsided, and the client reports increased
energy level.
Vitamin B12
intranasal cyanocobalamin (Nascobal)
Vitamin B12 is necessary to convert
folic acid from its inactive form to its active form.
Folic Acid
All cells rely on folic acid for DNA production.
Vitamin B12 deficiency can result in
which results in megaloblastic
anemia (macrocytic) and can cause fatal heart failure if not corrected
-Damage to rapidly multiplying cells can affect the skin and mucous membranes, causing GI disturbances.
Neurologic damage, which includes numbness and tingling of extremities and
CNS damage caused by demyelination of neurons,
Vitamin B12 deficiency affects ALL ________ in ____________
blood cells in bone marrow
Loss of erythrocytes leads to heart failure, cerebral vascular insufficiency, and hypoxia.
■ Loss of leukocytes leads to infections.
■ Loss of thrombocytes leads to bleeding and hemorrhage.
Why would a patient need B12 prescribed for the rest of life?
Loss of intrinsic factor within the cells of the stomach make in impossible to absorb B12 naturally
Adverse effect of B12
Hypokalemia secondary to the increased
RBC production effects of vitamin B12
Nursing Interventions of B12 to prevent hypokalemia
Monitor potassium levels during the start of treatment.
› Observe clients for findings of potassium deficiency
(muscle weakness, abnormal cardiac rhythm).
› Clients may require potassium supplements.
Hypokalemia
Low potassium in your bloodstream. Potassium is a chemical (electrolyte) that is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells.
Normally, your blood potassium level is 3.6 to 5.2 millimoles per liter (mmol/L). A very low potassium level (less than 2.5 mmol/L) can be life-threatening and requires urgent medical attention.
Contraindication of using folic acid to treat Vitamin B12 deficiency
Vitamin B12 deficiency should never be treated only with folic acid, which can result in neurological
damage. If folic acid is used for a client with vitamin B12 deficiency, ensure that dosage is adequate.
Oral and intranasal vitamin B12 are what pregnancy category?
Pregnancy Risk Category A
Parenteral formulation of Vitamin B12
is Pregnancy Risk Category C
signs of vitamin B12 deficiency
such as beefy red tongue, pallor, neuropathy
Which patients receive Vitamin B12 injections
loss of intrinsic factor (pernicious anemia), enteritis, and partial removal of the stomach
This type of Vitamin B12 medication should be taken atleast 1 hour before or after HOT food
Intranasal cyanocobalamin should be administered 1 hr before or after eating hot foods, which can cause the medication to be removed from nasal passages without being absorbed because of increased
nasal secretions.
irreversible malabsorption syndrome
(parietal cell atrophy or total gastrectomy)
Food group high in Vitamin B12
dairy products
Schillings test
to determine vitamin B12 absorption in the gastrointestinal tract.
Measurement of plasma B12 levels helps to determine need for therapy.
Prescribed Vitamin B12 tests
vitamin B12 levels should be monitored every 3 to 6 months
VITAMIN B12 Nursing Evaluation of Medication Effectiveness
◯ Improvement of megaloblastic anemia as evidenced by increased reticulocyte count, absence of
megaloblast in bone marrow, macrocytes in blood, and normal or increased Hgb and Hct levels.
◯ Improvement of neurologic symptoms such as absence of tingling sensation of hands and feet
and numbness of extremities. Improvement may take months, and some clients will never attain
full recovery.
Folic Acid is essential for
Folic acid is essential in the production of DNA and erythropoiesis (RBC, WBC, and platelets)
Treatment of megaloblastic (macrocytic) anemia ___________ to folic acid deficiency
secondary
Why is folic acid needed for all woman of child bearing age?
Prevention of neural tube defects during pregnancy