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RN Summer 2021 Test 1 > Ch. 34 Folic Acid, Sickle Cell, and Leukemia > Flashcards

Ch. 34 Folic Acid, Sickle Cell, and Leukemia Flashcards

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1
Q

Folic acid, also called

A

Vitamin B9

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2
Q

What two deficiencies can co-exist

A

Folic acid and Vit B12

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3
Q

Risk factors for folic acid deficiency

A

Older adults
Chronic illness
Alcohol abuse
Extreme diets

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4
Q

Deficiencies in Vit B12 and Folic acid act the same except what else does folic acid affect?

A

inhibit DNA synthesis to such an extent that during neural tube development, incomplete closure occurs in utero, with resulting congenital anomalies such as spina bifida, anencephaly, and cleft palate and lip.

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5
Q

Dietary sources of folic acid

A

include green leafy vegetables, bran, yeast, legumes, and nuts

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6
Q

Clinical manifestations of folic acid deficiency

A

Pallor, tachycardia, tachypnea, dizziness, and fatigue

Increased risk of bleeding – b/c affects platelet formation (decreased amount)

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7
Q

Diagnosis for folic acid deficiency

A

CBC
Serum folate
Serum MMA

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8
Q

Serum MMA and homocysteine levels are the best laboratory tests used

A

to differentiate between if deficiency is from folic acid or Vit B12

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9
Q

Serum MMA and homocysteine levels for Vit B12 deficiency

A

MMA is elevated

Homocysteine is normal

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10
Q

Serum MMA and homocysteine levels for folic acid deficiency

A

MMA is normal

Homocysteine is elevated

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11
Q

Medical management for folic acid deficiency

A
  • Fortification of cereals and grains with folic acid helps to reduce the incidence of this specific deficiency
  • Oral supplement
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12
Q

Complications of Folic Acid Deficiency

-Are they reversible?

A

cause neurological clinical manifestations such as confusion or disorientation. unlike a vitamin B12 deficiency, these clinical manifestations are reversible
-Impaired Neuro tube development

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13
Q

Nursing Diagnosis for folic acid deficiency

A

Inadequate tissue perfusion related to decreased oxygenation as a result of decreased hemoglobin and hematocrit
• Activity intolerance related to impaired oxygen-carrying capacity secondary to folate deficiency
• Risk for delayed development related to incomplete neural tube closure secondary to folate deficiency

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14
Q

Folic Acid Nursing Interventions: Assessment

A
  • Vital signs Tachycardia and tachypnea are secondary to the heart and lungs compensating for decreased oxygenation of body tissues caused by the reduced production of heme and RBC maturation demonstrated by decreased hemoglobin levels.
  • Fatigue, pallor, and shortness of breath Fatigue, pallor, and shortness of breath worsen with increasingly decreased levels of hemoglobin causing inadequate tissue perfusion.
  • Confusion, disorientation Neurological clinical manifestations are caused by decreased oxygenation to the central nervous system.
  • Hemoglobin levels, serum folate levels, RBC folate levels, and increased serum homocysteine levels Folic acid deficiency causes incomplete DNA synthesis that is necessary for the formation of heme, RBC maturation, and folate levels in the serum and RBCs and influences the metabolic pathway, which results in increased homocysteine levels.
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15
Q

Folic Acid Nursing Interventions: Actions

A
  • Ensure adequate folate/folic acid intake. Ensuring adequate intake of dietary sources of folate and folic acid through food fortification prevents anemia and neural tube defects
  • Administer folic acid supplements. Folic acid is the synthetic form for supplementation. Supplementation is needed when the body has increased folate demands, such as in pregnancy, early childhood, or alcoholism. It is also needed when malabsorption of folate occurs because of disorders such as Crohn’s disease, gastrointestinal resections, and the use of medications that interfere with folate absorption.
  • Differentiate anemia caused by folic acid deficiency versus vitamin B12 deficiency. Supplementation of folic acid may reverse the anemia caused by vitamin B12 but will not stop the neurological degenerations that occur with vitamin B12 deficits. These neurological changes may become irreversible if misdiagnosed.
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16
Q

Folic Acid Nursing Interventions: pt teaching

A

Dietary sources of folate/folic acid Good sources include fortified cereals and grains, legumes, green leafy vegetables, bran, yeast extracts, and nuts
• Immediately report any clinical manifestations of fatigue, shortness of breath, dizziness, and confusion. Resolution of the anemia through supplementation or blood transfusions is needed to increase tissue perfusion.
• Prenatal teaching Because of the strong link between folic acid deficiency and the occurrence of neural tube defects and orofacial abnormalities during embryonic development, it is essential to teach all women of childbearing years the importance of obtaining at least 400 mcg of folic acid daily during the preconception stage and during pregnancy.
• Need for supplementation Individuals who have had gastrointestinal resections, such as gastric bypass surgery or a Whipple procedure, need education regarding folic acid supplementation. Individuals on certain anticonvulsants (e.g., phenytoin), oral contraceptives, metformin, and chemotherapeutic agents (fluorouracil, methotrexate) need to be educated about the importance of folic acid supplementation because ordered medications may interfere with the absorption of folate.

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17
Q

Sickle Cell Anemia

A

RBCs become elongated and stiff and lose flexibility. On microscopic examination, these cells are sickle-shaped, thus the name of the disease (Fig. 34.4). Sickle-shaped RBCs carry less oxygen and are fragile. Because of the decreased flexibility and fragility, RBCs break apart as they pass through the capillary beds. The result is congestion and clumping in the capillary beds and the formation of thrombi

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18
Q

How does someone get sickle cell?

A

Both parents must carry the gene

*If both parents don’t have gene then kid becomes a carrier

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19
Q

Life span of sickle cell

A

15-20 days

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20
Q

What is hemolysis?

A

RBCs break apart

Happens with sickle cell anemia

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21
Q

Thrombosis vs emboli

A

Thrombi- clot

Emboli- clot that travels

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22
Q

Clinical manifestation on sickle cell

A

Anemia = Fatigue, pallor, shortness of breath

Vasoocclusion/thrombi = Pain, swelling

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23
Q

Is there a cure for sickle cell?

A

No - treatment based on symptom management

24
Q

Medical management for SCD

A
  • Need O2 and fluid therapy
  • Pain management
  • Hydroxyurea- chemo agent that helps create more fetal hemoglobin
  • Fetal blood has a lot of stem cells (which can convert to RBCs)
25
Q

Complications of SCD

A 
Acute chest syndrome
C V A - b/c of clots
Infection - b/c shape of cell causes injury/damage to vessel 
Developmental delay
Disability
Complications in pregnancy
26
Q

What should you assess for for pt with SCD?

A
  • Tachypnea
  • Shortness of breath
  • Tachycardia
  • Fatigue
  • Pallor
  • Jaundice
27
Q

What can multiple episodes of sickle cell crisis lead to?

A

• Hand-foot syndrome • Delayed puberty with developmental delay of secondary sexual characteristics • Cognitive impairment, ranging from learning disabilities to mental retardation • Psychosocial issues

28
Q

Nursing diagnosis for SCD

A

• Impaired tissue perfusion related to sickling of RBCs with resulting decreased oxygen-carrying capacity and tissue hypoxia
• Activity intolerance related to hypoxemia resulting from the sickling RBCs
• Acute pain related to clumping of sickled RBCs in the capillary beds, resulting in tissue ischemia
***• Risk for powerlessness related to frequent sickle cell crises, often for no apparent reason

29
Q

Nursing interventions: Assessment SCD

A

Vital signs = Tachycardia and tachypnea are a result of the sickling of RBCs that causes a decreased oxygen-carrying capacity of the hemoglobin molecules. It is also as a result of the decreased life span and increased destruction of RBCs.
• Fatigue, pallor, and shortness of breath Fatigue, pallor, and shortness of breath worsen with increasingly decreased levels of hemoglobin and RBCs causing inadequate tissue perfusion and hypoxia.
• Pain, swelling in joints and extremities Pain is caused by tissue hypoxia and clumping of cellular debris, particularly in the joints, bones, chest, and abdomen, leading to vaso-occlusion.
• Jaundice The decreased life span of RBCs in people with SCD and the increased destruction of those RBCs may cause an increase in serum bilirubin, leading to jaundice. What does dead RBC release?
• Hand-foot syndrome Multiple episodes of crises and bone infarctions may lead to uneven growth of the fingers and toes.
• Clinical manifestations of infection Fever may be present without infection. However, infection must be ruled out. X-rays to eliminate pneumonia or osteomyelitis may be necessary. Any skin lesions must be assessed for infection. Dental hygiene should not be overlooked as a source of infection.
• Hemoglobin and serum bilirubin levels The sickled RBCs have decreased hemoglobin levels, and increased hemolysis of RBCs elevates serum bilirubin. • Serum iron, vitamin B12, and folate levels Because of the lower-socioeconomic status of a large percentage of African descendants globally, malnutrition is a concern. Frequently, patients with SCD also have decreased levels of iron, vitamin B12, and folic acid. These deficiencies complicate the anemia and need to be corrected.
• Psychosocial issues Patients with SCD may have anger and/or depression in response to chronic disease. Frequent absences from work may interfere with employment, leading to feelings of guilt or anger.

30
Q

Nursing Interventions: actions SCD

A

Administer oxygen. Oxygen assists in decreasing hypoxia and minimizing the severity of the crisis.
• Provide aggressive hydration. Aggressive hydration increases blood volume (easing clumping of debris in capillaries) and flushes the kidneys, minimizing the risk for renal failure.
• Administer pain medication. Administering analgesia, usually opiates, helps manage the pain caused by vaso-occlusion.
• Administer blood transfusions. Blood transfusions may be needed in cases where the anemia is profound to improve oxygen delivery to the tissues.
• Administer antipyretics. Antipyretics help reduce fever if present and decrease the fluid loss associated with temperature elevation and increased metabolic rate.
Provide supportive measures. A sickle cell crisis can be frightening to all involved, the individual with SCD as well as the family. The nurse needs to provide emotional support and be cognizant of the possible need for counseling. Contact additional resources if needed.

31
Q

Nursing interventions: Teaching SCD

A

Pathophysiology of disease Parents need to understand the disease and its unpredictable course. The need for medical intervention early in a crisis can make the difference between a crisis lasting several hours or several days. Timely medical intervention can also minimize potential complications.
• Infection prevention measures Because patients with SCD are prone to infection as a result of impaired function of the spleen, the need for updated immunizations and annual flu and pneumococcal vaccines is essential. Good dental hygiene and frequent dental check-ups and careful monitoring of any cuts, sores, and insect bites are also key to minimizing infections.
• Avoid cold temperatures and wearing tight, restrictive clothing. Taking measures that may prevent vasoconstriction may help prevent sickle cell crises.
• Avoid high altitudes and depressurized airplanes. Avoiding environments with low oxygen tension may minimize sickling of RBCs and prevent a sickle cell crisis.
• Avoid dehydration. Being adequately hydrated helps blood move freely through capillary beds. • Avoid overexertion. It is important for the patient with SCD to take rest periods to avoid undue stress on the cardiovascular system.
• Maintain activities of daily life within prescribed limitations. Although care and special considerations need to be taken into consideration, it is still important for the person living with SCD to live as normal a life as possible. Therapy and counseling should be recommended if the patient needs assistance in coping with this chronic disease.
• Risk of more frequent sickle cell crises during pregnancy Because of the body’s increased demands during pregnancy, exacerbation of the SCD may occur. Pregnant individuals with SCD need to be monitored closely because they have a higher risk of maternal and infant mortality.
• Fetal complications Low birth weight, gestational hypertension, preterm labor, spontaneous abortions, and stillbirths are also higher in this population because of increased oxygen demands during pregnancy.
• Genetic counseling Because SCD is an inherited disease, genetic counseling is recommended for all individuals with SCD or the SCT.

32
Q

Leukemia

A

a malignant disease or “blood cancer,” is a disorder of the bone marrow in which WBCs begin multiplying uncontrollably
-WBCs never mature

33
Q

Four types of leukemia

A

acute myelogenous leukemia (AML)
chronic myelogenous leukemia (CML)
acute lymphoblastic leukemia (ALL)
chronic lymphocytic leukemia (CLL)

34
Q

Chronic exacerbation of leukemia can lead to

A

they eventually degenerate into an acute phase and progress to death if untreated

35
Q

Connection with Down Syndrome and Leukemia

A

they eventually degenerate into an acute phase and progress to death if untreated

36
Q

Which leukemia is associated with Downs

A

acute lymphoblastic leukemia (ALL)

37
Q

What cells are involved with myeloid leukemia?

A

granulocytes or neutrophils, erythrocytes, monocytes, and platelets

38
Q

What cells are involved with lymphoid leukemia?

A

lymphocytes

39
Q

Patho of Leukemia

A
  • Unknown stimulus mutates myeloid or lymphoid stem cell
  • Uncontrolled proliferation of leukemic cell (leukocytosis)
  • Apoptosis doesn’t occur
  • Bone marrow, spleen, lymph congested with blast
40
Q

What is apoptosis?

A

Cell death

41
Q

Clinical manifestations of Leukemia

A

Swollen lymph glands
Increased infections - affects WBC
Anemia - b/c myeloid affects RBCs
Bleeding - b/c of low platelets

42
Q

Risk factor of leukemia

A

Not sure- believe it may be passed down

43
Q

Diagnosis leukemia

A

CBC - shows leukocytosis, or increased WBC count, but also demonstrates anemia and thrombocytopenia that occurs as a result of the congested bone marrow
H&P performed
Bone marrow biopsy- shows the type of leukemia and extent of the malignancy
Genetic testing -performed on these cells to determine any chromosomal abnormalities

44
Q

Leukocytosis

A

Increased WBC

45
Q

Thrombocytopenia

A

Low platelets

46
Q

Medical Management of Leukemia

A

Chemotherapy

Bone marrow transplant (only way to cure it but body can reject it)

47
Q

Complications of Leukemia

A

Infection
Hemorrhage - b/c low platelets
Myelosuppression - means = low production of all blood cells
Bleeding - can happen in urine, need pt education to be careful with shaving

48
Q

What to assess for leukemia

A 
•**Neutropenia 
• Anemia 
• Thrombocytopenia 
• Shortness of breath, especially on exertion or lying flat **• Excessive bruising 
**• Petechiae 
• Fatigue 
 Pallor 
• Dizziness Fatigue 
***• Low-grade fevers in response to minor infections
49
Q

What precautions are need for neutropenic?

A

Can’t get rid of foreign bodies
-need reverse isolation = protect them for us = need to put on mask, children do not need to visit, no live plants, no raw fruit or vegs

50
Q

Nursing diagnosis for leukemia

A

Risk for infection related to immature leukemic cells’ inability to fight infection or neutropenia
• Risk for impaired tissue perfusion related to the bone marrow’s decreased ability to produce adequate RBCs because of the congestion caused by the increased number of leukemic WBCs
• Risk for bleeding related to the bone marrow’s decreased ability to produce adequate platelets because of the congestion caused by the increased number of leukemic WBCs
• Risk for compromised family coping related to the diagnosis of leukemia and lifestyle changes to accommodate treatment

51
Q

Nursing interventions: Assessment for leukemia

A

Vital signs Low-grade fevers in response to minor infections by cuts, abrasions, sores, and so forth occur because of the decrease in mature neutrophils needed to produce a more pronounced temperature elevation. • Fatigue, pallor, dizziness, shortness of breath These clinical manifestations of anemia occur as a result of decreased erythrocytosis because the bone marrow is congested with WBCs.
• Excessive bruising, petechiae (different from a rash—when you push, petechiae do not blanch) These clinical manifestations of thrombocytopenia occur as a result of decreased production of platelets because the bone marrow is congested with WBCs, and there may be spontaneous bleeding into the subcutaneous tissues.
• CBC values Leukocytosis of leukemic WBCs occurs from a single mutation. The excessive WBCs clog the bone marrow, resulting in decreased production of RBCs and platelets.

52
Q

Nursing interventions: actions for pt with leukemia

A

• Administer chemotherapy as prescribed.

The patient is started on chemotherapy to destroy the leukemic cells.

• Institute neutropenic precautions.

The patient needs to take extra precautions to prevent infection due to low neutrophil counts.

• Prophylactic use of antibiotics, antivirals, and antifungals as ordered

A prophylactic regimen of antibiotics, antivirals, and antifungals is often initiated to provide added protection against infection when the neutrophil count is low.

• Administer IV antibiotics.

When the ANC is less than 1,000, it is imperative to start IV antibiotics immediately in order to prevent sepsis and possible death.

• Symptom management (nausea/vomiting/diarrhea, ulcerations of the mouth)

Post-chemotherapy/post-radiation symptom management is continuously assessed to maintain the patient’s quality of life. Antiemetics or antidiarrheal medication are indicated to minimize discomfort as well as to decrease fluid loss.

• Administer ordered blood products. The patient may require blood products as cell counts (RBCs and platelets) drop because of the myelosuppression caused by chemotherapy.

53
Q

Nursing interventions: Teaching for leukemia

A

Neutropenic precautions It is essential that the patient/family is instructed in order to prevent a major infection or to initiate treatment immediately upon exhibiting the clinical manifestations of an infection.
• Clinical manifestations of anemia In order to minimize the anemia and its complications, education is essential for prompt administration of growth factor or transfusions.
• Manifestations of thrombocytopenia It is essential that the patient/family seek medical attention if the patient has any early signs of bleeding.
• Bleeding precautions The patient needs to have practical knowledge about how to prevent bleeding when the platelet count is low.
• Diagnosis of leukemia The patient/family needs to understand the course that the leukemia takes and why it is important to follow treatment plans as recommended.
• Adverse reactions of chemotherapy or radiation The patient/family needs to know what side effects may occur as a result of the treatment regimen in order to notify healthcare personnel of any problems that need to be addressed.
• Possibility of sterility Chemotherapy or radiation can render the patient sterile. The patient needs to be educated on alternative methods of family planning, including sperm or egg donation.

54
Q

What is Filgrastim

Brand name: Neupogen

A

Bone marrow stimulant
It can help the body make white blood cells after receiving cancer medications. It can also improve survival in people who have been exposed to radiation.

55
Q

Radiation vs chemo

A

Radiation - burns

Chemo - systemic

RN Summer 2021 Test 1 (9 decks)

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