Chapter 28 | Hematologic and Renal Emergencies

Question 1

List:

diseases that make patients prone to poor clotting

3 points

Answer 1

• advanced liver disease
• hemophilia
• von Willebrand disease

Question 2

Define:

coagulopathies

Answer 2

abnormal clotting of blood

Question 3

Fill in the blank:

Coagulopathies can occur when [BLANK] or [BLANK].

Answer 3

Coagulopathies can occur when the body forms clots too readily or patient clots too slowly.

Question 4

Define:

anemia

Answer 4

lower-than-normal amount of red blood cells

Question 5

Define:

acute anemia

Answer 5

lower-than-normal amount of red blood cells caused by sudden blood loss

Question 6

List:

complications of chronic anemia

2 points

Answer 6

• excessive menstrual periods
• slow GI bleeding

Question 7

Define:

sickle cell anemia

Answer 7

genetic disease causing red blood cells to have defective shape

Question 8

List:

complications of sickle cell anemia

5 points

Answer 8

• destruction of spleen (due to blockage)
• sickle pain crisis (especially when sick)
• acute chest pain (due to sludging)
• priapism (blockage of blood out of penis)
• stroke (clumping of blood in brain)

Question 9

List:

treatments for sickle cell anemia

2 points (give what and transport where)

Answer 9

• high flow supplemental oxygen
• transport to stroke center (if stroke suspected)

Question 10

Define:

UTI

(abbreviation)

Answer 10

urinary tract infection

Question 11

Describe:

most common disease that afflicts renal/urinary system

Answer 11

urinary tract infection (UTI)

Question 12

Fill in the blank:

UTIs are typically limited to [BLANK].

(part of body)

Answer 12

UTIs are typically limited to the bladder.

Question 13

Fill in the blank:

UTIs are typically caused by [BLANK].

(little thing)

Answer 13

UTIs are typically caused by bacteria.

Question 14

List:

signs/symptoms of urinary tract infection (UTI)

2 points

Answer 14

• urinary tract pain
• frequent urination

(can cause AMS in older patients)

Question 15

Fill in the blank:

If left untreated, a urinary tract infection (UTI) can cause [BLANK].

(other than sepsis)

Answer 15

a urinary tract infection (UTI) can cause pyelonephritis.

(UTI ascends up ureter into kidney)

Question 16

Define:

kidney stones

Answer 16

build-up of calcium within the kidney

Question 17

Fill in the blank:

When in the kidney, kidney stones usually cause [BLANK].

Answer 17

kidney stones usually cause no symptoms.

Question 18

Fill in the blank:

When they become dislodged, kidney stones can cause [BLANK].

Answer 18

kidney stones can cause severe unilateral flank pain.

known as “renal colic”

Question 19

True or false:

Patients with kidney stones may report nausea and vomiting.

Answer 19

true

shared nerve connections between the kidneys and the GI tract can be triggered by kidney stones

Question 20

List:

reasons to need urinary catheter

2 points

Answer 20

• obstruction of bladder outflow
• neurologic disorder

Question 21

Fill in the blank:

Urinary catheters are commonly inserted in [BLANK].

Answer 21

Urinary catheters are commonly inserted in the urethra.

Question 22

Define:

renal failure

Answer 22

failure of kidneys to adequately filter and remove toxins

Question 23

Fill in the blank:

Acute renal failure typically results from [BLANK] or [BLANK].

Answer 23

Acute renal failure typically results from shock or toxin ingestion.

Question 24

Fill in the blank:

Chronic renal failure may be caused by [BLANK] or [BLANK].

kidneys no work long time

Answer 24

Chronic renal failure may be caused by genetics or damage from uncontrolled diabetes or hypertension.

Question 25

Define:

ESRD

Answer 25

end stage renal disease

Question 26

Define:

end stage renal disease (ESRD)

Answer 26

irreversable renal failure

last stage of chronic kidney disease (CKD)

Question 27

Define:

Patients with ESRD typically require [BLANK].

(long-term treatment)

Answer 27

Patients with ESRD typically require dialysis.

(ESRD is end stage renal disease)

Question 28

Define:

hemodialysis

Answer 28

a procedure where a dialysis machine and a special filter (artificial kidney) are used to clean your blood

Question 29

Define:

peritoneal dialysis

Answer 29

treatment for kidney failure that uses peritoneum to filter your blood inside your body

Question 30

List:

broad groups of ESRD emergencies

2 points

Answer 30

• loss of kidney function
• complication of dialysis

Question 31

List:

underlying medical factors for most dialysis patients

2 points (other than kidney failure)

Answer 31

• diabetes
• hypertension

Question 32

Fill in the blank:

Complications of ESRD typically relate to [BLANK].

(patient’s action)

Answer 32

Complications of ESRD typically relate to the patient missing dialysis.

(ESRD is end stage renal disease)

Question 33

List:

signs/symptoms of ESRD

3 points

Answer 33

• shortness of breath (dyspnea)
• edema (pulmonary/peripheral)
• electrolyte disturbances

(similar to CHF because kidneys regulate fluid)

Question 34

List:

possible complications of dialysis

3 points

Answer 34

• bleeding from A-V fistula
• clotting and loss of A-V fistula function
• infection (peritonitis)

A-V fistula is the connection for dialysis

Question 35

Answer:

What is the most common organ transplant?

Answer 35

kidneys

(approx 21,000 transplants per year)

Question 36

True or false:

Patients experiencing renal colic may also refer to groin pain.

Answer 36

true

Question 37

True or false:

Patients experiencing renal colic may also refer to shoulder pain.

Answer 37

false

Question 38

Fill in the blank:

The connection between artery and vein for hemodialysis is called a(n) [BLANK].

Answer 38

The connection between artery and vein for hemodialysis is called an A-V fisula.

Question 39

Define:

A-V fistula

Answer 39

connection between an artery and a vein

typically abnormal (but also created artificially for hemodialysis)

Question 40

Choose:

You are dispatched to a sick call. The patient was just extricated from a bathtub where he was trapped under the shower door for 2 days. The 72-year-old male had limited access to water from the bathtub faucet. The patient is complaining of disorientation, nausea, and vomiting.

What do you think is the underlying cause for the illness?

A. Gastrointestinal infection

B. Chronic renal failure

C. End-stage renal disease

D. Acute renal failure

Answer 40

D

rapid onset on symptoms due to incident implies acute nature (not chronic)

severe dehydration can cause acute renal failure which shows these symptoms

Question 41

Fill in the blank:

Peritoneal dialysis is conducted at [BLANK].

(physical location)

Answer 41

Peritoneal dialysis is conducted at home.

Question 42

Fill in the blank:

Hemodialysis is conducted at [BLANK].

(physical location)

Answer 42

Hemodialysis is conducted at a special facility.

(like a dialysis clinic)

Question 43

Choose:

Peritoneal dialysis allows patients to dialyze at home through:

A. the abdomen.

B. the urethra.

C. a dialysis machine.

D. an AV fistula.

Answer 43

A

Question 44

Fill in the blank:

[BLANK] patients are at high risk for acquiring the inherited disorder called sickle cell anemia.

Answer 44

African American patients are at high risk for acquiring the inherited disorder called sickle cell anemia.

Question 45

Choose:

A patient with renal disease who is currently on dialysis and missed an appointment may present with dangerously high levels of the electrolyte:

A. potassium.

B. sodium.

C. phosphorous.

D. calcium.

Answer 45

A

Question 46

Choose:

You are attending to an end-stage renal disease (ESRD) patient who has missed dialysis. Which of the following statements is most accurate?

A. Patients who have missed dialysis and who become unresponsive and pulseless respond very well to the use of an AED.

B. Patients who have missed dialysis and who become unresponsive and pulseless do not respond very well to the use of an AED.

C. You should delay transport if necessary to wait for ALS.

D. Calling for ALS would not be very helpful because they cannot really do anything that an EMT cannot do in these situations.

Answer 46

B

Question 47

Choose:

You are dispatched to a private residence for a 52-year-old African American male sitting in his living room complaining of chest pain. During your assessment, he discloses that he has the sickle cell trait.

Because this patient has the sickle cell trait, you should:

A. administer high-concentration oxygen.

B. monitor for signs of inadequate respiration.

C. treat the patient as any other 52-year-old with chest pain.

D. be prepared to treat for shock if he also has a high fever.

Answer 47

C

Question 48

Choose:

Platelets are actually fragments of larger cells that are crucial to the formation of clots. Clumping (called aggregation) of platelets is the body’s most rapid response to stop bleeding from an injured site. However, in some situations the clumping of platelets is not​ desirable, such as when a plaque in a coronary artery ruptures. In this​ situation, the rapid clumping of platelets can cause a clot that then completely blocks the coronary artery and results in a heart attack (myocardial infarction).

One of the most effective and widely available drugs to prevent the aggregation of platelets is:

A. acetaminophen.

B. plasma.

C. hemoglobin.

D. aspirin.

Answer 48

D

Question 49

Answer:

How frequently is peritoneal dialysis treatment required?

Answer 49

multiple times per day

Question 50

Choose:

Under which of the following circumstances do the kidneys help the body retain fluid?

A. Kidney stones

B. Electrolyte imbalance

C. Urinary tract infection

D. Dehydration

Answer 50

D

Question 51

Choose:

You encounter a patient who has been having diffuse abdominal pain for one week. The patient has a pulse rate of 86, a blood pressure of 140/90, and a respiratory rate of 20. However, the patient appears pale and complains of generalized weakness and shortness of breath during everyday activities.

You suspect the patient is experiencing:

A. acute anemia.

B. chronic anemia.

C. sickle cell anemia.

D. anxiety disorder.

Answer 51

B

note how the patient complains of these symptoms during everyday activities

chronic anemia lasts over a longer period that acute anemia which happens in the moment

this is not related to anxiety or sickle cell anemia

Question 52

Choose:

A patient with a medical history of sickle cell anemia is complaining of chest pain and shortness of breath. The patient is breathing 26 times per minute in short, shallow respirations. However, the patient’s oxygen saturation via pulse oximetry is 100% on room air.

The best approach regarding supplemental oxygen is to:

A. place the patient on a nasal cannula.

B. place the patient on a nonrebreather mask.

C. place the patient on a simple face mask.

D. do nothing; no supplemental oxygen is necessary.

Answer 52

B

never deny oxygen to patient who needs it

Question 53

Choose:

You are dispatched to a private residence for a sick person. You arrive and find a 47-year-old male patient who recently completed his peritoneal dialysis and complains of severe abdominal pain that is worsened by movement. One of the more serious complications of this type of dialysis is a bacterial infection within the peritoneal cavity.

What would be the tell-tale sign that this is a case of bacterial infection in the peritoneal cavity?

A. The patient’s dialysis fluid appears clear when it is drained from the peritoneal cavity rather than having its normal cloudy appearance.

B. The patient has swollen ankles.

C. The patient’s dialysis fluid appears cloudy when it is drained from the peritoneal cavity rather than having its normal clear appearance.

D. The patient has trouble urinating.

Answer 53

C

Question 54

Choose:

The medications that transplant patients need to take for the rest of their lives to prevent organ rejection also often lead to high susceptibility of [BLANK].

Answer 54

The medications that transplant patients need to take for the rest of their lives to prevent organ rejection also often lead to high susceptibility of infection.

medications counteract immune system so it doesn’t attack foreign things

Question 55

Answer:

How frequently is peritoneal dialysis treatment required?

Answer 55

multiple times per day

Question 56

Choose:

One of the more serious diseases of the body is renal failure. Renal failure occurs when the:

A. pancreas stops working.

B. liver fails to function properly.

C. kidneys fail to function as required.

D. adrenal glands stop working.

Answer 56

C

Question 57

Choose:

Which of the following pathologies put patients at high risk for acute renal failure?

A. Shock

B. Polycystic kidney disease

C. Hypertension

D. Uncontrolled diabetes

Answer 57

A

Question 58

Choose:

Once you encounter uncontrolled bleeding from an AV fistula, which of the following methods would you consider using to control bleeding in addition to direct pressure and elevation?

A. Internal wound management

B. Hemostatic dressings

C. Tourniquet

D. Pressure points

Answer 58

B

Question 59

Choose:

Patients who dialyze at home are at high risk for what type of infection?

A. Fistula infection

B. Peritonitis

C. Decubitus ulcers

D. Cellulitis

Answer 59

B

because peritoneal dialysis

Question 60

Fill in the blank:

Chronic anemia is usually caused by [BLANK].

Answer 60

Chronic anemia is usually caused by diseases affecting bone marrow.

aplastic anemia occurs when your bone marrow doesn’t make enough red/white blood cells and platelets

having fewer red blood cells causes hemoglobin to drop

hemoglobin is the part of blood that carries oxygen through your body

Question 61

List:

primary concerns for patient with sickle cell anemia

2 points

Answer 61

• respiratory distress
• hypoperfusion

monitor for these things

Question 62

Choose:

Which blood component is responsible for cellular immune defense against infections?

A. Plasma

B. Platelets

C. Leukocytes

D. Erythrocytes

Answer 62

C

Leukocytes, or white blood cells, are responsible for immune defense against infections. Plasma, also, plays a role in immunity, but leukocytes are the cellular protection; plasma circulates antibodies (immunoglobulins).

Question 63

Define:

hematuria

Answer 63

blood in urine

Question 64

Define:

leukocyte

Answer 64

white blood cells involved in protecting the body against both infectious disease and foreign invaders

Question 65

Define:

erythrocytes

Answer 65

red blood cells that carry oxygen to the body and CO₂ away from it