Chapter 29 Flashcards
Lower than normal hemoglobin and fewer than normal circulating erythrocytes is known as?
**this is a sign if an underlying disorder
Anemia
_____ is a defect in production of RBCs.
*Caused by trauma, bleeding ulcers, GI bleeding, liver disease, or ruptured aneurysm
Hypoproliferative anemia
____ is excess destruction of RBCs.
**Caused by altered erythropoiesis, hypersplenism, drug-induced, autoimmune processes, mechanical heart valves, sickle cell
Hemolytic anemia
_____ is a protein in red blood cells that helps carry oxygen throughout the body.
Hemoglobin
What are some clinical manifestations of anemia?
fatigue, jaundice, SOB, dyspnea, tachycardia, chest pain, tongue (beefy red) and nail changes (brittle), PICA, angular cheilosis, forgetfulness, paresthesia, extremity numbness, memory loss
What diagnostic tests can be used to diagnose anemia?
H&H
RBC indices
iron studies
vitamin b12
folate
erythropoietin levels
bone marrow aspiration
What assessments should the nurse complete in a patient with anemia?
Health hx
labs
S/S
nutritional assessment
meds
cardiac and GI assessments
assess blood loss (period, GI)
neuro assessment
Medical management of a patient with anemia:
Correct or control the ____
_____ of packed RBC
treatment ____ to type of anemia
_____ therapy
____ or vitamin supplements
cause
tranfusion
specific
dietary
iron
What are some collaborative problems and potential complications for a patient with anemia?
heart failure
angina
paresthesia
confusion
injury related to falls
depressed mood
____ ____ are more likely to develop depressed mood, confusion, or experience falls with injury.
older adults
Patients with underlying ____ ____ are more likely to develop cardiac complications.
heart disease
Major treatment goals for a patient with anemia include:
- decreased ____
- ______ nutrition
- maintain of adequate ___ perfusion
- adherence to ____ plan
- ______ of complications
fatigue
adequate
tissue
treatment
absence
What is the MOST common symptom associated with anemia?
Fatigue
**encourage balance to rest and activity
What type of food should be encouraged in a patient with anemia?
Iron rich foods and limit alcohol
What is the most common type of anemia in ALL age groups?
Iron deficiency
What type of anemia occurs in chronic renal failure?
Anemia in renal disease
What type of anemia is common during cancer treatment, chronic infections, and autoimmune diseases?
Anemia of inflammation
What type of anemia is caused by bone marrow suppression?
Aplastic anemia
What type of anemia is caused by folic acid and vitamin B12 deficiency that leads to abnormally large erythrocytes?
megaloblastic anemia
TRUE OR FALSE.
We should assume the cause of iron deficiency anemia is bleeding until proven otherwise.
TRUE
What are some clinical manifestations of iron deficiency anemia?
dizziness, fatigue, weakness, pallor, dyspnea on exertion, swollen beefy red tongue, brittle nails
What is the definitive diagnosis for iron deficiency anemia?
Bone marrow aspiration
What is the mainstay treatment of iron deficiency anemia?
Oral iron supplements
what can inhibit the absorption of iron supplements?
Coffee, tea, soda, dairy products, and antacids
What drugs are associated with causing iron deficiency anemia due to GI bleeding?
NSAIDS, steroids, alcohol
What drugs are associated with causing iron deficiency anemia due to malabsorption of iron?
PPIs (Prilosec), H2 receptor blockers (Pepsid), antacids (tums, pepto)
Why does anemia in renal disease occur in patients with kidney failure?
Because kidneys produce EPO
What are S/S of anemia in renal disease?
- reduced O2 utilization
-decreased cognitive function
-impaired memory
-reduced immune response
-decreased libido
What are S/S of megaloblastic anemia?
-dyspnea
-jaundice
-fatigue
-neurological issues
What population is vitamin b12 deficiency common among?
vegans
What is the most common symptom of vitamin b12 deficiency?
neurological problems/disorders
What are some causes of a folic acid deficiency?
Alcoholism, oral contraceptives, meds that act as a folic acid antagonist, low dietary intake, old age, pregnancy
___ ____ conditions are when the erythrocytes have shortened lifespan, therefore their number in circulation is reduced.
hemolytic anemias
What will be released into systemic circulation in a patient with hemolytic anemia?
reticulocytes (immature RBCs)
What are the different types of hemolytic anemias?
-sickle cell disease
-thalassemia
-glucose 6 phosphate dehydrogenase deficiency
___ ___ ____ is an inherited condition that results in oddly shaped erythrocytes that can adhere to the wall of small vessels causing a thrombus and tissue ischemia.
*More common among African Americans
sickle cell disease
What is the inherited gene that causes sickle cell disease?
HbS gene
Sickle-shaped cells has a ____ lifespan, resulting in anemia.
shortened
What assessments should be done on a patient with sickle cell disease?
health hx
physical exam
pain assessment
labs
S/S
sickle cell crisis assessment
blood loss (period, GI)
Cardiovascular assessment
neuro assessment
Symptoms will vary in sickle cell disease based on the amount of ___ ____.
HbS gene
What are the clinical manifestations of sickle cell disease?
primary symptom is pain due to ischemic tissue, anemia, fever, swelling, tenderness, hypertension, tachycardia, N/V, ulcerations of lower legs
What usually triggers a sickling episode?
low O2 tension in the blood
____ is the most common precipitating factor of a sickling episode.
infection
Initially, sickling is reversible with ______.
re-oxygenation
_____ ____ is extremely painful and caused by sickle cells getting trapped in small vessels preventing blood flow.
Vaso-occlusive crisis
____ ___ is caused by infection from HPV.
*hemoglobin fail rapidly and bone marrow cannot compensate
Aplastic crisis
____ ___ happens when organs pool sickled cells.
*commonly seen in spleen, liver, and lungs
Sequestration crisis
What are potential complications of sickle cell disease?
hypoxia, ischemia, infection, dehydration, CVA, anemia, kidney disease, heart failure, impotence, substance abuse, acute chest syndrome
___ ____ ___ is a term used to convert conditions characterized by chest pain, cough, fever, hypoxia, and lung infiltrates.
Acute chest syndrome
What is the main cause of death in young adults with sickle cell disease?
Thromboembolism
What is the only chemotherapy agent that is FDA approved to treat a sickle cell crisis?
Hydroxyurea
Management of sickle cell disease:
____ used for hypoxia
____ used for dehydration
oxygen
IV fluids
____ ____ ____ ___ may CURE disease.
BUT
there is a small donor pool and failure a risk in its with preexisting organ damage
Hematopoietic stem cell transplant
What is polycythemia?
increased volume of RBCs
___ ___ is caused by a congenital gene mutation.
Primary polycythemia
____ ____ is caused by an excessive production of erythropoietin from reduced amounts of oxygen, cyanotic heart disease, non-pathologic conditions or neoplasms
secondary polycythemia
What is the medical management of polycythemia?
**treatment NOT NEEDED if condition is mild
treat underlying cause
therapeutic phlebotomy
In order to be diagnosed with polycythemia, a females hematocrit must be ___, and male ____.
50%
55%
**dehydration is NOT A CAUSE
___ ____ ____ is a calculation of the total number of circulating neutrophils.
absolute neutrophil count
___ is uncontrolled proliferation of WBCs, often immature
Leukemia
___ is lower than normal number of neutrophils. (<2000/mm3)
neutropenia
____ is a lower than normal platelet count.
thrombocytopenia
____ is an abnormal decrease in WBCs, RBCs, and platelets
Pancytopenia
____ is a lymphocyte count less than 1500/mm3.
Lymphopenia
___ is a higher than normal platelet count.
thrombocytosis
___ is tiny capillary hemorrhages.
Petechiae
TRUE or FALSE.
A patient with neutropenia will have clinical manifestations before they develop an infection.
FALSE
they DO NOT have S/S until infection has developed
What type of patient is at an increased risk for infection and needs to be monitored closely?
Neutropenic
What are some causes of lymphopenia?
-exposure to radiation
-long-term use of corticosteroids
-infections
-neoplasms
-alcohol abuse
Most blood coagulation factors are synthesized in the ____.
liver
___ liver disease and ___ can negatively impact clotting.
Alcoholic
Hepatitis
_____ is a fat-soluble vitamin that effect production of clotting factors in the liver.
Vitamin K
What kind of foods are rich in vitamin K?
Leafy greens, broccoli, soybeans, pumpkin, smaller amounts of meats and cheese.
Who is more likely to be deficient in vitamin K?
pts who had bariatric surgery, bowel diseases, or malabsorption disorders
What mediations impact clotting factors?
Coumadin (warfarin)
heparin
What is a normal platelet count?
140,000-400,000
___ ___ is failure of hemostatic mechanisms, blood cannot clot properly.
bleeding disorders
What are some common causes of bleeding disorders?
trauma, platelet abnormality, coagulation factor abnormality
What is medical management of bleeding disorders?
specific blood products
What is nursing management of bleeding disorders?
limit injury, asses for bleeding, bleeding precautions
What are some common bleeding disorders?
-secondary thrombocytosis
-thrombocytopenia
-immune thrombocytopenia purpura
-platelet defects
-hemophillia
-von willebrand disease
What are clinical manifestations of thrombocytopenia?
**usually DO NOT occur until count <50,00
petechiae, nosebleeds, bleeding gums, excessive menstrual flow, surgery, hemorrhage
What is the treatment for thrombocytopenia?
*treat underlying cause
corticosteroids, platelet transfusion, IVIG
True or False.
A patient with thrombocytopenia should notify provider or dentist prior to any procedures or taking any new meds
TRUE
Nurses should ensure they do patient teaching concerning ___ ___ to a patient with thrombocytopenia.
Bleeding precautions
_____ ___ is caused by a genetic defect making person deficient in clotting factor VIII. Most common effects 1 in 5000 births.
Hemophilia A
____ __ is a genetic defect that makes person deficient in clotting factor IX. Most commonly effects males and occurs in all ethnic groups.
Hemophilia B
TRUE OR FALSE.
75% of all bleeding In hemophilia patients occurs in joints. Commonly affected are knees, ankles, shoulders, wrists, and hips.
TRUE
What is the most common sign of hemophilia?
BLEEDING, anytime and anywhere
Medical management of hemophilia consists of?
transfusion of factor VIII and IX concentrates or FFP
What is nursing management for a patient with hemophilia?
education, avoid using aspirin and NSAIDS, don’t take warm baths, encourage excellent oral hygiene
What are some acquired coagulation disorders?
liver disease, vitamin K deficiency, DIC, thrombotic disorders, hyperhomocysteinemia, antithrombin deficiency, protein C & S deficiency, thrombophilia
DIC is NOT a ____ but a sign of an underlying disorder.
disease
What are triggers of DIC?
sepsis, trauma, shock, cancer, abruption placentae, toxins, allergic reactions
What is the treatment for DIC?
**treat underlying cause
correct tissue ischemia
replace fluids and electrolytes
maintain BP
replace coagulation factors
use heparin or LMWH
What are potential nursing diagnoses for a patient with DIC?
fluid volume deficiency, impaired skin integrity, imbalanced fluid volume, ineffective tissue perfusion, risk for injury, death anxiety
What are some potential complications of DIC?
-kidney injury
-gangrene
-pulmonary embolism or hemorrhage
-acute respiratory distress syndrome
-stroke
TRUE OR FALSE.
In a patient with DIC, the nurse should avoid trauma and procedures that increase risk fo bleeding, including activities that would increase ICP.
TRUE
What is the anecdote to heparin?
Protamine sulfate
What is the anecdote to Warfarin?
Vitamin K
