E x a m #2 Flashcards
side effects of thrombolytic therapy
constipation, bleeding from cuts, gyms, & wounds.
fever & hypotension.
cardiogenic shock
when there is a failure of the pump action of the heart, resulting in a decrease in cardiac output causing reduced end - organ perfusion
RBC range
F 4.2 - 5.4
M 4.7 - 6.1
function of hemoglobin & hematocrit
hemoglobin - transport oxygen to lungs
hematocrit - measures the volume of RBC compared to the total blood volume
indicators of shock
restlessness, hypotension, tachycardia, tachypnea. cool clammy skin.
expected findings in aortic aneurysm
“egg shell” appearance. pulsating mass. bruit. hypertension unless ruptured. back/flank pain.
priority assessment of client w/ arterial occlusion of leg
CMST, pain
nursing interventions for preventing venous stasis
ambulation, avoid constrictive clothing, elevate legs, wear elastic stockings after surgery
Tx for thrombophlebitis
Anticoagulants - Lovenox, Coumadin
Thrombolytic therapy - Activase
Platelet inhibitors - abciximab, eptifibatide
myocarditis
inflammation of the myocardium
S/S: tachycardia, MURMUR, friction rub, cardiomegaly, dysrhythmias
usually caused by viral infection
Tx: treat underlying cause
S/S of endocarditis (bacterial/infective)
fever & flu like symptoms, murmur, petechiae on trunk & mucous membranes. positive blood cultures, splinter hemorrhages on nail bed
priority assessment for the client w/ acute infective endocarditis
fluctuation of temp, effects of antibiotics
care of client in acute stage of bacterial endocarditis
oxygen, antibiotics, rest, analgesics
CONSERVE ENERGY
rheumatic fever
caused after infection of upper respiratory tract w/ group A beta-hemolytic streptococci (pharyngitis, impetigo)
diagnosis: ^WBC, ESR. positive c - reactive protein. ^cardiac enzymes in severe pancarditis, ASOTITER, positive throat cultures, prolonged PR interval, cardiomegaly.
Tx: antibiotics (penicillin/erythromycin) antipyretics, corticosteroids, antiHTN, digoxin, diuretics
location of mitral valve
left atrium & left ventricle
greatest priority in care of a client w/ varicose veins w/ edema and ulcerations
elevate legs, avoid sitting/standing for long periods, DO NOT CROSS LEGS, don’t massage, elastic stockings, avoid dangling
care of client following a vein ligation & stripping
supine w/ legs @ 15 degree angle. ROM exercises, elastic bandages, avoid dangling, don’t cross legs, assist with vein marking. monitor for bleeding through bandages. don’t massage. monitor CMST.
what stimulate the production of RBC’s?
erythropoietin
erythrocytes function
carry oxygen to the body and bring back carbon dioxide back into the lungs to be expelled
granulocytes function
neutrophils; fight of pathogens, eosinophils fight allergies, basophils prevent blood clots, reduce growth
thrombocytes function
stop bleeding & stop blood vessel injuries
lymphocytes function
respond to foreign invaders in the body
cells known for phagocytic activity
neutrophils, monocytes, eosinophils, basophils
position of the client undergoing a bone marrow biopsy from the iliac crest
prone
procedure for checking packed RBC
verify client, blood compatibility, and expiration time of blood product w/ another nurse. verify order.
assess labs H&H
obtain blood from bank, inspect discoloration, bubbles, or cloudiness
5 food sources of iron
red meat, poultry, seafood, beans, and dark leafy greens. dried fruit.
pernicious anemia
a decrease in RBC when the body can’t absorb enough vitB12
discharge teaching for client w/ aplastic anemia
conserve energy when standing to prevent dizziness.
wash hands and avoid other sick people, avoid bleeding activities
priority diagnosis for a client with sickle cell CRISIS
- peripheral blood smear show presence of sickled cells
- sickle cell test evaluating sickling of RBC’s
expected treatment for sickle cell crisis
support, oral hydroxyurea to reduce number of sickle cell crisis
narcotics
IV hydration, folic acid supplements
genetic counseling and blood transfusion as necessary
thrombocytopenia
stem cell disorder of the bone marrow that is diagnosed when a client’s platelet count falls below 50,000.
Tx: remove underlying cause. blood transfusions, platelet infusions, corticosteroids, immunosuppressants, splenectomy
Tx for hemarthrosis (bleeding in joints causing bleeding and swelling)
arthrocentesis
priority of care for client w/ neutropenia
increase WBC’s, antibiotics
S/S of transfusion reaction. first priority intervention?
chills, fever, LOW BACK PAIN, tachycardia, flushing, hypotension, chest tightening, tachypnea, nausea, anxiety, hemoglobinuria (FOR ACUTE)
chills, fever, flushing, headache, anxiety (FOR FEBRILE)
*STOP TRANSFUSION, administer NS
S/S of folic acid deficiency
pallor, progressive weakness and fatigue, SOB, glossitis(tongue), cheilosis(cracks on corners of mouth), & diarrhea.
S/S of aplastic anemia
fatigue/weakness, pallor, dyspnea (decreased RBC), petechiae/ecchymosis (decreased platelets), infection (decreased WBCs)
S/S of polycythemia
hypertension, headaches, dizziness, vision and hearing disruptions, ruddy red color of the face, hands, feet, and mucous membranes. severe, painful pruritus.
hepatomegaly, splenomegaly, JVD, thrombosis
S/S od thrombocytopenia
petechiae/ecchymosis, prolonged bleeding/oozing from mouth/nose, epistaxis, menorrhagia, bloody stools.
2 nursing interventions for client w/ PVD reporting cold feet
socks, warm environment
thrombocytosis
a disorder in which your body produces too much platelets
leukocytosis
high levels of WBC’s in the blood
pernicious anemia
a decreased in RB when the body can’t absorb enough vitB12
pancytopenia
deficiency of all 3 cellular components of the blood
2 expected lab values for client w/ polycythemia vera
^RBC mass & total blood volume
excess production of myeloid stem cells
expected lab findings for client w/ disseminated intravascular coagulation
- decreased serum platelet count, serum fibrinogen level
- prolonged prothrombin & partial thromboplastin time
- decreased clotting factors V & VIII
- positive d - dimer test (specific test for DIC) ***
- peripheral blood smear shows schistocytes
normal range for neutrophils
43-62% 1800-7800mmg
thrombus vs. embolus
thrombus: blood clot that stays in one place, can lead to emboli
embolus: a clot that travels, can lead to pulmonary embolism
tx for heparin induced thrombocytopenia
discontinuing heparin
instructions for taking iron supplements
empty stomach is best, little food is ok.
milk, calcium, antacids should be taken 2 hours after iron or 1 hr before.
vitC supplements to help absorb.
avoid caffeine & high fiber foods.
Tx for pernicious anemia
vitb12 suppl. for life injections
Med to treat hemophilia A
- IV Cyroprecipitate
- clotting factors VII or IX to increase
- fresh frozen plasma and PRBC’s
normal range for digoxin
0.5 - 2ng/ml
causes of chronic venous insufficiency
- obesity, pregnancy, thrombophlebitis
- sitting/standing for long periods of time
expected finding in client w/ history of mitral valve insufficiency
crackles (pulmonary congestion), SOB, rapid fluttering HB, pink frothy sputum, murmur
expected findings in client w/ pericarditis
pericarditis friction rub, SOB, chest pain, pain relieved when sitting/leaning forward
which lab test is used to confirm rheumatic endocarditis
positive throat culture, ESR, ADB, c - reactive protein
expected findings in fluid volume excess
bounding, increased pulse rate. elevated BP. distended neck veins. elevated CVP. dysrhythmias.
labs for hemophilia
CBC, coagulation studies, factor VIII
PT(11-12.5sec) PTT(30-45sec) INR (0.7-1.8)
teaching for client undergoing bone marrow biopsy?
may hear crunching sound or scraping sensation as needle punctures bone
apply pressure to site for 10-15min
prone/sidelaying
med given for a mild allergic reaction to food transfusion
Benadryl or another antihistamine
3 nursing interventions for fluid overload
give diuretics, daily weights, monitor I&O, avoid fluids and salts
S/S of anemia
fatigue, weakness, bruising, spoon shaped nails, pallor
erythropoietin (epogen) teachings
report headache, don’t make up dose. avoid driving.
antidote for heparin
protamine sulfate
S/S of suspected of occlusion/rupture of graft of abdominal aorta
back pain, flank bruising, hypovolemic shock, absent extremity pulses, sudden pain, bruit
3 adverse effects of daily aspirin therapy
stroke, gi bleed, rash
adverse effects of epoietin alfa
hypertension, cold symptoms, stomach pain, joint/bone pain, fatigue, insomnia
med for hemophilia A
cryoprecipitate rate
labs monitored in pt w/ DIC
platelets, fibrinogen, prothrombin, partial thromboplastin time, clotting factors
expected findings in client w/ a low platelet count?
autoimmune disease, bone marrow suppression, microscopic hematuria, positive fecal, prolonged bleeding time.
S/S of DIC
abnormal bleeding
cyanosis, cold, mottled finger and toes
severe muscle, back, abdominal, chest pain
dyspnea, confusion, oliguria, shock
universal donor/recipient
donor: O
recipient: AB
3 risk factors for pernicious anemia
chronic gastritis, being strictly vegetarian, resection of stomach, lost pancreatic secretions
nursing intervention for suspected phlebitis
observe q2hr, use smallest gauge needle, clean/change site. monitor redness, increased temp.
schilling test
24hr urine test that measures absorption of vitb12 for pernicious anemia
labs that may be elevated in an infective process
elevated WBC and ESR
relationship between RBC and blood viscosity
the amount of RBC will determine how thick and sticky it will be
IV dextron (iron) administration
IV give very gradually, can cause phlebitis
IM: Ztrack
what should the nurse monitor in client receiving heparin
bleeding & hemorrhage. allergies. increased thrombosis.
labs monitored when on heparin
aPTT, PT, blood clotting time, CBC
risks for DVT
inherited a blood clot disorder, BED RIDDEN, injury, PREGNANCY, smoking, obesity, SURGERY, HF, CONTRACEPTIVES
possible food interaction during heparin therapy
vit K (helps clots), green leafy veg, animal liver alcohol
how does heparin work in treating thrombophlebitis?
to prevent enlargements of existing clots or prevent new clots
why is Benadryl used in clients receiving a transfusion?
for a mild allergy reaction
teaching for client discharged on iron supplements
antacids, antibiotics decreases absorption
vitc can increase absorption
may stain teeth
take on empty stomach, 1 hr before or 2 hr after meals
Tx for hypovolemic shock
IV fluids, blood transfusions, plasma expanders
patho of sick cell anemia
elongated RBC that for sickle shape, increases blood viscosity, accumulation in the smaller blood vessels leads to obstruction then tissue death
patho for DIC
extensive thrombin enters systemic circulations and overwhelms natural anticoagulant.
wide spread clotting consume clotting factors and activates fibrinolytic process with anticoag productions causes hemorrhage
