Exam 1 Review pt.2 Flashcards
What does a CBC consist of?
RBC
H&H
MCV & MCHC
What is hemoglobin?
The iron containing pigment of the RBC
(the seats)
(carry O2)
What is important when taking labs into consideration
Trending the labs
Causes of anemia
Bleeding
Bone marrow failure
Dietary deficiency
Renal disease
Causes for increase H&H
Polycythemia (too many RBC’s)
Dehydration
What protein transports iron?
Serum transferrin
What protein stores iron?
Serum ferritin
What is the most sensitive test to determine iron deficiency anemia
Serum ferritin
What test indicates whether the body is attacking its own RBC?
Direct coombs
What test is used to screen for antibodies prior to blood transfusion?
Indirect coombs
Indications for bone marrow biopsy
Unexplained anemia
Thrombocytopenia
Leukopenia
(when we do not know the cause)
Three main causes for anemia
- Decrease production (iron-b12-folic-kidney-liver)
- Blood loss (trauma) (ulcer)
- Increase destruction (sickle cell) (medication) (blood transfusion)
Decreased RBC production anemias
Iron deficiency
(hgb synthesis)
Cobalamin b12
Pernicious b12
Folic acid deficiency
(Defective DNA synthesis)
aplastic
renal failure
medication
(Decrease number of RBC precursors)
Megaloblastic anemias are caused by
Impaired DNA synthesis
What Hgb level is considered severe and will often result in blood transfusion?
6 g/dL
Anemia clinical manifestations
Weakness
Fatigue
Pallor
Increase HR
Bone pain
Angina
Dyspnea
Increase RR
Clinical manifestations of iron deficiency anemia
PALLOR = #1 (loss of demarcation)
Glossitis (tongue)
Cheilitis (lips)
Koilonychia (spoon nails)
Pica
Pagophagia
Iron deficiency morphology
Microcytic (small)
Hypochromic (pale)
Who gets cobalamin deficiency anemia
Pernicious anemia (no IF)
Hx of bowel surgery
Strict vegans
Alcohol abuse
Cobalamin Deficiency Clinical Manifestations
NEUROMUSCULAR
-weakness
-paresthesia
-ataxia
-impaired thought
Abdominal Pain
N/V
Glossitis
Cheilitis
Decrease RBC due to decreases hgb synthesis
Iron deficiency anemia
Decreased RBC due to defective DNA synthesis
Cobalamin
Pernicious
Folic
Aplastic Anemia results in
Pancytopenia
Decrease:
Platelets
RBC
WBC
Aplastic Anemia Morphology
Normocytic normochromic
Nursing Implication: Iron supplement
Ferrous Sulfate
Absorbed in duodenum (avoid enteric coated or XL)
Best in acidic environment take one hour before meals (if possible) (might have to wing)
Undiluted liquid will stain
May turn stool black
Z-track method
Before give IV ferrous sulfate we should
give test does because of risk of fatal anaphylaxis
ferrous sulfate side effects
Heartburn
Constipation
Diarrhea
epoetin alfa
Many adverse reaction
BBW: Discontinue when Hgb >10
Relative Polycythemia
Cause by decreased plasma volume / dehydration
false high Hct
Primary polycythemia
VERA
Automine
Secondary polycythemia
COPD or High Altitude
Body is compensating low O2 levels by make more RBC to transport the O2
Polycythemias Clinical Manifestations
Increase Blood Viscosity
Increase Blood Volume
Hypermetabolism
Increase RBC and H&H
Most serious complication of polycythemia
Stroke
Type and Cross match is also known as
Indirect coombs test
Pre transfusion Responsibilities
Asses lab values
Verify order
Type and Cross match (q 48)
Consent form
Pre-medicate PRN
IV set upt
30 min to start blood once received from blood bank
Blood Transfusion IV set up
20 ga or larger IV
Y tubing
Filter
NS (only NS)
Transfusion Responsibilities
Assess VS before procedure (baseline)
Constant observation first 15 min
Assess VS in 15 minutes
Take VS q hr and at end
4 hours maximum
ABO is a factor when giving
FFP and RBC
Platelets
Kept and room temp and good for 1-5 days
Bag should be agitated periodically to prevent clumping
Given when less than 20,000
Signs and Symptoms of Acute Hemolytic Transfusion Reaction
Immediate onset
Facial flushing
Fever and chills
Lower back pain
Hemoglobinuria
Dyspnea
Tachypnea
Hypotension
Cardiac arrest
Febrile Non-hemolytic Transfusion Reaction
Most common
S/S
-Fever
-HA
-Flushing
-Anxiety
-Vomiting
-Muscle pain
Nursing:
-Antipyretic
-Re-start order
-Leukocyte reduced
Mild Transfusion Reaction
S/S:
Flushing
Itching
Urticaria
Nursing:
Antihistamine
Corticosteroid
Washed RBC and platelets
Severe Allergic Transfusion Reaction
S/S:
Anxiety
Dyspnea
Wheezing
Bronchospasm
Cardiac Arrest
Nursing:
CPR
O2
Epinephrine
Autologous components
Bacterial Sepsis Transfusion Reaction
S/S:
Rapid onset of chills
Vomiting
Diarrhea
Hypotension
Nursing:
Blood culture
Antibiotics
Vasopressors
Follow blood bank orders
Transfusion Associated Circulatory Overload
S/S:
Cough
Dyspnea
Pulmonary congestion
Headache
Increase VS
JVD
Nursing:
Diuretics
O2
Morphine
CXR
3 chambers of chest tube
Collection
Water seal
Suction
Chest tube insertion
Provider insert
Pre medicate
Obtain thoracotomy tray, chest tube, and drainage system
Maintain correct position
Support
A patient with a chest tube should still
Get OOB and aggressive pulmonary toilet
What to do if bleeding is noted on a dressing
Mark the edge of area with pen DIT
Notify provider if it starts to increase
Not tidaling in means
Lungs have re-expanded
There is kink or obstruction
Suction is one
Constant or abnormal bubbling in chest tube could indicate
There is a leak
Three reasons why you should ever clamp a chest tube
Trying to determine location of air leak
Changing drainage system
Provider orders to see what is tolerated
PleurX
Used only when symptomatic at home. Wait 2-5 days in between use
Benefits:
Less hospital trips
Patient has control
Decrease respiratory complications
Safe and easy
Chest tube removal
CXR
Pre-medicate
have patient bear down
Airtight dressing
