Exam 2 Review: Hematologic Problems Flashcards
What patient population might have the most issues with anemia?
Women
What are the signs and symptoms of anemia caused by?
Body’s response to tissue hypoxia
What expected patient outcome of anemia displays that the patient is trying to compensate for low RBC levels?
Tachycardia, the heart is beating faster to circulate more blood in order to compensate for low fluid levels
What is the ultimate goal of anemia?
Correcting the cause of anemia
What treatment option is prioritized for patients with anemia?
Oxygen therapy
Anemia patients are treated with what supplement? What is a side effect?
Iron; constipation
What are some underlying causes of anemia? (5)
- iron deficiency
- bleeding
- chronic disease/inflammation
- renal insufficiency
- hematologic cancer
Why is it difficult to diagnose older patients with anemia?
Because there may be no identifiable cause of anemia in the older adult
What signs and symptoms may not be recognized for anemia? (4)
Pallor, cyanosis, confusion, fatigue
In severely anemic patients, what would you expect to find?
Dyspnea and tachycardia
A client with anemia may be tired due to a tissue deficiency of what substance?
Oxygen
What is the most common nutritional disorder in the world?
Iron deficiency anemia
What can iron deficiency anemia be caused by? (4)
- inadequate dietary intake
- blood loss
- hemolysis
- chronic GI blood loss
Signs and symptoms of iron deficiency anemia? (3)
- pallor: most common
- glossitis: inflammation of the tongue
- cheilitis: inflammation of the lips
Iron deficient patients will receive what supplement? What is it best absorbed with? What patient teaching should be included?
- iron
- best absorbed with vitamin C (orange juice)
- warn patient that stool will be dark and tarry
What is thalassemia?
Inadequate production of normal hemoglobin resulting in a decrease in erythrocyte production
How is thalassemia managed? (3)
- blood transfusions
- iron/zinc supplements
- chelating agents to bind iron
What is the primary pathophysiology underlying thalassemia?
Inadequate hemoglobin of synthesis
Megaloblastic anemia is caused by?
Impaired DNA synthesis causes the RBCs to become large (macrocytic) and abnormal
What are the GI signs and symptoms of pernicious anemia? (4)
- soreness
- red
- beefy tongue
- anorexia
Patients with pernicious anemia have the inability to absorb? How is it treated?
Unable to absorb vitamin B12 due to a lack of intrinsic factor; treated using an IM injection of B12
What are the neuromuscular signs and symptoms of pernicious anemia? (3)
- muscle weakness
- paresthesia of exts
- impaired thought process
What deficiency can cause megaloblastic anemia?
Folic acid deficiency (needed for the synthesis of RBC)
What is the normal serum folate level?
3-16 mg/mL
Folic acid deficiency is treated with replacement therapy. What is the usual dose?
1 mg per day PO
The nurse should instruct the patient to eat which food to obtain the best supply of vitamin B12?
Meats and dairy products
Patients with pernicious anemia have which lab result?
Intrinsic factor, absent
Patient with pernicious anemia asks the nurse why she must take vitamin B12 injections for the rest of her life. What is the best response?
You are unable to absorb the vitamin because your stomach is not producing enough intrinsic factor
What is aplastic anemia?
Disease in which patient has peripheral blood pancytopenia, a decrease in all types of RBC (WBC, platelets, red blood cells)
What is the main concern for patients with aplastic anemia?
The patient will not have a high functioning immune system
Which lab finding supports the diagnosis for aplastic anemia?
Reduced RBCs (WBC, platelets, red blood cells)
What is the main vital sign that a nurse should be concerned about in a patient with acute blood loss?
O2 saturation
Why is pain assessment important for patients with acute blood loss?
To determine internal hemorrhage
Chronic blood loss is related to? It is considered as?
Depletion of iron stores and is considered an iron-deficiency anemia
How is chronic blood loss managed? (2)
- identifying the source and stop the bleeding
- supplemental iron
Hemolytic anemia is caused by?
destruction or hemolysis of RBCs at a rate that exceeds production
What is the major focus during treatment for a patient with hemolytic anemia?
Maintain renal function (kidneys are not getting perfused because of low RBC and must work extra hard to filter the hemolyzed RBC)
Sickle cell disease is caused by?
Hemoglobin S, causes the erythrocyte to stiffen and take on a sickle shape due to inadequate oxygen
Sickle cell anemia affects what part of ventilation?
transportation
What can cause a sickling event? (8)
- infection
- high altitude
- emotional/physical stress
- surgery
- blood loss
- dehydration
- hypoxemia
- temp variations esp cold weather
Sickle cell crisis causes?
acute exacerbation causing vaso-occlusive crisis which causes severe pain
How to prevent pulmonary embolism in patients with sickle cell anemia? (2)
ambulation and SCD devices
Sickle cell anemic patients are on high alert because they are at risk for?
respiratory failure
A patient who is having a sickle cell crisis asks the nurse why the sickling causes such pain. The nurse explains that the pain is caused by?
Tissue hypoxia caused by small blood vessel occlusion, leading to tissue necrosis
What should be part of the patient teaching for sickle cell disease? (2)
- avoid dehydration
- avoid high altitudes
Acquired hemolytic anemia is treated by? (3)
- supportive care until the causing agent is found
- aggressive hydration
- electrolyte replacement
What are additional treatment options for acquired anemia? (3)
- corticosteroid
- blood products
- remove the spleen
Acquired hemolytic anemia is caused by? (3)
Hemolysis of RBCs from extrinsic factors:
- physical destruction
- antibody reaction
- infectious agents
Hemochromatosis is?
Iron overload disorder
What are nonspecific signs and symptoms of hemochromatosis? (5)
- PAIN
- fatigue
- arthralgia
- impotent
- weight loss
Hemochromatosis is mostly seen in?
Men
What is the normal iron level?
2-6 g
Thrombocytopenia is?
Platelet below 150,000 (needed to clot)
Signs and symptoms of thrombocytopenia? (3)
- mucosal bleeding
- petechiae
- superficial ecchymosis
When there are multiple petechiae, what is this called?
purpura
What is the antidote for heparin?
protamine sulfate
Nursing management for thrombocytopenia? (2)
- discourage OTC (gingko, garlic, ginger)
- keep surroundings clean and cover sharp corners
What risk factor increases the chances of sickle cell crisis?
dehydration
