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exam 4 Flashcards

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1
Q

what is hemophilia

A

inherited bleeding disorder
x-linked genetic defect(more prevalent in males)

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2
Q

hemophilia a vs hemophilia b

A

hemophilia a- caused by a genetic defect that results in deficient factor VIII
hemophilia b- stems from a genetic defect that causes deficient factor IX

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3
Q

clinical manifestations of hemophilia

A

(frequency & severity of bleeding depends on how deficient factor is as well as the intensity of the injury)
hemorrhage
hematuria
joint pain
muscle compressing nerves
poor wound healing
tarry stools

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4
Q

labs/diagnostics for hemophilia a

A

factor VIII assay is 25% of normal or less
PTT and bleeding time are prolonged
platelets and PT are normal

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5
Q

labs/diagnostic for hemophilia b

A

factor IX assay is deficient
baseline coagulation results are similar to those of hemophilia a but with normal factor VIII

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6
Q

treatment for hemophilia

A

fresh-frozen plasma
factor replacement therapy
prophylaxis of procedures
glucocorticoids for joint pain and edema

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7
Q

what drug is used iv subq or intranasal spray for hemophilia a

A

desmopressin acetate (DDAVP)

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8
Q

nursing interventions for hemophilia

A

administer factor
promote good nutrition
monitor for s/s of bleeding
elevate/put pressure on limb
restrict activity for 48 hrs after bleeding is under control
avoid IM injections
bleeding precautions
avoid anticoags, nsaids, aspirin, alcohol
ROM-keep joint flexible

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9
Q

b12 and folic acid help make

A

RBC

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10
Q

folic acid stimulates

A

erythropoeisis

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11
Q

nutritional anemias include

A

iron deficiency
b12 deficiency
folic acid deficiency

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12
Q

b12 needed for making

A

DNA

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13
Q

what is iron deficiency anemia

A

most common nutritional anemia
resulting from low iron levels, the iron stores are depleted first, followed by hemoglobin stores

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14
Q

what can cause iron deficiency anemia

A

lack of oral iron intake, blood loss, seen in alcoholics, GI malabsorption issues

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15
Q

labs with iron deficiency anemia

A

low h&h
low RBC
low MCV
low serum iron
low ferritin

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16
Q

what is ferritin

A

protein that stores iron

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17
Q

clinical manifestations of iron deficiency anemia

A

pale
fatigue
dyspnea
tachycardia
smooth red tongue
epithelial atrophy
cheilosis (cracks in lips)

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18
Q

treatment for iron deficiency anemia

A

increase dietary intake of iron
control chronic bleeding
iron supplements (oral- ferrous sulfate & ferrous gluconate)

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19
Q

foods to increase iron intake

A

beef
leafy greens
organ meats
vitamin c in addition for absorption
branflakes
oatmeal
whole grain bread
dry beans

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20
Q

Nursing interventions for iron deficiency anemia

A

monitor labs
educate on diet
vs
activity intolerance
s/s bleeding
take iron on empty stomach
dont mix with milk

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21
Q

what is vitamin b12 deficiency anemia

A

megaloblastic
lack of dietary intake or absorption of b12

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22
Q

what are causes of b12 deficiency anemia

A

malnutrition
atrophy of gastric mucosa
long term use of h2 receptor blockers and ppi’s

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23
Q

what differentiates b12 deficiency anemia and pernicious anemia

A

pernicious has a positive intrinsic factor

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24
Q

what foods have b12

A

soy products
breads
cereal
poultry
eggs
oysters
milk
no plant based sources of b12

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25
Q

labs/diagnostics for b12 deficiency anemia

A

low h&h
low RBC
low reticulocytes
high MCV
vitamin b12 <280
high bilirubin
intrinsic factor antibody testing

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26
Q

clinical manifestations for b12 deficiency anemia

A

paraesthesia
hypoxemia
pallor
jaundice
glossitis (beefy red tongue/pernicious)
poor balance
anorexia
nausea
depression
dementia

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27
Q

treatment for b12 deficiency anemia

A

cyanocobalamin(1,000mcg IM daily for 2 wks, then weekly til hct therapeutic, then monthly for life)
increase po intake in food sources
po b12 supplements

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28
Q

nursing interventions for b12 deficiency anemia

A

monitor labs
promote rest
encourage balanced diet
administer b12 supplements

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29
Q

what is folic acid deficiency anemia

A

megaloblastic cells
similar to b12 deficiency
caused by folic acid deficiency

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30
Q

what is folic acid required for in the body

A

DNA synthesis and RBC maturation

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31
Q

what foods is folic acid found in

A

green leafy vegetables
seafood
liver
fruits
whole grains
beans

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32
Q

contributing factors of folic acid deficiency anemia

A

malnutrition
malabsorption syndromes (celiacs or crohns)
drugs
etoh
anticonvulsants

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33
Q

labs/diagnostics for folic acid deficiency anemia

A

low h&h
low RBC
high MCV
low folate

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34
Q

clinical manifestations for folic acid deficiency anemia

A

I HAVE THIS SLIDE EMPTY IF YOU HAVE ANYTHING PLS ADD LMAO PROBABLY TOO BUSY TALKING ABOUT MY SLICKED BACK HAIR- I’m laughing

pale, weakness, SOB, palpitations, folate labs low (duh)

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35
Q

treatment for folic acid deficiency anemia

A

po folic acid tablets

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36
Q

nursing interventions for folic acid deficiency anemia

A

monitor labs
encourage diet
identify high risk patients

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37
Q

what does a low MCV mean

A

microcytic
means a hemoglobin problem

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38
Q

what does a normal MCV mean

A

good RBCs but not enough

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39
Q

what does a high MCV mean

A

macrocytic
means a DNA problem

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40
Q

3 types of inherited hemolytic anemia

A

sickle cell
G6PD
Thalassemia

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41
Q

clinical manifestations of sickle cell anemia

A

pallor
jaundice
fatigue
irritability
increased risk for stroke
low h&h
high reticulocytes
low MCV
rbc indices

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42
Q

treatment for sickle cell anemia

A

hydrate
oxygen
pain control
blood transfusions
prophylactic antibiotics

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43
Q

nursing interventions for sickle cell anemia

A

administer narcotics
provide O2
encourage hydration (150ml/kg/day)

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44
Q

2 major consequences of sickle cell disease

A

anemia
blood vessel occlusion

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45
Q

factors associated with sickling and vessel occlusion

A

cold
stress
physical exertion
infection
illness that causes hypoxia, dehydration, or acidosis

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46
Q

other complication manifestations with sickle cell anemia

A

enlarged spleen and liver
tachycardia
renal insufficiency
increased risk for gallstones
abdominal pain
priopism (emergent)(boner lasting longer than 4 hours)

47
Q

how does a sickle cell crisis present

A

severe pain lasting longer than 2-6 hours
they are medicated with narcotics
hydrated

48
Q

one of the leading causes of death in kids with sickle cell anemia

A

acute chest syndrome(microscopic infarct around lining of lung)

49
Q

pediatric clients with sickle cell anemia are usually asymptomatic until

A

4-6 months of age

50
Q

what is hydroxyurea(idk about spelling)

A

drug treatment for sickle cell anemia
inhibits dna synthesis, reduces pain

51
Q

why do we always ask about prior blood infusions

A

worried about iron overload

52
Q

antidote for iron overload

A

deferoximine

53
Q

what is thalassemia

A

inherited blood disorder in which the body makes an abnormal form of hemoglobin, resulting in excessive destruction of RBCs which then leads to anemia

54
Q

contributing factors of thalassemia

A

must inherit the defective gene from both parents

55
Q

clinical manifestations of thalassemia

A

develops in 1st year of life
splenomegally
bronze skin
bone marrow hyperplasia

56
Q

labs/diagnostics of thalassemia

A

low RBC
low H&H

57
Q

treatment for thalassemia

A

blood transfusions

58
Q

nursing interventions for thalassemia

A

increase folate
administer blood transfusions
promote rest
recommend genetic counseling

59
Q

signs of allergic reaction to blood transfusion

A

temperature
itching
flank pain

60
Q

where is excess iron stored

A

heart
testes
thyroid
pancreas
(excess iron can destroy these organs)

61
Q

folate helps

A

DNA production in cells

62
Q

Blood transfusions can only run with

A

normal saline

63
Q

folate foods

A

green leafy vegetables
dried beans
legumes
citrus fruits

64
Q

what size gauge for blood transfusions

A

18 or smaller

65
Q

2 types of acquired hemolytic anemias

A

NON-antibody related
antibody related

66
Q

contributing factors for non-antibody anemia

A

infections
various drugs
chemicals
renal disease
mechanical factors (prosthetic heart valve)

67
Q

contributing factors for antibody related anemia

A

transfusion reaction
cold agglutinin disease (wtf)

68
Q

clinical manifestations of acquired hemolytic anemias

A

dark urine
chills
enlarged spleen
SOB
tachycardia
jaundice

69
Q

treatment for acquired hemolytic anemias

A

steroid therapy for both

70
Q

nursing interventions for acquired hemolytic anemias

A

treat underlying cause
hydration
blood transfusion
emotional support

71
Q

labs/diagnostics for acquired hemolytic anemias

A

direct & indirect coombs test

72
Q

what is glucose-6-phosphate dehydrogenase anemia (G6PD)

A

the RBCs are missing an important enzyme (G6PD)

73
Q

G6PD is a _____ linked disorder

A

x linked recessive disorder

74
Q

who is a carrier of G6PD

A

females are carriers
males are effected

75
Q

clinical manifestations of G6PD

A

weakness
tachycardia
jaundice
pallor
R upper quadrant pain

76
Q

Labs/diagnostics for G6PD

A

low h&h
high reticulocytes
low RBC
low MCV
high bilirubin
G6PD assay

77
Q

treatment for G6PD

A

avoids medications
treat infections quickly
avoid foods

78
Q

nursing interventions for G6PD

A

administer antibiotics
avoid oxidant meals/foods
patient education

79
Q

episodes of G6PD anemia are triggered by

A

infections
drugs
ketoacidosis
tonic water

80
Q

nursing care for patient receiving blood

A

stay with for first 15 min
vitals q15min(?)
ask prior transfusions
observe for allergic reactions
2 RNs to sign off

81
Q

what is rheumatoid arthritis

A

chronic systemic autoimmune disorder caused by long term exposure to unidentified antigen

82
Q

biggest indicator of RA

A

morning stiffness

83
Q

clinical manifestations of RA

A

pain
mobility changes
fatigue
morning stiffness
fever

84
Q

what drug may increase risk of rheumatoid arthritis

A

methotrexate

85
Q

normal ANA is

A

negative

86
Q

diagnostic criteria for RA (need 4 of the following)

A

morning stiffness 1 hour for 6 weeks
arthritis w/ swelling or effusion of 3+ joints for 6 weeks
arthritis of wrist knuckles pip joints for 6 weeks
symmetrical arthritis
rheumatoid nodules
positive rheumatoid factor
characteristic xray

87
Q

what does DMARD stand for

A

disease modifying antirheumatic drugs
ex- hydroxichloroquine

88
Q

5 general approaches for RA

A

aspirin
nsaids
dmards
immune modulators
tumor necrosis factors

89
Q

what is lupus

A

chronic inflammatory connective tissue disease that affects almost all body systems

90
Q

major side effect of lupus

A

butterfly rash

91
Q

what type of drug is used to treat arthritic manifestations

A

antimalarial drugs

92
Q

treatment for severe and life threatening manifestations of lupus

A

corticosteroid therapy in high doses

93
Q

diagnostic tests for lupus

A

ana +
high SED
low c4 reactive protein
low h&h

94
Q

drugs to treat lupus

A

immunosuppressive agents
nsaids
antimalaria
steroids

95
Q

with lupus, avoid

A

estrogen drugs

96
Q

emergent vs urgent

A

emergent- w/out delay
urgent- w/in 24-48 hours

97
Q

when is informed consent signed for a procedure

A

before any medication is given

98
Q

what is malignant hyperthermia

A

inherited muscle disorder which anesthesia induces chemically

99
Q

treatment for malignant hyperthermia

A

administer IV dantrolene(muscle relaxant)
administer 100% oxygen

100
Q

what are surgical complications

A

airway obstruction
neg pressure pulmonary edema
hypoxia
pulmonary embolism
hemorrhage
hypovolemia
DVT
wound dehiscence or evisceration

101
Q

normal hematocrit level

A

40%-50% for men, 37%-47% for women

102
Q

normal hemoglobin levels

A

14-16.5 for men, 12-15 for women

103
Q

what can high platelet count be caused by?

A

low iron levels, autoimmune diseases

104
Q

sx of elevated platelet levels?

A

headache, dizziness, bleeding, clotting, chest pain, tingling in hands and feet

105
Q

tx for elevated platelets?

A

anticoagulants, antiplatelets, baby aspirin

106
Q

sx of low platelet levels?

A

bruising (purpura), petechiae, prolonged bleeding, bleeding from gums or nose, fatigue

107
Q

tx for thrombocytopenia (low platelets)?

A

packed RBC transfusion, platelet transfusion, corticosteroid

108
Q

when does erythropoiesis occur?

A

when there is decreased oxygen in the blood

109
Q

What happens when not enough oxygen is getting to the body?

A

kidneys release erythropoietin that signals bone marrow to produce more RBCs

110
Q

what is mean corpuscular volume?

A

size of red cell

111
Q

normal MCV level?

A

85-100

112
Q

what is mean corpuscular hemoglobin concentration?

A

concentration of hemoglobin in the red cell

113
Q

normal MCHC levels?

A

31-35

Nursing 210 (2 decks)

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