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exam 4 Flashcards

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
labs/diagnostics for b12 deficiency anemia
low h&h low RBC low reticulocytes high MCV vitamin b12 <280 high bilirubin intrinsic factor antibody testing
26
clinical manifestations for b12 deficiency anemia
paraesthesia hypoxemia pallor jaundice glossitis (beefy red tongue/pernicious) poor balance anorexia nausea depression dementia
27
treatment for b12 deficiency anemia
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
28
nursing interventions for b12 deficiency anemia
monitor labs promote rest encourage balanced diet administer b12 supplements
29
what is folic acid deficiency anemia
megaloblastic cells similar to b12 deficiency caused by folic acid deficiency
30
what is folic acid required for in the body
DNA synthesis and RBC maturation
31
what foods is folic acid found in
green leafy vegetables seafood liver fruits whole grains beans
32
contributing factors of folic acid deficiency anemia
malnutrition malabsorption syndromes (celiacs or crohns) drugs etoh anticonvulsants
33
labs/diagnostics for folic acid deficiency anemia
low h&h low RBC high MCV low folate
34
clinical manifestations for folic acid deficiency anemia
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)
35
treatment for folic acid deficiency anemia
po folic acid tablets
36
nursing interventions for folic acid deficiency anemia
monitor labs encourage diet identify high risk patients
37
what does a low MCV mean
microcytic means a hemoglobin problem
38
what does a normal MCV mean
good RBCs but not enough
39
what does a high MCV mean
macrocytic means a DNA problem
40
3 types of inherited hemolytic anemia
sickle cell G6PD Thalassemia
41
clinical manifestations of sickle cell anemia
pallor jaundice fatigue irritability increased risk for stroke low h&h high reticulocytes low MCV rbc indices
42
treatment for sickle cell anemia
hydrate oxygen pain control blood transfusions prophylactic antibiotics
43
nursing interventions for sickle cell anemia
administer narcotics provide O2 encourage hydration (150ml/kg/day)
44
2 major consequences of sickle cell disease
anemia blood vessel occlusion
45
factors associated with sickling and vessel occlusion
cold stress physical exertion infection illness that causes hypoxia, dehydration, or acidosis
46
other complication manifestations with sickle cell anemia
enlarged spleen and liver tachycardia renal insufficiency increased risk for gallstones abdominal pain priopism (emergent)(boner lasting longer than 4 hours)
47
how does a sickle cell crisis present
severe pain lasting longer than 2-6 hours they are medicated with narcotics hydrated
48
one of the leading causes of death in kids with sickle cell anemia
acute chest syndrome(microscopic infarct around lining of lung)
49
pediatric clients with sickle cell anemia are usually asymptomatic until
4-6 months of age
50
what is hydroxyurea(idk about spelling)
drug treatment for sickle cell anemia inhibits dna synthesis, reduces pain
51
why do we always ask about prior blood infusions
worried about iron overload
52
antidote for iron overload
deferoximine
53
what is thalassemia
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
contributing factors of thalassemia
must inherit the defective gene from both parents
55
clinical manifestations of thalassemia
develops in 1st year of life splenomegally bronze skin bone marrow hyperplasia
56
labs/diagnostics of thalassemia
low RBC low H&H
57
treatment for thalassemia
blood transfusions
58
nursing interventions for thalassemia
increase folate administer blood transfusions promote rest recommend genetic counseling
59
signs of allergic reaction to blood transfusion
temperature itching flank pain
60
where is excess iron stored
heart testes thyroid pancreas (excess iron can destroy these organs)
61
folate helps
DNA production in cells
62
Blood transfusions can only run with
normal saline
63
folate foods
green leafy vegetables dried beans legumes citrus fruits
64
what size gauge for blood transfusions
18 or smaller
65
2 types of acquired hemolytic anemias
NON-antibody related antibody related
66
contributing factors for non-antibody anemia
infections various drugs chemicals renal disease mechanical factors (prosthetic heart valve)
67
contributing factors for antibody related anemia
transfusion reaction cold agglutinin disease (wtf)
68
clinical manifestations of acquired hemolytic anemias
dark urine chills enlarged spleen SOB tachycardia jaundice
69
treatment for acquired hemolytic anemias
steroid therapy for both
70
nursing interventions for acquired hemolytic anemias
treat underlying cause hydration blood transfusion emotional support
71
labs/diagnostics for acquired hemolytic anemias
direct & indirect coombs test
72
what is glucose-6-phosphate dehydrogenase anemia (G6PD)
the RBCs are missing an important enzyme (G6PD)
73
G6PD is a _____ linked disorder
x linked recessive disorder
74
who is a carrier of G6PD
females are carriers males are effected
75
clinical manifestations of G6PD
weakness tachycardia jaundice pallor R upper quadrant pain
76
Labs/diagnostics for G6PD
low h&h high reticulocytes low RBC low MCV high bilirubin G6PD assay
77
treatment for G6PD
avoids medications treat infections quickly avoid foods
78
nursing interventions for G6PD
administer antibiotics avoid oxidant meals/foods patient education
79
episodes of G6PD anemia are triggered by
infections drugs ketoacidosis tonic water
80
nursing care for patient receiving blood
stay with for first 15 min vitals q15min(?) ask prior transfusions observe for allergic reactions 2 RNs to sign off
81
what is rheumatoid arthritis
chronic systemic autoimmune disorder caused by long term exposure to unidentified antigen
82
biggest indicator of RA
morning stiffness
83
clinical manifestations of RA
pain mobility changes fatigue morning stiffness fever
84
what drug may increase risk of rheumatoid arthritis
methotrexate
85
normal ANA is
negative
86
diagnostic criteria for RA (need 4 of the following)
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
what does DMARD stand for
disease modifying antirheumatic drugs ex- hydroxichloroquine
88
5 general approaches for RA
aspirin nsaids dmards immune modulators tumor necrosis factors
89
what is lupus
chronic inflammatory connective tissue disease that affects almost all body systems
90
major side effect of lupus
butterfly rash
91
what type of drug is used to treat arthritic manifestations
antimalarial drugs
92
treatment for severe and life threatening manifestations of lupus
corticosteroid therapy in high doses
93
diagnostic tests for lupus
ana + high SED low c4 reactive protein low h&h
94
drugs to treat lupus
immunosuppressive agents nsaids antimalaria steroids
95
with lupus, avoid
estrogen drugs
96
emergent vs urgent
emergent- w/out delay urgent- w/in 24-48 hours
97
when is informed consent signed for a procedure
before any medication is given
98
what is malignant hyperthermia
inherited muscle disorder which anesthesia induces chemically
99
treatment for malignant hyperthermia
administer IV dantrolene(muscle relaxant) administer 100% oxygen
100
what are surgical complications
airway obstruction neg pressure pulmonary edema hypoxia pulmonary embolism hemorrhage hypovolemia DVT wound dehiscence or evisceration
101
normal hematocrit level
40%-50% for men, 37%-47% for women
102
normal hemoglobin levels
14-16.5 for men, 12-15 for women
103
what can high platelet count be caused by?
low iron levels, autoimmune diseases
104
sx of elevated platelet levels?
headache, dizziness, bleeding, clotting, chest pain, tingling in hands and feet
105
tx for elevated platelets?
anticoagulants, antiplatelets, baby aspirin
106
sx of low platelet levels?
bruising (purpura), petechiae, prolonged bleeding, bleeding from gums or nose, fatigue
107
tx for thrombocytopenia (low platelets)?
packed RBC transfusion, platelet transfusion, corticosteroid
108
when does erythropoiesis occur?
when there is decreased oxygen in the blood
109
What happens when not enough oxygen is getting to the body?
kidneys release erythropoietin that signals bone marrow to produce more RBCs
110
what is mean corpuscular volume?
size of red cell
111
normal MCV level?
85-100
112
what is mean corpuscular hemoglobin concentration?
concentration of hemoglobin in the red cell
113
normal MCHC levels?
31-35

Nursing 210 (2 decks)

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