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Med Surg > Exam 4 - Oxygenation/Anemia > Flashcards

Exam 4 - Oxygenation/Anemia Flashcards

1
Q

Functions of Blood

A

Transportation, Regulation, Protection

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2
Q

Plasma

A
  • 55% of blood

Composed primarily of water; but it also contains proteins, electrolytes, gases, nutrients, and waste.

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3
Q

Albumin

A

a protein that helps maintain oncotic pressure in the blood.

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4
Q

Anemia

A

a deficiency in the number of erythrocytes (RBC’s), the quality or quantity of hemoglobin, and/or the volume of the packed RBC’s (hematocrit).
A prevalent production or increased destruction of erythrocytes.

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5
Q

Anemia and Hypoxia

A

Because RBC’s transport O2, erythrocyte disorders can lead to tissue hypoxia; which accounts for many of the signs and symptoms of anemia.

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6
Q

Normocytic, normochromic

A

Normocytic= normal RBC size
Normochromic= normal RBC concentration (normal color)
- MCH 80-100 fL, MVH 27-34 pg
- Etiology: Acute blood loss, henolysis, CKD, Chronic disease, cancer, siderblastic anemia, endocrine disorders, starvation, aplastic anemia, sickle cell anemia, pregnancy.

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7
Q

Microcytic, hypochromic

A
  • Small size and pale color
  • MCV <27
  • Etiology: Iron deficiency anemia, Vit B deficiency, copper deficiency, thalassemia, lead poisoning.
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8
Q

Macrocytic, Normochromic

A
  • large size and normal color
    MCV >100, MCH >34
  • Etiology: Cobalamin (vit B) deficiency, folic acid deficiency, liver disease (ncluding effects of alcohol abuse), postplenectomy.
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9
Q

Mild Anemia symptoms

A

HgB 10-12 g/dL

  • May have no symptoms
  • If symptoms develop it is because the patient has an underlying disease or is experiencing a compensatory response to heavy exercise. Symptoms include: palpitations, dyspnea, and mild fatigue.
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10
Q

Moderate anemia symptoms

A

HgB 6-10 g/dL
- Cardiopulmonary symptoms are increased. Patient may experience them while resting, as well as with activity. Fatigue, SOB, palpations

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11
Q

Severe anemia symptoms

A

HgB less than 6 g/dL

- the patient has many clinical manifestations involving multiple body systems.

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12
Q

Pallor results from…

A

reduced amounts of hemoglobin and reduced blood flow to the skin.

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13
Q

Jaundice results from…

A

hemolysis of RBC’s results in an increased concentration of serum bilirubin.

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14
Q

Pruritis results from

A

increased serum and skin bile salt concentrations.

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15
Q

Clinical Manifestations of Anemia

A

Tired, decreased tissue perfusion, Increased heart rate, Increased respiratory rate, Numbness; tingling, spoon nails

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16
Q

Hemalytic anemia

A

RBC’s rupture faster than they should

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17
Q

Vitamin B deficiency

A

Glossy tongue

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18
Q

Normal Hemaglobin and Hematocrit for female

A

HgB: 12-16
Hematocrit: 37-47

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19
Q

Normal Hemaglobin and Hematocrit for male

A

HgB: 13-18
Hematocrit: 42-52

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20
Q

Symptoms of Anemia

A 
Yellowing of eyes
Skin: Pale, Cool, Yellow
Respiratory: SOB
Muscular Weakness
Intestinal: Changed stool color
CNS: Fatigue, Dizziness, Fainting
Blood Vessels: Low BP
Heart: Palpitations, Rapid Heart Rate, Chest pain, angina, Heart Attack
Spleen: Enlarged.
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21
Q

MCV

A

RBC Size
Normal: Normocytic
Small: Microcytic
Larger: Marcocytic

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22
Q

MCH

A

Concentration or color
Normal: Normochromic
Low: Hypochromic
High: Hyperchromic

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23
Q

Who is at risk?

A

Family Hx, Pregnancy, Children, Recent course of antibiotics, surgery, cardiac valve replacement, anyone in the hospital probably has anemia.

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24
Q

Illnesses that may lead to anemia:

A

GI tract problems, liver disease, exposure to toxins and radiation

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25
Q

Medications that may cause anemia

A

Glyburide, methlydopa, someantibiotics, eg Cholamphenical, Sulfonamindes, anticoagulants, ASA, NSAIDS, immunosuppresive drugs, herbals

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26
Q

Polycythemia

A

> 60% RBCs

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27
Q

Peripheral blood smear morphology

A

Looks at RBC shape

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28
Q

Reticulocyte count

A

RBC production in Bone Marrow

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29
Q

TIBC

A

Total Iron Binding Capacity = Iron probably has increased amount of open binding sites when anemic

30
Q

Ferritin

A

Liver stores of iron = decrease in number when anemic

31
Q

Serum iron

A

Iron in blood = decreased in number when anemic

32
Q

Schilling’s Test

A

Urine test: 24 hours. Tests B12 deficiency or pernicious anemia.

33
Q

Most common site for Bone Marrow Biopsy

A

Illiac Crest or Sternum.

34
Q

Iron deficiency anemia

A

Most prevelent. May develop as a result of inadequate dietary intake, malabsorption, blood loss, hemolysis.
- Iron needed to form heme. Most Iron found in RBC’s and Hgb. Remainder is stored in the liver.

35
Q

Diagnosis of Iron deficiency anemia

A

Microcytic, hypochromic, Hgb, Increased TIBC, decreased ferritin

36
Q

Etiology for Iron deficiency anemia

A

Dietary, impaired absorption, or Chronic blood loss

Possibly too much dairy

37
Q

Rx for Iron deficiency anemia

A

Iron replacements PO, IM, IVPB
May increase constipation and cause dark, tarry stools.
As little as 2-3 mL of blood loss each day can cause Iron deficiency anemia.
2mL of blood = 1 mL of iron

38
Q

Iron Supplements

A

Ferrous Sulfate 325 mg PO tid
Ferrous gluconate 300 mg PO bid for 3-6 mo
Iron Dextran IM Z-track
IV iron - given under controlled conditions

39
Q

What enhances iron absorption?

A

Vitamin C and OJ

40
Q

What blocks iron absorption?

A

Grape Juice, Dairy products

41
Q

Pernicious Anemia Etiology

A

Cobalamin (Vit B) deficiency which is caused by an absence of intrinsic factor or decreased absorption in terminal ileum or decreased gastric acid, or combination. Intrinsic factor is a protein secreted by the parietal cells of the gastric mucosa.
NO FIX

42
Q

Pernicious Anemia Signs and Symptoms

A

GI Symptoms: Weight loss, poor appetite, N&V, Abdominal distention, Diarrhea, Constipation
Neuro Symptoms: Numbness, LOS in feet and hands, Poor gait, Increased memory loss.
Sore, Red, Beefy, Glossy tongue, Anorexia, N&V, abdominal pain.

43
Q

Pernicious Anemia Labs

A

HgB, macrocytic, normochromic, Schillings test

44
Q

Pernicious Anemia Tx

A

B12 injections IM daily first 1-2 weeks, then weekly, then monthly. May be able to take oral B12 if patient has IF

45
Q

Folic Acid Deificiency Etiology

A

Causes megablastic anemia. Dietary deficiency. Decreased intake and absorption. Drugs may cause Folic Acid Deificiency (dilantin, anticonvulsives, bactrim, oral contraceptives. Dialysis patients lose Folic Acid. People with alcoholism and eating deficiencies need supplements.

46
Q

Folic Acid Deificiency Diagnosis

A

HbG, macrocytic, normochomic, folic acid levels

47
Q

Folic Acid Deificiency Treatment

A

Folic acid 1 mg PO/day, green leafy veggies, fruits.

48
Q

Polycythemia Vera Etiology

A

Erythrocyte excess. Excessive bone marrow production of erythrocytes, leukocytes and platelets. Increased blood viscosity, increased total blood.

49
Q

Polycythemia Vera S/S

A

Ruddy complexion, increased Hct, hypervolemia, dizziness, HA, visual disturbances, HTN, Heart Failure, CVA, MI, Peripheral gangrene, Increase in blood clots, Angina, TIA.

50
Q

Polycythemia Vera Dx

A

CBC, Bone marrow biopsy

51
Q

Polycythemia Vera Rx

A

Phlebotomy, myelosuppressive drugs, radiation with hopes of slowing down production. May remove up to 2000 mL of blood at a time.

52
Q

Erythropoetin

A

EPO is a hormone produced by the kidneys that increase production of RBC in the bone marrow. EPO can be synthesized and used to treat some anemias.
Routinely given to dialysis patients.
Must have healthy bone marrow and minerals

53
Q

Blood products: Packed RBC’s

A

Blood loss replacement. 250 mL bag of 80% RBC and 20% plasma
Most common blood transfusion
Appropriate to treat anemia when Hgb is <10 and symptomatic

54
Q

Blood products: Platelets

A

Clotting proteins

50-100 mL

55
Q

Blood products: Fresh frozen plasma

A

Clotting proteins

200-250 mL

56
Q

Blood products: Cryoprecipitate

A

Clotting factors

57
Q

Blood products: Granulocytes

A

Use if antibiotics are not working

58
Q

Factor VIII, Factor IX

A

Clotting

59
Q

Autologous

A

Client donates and banks own blood for later

60
Q

Blood salvage

A

Blood is drained during surgical procedure through closed vacuum systems and then reinfused

61
Q

Donor

A

Must be matched for ABO/Rh compatibility

  1. Type and Screen ABO/Rh Hemologous
  2. Type and Cross
62
Q

Steps to ensure safety when transfusing PRBC’s

A
  1. Sample the blood
  2. Blood bank
  3. Separate consent for BT
  4. 2 nurses to compare paperwork and patient
  5. 2 nurses check and bedside blood started within 30 min from leaving the blood bank.
  6. From start time, must transfuse within 4 hrs. Throw out if any left.
63
Q

Hanging PRBC’s

A

Always hang with 0.9 NS
“Y” hang
Never piggy back into anything else

64
Q

Nursing precautions for blood transfusion

A 
Obtain baseline vitals
Stay in the room the first 15 min
Reactions typically occur in the first 15 min or first 50 mL
Everything ok? Increase tranfusion rate
Vitals every hour and at completion
65
Q

Giving someone the wrong unit of blood would be considered…?

A

a sentinel event

66
Q

Blood transfusion Reactions

A

Immediate: Chills, HA, anxiety, back pain, muscle pain, hypotension, SOB, circulatory collapse, flushing, itching, rash, fever
Delayed: Fever, jaundice, rash
Fluid overload
Hypocalcemia

67
Q

True or false: Some patients always get a reaction to blood transfusions

A

True

68
Q

What do you do if you suspect a blood transfusion reaction?

A
  1. Stop transfusion
  2. Close clamp
  3. Start normal saline
  4. Call doc and blood bank
  5. IV site up goes back to blood bank. Everything but the site.
69
Q

What are the 6 components that are needed for healthy RBCs in addition to healthy bone marrow?

A
  1. Iron
  2. B12
  3. Folic Acid
  4. Protein
  5. Trace copper
  6. Pyridoxine
70
Q

Long term iron deficient symptom

A

Spoon nails

71
Q

When assessing laboratory values on a patient admitted with septicemia, what should the nurse expect to find?

A

Increased bands in the white blood cell (WBC) differential (shift to the left)
When infections are severe, such as in septicemia, more granulocytes are released from the bone marrow as a compensatory mechanism. To meet the increased demand, many young, immature polymorphonuclear neutrophils (bands) are released into circulation. WBCs are usually reported in order of maturity (initially with the less mature forms on the left side of a written report). Hence, the term “shift to the left” is used to denote an increase in the number of bands.

72
Q

What effect is aging likely to have on hematologic function of older adults?

A

Decreased hemoglobin

Med Surg (20 decks)

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