Exam 4 - Oxygenation/Anemia Flashcards
Functions of Blood
Transportation, Regulation, Protection
Plasma
- 55% of blood
Composed primarily of water; but it also contains proteins, electrolytes, gases, nutrients, and waste.
Albumin
a protein that helps maintain oncotic pressure in the blood.
Anemia
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.
Anemia and Hypoxia
Because RBC’s transport O2, erythrocyte disorders can lead to tissue hypoxia; which accounts for many of the signs and symptoms of anemia.
Normocytic, normochromic
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.
Microcytic, hypochromic
- Small size and pale color
- MCV <27
- Etiology: Iron deficiency anemia, Vit B deficiency, copper deficiency, thalassemia, lead poisoning.
Macrocytic, Normochromic
- 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.
Mild Anemia symptoms
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.
Moderate anemia symptoms
HgB 6-10 g/dL
- Cardiopulmonary symptoms are increased. Patient may experience them while resting, as well as with activity. Fatigue, SOB, palpations
Severe anemia symptoms
HgB less than 6 g/dL
- the patient has many clinical manifestations involving multiple body systems.
Pallor results from…
reduced amounts of hemoglobin and reduced blood flow to the skin.
Jaundice results from…
hemolysis of RBC’s results in an increased concentration of serum bilirubin.
Pruritis results from
increased serum and skin bile salt concentrations.
Clinical Manifestations of Anemia
Tired, decreased tissue perfusion, Increased heart rate, Increased respiratory rate, Numbness; tingling, spoon nails
Hemalytic anemia
RBC’s rupture faster than they should
Vitamin B deficiency
Glossy tongue
Normal Hemaglobin and Hematocrit for female
HgB: 12-16
Hematocrit: 37-47
Normal Hemaglobin and Hematocrit for male
HgB: 13-18
Hematocrit: 42-52
Symptoms of Anemia
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.
MCV
RBC Size
Normal: Normocytic
Small: Microcytic
Larger: Marcocytic
MCH
Concentration or color
Normal: Normochromic
Low: Hypochromic
High: Hyperchromic
Who is at risk?
Family Hx, Pregnancy, Children, Recent course of antibiotics, surgery, cardiac valve replacement, anyone in the hospital probably has anemia.
Illnesses that may lead to anemia:
GI tract problems, liver disease, exposure to toxins and radiation
Medications that may cause anemia
Glyburide, methlydopa, someantibiotics, eg Cholamphenical, Sulfonamindes, anticoagulants, ASA, NSAIDS, immunosuppresive drugs, herbals
Polycythemia
> 60% RBCs
Peripheral blood smear morphology
Looks at RBC shape
Reticulocyte count
RBC production in Bone Marrow
TIBC
Total Iron Binding Capacity = Iron probably has increased amount of open binding sites when anemic
Ferritin
Liver stores of iron = decrease in number when anemic
Serum iron
Iron in blood = decreased in number when anemic
Schilling’s Test
Urine test: 24 hours. Tests B12 deficiency or pernicious anemia.
Most common site for Bone Marrow Biopsy
Illiac Crest or Sternum.
Iron deficiency anemia
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.
Diagnosis of Iron deficiency anemia
Microcytic, hypochromic, Hgb, Increased TIBC, decreased ferritin
Etiology for Iron deficiency anemia
Dietary, impaired absorption, or Chronic blood loss
Possibly too much dairy
Rx for Iron deficiency anemia
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
Iron Supplements
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
What enhances iron absorption?
Vitamin C and OJ
What blocks iron absorption?
Grape Juice, Dairy products
Pernicious Anemia Etiology
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
Pernicious Anemia Signs and Symptoms
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.
Pernicious Anemia Labs
HgB, macrocytic, normochromic, Schillings test
Pernicious Anemia Tx
B12 injections IM daily first 1-2 weeks, then weekly, then monthly. May be able to take oral B12 if patient has IF
Folic Acid Deificiency Etiology
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.
Folic Acid Deificiency Diagnosis
HbG, macrocytic, normochomic, folic acid levels
Folic Acid Deificiency Treatment
Folic acid 1 mg PO/day, green leafy veggies, fruits.
Polycythemia Vera Etiology
Erythrocyte excess. Excessive bone marrow production of erythrocytes, leukocytes and platelets. Increased blood viscosity, increased total blood.
Polycythemia Vera S/S
Ruddy complexion, increased Hct, hypervolemia, dizziness, HA, visual disturbances, HTN, Heart Failure, CVA, MI, Peripheral gangrene, Increase in blood clots, Angina, TIA.
Polycythemia Vera Dx
CBC, Bone marrow biopsy
Polycythemia Vera Rx
Phlebotomy, myelosuppressive drugs, radiation with hopes of slowing down production. May remove up to 2000 mL of blood at a time.
Erythropoetin
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
Blood products: Packed RBC’s
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
Blood products: Platelets
Clotting proteins
50-100 mL
Blood products: Fresh frozen plasma
Clotting proteins
200-250 mL
Blood products: Cryoprecipitate
Clotting factors
Blood products: Granulocytes
Use if antibiotics are not working
Factor VIII, Factor IX
Clotting
Autologous
Client donates and banks own blood for later
Blood salvage
Blood is drained during surgical procedure through closed vacuum systems and then reinfused
Donor
Must be matched for ABO/Rh compatibility
- Type and Screen ABO/Rh Hemologous
- Type and Cross
Steps to ensure safety when transfusing PRBC’s
- Sample the blood
- Blood bank
- Separate consent for BT
- 2 nurses to compare paperwork and patient
- 2 nurses check and bedside blood started within 30 min from leaving the blood bank.
- From start time, must transfuse within 4 hrs. Throw out if any left.
Hanging PRBC’s
Always hang with 0.9 NS
“Y” hang
Never piggy back into anything else
Nursing precautions for blood transfusion
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
Giving someone the wrong unit of blood would be considered…?
a sentinel event
Blood transfusion Reactions
Immediate: Chills, HA, anxiety, back pain, muscle pain, hypotension, SOB, circulatory collapse, flushing, itching, rash, fever
Delayed: Fever, jaundice, rash
Fluid overload
Hypocalcemia
True or false: Some patients always get a reaction to blood transfusions
True
What do you do if you suspect a blood transfusion reaction?
- Stop transfusion
- Close clamp
- Start normal saline
- Call doc and blood bank
- IV site up goes back to blood bank. Everything but the site.
What are the 6 components that are needed for healthy RBCs in addition to healthy bone marrow?
- Iron
- B12
- Folic Acid
- Protein
- Trace copper
- Pyridoxine
Long term iron deficient symptom
Spoon nails
When assessing laboratory values on a patient admitted with septicemia, what should the nurse expect to find?
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.
What effect is aging likely to have on hematologic function of older adults?
Decreased hemoglobin
