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Med-Surg > Gas Exchange (Anemia) > Flashcards

Gas Exchange (Anemia) Flashcards

1
Q

What are some causes of anemia ?

A
  • decreased RBC production
  • blood loss
  • increased RBC destruction
  • renal and liver failure
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2
Q

Which anemia’s are megaloblastic ?

A
  • pernicious
  • folic acid
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3
Q

What does a megaloblastic anemia mean ?

A

RBCs are bigger which means they aren’t as effective
- since they are bigger they take up more space and there isn’t enough of them

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4
Q

What is the importance of intrinsic factor ?

A

need this factor to absorb extrinsic factor/cobalamin/vita. B12
- need to make RBCs

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5
Q

Where is intrinsic factor secreted ?

A

the parietal cells of the gastric mucosa
- this factor depends upon the parietal cells and an acidic environment

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6
Q

What is the importance of B12 ?

A

need this to convert folate into normal RBCs
- without B12 or if it can’t be absorbed then the RBCs are stuck in a specific phase which cause them to be large and misshapen

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7
Q

What are some causes of pernicious anemia ?

A
  • autoimmune diseases that destroy the parietal cells
  • decrease in stomach size (gastric bypass gastrectomy)
  • ileum resection
  • chronic gastritis, Crohns
  • chronic use of acid reducing medications
  • poor intake of B12-rich foods
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8
Q

What are some S&S of pernicious anemia ?

A
  • sore, red, “beefy”, tongue
  • numbness/tingling (decreased sensation)
  • muscle ataxia
  • mouth sores
  • pallor
  • dyspnea/tachypnea
  • tachycardia
  • loss of appetite/anorexia
  • N/V
  • weakness
  • impaired though processes
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9
Q

Why is B12 important for the nervous system ?

A

helps maintain it and if pernicious anemia is left untreated it damages the myelin sheath around the nerves
- if not enough B12 then it can cause irreversible nerve damage
- can cause progressive muscle coordination loss

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10
Q

Which lab values measures the size of RBCs ?

A

mean corpuscular volume (MCV)
- increased MCV means a megaloblastic anemia

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11
Q

What are expected lab values for pernicious anemia ?

A
  • increased mean corpuscular volume (MCV)
  • decreased hemoglobin
  • decreased hematocrit
  • decreased serum B12
  • normal iron & folate
  • can also test for intrinsic factor antibodies if autoimmune component is suspected
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12
Q

Why wouldn’t B12 supplements be the best for treatment of pernicious anemia ?

A

these oral supplements have to be digested and this anemia is caused by an impaired stomach
- injections are best because they bypass the digestive system

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13
Q

What is the treatment for pernicious anemia ?

A
  • B12 IM injections (daily then bi-weekly and ultimately monthly)
  • nasal spray also available (expensive)
  • in some cases, if GI system and absorption is intact then high doses or PO of sublingual B12 can be used and encouraged dietary intake
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14
Q

What are some foods high in B12 ?

A
  • red meats (liver)
  • organ meats
  • sardines
  • eggs
  • enriched grains
  • milk/dairy
  • fish
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15
Q

What is the function of folic acid ?

A
  • RBC formation
  • formation of the neural tube in a fetus
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16
Q

What are some causes of folic acid deficiency ?

A
  • poor dietary intake/anorexia
  • alcoholism (get calories from alcohol so they don’t feel hungry and won’t eat a proper meal which causes a deficiency and it changes the way we absorb)
  • malabsorption syndromes (Crohns, etc)
  • medications that block uptake of folic acid (methotrexate, anti-seizure meds)
  • hemodialysis (folic acid removed in dialysis)
  • pregnancy
17
Q

What are some S&S of folic acid deficiency ?

A
  • no neuro symptoms
  • sore, red, “beefy”, tongue,
  • mouth sores
  • weakness
  • pallor
  • dyspnea/tachypnea
  • tachycardia
  • loss of appetite/anorexia
  • N/V
18
Q

What are some expected lab values for folic acid deficiency ?

A
  • increased mean corpuscular volume (MCV)
  • decreased hemoglobin
  • decreased hematocrit
  • normal B12 and iron
  • decreased folate
19
Q

What is the treatment for folic acid deficiency ?

A

PO supplements
- 1 mg per day up to 5 mg per day in cases of poor absorption/alcohol use

20
Q

Which foods are high in folic acid ?

A
  • liver
  • green, leafy vegetables
  • legumes
  • whole grains
  • orange juice
  • meat/fish
  • peanuts
21
Q

What are some causes of iron deficiency anemia ?

A
  • poor diet
  • poor absorption
  • blood loss
  • increased need (pregnancy or menstruating women)
22
Q

What are some S&S of iron deficiency anemia ?

A

may be asymptomatic
- general symptoms of anemia
- start to feel symptoms when doing activities that require exertion
- pallor
- glossitis (shiny tongue) and may feel tingly (not nerve damage)
- cheilitis (lip inflammation)

23
Q

What are some expected lab values for iron deficiency anemia ?

A
  • low MCV
  • low hemoglobin
  • low hematocrit
  • normal B12 and folate
  • low serum iron/ferotin
    Ferotin is the storage of iron
24
Q

What are the treatments for iron deficiency anemia ?

A
  • increase dietary intake
  • oral iron (best before meals)
  • IV/parenteral iron in severe cases (risk of allergy so monitor pt)
25
Q

What are some considerations for oral iron supplements ?

A
  • GI side effects: N,C and dark stool
  • take with vitamin C, like orange juice, to aid in absorption
26
Q

What are foods that are high in Iron ?

A
  • red meats
  • spinach
  • tofu
  • organ meats
  • beans

Med-Surg (23 decks)

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