Gas Exchange Study Flashcards
Potential causes of a sickle cell crisis
Significant blood loss; Illness; Climbing or flying to high altitudes; Continued stress; Dehydration; Elevated heat or cold
What would you do as the nurse to care for the patient with sickle cell disease in extreme pain, SOB, and dehydration?
Administer oxygen, administered prescribed pain medications, hydrate with normal saline IV
How would you position a patient in bed in a sickle cell crisis?
Encourage to keep extremities extended. DO NOT RAISE THE KNEE POSITION OF THE BED. Elevate the HOB NO MORE THAN 30 DEGREES.
How often would you check circulation of extremities in a patient in sickle cell crisis? (pulse ox of fingers and toes, peripheral pulses, capillary refill)
Every hour
Education for a sickle cell patient to avoid a crisis
Avoid dehydration (3-4L/day). Avoid alcohol and tobacco. Get immunizations to avoid infection. Avoid extreme temperatures. Avoid high altitudes. Avoid STRENUOUS exercise. Perform mild, low-impact exercise three times a week.
For a child to have even a 25% chance of having sickle cell anemia, __________ of their parents have to have the sickle cell trait.
Both
What type of Anemia is caused by an inadequate supply or loss of iron. Sometimes referred to as microlytic anemia because the RBC are small
Iron deficiency anemia
At what age should breast fed babies start receiving iron supplements?
4 months
Why should iron supplements be administered through a dropper to an infant?
To avoid teeth discoloration
What beverage should iron supplements be administered with and why?
Orange Juice because vitamin C increases the absorption of iron
What beverages should be avoided with iron supplements and why?
Milk, caffeine, tea because it decreases the absorption of vitamin C
At what age should an infant be started on cow’s milk and how much cow’s milk should they have a day?
At one year old. Limit intake of cow’s milk to 16-24 ounces a day.
Risk factors for iron deficiency anemia include
Ulcers, menstruation, bleeding, alcoholism, decreased iron absorption, decreased iron intake
S/s of iron deficiency anemia
pallor (ash-gray/paleness), fatigue, fissures at corners of mouth, decreased exercise tolerance, extremities cool to touch
labs and diagnostics for iron deficiency anemia
H/H decreased. Need a CBC to show decreased RBC. Decreased iron levels (ferritin or iron). Stool hemoccult to rule out GI bleed which can be a cause of iron deficiency anemia
Treatment of iron deficiency anemia
Oral iron supplements like ferrous sulfate are typically the first line of treatment. For those unable to tolerate or absorb oral iron, parenteral (intravenous or intramuscular) iron therapy may be given. In cases of severe anemia, blood transfusions may be required.
What should a patient with iron deficiency anemia increase their intake of or take supplements of?
1. To increase absorption
2. _________ and __________ to prevent/aid in constipation (a common side effect of iron supplements)
- Vitamin C increases absorption
- Increase fluid intake and take stool softeners to prevent/aid in constipation
What should someone with iron deficiency anemia increase in their diet?
Iron fortified foods: Red meats, organ meats, eggs, green leafy vegetables, raisins, lentil beans
Increase fiber intake
What should someone taking iron supplements be made aware of pertaining to their stool?
Stool may appear dark, but this is normal and expected
True or false: Iron supplements should be initially taken on an empty stomach unless GI upset occurs-then it can be taken with food.
True
For a patient on iron and calcium supplements, how long should they wait between taking each medication?
2 hours
What is the priority intervention before and after administering an iron infusion?
Give a small test dose before administration and monitor patient for an hour after administration d/t risk of anaphylaxis
This condition is an autoimmune disorder caused by the lack of intrensic factor in the body, which is a necessity to absorb vitamin B12 and is sometimes reffered to as macrolytic anemia because the RBC are large and oval shaped
Pernicious anemia
Risk factors for pernicious anemia include
Removal of part of the stomach in surgery. Older adult d/t decreased gastric absorption
S/s of pernicious anemia
Smooth, shiny, beefy, red tongue (glossitis); pallor; fatigue; weight loss; parasthesia in hands and feet; poor balance and coordination deficits; fissures at corner of mouth
Labs that aid in diagnosis of pernicious anemia
Complete blood count (specifically blood smear) showing macrocytic (high MCV) anemia
Low serum vitamin B12 levels
Elevated serum methylmalonic acid and homocysteine levels
Positive intrinsic factor antibody test
Schilling test showing impaired vitamin B12 absorption
Cyanocobalamin injections are used in treatment of ___________________ because they are B12 injections
Pernicious anemia
How often should Cyanocobalamin injections be administered initially and after B12 levels are within therapeutic range?
Initially: Administered weekly
After therapeutic range achieved: Monthly injections or can be administered orally or via nasal route monthly
Education for someone with pernicious anemia
B12 supplement is lifelong medication. Routine B12 lab checks will need to be done. Safety measures need to be taken for parasthesia and balance issues. Good oral care needs to be done d/t tongue changes (glossitis).
This is a lifelong condition caused by a homozygous mutation in the hemoglobin gene, resulting in the production of abnormal sickle hemoglobin (HbS). This causes red blood cells to become sickle or crescent-shaped, which can lead to vascular occlusion, pain crises, acute chest syndrome, stroke, and other complications.
Sickle cell anemia
A patient with sickle cell anemia is experiencing a vasocclusive crisis. What is the cause of this? What are the two priority interventions for this patient?
A lack of oxygen causes this. Oxygen therapy and D5W NS IV is priority.
What is the normal lifespan of RBC? What is the lifespan of RBC in someone with sickle cell anemia?
The normal lifespan of a blood cell is 120 days but in sickle cell it is 10-20 days. This is what causes the anemia.
What complication from sickle cell anemia is caused by the spleen not being able to keep up with the death of RBC?
Spenomegaly
What part of the body can be affected by sickle cell anemia due to not being able to keep up reproduction of RBC quickly enough?
Bone marrow
Signs and symptoms of a vasocclusion crisis in extremities in someone with sickle cell anemia
Extremities cold to touch; diminished pulse; extreme pain in extremeties
S/s of the complication, acute chest syndrome, in someone with sickle cell anemia
cough, infiltrate on c-xray, fever, chest pain, SOB—— Presents like pneumonia
What is the major complications in someone with sickle cell anemia if acute chest syndrome occurs?
Respiratory and organ failure
S/s of the complication of sickle cell anemia, priaprism and what is your immediate intervention if this occurs
Prolonged, painful penile erection lasting more than 4 hours without sexual stimulation
Rigid penile shaft
Progressive penile pain and tenderness
Inability to achieve detumescence (return to flaccid state)
Discoloration of the penis, becoming bluish or bruised in appearance.
This is an emergency so immediately notify the HCP
Babies with sickle cell anemia may not show s/s until after _____________ of age. Why?
May not present with s/s of sickle cell anemia until 6 months of age because of the presence of HgbF.
A patient in a sickle cell crisis may exhibit CNS abnormalities. Monitoring for pronator drift, decreased bilateral hand grasp, and unsteady gait should be done every ____________.
Monitor for this every 4 hours
What is sickle Dex test used for in sickle cell anemia
It can identify abnormal hemoglobin but cannot distinguish between sickle cell trait and cannot confirm disease
Which two tests can be done to confirm sickle cell anemia
Hemoglobin electrophoresis and High-performance liquid chromatography (HPLC)
What is an HPLC screening used for?
It is the preferred method for diagnosing sickle cell disease. HPLC can detect abnormal hemoglobin variants like hemoglobin S, which causes sickle cell disease. It separates and quantifies the different types of hemoglobin present.
What is a Hgb electrophoresis screening used for?
It is used to detect abnormal hemoglobin variants like hemoglobin S, which causes sickle cell anemia. It separates the different types of hemoglobin present in the blood based on their electrical charges
What type of pain medications will be administered to someone in a sickle cell crises?
Moderate to severe pain is typically managed with opioid analgesics like morphine or hydromorphone- via PCA Pump. Avoid “as needed” dosing - use around-the-clock scheduled dosing for adequate relief. NSAIDs like ketorolac can be administered for mild to moderate pain- via orally.
What will you administer to prevent sepsis in a patient experiencing a sickle cell crisis?
Penicillin. For patients with a penicillin allergy, administer erythromycin
What IV fluids would you administer to someone experiencing a sickle cell crises to thin the blood?
D5W NS
For a child with sickle cell anemia, what can be done to cure sickle cell anemia?
Stem cell. Can not be done in adulthood
How does Hydroxyurea treat sickle cell anemia?
It increases HgbF (fetal hemoglobin) in the blood
Patient education for a patient taking Hydroxyurea
Requires patient to come in for routine follow up blood counts (CBC) d/t suppressed bone marrow function of this medication. Side effect is an icreased risk of leukemia. It can cause birth defects so adhere to strict contraception while taking the medication and for one month after stopping the medication.
How is Endari administered for treatment of sickle cell anemia?
Mix with 8 ounces of liquid to drink it orally
What effect does Endari have on sickle cell anemia
It decreases sickling episodes and increases lifespan of RBC
Side effects to monitor for in a patient taking Endari for sickle cell anemia
Constipation, nausea, headache, abdominal pain, cough, chest pain
How does Crizanlizumab (monoclonal antibody) work in treating sickle cell anemia
It prevents blood cells from sticking together, clumping together, and sticking to vessel walls. Ultimately puts patient at less risk of vasocclusion and sickle cell crisis
What route is Crizanlizumab (monoclonal antibody) administered when treating sickle cell anemia? What is the schedule of the administration?
Given by infusion. Given initially and then at week 2 and then monthly.
