Gas Exchange Study

Question 1

Potential causes of a sickle cell crisis

Answer 1

Significant blood loss; Illness; Climbing or flying to high altitudes; Continued stress; Dehydration; Elevated heat or cold

Question 2

What would you do as the nurse to care for the patient with sickle cell disease in extreme pain, SOB, and dehydration?

Answer 2

Administer oxygen, administered prescribed pain medications, hydrate with normal saline IV

Question 3

How would you position a patient in bed in a sickle cell crisis?

Answer 3

Encourage to keep extremities extended. DO NOT RAISE THE KNEE POSITION OF THE BED. Elevate the HOB NO MORE THAN 30 DEGREES.

Question 4

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)

Answer 4

Every hour

Question 5

Education for a sickle cell patient to avoid a crisis

Answer 5

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.

Question 6

For a child to have even a 25% chance of having sickle cell anemia, __________ of their parents have to have the sickle cell trait.

Answer 6

Both

Question 7

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

Answer 7

Iron deficiency anemia

Question 8

At what age should breast fed babies start receiving iron supplements?

Answer 8

4 months

Question 9

Why should iron supplements be administered through a dropper to an infant?

Answer 9

To avoid teeth discoloration

Question 10

What beverage should iron supplements be administered with and why?

Answer 10

Orange Juice because vitamin C increases the absorption of iron

Question 11

What beverages should be avoided with iron supplements and why?

Answer 11

Milk, caffeine, tea because it decreases the absorption of vitamin C

Question 12

At what age should an infant be started on cow’s milk and how much cow’s milk should they have a day?

Answer 12

At one year old. Limit intake of cow’s milk to 16-24 ounces a day.

Question 13

Risk factors for iron deficiency anemia include

Answer 13

Ulcers, menstruation, bleeding, alcoholism, decreased iron absorption, decreased iron intake

Question 14

S/s of iron deficiency anemia

Answer 14

pallor (ash-gray/paleness), fatigue, fissures at corners of mouth, decreased exercise tolerance, extremities cool to touch

Question 15

labs and diagnostics for iron deficiency anemia

Answer 15

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

Question 16

Treatment of iron deficiency anemia

Answer 16

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.

Question 17

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)

Answer 17

1. Vitamin C increases absorption
2. Increase fluid intake and take stool softeners to prevent/aid in constipation

Question 18

What should someone with iron deficiency anemia increase in their diet?

Answer 18

Iron fortified foods: Red meats, organ meats, eggs, green leafy vegetables, raisins, lentil beans
Increase fiber intake

Question 19

What should someone taking iron supplements be made aware of pertaining to their stool?

Answer 19

Stool may appear dark, but this is normal and expected

Question 20

True or false: Iron supplements should be initially taken on an empty stomach unless GI upset occurs-then it can be taken with food.

Answer 20

True

Question 21

For a patient on iron and calcium supplements, how long should they wait between taking each medication?

Answer 21

2 hours

Question 22

What is the priority intervention before and after administering an iron infusion?

Answer 22

Give a small test dose before administration and monitor patient for an hour after administration d/t risk of anaphylaxis

Question 23

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

Answer 23

Pernicious anemia

Question 24

Risk factors for pernicious anemia include

Answer 24

Removal of part of the stomach in surgery. Older adult d/t decreased gastric absorption

Question 25

S/s of pernicious anemia

Answer 25

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

Question 26

Labs that aid in diagnosis of pernicious anemia

Answer 26

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

Question 27

Cyanocobalamin injections are used in treatment of ___________________ because they are B12 injections

Answer 27

Pernicious anemia

Question 28

How often should Cyanocobalamin injections be administered initially and after B12 levels are within therapeutic range?

Answer 28

Initially: Administered weekly After therapeutic range achieved: Monthly injections or can be administered orally or via nasal route monthly

Question 29

Education for someone with pernicious anemia

Answer 29

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).

Question 30

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.

Answer 30

Sickle cell anemia

Question 31

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?

Answer 31

A lack of oxygen causes this. Oxygen therapy and D5W NS IV is priority.

Question 32

What is the normal lifespan of RBC? What is the lifespan of RBC in someone with sickle cell anemia?

Answer 32

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.

Question 33

What complication from sickle cell anemia is caused by the spleen not being able to keep up with the death of RBC?

Answer 33

Spenomegaly

Question 34

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?

Answer 34

Bone marrow

Question 35

Signs and symptoms of a vasocclusion crisis in extremities in someone with sickle cell anemia

Answer 35

Extremities cold to touch; diminished pulse; extreme pain in extremeties

Question 36

S/s of the complication, acute chest syndrome, in someone with sickle cell anemia

Answer 36

cough, infiltrate on c-xray, fever, chest pain, SOB------ Presents like pneumonia

Question 37

What is the major complications in someone with sickle cell anemia if acute chest syndrome occurs?

Answer 37

Respiratory and organ failure

Question 38

S/s of the complication of sickle cell anemia, priaprism and what is your immediate intervention if this occurs

Answer 38

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

Question 39

Babies with sickle cell anemia may not show s/s until after _____________ of age. Why?

Answer 39

May not present with s/s of sickle cell anemia until 6 months of age because of the presence of HgbF.

Question 40

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 ____________.

Answer 40

Monitor for this every 4 hours

Question 41

What is sickle Dex test used for in sickle cell anemia

Answer 41

It can identify abnormal hemoglobin but cannot distinguish between sickle cell trait and cannot confirm disease

Question 42

Which two tests can be done to confirm sickle cell anemia

Answer 42

Hemoglobin electrophoresis and High-performance liquid chromatography (HPLC)

Question 43

What is an HPLC screening used for?

Answer 43

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.

Question 44

What is a Hgb electrophoresis screening used for?

Answer 44

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

Question 45

What type of pain medications will be administered to someone in a sickle cell crises?

Answer 45

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.

Question 46

What will you administer to prevent sepsis in a patient experiencing a sickle cell crisis?

Answer 46

Penicillin. For patients with a penicillin allergy, administer erythromycin

Question 47

What IV fluids would you administer to someone experiencing a sickle cell crises to thin the blood?

Answer 47

D5W NS

Question 48

For a child with sickle cell anemia, what can be done to cure sickle cell anemia?

Answer 48

Stem cell. Can not be done in adulthood

Question 49

How does Hydroxyurea treat sickle cell anemia?

Answer 49

It increases HgbF (fetal hemoglobin) in the blood

Question 50

Patient education for a patient taking Hydroxyurea

Answer 50

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.

Question 51

How is Endari administered for treatment of sickle cell anemia?

Answer 51

Mix with 8 ounces of liquid to drink it orally

Question 52

What effect does Endari have on sickle cell anemia

Answer 52

It decreases sickling episodes and increases lifespan of RBC

Question 53

Side effects to monitor for in a patient taking Endari for sickle cell anemia

Answer 53

Constipation, nausea, headache, abdominal pain, cough, chest pain

Question 54

How does Crizanlizumab (monoclonal antibody) work in treating sickle cell anemia

Answer 54

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

Question 55

What route is Crizanlizumab (monoclonal antibody) administered when treating sickle cell anemia? What is the schedule of the administration?

Answer 55

Given by infusion. Given initially and then at week 2 and then monthly.