GROUP 5 Flashcards
ANEMIA
TYPES OF ANEMIA
1. Hemorrhagic Anemia
Definition: Caused by acute or chronic blood loss, leading to a decrease in RBCs.
Common Causes: Trauma or surgery,
Gastrointestinal bleeding (e.g., ulcers, cancers), Menorrhagia (heavy menstrual bleeding)
- Nutritional Anemia
Definition: Results from deficiencies in essential nutrients required for RBC production.
Types: Iron Deficiency Anemia: Most common nutritional deficiency; caused by inadequate iron intake or absorption.
Vitamin B12 Deficiency Anemia: Often due to poor dietary intake or malabsorption (e.g., pernicious anemia).
Folate Deficiency Anemia: Caused by insufficient dietary folate, affecting RBC formation. - Hypoproliferative Anemia
Definition: Characterized by the underproduction of RBCs due to bone marrow dysfunction.
Causes: Bone marrow disorders (e.g., aplastic anemia), Chronic kidney disease (leading to decreased erythropoietin production), Endocrine disorders (e.g., hypothyroidism) - Hemolytic Anemia
Definition: Increased destruction of circulating RBCs.
Mechanism: The reticuloendothelial system (RES) destroys RBCs prematurely.
Causes:
Autoimmune disorders (e.g., autoimmune hemolytic anemia), Infections (e.g., malaria), Hereditary conditions (e.g., sickle cell disease, thalassemia)
DIAGNOSTIC CRITERIA
WHO Guidelines:
Hemoglobin (Hgb) levels < 12 g/dL in non-pregnant women.
Hgb < 13 g/dL for men.
SIGNS AND SYMPTOMS…
Severe Symptoms: Hgb < 6 g/dL
General Symptoms: Fatigue, weakness, malaise, Pallor, Dyspnea on exertion (DOE)
Cardiac symptoms: palpitations, tachycardia
Cerebral symptoms: dizziness, confusion
Muscle pain or cramping
Specific Symptoms:
Jaundice (associated with megaloblastic or hemolytic anemia)
Beefy-red, sore, smooth tongue (GLOSSITIS) (megaloblastic anemia)
Brittle, rigid, concave nails (iron deficiency)
Pica (craving non-nutritive substances, often iron deficiency)
Angular cheilosis (cracks at the corners of the mouth)
Paresthesia (tingling sensations, associated with megaloblastic anemia)
Bone pain (due to increased erythropoiesis in the bone marrow)
CLASSIFICATION OF ANEMIA SEVERITY…
Chronic Anemia
Symptoms: Often asymptomatic or mild fatigue.
Hgb: Slightly low, but usually not below 10 g/dL.
Mild Anemia
Hgb: 10-12 g/dL
Symptoms: Typically asymptomatic, possibly mild fatigue.
Moderate Anemia
Hgb: 6-10 g/dL
Symptoms: Fatigue, dyspnea on exertion, palpitations, tachycardia, diaphoresis during exertion.
Severe Anemia
Hgb: < 6 g/dL
Symptoms: Chronic fatigue, severe symptoms, peripheral edema.
MEDICAL MANAGEMENT…
Alleviate Cause: Identify and treat underlying cause (e.g., iron supplementation for iron deficiency).
Relieve Symptoms: Provide supportive care based on individual symptoms.
Blood Transfusions: Considered in severe cases to restore RBC levels.
Erythropoietin: Used in hypoproliferative anemia to stimulate RBC production.
Iron Replacement: Oral or intravenous iron supplementation for iron deficiency.
Oxygen Therapy: May be required in severe cases to manage hypoxia.
NURSING DIAGNOSES
Fatigue
Activity intolerance
Altered tissue perfusion
Altered nutrition: less than body requirements
Risk for ineffective management of therapeutic regimen
DIAGNOSTICS
History and Physical Examination: Assessing symptoms and risk factors.
Complete Blood Count (CBC): Evaluates hemoglobin levels, hematocrit, RBC count, and platelets.
Reticulocyte Count: Assesses bone marrow response and RBC production.
Coagulation Screening: Includes INR, PT, and PTT to assess bleeding risk.
Bone Marrow Aspiration: Used in specific cases to evaluate bone marrow function and diagnose disorders.
IRON DEFICIENCY ANEMIA
Nursing Management:
Diet rich in iron
Avoid foods that block iron absorption
Supplemental Iron:
Ensure compliance, expect dark tarry stools
Take with juice/water (use straw, rinse mouth)
Monitor for toxicity, Vitamin C enhances absorption
Avoid antacids
Iron Injections: Use Z-track method
Diagnosis:
GI series (Barium studies), Occult blood
Upper endoscopy, Colonoscopy
Symptoms:
Dyspnea, Tachycardia, Pallor, Fatigue, Irritability, Headache, Brittle nails, Angular cheilosis, Pica, Hair loss, Increased sensitivity to cold, Restless leg syndrome
Etiology/Risk Factors:
Blood loss (most common), Menstruating/pregnant women
Adolescents, Children, Infants, GI tumors, Malabsorption, High fiber diet, Chronic alcoholism
Iron Deficiency Anemia (Microcytic):
The most common type worldwide, depleted iron stores
1 mg absorbed for every 10-20 mg ingested
Ferritin levels <12 G/L
MEGALOBLASTIC ANEMIA
DUE TO FOLATE DEFICIENCY
- NERVOUS SYSTEM NOT AFFECTED
SYMPTOMS OF MEGALOBLASTIC ANEMIA…
PALLOR
DECREASED APPETITE
IRRITABILITY
FATIGUE
DIARRHEA
GLOSSITIS
PERNICIOUS ANEMIA
Type: Megaloblastic anemia (autoimmune)
Cause: Decreased absorption of Vitamin B12 (lack of intrinsic factor)
Risk Factors:
Family history
North European descent
Chronic gastritis
Certain medications
Vegetarian diet
Gastric surgery
Symptoms:
Pallor
Fatigue
Nausea, vomiting
Glossitis
Loss of appetite
Management:
Vitamin B12 (Cyanocobalamin) Injections (monthly)
IM or nasal spray
Iron supplements
Folic acid
Diet management
Monitor:
Cardiac rhythm
Daily weight
Dizziness
Oxygen levels
Support: Energy conservation, blood transfusion, oral nutrient intake
Erythropoietin: Hgb and Hct checked 2x/week
APLASTIC ANEMIA
- Normocytic, normochromic anemia
- Bone marrow hypoplasia/aplasia
- Normal-sized erythrocytes with normal hemoglobin, but insufficient in number
- Pancytopenia (deficiency of all blood cells)
Etiology/Risk Factors:
- Congenital
- Idiopathic
- Acquired
Myelotoxins, Autoimmune disorders, Infections
Pathophysiology:
Stem cell alteration
Bone marrow replaced by fat
Clinical Manifestations:
Pancytopenia, Fatigue, Lassitude, Dyspnea, Pallor
Anorexia, Infection, Petichiae, Purpura
Retinal hemorrhage, Hypoxia
Medical Management:
Immediate withdrawal of the offending agent
Pharmacologic treatment, Transfusion, Radiotherapy
Bone marrow transplant
Nursing Management:
- Explain bone marrow Aspiration/biopsy:
- Posterior iliac crest (prone/lateral),
- Anterior iliac crest (supine), Vertebrae, Ribs, Sternum
- Proper positioning, eyes away
- Monitor for infection risk
- Manage impaired gas exchange and ineffective tissue perfusion
WHAT ARE HEMOLYTIC ANEMIAS AND THE TYPES ?
Hemolytic anemias are a group of disorders characterized by the premature destruction of red blood cells (RBCs), leading to anemia, increased bilirubin levels, and compensatory erythropoiesis.
TYPES…
Sickle Cell Anemia
Thalassemia
Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency
Immune Hemolytic Anemia
Hereditary Hemochromatosis
SICKLE CELL ANEMIA
GENETICS…
Inheritance requires both parents to carry the sickle cell trait (HbAS), with a 1 in 4 chance per pregnancy for the child to have sickle cell disease (HbSS).
PATHOPHYSIOLOGY…
SCA occurs due to the replacement of normal hemoglobin (HbA) with abnormal hemoglobin (HbS), causing RBCs to assume a rigid, sickle shape, leading to vascular occlusion and ischemia.
CLINICAL PRESENTATION…
Asymptomatic until 4-6 months due to fetal hemoglobin (HbF). Symptoms include pain crises, swelling, fever, and organ complications.
DIAGNOSIS…
Hemoglobin Electrophoresis: Differentiates between normal and sickle hemoglobin.
Sickle-Turbidity Test (SickleDex): Rapid screening for sickle cell disease.
Comprehensive assessment for pain, swelling, fever, and anemia.
MANIFESTATIONS…
Anemia: HGB levels between 5–11 g/dL.
Hemolysis: Increased RBC destruction and jaundice.
Bone Expansion: Increased erythropoiesis in marrow.
Cardiovascular Involvement: Increased heart workload due to anemia.
Organ Damage: Possible from sickling and occlusion.
MEDICAL MANAGEMENT…
Pain Management: Analgesics during crises.
Hydration: IV fluids to lower blood viscosity.
Infection Control: Prophylactic antibiotics from 2 months to 5 years.
Chemotherapy and Corticosteroids: For symptom management.
Stem Cell Transplant: Potentially curative for eligible patients.
Blood Transfusion: To correct severe anemia.
NURSING DIAGNOSES…
Ineffective Coping, Fluid Volume Deficit, Fatigue, Acute Pain, Risk for Infection, Risk for Powerlessness, Deficient Knowledge.
COMPLICATIONS…
Hypoxia: Low oxygen levels.
Ischemia: Reduced organ blood flow.
Infection: Increased susceptibility due to splenic dysfunction.
Cerebrovascular Accident (CVA): Increased risk of stroke.
Acute and Chronic Renal Failure: From compromised blood flow.
Heart Failure: From chronic anemia.
COMMON CRISES…
Vaso-Occlusive Crisis: Thrombotic crisis causing severe pain.
Aplastic Crisis: Severe anemia due to parvovirus B19.
Splenic Sequestration Crisis: Life-threatening blood pooling in the spleen.
Acute Chest Syndrome: Chest pain, fever, respiratory distress.
Emotional and Behavioral Problems: Related to chronic pain and disease management challenges.
SECONDARY POLYCYTHEMIA
DEFINITION…
Excessive production of red blood cells (RBCs) due to increased erythropoietin, often in response to chronic hypoxia.
CAUSES…
Reduced oxygen levels (e.g., chronic lung disease, cyanotic heart disease).
Nonpathologic conditions or neoplasms.
MANAGEMENT…
Therapeutic phlebotomy.
Frequent blood transfusions to manage symptoms.
Iron-chelation therapy (e.g., Feroxamine + Vitamin C) to promote iron excretion.
Hydroxyurea (cytotoxic agent) to decrease production of abnormal blood cells and reduce pain.
Transfusion Process: Packed Red Blood Cells (PRBC)
Preprocedure
Confirm transfusion prescription and ensure blood is typed and cross-matched.
Verify patient consent per policy.
Explain the procedure and signs of transfusion reactions (itching, hives, shortness of breath, fever, chills).
Establish baseline vitals (temperature, pulse, respiration, blood pressure) and assess lung sounds and jugular venous distention.
Perform hand hygiene and wear gloves; use a 20-gauge or larger needle with blood filter tubing.
Procedure
Obtain PRBCs from the blood bank after IV line initiation.
Double-check labels with another nurse or physician for ABO and Rh compatibility. Confirm patient identity using their name and wristband.
Inspect blood for gas bubbles or abnormal color/cloudiness (indicating potential issues).
Initiate transfusion within 30 minutes of PRBC removal; run slowly for the first 15 minutes (no faster than 5 mL/min). Observe closely for reactions.
If no adverse effects are observed, increase flow rate as appropriate.
Monitor for 15-30 minutes for signs of reactions; check vital signs regularly and compare to baseline. Be alert for symptoms like restlessness, hives, nausea, or back pain. Stop infusion and notify the provider if reactions occur.
Ensure the transfusion does not exceed 4 hours to prevent bacterial growth; change blood tubing after every 2 units.
Postprocedure
Obtain and compare post-transfusion vital signs with baseline.
Dispose of materials properly and document the procedure in the patient’s medical record, including assessment findings and patient tolerance.
Monitor the patient for response and effectiveness of the transfusion.
Notes
Never add medications to blood products; normal saline may be added if necessary for flow.
Use an in-line blood warmer if blood needs warming, ensuring it has a monitoring system.
iron should never be taken with…
milk
how long does it take the hgb and hct to return to normal after treatment ?
4-6 weeks
PNEUMONIA
DEFINITION
Pneumonia is an inflammation of the lungs caused by various infectious agents, leading to the obstruction of bronchioles, increased exudate production, and decreased gas exchange. It can result in significant morbidity and mortality, particularly among vulnerable populations.
TYPES
Inflammation of the Lungs
- Can be caused by bacterial, viral, or fungal infections.
- The inflammatory response leads to fluid accumulation and impaired gas exchange.
Pneumonitis
- Inflammation of lung tissue not always due to infection (can be due to chemical irritants, allergens, etc.).
Bronchopneumonia
- A form of pneumonia characterized by inflammation that primarily affects the bronchi and surrounding alveoli.
- Can be caused by bacterial infections, often following viral respiratory infections.
Community-Acquired Pneumonia (CAP)
- Acquired outside of a healthcare setting. (Examples include Legionnaires’ disease and infections from Streptococcus pneumoniae)
Hospital-Acquired Pneumonia (HAP)
- Occurs in patients hospitalized for at least 48 hours. (More likely caused by resistant bacteria (e.g., Pseudomonas aeruginosa, Acinetobacter).
Aspiration Pneumonia
- Results from the inhalation of food, liquid, or vomit into the lungs.
- Common in individuals with impaired swallowing or altered consciousness.
INCIDENCE
Prevalence: Third leading cause of death among individuals over 85 years old.
Age Factor: Increased incidence in those over 64 years of age.
Mortality Rate: Can be as high as 50% in cases caused by Pseudomonas or Acinetobacter, especially in the presence of complications or in patients with significant comorbidities (e.g., flu).
ETIOLOGY/RISK FACTORS
Infectious Agents:
Influenza virus: Common cause of viral pneumonia.
Bacteria: Streptococcus pneumoniae, Staphylococcus aureus, and others.
Risk Factors:
Impaired immune function (elderly, chronic diseases).
Prolonged immobility.
Smoking.
Altered level of consciousness (LOC).
Ineffective cough reflex.
Recent hospitalization or use of respiratory equipment.
Symptoms of Pneumonia
Common Symptoms:
Cough (may be productive)
Fever and chills
Tachycardia (increased heart rate)
Tachypnea (increased respiratory rate)
Dyspnea (shortness of breath)
Pleuritic chest pain (sharp pain during breathing)
Malaise (general discomfort)
Decreased breath sounds on auscultation
Sputum Characteristics:
Green/yellow sputum: Suggestive of Streptococcal infection.
Yellow/bloody sputum: Indicative of Staphylococcal infection.
DIAGNOSTIC ASSESSMENT
History and Physical Examination: Assessing symptoms, risk factors, and clinical signs.
Nutrition Assessment: Evaluating nutritional status and needs.
Chest X-ray: Helps visualize lung inflammation or consolidation.
Blood Culture: Identifies pathogens in the bloodstream.
Sputum Culture: Determines the causative agent of pneumonia.
Arterial Blood Gas (ABG): Assesses oxygenation and acid-base status.
Capillary Blood Gas (CBG): Less common, may provide similar information as ABG.
Bronchoscopy: Direct visualization and possible sampling of the lower respiratory tract.
Pulse Oximetry: Monitors oxygen saturation levels.
NURSING DIAGNOSES
Impaired Gas Exchange: Due to fluid in the alveoli and inflammation.
Ineffective Airway Clearance: Related to excessive secretions and weak cough.
Deficient Fluid Volume: May occur due to fever and reduced intake.
Sleep Pattern Disturbance: Resulting from respiratory distress.
Pain: Due to pleuritic involvement or muscle strain from coughing.
Injury: High Risk: Related to altered LOC or fatigue.
Activity Intolerance: Due to fatigue and dyspnea.
COMPLICATIONS
Atelectasis: Collapse of lung tissue due to fluid or mucus obstruction.
Pleural Effusion: Accumulation of fluid in the pleural space.
Lung Abscess: Localized collection of pus within the lung tissue.
Pleurisy: Inflammation of the pleura, causing sharp pain during breathing.
Pericarditis: Inflammation of the pericardium, potentially leading to chest pain.
Endocarditis: Infection of the heart valves that can occur in severe cases.
Superinfection: Secondary infection following initial pneumonia.
Hypotension: Drop in blood pressure due to severe infection.
Shock: Potentially life-threatening condition resulting from sepsis or respiratory failure.
OXYGENATION
DEFINITION
Oxygenation refers to the process of exchanging respiratory gases (oxygen and carbon dioxide) in the lungs and maintaining acid-base balance in the body. Proper oxygenation is essential for cellular metabolism and overall health.
KEY COMPONENTS OF OXYGENATION
Lungs
Responsible for the exchange of respiratory gases and maintaining acid-base balance through ventilation and perfusion.
Alveoli
Small air sacs in the lungs where gas exchange and diffusion occur. Oxygen enters the bloodstream while carbon dioxide is expelled.
Mucus
A protective secretion that traps pathogens, particles, and irritants, preventing them from entering the lungs.
Cilia
Tiny hair-like structures that line the respiratory tract, moving mucus upwards toward the throat to be swallowed or expelled.
Pleura
Membranes lining the lungs and thoracic cavity that secrete pleural fluid, allowing for smooth movement during respiration and creating surface tension.
Surfactant
A substance that reduces surface tension in the alveoli, facilitating inflation and preventing alveolar collapse (atelectasis).
SIGNS OF INADEQUATE OXYGENATION
Gravity Dependent
Symptoms may worsen when lying down due to changes in lung mechanics (orthopnea).
Use of Accessory Muscles
Increased effort in breathing may lead to visible use of neck and shoulder muscles.
Orthopnea
Shortness of breath (SOB) while lying flat, often relieved by sitting up.
Tidal Volume
The volume of air inhaled or exhaled in one breath; may be reduced in cases of respiratory distress.
Total Lung Capacity
The maximum amount of air the lungs can hold; may be affected by restrictive or obstructive lung diseases.
Controlled Breathing Techniques
Techniques such as pursed-lips breathing and diaphragmatic breathing to enhance ventilation and oxygenation.
Controlled Cough
Effective coughing helps clear secretions, improving airway patency.
Factors Affecting Oxygenation
Pathology
Respiratory diseases (e.g., COPD, asthma, pneumonia) impact lung function and gas exchange.
Age
Aging can lead to decreased lung elasticity and capacity.
Physiologic Conditions
Conditions such as obesity or neuromuscular disorders can impair respiratory function.
Medications
Some drugs (e.g., opioids) can depress respiratory drive.
Lifestyle Choices
Smoking, lack of exercise, and poor nutrition can adversely affect lung health.
Nutrition
Adequate nutrition is essential for respiratory muscle strength and immune function.
Environmental Factors
Pollution, allergens, and occupational exposures can contribute to respiratory issues.
Psychological Factors
Anxiety and stress can lead to altered breathing patterns and inadequate oxygenation.
ASSESSMENT OF OXYGENATION
Cough
Assessing the frequency and nature (productive vs. non-productive) of cough.
Secretions
Observing the amount, color, and consistency of sputum.
Pain
Evaluating for any chest pain that may indicate pleuritic involvement or other issues.
Barrel Chest
Observing for changes in chest shape that may indicate chronic lung disease.
Auscultation
Listening for abnormal lung sounds (e.g., wheezing, crackles).
DIAGNOSTIC STUDIES
Chest X-ray
Imaging to assess lung structure and detect abnormalities (e.g., consolidation, effusions).
Lung Scan (Q Scan/V Scan)
Evaluating blood flow and ventilation in the lungs.
Endoscopic Procedures
Laryngoscopy and bronchoscopy for direct visualization of the airways and obtaining samples.
Sputum Culture
Identifying pathogens causing respiratory infections.
Skin Test (PPD, Tuberculin)
Testing for tuberculosis exposure.
Blood Gas Analysis (ABGs)
Assessing oxygen and carbon dioxide levels, as well as acid-base balance.
Complete Blood Count (CBC)
Evaluating white blood cells (WBC), red blood cells (RBC), hemoglobin (HGB), and hematocrit (HCT).
Pulmonary Function Tests (PFTs)
Measuring lung volumes (tidal volume, total lung capacity, vital capacity) and expiratory flow rates.
Pulse Oximetry
Non-invasive measurement of oxygen saturation in the blood.
Thoracentesis
Procedure to remove fluid from the pleural space for diagnostic or therapeutic purposes.
NURSING DIAGNOSES FOR INADEQUATE OXYGENATION
Impaired Gas Exchange
Due to ventilation-perfusion mismatch or alveolar collapse.
Ineffective Breathing Pattern
Characterized by altered depth or rate of breathing.
Ineffective Airway Clearance
Related to excessive secretions or weak cough.
Anxiety
Resulting from difficulty breathing and fear of suffocation.
Altered Nutrition
Less than body requirements due to increased metabolic demand or inadequate intake.
