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Heme Flashcards

1
Q

Normal plt count

A

150-350k is normal

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2
Q

RBC morphology

A

Size, color, and shape of the cell

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3
Q

Normal hgb

A

M 14-18
F 12-16

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4
Q

Normal hct

A

M 42-52%
F 37-47%

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5
Q

Hgb

A

iron containing pigment of RBCs

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6
Q

How much iron is stored as ferritin and hemosiderin, bound to transferrin?

A

30%

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7
Q

NC for bone marrow biopsy

A

Premedicate and consent, take blood pressure and watch for bleeding after

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8
Q

Indications for bone marrow biopsy

A

Leukopenia, thrombocytopenia, unexplained anemia

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9
Q

Guiac

A

occult blood

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10
Q

Frank blood

A

visible to the eye

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11
Q

What does -scopy mean?

A

To observe

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12
Q

How does CKD affect RBCs?

A

Kidneys not functioning well and making erythropoietin so hgb is low

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13
Q

What types of anemia are caused by increase RBC destruction?

A

SCA, mediations, hemolytic reactions, incompatible blood products

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14
Q

General cause of IDA

A

dec hgb synthesis

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15
Q

General symptoms of anemia

A

Fatigue, lethargy, weak, SOB, pallor in face, palms, and conjunctiva

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16
Q

Severe symptoms of anemia

A

Angina, heart attack, faint, worsening CHF, pallor

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17
Q

Why do anemia people get pallor?

A

Blood is shunted to more vital organs

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18
Q

What causes bone pain with anemia?

A

Inc secretion of erythropoietin from the bones

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19
Q

Why people anemia people get hypoxia and what can it cause

A

Lack good oxygen to heart/muscles (hypoxia) and can cause angina/MI, heart fail, inc RR, dyspnea

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20
Q

Mild symptoms of anemia and range

A

10-14, asymptomatic or mild sx

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21
Q

Moderate symptoms of anemia and range

A

6-10, inc cardiopulmonary sx, may be at rest

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22
Q

Severe sx of anemia and range

A

Under 6, many systems involved; sx at rest, can be life-threatening

23
Q

Why does CO inc with anemia?

A

Compensatory mechanism, trying to push O2 where it needs to go

24
Q

Cardiac output

A

Amount of blood ejected from the L ventricle each minute

25
Indirect measure of CO
BP and pulse pressure
26
Causes of IDA
Not eating enough, problems with gut absorption, blood loss, hemolysis
27
Symptoms specific to IDA
Pallor (esp pale conjunctiva), glossitis from epithelial atrophy, cheilitis, koilonychia (long-term IDA), pagophagia, microcytic, hemochromic cells
28
Risk factors for B12 deficiency
Vegans, hx alc abuse, those w/o IF (pernicious anemia), gastrectomy
29
Pernicious anemia
Autoimmune dx where lack IF that is usually secreted by parietal cells in the gastric mucosa (required for cobalamin absorption)
30
Manifestations of B12 deficiency
INSIDIOUS, N/V, anorexia, abdominal pain, glossitis, cheilitis, macrocytic and norm chronic cells, paresthesia, ataxia, dec vibratory sense, impaired thought process, weakness
31
Folate deficiency causes and symptoms
Dec intake of pregnancy, alcohol abuse; insidious—similar to B12 but no neuro sx - macrocytic, normochromic cells
32
Aplastic anemia
- impacts RBCs, plts, WBCs—pancytopenia - mostly idiopathic
33
Aplastic anemia CM
S/s anemia, leukopenic/neutropenic (infx risk), s/s low plt - normocytic and normochromic RBCs bc problem at the level of hematopoiesis
34
Nursing problems for aplastic anemia
- risk for fatigue, infection, bleeding
35
How is aplastic anemia diagnosed?
Bone marrow biopsy
36
Nursing problems for all anemia
- activity tolerance/fatigue (palpitations, SOB, anxious with movement) - nutrition (intake may be less than needed)
37
What do you treat in anemia?
The underlying cause
38
Oral iron
- cheap, easy - absorbed in the duodenum (no EC or ER) - better taken with meals or with food (can gradually adjust to not upset stomach) - stains - SE: constipation, heartburn, constipation, black stool (melena)
39
IV dextran
IM or IV - z-track (stains skin) - risk for fatal anaphylaxis (start slow)
40
Cobalamin
- IM preferred for severe deficiency of neuro sx - PO as effective as IM if IF present and megadoses given (1000 mcg) - pernicious anemia will be treated for life
41
Folic acid supplement
- by mouth - no adverse effects - preg need 400 mcg
42
Erythropoietin (synthetic)—Epoetin
- esp with renal disease/cancer - often give with iron - SQ or IV 3x/W - BLACK BOX—discontinue when Hgb over 10 bs risk of CV problems
43
Foods high in iron
Leafy greens, liver, egg, potato, legumes, dry fruit, whole grains
44
Foods high in B12
Only animal products, enriched grains, red meat, fish, milk, eggs
45
Foods high in folic acid
OJ, green leafy vegetables, legumes, whole grains, nuts
46
NC for anemia tx
- monitor labs, VS, oxygen - s/s hypoxemia - neuro status—B12 deficiency - admin oxygen and rest - keep them warm - blood transfusion
47
What population can you not use heating pads with?
Paresthesia
48
Polycythemia
- high serum H&H and RBCs
49
Relative polycythemia
False high hct due to Dec plasma volume and dehydration
50
Polycythemia Vera
Not preventative and chronic - genetic change - never goes away
51
Secondary polycythemia
Compensatory response to tissue hypoxia (high altitude, COPD especially) - body compensates to hypoxia by making more buses
52
CM of polycythemia
Inc blood volume and thickness - HTN, dusky red color, cyanosis, can’t concentrate - complications of dec BF—DVT, hemorrhage, angina, cerebral insufficiency, TIA, STROKE - hyper metabolism—night sweats, weight loss - inc RBCs, h&h—pruritis exacerbated by a hot bath—pain in fingers and toes
53
Care for polycythemia
- phlebotomy—300-500mL/every other day, them move to every few months - goal is Hct<42% in W, 45% in M - HYDRATION - anticoagulants - avoid immobility - treat purities with antihistamines

Med-surg (7 decks)

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