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Med-surg > Heme > Flashcards

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
Q

Indirect measure of CO

A

BP and pulse pressure

26
Q

Causes of IDA

A

Not eating enough, problems with gut absorption, blood loss, hemolysis

27
Q

Symptoms specific to IDA

A

Pallor (esp pale conjunctiva), glossitis from epithelial atrophy, cheilitis, koilonychia (long-term IDA), pagophagia, microcytic, hemochromic cells

28
Q

Risk factors for B12 deficiency

A

Vegans, hx alc abuse, those w/o IF (pernicious anemia), gastrectomy

29
Q

Pernicious anemia

A

Autoimmune dx where lack IF that is usually secreted by parietal cells in the gastric mucosa (required for cobalamin absorption)

30
Q

Manifestations of B12 deficiency

A

INSIDIOUS, N/V, anorexia, abdominal pain, glossitis, cheilitis, macrocytic and norm chronic cells, paresthesia, ataxia, dec vibratory sense, impaired thought process, weakness

31
Q

Folate deficiency causes and symptoms

A

Dec intake of pregnancy, alcohol abuse; insidious—similar to B12 but no neuro sx
- macrocytic, normochromic cells

32
Q

Aplastic anemia

A
  • impacts RBCs, plts, WBCs—pancytopenia
  • mostly idiopathic
33
Q

Aplastic anemia CM

A

S/s anemia, leukopenic/neutropenic (infx risk), s/s low plt
- normocytic and normochromic RBCs bc problem at the level of hematopoiesis

34
Q

Nursing problems for aplastic anemia

A
  • risk for fatigue, infection, bleeding
35
Q

How is aplastic anemia diagnosed?

A

Bone marrow biopsy

36
Q

Nursing problems for all anemia

A
  • activity tolerance/fatigue (palpitations, SOB, anxious with movement)
  • nutrition (intake may be less than needed)
37
Q

What do you treat in anemia?

A

The underlying cause

38
Q

Oral iron

A
  • 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
Q

IV dextran

A

IM or IV
- z-track (stains skin)
- risk for fatal anaphylaxis (start slow)

40
Q

Cobalamin

A
  • 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
Q

Folic acid supplement

A
  • by mouth
  • no adverse effects
  • preg need 400 mcg
42
Q

Erythropoietin (synthetic)—Epoetin

A
  • 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
Q

Foods high in iron

A

Leafy greens, liver, egg, potato, legumes, dry fruit, whole grains

44
Q

Foods high in B12

A

Only animal products, enriched grains, red meat, fish, milk, eggs

45
Q

Foods high in folic acid

A

OJ, green leafy vegetables, legumes, whole grains, nuts

46
Q

NC for anemia tx

A
  • monitor labs, VS, oxygen
  • s/s hypoxemia
  • neuro status—B12 deficiency
  • admin oxygen and rest
  • keep them warm
  • blood transfusion
47
Q

What population can you not use heating pads with?

A

Paresthesia

48
Q

Polycythemia

A
  • high serum H&H and RBCs
49
Q

Relative polycythemia

A

False high hct due to Dec plasma volume and dehydration

50
Q

Polycythemia Vera

A

Not preventative and chronic
- genetic change
- never goes away

51
Q

Secondary polycythemia

A

Compensatory response to tissue hypoxia (high altitude, COPD especially)
- body compensates to hypoxia by making more buses

52
Q

CM of polycythemia

A

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
Q

Care for polycythemia

A
  • 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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