MIDTERM

Question 1

TRALI (Transfusion-Related Acute Lung Injury)

Answer 1

development of acute lung injury occurring within 6 hours after the blood transfusion

Question 2

Transfusion-associated circulatory overload (TACO)

Answer 2

It can occur after transfusion of any type of blood product but is most frequently associated with red blood cells (Smith, 2023). TACO is characterized by volume overload. The patient cannot compensate for increased vascular volume from the blood transfusion

Question 3

more likely to occur when a person has an underlying heart condition of is an older adult. You mentioned that a diuretic is often used in the treatment of TACO.

Answer 3

furosemide

Question 4

Septic shock

Answer 4

caused by widespread infection or sepsis
hypotension, tachycardia, fever, bounding pulses, changes in mental status, SOB, and chills.

The acid base imbalance that a person with sepsis/septic shock is at risk for is metabolic acidosis (Morton & Thurman, 2023). Lactic acid release causes metabolic acidosis.

Question 5

What causes the hyperkalemia that can happen with a transfusion of PRBC?

What causes the hypocalcemia that can happens with a transfusion of PRBC?

Answer 5

Hyperkalemia occurs because most of our potassium is stored inside our cells while hypocalcemia occurs because of citrate.

Question 6

Aplastic anemia

Answer 6

disease in which a patient is deficient in red blood cells, white blood cells, and platelets

pancytopenia- which means reduced counts of all three types of blood cells.

bone marrow aspiration is often used in the diagnosis

Question 7

Neutropenia

Answer 7

insufficient numbers of neutrophils due to a decreased production or increased destruction of white blood cells

neutrophil count is below 2,000

Question 8

what is a thrombocyte? If a patient has received a transfusion of thrombocytes, what should we see?

Answer 8

Thrombocytes are also known as platelets. The primary purpose of a platelet is to initiate the clotting process by producing a “plug” at the site of injury.

decreased bleeding from IV sites and decreased oozing from old lab sites after a transfusion of platelets

Question 9

Sickle cell crisis/sickle cell disease

Answer 9

chronic hereditary hemolytic anemia that occurs mostly in African or African-Caribbean origin. The sickle cell gene results in abnormal hemoglobin, usually hemoglobin S (HbS). These sickled cells can’t pass through small blood vessels which causes inflammation, obstruction of the vessels and decreased delivery of oxygen. Sickle cell crisis begins suddenly because of an infection or change in temperature or sometimes for no identifiable reason

Triggers for a sickle cell crisis can stem from an infection, a change in temperature, or can happen for no identifiable reason (Morton & Thurman, 2023). Aggressive IV fluid hydration is started right away with a crisis to decrease blood viscosity and maintain renal perfusion (Morton & Thurman, 2023). This will help slow the sickling process.

Pregnancy can increase the risk of sickle cell crisis because the abnormal red blood cells and anemia cause lower amounts of oxygen. This also puts the baby at risk. Strenuous activity increases a person’s blood flow so this could increase the chances of a sickle cell crisis. High altitudes can also cause an increased risk because of the lower oxygen levels at that level

Question 10

erythropoietin stimulating agents

Answer 10

Erythropoietin stimulating agents are given to help stimulate the bone marrow to make red blood cells (Morton & Thurman, 2023). They are used to treat anemia of chronic disease such as kidney injury, infections, malignancies, and connective tissue diseases. Suppression of red blood cell production, decreased red blood cell survival time, and low serum erythropoietin levels can cause anemia. It is given either by IV or subcutaneously one to three times a week with adjustments being made based on how the patient responds

Question 11

Hemophilia B

Answer 11

Hemophilia B is a genetic disorder. This is known as the Christmas disease and is because of a deficiency or defect in factor IX

Question 12

if we suspect Heparin induced thrombocytopenia, what is the first thing we would do? Why?

Answer 12

Non-heparin anticoagulant should be continued until the platelet count has reached a stable plateau.

Question 13

Someone with hemophilia will often bleed into their joints. How is this treated? Are there medications that someone with hemophilia should avoid?

Answer 13

Hemophilia is often treated with IV or nasal spray desmopressin acetate (Morton & Thurman, 2023). This is a hormone that stimulates the release of factor VIII and control bleeding. Patients with hemophilia should avoid NSAIDS such as Ibuprofen, advil and aspirin as this can cause bleeding. They should also be aware of their safety that could result in injury such as knives, needles and other trauma that can happen. Anything that can put them at risk for bleeding, they need to be aware of. Nurses should be aware of this during cares to avoid further complications.

Question 14

Heparin induced thrombocytopenia (HIT)

Answer 14

the body rapidly loses platelets and antibodies against the heparin platelets develop (Hinkle et al., 2021). These antibodies cause the development of platelets and can lead to blood clots. This condition can be life threatening if not treated right away

Question 15

Pernicious anemia

Answer 15

body is unable to produce enough red blood cells due to a deficiency of vitamin B12

Question 16

Idiopathic thrombocytopenic purpura

Answer 16

hematologic disorder that causes a low platelet count but there is no known cause of the disorder. The risk factors for idiopathic thrombocytopenic purpura are chronic liver disease, bone marrow suppression, pregnancy, HIV, Systemic lupus erythematosus, myelodysplastic syndrome, hepatitis C virus infection, and chronic alcohol use (Lippincott Advisor, 2023). Clinical manifestations of idiopathic thrombocytopenic purpura are petechia, ecchymosis, bleeding mucus membranes, bleeding gums, GI bleed, urinary tract bleed, retinal hemorrhage, and blood oozing from wound any wound sites.

Question 17

Hypovolemic shock

Answer 17

condition characterized by deficient fluid volume (Hinkle et al., 2021). Severe blood loss is the main cause of this type of shock.

Hypotension

Regarding hypovolemic shock the patient’s heart rate will increase due to decreased blood volume(Morton & Thurman, 2023. This is the body’s method of compensating for the inadequate supply of white blood cells to carry oxygen. In turn the heart pumps faster to attempt to increase blood circulation. This patients’s respiratory rate will also increase to compensate for decreased oxygenation.

Question 18

Why do we watch a lactic acid level closely when a person has sepsis? What does an elevated level tell us? Is there metabolic acidosis happening here?

Answer 18

Increased blood lactate concentration is common with patients with sepsis and septic shock because there is an increase in O2 demand which the body is not able to deliver. An elevated lactic acid throws the body into anaerobic metabolism, thus breaking down fat and producing ketones. According to Morton et al., p233 (2023), “hypoxia and oxygen debt are associated with anaerobic metabolism” which causes “lactic acid accumulation causes metabolic acidosis in a hypoxic state”

Question 19

hemolytic transfusion reaction

Answer 19

complication that occurs after a blood transfusion. This happens when the red blood cells that were given during the transfusion are not compatible and the patient’s immune system attacks and destroys them

Question 20

hemophilia A

Answer 20

genetic disorder and factor 8 is missing. I agree with you that risk for bleeding is the greatest concern for a patient with hemophilia A

Question 21

DIC (disseminated intravascular coagulation)

Answer 21

systemic syndrome characterized by microthromboses and bleeding. it is potentially life-threatening. Risk factors include sepsis, trauma, cancer, complications during pregnancy, allergic reactions, or other conditions. The primary focus of DIC treatment is addressing the underlying cause while supporting organ function and managing the coagulation process. Sepsis is one of the causes that can precipitate DIC and is a significant risk factor. The diagnosis of DIC is frequently based on laboratory tests that demonstrate the consumption of platelets and clotting factors. DIC lab values typically show low platelet count, prolonged clotting times, decreased fibrinogen levels, and elevated levels of fibrin degradation products

Question 22

leukostasis

Answer 22

excessive number of immature white blood cells

caused by certain types of lymphomas

Question 23

Cardiac tamponade

Answer 23

excessive pericardial fluid in the pericardial space or there is a tumor that presses against the heart

Distant or muffled heart sounds is a classic symptom of cardiac tamponade. You are correct that a pericardiocentesis is the preferred method of treatment.

Question 24

interferons

Answer 24

helpful in the fight against viral infections. There are also often given in the treatment of malignant melanoma.

Question 25

Acute Graft-Versus-Host Disease

Answer 25

donor T cells attack the host causing an inflammatory cascade causing damage to the epithelial tissue in the organs that are effected

You are right that skin changes/rashes are seen with engraftment syndrome.

Question 26

Leukapheresis

Answer 26

white blood cells are removed from the blood (Morton & Thurman, 2023). This type of procedure is used when a patient has leukostasis which is a disorder of too many immature white blood cells, typically seen in cancers such as acute leukemias. This is used when hematopoietic progenitor cells from the peripheral blood are collected by an apheresis procedure team. for removal of white blood cells. This procedure is done by an apheresis procedure team using a commercial cell separator machine. The machine collects the progenitor cells from the patient and then return the remainder plasma and cellular components to the blood stream. The patient would be connect to a large-bore antecubital IV catheter, procedure takes approximately 3 to 4 hours (Morton & Thurman, 2023).

Question 27

innate immunity

Answer 27

body’s first line of defense and we are born with it. You are also correct that it is the barriers and chemicals in our body that play a significant role.

Question 28

ARDS

Answer 28

acute respiratory distress syndrome. This is a progressive respiratory distress disorder characterized by severe hypoxemia, low lung compliance, noncardiogenic pulmonary edema, and diffuse infiltrates on chest radiography

the body has a severe inflammatory response which causes alveolar damage, pulmonary edema, hypoxemia, and the absence of left atrial pressure

Question 29

Respiratory acidosis

Answer 29

PaCO2 is greater than 45 mm Hg and the pH is less than 7.35

Respiratory acidosis results from carbon dioxide not being released from the lungs properly, due to a problem with pulmonary function or too much carbon dioxide being produced

Hyperkalemia is a risk factor for respiratory acidosis. because there is a decrease in the excretion of potassium by the kidneys

Question 30

PaO2

Answer 30

80-100

partial pressure of oxygen and that measures the pressure at which the oxygen dissolves in the blood

Question 31

Kussmaul breathing

Answer 31

deep, rapid breathing in an attempt to quickly eliminate excess carbon dioxide. These deep, rapid breaths are a form of hyperventilation

metabolic acidosis because respiratory compensation is taking place to blow off the excess carbon dioxide in an effort to raise the pH. Kussmaul respirations indicate that the person’s pH is at or below 7.2

Question 32

anion gap

Answer 32

difference between the sum of the positively charged ions (cations) and the negatively charged ions

Normal anion gap is 8-12mEq/L without potassium in the equation and 12-16mEq/L if potassium is included.

Question 33

Ventilator acquired pneumonia VAP

Answer 33

pneumonia that is acquired 48 hours after a patient is admitted to a hospital (Hinkle et al., 2021). This patient should not appear to be incubated at the time of hospitalization. Risk factors for hospital acquired pneumonia are those who have had a Endotracheal intubation. Clinical manifestations include purulent tracheal discharge, fevers, and respiratory distress in the presence of microorganisms

Question 34

vent bundle

Answer 34

interventions to reduce the risk of VAP. According to Morton, “The advent of the ventilator bundle of standard orders, which incorporates gastrointestinal and deep venous thrombosis prophylaxis, along with getting the patient out of bed, oral care, and keeping the HOB elevated 30 to 45 degrees, has reduced the incidence of VAP in many institutions”

Question 35

respiratory alkalosis

Answer 35

low CO2 value and a high pH. When compensation occurs, there with would be a decrease in HCO3

Question 36

Pneumothorax

Answer 36

partial or collapsed lung. The signs and symptoms are a sudden onset of acute pleuritic chest pain that is localized to the affected lung, shortness of breath, tachycardia, an increased work of breathing, and dyspnea (Morton & Thurman, 2023). Breath sounds may be decreased or absent on the affected side

Question 37

tension pneumothorax

Answer 37

air is drawn into the pleural space from a lacerated lung, or a small opening or wound in the chest wall. The air that is drawn in becomes trapped and cannot be expelled during expiration through the air passages or the opening in the chest wall. With each breath, the tension (positive pressure) builds within the affected pleural space. Too much pressure causes the lung to collapse, and the trachea and greater heart vessels to shift to the unaffected side.

Question 38

End-tidal CO2 (ETCO2)

Answer 38

measures the level of carbon dioxide at the end of exhalation

Question 39

chelation

Answer 39

use of binding agents to remove toxic levels of metals from the body, such as mercury, lead, iron, and arsenic. Examples of chelating agents are dimercaprol (blood alcohol level [BAL] in oil), calcium disodium edetate (ethylenediaminetetraacetic acid [EDTA]), succimer (dimercaptosuccinic acid [DMSA]), and deferoxamine. Concerns about the toxicity of the chelators; their tissue distribution characteristics; and the stability, distribution, and elimination of the chelator–metal complex make chelation a complicated procedure.

Question 40

tylenol OD

Answer 40

mucomyst 140 mg/kg q 4 for 17 doses
acetylcysteine and is given by mouth or via IV serially over the course of 24 hours, up to several days.

Question 41

opiods OD

Answer 41

naloxone

Question 42

calcium chanel blockers OD

Answer 42

glucagon, promotes calcium entry into the cells

Question 43

beta blockers OD

Answer 43

GLUCAGON
increases heart rate and myocardial contractability and improves av conduction

Question 44

ACE inhibitor s OD

Answer 44

naloxone
may overcome excess vasopressor activity