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Nursing Semester 2 > Monica - Week 2 - Exam 1 > Flashcards

Monica - Week 2 - Exam 1 Flashcards

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1
Q

why do we make new RBCs every day?

A

because we have to replace the ones that die during normal processes or are destroyed due to illness.

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2
Q

where is red bone marrow and where it is found?

A

it is the red spongy tissue found in the middle of bone.

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3
Q

what is red bone marrow needed for?

A

hematopoiesis

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4
Q

what is hematopoiesis?

A

the production of stem cells, which are immature blood cells made in the red bone marrow.

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5
Q

Stem cells have the ability to ________?

A

differentiate, meaning become more specific

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6
Q

what are the 3 type of cells that stem cells can differentiate into?

A

RBCs, WBC, and platelets

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7
Q

Hematopoesis requires which 4 nutrients to make healthy functional blood cells?

A

Protein, B12, Iron and Folic acid

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8
Q

T/F. When deficient in any of these nutrients, we may not make healthy functional blood cells.

A

TRUE. they may be large, immature, or smaller than they need to be.

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9
Q

Hematopoeisis occurs in response to what?

A

regulatory hormones, like erythropoietin which is released by the kidneys

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10
Q

what is erythropoiesis?

A

the production of red blood cells and hemoglobin

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11
Q

what is erythropoiesis regulated by?

A

it is regulated by erythropoietin, which is 90% secreted by the kidney

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12
Q

how do the kidneys know when to secret more erythropoietin?

A

kidneys are stimulated by hypoxia – not enough oxygen; so they secret erythropoetin → travels to the bone marrow and interacts with stem cells to make more RBC → reverse hypoxia

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13
Q

T/F without hemoglobin the RBC can still be functional

A

FALSE. the RBC needs hemoglobin for O2/CO2 transport

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14
Q

Hemoglobin has 4 ______ and 1 _______.

A

four globulin chains; 1 heme molecule

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15
Q

Why is the heme important?

A

In the heme is the IRON - IRON transports oxygen in the blood; gives RBCs the red color

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16
Q

what are the two different definitions of anemia?

A

Anemia is a deficiency in the number of RBC; Also can be a deficiency in the quality and quantity of hemoglobin

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17
Q

Anemia is a sign of what?

A

sign of underlying disorder rather than disease process

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18
Q

Patients with anemia have a diminished capacity to deliver _____ to the body’s tissues?

A

OXYGEN

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19
Q

what are the s/sx of mild anemia?

A

mild anemia may be asymptomatic

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20
Q

what are the s/sx of moderate to severe anemia?

A

fatigue, weakness, pale skin, cold hands/feet, dizziness, headache, exercise intolerance, SOB, possibly cognitive problems d/t ↓ O2 to the brain, and chest pain d/t ↓ O2 to the ♥

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21
Q

what are the two characteristics of epoietin alfa?

A

blood forming agent and serves as a hematopoietic growth factor

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22
Q

what is the purpose of epoietin alfa?

A

the purpose is to elevate RBC count and create hemoglobin

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23
Q

what forms is epoietin alfa available in?

A

IV and SubQ

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24
Q

what are the two things that a patient is going to need for this drug to be effective?

A

functional bone marrow and sufficient/adequate iron stores needed to produce functional RBCs

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25
Q

when is this drug contraindicated and why?

A

not indicated for emergent anemia because this drug has an onset of 1-2 weeks

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26
Q

epoietin alfa may prevent those with chronic anemia from getting ____?

A

blood transfusions

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27
Q

review: where do we store our iron?

A

we store it in our liver as ferritin

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28
Q

if iron stores aren’t adequate, a patient may need _______?

A

iron supplementation

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29
Q

what are the indications of epoietin alfa?

A

anemia associated with stage 4/5 CKD and chemotherapy

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30
Q

what is the adverse effect of epoietin alfa?

A

hypertension - occurs in 30% of patients - may have to take an antihypertensive

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31
Q

what is the black box warning for epoietin alfa?

A

↑ risk of CV events and thromboembolic events`

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32
Q

what are the nursing implications for epoietin alfa?

A
  • assess BP, Hgb, Hct
  • do not initiate if Hgb greater than or equal to 10
  • monitor for thromboembolic events
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33
Q

what is MCV?

A

mean corpuscular volume

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34
Q

what does mean corpuscular volume measure?

A

the average size of RBC

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35
Q

what is the normal range for MCV?

A

80-100 femtoliter

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36
Q

T/F: A MCV of < 80 is considered to be microcytic, while a MCV of > 100 is considered to be macrocytic

A

TRUE

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37
Q

Microcytic cells indicate which type of deficiency?

A

Iron deficiency

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38
Q

Macrocytic cells indicate which type of deficiency?

A

B12 or Folate deficiencies

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39
Q

what is MCH?

A

mean corpuscular hemoglobin

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40
Q

what does mean corpuscular hemoglobin measure?

A

the weight of hemoglobin within the cell

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41
Q

what is the normal range for MCH?

A

27 - 34 picograms

42
Q

what does less than 27 pg mean?

A

less hemoglobin weight - microcytic - iron deficiency

43
Q

what does more than 34 pg mean?

A

more hemoglobin weight - macrocytic - B12/Folate deficiency

44
Q

what is MCHC?

A

mean corpuscular hemoglobin concentration

45
Q

what does mean corpuscular hemoglobin concentration measure?

A

it measures the average concentration of hemoglobin in each RBC (the proportion of RBC taken by Hgb)

46
Q

what is the normal range of MCHC?

A

32% - 36%

47
Q

a RBC with a MCHC of 32 - 36% is considered to be ________?

A

normochromic - normal color

48
Q

a RBC with an MCHC of < 32% is considered to be _______?

A

hypochromic - pale in color - iron deficient

49
Q

how is a macrocytic - normochromic cell defined? what type of anemia would this indicate?

A

large RBC with a normal hemoglobin concentration - indicates folate anemia, B12 anemia, or pernicious anemia

50
Q

how is a microcytic - hypochromic cell defined? what type of anemia would this indicate?

A

small RBC with decreased hemoglobin concentration - indicated iron deficient anemia

51
Q

review: iron needs what kind of environment for absorption?

A

an acidic environment (at risk: elderly and chronic antacid users)

52
Q

Iron is essential for ______ formation.

A

hemoglobin - 60-80% associated with hemoglobin in RBC to help us transport O2

53
Q

T/F free iron is toxic to our body

A

TRUE; needs to bind to protein (ferritin)

54
Q

What two characteristics determine iron deficiency anemia?

A

low serum iron levels and low serum ferritin levels

55
Q

what do the cells of an iron deficiency anemia patient look like?

A

microcytic and hypochromic

56
Q

list good sources of iron

A

liver, red meats, fish, fortified cereals, lima beans, leafy veggies, dried fruit,

57
Q

who is majority at risk for iron deficiency anemia d/t dietary needs?

A

vegans and vegetarians

58
Q

What are the s/sx of iron deficiency anemia?

A

anemia sxs, SORE TONGUE, BRITTLE NAILS, “CRAWLING FEELING IN LEGS” AND CAN DEVELOP RESTLESS LEG SYNDROME

59
Q

how is an iron supplement chosen?

A

there are varying types or iron salts and elemental iron; based on amount needed and GI tolerance

60
Q

when is iron best absorbed?

A

1 hour before or two hours after a meal - absorption can ↓ by 33 - 50% when taken concurrently with food

61
Q

what are the adverse effects of iron supplement?

A

N + V, constipation, stomach cramps, abdominal discomfort

62
Q

what is a common AE that we should educate patients about?

A

Iron supplements may turn stools dark green or black d/t iron being excreted

63
Q

what decreases the absorption of iron?

A

antacids and calcium

64
Q

what increases the absorption of iron

A

vitamin C - OJ, tomato juice - 30% ↑

65
Q

why is B12 needed for in the body?

A

rapid and normal production of RBCs, cell maturation, normal cell division, and DNA replication

66
Q

how is B12 important to neuromuscular conduction?

A

it helps maintain healthy nerve cells and is used to preserve the myelin sheath of nerves

67
Q

review: how is B12 absorbed?

A

B12 needs to form a complex with intrinsic factor. Intrinsic factor is secreted by the parietal cells in the stomach.

68
Q

if there is a deficiency in B12, which type of anemia is it?

A

megaloblastic anemia, which includes large, immature cells that have a diminished lifespan)

69
Q

what dietary sources is B12 found in?

A

animal sources - chicken, fish, poultry, milk, cheese, eggs, fortified foods

70
Q

who is at risk for B12 deficiency?

A

strict vegans and vegetarians

71
Q

what’s the difference between B12 deficiency anemia and pernicious anemia?

A

B12 anemia is r/t the lack of the nutrient (vegans/vegetarians)
Pernicious anemia is r/t the fact that we aren’t absorbing B12 d/t the lack of intrinsic factor.

72
Q

pernicious anemia is what type of anemia?

A

megaloblastic; d/t lack of intrinsic factor

73
Q

what type of conditions can cause a lack of intrinsic factor?

A

gastric bypass, GI chronic inflammation disorders, and autoimmune disorders (antibodies block the complex binding of IF and B12) (ciliac disease)

74
Q

Why are parenteral doses of B12 effective

A

because B12 is going directly into the blood stream; doesn’t need to bind with IF

75
Q

what are the B12 deficiency sxs?

A

anemia sxs, numbness in the fingers and toes

76
Q

what are the pernicious anemia sxs?

A

anemia sxs, numbness/tingling in hands/feet, loss of balance, confusion, memory loss, mood disturbances MORE NEUROLOGICAL - POTENTIALLY FATAL IF NOT TX

77
Q

what forms are B12 - cyanocobalamin available in?

A

PO, SubQ, IM, topical, nasal

78
Q

why is PO contraindicated for patients that have malabsorption issues? who should take PO?

A

because they won’t be absorbed; they should be used for those with dietary problems and have IF present, like vegans s

79
Q

what is parenteral cyanocobalamin used for?

A

patients with pernicious anemia

80
Q

What is the initial treatment and the follow up treatment for pernicious anemia?

A

initial tx: parenteral tx

follow up after remission from CNS involvement (n + t, etc): nasal spray or topical

81
Q

T/F: those with pernicious anemia will have life long B12 replacement and periodic testing

A

TRUE; N+T may never resolve

82
Q

why is folate important for the body?

A

needed for cell division, the production of new cells (RBC, WBC, and Platelets), maturation of cells, and aids in the production of heme

83
Q

how long is folate stored in the liver?

A

3-6 months

84
Q

which anemia is folate deficiency?

A

megaloblastic anemia

85
Q

what are dietary sources of folate?

A

fortified cereals, grains, dark green leafy veggies, citrus fruits, and dried beans

86
Q

what is another condition that interferes with folate?

A

alcoholism interferes with folate metabolism in the liver

87
Q

what are the causes of folate deficiency?

A

insufficient dietary sources and alcoholism

88
Q

what are the sxs of folate deficiency?

A

similar to B12 without neurologic signs, anemia sxs, BEEFY RED TONGUE, sore tongue

89
Q

what is the treatment for folate deficiency

A

↑ dietary intake and folic acid supplement

90
Q

what are 7 different chronic diseases that cause anemia?

A
  • autoimmune disease (lupus - attacks healthy cells)
  • alcoholism (interferes with folate metabolism - immature cells)
  • inflammatory bowel disease (crohn’s - interferes with nutrient absorption)
  • gastric resection (lack of IF → pernicious anemia)
  • liver disease (unable to store iron or folic acid - underproduction of RBC)
  • chronic kidney disease ( suppression of erythropoietin)
  • osteomyelitis (bone marrow impairment)
91
Q

what is neutropenia?

A

reduction in neutrophils, type of wbc that help fight against bacterial and fungal infections; predisposes pt to opportunistic pathogens

92
Q

what is the range for neutropenia?

A

absolute neutrophil count < 1000 cells/mcl

93
Q

T/F neutropenia has to do with life threatening infections with low absolute neutrophil count

A

TRUE

94
Q

how do you calculate ANC?

A

WBC x (% of neutrophil +% of bands)

95
Q

what does it mean if ANC is less than 1000?

A

risk of infection; assess for temp > 100.4

96
Q

what are the causes of neutropenia?

A

chemotherapy, bone marrow depression, radiation

97
Q

what is filgrastim?

A

colony stimulating factor; stimulates neutrophils to grow and mature by binding to receptors on stem cells and asking the to become, divide, and mature into functional neutrophils.

98
Q

continued filgrastim therapy is based on what?

A

based on ANC - D/C once ANC > 10,000 cells/mm3

99
Q

what are adverse effects of filgrastim?

A

medullary bone pain (bone marrow ↑ stem cells), acute respiratory distress (SOB, tachypnea)

100
Q

what is the goal of filgrastim?

A

to raise neutrophil count

Nursing Semester 2 (21 decks)

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