Nursing Care of H&L Disorders Flashcards
S&S of anemia
Extreme weakness Dyspnea Fever Hypoxia Weight loss Slight jaundice with pallor Lower extremity edema Intermittent constipation & diarrhea Flatulence, N, and indigestion Palpitations Dysphagia Hand/feet tingling Partial or total paralysis
What is the pathophysiology of:
Aplastic anemia
Iron-deficiency anemia
Pernicious anemia
Impaired production of RBCs
What is the pathophysiology of:
Sickle cell anemia
Thalassemia
Increased destruction of RBCs
What is the pathophysiology of anemia r/t:
Trauma- hypovolemia
Chronic infection
Renal failure
Massive or chronic blood loss
Aplastic anemia
Decrease of bone marrow function
Depression of erythrocyte production, which results in lowerd hgb and RBCs
All formed elements of blood are defective
What may develop due to Aplastic anemia?
Leukopenia and thrombocytopenia
Primary causes of aplastic anemia
Congenital
Secondary causes of aplastic anemia
Viral invasion
Meds
Chemicals
Radiation/Chemo
Diagnostic tests r/t aplastic anemia
CBC- all values low (except RBCs- they have longer life span)
Bone marrow aspiration- pale,yellow, fatty marrow
Total Iron-binding capacity
Serum iron level
Peripheral blood smears
Medical management of aplastic anemia
Bone Marrow and Stem Cell transplant
Blood transfusions
Antibiotics
Immunosuppressant agents (if autoimmune) -
-Antithymocyte globulin, Cyclosporine,
Methyprednisolone
Medications that stimulate bone marrow
-Colony-stimulating factors, Epogen-RBCs,
Neupogen- WBCs
Nursing interventions for aplastic anemia
Prevent infection
Neutropenic precautions
Hand hygiene
Avoid contact with those who have an infection
Bleeding precautions
Eliminate intake of raw meats, fruits, or veggies
Report S&S of infection or bleeding
Observe for blood in urine/stool, or petechiae
Use soft toothbrush or swab mouth
Avoid enemas or other rectal insertions
No nose picking or blowing nose forcefully
Avoid IMs
Avoid trauma, falls, bumps, and cuts
Avoid contact sports
Avoid aspirin
Use electric razor
Use lubrication and gentleness during intercourse
Nutrients needed for RBC formation
Iron- meats, green leafy vegetables, seafood
Folic acid- dark green, leafy veggies, citrus foods, avocados, seeds, nuts
Vitamin B12- shellfish, cheese, eggs, veggie burgers
Dietary deficiencies that lead to impaired RBC production
Iron
Folic acid
B12
Pernicious anemia is a lack of what vitamin?
Vitamin B12
Another term for pernicious anemia
Macrocytic anemia (large cells)
Pernicious Anemia
Autoimmune dx
Abscence of the intrinsic factor due to destruction of parietal cells
-essential for absorptoin of vitamin B12, transport of vitamin B12 is prevented, and affects the frowth and maturation of RBCs
Pernicious anemia has a insidious onset after what age?
40; higher in women
Perniciuos anemia has highest incidence in what descent?
African
Scandinavian
What can you get pernicious anemia from?
Gastrectomy
Bowel resection
Crohn’s
Other autoimmune diseases
What kind of diet is required with pernicious anemia?
Diet that includes :
Citrus fruits
Leafy green vegetables
Fortified cereals
S&S of pernicious anemia
Soreness/burning of the tongue
Chronic B12 deficiency can cause irreparable nerve damage (B12 is needed for production of myelin)
Diagnositc tests for pernicious anemia
Schilling test
Serum megaloblastic anemia profile
Bone marrow aspiration (revelas abnormal RBC development)
Gastric analysis (decreased hydrochloric acid secretion)
Medical management of pernicious anemia
Lifelong B12 injections, folic acid supplements, and iron supplements
-1000 mg vitamin B12 IM for life
*Daily for 2 weeks, weekly for 1 month, monthly
for life
-Intra-nasal form of B12 once a week
PRBCs if anemia is severe
CBC- every 3-6 months for life
Death can occur in 1-3 years if no treatment
Who is at risk for Vitamin B12 deficiency?
Strict vegetarians
NIs for pernicious anemia
Mouth care- several times a day
High protein, vitamins, and minerals diet
Light weight blanket- cold sensitivity
Interventions should conserve energy and prevent injury
Teach about lifelong vitamin B12 treatment
Folic acid deficiency
Can occur in pregnancy
Can occur with sickle cell disease
ETOH can aggravate deficiency
Certain medications can cause it (ones used to treat cancer, RA, and seizures)
Amino acid sources
Eggs Meat Milk and milk products Poultry Fish Nuts Legumes
Folic acid sources
Green leafy veggies Asparugus, broccoli Organ meats Whole grain breads Enriched cereal Fish Legumes
Spina bifida
Linked to folic acid deficiency in the mother
Babies have early exposure to latex products during surgery and develop allegy
Another term for iron deficiency anemia
Microcytic anemia
smaller than normal cells
Iron deficiency anemia
Insufficent intake of iron, excess blood loss, or lack of stomach acid
What is the most common type of anemia in all ages?
Iron deficiency anemia
Infants and children who have a high milk intake are at a higher risk for what?
Iron deficiency anemia
What is the most common cause of iron deficiency anemia?
Excess iroin loss in adults
Inadequate intake of iron in children
What is a common source of iron deficiency anemia
Chronic intestinal or uterine bleeding
Iron deficiency anemia may be caused by
bleeding from gastric or duodenal ulcer Esophageal varices Hiatal hernias Colonic diverticulitis Tumors Celiac disease Sprue Malabsorption- less common
When can iron deficiency anemia occur?
When the body’s demand for iron exceeds it’s absorption
How much blood loss from upper GI is required for melena?
50-75 mLs
What is a common cause of iron deficiency anemia in young adult women?
Menstrual blood loss
Diagnositc tests for iron deficiency anemia
History- especially children Reiculocyte count CBC Serum iron levels- (Ferritin- major iron storage protein) \+ Direct Coombs antigobulin test
What does a direct coombs antiglobulin test look for?
Antibodies that may bind to RBCs and cause premature RBC destruction
Hemolysis
premature RBC destruction
Food sources of Iron
Organ meats Muscle meats Eggs Shellfish Whole-grain bread and cereal Iron-enriched breads and cereal Legumes Nuts Dried fruits Dark green vegetables Orange juice Grape juice
Medical management for iron deficiency anemia
Ferrous sulfate- 900 mg/day given with citrus fruits and juices;Oral or injection (z-track-staining) Iron administered orally or injection IM dextran or IV venofer Ascorbic acid Nutritional counseling Treatment of underlying conditions
NIs for iron deficiency anemia
Plan rest periods
Diet adequate in iron
Teach SE of iron therapy (dark, tarry stool)
Balance between rest/activites
Report N/D
Do not take with tetracycline antibiotics
Toxic to children
Teaching for iron deficiency anemia
Stew acidic foods in iron cookware
Can give iron-fortified formula
Pregnancy can deplete mother’s iron stores
For children, give liquid iron through a straw (avoids teeth staining)
Best solid food iron source for children is infant cereal
Infants need more than just milk
Erythropoietin
Protein made in the kidneys
Stimulates bone marrow to produce RBCs
Erythropoietin can:
Cause: hives, dyspnea, swelling of face, lips, tongue or throat
Increase: risk of blood clots
Hemolyteic anemias cause what?
Increased destruction of RBCs
Main types of hemolytic anemias
Sickle cell anemia
Thalassemia
More types of hemolytic anemias
G6PD deficiency Aquired hemolytic anemia Immune hemolytic anemia Malaria Tick-borne diseases Snake venom Toxic chemicals
Hemolytic anemia
Marrow produces enough RBCs, but they are destroyed
R/T defects of the cell membrane of RBC, inherited enzyme defects, or trauma
Causes of hemolytic anemia include
Infections
Drug reactions
Certain cancers
Delivery of a newborn with Rh+ blood while mom is Rh-
What is the most common genetic disorder?
Sickle cell anemia
What is sickle cell?
Abnormal crescent/sickle shape RBC containing hemoglobin S
Sickle cell anemia is a _____, _______, ______ condition
Severe;chronic;incurable
The sickle cell cases the RBC to be …..
Unable to carry as much O2, which causes pt. to become more sickled due to lack of O2
Crises cna be life threatening- Hypoxia and ischemia
Sickle cell anemia is seen in descendants from?
People of: Africa Saudi arabia India Meditarranean area
1 in _____ african americans have sickle cell anemia
400
Sickle cell trait occcurs in the person wtih…
One defective gene and one normal one
Often the carrier of ____________ shows no S&S
sickle cell anemia
Infants with sickle cell anemia do not show S&S until what age?
> 6 months
Sickles RBCs live how many days?
10-20 days
Sickle cell anemia crisis lasts how many days?
4-6 days; may come in clusters or far apart
What happens in sickle cell disease?
When O2 is released to the tissues, the abnormal hemoglobin becomes more viscous and crystallizes, causing the erythrocyte to change from a round shape to an elongated crescent shape.
As the sickles cells clump together, circulations slows, resulting in obstruction with severe hypoxia and necrosis
Precipitated by infection, fever, hypoxemia, dehydration, high altitudes, cold, or emotional stress
G6PD deficiency
Glucose-6-phosphate dehydrogenase
Genetic disorder
In affected individuals, a defect in the enzyme G6PD causes RBCs to break down prematurely.