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Pn2 Test2 Concept Guide Flashcards

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1
Q

S/s of asthma attack?

Can progress to what?

A 
Wheezing 
Labored breathing 
Stridor 
Use of accessory muscles 
Distended neck veins

Pneumothorax (abnormal collection of air in the pleural space between the lung and the chest wall.Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath.)
and cardiac/respiratory arrest; intubation

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2
Q

What to do when ones wheezing stops in an asthma attack?

A

Prepare for emergency trach ! Stat.

It means they have a complete airway obstruction

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3
Q

Meds/Tx for asthma attack

A 
IV fluids 
Potent systemic bronchodilator 
Steroids 
Epinephrine 
Oxygen
Mag sulfate 
Intubation 
Tracheotomy
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4
Q

What part of the body does asthma affect ?

A

Airways

NOT alveoli

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5
Q

Asthma can occur how (2 ways) in the body?

A

Inflammation obstructing lumens

Airway hyper responsiveness leading to bronchoconstriction

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6
Q

What history nurse should assess with asthma

A 
Symptoms-onset 
Exposure 
Prior allergies 
Smoking 
Family hx /family allergies
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7
Q

Physical assessment in one with asthma attack

A 
Wheeze 
Increased respiratory rate 
Increased cough
Use of accessory muscles
Barrel chest
Long breathing cycle 
Cyanosis 
Hypoxemia
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8
Q

Lab assessment to obtain with asthma ?

A

ABGs

PFT

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9
Q

Pulmonary function tests with asthma

A

Forced vital capacity

Forced expiratory volume

Peak expiratory flow rate

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10
Q

Goal is to improve what function in one with asthma attack?

A

Air flow and gas exchange

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11
Q

Self management patient education with asthma

A

Personal asthma action plan

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12
Q

Drug therapy with asthma ?

A

Use control drugs daily (LABA long acting)

Reliever drugs (SABA) use to stop attacks

Bronchodilators

Anti-inflammatory agents

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13
Q

Patient education with asthma

A

Avoid triggers if possible such as smoke, dust , fireplaces , mold, weather changes

Avoid smoking

Teach when to use rescue inhaler vs maintenance inhaler

Proper sleep, reduce stress, relaxation techniques

Wash all bedding with hot water

Monitor peak expiratory flow rates

Avoid food with metabisulfate or MSG

Usually have family hx

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14
Q

How long before should you use a bronchodilator before exercise to prevent bronchospasm

A

30 min before

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15
Q

What drugs one should avoid that can trigger asthma ?

A

Aspirin
NSAIDs
Beta blockers

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16
Q

Document patient allergies where

A

Medical record

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17
Q

SABA teachings

A

Carry with you at all times

Use before engaging in activity that triggers asthma or during attack

Monitor heart rate- drug increases pulse

Use 5 minutes before any other inhaler

Correct technique

Shake well before using

Albuterol
Levalbuterol (vetoli, proventil)

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18
Q

LABA teachings and meds

A

Report insomnia, shakiness, tremors , headache, eye pain, palpitations, nausea , and blurry vision - may be due to overdose

Increase fluids -causes dry mouth

Shake well before using

Should never be prescribed as the only drug therapy for asthma

Salmeterol 
Indacaterol 
Formoterol 
Arformoterol
Ipratropium 
Tiotropium (spiriva)
Serevent
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19
Q

group of lung diseases that block airflow and make it difficult to breathe.
Emphysema and chronic bronchitis are the most common conditions that make up This condition
Damage to the lungs from it can’t be reversed.

A

COPD

Chronic obstructive pulmonary disease

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20
Q

Which ABg is the result of COPD ?

A

Respiratory acidosis because CO2 increases

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21
Q

Copd can result in which conditions?

A

Hypoxemia - due to no oxygen

Impaired alveoli due to decreased gas exchange

Acidosis- CO2 increases

Respiratory infections

Cardiac failure

Cardiac dysrythmias - due to hypoxia (decreased oxygen perfusion)

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22
Q

What to asses in COPD patient?

A

Patient history

Activity tolerance

General appearance

Respiratory changes

  • limited chest movement with emphysema due to flattened diaphragm
  • wheezes inspiration and expiration

Cardiac changes
-signs of Right aided heart failure

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23
Q

Respiratory changes in copd

A

limited chest movement with emphysema due to flattened diaphragm

wheezes inspiration and expiration

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24
Q

Cardiac changes in COPD

A

-signs of Right sided heart failure

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25
Q

Management of chronic symptoms of COPD

A

Improve gas exchange and reduce carbon dioxide retention

O2 sats- 88-90%

Up in chair - for meals

Bipap, intubation for CO2 retention/respiratory failure

Prevent weight loss

Coughing exercises before meals

Small frequent meals, avoid gas producing foods or lots of liquids

Take bronchodilator 30 minutes before eating

Nutrition supplements

Minimize anxiety

Teach to breath through diaphragm and Pursed lip breathing; tripod position

Maintain high protein diet and increase fluids 2-3 L/day to thin mucus

Rest periods, sleep conserve energy

Avoid pollutants

Metered dose inhaler use

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26
Q

Drug therapy for COPD

A

Beta adrenergic agents (albuterol)

Methylxanthines ex: theophylline

Corticosteroids (prednisone)

NSAIDs

Mucolytics (guaifenesin, tessalon, pearles)

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27
Q

Home care management for copd

A

Long term use of oxygen -proper use on lowest possible needed

Pulmonary rehab program

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28
Q

Copd self management education

A

Drug therapy

Manifestations of infections

Breathing techniques; energy conservation

Relaxation therapy

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29
Q

Health care resources for copd patients

A

Food delivery services

Transportation

Cleaning

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30
Q

Copd-

Use caution with what in these patients?

A

Oxygen - should not exceed 3L due to them retaining too much CO2 which could suppress their respiratory drive (lose of natural stimulus for respiration) instead of elevated CO2

Be careful giving narcotics - could suppress oxygen

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31
Q

Nursing interventions for COPD

A

Asses for skin breakdown around nose and mouth from oxygen device

Encouraging incentive spirometer deep breathing

Encourage coughing or suction to remove secretions

Monitor vitals and o2

Encourage to quit smoking

High Fowler’s positioning

Small frequent meals

Increase fluids

Oxygen 1-2 L

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32
Q

What does pursed breathing do for the patient?

How to explain to patient ?

A

Increases oxygen

Breathe like you are blowing out a birthday candle

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33
Q

What does breathing from diaphragm do for copd patients

A

Makes diaphragm stronger

Makes breathing easier

Decreases energy used due to slowed down breathing rate

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34
Q

Prehypertension range

A

120-139/ 80-90

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35
Q

Stage 1 hypertension range

A

140-159/90-99

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36
Q

Stage hypertension 2 range

A

160 or above/ 100 or above

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37
Q

Desired bp for people over 60

A

Below 150/90

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38
Q

Desired bp for people younger than 60

A

Below 140/90

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39
Q

Patient assessment with hypertension

A

History

Bp both arms and appropriate sized cuff

Secondary disorder

Psychological assessment

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40
Q

Assessment for secondary HTN

A

Protein and RBC in urine

High BUN and GFR

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41
Q

HTN education

A

Exercise
Diet - decrease sodium and foods high in fat
Don’t smoke or drink alcohol
Decrease stress

Increase fluids

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42
Q

Co=sv x hr

Bp is product of what

Bp is affected by what

A

CO

PVR

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43
Q

Risk factors of HTN

A

Obesity
Smoking
Stress
Family hx

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44
Q

HTN causes to do what to the body?

May result in what

A

Causes medial hyperplasia (thickening) of arterioles blood flow decreases vital organs are damaged

As arteries thicken blood flow decreases and vital organs are damaged

Which may result in MI, CVA, PVD, CRF

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45
Q

Secondary HTN causes

A

Renal disease

Primary aldosteronism

Pheochromocytoma

Cushing s syndrome

Medications

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46
Q

Malignant HTN symptoms and results

A

Morning headaches
Blurred vision
Dyspnea

Kidney failure

LV heart failure

CVA

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47
Q

Tx for HTN

A

Lifestyle changes

Meds along with lifestyle changes when not responsive

Or combination of both

Ace (prils) can cause cough and high K

ARBs (sartan) good when ace aren’t helping

Beta-adrenergic blockers (lols) for ischemic heart disease, bradycardia

Calcium-channel blockers (ipine)- vasodilation and decrease HR

Diuretics- thiazide, loop, k sparing

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48
Q

A blood clot in a deep vein, usually in the legs.

This condition is serious because blood clots can loosen and lodge in the lungs. (Pulmonary embolism)

A

Deep vein thrombosis (DVT)

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49
Q

What can DVT be caused from

A 
Surgery 
Pregnancy
Trauma 
sitting for long periods of time 
Fracture 
Heart failure 
Shock

(Promotes venous restriction and obstructs flow)

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50
Q

S/s of pulmonary embolism

And what to do?

A

Tachycardia

Crushing chest

  • lay them on left side and give oxygen, call code
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51
Q

What percent of hospital deaths start in the calf?

A

25%

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52
Q

DVT findings?

A

Swelling at the site
Redness
Tenderness

Do not use homans sign -unreliable

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53
Q

Diagnostic tests for DVT

A

Venogram dye -ultrasound

IPG-more accurate

D-dimmer

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54
Q

How to prevent DVT

A

Promote activity after surgery

Elastic stockings

PPDs

Repo q 2 hours

Leg exercises

Anticoagulants

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55
Q

Anticoagulants for clot formation

A

Heparin
Coumadin
Lovanox

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56
Q

Teachings for heparin

A

Need to know the PT and INR before admin of IV anticoagulant

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57
Q

Teaching for lovenox

A

Longer half life than heparin

Can be taught home management

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58
Q

Coumadin teachings

A

Given for 6 months for DVT and will start low dose 5 days before ending heparin or lovenox

Give vitamin k if excessive bleeding

Watch patient for bleeding, blood in stools, bruising, purple spots under skin

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59
Q

Patient teaching for DVTs

A

Monitor labs

Alcohol decrease

Use teds or supportive stockings

Avoid inactivity for long periods

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60
Q

Corticosteroid medication for asthma

A

Serevent

Advair

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61
Q

Cuff bladder width and length for bp should be what circumference ?

A

Width- 40%

length-80-100%

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62
Q

How many drinks is excessive alcohol intake?

A

3+ drinks

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63
Q

Headache is most reported s/s upon waking -related to what?

A

Sleep apnea /HTN

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64
Q

A circulatory condition in which narrowed blood vessels reduce blood flow to the limbs.

It is a sign of fatty deposits and calcium building up in the walls of the arteries (atherosclerosis).

Risk factors include aging, diabetes, and smoking.

Also a risk factor for PAD

involves damage to or blockage in the blood vessels distant from your heart—the peripheral arteries and veins.

A

Peripheral vascular disease

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65
Q

When PVD affects only the arteries and not the veins it is called?

A

Peripheral arterial disease

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66
Q

Pain that is worse when you elevate your legs, and improves when you dangle your legs over the side of the bed.

A

PAD

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67
Q

Results in prolonged venous HTN , stretching veins , and damaged valves

Back up of blood causes increased pressure and swelling

A

Venous insufficiency

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68
Q

Manifestations of venous insufficiency

A

Reddish brown pigmentation lower legs

Stasis dermatitis, stasis ulcers

Ulcers Difficult to heal

Edema

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69
Q

How to manage s/s with venous insufficiency

A

Don’t cross legs

Elevate legs /compression

Avoid sitting or standing for long periods

Loose clothes

Drugs , manage ulcers, surgical management

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70
Q

When the heart can not pump blood throughout the body effectively

Heat doesn’t fill with enough blood or pump with enough force

A

Heart failure

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71
Q

What happens when the heart can not pump enough blood

A

Compensates by increasing HR which dilates ventricles

Increased HR= decreased cardiac output

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72
Q

PAD risk factors

A 
Men 50+ 
Postmenopausal women 
HTN, hyperlipedema 
Obesity 
Decreased activity 
Smoking 
Diabetes 
Family hx 
Stress
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73
Q

Clinical manifestations of PAD

A

Occurs unilaterally
Skin mottling , ulcerations, Black gangrenous

Muscle atrophy

Shiny skin sparse hair

Thickened nails

6 P’s (seen in affected extremity)

Pulseless 
Pain-worse at night-crampingfatigue 
Pallor
Paresthesia 
Paralysis 
Poikilothermia (coldness)
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74
Q

PAD interventions /tx

A 
Anticoagulants 
Place extremity in dependent position 
PTA balloon catheter 
Laser assisted angioplasty 
Bypass grafts
Amputation
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75
Q

PAD diagnostic

A

Doppler pulses

ABI

Ultrasound

Treat mill testing

Arterio-angiograms

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76
Q

Diastolic (relaxation) HF

A

Inability to relax

Causes decrease in ventricular filling

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77
Q

Systolic HF

A

Inability of the ventricles to contract and pump blood adequately

More common related to aging d/t stiffness of vasculature

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78
Q

Reduced capacity to pump blood into systemic circulation

Decreased CO and stasis or backup of fluid into pulmonary circulation

A

Left sided HF

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79
Q

Left sided HF causes

A

HTN

Alcoholism

MI

Coronary artery blockage

Hypothyroidism

Heart infection

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80
Q

Left sided heart failure symptoms

A 
Dyspnea on exertion 
Orthopnea (sob while laying flat) 
Cough w pink sputum 
Crackles , wheezes 
Cyanosis 
Heart murmur/gallop 
Pulmonary edema
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81
Q

Reduced capacity to pump blood into pulmonary circulation

Causes stasis or backup of fluid in venous circulation

A

Right sided HF

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82
Q

Rt sided HF causes

A

Pulmonary hypertension, congenital heart disease is, heart valve disease, COPD/chronic lung diseases/cystic fibrosis, left heart failure

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83
Q

Right sided heart failure symptoms

A

Jugular vein distention, dependent edema in lower extremity, abdominal discomfort, nausea from fluid congestion, irregular heart rate, enlarged liver, weight gain

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84
Q

How to diagnose HF

A

ECG
ECHO (main test) shows heart enlargement

CXR

Stress tests
MRI
BNP
Cardiac catheterization

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85
Q

HF interventions

A

Decrease heart workload , Improve cardiac function and symptoms

Decreased fluid and sodium intake

Elevate head of bed and dangle legs

Oh to be a non-breather or mechanical vent

Pulmonary edema= sitting position, high O2, diuretics, intubation

86
Q

What are diuretics used for?

What to monitor for

A

HF
HTN
DCM

Dehydration , hyponatremia , hypokalemia

87
Q

Nitrates used for? Nitr

A

HF

Do not give if pt has hypotension, tachycardia, bradycardia

Angina

Increase venous capacity

88
Q

Beta blockers (lol)

A

HF, HTN, DCM
Decreases HR & BP
Decreases contraction force/workload

89
Q

Dipine (calcium channel blockers) used for

A 
HF 
HTN
Decreases HR and BP
Vasodilators
Reduces angina 
Dilated coronary arteries
90
Q

Ace inhibitors used for

A

HF
HTN
DCM

Decreased pressure the heart must overcome to eject blood from the heart by interfering with the renin-angiotensin- aldosterone system

Promotes vasodialation

91
Q

Digoxin used for?

A

HF
Cardiac glycoside
Increase hearts contractility
Increases myocardial cell contraction

92
Q

anticoagulants and anti-platelets used for?

A 
HF
HTN
DCM
Arteriosclerosis 
Atherosclerosis 
Thrombophlebitis 
Heparin, Lovenox , Coumadin, aspirin, plavix 
Prevent cardiac events 
Not the primary tx of HF
93
Q

Vasodilators used for

A 
HF
HTN 
DCM
Buergers disease raynauds 
Isosorbide 
Decrease BP
94
Q

Cardiac changes in older adults

A

Valves degenerate

Natural pacemaker cells decrease in number

LV hypertrophy

Aorta thickens, less flexible

95
Q

Refers to inflammation of the pericardium

A swelling and irritation of the thin saclike membrane surrounding the heart

A

Pericarditis

96
Q

Cause of pericarditis

A

Unknown

97
Q

Symptoms of pericarditis

A

Sharp stabbing chest pain- travel to left shoulder and neck

Pain with inspiration, cough, swallowing

Sudden onset- short duration

SOB, fever orthopnea

Rt sided HF- most common

Fatigue, fever

JVD, high BP

SOB

98
Q

Pericarditis labs

A 
Elevated WBC 
ECG
T wave elevation
Positive BC 
Leukocytosis
99
Q

Pericarditis tx

A

Improve on own

NSAIDs

Surgery

Sitting up and leaning forward relieves pain

100
Q

What to do if one with pericarditis needs surgery

What Should INR be?

A

Out patient on prophylactic antibiotic

INR normal 1-2 but should be 2-3

If above 7 monitor for bleeding

101
Q

Mechanical valves -

Valve leaflets become stiff and opening narrows

Rumbling , murmur

Results from Rheumatic carditis (thickening by fibrosis and calcification)

A

Mitral stenosis

102
Q

Valve doesn’t close completely

High pitched murmur

A

Mitral regurgitation

103
Q

Leaflets enlarge and fall into left atrium

Chest pain; systolic click

A

Mitral valve prolapse

104
Q

Aorta opening narrows from artheroscleroais

Harsh murmur

Most common valve dysfunction in the US and is caused by wear and tear

A

Aortic stenosis

105
Q

Blood backs up into LV and LV hypertrophies

Blowing murmur

Valve leafs do most close properly during diastole

A

Aortic regurgitation

106
Q

Mechanical valve treatments

A 
NSAIDs
Corticosteroids 
Antibiotics 
Monitor for change in symptoms
Monitor cardiac tamponade
107
Q

Compression of the heart caused by fluid collecting in the sac surrounding the heart.

This puts pressure on the heart and keeps it from filling properly. The result is a dramatic drop in blood pressure that can be fatal.

A

Cardiac tamponade

108
Q

Cardiac tamponade manifestations s/s

A

JVD with clear lungs

Muffled heart sounds

Altered mental status; anxiety; restlessness

109
Q

Treatment for Cardiac tamponade

A

Hemodynamic monitoring for decreased CO

Pulses paradoxus- widens pulse pressure

Pericardiocentesis

Pericardial window - removal of part of pericardium to allow drainage

Pericardiectomy- removal of part of pericardium that is encasing the heart

110
Q

condition caused by excess fluid in the lungs.

A

Pulmonary edema

111
Q

Pulmonary Edema signs and symptoms

A

Crackles in the lungs

Dyspnea at rest

Disorientation or confusion

Tachycardia

Hypertension /hypotension

Reduced urinary output

Cough with frothy pink sputum

Premature ventricular contractions and other dysthymias

Anxiety

Restlessness

Lethargy

112
Q

Pulmonary edema prevention/management

A

High Fowler’s position

Oxygen therapy; Cpap

Diuretics

IV morphine

I&O and vitals

Diet

Weight monitoring

Activity

Stick to tx plan and understanding of the illness

113
Q

Amount of blood pumped from the left ventricle per minute

A

Cardiac output

114
Q

Heart rate x stroke volume =

A

Cardiac output

115
Q

What is the mean arterial pressure with in the heart

A

MAP

Must maintain at least 60mm hg to perfume vital organs and coronaries

average pressure in a patient’s arteries during one cardiac cycle. It is considered a better indicator of perfusion to vital organs than systolic blood pressure

116
Q

Pressure the heart has to pump against to move blood forward

(Resistance the left ventricle must overcome to circulate blood )

Increased in hypertension and vasoconstriction

Increase of this - increases cardiac workload

A

Afterload

117
Q

Volume of the blood in ventricles at end of diastole (ends diastole pressure) - like blowing up balloon

Increased in hypervolemia
Regurgitation of cardiac valves

A

Preload

118
Q

An acquired or hereditary disease of heart muscle,

Heart chambers become enlarged and makes it hard for the heart to deliver blood to the body, and can lead to heart failure.

A

Cardiomyopathy

119
Q

Cardiomyopathy stems from which HF side?

S/s?

A

Starts from Lt can lead to Rt

Edema in legs

SOB

Afib

DOE

Syncope(fainting)

Decrease activity tolerance

120
Q

Management of cardiomyopathy

A

Meds:
Diuretics
Vasodilation agents
Digoxin

Toxin exposure avoidance

Alcohol avoidance

Strenuous exercise prohibited

Surgical intervention:
Depends on type -

Cardiac Defibrillator (Incase of sudden MI)

Ventriculomyomectomy - remove part of septum

Percutaneous alcohol ablation -inject alcohol into heart to create infarct

Heart transplant

121
Q

cardiomyopathy
o Most common type?
o Both ventricles are dilated, LV usually worse

Viral, HIV , Lyme disease

A

Dilated cardiomyopathy

122
Q

cardiomyopathy-

Hypertrophied walls and/or septum, decreases SV & CO

o High incidence of fatal arrhythmias
o Restrictive cardiomyopathy
o Rarest; assoc. with sarcoidosis, amyloidosis
o Stiff ventricles that restrict filling during diastole

Leading cause with athletes

Swelling -thickened

A

Hypertrophic cardiomyopathy

123
Q

cardiomyopathy-

o Replacement of cardiac tissue with fibrous, fatty tissue

A

Arrhythmogenic right ventricular cardiomyopathy

124
Q

Reduction in either the number of RBCs, amount of hemoglobin, or hematocrit and decreases oxygen in blood

A

Anemia

125
Q

First cause of anemia

Second

Third

A

Blood loss

Decreased RBC/renal disease/bone marrow

Rbc distruction - sickle cell anemia

126
Q

Increased risk for anemia:

A

iron deficiency from poor nutrition

menorrhagia (heavy period bleeding) from menstrual,

sickle cell anemia,

trauma from excessive bleeding,

lack of erythropoietin from renal disease,

immunosuppression- from leukemia or lymphoma and medication therapy that depresses bone marrow activity.

127
Q

S/s of anemia

A

The quicker the onset the more serious the condition.
Slowly becoming anemic may adapt to low hemoglobin levels:

common symptoms fatigue, weakness, skin pallor, tachycardia, shortness of breath. – severe may need to consider cardiovascular implications- heart pump faster in attempt to make up for low oxygen. Most common found in active adults, who will show a sign of anemia.

128
Q

Tests for anemia

A 
➢ Tests: 
hemoglobin,  
hematocrit, 
RBC indices
, reticulocyte count, 
iron studies,
Mcv- size of RBCs 
 serum vitamin B12 are looked over.

Later CBC and erythropoietin and bone marrow are considered

129
Q

Anemia ➢ Planning and Treatment:

What can occur from it and interventions

A

Arrhythmias can occur from anemic condition, as well as Hypovolemic shock when anemia continues to deteriorate-

interventions:

giving oxygen;

blood and blood products,

fluid and monitoring are all important steps to consider.

130
Q

What to asses in anemia patients ?

A 
o Assessment
➢ Risk for infection, risk for bleeding
s/s:
➢ Cardiovascular changes
➢ Respiratory changes
➢ Intestinal changes
➢ Central nervous system changes
o Laboratory assessment
▪ The definitive test for leukemia is an examination of cells obtained from bone marrow aspiration and biopsy
131
Q

: type of anemia that occurs hemolysis outside RBC
o Genetic, Burns, radiation, drugs, toxins, autoimmune disease, transfusion reactions and bacterial infections can all cause.

o Enlarged spleen from removing damages RBCs.

Liver is pushed to it limits and can increase bilirubin levels and jaundice!

Most sever bone marrow can fracture, patient having deoxygenating and skin pallor, tachycardia and hypotension.

A

Hemolytic Anemia’s

132
Q

Autosomal Recessive defect and a type of hemolytic anemia, causing synthesis of an abnormal form of hemoglobin within the red blood cells. Common in African descent, from parent to offspring- giving 50 percent chance of transmitting the gene to child.

**Deoxygenation is the most important variable!

A

Sickle Cell Anemia

133
Q

Sickle cell findings

A

fatigue, pallor, jaundice, irritability- occluded circulation

134
Q

Sickle cell anemia tests

A

➢ Tests:

Hematological test and essential and family history- presence of Hgbs in the blood.

135
Q

Tx of sickle cell

A

➢ Treatment:

IV fluids for dehydration,

antibiotic therapy, and

bone marrow transplants,

splenectomy.

136
Q

Medication for sickle cell

A

Oxygen as it effect oxygenation, Antisickling agents like urea, cyanate are given.

Folic acid supplements must be given to meet RBC production-

blood transfusion are often needed.

137
Q

: loss of iron becomes inadequate for RBC production- common in elderly, Increase dietary intake & absorption

Most common type

A

Iron Anemia

138
Q

Folic Acid Deficiency Anemia

Found in who

Diet?

A

Normally in green leafy vegetables, fruits, and cereals.

Found in drug abusers, elderly and alcoholics. Poor nutrition, malabsorption, drugs, etoh

139
Q

Tx for anemia

A 
RBC infusion
Folic acid -green leafy veggies 
vit b12 
Iron replacement (meat) 
O2
Hemodynamic and cardiac monitoring 
Erythropoietin -hormone by kidney that produces bone marrow (when then produce blood cells)
140
Q

lack of intake or malabsorption, higher if cognitive disability, Smooth, beefy red tongue, paresthesias, jaundice, wt loss. Increase dietary intake, supplements, B12 injections

A

Vitamin B12 Anemia:

141
Q
  • Deficiency of RBC’s due to impaired cellular regulation of bone marrow
    And injury to pre-cursor cells

Due to bone marrow damage

A

Aplastic anemia

142
Q

the body’s immune system stops red blood cells from forming or causes them to clump together.

Treated with Immunosuppressant, steroids, splenectomy

A

Immunohemolytic anemia-

143
Q

• Is an inherited disease whereby hemoglobin synthesis is missing either the alpha or beta chain of the hemoglobin molecule. Resulting in hemoglobin production being deficient and weak, hypochromic RBCs are formed and labeled target cells (bull eye appearance).

blood disorder involving less than normal amounts of an oxygen-carrying protein and fewer RBC than normal.

If children get this young, rarely live to adulthood, most common in Asians from China, Philippines and Thailand.

A

Thalassemia

144
Q

What causes Thalassemia

A

Four genes causes alpha chain formation, with either one, two, three, or all four may cause the thalassemia conditions.

If all 4 are defective, the result is labeled alpha thalassemia major and is fatal, most commonly in utero.

145
Q

Findings of Thalassemia

A

➢ Findings: mild to moderate anemia, bone marrow hyperplasia, bronze skin coloring-

more serious results in heart failure, liver and spleen dysfunction from increased RBC destruction, sever anemia, and fractures to long bones, ribs .

146
Q
  • form of anemia caused by genetic defect in RBC metabolism.

Contracted most commonly from medication that caused inflammatory disorder.

It is more common in males as it is on the X chromosome, usually Mediterranean or African people.

A condition causing red blood cells to break down in response to certain medications, infections, or other stressors.

A

Glucose- 6- Phosphate Dehydrogenase Anemia
G6PD

Aka - hemolytic anemia

147
Q

➢ Findings of
​Glucose- 6- Phosphate Dehydrogenase Anemia :

Aka hemolytic anemia

A

will normally have normal hemoglobin levels, but certain medication cause hemolytic effects-

jaundice, skin pallor, hemoglobinuria (in urine).

148
Q

Tests for Glucose- 6- Phosphate Dehydrogenase Anemia :

Aka- hemolytic anemia

A

➢ Test: screening test, Heinz bodies may be identified, as well as hemoglbinuria.

149
Q

Medications that will heighten effects of Glucose- 6- Phosphate Dehydrogenase Anemia :

Aka hemolytic anemia

A

Vitamin K, Thiazide diuretics, Sulfonamides, oral hypoglycemic, antimalarial drugs, and Nitrofurantoin.

150
Q

is the MOST COMMON HEMOLYTIC DISORDER.

There is no abnormality of the hemoglobin and it is found in 1-5000.

Autosomal dominant disorder- abnormality of the erythrocyte membrane, and prematurely destroyed in the spleen.

Aka

A

Hereditary Spherocytosis

Also known as congenital hemolytic anemia and

151
Q

Hereditary Spherocytosis findings

A

Findings:
starts in utero or early infancy exhibits anemia and hyperbilirubinema, higher severity so does jaundice appearance.

Gallstones develop young, and Aplastic crises are the most serious complication.

152
Q

Hereditary Spherocytosis tests

A

➢ Test: family history, blood smear, no single test to identify.

153
Q

➢ Hematological changes in older adults

A

➢ Decrease in blood volume with lower levels of plasma proteins
➢ Bone marrow produces fewer blood cells
➢ RBC, WBC counts lower
➢ Lymphocytes less reaction to antigens, lose immune function
➢ Hemoglobin levels fall after middle-age

154
Q

FINDINGS IN HEMATOLOGIC DISORDERS NORMAL CHANGES IN THE OLDER ADULT SIGNIFICANCE/ALTERNATIVES

A

Nail Beds (for Capillary Refill) Pallor or cyanosis may indicate a hematologic disorder.

Thickened or discolored nails

Hair Distribution Thin or absent hair on the trunk or extremities may indicate poor PERFUSION to a particular area.

Progressive loss of body hair is a normal facet of aging. A relatively even pattern of hair loss that has occurred over an extended period is not significant.

Older adults also have decreased pubic hair as a result of age-related hormone changes.

Skin Moisture Skin dryness may indicate any of a number of hematologic disorders.

Skin dryness is a normal result of aging.

Skin moisture is not usually a reliable indicator of an underlying pathologic condition in the older adult.

Skin Color Skin color changes, especially pallor and jaundice, are associated with some hematologic disorders.

Pigment loss and skin yellowing are common changes associated with aging.

Pallor in an older adult may not be a reliable indicator of anemia. Laboratory testing is required.

Yellow-tinged skin in an older adult may not be a reliable indicator of increased serum bilirubin levels. Laboratory testing is required.

155
Q

➢ Blood transfusion therapy
Pretransfusion:

Interventions

A
  • Verify order with another RN
  • Obtain consent, educate patient
  • Test donor’s/recipient’s blood for compatibility
  • Determine IV access
  • Obtain blood product from lab
  • Verify patient’s identity with another RN
  • Examine blood bag label, attached tag, and requisition slip for ABO and Rh compatibility with the patient with another RN
  • Check expiration date with another RN
  • Inspect blood for discoloration, gas bubbles, cloudiness
156
Q

Blood transfusion

• During transfusion?

Nursing interventions

A
  • Provide patient education re: reaction symptoms
  • Assess vital signs immediately before starting infusion
  • Begin transfusion slowly, stay with patient first 15 minutes
  • Ask patient to report unusual sensations (for example, chills, shortness of breath, chest or back pain, hives, itching)
  • Administer blood product per protocol
  • Assess for hyperkalemia
157
Q

Older adult receiving transfusion?

Nursing interventions

A 
Consider chronic diseases
• Monitor for fluid overload
• Transfuse slower
• Decrease chance of overload
• Decrease chance of infiltration
• Space units apart
158
Q

• Post Transfusion

Nursing interventions

A
  • Post Transfusion
  • Vital Signs
  • Flush access site until clear
  • Red bag blood bag & tubing
  • Nursing Note/Complete documentation
  • Follow up on lab values
159
Q

—

• given to replace cells lost from trauma or surgery

A

RBC transfusions

160
Q

—given for low platelet counts, active bleeding, scheduled for invasive procedure

A

Platelet transfusions

161
Q

—given to replace blood volume and clotting factors

A

Plasma transfusions

162
Q

Transfusion —-given (rarely) to neutropenic patients

A

Granulocyte (WBC) transfusions

163
Q

Acute transfusion reactions

A 
• Febrile
• Hemolytic
• Allergic
• Bacterial
• Circulatory overload
Transfusion-associated graft-versus-host disease (GVHD
164
Q

shape into sickle shape, cells die early, shortage of RBC which results in anemia, blocks blood flow which causes pain=crisis

A

➢ sickle cell disease

165
Q

Sickle cell s/s

A

s/s:
➢ Hypoxia, dehydration, infection, venous stasis, pregnancy, etoh, high altitudes, fever, acidosis, strenuous exercise, emotional stress, anesthesia

166
Q

What to asses in sickle cell disease

A 
o Pain is the most common SCD symptom
o Cardiovascular changes
o Respiratory changes
o Skin changes
o Abdominal changes
o Kidney and urinary changes
o Musculoskeletal changes
o Central nervous system changes
167
Q

: blocks blood flow which causes pain=crisis, pain can last from hours to days. Pain is usually in back, legs, knees, chest, arms, stomach. (sharp, throbbing, dull, stabbing)

A

Sickle cell crisis

168
Q

Priorities of care in sickle cell

A

o priorities of care
o Manage pain
o Drug therapy (opioids, hydroxyurea)
o Hydration (decreases sickling)
o Oxygen (hypoxia is main cause of sickling)
o Prevent sepsis/infection
o Continual assessment
o Prevention & early detection strategy
o Drug therapy
o Care coordination & transition management

169
Q

Red blood cell (RBC) count

Male range ?

Female range?

Increased and decreased levels mean what?

A

Females: 4.2-5.4 million/

Males: 4.7-6.1 million/

Decreased levels indicate possible anemia or hemorrhage.

Increased levels indicate possible chronic hypoxia or polycythemia vera.

170
Q

➢ Hemoglobin (Hgb)

Ranges?

A

Females: 12-16 g/ Same as for RBC. Males: 14-18 g

171
Q

Hematocrit (Hct)

Ranges

A

Females: 37%-47% volume fraction Same as for RBC. Males: 42%-52%

172
Q

Mean corpuscular hemoglobin concentration (MCHC)

Increased ?

Decreased?

A

32-36 g/dL or 32%-36% Same as reference range

Increased levels may indicate spherocytosis or anemia.

Decreased levels may indicate iron deficiency anemia or a hemoglobinopathy.

173
Q

Mean corpuscular volume (MCV)

Ranges

Increased ?

Decreased?

A

80-95 fL Same as reference range

Increased levels indicate macrocytic cells, possible anemia

. Decreased levels indicate microcytic cells, possible iron deficiency anemia.

174
Q

Mean corpuscular hemoglobin (MCH) 27-31 pg Same as reference range Same as for MCV.

A

Y

175
Q

White blood cell (WBC) count

Increased ?

Decreased?

A

5000-10,000/mm3 5.0-10.0 × 109 cells/L

Increased levels are associated with infection, inflammation, autoimmune disorders, and leukemia.

Decreased levels may indicate prolonged infection or bone marrow suppression.

176
Q

Reticulocyte count

Increased ?

Decreased?

A

0.5%-2.0% of RBCs Same as reference range

Increased levels may indicate chronic blood loss.

Decreased levels indicate possible inadequate RBC production

177
Q

Total iron-binding capacity

Increased ?

Decreased?

A

(TIBC) 250-460 mcg/dL 45-82 mcmol/L

Increased levels indicate iron deficiency.

Decreased levels may indicate anemia, hemorrhage, hemolysis.

178
Q

Iron (Fe)

Females:

Increased ?

Decreased?

A

60-160 mcg/dL

Increased levels indicate iron excess, liver disorders, hemochromatosis, megaloblastic anemia.

Decreased levels indicate possible iron deficiency anemia, hemorrhage.

Males: 80-180 mcg/dL

179
Q

Serum ferritin Females:

A

Female: 10-150 ng/mL

Same as for iron.

Males: 12-300 ng/mL

180
Q

Platelet count

Increased

Decreased

A

150,000-400,000/mm

Increased levels may indicate polycythemia vera (too many red blood cells) or malignancy.

Decreased levels may indicate bone marrow suppression, autoimmune disease, hypersplenism.

181
Q

Hemoglobin electrophoresis Hgb A1:

A

Variations indicate hemoglobinopathies.

182
Q

Direct and indirect Coombs’ test Positive or negative findings indicate antibodies to RBCs

It is abnormal And means your body will fight against the RBCs

A

Positive

183
Q

International normalized ratio (INR)

Increase and decrease means?

A

0.8-1.1

times the control value Same as reference range Increased values indicate longer clotting times. This is desirable for anticoagulation therapy with warfarin.

Increased number means thinner blood

Decreased values indicate hypercoagulation and increased risk for venous thromboembolic events. (Clotting )

184
Q

Prothrombin time (PT)

Increase ?

Decrease? Means what

A

11-12.5 sec 85%-100% Same as reference range

Increased time indicates possible deficiency of clotting factors V and VII.

Decreased time may indicate vitamin K excess.

185
Q

Pallor and cyanosis are more easily detected in adults with darker skin by examining the ???

Jaundice can be seen more where??

Petechiae may be visible only ??

Bruises can be seen as darker areas of skin and palpated as??

Ask the patient about pain when skin surfaces are touched lightly or palpated. (

Chapter 24 provides tips for assessing darker skin.)

A

oral mucous membranes and the conjunctiva of the eye.

On the roof of the mouth

on the palms of the hands or the soles of the feet.

slight swellings or irregular skin surfaces.

186
Q

Verify that a patient having a bone marrow aspiration or biopsy has signed a/an??

A

informed consent statement.

187
Q

Risk factors for those with hematologic disorders

A

Age-elderly
Gender -female
Drug use, anticoagulants, NSAIDS, illicit
Iron and protein deficiency

Poor- Healthy foods are more spendy

Family hx of clotting disorders

Currents health issues

188
Q

• Do not palpate the of any patient suspected of having a hematologic problem.

QSEN: Safety

A

splenic area

189
Q

• Maintain pressure over a venipuncture site for at least how long to prevent excessive bleeding.

QSEN: Safety

A

5 min

190
Q

Patient with hematologic disorders should eat a diet high in what?

A

Instruct patients about the importance of eating a diet with adequate amounts of foods that are good sources of

iron, folic acid, and vitamin B12.

191
Q

• The most common symptom of a hematologic problem is ?•

A

Fatigue

192
Q

Both clotting forces and anticlotting forces are needed to maintain adequate what??

A

Perfusion

193
Q

Use the ? rather than nail beds to assess capillary refill on older adults.

A

Lip

194
Q

• Rely on ?? rather than skin color changes in older adults to assess anemia or jaundice.

A

Lab results

195
Q
  • Assess the patient’s endurance in performing ADLs.
  • Teach patients and family members about what to expect during procedures to assess hematologic function,

including restrictions, drugs, and follow-up care.

A

Yes

196
Q

Apply what? to the needle site after a bone marrow aspiration or biopsy.

A

Ice pack

197
Q

Check the needle insertion site at least every 2 hours after a bone marrow aspiration or biopsy.

If the patient is going home, teach the patient and family how to assess the site for bleeding and when to seek help.

QSEN: Patient-Centered Care •
Instruct patients to avoid ??

A

activities that may traumatize the site after a bone marrow aspiration or biopsy.

198
Q

• In collaboration with who? help the patient incorporate healthy eating behaviors to lower cholesterol and saturated fats and increase :
? What ??

Teach patients to engage in how long/type of exercise?? to lower blood pressure and LDL-C levels.

A

Dietitian

fresh fruits, vegetables, and fiber in the diet. For overweight patients, assist in a weight-reduction plan•

40 minutes of moderate-to-vigorous physical activity three or four times a week

199
Q

?? occurs when fatty plaques occlude arteries and prevent adequate PERFUSION to vital body tissues

. • Monitor what labs?

A

atherosclerosis

total cholesterol, HDL-C, and LDL-C levels to assess patient risk for atherosclerosis.

200
Q

• Teach patients taking any of the statins …
in Table 36-5
to report any adverse effects,

including ??? to their primary health care provider.

Monitor the patient’s ??? carefully.

A

Monitor muscle cramping

Monitor liver enzymes

201
Q

Monitor for ??? levels when patients are taking thiazide or loop diuretics

Why?

A

decreased serum potassium

hypokalemia could cause life-threatening cardiac dysrhythmias (

see Chart 36-1).

202
Q

??? is the most common type of peripheral vascular problem.

A

Deep vein thrombosis (DVT)

203
Q

Teach foot care for patients with PVD as outlined in Chart 36-6.

A

Yes

204
Q

Monitor for indications of aneurysm rupture:

What are the s/s?

A 
diaphoresis, 
nausea, 
vomiting, 
pallor, 
hypotension, 
tachycardia, 
severe pain, 
decreased level of consciousness.
205
Q

• Varicose veins can cause severe pain and reflux requiring the three Es:

A

elastic compression hose
exercise
elevation.

206
Q

Ace inhibitors and arbs (prils and sartins) decrease afterload or preload of hf and arbs

A

Decrease afterload (pressure it takes to expel blood through vessel)

207
Q

First line Tx for preload hf

A

Diet, then diuretics ..morphine?

208
Q

average pressure in a patient’s arteries during one cardiac cycle. It is considered a better indicator of perfusion to vital organs than systolic blood pressure

A

MAP

Mean arterial pressure

209
Q

Tx for anemia?

A

oxygen

pain relievers

oral and intravenous fluids-to reduce pain and prevent blood transfusions

folic acid supplements and antibiotics.

210
Q

When DVT symptoms are present, they include??

• Be aware that DVT can lead to ?

A

swelling, redness, localized pain, and warmth.

pulmonary embolism, a life-threatening emergency!
Clinical Judgment

PN2 RN (17 decks)

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