Test 1 (Renal/Hematological) Flashcards
1
Q
What is needed to make RBC’s?
A
Iron Vitamin b12 Folate Bone marrow tissue Erythropoietin
2
Q
Normal WBC count
A
5,000-10,000
3
Q
A WBC count greater than 10,000 means
leukocytosis
A
Inflammation or infection
4
Q
A WBC count less than 5,000 means
leukopenia
A
Immune compromised
5
Q
Normal platelet count
A
150,000-450,000
6
Q
Plasma is made of
A
water
sugar
protein
albumin
7
Q
What medication is used to treat and prevent polycythemia?
A
Hydroxurea
8
Q
What occurs in polycythemia?
A
Transport of RBC's slows down Viscosity increases Ruby red color High risk for DVT May have excess Ca+
9
Q
What disease destroys RBC’s
A
Malaria and receiving the wrong Rh factor
10
Q
Iron deficiency anemia
A
Result when the dietary intake of iron is inadequate for hgb synthesis
11
Q
Most common cause of iron deficiency anemia in men and post menopausal women is
A
Bleeding (ulcers, gastritis, or GI tumors)
12
Q
Most common cause of iron deficiency anemia in pre menopausal women is
A
menorrhagia and pregnancy with inadequate iron supplementation
13
Q
S/S of anemia
A
Fatigue Malaise Pallor Weakness Dyspnea Tachycardia Dizziness Orthopnea
14
Q
A person with iron deficiency anemia may have what kind of tongue?
A
Smooth, sore and red
15
Q
How to take oral iron supplements
A
Increase vitamin C intake
Take on empty stomach
Antacids/dairy products should be avoided
Drink liquid solutions thru straw
16
Q
S/E of iron supplements
A
Constipation
Cramping
N/V
Dark green/black stools
17
Q
What is aplastic anemia?
A
Bone marrow is replaced by fat. Most cases are idiopathic
18
Q
What is the treatment for aplastic anemia?
A
Bone marrow transplant
19
Q
S/S of aplastic anemia
A
Fatigue Pallor Purpura Dyspnea Weakness
20
Q
Aplastic anemia can be manged with immunosuppressive therapy commonly using
A
Cyclosporine
21
Q
Antihemocyte globulin (ATG)
A
Removes the immunologic function that prolongs anemia and allows bone marrow to recover
22
Q
Megaloblastic anemia is caused by
A
Deficiencies if vitamin B12 and folic acid
23
Q
Nursing interventions for aplastic anemia
A
Observe for tissue hypoxia/bleeding
Good oral hygiene
No IM or SC injections
24
Q
Neurologic manifestations occur in which kind of anemia
A
Vitamin B12 deficiency
25
S/S of folic acid and vitamin b 12 deficiency anemia
Extremely pale
Paresthesia in extremities
Difficulty maintaining balance
Proprioception
26
What is the classic method of determining the cause of vitamin B12 deficiency
Schilling test
27
What is the Schilling test?
Oral dose of radioactive vitamin B12, followed by nonradioactive vit B12. If no radioactive is present in urine, the cause is GI malabsorption. If the radioactive is present in urine the cause is not ilieal disease or pernicious anemia
28
How is folic acid deficiency treated
Increase folic acid intake 1mg daily
29
Folic acid is administered IM only to people with
Malabsorption problems
30
Absence of intrinsic factor is treated by
Monthly IM injection of vitamin B12 for life
31
What can cause/trigger a sickle cell crisis?
```
Cold
Dehydration
Fatigue
Menstruation
ETOH
Acidosis
```
32
Sickle cell is associated with
Tacycardia
Cardiac murmurs
Cardiomegaly
33
Patients with sickle cell anemia are susceptible to
```
infection
pneumonia
osteomyelitis
leg ulcers
priaprism
```
34
Painful sickle crisis commonly result from
Tissue hypoxia and necrosis due to inadequate blood flow to a specific region or tissue or organ
35
Aplastic crisis results from
infection with the human parovirus
36
Treatment for sickle cell crisis is
HOP: hydration, oxygen, pain management
37
Pain meds used to relieve pain during crisis
Aspirin (mild/moderate pain, inflammation)
NSAIDS (moderate pain)
Morphine (most common for acute)
38
Hemophilia is a genetic defect caused by
A deficiency in factor 8 or 9, manifested by hemorrhage into various body parts. X-linked traits. almost all affected people are males
39
Most of the bleeding in pts with hemophilia occurs into
Joints (knees, elbow, ankles, shoulders, wrist and hips)
40
Other s/s of hemophilia include
Spontaneous hematuria and GI bleeding
Coffee colored emesis
Cola colored urine
Tarry stools
41
Nursing interventions for patients with hemophilia
```
Avoid IM and SC injection
Avoid aspirin, NSAIDS, herbs and alcohol.
Apply pressure to control bleeding
Splints to immobilize joints
Good oral hygiene
```
42
Heat is avoided during bleeding episodes because
It can accentuate bleeding
43
DIC can be triggered by
```
Sepsis
Trauma
Cancer
Shock
Abruptio placentae
Toxins
Allergic reactions
```
44
Patients with DIC bleed from
Mucous membranes
Venipuncture sites
GI and urinary tracts
45
Steps before beginning blood transfusion
```
Check Rx
Order to type and cross pt
Explain procedure to pt
OBTAIN CONSENT
Take baseline vitals
Use a 18/20 guage needle
Bring Y-tube (NS)
```
46
Why cant dextrose be used for blood transfusions?
It is hypertonic and will kill RBCs
47
When transfusing blood obtain blood from blood bank after
The IV line is started
48
After obtaining blood from blood bank what are the next steps to take
Start blood transfusion w/in 30min from blood bank
Double check label with 2nd nurse
Check blood for gas bubbles/ unusual color
49
What should the 2 nurses verify before starting blood transfusion?
```
Right pt
Right blood type
Right bag number
Right unit number
Expiration date
```
50
A blood transfusion should take no longer than
2-4hrs
51
A reaction to a blood transfusioncan occur
Within the first 15 min
52
During a blood transfusion, vital signs should be taken
Every 5 min for the first 15 min.
53
If multiple transfusions are being given, what medication should be given to prevent fluid overload?
Lasix
54
S/S of adverse reaction during a blood transfusion
```
Restlessness
Hives
N/V
Torso or back pain
SOB
Flushing
Hematuria
Fever or chills
```
55
If a reaction occurs during a blood transfusion, what action should the nurse take?
Stop the transfusion immediately and notify HCP
56
A blood transfusion should not go over 4hrs because
It increases the risk for bacterial infection
57
Different reactions that can occur during a blood transfusion
```
Febrile
Overload
Anaphylaxis
Hemolytic
Septic (Infection)
Allergic
Shock
Acute lung injury
Disease acquisition (Hep B and C, AIDS, CMV)
```
58
Causes of pre renal failure
```
Decreased CO
Hemorrhage
MI
Sepsis
HF
Low BP
```
59
Causes of intra renal failure
```
NSAIDS
Amino glycosides
ACE inhibitors
Metformin
Trauma, burns
```
60
Causes of post renal failure
UTIs
Kidney stones
Tumors
BPH
61
What are the four phases of ARF
Initiation
Oliguric
Diuresis
Recovery
62
What occurs in the oliguric phase
Lasts 8-15 days, urinary output is less than 400 ml/day. Metabolic acidosis, hyperkalemia, HTN, edema, N/V, BUN/creatinine increase. Decrease in pH, hypocalcemia, increase in specific gravity
63
What occurs in the diuresis phase?
Nephrons begin to recover, increase in urinary output. Decline in BUN and creatinine. Dehydration and hypotension may occur
64
Causes of chronic renal failure
DM, HTN, chronic urinary obstruction, autoimmune disorders
65
S/S of chronic RF
```
Same as acute
Crackles
Protein in urine
Yellow/grey pallor
SOB
Hematuria
```
66
Nursing interventions for pts with RF
```
Monitor I/O
Limit Na and fluid intake
Weigh daily
Monitor/diet low in K
Administer HCO3 IV
Administer lasix
ABGs (metabolic acidosis)
Cardiac monitor
Monitor BP/ give anti HTN
Give Ca
Kayaxelate
```
67
What is used to treat emergency hyperkalemia
Insulin or Ca gluconate
68
What can be prescribed to initiate diuresis
Mannitol or lasix
69
S/S of disequilibrium syndrome
```
Headache
N/V
Restlessness
Decreased LOC
Seizures
```
70
Nursing interventions for overload reaction during a transfusion
Stop transfusion
NS to KVO
Notify MD
71
What are s/s of over load reaction during a transfusion
```
Crackles
SOB, JVD
Increase in BP
Flushed feeling
Back pain
Fever, chills
Cyanosis
```
72
What are the nursing interventions during a febrile reaction during a transfusion
```
Stop transfusion
NS to KVO
Notify MD
Call blood bank
Return blood
```
73
What are the s/s of a febrile reaction during a transfusion
```
Flushed face
Palpitations
Cough
Tightness of chest
Increase in pulse
Fever, chills
```
74
What are the nursing interventions for a septic reaction during a blood transfusion
```
Blood infused over 4 hrs
Abnormal looking blood
NS to KVO
Stop transfusion
Notify MD
```
75
What are the nursing interventions for a hemolytic reaction during a blood transfusion (donor and recipient incompatibility)
```
Most dangerous
Stop transfusion
IV colloids
Mannitol
Renal complications
```
76
S/S of a hemolytic reaction during a blood transfusion (acute)
General: Chills, Back/chest pain, Hemoglobinuria, anxiety
Acute: Fever, increased HR, dyspnea, flank pain
77
S/S of a delayed hemolytic reaction
Increased anemia
Increaed Billirubin
Hemolysis
78
S/S of an air embolism during a blood transfusion reaction
Cyanosis
Dyspnea
Shock
Cardiac arrest
79
S/S of a hypothermic reaction during a blood transfusion
Chills
Decreased in body temp
Peripheral vasoconstriction
Cardiac arrest
80
What is BPH
The prostate increases in size. Cause is unknown. It extends into the bladder causing bladder outlet obstruction
81
What is TURP?
Common surgery for BPH, when the enlarged portion of the prostate is cut into pieces and removed thru the urethra by and endoscopic instrument.
82
S/S of an allergic reaction during a blood transfusion
HIves
Generalized itching
Flushing
83
S/S of a severe allergic reaction during a blood transfusion
Bronchospasm
Laryngeal edema
Shock
