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Advanced Med Surg > Test 1 (Renal/Hematological) > Flashcards

Test 1 (Renal/Hematological) Flashcards

1
Q

What is needed to make RBC’s?

A 
Iron
Vitamin b12
Folate
Bone marrow tissue
Erythropoietin
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2
Q

Normal WBC count

A

5,000-10,000

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3
Q

A WBC count greater than 10,000 means

leukocytosis

A

Inflammation or infection

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4
Q

A WBC count less than 5,000 means

leukopenia

A

Immune compromised

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5
Q

Normal platelet count

A

150,000-450,000

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6
Q

Plasma is made of

A

water
sugar
protein
albumin

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7
Q

What medication is used to treat and prevent polycythemia?

A

Hydroxurea

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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+
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9
Q

What disease destroys RBC’s

A

Malaria and receiving the wrong Rh factor

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10
Q

Iron deficiency anemia

A

Result when the dietary intake of iron is inadequate for hgb synthesis

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11
Q

Most common cause of iron deficiency anemia in men and post menopausal women is

A

Bleeding (ulcers, gastritis, or GI tumors)

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12
Q

Most common cause of iron deficiency anemia in pre menopausal women is

A

menorrhagia and pregnancy with inadequate iron supplementation

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13
Q

S/S of anemia

A 
Fatigue
Malaise
Pallor
Weakness 
Dyspnea
Tachycardia
Dizziness 
Orthopnea
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14
Q

A person with iron deficiency anemia may have what kind of tongue?

A

Smooth, sore and red

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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

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16
Q

S/E of iron supplements

A

Constipation
Cramping
N/V
Dark green/black stools

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17
Q

What is aplastic anemia?

A

Bone marrow is replaced by fat. Most cases are idiopathic

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18
Q

What is the treatment for aplastic anemia?

A

Bone marrow transplant

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19
Q

S/S of aplastic anemia

A 
Fatigue
Pallor
Purpura 
Dyspnea
Weakness
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20
Q

Aplastic anemia can be manged with immunosuppressive therapy commonly using

A

Cyclosporine

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21
Q

Antihemocyte globulin (ATG)

A

Removes the immunologic function that prolongs anemia and allows bone marrow to recover

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22
Q

Megaloblastic anemia is caused by

A

Deficiencies if vitamin B12 and folic acid

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23
Q

Nursing interventions for aplastic anemia

A

Observe for tissue hypoxia/bleeding
Good oral hygiene
No IM or SC injections

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24
Q

Neurologic manifestations occur in which kind of anemia

A

Vitamin B12 deficiency

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25
Q

S/S of folic acid and vitamin b 12 deficiency anemia

A

Extremely pale
Paresthesia in extremities
Difficulty maintaining balance
Proprioception

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26
Q

What is the classic method of determining the cause of vitamin B12 deficiency

A

Schilling test

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27
Q

What is the Schilling test?

A

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

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28
Q

How is folic acid deficiency treated

A

Increase folic acid intake 1mg daily

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29
Q

Folic acid is administered IM only to people with

A

Malabsorption problems

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30
Q

Absence of intrinsic factor is treated by

A

Monthly IM injection of vitamin B12 for life

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31
Q

What can cause/trigger a sickle cell crisis?

A 
Cold
Dehydration
Fatigue
Menstruation
ETOH
Acidosis
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32
Q

Sickle cell is associated with

A

Tacycardia
Cardiac murmurs
Cardiomegaly

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33
Q

Patients with sickle cell anemia are susceptible to

A 
infection
pneumonia
osteomyelitis 
leg ulcers 
priaprism
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34
Q

Painful sickle crisis commonly result from

A

Tissue hypoxia and necrosis due to inadequate blood flow to a specific region or tissue or organ

35
Q

Aplastic crisis results from

A

infection with the human parovirus

36
Q

Treatment for sickle cell crisis is

A

HOP: hydration, oxygen, pain management

37
Q

Pain meds used to relieve pain during crisis

A

Aspirin (mild/moderate pain, inflammation)
NSAIDS (moderate pain)
Morphine (most common for acute)

38
Q

Hemophilia is a genetic defect caused by

A

A deficiency in factor 8 or 9, manifested by hemorrhage into various body parts. X-linked traits. almost all affected people are males

39
Q

Most of the bleeding in pts with hemophilia occurs into

A

Joints (knees, elbow, ankles, shoulders, wrist and hips)

40
Q

Other s/s of hemophilia include

A

Spontaneous hematuria and GI bleeding
Coffee colored emesis
Cola colored urine
Tarry stools

41
Q

Nursing interventions for patients with hemophilia

A 
Avoid IM and SC injection
Avoid aspirin, NSAIDS, herbs and alcohol. 
Apply pressure to control bleeding 
Splints to immobilize joints 
Good oral hygiene
42
Q

Heat is avoided during bleeding episodes because

A

It can accentuate bleeding

43
Q

DIC can be triggered by

A 
Sepsis 
Trauma
Cancer
Shock
Abruptio placentae 
Toxins 
Allergic reactions
44
Q

Patients with DIC bleed from

A

Mucous membranes
Venipuncture sites
GI and urinary tracts

45
Q

Steps before beginning blood transfusion

A 
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
Q

Why cant dextrose be used for blood transfusions?

A

It is hypertonic and will kill RBCs

47
Q

When transfusing blood obtain blood from blood bank after

A

The IV line is started

48
Q

After obtaining blood from blood bank what are the next steps to take

A

Start blood transfusion w/in 30min from blood bank
Double check label with 2nd nurse
Check blood for gas bubbles/ unusual color

49
Q

What should the 2 nurses verify before starting blood transfusion?

A 
Right pt 
Right blood type
Right bag number 
Right unit number 
Expiration date
50
Q

A blood transfusion should take no longer than

51
Q

A reaction to a blood transfusioncan occur

A

Within the first 15 min

52
Q

During a blood transfusion, vital signs should be taken

A

Every 5 min for the first 15 min.

53
Q

If multiple transfusions are being given, what medication should be given to prevent fluid overload?

54
Q

S/S of adverse reaction during a blood transfusion

A 
Restlessness
Hives
N/V
Torso or back pain 
SOB
Flushing
Hematuria
Fever or chills
55
Q

If a reaction occurs during a blood transfusion, what action should the nurse take?

A

Stop the transfusion immediately and notify HCP

56
Q

A blood transfusion should not go over 4hrs because

A

It increases the risk for bacterial infection

57
Q

Different reactions that can occur during a blood transfusion

A 
Febrile 
Overload
Anaphylaxis 
Hemolytic
Septic (Infection)
Allergic
Shock 
Acute lung injury 
Disease acquisition (Hep B and C, AIDS, CMV)
58
Q

Causes of pre renal failure

A 
Decreased CO
Hemorrhage
MI
Sepsis
HF
Low BP
59
Q

Causes of intra renal failure

A 
NSAIDS 
Amino glycosides 
ACE inhibitors
Metformin
Trauma, burns
60
Q

Causes of post renal failure

A

UTIs
Kidney stones
Tumors
BPH

61
Q

What are the four phases of ARF

A

Initiation
Oliguric
Diuresis
Recovery

62
Q

What occurs in the oliguric phase

A

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
Q

What occurs in the diuresis phase?

A

Nephrons begin to recover, increase in urinary output. Decline in BUN and creatinine. Dehydration and hypotension may occur

64
Q

Causes of chronic renal failure

A

DM, HTN, chronic urinary obstruction, autoimmune disorders

65
Q

S/S of chronic RF

A 
Same as acute
Crackles
Protein in urine
Yellow/grey pallor
SOB
Hematuria
66
Q

Nursing interventions for pts with RF

A 
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
Q

What is used to treat emergency hyperkalemia

A

Insulin or Ca gluconate

68
Q

What can be prescribed to initiate diuresis

A

Mannitol or lasix

69
Q

S/S of disequilibrium syndrome

A 
Headache
N/V
Restlessness
Decreased LOC
Seizures
70
Q

Nursing interventions for overload reaction during a transfusion

A

Stop transfusion
NS to KVO
Notify MD

71
Q

What are s/s of over load reaction during a transfusion

A 
Crackles
SOB, JVD
Increase in BP
Flushed feeling
Back pain
Fever, chills 
Cyanosis
72
Q

What are the nursing interventions during a febrile reaction during a transfusion

A 
Stop transfusion
NS to KVO
Notify MD
Call blood bank
Return blood
73
Q

What are the s/s of a febrile reaction during a transfusion

A 
Flushed face
Palpitations
Cough
Tightness of chest
Increase in pulse
Fever, chills
74
Q

What are the nursing interventions for a septic reaction during a blood transfusion

A 
Blood infused over 4 hrs
Abnormal looking blood
NS to KVO
Stop transfusion
Notify MD
75
Q

What are the nursing interventions for a hemolytic reaction during a blood transfusion (donor and recipient incompatibility)

A 
Most dangerous 
Stop transfusion
IV colloids
Mannitol
Renal complications
76
Q

S/S of a hemolytic reaction during a blood transfusion (acute)

A

General: Chills, Back/chest pain, Hemoglobinuria, anxiety
Acute: Fever, increased HR, dyspnea, flank pain

77
Q

S/S of a delayed hemolytic reaction

A

Increased anemia
Increaed Billirubin
Hemolysis

78
Q

S/S of an air embolism during a blood transfusion reaction

A

Cyanosis
Dyspnea
Shock
Cardiac arrest

79
Q

S/S of a hypothermic reaction during a blood transfusion

A

Chills
Decreased in body temp
Peripheral vasoconstriction
Cardiac arrest

80
Q

What is BPH

A

The prostate increases in size. Cause is unknown. It extends into the bladder causing bladder outlet obstruction

81
Q

What is TURP?

A

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
Q

S/S of an allergic reaction during a blood transfusion

A

HIves
Generalized itching
Flushing

83
Q

S/S of a severe allergic reaction during a blood transfusion

A

Bronchospasm
Laryngeal edema
Shock

Advanced Med Surg (4 decks)

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