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202D > Test #1...Week 2&3 > Flashcards

Test #1...Week 2&3 Flashcards

1
Q

What is hematopoiesis

A

The production of stem cells

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2
Q

What is needed for hematopoiesis to be effective

A

We need B 12, iron and folic acid so are bone marrow can rapidly make new healthy cells, help them mature so they are functional

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3
Q

What would result if we did not have the essential nutrients for hematopoiesis

A

The cells may be immature and non functional. This can result in the inability to carry the same amount of oxygen and RBCs leading to Anemias

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4
Q

What hormone does hematopoiesis respond to

A

Erythropoietin

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5
Q

What secretes erythropoietin

A

The kidneys-90%

The liver-10%

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6
Q

What stimulates the kidneys to secrete erythropoietin

A

Hypoxia
The kidneys sense hypoxia thus it secretes erythropoietin which then travels to the bone marrow where it interacts with the receptors on the stem cells to increase RBC production (stem cells differentiate into RBCs)

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7
Q

What does erythropoietin stimulate

A

Erythropoiesis

The production of RBCs from stem cells & the production of hemoglobin which is needed for the RBC to be functional

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8
Q

What is hemoglobin

A

A 4 protein molecule (globulin chain) and
within each globulin chain is a heme molecule and
Within the heme molecule is iron

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9
Q

What is iron responsible for

A

Carrying the oxygen & giving the RBC the red color

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10
Q

What does Epoetin Alfa do

A

Stimulate erythropoiesis

It is to increase the RBC production amount and hgb which will decrease the need for blood transfusion

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11
Q

What is Epoetin Alfa for

A

For pts who do not make enough erythropoietin
Chemo pts
Anemia associated with CKD

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12
Q

Could you use Epoetin Alfa in an emergent anemia case

A

No

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13
Q

What are key components a pt must have for Epoetin Alfa

A

They must have a functional bone marrow and sufficient iron stores

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14
Q

What would iron deficiency anemia do to the effectiveness of Epoetin Alfa

A

It would reduce the effect of the medication b/c you must have sufficient iron stores to keep up with the RBC and heme production

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15
Q

What tests can the MD order to check iron levels

A

He can order labs for iron and/or Ferritin levels

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16
Q

What is ferritin

A

Iron that is stored in the liver,spleen, skeletal muscles and bone marrow

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17
Q

What are adverse effects of Epoetin Alfa

A

Hypertension

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18
Q

Why is there a black box warning for Epoetin Alfa

A

Because the AE is HTN which can lead to a cardiovascular or thromboembolic event

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19
Q

What do you need to asses when administering Epoetin Alfa

A

-BP before and during
-Monitor hgb and hct
-Signs of CV or thromboembolic events:
Pain in the LE
Signs of stroke (facial droop slurred speech)
Chest pain
Dyspneic
Tachypneic

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20
Q

When would you not administer Epoetin Alfa

A

If the hgb was greater than or equal to 10

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21
Q

What are the symptoms of anemia

A 
Fatigue 
Weak 
Sob
Pale skin
Cold hands/feet
Dizzy
Headache
Possible cognitive issues
Chest pain
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22
Q

Why might you see an increased heart rate in an anemic pt

A

Because when the heart (and kidneys) sense they are not getting enough oxygen the heart is going to pump faster to compensate for the decreased perfusion

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23
Q

what is the MCV and the normal

A

mean corpuscular volume.

  • the average size of the RBC
    range: 80-100 femtoliter
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24
Q

what is indicative of abnormal MCV levels

A 
decreased = microcytic cell= iron deficiency 
increased = microcytic= B12 or folic acid deficiency (these nutrients are needed to make mature cells from hematopoiesis, therefore w/o the cells are large and immature)
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25
Q

what is the MCH & normal level

A

mean corpuscle Hgb

  • measures the weight of hgb in the cell in relation to the size.
  • 27-34 picograms(pg)
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26
Q

what is indicative of abnormal MCH levels

A 
decreased = less hgb weight = small size cell
increased = more hgb weight = larger cell
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27
Q

what is MCHC and the normal level

A

Mean corpuscular hgb concentration
the proportion of hgb in the RBC
-32%-36% -proportion of RBC that is taken up by hgb

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28
Q

if someones labs came back and the MCV & MCHC is low what does that indicate

A

iron deficiency anemia- the RBC is small and there is less hgb concentration

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29
Q

what does it indicate if the MCV is high and the MCHC is normal

A

Folate anemia or Pernicious anemia
the RBC is large but the hgb % is normal indicating there is a folate or B12 deficiency creating a macrocytic immature cell.

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30
Q

for someone who has iron deficiency anemia what will their labs look like

A

mcv is low and mchc is low. the RBCs are going to be microcytic and hypochromic(d/t the lack of hgb= lack of iron in the RBC)

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31
Q

signs and symptoms of Iron deficiency anemia

A 
s&s of anemia(sob, chest pain, cold hands & feet, fatigue, dizzy, headache)
sore tongue
brittle nails
"crawling" feeling in legs
RLS
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32
Q

what can be the cause of iron deficiency anemia

A
  • liver disease (d/t ferritin is stored in the liver, so if the liver is not functioning it will not be able to adequately store ferritin thus reducing the amount of iron stores in the body.
  • vegetarians
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33
Q

what does iron need to be absorbed

A

an acidic environment

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34
Q

what are sources of iron

A 
liver & red meats(highest source)
fish
fortified cereals
lima beans
leafy veggies
dried fruit
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35
Q

when is it the best time to take an iron supplement

A

1 hour before or 2 hours after meals

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36
Q

what is the issue with taking iron with food

A

it decreases the absorption of iron 33-50%

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37
Q

adverse effect of iron supplements

A

N/V
constipation
stomach cramps

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38
Q

what can you do to decrease GI upset when taking iron supplement

A

you can take it with food if needed to prevent GI upset. However, Vitamin C increases iron absorption by 30% so you can give the supplement with OJ therefore it decreases the gi upset and increases iron absorption

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39
Q

what can happen when you take iron supplement

A
  • stools may turn dark green or black
  • decreased absorption w/ antacids and calcium
  • increased absorption with Vit C
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40
Q

why does iron supplement turn stools black

A

it is d/t the breakdown of iron and it being excreted

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41
Q

what is B12 Important for

A
  • myelin sheath production

- rapid normal production of RBCs-

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42
Q

what does B12 need to be absorbed

A

It needs Intrinsic factor. It binds with IF in the stomach and it is then absorbed by the ilium then to circulation

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43
Q

where is B12 stored

A

the liver

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44
Q

what is the cause of B12 deficiency

A

the lack of intrinsic factor
..we store B12 in the liver for up to 3-5 years therefore the deficiency is not usually from lack of intake but from the lack of IF

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45
Q

what will labs look like with B12 deficiency

A

macrocytic RBCs = increased MCV level

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46
Q

what type of anemia comes from B12 deficiency

A

megaloblastic anemia

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47
Q

what is the source of B12

A

Meat, fish, poultry, cheese, eggs, fortified cereals and pastas

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48
Q

who may be at risk for B12 deficiency

A

strict vegetarians

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49
Q

cause of megaloblastic anemia

A

most commonly d/t pernicious anemia(lack of IF) not necessarily lack of intake

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50
Q

Cause of pernicious anemia

A

absence of IF

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51
Q

why would there be a lack of IF

A
  • gastric resection
  • elderly- not enough IF d/t lack of parietal cells
  • antacids
  • genetic condition-autoimmune condition- body makes –antibodies that attacks IF
  • crohns
  • ulcerative colitis
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52
Q

what are S&S of pernicious anemia (unable to absorb B12 d/t lack of IF-may have enough B12 in body)

A

s&s of anemia(sob, chest pain, cold hands & feet, fatigue, dizzy, headache)
-numbness, tingling in the hands/feet
-loss of balance
-confusion
-memory loss
-mood disturbances
(neuro/muscular symptoms d/t the inability of formation of myelin sheath)

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53
Q

what are s&s of B12 deficiency

A

s&s of anemia(sob, chest pain, cold hands & feet, fatigue, dizzy, headache)
- numbness in fingers and toes

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54
Q

what is cyanocobalamin

A

complex B12 supplement

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55
Q

what forms does cyanocobalamin come in

A

PO & Parenteral

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56
Q

when would you choose to give PO b12 supplement

A

someone who has B12 deficiency (NOT pernicious anemia)

give with food to increase absorption

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57
Q

why would you give parenteral b12 supplements

A

to bypass the GI system/liver. You would give it to someone who lacks IF or have malabsorption issues.

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58
Q

when would you choose to give a nasal spray B12 supplements

A

after all symptoms of CNS involvement have resolved.

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59
Q

what is folate important for

A

-cell division and maturation of RBC, WBC & platelets
most needed during pregnancy to reproduce healthy cells for fetal development
-aids in production of heme

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60
Q

what type of anemia wills someone have if they have a folate deficiency

A

megaloblastic anemia.

the MCV will be increased but the MCHC will be normal

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61
Q

what is the most common cause of folate deficiency

A
  • not enough dietary intake

- chronic alcoholism b/c alcohol interferes with metabolism in the liver

62
Q

what are the symptoms of folate deficiency

A

s&s of anemia(sob, chest pain, cold hands & feet, fatigue, dizzy, headache)
-mouth sores, swollen tongue

63
Q

sources of folate

A

leafy greens, fortified cereals, whole grains, nuts and yeast

64
Q

what are chronic conditions inhibiting RBC production

A
  • autoimmune disorders-lupus- builds immunity against body & attacks and destroys body tissues
  • alcoholism- interferes w/ folate causing megaloblastic anemia, suppress RBC production
  • inflammatory bowel disease- impairs absorption
  • gastric resection- reduces surface area-pernicious anemia,
  • liver disease- unable to store/metabolize ferritin-iron deficiency anemia
  • CKD- decreased erythropoietin production
  • osteomyelitis- affects the function of the bone marrow-decreased RBC production
65
Q

what do neutrophils do

A

help fight off infections particularly those caused by bacteria and fungus

66
Q

what is the ANC

A

absolute neutrophil count
ANC=WBCx(% of neutrophils + & of bands)
<1000cells/mcL = risk of infection

67
Q

what are bands

A

immature neutrophils that are released from the bone marrow when the body is rapidly trying to fight off infection. It is released once all neutrophils are used up and the body is sending out immature neutrophils to fight

68
Q

at what temp should you be worried with a neutropenic pt

A

any temp at or above 100.4

69
Q

what are causes of neutropenia

A

chemo, bone marrow depression (bone marrow is under attack for some reason
radiation

70
Q

what is filgrastim

A

hormones that stimulates neutrophils to grow and mature

71
Q

how does filgastim work

A

it binds to receptors on the stem cells in bone marrow which helps them mature and divide and help them become functional neutrophils

72
Q

what needs to be monitored while pt is on filgastim

A

the ANC b/c once the ANC gets above 10,000 the filgrastim needs to be d/c’d

73
Q

adverse effects of filgrastim

A

medullary bone pain, acute respiratory distress

74
Q

what do WBCs differentiate into

A

granulocytes - basophils, eosinophils, neutrophils (-phills with granules, 2-5 segmented nuclei)
lymphocytes- monocytes, lymphocytes

75
Q

WBC level

A

45000-10,000cells/mcL

76
Q

what are segs and bands

A

segs are neutrophils - b/c they have 2-5 segmented neuclei

bands are immature neutrophils

77
Q

what do neutrophils do

A

respond to bacterial infections by phagocytosis

78
Q

what stimulates neutrophil production

A

bacterial infections.

79
Q

what is the lifespan of neutrophils

A

1-2 days

80
Q

why would you see neutrophil count going down and band count going up

A

because an ongoing bacterial infection, the neutrophils are running out so the bone marrow is releasing more bands to make up for the fact that there are no longer enough neutrophils left

81
Q

what do monocytes do

A

considered the 2nd line of defense.
they transform into macrophages
they are phagocytic cells that ingest bacteria, foreign substances and clean up debri, facilitate tissue repair
They are slower to respond to infection but are stronger than neutrophils

82
Q

how long does it take for a monocyte to reach the site of infection

A

3-7 days but have a longer lifespan than neutrophils

83
Q

what are lymphocytes for

A

they play a role in the immune response.

B & T cells

84
Q

B cells do

A

they are a humoral response- antibodies
they are activated when an antigen encounters a B cell and then b cells divide and secrete antibodies to that specific antigen

85
Q

what do T cells do

A

they are apart of cell mediated immunity
these cells recognize the antigen, attack and destroy it. They release cytokines (chemical messenger-histamines) that have the ability to stimulate more cells to come to the site of infection

86
Q

what can T cells fight agains

A

chronic bacterial infections and acute viral infections

87
Q

what is CRP

A

C-reactive protein

a protein that is produced by the liver in response to injury and inflammation

88
Q

what does a non specific inflammatory marker mean

A

it is a blood test that will tell you there is injury or inflammation somewhere in the body but does not tell you where the site is.

89
Q

besides injury and inflammation, why would CRP be elevated

A

patients with CAD

or elevated levels is an indication of unstable plaque

90
Q

what is the purpose of C&S

A

process of identifying pathogens so the MD can prescribe the correct abx

91
Q

what can happen if you do a C&S after a patient starts abx

A

you may get false negative results

92
Q

when looking at a agar plate with bacteria for a C&S how will you know if the bacteria is sensitive or resistant

A

if the pathogen is resistant it will grow up to the disk of the abx.
if it is sensitive it will not have any growth thus leaving a ring

93
Q

what is MIC

A

minimal inhibitory concentration:
the lowest concentration of drug that inhibits the growth of the organism. the lower the MIC means the less drug required to inhibit the growth of the organism

94
Q

what is the purpose of a urinalysis

A

to diagnose UTI, kidney function and metabolic disease(diabetes)

95
Q 
what should the characteristics of a urinalysis be
Cautiously
Connie
Offers
Paul
Her
Notes
Lately
A 
color- should be lighter yellow
clarity- should be translucent
odor-should be aromatic
protein- should be <20mg/dL
hgb-<5 under microscope, neg on dipstick
Nitrite- should be negative
leukocyte esterase- negative dipstick, <5 microscope
96
Q

what does protein in the urine indicate

A

most common indicator of renal disease. also increased in diabetic nephropathy, glomerulonephritis and also d/t stress or extrenuous exercise

97
Q

why would you detect hgb in a urine sample

A

UTI, kidney issues, trauma, menstration, nephrolithiasis

98
Q

what would nitrite in the urine indicate

A

it would indicate there is the presence of nitrite creating bacteria- most commonly e. coli

99
Q

why would there be WBC in urine

A

bacterial infection-leukocyte esterase is an enzyme produced by neutrophils
calculus formation

100
Q

what can cause the urine to be darker in color

A

infection

but also some medications as well

101
Q

what is specific to gram positive bacteria

A

they have a thick cell wall (peptoglycan layer) stain purple
staphylococcus
streptococcus
enterococcus

102
Q

what is specific to gram negative bacteria

A

they have a complex cell wall but thinner peptoglycan layer, stain pinkish color
E.coli
salmonella
clubsiella

103
Q

what are empiric anti-infectives

A

a broad spectrum abx. Used when a pathogen is unknown. Used to cover a wide variety of organisms
covers gram + and gram -

104
Q

what are definitive anti-infectives

A

a narrow spectrum agent. used when we know the pathogen causing the infection.

105
Q

what is the benefits of using a definitive anti-infective over an empiric anti-infective

A

the definitive is cheaper, and can reduce toxicity and antimicrobial resistance.

106
Q

what type of abx are used for prophylactic measures

A

a lot that are used are broad spectrum. they are used against the most likely organisms to cause infection

107
Q

what are the 4 common mechanisms of anti-infectives

A
  • interrupt cell wall synthesis
  • folate synthesis-disruptions of metabolic synthesis
  • interference of nucleic acid synthesis
  • interruption with protein synthesis
108
Q

what do beta lactams do and what anti-infective are they

A

-interference of bacterial cell wall formation: penicillins, cephalosporins, carbapenems, monobactams
bind to specific proteins necessary for bacteria to build its cell walls

109
Q

how do anti-infective act on folate synthesis and what anti-infective are they

A

disturb the protein synthesis
(Folate is needed for protein synthesis- amino acids, DNA, RNA. )
Sulfonamides, trimethoprim
(bactrim/septra)

110
Q

how do anti-infective act on nucleic acid synthesis and what anti-infective are they

A

Quinolones inhibit DNA synthesis so the pathogen cannot continue to duplicate

111
Q

how do anti-infective act on protein synthesis and what anti-infective are they

A

interrupt the process with the transfer of RNA or change the shape of ribosomes(protein builders)
Tetracyclines
ahminoglycosides
macrolides

112
Q

how do beta lactams interfere with bacterial cell wall synthesis

A

they resemble the chemical peptidoglycan layer of the bacterial cell wall thus the beta lactams prevent the complete cell wall formation and the pathogen is unable to live b/c the cell contents leak out.

113
Q

which abx are the beta lactams

A

penicillin and cephalosporins

114
Q

what is beta lactamase

A

an enzyme bacteria began to produce to inhibit the effect of beta lactam abx.
it hydrolyzes the beta lactic ring which prevents the abx from working

115
Q

which abx are the beta lactamase inhibitors

A

amoxicillin+clavulanic acid (augmentin)
piperacillin + tazobactam (zosyn)
ampicillin + sulbactam (Unasyn)

they have penicillin type abx combined with a beta lactamase inhibitor

116
Q

what is penicillin

A

bactericidal abx

NARROW SPECTRUM against GRAM +

117
Q

what infections can penicillins treat

A

streptococcal and staphylococcal infections

118
Q

why would you give a penicillin abx

A

pneumonia
gonorrhea
and syphillis strains

119
Q

use caution with who when giving penicillin

A

with patients that have a hypersensitivity to cephalosporins because cephalosporins and penicillins have the same beta lactam ring structure

120
Q

what drug may penicillins react with

A

oral contraceptives.

they may decrease the effectiveness of the contraceptives

121
Q

what are cephalosporins

A

bactericidal- inhibition of bacterial cell wall synthesis
BROAD SPECTRUM abx.
cover aerobic and anaerobic infections

122
Q

what happens with coverage of gram + & - with each generation of cephalosporins

A

the level of gram neg coverage increases with each successive generation

123
Q

what is special about 5th generation cephalosporin

A

effective against MRSA

extended Gram + effectiveness

124
Q

what are the 1st gen cephalosporins

A

Cefazolin/cephalexin
- effective against mostly gram + and some gram -

beta lactamase are resistant to 1st Gen

125
Q

what are 1st gen cephalosporins active against

A

septicemia, UTI, pneumonia, genital infections

126
Q

2nd gen cephalosporins

A

cefoxitin & cefotetan

- cover gram + & - and anaerobes

127
Q

what can cefoxitin do that cefotetan not do

A

cover septicemia

128
Q

adverse effect of 2nd gen cepholosporin

A

they can enhance the anti-coag effect of warfarin

129
Q

3rd gen cephalosporins

A

Ceftriaxone & ceftazidime
covers anaerobes
more coverage of gram -, some coverage of gram +

130
Q

what are some indications for 3rd gen cephalosporins

A

similar to the others- bone joint infections, UTIs, lower respiratory tract, intra abdominal infections, gynecologic, SEPTICEMIA & MENINGITIS

131
Q

which generation is the only generation to cross the blood brain barrier

A

the 3rd generation of cephalosporins.

the only generation that can treat meningitis

132
Q

what is an important implementation with 3rd generation cephalosporins

A

do not administer with LR (calcium infusions)

133
Q

which generations are used for prophylactic measures

A

generations 1 and 2

134
Q

4th generation cephalosporin

A

cefepime

more active against gram - anaerobes

135
Q

why use a 4th generation cephalosporin

A

more complicated difficult to treat infections d/t the complicated peptoglycan layer on the bacterial cell wall
also better to use against more resistant microorganisms

136
Q

5th generation abx

A

Ceftaroline

its a derivative- has some cephalosporin in it.

137
Q

sulfonamide abx

A

sulfamethoxazole
but normally found combined with trimethoprim.
BROAD SPECTRUM

138
Q

how does sulfonamide abx work

A

they inhibit the synthesis of folic acid

139
Q

why add trimethoprim to sulfamethoxazole

A

alone sulfamethoxazole is a bacteriostatic abx. so it just inhibits growth of bacteria.
adding the trimethoprim causes it to become a bacteriocidal thus allowing it to kill the bacteria

140
Q

what are the indications of sulfonamides

A

prevent UTIs/treat UTIs, bronchitis, otitis media

141
Q

who would you not want to give a sulfonamide abx to and why

A

someone with megaloblastic anemia
because we need folic acid to mature our RBCs
so we would not want to give a pt something that is going to inhibit that when they already have an issue with immature RBCs
-and pregnant women

142
Q

adverse effect of sulfonamides

A

crystalluria- monitor w/ BUN and creatinine

steven johnson syndrome

143
Q

what are nursing interventions for pts who are taking sulfonomides

A

encourage them to drink plenty of fluids to prevent crystalluria.
you want their urine output to be 1200-1500mL in a 24 hr period

144
Q

what drug interactions does sulfonamides have

A

increasing the effects of anticoagulants
-K+ sparing drugs (sprionolactione)- sulfonamides have a K+ sparing effect so used in conjunction with sprionolactone can increase the risk of K+ toxicity

145
Q

what are aminoglycosides and what are they used for

A

Gentamicin-

narrow spectrum- for serious sytemic infections such as septicemia & meningitis

146
Q

What is Vancomycin used for

A

Active against Gram + pathogens
IV form= septicemia, MRSA
PO- C-Diff

147
Q

what can IV Vancomycin cause

A

-necrosis and extravasation at the site
therefore you need to assess the site first for patency and without pain
-Red Man syndrome- caused from giving the abx too quickly
-Hypotension

148
Q

why can’t you give IV vancomycin for C-Diff

A

because when vancomycin is given orally it acts locally in the intestines
the IV vancomycin will not be able to treat the c-diff because it cannot get to the intestines.

149
Q

how long should you monitor pt for red man syndrome

A

4-10 hrs AFTER the infusion is given

150
Q

what are adverse effects of both Gentamicin and vancomycin

A
  • nephrotoxicity-b/c 90% is excreted through the kidneys (except PO vanc)
  • ototoxicity
151
Q

what do you need to monitor during gentamicin and vancomicin

A
  • kidney function- BUN Creatinine
  • baseline hearing- then monitor hearing loss, ringing, fullness
  • accurate I&O
  • assess urine- for any blood- will indicate kidney damage

202D (6 decks)

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