Test 3- Part 2 Flashcards
1
Q
2 main common side effects of Iron supplements
A
- Stools often appear black, may have constipation, cramping, nausea
- Liquid iron may stain teeth
2
Q
When might a patient need to take iron supplements with food, and what is the impact on absorption?
A
- If they experience GI discomfort.
- This can lead to decreased absorption, resulting in a longer time to replenish iron stores.
3
Q
Q: How can sustained-release iron supplements affect GI side effects?
A
May help decrease GI side effects compared to standard formulations, providing a gentler option for patients.
4
Q
Q: What precautions should be taken when using liquid iron supplements to prevent tooth staining?
A
- drink it with a straw
- rinse the mouth afterward to minimize staining
(liquid iron is undiluted=stronger)
5
Q
Q: What is the primary approach to managing iron deficiency anemia?
A
treat the underlying cause
6
Q
Q: What are the two types of iron replacement therapy?
A
oral and parenteral (injected).
7
Q
Q: What are the 2 routes of administration for parenteral iron supplements?
A
- intramuscular (IM) injection
- intravenously (IV)- risk of an allergic reaction, and the patient should be monitored accordingly.
8
Q
Q: What precautions should be taken when administering intramuscular (IM) iron solutions?
A
- may stain the skin
- therefore, separate needles should be used for withdrawing the solution and for injecting the medication.
9
Q
2nd type of Hypoproliferate anemia:
Occurs due to reduced production of erythropoietin hormone (EPO)
A
Anemia in Renal disease
10
Q
Whats the main job of erythropoietin hormone (EPO)
A
is the hormone that signals the bone marrow to produce RBCs
11
Q
Renal Disease Anemia is more sever in what type of patients.
A
patients with BOTH chronic kidney disease (CKD) and diabetes
12
Q
3 MAIN troubling symptoms of Renal Disease Anemia
A
- Increased cardiac output
- Reduced oxygen utilization
- Decreased libido
13
Q
3RD type of Hypoproliferate anemia:
Rare, life-threatening disease – caused by a decrease or damage to bone marrow stem cells = bone marrow failure
A
Aplastic anemia
“not forming”
14
Q
How exactly does bone marrow fail in Aplastic anemia
A
Body’s T-cells attack bone marrow – bone marrow is replaced with FAT
15
Q
What is pancytopenia
A
ALL blood cells are decreased
- Aplastic anemia should be called pancytopenia
16
Q
Q: What complications can arise from aplastic anemia due to bone marrow failure?
A
All the usual signs of anemia PLUS
* bleeding **
* infection **
* cardiac arrhythmias
* heart failure
17
Q
7 Treatments for Aplastic Anemia
A
- Immediate cessation of any medications/chemicals that may have triggered aplastic anemia.
- Stem Cell Transplant
- Immunosuppressive therapy- prevent T-cells (lymphocytes) from destroying stem cells
- Eltrombopag (Promacta) **
- Eryhtropoietin (EPO)
- Transfusion PRBCs
- Treat infections
18
Q
Aplastic Anemia:
Immunosuppresive therapy will include a triple medication treatement.
What 3 meds are used
A
- Cyclosporoine
- Antithymocyte Globulin (ATG)
- Corticosteroids
19
Q
4th type of Hypoproliferate anemia:
- Characterized by very large RBCs (MCV very high)
- RBCs inner contents NOT completely developed – causes the bone marrow to produce fewer cells and cells may die earlier than 120-day life expectancy
A
B12 or Folic Acid Deficiency
(Megaloblastic anemias)
20
Q
Q: What are the 2 most common causes of Megaloblastic anemia?
A
- folic acid (folate) deficiency
- or Vitamin B12 (cobalamin) deficiency
21
Q
Q: How does a deficiency of intrinsic factor contribute to megaloblastic anemia?
A
deficiency of intrinsic factor leads to decreased absorption of vitamin B12
- this is called pernicious anemia- a type of megaloblastic anemia
22
Q
Lab test for Intrinsic Facor
A
Intrinsic antibody test
23
Q
What does a POSITIVE Intrinsic Antibody test indicate?
A
indicates antibodies are present and are interfering with the binding of B12, preventing absorption
24
Q
Q: How do symptoms of megaloblastic anemia typically develop?
A
- Symptoms often develop over MONTHS, allowing the body to compensate for the gradual decrease in red blood cells.
- As a result, symptoms may NOT appear until the anemia is severe
25
S/S for Megaloblastic anemia
All the usual signs of anemia **PLUS**
* **Numbness or tingling in hands and feet** (peripheral neuropathy **
**know**
26
Folic Acid Deficiency occurs with
1. **Alcohol abuse** - alcohol ingestion increases folic acid requirements
2. Pregnancy
27
Vitamin B12 Deficiency occurs with
1. **Strict VEGAN diet**- due to no meat or dairy
2. **Impaired absorption from GI tract** - most common
3. **Absence of intrinsic factor** (Pernicious Anemia)
28
**Megaloblastic Anemia** requires special assessment of
**Neurologic**- close attention to gait and stability with ambulation
**know**
29
How is vitamin B12 **administered** in the treatment of pernicious anemia?
2 options
B12 injections or nasal spray
30
2 types of **Hemolytic Anemias**
(*caused by erythrocyte destruction*)
1. Thalassemia
2. Sickle Cell Disease
31
*1st type under Hemolytic Anemias*:
**Genetic disorder** caused by mutated genes that are responsible for **making hemoglobin**
Thalasssemia- Intrinsic Cause
32
*Thalassemia*:
**2 globin chains in hemoglobin** are essential for the formation of hemoglobin
What are they
1. Alpha α-Thalassemia
2. Beta β-Thalassemia
33
Q: What happens in Thalassemia anemia regarding **alpha and beta globin chains**?
* **either the alpha or beta globin chains are not being produced adequately**.
* This deficiency leads to an imbalance in hemoglobin production
34
Q: In which populations is thalassemia commonly seen?
Meditterranean sea population
35
There are 2 forms of Thalassemia
1. **Thalassemia Minor**: *milder form, typically has one mutated gene affecting either the alpha or beta globin chain*
2. **Thalassemia Major**: *severe form; resulting from two mutated genes (one from each parent)*
36
**2** main S/S for **Thalassemia Minor**
* Asymptomatic
* Microcytic, hypochromic anemia
37
**5** S/S of **Thalassemia Major**
* Physical/mental growth **retardation**
* **Jaundice**
* **Splenomegaly, hepatomegaly, cardiomyopathy**
* **Increased iron levels**
* **Bone deformities** - *especially in face and skull*
-Bone marrow expands causing bones to widen
38
Tx for Thalassemia **Minor**
No treatment- can usually live a normal life
- body adapts to reduction of normal Hgb
39
4 Treatments for Thalassemia **Major**
1. **Blood transfusions**: *frequent blood transfusions to keep Hgb app. 10 g/dL*
2. **Chelating agents** - *subcutaneous infusion of deferoxamine*
3. **Splenectomy**- *removal of spleen*
4. **Hematopoietic stem cell transplantation (HSCT)**
-
40
Review:
What are Chelating agents
bind and remove excess metals or minerals from the body, often used to treat metal poisoning or **iron overload.**
41
Why is Splenectomy an option for Thalassemia
* to stop the spleen from trapping too many red blood cells (RBCs)
* the spleen can get bigger and hold onto a lot of **abnormal** RBCs, **making anemia worse**.
* Removing the spleen can help improve blood counts and lessen anemia
42
The ONLY cure for Thalassemia
Hematopoietic stem cell transplantation (HSCT)
43
*2nd type under Hemolytic Anemias*:
* Genetic blood disorder, inherit two copies of a mutated gene (one from each parent)
* RBCs become rigid and shaped like a crescent or sickle, instead of being round and flexible
Sickle cell disease
44
There are 2 types of Sickle Cell Disease
1. Sickle Cell **Anemia**
2. . Sickle Cell **Trait**
45
The **#1 S/S** of **Sickle Cell Disease**
PAIN!!!- *may need large doses of continuous opioids*
**KNOW**
46
Complications of Sickle Cell Dz have to do mostly with
**blood clots.**
* Pulmonary infarctions
* Retinal vessel obstruction
* Renal failure
* PE or stroke
* Osteoporosis/osteosclerosis
47
Care for Sickle Cell Dz includes
* PAIN RELIEF **
* Education
* O2- no smoking
* Vigilant assessment of **respiratory system**
48
The ONLY med with some clinical benefit for Sickle Cell Disease
Hydroxyurea
* reduce the number of painful crises caused by disease and reduces the need for blood transfusions
**know**
49
Another treatment choice for Sickle Cell Dz
Hematopoietic stem cell transplantation (HSCT)
50
4 types of Hemostatic Anemia
(*impaired blood clotting (hemostasis)*)
* Thrombocytopenia
* Disseminated intravascular coagulation (DIC)
* Hemophilia
* von Willebrand Disease
51
*1st type of Hemostatic Anemia*
condition characterized by a low **platelet** count in the blood (below 150,000)
thrombocytopenia
52
2 Main S/S of Thrombocytopenia
1. Asymptomatic
2. Bleeding
53
Caring for Thrombocytopenic Patients
1. **Prevent or control hemorrhage – SAFETY**
2. **Education**: *blowing nose, no bending with head lower than waist, use electric razor, no invasive procedures.*
54
*2nd type of Hemostatic Anemia*
serious condition characterized by **widespread activation of the clotting cascade**, leading to the **formation of small blood clots** throughout the blood vessels **and bleeding**
Disseminated Intravascular Coagulation (DIC)
55
Q: Does **Disseminated Intravascular Coagulation (DIC)** occur on its own?
No! Usually occurs as **secondary response to another underlying condition**, such as severe infection, malignancy, trauma, or complications during pregnancy.
56
Q: How does Disseminated Intravascular Coagulation (DIC) **lead to organ failure**?
* excessive clot formation can obstruct small blood vessels, **reducing blood flow to organs**.
* This impaired circulation can result in organ damage and ultimately lead to organ failure due to insufficient oxygen and nutrients reaching the tissues.
57
*DIC:*
Over time clotting factors are consumed and ____ then occurs
bleeding
58
How do we **treat** Disseminated intravascular coagulation (DIC)
treat underlying cause – may reverse DIC
59
What blood products may be necesary for Disseminated intravascular coagulation (DIC) while treating disorder?
Platelets, cryoprecipitate, Frozen Fresh Plasma
60
Nurse prioriteis for **Disseminated intravascular coagulation (DIC)**
* Monitor VS closely- including Neurological checks
* **recognize s/sx of DIC**
* **patient safety**
* Bleeding precautions!!!
61
What medications should be avoided for Patients with Disseminated Intravascular Coagulation (DIC)
* aspirin
* NSAIDS
* beta-lactam antibiotics
62
*3rd type of Hemolitic Anemia*:
* Genetic (inherited) bleeding disorder characterized by the Ability of blood to clot is **severely** reduced
* Can be severe and occur with **minimal trauma**
Hemophilia
63
2 types of Hemophilia
1. Hemophilia A – defective **factor VIII**
2. Hemophilia B – defective **factor IX**
64
In HEMOPHILIA, About 75% of bleeding occurs in the ___.
joints
65
Q: How is hemophilia treated with clotting factor replacement?
3 treatments available
Treatment for hemophilia involves replacing the defective clotting factor through:
1. **Recombinant Clotting Factor Concentrates**: These are man-made factors that do not require transfusion consent
2. **Plasma-Derived Factor VIII and von Willebrand Factor**: These are derived from donated human plasma
3. **Prophylactic Administration**: Factors may be given preventively **before** traumatic procedures to minimize the risk of bleeding.
66
Q: How often do children with **hemophilia** typically receive prophylactic treatment, and why?
3 to 4 times a week to minimize the risk of joint complications
67
What ANTIBODY med is given to patients with HEMOPHILIA A?
Emicizumab- prevents bleeding
68
Nursing Management for Hemophilia
* Extensive education on activity restrictions to reduce risk of bleeding
* Teach how to administer factor concentrate at home at earliest sign of bleeding
* **Instruct to avoid aspirin, NSAIDS, alcohol, nettle, chamomile, alfalfa**
* Help families **develop written emergency plan in case of bleeding**
* Arrange genetic counseling if needed
**know**
69
Q: What symptoms are commonly associated with von Willebrand disease (vWD)?
* Frequent nosebleeds
* Easy bruising
* Heavy menstrual bleeding
* Prolonged bleeding after injuries or surgeries
70
*4th type of Hemolitic Anemia*:
Genetic (inherited) bleeding disorder caused by a deficiency or dysfunction of von Willebrand factor (vWF), a protein essential for blood clotting
von willebrand disease (vWD)
71
Goal of treatment for **von Willebrand Disease (vWD)**
REPLACE deficient protein at time of spontaneous bleeding or prior to invasive procedures
**know**
72
What is the **medication** is often used to **prevent bleeding** associated with dental and surgical procedures
Desmopressin
73
*von willebrand disease (vWD)*:
Platelet transfusion is done if
there is significant bleeding
74
What Blood Product can be given for von willebrand disease (vWD)
**Cryoprecipitate** (contains vWF and factor VIII) in emergency situations
