Test 3- Part 2 Flashcards
2 main common side effects of Iron supplements
- Stools often appear black, may have constipation, cramping, nausea
- Liquid iron may stain teeth
When might a patient need to take iron supplements with food, and what is the impact on absorption?
- If they experience GI discomfort.
- This can lead to decreased absorption, resulting in a longer time to replenish iron stores.
Q: How can sustained-release iron supplements affect GI side effects?
May help decrease GI side effects compared to standard formulations, providing a gentler option for patients.
Q: What precautions should be taken when using liquid iron supplements to prevent tooth staining?
- drink it with a straw
- rinse the mouth afterward to minimize staining
(liquid iron is undiluted=stronger)
Q: What is the primary approach to managing iron deficiency anemia?
treat the underlying cause
Q: What are the two types of iron replacement therapy?
oral and parenteral (injected).
Q: What are the 2 routes of administration for parenteral iron supplements?
- intramuscular (IM) injection
- intravenously (IV)- risk of an allergic reaction, and the patient should be monitored accordingly.
Q: What precautions should be taken when administering intramuscular (IM) iron solutions?
- may stain the skin
- therefore, separate needles should be used for withdrawing the solution and for injecting the medication.
2nd type of Hypoproliferate anemia:
Occurs due to reduced production of erythropoietin hormone (EPO)
Anemia in Renal disease
Whats the main job of erythropoietin hormone (EPO)
is the hormone that signals the bone marrow to produce RBCs
Renal Disease Anemia is more sever in what type of patients.
patients with BOTH chronic kidney disease (CKD) and diabetes
3 MAIN troubling symptoms of Renal Disease Anemia
- Increased cardiac output
- Reduced oxygen utilization
- Decreased libido
3RD type of Hypoproliferate anemia:
Rare, life-threatening disease – caused by a decrease or damage to bone marrow stem cells = bone marrow failure
Aplastic anemia
“not forming”
How exactly does bone marrow fail in Aplastic anemia
Body’s T-cells attack bone marrow – bone marrow is replaced with FAT
What is pancytopenia
ALL blood cells are decreased
- Aplastic anemia should be called pancytopenia
Q: What complications can arise from aplastic anemia due to bone marrow failure?
All the usual signs of anemia PLUS
* bleeding **
* infection **
* cardiac arrhythmias
* heart failure
7 Treatments for Aplastic Anemia
- 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
Aplastic Anemia:
Immunosuppresive therapy will include a triple medication treatement.
What 3 meds are used
- Cyclosporoine
- Antithymocyte Globulin (ATG)
- Corticosteroids
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
B12 or Folic Acid Deficiency
(Megaloblastic anemias)
Q: What are the 2 most common causes of Megaloblastic anemia?
- folic acid (folate) deficiency
- or Vitamin B12 (cobalamin) deficiency
Q: How does a deficiency of intrinsic factor contribute to megaloblastic anemia?
deficiency of intrinsic factor leads to decreased absorption of vitamin B12
- this is called pernicious anemia- a type of megaloblastic anemia
Lab test for Intrinsic Facor
Intrinsic antibody test
What does a POSITIVE Intrinsic Antibody test indicate?
indicates antibodies are present and are interfering with the binding of B12, preventing absorption
Q: How do symptoms of megaloblastic anemia typically develop?
- 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
S/S for Megaloblastic anemia
All the usual signs of anemia PLUS
* Numbness or tingling in hands and feet (peripheral neuropathy **
know
Folic Acid Deficiency occurs with
- Alcohol abuse - alcohol ingestion increases folic acid requirements
- Pregnancy
Vitamin B12 Deficiency occurs with
- Strict VEGAN diet- due to no meat or dairy
- Impaired absorption from GI tract - most common
- Absence of intrinsic factor (Pernicious Anemia)
Megaloblastic Anemia requires special assessment of
Neurologic- close attention to gait and stability with ambulation
know
How is vitamin B12 administered in the treatment of pernicious anemia?
2 options
B12 injections or nasal spray
2 types of Hemolytic Anemias
(caused by erythrocyte destruction)
- Thalassemia
- Sickle Cell Disease
1st type under Hemolytic Anemias:
Genetic disorder caused by mutated genes that are responsible for making hemoglobin
Thalasssemia- Intrinsic Cause
Thalassemia:
2 globin chains in hemoglobin are essential for the formation of hemoglobin
What are they
- Alpha α-Thalassemia
- Beta β-Thalassemia
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
Q: In which populations is thalassemia commonly seen?
Meditterranean sea population
There are 2 forms of Thalassemia
- Thalassemia Minor: milder form, typically has one mutated gene affecting either the alpha or beta globin chain
- Thalassemia Major: severe form; resulting from two mutated genes (one from each parent)
2 main S/S for Thalassemia Minor
- Asymptomatic
- Microcytic, hypochromic anemia
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
Tx for Thalassemia Minor
No treatment- can usually live a normal life
- body adapts to reduction of normal Hgb
4 Treatments for Thalassemia Major
- Blood transfusions: frequent blood transfusions to keep Hgb app. 10 g/dL
- Chelating agents - subcutaneous infusion of deferoxamine
- Splenectomy- removal of spleen
- Hematopoietic stem cell transplantation (HSCT)
-
Review:
What are Chelating agents
bind and remove excess metals or minerals from the body, often used to treat metal poisoning or iron overload.
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
The ONLY cure for Thalassemia
Hematopoietic stem cell transplantation (HSCT)
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
There are 2 types of Sickle Cell Disease
- Sickle Cell Anemia
- . Sickle Cell Trait
The #1 S/S of Sickle Cell Disease
PAIN!!!- may need large doses of continuous opioids
KNOW
Complications of Sickle Cell Dz have to do mostly with
blood clots.
- Pulmonary infarctions
- Retinal vessel obstruction
- Renal failure
- PE or stroke
- Osteoporosis/osteosclerosis
Care for Sickle Cell Dz includes
- PAIN RELIEF **
- Education
- O2- no smoking
- Vigilant assessment of respiratory system
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
Another treatment choice for Sickle Cell Dz
Hematopoietic stem cell transplantation (HSCT)
4 types of Hemostatic Anemia
(impaired blood clotting (hemostasis))
- Thrombocytopenia
- Disseminated intravascular coagulation (DIC)
- Hemophilia
- von Willebrand Disease
1st type of Hemostatic Anemia
condition characterized by a low platelet count in the blood (below 150,000)
thrombocytopenia
2 Main S/S of Thrombocytopenia
- Asymptomatic
- Bleeding
Caring for Thrombocytopenic Patients
- Prevent or control hemorrhage – SAFETY
- Education: blowing nose, no bending with head lower than waist, use electric razor, no invasive procedures.
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)
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.
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.
DIC:
Over time clotting factors are consumed and ____ then occurs
bleeding
How do we treat Disseminated intravascular coagulation (DIC)
treat underlying cause – may reverse DIC
What blood products may be necesary for Disseminated intravascular coagulation (DIC) while treating disorder?
Platelets, cryoprecipitate, Frozen Fresh Plasma
Nurse prioriteis for Disseminated intravascular coagulation (DIC)
- Monitor VS closely- including Neurological checks
- recognize s/sx of DIC
- patient safety
- Bleeding precautions!!!
What medications should be avoided for Patients with Disseminated Intravascular Coagulation (DIC)
- aspirin
- NSAIDS
- beta-lactam antibiotics
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
2 types of Hemophilia
- Hemophilia A – defective factor VIII
- Hemophilia B – defective factor IX
In HEMOPHILIA, About 75% of bleeding occurs in the ___.
joints
Q: How is hemophilia treated with clotting factor replacement?
3 treatments available
Treatment for hemophilia involves replacing the defective clotting factor through:
- Recombinant Clotting Factor Concentrates: These are man-made factors that do not require transfusion consent
- Plasma-Derived Factor VIII and von Willebrand Factor: These are derived from donated human plasma
- Prophylactic Administration: Factors may be given preventively before traumatic procedures to minimize the risk of bleeding.
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
What ANTIBODY med is given to patients with HEMOPHILIA A?
Emicizumab- prevents bleeding
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
Q: What symptoms are commonly associated with von Willebrand disease (vWD)?
- Frequent nosebleeds
- Easy bruising
- Heavy menstrual bleeding
- Prolonged bleeding after injuries or surgeries
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)
Goal of treatment for von Willebrand Disease (vWD)
REPLACE deficient protein at time of spontaneous bleeding or prior to invasive procedures
know
What is the medication is often used to prevent bleeding associated with dental and surgical procedures
Desmopressin
von willebrand disease (vWD):
Platelet transfusion is done if
there is significant bleeding
What Blood Product can be given for von willebrand disease (vWD)
Cryoprecipitate (contains vWF and factor VIII) in emergency situations
