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N3 > Test 3- Part 2 > Flashcards

Test 3- Part 2 Flashcards

1
Q

2 main common side effects of Iron supplements

A
  1. Stools often appear black, may have constipation, cramping, nausea
  2. Liquid iron may stain teeth
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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.
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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.

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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)

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5
Q

Q: What is the primary approach to managing iron deficiency anemia?

A

treat the underlying cause

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6
Q

Q: What are the two types of iron replacement therapy?

A

oral and parenteral (injected).

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7
Q

Q: What are the 2 routes of administration for parenteral iron supplements?

A
  1. intramuscular (IM) injection
  2. intravenously (IV)- risk of an allergic reaction, and the patient should be monitored accordingly.
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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.
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9
Q

2nd type of Hypoproliferate anemia:

Occurs due to reduced production of erythropoietin hormone (EPO)

A

Anemia in Renal disease

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10
Q

Whats the main job of erythropoietin hormone (EPO)

A

is the hormone that signals the bone marrow to produce RBCs

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11
Q

Renal Disease Anemia is more sever in what type of patients.

A

patients with BOTH chronic kidney disease (CKD) and diabetes

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12
Q

3 MAIN troubling symptoms of Renal Disease Anemia

A
  • Increased cardiac output
  • Reduced oxygen utilization
  • Decreased libido
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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”

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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

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15
Q

What is pancytopenia

A

ALL blood cells are decreased
- Aplastic anemia should be called pancytopenia

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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

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17
Q

7 Treatments for Aplastic Anemia

A
  1. Immediate cessation of any medications/chemicals that may have triggered aplastic anemia.
  2. Stem Cell Transplant
  3. Immunosuppressive therapy- prevent T-cells (lymphocytes) from destroying stem cells
  4. Eltrombopag (Promacta) **
  5. Eryhtropoietin (EPO)
  6. Transfusion PRBCs
  7. Treat infections
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18
Q

Aplastic Anemia:

Immunosuppresive therapy will include a triple medication treatement.

What 3 meds are used

A
  1. Cyclosporoine
  2. Antithymocyte Globulin (ATG)
  3. Corticosteroids
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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)

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20
Q

Q: What are the 2 most common causes of Megaloblastic anemia?

A
  1. folic acid (folate) deficiency
  2. or Vitamin B12 (cobalamin) deficiency
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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

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22
Q

Lab test for Intrinsic Facor

A

Intrinsic antibody test

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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

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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
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25
Q

S/S for Megaloblastic anemia

A

All the usual signs of anemia PLUS
* Numbness or tingling in hands and feet (peripheral neuropathy **

know

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26
Q

Folic Acid Deficiency occurs with

A
  1. Alcohol abuse - alcohol ingestion increases folic acid requirements
  2. Pregnancy
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27
Q

Vitamin B12 Deficiency occurs with

A
  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)
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28
Q

Megaloblastic Anemia requires special assessment of

A

Neurologic- close attention to gait and stability with ambulation

know

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29
Q

How is vitamin B12 administered in the treatment of pernicious anemia?

2 options

A

B12 injections or nasal spray

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30
Q

2 types of Hemolytic Anemias
(caused by erythrocyte destruction)

A
  1. Thalassemia
  2. Sickle Cell Disease
31
Q

1st type under Hemolytic Anemias:

Genetic disorder caused by mutated genes that are responsible for making hemoglobin

A

Thalasssemia- Intrinsic Cause

32
Q

Thalassemia:

2 globin chains in hemoglobin are essential for the formation of hemoglobin

What are they

A
  1. Alpha α-Thalassemia
  2. Beta β-Thalassemia
33
Q

Q: What happens in Thalassemia anemia regarding alpha and beta globin chains?

A
  • either the alpha or beta globin chains are not being produced adequately.
  • This deficiency leads to an imbalance in hemoglobin production
34
Q

Q: In which populations is thalassemia commonly seen?

A

Meditterranean sea population

35
Q

There are 2 forms of Thalassemia

A
  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
Q

2 main S/S for Thalassemia Minor

A
  • Asymptomatic
  • Microcytic, hypochromic anemia
37
Q

5 S/S of Thalassemia Major

A
  • 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
Q

Tx for Thalassemia Minor

A

No treatment- can usually live a normal life
- body adapts to reduction of normal Hgb

39
Q

4 Treatments for Thalassemia Major

A
  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
Q

Review:

What are Chelating agents

A

bind and remove excess metals or minerals from the body, often used to treat metal poisoning or iron overload.

41
Q

Why is Splenectomy an option for Thalassemia

A
  • 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
Q

The ONLY cure for Thalassemia

A

Hematopoietic stem cell transplantation (HSCT)

43
Q

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
A

Sickle cell disease

44
Q

There are 2 types of Sickle Cell Disease

A
  1. Sickle Cell Anemia
  2. . Sickle Cell Trait
45
Q

The #1 S/S of Sickle Cell Disease

A

PAIN!!!- may need large doses of continuous opioids

KNOW

46
Q

Complications of Sickle Cell Dz have to do mostly with

A

blood clots.

  • Pulmonary infarctions
  • Retinal vessel obstruction
  • Renal failure
  • PE or stroke
  • Osteoporosis/osteosclerosis
47
Q

Care for Sickle Cell Dz includes

A
  • PAIN RELIEF **
  • Education
  • O2- no smoking
  • Vigilant assessment of respiratory system
48
Q

The ONLY med with some clinical benefit for Sickle Cell Disease

A

Hydroxyurea
* reduce the number of painful crises caused by disease and reduces the need for blood transfusions

know

49
Q

Another treatment choice for Sickle Cell Dz

A

Hematopoietic stem cell transplantation (HSCT)

50
Q

4 types of Hemostatic Anemia
(impaired blood clotting (hemostasis))

A
  • Thrombocytopenia
  • Disseminated intravascular coagulation (DIC)
  • Hemophilia
  • von Willebrand Disease
51
Q

1st type of Hemostatic Anemia

condition characterized by a low platelet count in the blood (below 150,000)

A

thrombocytopenia

52
Q

2 Main S/S of Thrombocytopenia

A
  1. Asymptomatic
  2. Bleeding
53
Q

Caring for Thrombocytopenic Patients

A
  1. Prevent or control hemorrhage – SAFETY
  2. Education: blowing nose, no bending with head lower than waist, use electric razor, no invasive procedures.
54
Q

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

A

Disseminated Intravascular Coagulation (DIC)

55
Q

Q: Does Disseminated Intravascular Coagulation (DIC) occur on its own?

A

No! Usually occurs as secondary response to another underlying condition, such as severe infection, malignancy, trauma, or complications during pregnancy.

56
Q

Q: How does Disseminated Intravascular Coagulation (DIC) lead to organ failure?

A
  • 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
Q

DIC:

Over time clotting factors are consumed and ____ then occurs

A

bleeding

58
Q

How do we treat Disseminated intravascular coagulation (DIC)

A

treat underlying cause – may reverse DIC

59
Q

What blood products may be necesary for Disseminated intravascular coagulation (DIC) while treating disorder?

A

Platelets, cryoprecipitate, Frozen Fresh Plasma

60
Q

Nurse prioriteis for Disseminated intravascular coagulation (DIC)

A
  • Monitor VS closely- including Neurological checks
  • recognize s/sx of DIC
  • patient safety
  • Bleeding precautions!!!
61
Q

What medications should be avoided for Patients with Disseminated Intravascular Coagulation (DIC)

A
  • aspirin
  • NSAIDS
  • beta-lactam antibiotics
62
Q

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
A

Hemophilia

63
Q

2 types of Hemophilia

A
  1. Hemophilia A – defective factor VIII
  2. Hemophilia B – defective factor IX
64
Q

In HEMOPHILIA, About 75% of bleeding occurs in the ___.

A

joints

65
Q

Q: How is hemophilia treated with clotting factor replacement?

3 treatments available

A

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

Q: How often do children with hemophilia typically receive prophylactic treatment, and why?

A

3 to 4 times a week to minimize the risk of joint complications

67
Q

What ANTIBODY med is given to patients with HEMOPHILIA A?

A

Emicizumab- prevents bleeding

68
Q

Nursing Management for Hemophilia

A
  • 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

Q: What symptoms are commonly associated with von Willebrand disease (vWD)?

A
  • Frequent nosebleeds
  • Easy bruising
  • Heavy menstrual bleeding
  • Prolonged bleeding after injuries or surgeries
70
Q

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

A

von willebrand disease (vWD)

71
Q

Goal of treatment for von Willebrand Disease (vWD)

A

REPLACE deficient protein at time of spontaneous bleeding or prior to invasive procedures

know

72
Q

What is the medication is often used to prevent bleeding associated with dental and surgical procedures

A

Desmopressin

73
Q

von willebrand disease (vWD):

Platelet transfusion is done if

A

there is significant bleeding

74
Q

What Blood Product can be given for von willebrand disease (vWD)

A

Cryoprecipitate (contains vWF and factor VIII) in emergency situations

N3 (2 decks)

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