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NURSING 210 > Test 4 > Flashcards

Test 4 Flashcards

1
Q

Risk factors for RA

A

-Women between 40-60 years
-Family history
-Smokers
-Possible Genetic link

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2
Q

RA extra-articular manifestations

A

fever, fatigue, anemia, lymph node enlargement, Raynaud’s phenomenon and Sjogren’s syndrome(dry eyes/mucus membranes), skin and mucosal manifestations

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3
Q

RA treatment

A

no cure, treat/relieve manifestations, balance rest & exercise, PT and suppression of inflammatory processes

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4
Q

RA diagnostic tests

A

-rheumatoid factors
-sed rate
-CBC & infectious process/anemia
-asp. of sinovial fluid
-xray (shows demineralization/progression)
-c-reactive protein (will be elevated and shows inflammation)
-ANA & C3&C4 (shows complement levels)

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5
Q

RA pharmacologic therapies

A

-salisalates (aspirin)
-NSAIDS anti-inflamm.
-DEMARDS (disease modifying anti-rheumatic drugs)
-immune modulators
-TNF blockers (tumor necrosis blockers)

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6
Q

RA surgeries/procedures

A

-synovectomy
-arthrodesis
-arthroplasty
-plasmapheresis total lymphoid irradiation

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7
Q

Diagnostic criteria for RA

A

(4 of the following)
-morning stiffness lasting 1hr for 6 weeks
-arthritis w/ swelling of effusion of 3 or more joints lasting 6 weeks
-arthritis of the wrist, knuckles & PIP joints for 6 weeks
-symmetrical arthritis
-rheumatoid nodules
-positive rheumatoid factor(blood test)
-characteristic xray changes of RA

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8
Q

what is systemic lupus erythematosus?

A

a chronic inflammatory connective tissue disease that affects almost all body systems. Caused by deposition of antigen-antibody complexes in connective tissues

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9
Q

Lupus risk factors

A

-more women than men 9:1
-women of childbearing age
-drug-induced lupus– resolves when medication is discontinues
-need to be in remission for at least 6 months before becoming pregnant

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10
Q

lupus manifestations

A

butterfly rash, inflamm. of lungs, splenomegaly, arthritis in joints, glomerulonephritis, anti-nuclear antibodies, neurological damage, anemia, thrombocytopenia

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11
Q

lupus diagnostic tests

A

-complement levels (C4 will be low)
-H&H low (anemia)
-ANA would be positive
-sed rate would be high

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12
Q

lupus pharmacologic therapy– mild/remittent

A

little or no therapy

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13
Q

lupus pharmacologic therapy–skin/arrhythmic manifestations

A

antimalarial drugs
(plaquenil)

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14
Q

lupus pharmacologic therapy–severe& life threatening menifestations

A

corticosteroid therapy in high doses
-40-60mg prednisone daily
-taper as rapidly as the disease allows

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15
Q

lupus pharmacologic therapy

A

immunosuppressants, NSAIDS, steroids, DHEA (mild male hormone therapy that helps treat mild to moderate lupus symptoms)

client at risk for infection

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16
Q

lupus clinical therapy

A

-topical steroids
-avoid estrogens
-complementary therapies (exacerbation linked to stress & stress reducing techniques)

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17
Q

Nursing process for lupus

A

watch lungs, BUN&creatinine, look at heart, med. education, avoid the sun

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18
Q

how long do RBC’s live?

A

last about 90-120 days

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19
Q

if there is not enough O2 in the body what do they kidneys do?

A

release erythropoeitin and signals the bone marrow to produce more RBCs

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20
Q

what do B12 and folic acid do?

A

help make and develop healthy RBCs

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21
Q

anemia prevalence in the elderly?

A

bone marrows ability decreases and in an event they cant quickly compensate with new RBCs. This impacts cognition, mobility and increased depression

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22
Q

nutritional anemia

A

anemia based on the lack of certain nutritional elements in the diet

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23
Q

hemolytic anemia

A

inherited disorder of the RBC membrane (breaking of RBCs)

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24
Q

aplastic anemia

A

hypoproliferative (not making any RBCs)

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25
iron deficiency anemia
MOST COMMON from lack of iron intake, acute bleeding, alcoholism, pregnancy and GI malabsorption. Iron stores are depleted first followed by hemoglobin stores Iron helps carry O2= impairment of O2 delivery
26
what is feratin?
a supplement that holds onto the iron
27
frank blood & occult blood
frank blood= bright red occult blood= in the body/stool & black
28
iron deficiency anemia clinical manifestations
cheilosis (cracking of lips), pale, fatigue, possible dyspnea, tachy, brittle hair&nails, smooth red tongue in children: poor motor and emotional cognition
29
iron deficiency anemia treatment
increase vit. C & protein (iron), control chronic bleding, iron supplements * take iron 1 hour before meals on an empty stomach, and do not drink with milk
30
what to give if overloaded with iron?
deferoximine- binds with iron and removes it from the system s/s: N/V/D
31
what do the cells of someone with iron deficiency anemia look like?
small, pale cells
32
what do the cells of someone with vit. B12 deficiency anemia look like?
very large RBCs
33
why is vit.B12 important?
essential for DNA synthesis and nuclear maturation which leads to normal RBC maturation and division. -- helps make DNA
34
causes of vit.B12 deficiency anemia?
malnutrition (alcoholics & strict vegans), lack of intrinsic factor and underproduction of hydrochloric acid in the stomach (long term use of H-2 receptor blockers and PPIs)
35
what is pernicious anemia?
when there is a lack of intrinsic factor and thus decreases the absorption of B12 in the intestines. IF is made in the stomach.
36
vit.B12 deficiency anemia clinical manifeststions
**numbness and tingling of extremities (paresthesia), red beefy smooth tongue(glossitis)- in pernicious hypoxemia, pallor, jaundice, poor balance, anorexia, nausea, dementia, depression
37
vit.B12 deficiency anemia treatment
cyanocobalamin(IM B12), increase PO intake of B12 in food, and PO B12 supplements
38
what do folic acid deficiency anemia cells looks like?
Big RBC's (megaloblastic)
39
Why is folic acids role in the body?
it is required for DNA synthesis and RBC maturation
40
Foods high in folic acid
fruits, seafood, liver, whole grains and beans
41
risk factors of folic acid deficiency anemia?
celiac, chrons, alcoholics, people on anticonvulsants
42
treatment of folic acid deficiency anemia
PO folic acid, stop alcohol consumption and beef up diet in high folic acid foods
43
MCV low: microcytic cells
hemoglobin problem- need iron
44
MCV normal
Good RBC's but not enough- not a nutrition issue- blood loss
45
MCV high: macrocytic
DNA problem- B12 and folic acid
46
4 types of hemolytic anemia
thalassemia, acquired hemolytic anemia, glucose-6 phasphate dehydrogenase anemia and sickle cell anemia
47
thalassemia cause
recessive gene(must inherit the defective gene by both parents) most common in asians, mediterranians and africans
48
what do RBCs look like in thalassemia?
pale color of RBCs
49
thalassemia clinical manifestations
bronze skin, develops in first year of life, big bones due to bone marrow trying to grow more and more RBCs, splenomegaly
50
thalassemia treatment
blood tx, too much iron is being stored in testes, pancreas, thyroid and heart so chelation is needed to get rid of the excess iron
51
what should you do as the nurse for thalassemia
adm blood tx, 18G IV, encourage rest and recommend genetic counseling
52
acquired hemolytic anemia labs and diagnostics
direct and indirect coombs test
53
acquired hemolytic anemia treatment
steriod therapy for severe autoimmune, and stem cell transplant in aplastic anemia only, tx is same for both antibody and non-antibody types
54
glucose 6 phosphate dehydrogenase anemia (most common)
X linked recessive disorder where men are effected and females are carriers. Most common in asians africans and mediterranians
55
what can trigger glucose 6 phosphate dehydrogenase anemia
infections, drugs that increase oxidative stress, fava beans, ketoacidosis, moth balls and tonic water
56
glucose 6 phosphate dehydrogenase anemia clinical manifestations
weakness, tachy, jaundice, pallor, and RUQ pain because thats where the liver and gallbladder are (possible gallstones)
57
glucose 6 phosphate dehydrogenase anemia treatment
tx any infection quickly, avoid oxidant medication and foods (antimalarials, sulfonamides, nitrofurantoin and legumes), educate on food
58
sickle cell anemia
inherited recessive disorder causing abnormal hemoglobin
59
HgbS
linked to levels of O2 and stress
60
HgbF
highest in infants
61
RBCs of sickle cell anemia
sticky cells that clump up(hemolysis) and then occlude the capillaries
62
complications of sickle cell anemia
anemia, and blood vessel occlusion- stroke, death, tissue ischemia and tissue death
63
factors that cause sickling
cold, stress, physical exertion, infection, and illness that causes hypoxia, dehydration or acidosis
64
what to give in a sickle cell crisis
keep hydrated, medicate with narcotics- could lead to aplastic anemia
65
sickle cell anemia in pediatrics
leading cause of death, asymptomatic until 4-6 months(because of HgbF), prone to lung infections, high risk of stroke
66
sickle cell anemia in pregnant women
more freq pain crises, more intense symptoms and higher risk of complications
67
**sickle cell anemia treatment
blood tx(know when last one was), antibiotics prophalactically-hydroxyurea, increased HgbF- inhibits DNA synthesis and reduce pain crisis
68
what is aloe immunization
an immune response to foreign antigens- happens with multiple blood transfusions
69
aplastic anemia (hypoproliferative) cells
RBCs are normal size and color there just aren't enough- decreased red, white and platelets
70
aplastic anemia cause
is an immune response and not sure why it happens
71
pancytopenia
if there is a decrease in WBCs, RBCs and platelets
72
aplastic anemia treatment
immunosupressive therapy(prednisone), blood & platelet tx, bone marrow transplant(if cant be corrected) and splenectomy(last resort)
73
aplastic anemia nursing
monitor labs, neutropenic prec., bleeding prec., monitor for infection and emotional support esp. for bone marrow biopsy
74
testing for all anemias
-H&H will be LOW -reticulocyte count -MCV,MCH,MCHC (cell size) -iron studies -vit. B12 -folate -bone marrow asp.
75
hemophilia
inherited bleeding disorder, X linked genetic trait, females are more common
76
two types of hemophilia
hemophilia A- factor 8 is deficient or defective hemophilia B- factor 9 is deficient or defective
77
clinical manifestations of hemophilia
1st sign is joint pain, muscle/nerve swelling, poor wound healing, tarry stools, prolonged bleeding, hemmorhage, hematuria
78
what happens in severe hemophilia
you can just randomly spontaneously bleed out of nowhere
79
hemophilia treatment
fresh frozen plasma, factor replacement therapy(may be everyday is severe), prophylaxis and glucocorticoids for joint pain and edema

NURSING 210 (5 decks)

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