Week 2 - Pulmonary & Hematology Flashcards
Pneumonia - acute infection of:
lung parenchyma
Pneumonia diagnostic
Chest X-ray
Sputum analysis
CBC
ABG’s
Pulse O2
BC
Thoracentesis
CRP
Procalcitonin
Expanded CURB-65 scale
Pneumonia categories
CAP [community]
HAP [hospital]
VAP [ventilator]
Pneumonia S&S
Dyspnea
Hypoxia
Cough
fever, chills
tachypnea
_________ chest pain
green/yellow/rust ___________
ALOC
Dyspnea
Hypoxia
Cough
fever, chills
tachypnea
pleuritic chest pain
green/yellow/rust sputum
ALOC
Pneumonia nursing management
O2
Abx
IVF
Antipyretics
Analgesics
Incentive spirometer
CDB [Cpugh, deep breathe]
I&O
Vaccine
Admission
Nutrition therapy
O2
Abx
IVF
Antipyretics
Analgesics
Incentive spirometer
CDB [Cpugh, deep breathe]
I&O
Vaccine
Admission
Nutrition therapy
Pneumonia complications
Sepsis/shock
Acute respiratory failure - intubation & MV
CURB-65 Scale scores
0-2 - low risk - outpatient
3-4 - medium - in patient
5-8- high risk - ICU
CURB-65 Scale
C- Confusion
U- BUN over 20
R- Resp over 30
B- BP under 90/60
Over 65 years old
Expanded Curb 65 factors
LDH over 230
Albumin under 3.5
Platelets under 100 x 10^9
Empiric Antibiotic Treatment (PNA)
Tuberculosis - infectious disease caused by ______________
Mycobacterium Tuberculosis
Tuberculosis classifications
Primary infection
Active
Latent
Tuberculosis S&S
______________ cough
fatigue
malaise
anorexia
weight loss
low-grade _____
______ sweats
dyspnea
____________ (late)
ALOC
Dry-productive cough
fatigue
malaise
anorexia
weight loss
low-grade fever
night sweats
dyspnea
hemoptysis (late)
ALOC
Tuberculosis diagnostics
Tuberculin _____ test
IGRAs
Chest _______
Tuberculin skin test
IGRAs
Chest X-ray
Tuberculosis nursing management
___________ isolation
immediate medical workup
identify & screen close ____________
patient teaching
airborne isolation
immediate medical workup
identify & screen close contacts
patient teaching
Tuberculosis drug therapy
Isoniazid (INH)
Rifampin (Rifadin)
Pyrazinamide
Ethambutol
Take all 4 drugs daily for 8 weeks
then take first 2 drugs for 7 months
[Risk for liver toxicity] - avoid alcohol, monitor for liver issues
Pulmonary Embolism (PE) - ______________ pulmonary arteries by a thrombus, fat, or air embolus, or tumor
blockage of 1+
Pulmonary Embolism (PE) risk factor
Virchow’s triad
Oral contraceptives
Afib
Virchows triad -
3 factors that predisposes to blood clot formation/ PE
Venous stasis
endothelial damage
blood hypercoagulability
Pulmonary Embolism (PE) S&S
Dyspnea, wheezing
Hypoxemia
Tachypnea, tachycardia
Hypo_______
Cough, chest pain
syncope
hypo________
shock
feeling of ____________
Dyspnea, wheezing
Hypoxemia
Tachypnea, tachycardia
Hypocarbia
Cough, chest pain
syncope
hypotension
shock
feeling of impending doom
Pulmonary Embolism (PE) diagnostics
D-______
CT( CTA)
V/Q Scan
D-dimer
CT( CTA)
V/Q Scan
Pulmonary Embolism (PE) nursing management
O2
_____-fowler
VS, pulse oximetry
cardiac monitor
ABGs
______ sounds
IV line, IVF
Heparin, Coumadin
Embolectomy
O2
Semi-fowler
VS, pulse oximetry
cardiac monitor
ABGs
lung sounds
IV line, IVF
Heparin, Coumadin
Embolectomy
Asthma = heterogenous disease characterized by a combination of clinical manifestations along with reversible expiratory airflow limitation or ______________ _____________
Asthma = heterogenous disease characterized by a combination of clinical manifestations along with reversible expiratory airflow limitation or bronchial hyperresponsiveness
Asthma complication
Status asthamaticus - an extreme form of asthma ____________ characterized by hypoxemia, hypercarbia, and secondary __________ failure
Status asthamaticus - an extreme form of asthma exacerbation characterized by hypoxemia, hypercarbia, and secondary respiratory failure
Asthma risk factors
Allergens
EIA
air pollutants
infections
Drugs
GERD
stress
Allergens
EIA
air pollutants
infections
Drugs
GERD
stress
Asthma S&S
cough
______ production
shortness of breath, dyspnea
wheezing
chest ___________
unpredictable/ variable
cough
mucus production
shortness of breath, dyspnea
wheezing
chest tightness
unpredictable/ variable
Asthma diagnostics
PEFR [peak exp. flow meter]
chest x-ray
oximetry
PEFR [peak exp. flow meter]
chest x-ray
oximetry
Asthma nursing management
_______ fowler’s
O2
Bronchodilators
corticosteroids
assess lung sounds
severe asthma- Iv Mg, intubate, MV
High fowler’s
O2
Bronchodilators
corticosteroids
assess lung sounds
severe asthma- Iv Mg, intubate, MV
Asthma- Drug therapy
-Short acting Beta Agonist (SABA) - ________
-Anticholinergics - Ipratropium
-Long acting Beta Agonist (LABA) - Salmeterol, Formoterol
-Methylxanthines (Theophylline)
-Inhaled corticosteroids (ICS) - Beclomethasone, Budesonide
-___________ modifiers - Zafirlukast, Montelukast, Pileuton
-Anti IgE - Xolair
-Short acting Beta Agonist (SABA) - albuterol
-Anticholinergics - Ipratropium
-Long acting Beta Agonist (LABA) - Salmeterol, Formoterol
-Methylxanthines (Theophylline)
-Inhaled corticosteroids (ICS) - Beclomethasone, Budesonide
-Leukotriene modifiers - Zafirlukast, Montelukast, Pileuton
-Anti IgE - Xolair
COPD - characterized by __________ ____________ caused by chronic bronchitis or emphyesema or both
airflow obstruction
risk factors for COPD
__________
air pollution
resp. ___________
A1-Antitrypsin deficiency
smoking
air pollution
resp. infection
A1-Antitrypsin deficiency
COPD S&S
Chronic bronchitis:
cough & sputum for 3+ months
Hypoxemia, wheezing
peripheral edema
hypercarbia, acidosis
Emphysema:
Alveolar destruction
dyspnea
purse lip breathing
underweight, anorexia
chronic fatigue
barrell chestr
polycthemia, cyanosis
Chronic bronchitis:
cough & sputum for 3+ months
Hypoxemia, wheezing
peripheral edema
hypercarbia, acidosis
Emphysema:
Alveolar destruction
dyspnea
purse lip breathing
underweight, anorexia
chronic fatigue
barrell chestr
polycthemia, cyanosis
COPD diagnostics
increased FRC due to auto PEEP
decreased FEV1
chest x-ray
ABGs
Sputum culture
CBC
increased FRC due to auto PEEP
decreased FEV1
chest x-ray
ABGs
Sputum culture
CBC
COPD- drug therapy
COPD complications
Pulmonary _____
Cor Pulmonale [______side heart disease]
Excacerbations of COPD
Acute _______ . failure
Peptic ulcer disease
depression/anxiety
Pulmonary HTN
Cor Pulmonale [right side heart disease]
Excacerbations of COPD
Acute resp. failure
Peptic ulcer disease
depression/anxiety
COPD nursing management
Fowlers/ lean forward
VS, BiPAP, meds, breathing techniques
if necessary, lung suction
Assess sputum
weight
small, freq. meals, high cal/protein
Fluids to thin secretions
Fowlers/ lean forward
VS, BiPAP, meds, breathing techniques
if necessary, lung suction
Assess sputum
weight
small, freq. meals, high cal/protein
Fluids to thin secretions
Anemia is the ___________ in either RBC, PRBC/hematocrit, or hemoglobin
reduction
Anemia S&S
fatigue
dyspnea
dizziness
cold hands and feet
pale
palpitations
fatigue
dyspnea
dizziness
cold hands and feet
pale
palpitations
Iron deficiency anemia S&S
General anemia S&S
pallor
glossitis (tongue)
Cheilitis (lips)
HA
burning on tongue
General anemia S&S
pallor
glossitis (tongue)
Cheilitis (lips)
HA
burning on tongue
Anemia diagnostics
H/H [HGB, HCT]
reticulocytes
iron, transferrin
bilirubin
H/H [HGB, HCT]
reticulocytes
iron, transferrin
bilirubin
Anemia nursing management
Correct _______
O2 if needed
______ (packed RBC)
IVF, lifestyle/diet changes
fatigue management/safety
Correct cause
O2 if needed
PRBC (packed RBC)
IVF, lifestyle/diet changes
fatigue management/safety
Iron deficiency anemia = most _______ type of anemia
common
Iron deficiency anemia etiology
diet
malabsorption
blood loss
hemolysis
diet
malabsorption
blood loss
hemolysis
Cobalamin (B12) deficiency etiology
____ surgery, Crohns/Celiac
Long term use ____ or H2 blockers
alcohol, poor diet
pernicious anemia
GI surgery, Crohns/Celiac
Long term use PPI or H2 blockers
alcohol, poor diet
pernicious anemia
Cobalamin deficiency (B12) S&S
general anemia S&S
Sore, red, beefy, shiny _______
A/N/V, Abd pain
Weakness, ___________
confusion, severe memory loss
general anemia S&S
Sore, red, beefy, shiny tongue
A/N/V, Abd pain
Weakness, paresthesia
confusion, severe memory loss
Cobalamin deficiency (B12) diagnostics
CBC
Vit B12 levels
________ test [cobalamin absorption measured with radioactive urine]
CBC
Vit B12 levels
Schilling test [cobalamin absorption measured with radioactive urine]
Cobalamin deficiency (B12) nursing management
dietary intake of ____
orar/parenteral/__________replacement
dietary intake of B12
orar/parenteral/intranasal replacement
Folic acid deficiency [B9] etiology
poor nutrition
malabsorption
alc, drugs
poor nutrition
malabsorption
alc, drugs
Folic acid deficiency [B9] S&S
General anemia S&S
Smooth, beefy ________
prone to mouth ________
General anemia S&S
Smooth, beefy tongue
prone to mouth sores
Folic acid deficiency [B9] diagnostics
_________ levels
CBC
Folic acid levels
CBC
Folic acid deficiency [B9] nursing management -
Dietary/oral replacement
Sickle cell anemia etiology
_________ disorder; homozygous Hb SS [from both parents]
formation of abnormal HGB chains; S shapes clump in capillaries
common in ______________
genetic disorder; homozygous Hb SS [from both parents]
formation of abnormal HGB chains; S shapes clump in capillaries
common in african americans
Sickle cell anemia; conditions causing ___________ of RBCs:
hypoxia
dehydration
infections
venous stasis
low env. body temp
acidosis
strenuous exercise
anesthesia
sickling
Sickle cell anemia S&S
Sickling criss
chronic anemia
pain
organ damage
jaundice
cholelithiasis
Sickling criss
chronic anemia
pain
organ damage
jaundice
cholelithiasis
Sickle cell anemia nursing management
PRBC
pain
O2
Abx
DVT prophylaxis
rest, IVF, electrolytes
_____ cell transplant, pt teaching
PRBC
pain
O2
Abx
DVT prophylaxis
rest, IVF, electrolytes
stem cell transplant, pt teaching
Thrombocytopenia - bone marrow doesnt make enough platements, or body _________ platelets
destroys
Thrombocytopenia S&S
Epistaxis
bleeding gums
petechiae
purpura, ecchymosis
prolonged bleeding
dizzy, tachycardia, faint
intracranial bleeding, blood in urine
Epistaxis
bleeding gums
petechiae
purpura, ecchymosis
prolonged bleeding
dizzy, tachycardia, faint
intracranial bleeding, blood in urine
Thrombocytopenia 3 types
ITP
TTP
HIT
Immune Thrombocytopenia Purpura - immune disorder; antiplatelet antibodies
Thrombotic Thrombocytopenic Purpura - enhanced aggregation of platelets that form microthrombi that deposit in arterioles/capillaries
Heparin-induced thrombocytopenia - 5-10 days after heparin therapy
Polycthemia Vera - overproduction of :
RBC, WBC, PLT
Polycthemia Vera etiology
______________ in single stem cell, JAK2 gene
DNA mutations
Polycthemia Vera S&S
HTN caused by hyperviscosity and hypervolemia
HA, vertigo
vision problems
itching, MI, HF, stroke, bleeding, gout
HTN caused by hyperviscosity and hypervolemia
HA, vertigo
vision problems
itching, MI, HF, stroke, bleeding, gout
Polycthemia Vera diagnostics:
RBC, PLT, WBC
Neutropenia is
low neutrophils under 1000
Neutropenia etiology
________/immunosuppressive therapy; autoimmune disease
chemo/immunosuppressive therapy; autoimmune disease
Neutropenia S&S
infection
treat fever aggresively
RISK: ________
infection
treat fever aggresively
RISK: sepsis
Neutropenia nursing management
monitor for __________
find cause
collect BC x2
Start Abx (broad spectrum until cause known)
may need antifungals, Neupogen
Reverse isolation
monitor for infection
find cause
collect BC x2
Start Abx (broad spectrum until cause known)
may need antifungals, Neupogen
Reverse isolation
Lobes of the lung
Right lung - 3 lobes
Left lung- 2 lobes
3 Mechanisms of the Respiratory System
- __________ : inhaling O2 , exhaling CO2 (very important for ventilation), Diaphragm
important muscle (promotes ventilation - ___________ : gas exchange occurs in alveoli, O2 and CO2 exchange
- ___________ : inhaled O2 is carried by RBCs and then transported to cells
3 Mechanisms of the Respiratory System
- Ventilation: inhaling O2 , exhaling CO2 (very important for ventilation), Diaphragm
important muscle (promotes ventilation - Diffusion: gas exchange occurs in alveoli, O2 and CO2 exchange
- Perfusion: inhaled O2 is carried by RBCs and then transported to cells
___________ : inhaling O2 , exhaling CO2 (very important for ventilation), Diaphragm
important muscle (promotes ventilation)
Ventilation
Diffusion: ______________ occurs in alveoli, O2 and CO2 exchange
gas exchange
Perfusion: inhaled O2 is carried by _____ and then transported to cells
RBCs
Inhale O2 -> Lungs -> Alveoli -> Gas Exchange occurs (O2 and CO2 from high concentration to low – diffusion) -> O2 now in RBC (each hemoglobin can bind 4 O2)
Inhale O2 -> Lungs -> Alveoli -> Gas Exchange occurs (O2 and CO2 from high concentration to low – diffusion) -> O2 now in RBC (each hemoglobin can bind 4 O2)
●SpO2 (______________): measures amt of O2 saturated in the hemoglobin of the 4 hemes
● PaO2 (_______________): measures O2 outside RBCs,dissolved in blood
●SpO2 (Oxygen Saturation): measures amt of O2 saturated in the hemoglobin of the 4 hemes
● PaO2 (Partial Oxygen): measures O2 outside RBCs,dissolved in blood
A patient with chronic obstructive pulmonary disease (COPD) has been eating very little and
has lost weight. Which intervention would be most appropriate for the nurse to include in the plan of care?
a. Encourage increased intake of whole grains.
b. Increase the patient’s menu order of fruits and fruit juices.
c. Offer high-calorie protein snacks between meals and at bedtime.
d. Assist the patient in choosing foods with high vegetable content.
c. Offer high-calorie protein snacks between meals and at bedtime.
Eating small amounts more often (as occurs with snacking) will increase caloric
intake by decreasing the fatigue and feelings of fullness associated with large
meals. Patients with COPD should rest before meals. Foods that have a lot of texture
such as whole grains may take more energy to eat and get absorbed and lead to
decreased intake. Although fruits, juices, and minerals are not contraindicated,
foods high in protein are a better choice.
Which action should the nurse take to prepare a patient for spirometry?
a. Give the rescue medication immediately before testing.
b. Administer oral corticosteroids 2 hours before the procedure.
c. Withhold bronchodilators for 6 to 12 hours before the examination.
d. Ensure that the patient has been NPO for several hours before the test
c. Withhold bronchodilators for 6 to 12 hours before the examination.
Bronchodilators are held before spirometry so that a baseline assessment of airway function can be determined. Testing is repeated after bronchodilator use to determine whether the
decrease in lung function is reversible. There is no need for the patient to be NPO. Oral
corticosteroids should be held before spirometry. Rescue medications (which are bronchodilators) would not be given until after the baseline pulmonary function was assessed.
The nurse teaches a patient who has asthma about peak flowmeter use. Which action by the
patient indicates that teaching was successful?
a. The patient inhales rapidly through the peak flowmeter mouthpiece.
b. The patient takes montelukast (Singulair) for peak flows in the red zone.
c. The patient uses albuterol (Ventolin HFA) for peak flows in the yellow zone.
d. The patient calls the health care provider when the peak flow is in the green zone.
c. The patient uses albuterol (Ventolin HFA) for peak flows in the yellow zone.
Readings in the yellow zone indicate a decrease in peak flow. The patient should use
short-acting Beta 2-adrenergic (SABA) medications. Readings in the green zone indicate good
asthma control. The patient should exhale quickly and forcefully through the peak flowmeter
mouthpiece to obtain the readings. Readings in the red zone do not indicate good peak flow,
and the patient should take a fast-acting bronchodilator and call the health care provider for
further instructions. Singulair is not indicated for acute attacks but is used for maintenance
therapy
The nurse provides dietary teaching for a patient with chronic obstructive pulmonary disease (COPD) who has a low body mass index (BMI). Which patient statement indicates that the teaching has been effective?
a. “I will drink lots of fluids with my meals.”
b. “I will exercise for 15 minutes before meals.”
c. “I will decrease my intake of meat and poultry.”
d. “I can have ice cream as a snack every day.”
d. “I can have ice cream as a snack every day.”
High-calorie foods such as ice cream are an appropriate snack for patients with COPD. Fluid
intake of 3 L/day is recommended, but fluids should be taken between meals rather than with meals to improve oral intake of solid foods.
The nurse determines that the patient understood medication instructions about the use of
a spacer device when taking inhaled medications after hearing the patient state what as the
primary benefit?
a) “I will pay less for medication because it will last longer.”
b) “More of the medication will get down into my lungs to help my breathing.”
c) “Now I will not need to breathe in as deeply when taking the inhaler medications.”
d) “This device will make it so much easier and faster to take my inhaled medications.”
b) “More of the medication will get down into my lungs to help my breathing.”
A spacer assists more medication to reach the lungs, with less being deposited in the mouth
and the back of the throat. It does not affect the cost or increase the speed of using the inhaler.
Normal SpO2 is
95-100%
●SpO2 (Oxygen Saturation): measures amt of _________________ in the hemoglobin of the 4 hemes
O2 saturated
● PaO2 (Partial Oxygen): measures O2 outside RBCs, ________________
dissolved in blood
2 Problems during Respiration
Physiological Dead Space
Intrapulmonary Shunt
Resp Problem: Physiological Dead Space (area of no gas exchange): breathing in air, but _____________ is not occurring
Areas of Dead space
1. MOST COMMON: obstruction from Pulmonary Embolism/blood clot prevents RBC from picking up O2 in alveoli
- COPD (destruction of alveoli with emphysema)
gas exchange
Intrapulmonary Shunt: occurs when ________ is filled with mucus, fluid or pus
Examples of Intrapulmonary Shunting
1. Pneumonia: filling alveoli with pus, no gas exchange
2. Pulmonary Edema
3. ARDS (Acute Respiratory Distress Syndrome)
alveoli
Nasal Canula –> ____ L
Simple Mask –> _____ L
Nasal Canula –> 1-6 L
Simple Mask –> 6-12L
Non-Rebreather –> ______ L/min,Pure O2, CO2 filtered out
10 -15
CPAP –> Continuous___________airway- only one pressure provided
positive
BiPAP –> Bilevel positive airway pressure (Noninvasive)
- High pressure Inhaling
- Lower pressure Exhaling (Pt does not have to overcome as much pressure when exhaling)
- Pressure forces _________ to ________ & facilitate mores oxygen exchange
alveoli to open
High Flow Nasal Cannula
- Humidified to body temperature
- ___ L, does not provide pressure support like CPAP, BiPAP
- Less Restrictive
60L
Pneumonia - Lower respiratory tract infection that causes inflammation of the _____________
alveoli sacs
Types
* CAP: ___________ acquired
* HAP: _________ acquired
* VAP: ___________ associated
- CAP: community acquired
- HAP: hospital acquired
- VAP: ventilation associated
Pneumonia Risk factors
- Prior infection
- Smoking
- Lung disease
- Immunocompromised
- Immobility
- Prior infection
- Smoking
- Lung disease
- Immunocompromised
- Immobility
Pneumonia Clinical Manifestations
* Dyspnea
* Hypoxia ( avevoli filled with mucus and pus)
* Cough
* Fever
* Chills
* Productive cough (purulent sputum)
* Increased RR, HR
* Chest pain
* Fever > 100.3, sweating/chills
- Dyspnea
- Hypoxia ( avevoli filled with mucus and pus)
- Cough
- Fever
- Chills
- Productive cough (purulent sputum)
- Increased RR, HR
- Chest pain
- Fever > 100.3, sweating/chills
Pneumonia Complications
* Sepsis, septic shock
* Acute respiratory failure
* MV
- Sepsis, septic shock
- Acute respiratory failure
- MV
Pulmonary Embolism: BLOCKAGE in one or more of the pulmonary arteries caused by _______________ that travel to the lungs from the deep veins. LIFE THREATENING!
blood clots
Pulmonary Embolism S/S:
* Dyspnea
* Hypoxemia
* Wheezing
* Hypocarbia
* Chest pain
* Hypotension shock
* Feeling of impending doom
* Tachycardia
- Dyspnea
- Hypoxemia
- Wheezing
- Hypocarbia
- Chest pain
- Hypotension shock
- Feeling of impending doom
- Tachycardia
Pulmonary Embolism Treatment
- lovenox and coumadin (PT/INR)
- Unfractionated heparin (aPTT)
- TPA: clot buster
- Embolectomy: surgery to remove the ______
- lovenox and coumadin (PT/INR)
- Unfractionated heparin (aPTT)
- TPA: clot buster
- Embolectomy: surgery to remove the clot
Receptors in lung vs heart
Lung- B1 receptos
Heart- B2 receptors
why is COPD associated with being underweight?
2 reasons
burning more calories due to breathing
hyperinflation = diaphragm stays flat - presses stomach = “full” sensation
For COPD, be cautious giving too much oxygen, because it will reduce their ______________
drive to breathe
WBC range
5,000 - 10,000 mm^3
PLT platelets range
150 - 400 k/uL
INR range
0.8 - 1.1
or
2 - 3 (warfarin)
_________ - reduction in erythrocyes/RBC, hemoglobin OR volume of hematocrit (PRBC)
Anemia
HGB range
12 - 16
HCT range
37 - 52%
HGB below ___ is really not good
7
Iron deficiency anemia diagnostics
CBC
Serum iron
serum ferritin
TIBC total iron-binding capacity
CBC
Serum iron
serum ferritin
TIBC total iron-binding capacity
Iron deficiency anemia nursing management
find cause
oral, IM or IV iron; with OJ before food [liquid stains teeth - use straw]
SE: constipation, black stool
find cause
oral, IM or IV iron; with OJ before food [liquid stains teeth - use straw]
SE: constipation, black stool
Polycthemia Vera nursing management
phlebotomoy
balance hydration
low dose ASA, hydroxyurea
phlebotomoy
balance hydration
low dose ASA, hydroxyurea
Immune Thrombocytopenia Purpura - immune disorder; antiplatelet __________
Thrombotic Thrombocytopenic Purpura - enhanced ____________ of platelets that form microthrombi that deposit in arterioles/capillaries
Heparin-induced thrombocytopenia - 5-10 days after _________ therapy
Immune Thrombocytopenia Purpura - immune disorder; antiplatelet antibodies
Thrombotic Thrombocytopenic Purpura - enhanced aggregation of platelets that form microthrombi that deposit in arterioles/capillaries
Heparin-induced thrombocytopenia - 5-10 days after heparin therapy
Thrombocytopenia nursing management
ITP: corticosteroids, splenectomy, IV Immunoglobulins, platelets if under ____
TTP: plasma exchange/ plasmapheresis, corticosteroids, splenectomy or immusupp. meds, NO platelets (increased clotting)
HIT: D/C heparin, start Factor XA inhibitor: Arixtra, No platelet transfusion; NEVER receieve heparin/Lovenox again
ITP: corticosteroids, splenectomy, IV Immunoglobulins, platelets if under 10k
TTP: plasma exchange/ plasmapheresis, corticosteroids, splenectomy or immusupp. meds, NO platelets (increased clotting)
HIT: D/C heparin, start Factor XA inhibitor: Arixtra, No platelet transfusion; NEVER receieve heparin/Lovenox again
Asthma: a chronic lung disease that cause inflammation and _______________________ and bronchioles
narrowing of the bronchi
Pulmonary Embolism Prevention
* Educate the patient on ___________ to avoid
* Early ___________ post surgery
* Prophylactic ____________ medications
- Educate the patient on risk factors to avoid
- Early ambulation post surgery
- Prophylactic anticoagulation medications
Asthma Complication
Status Asthmaticus: acute, severe asthma that is ____________ to standard treatments
unresponsive
Asthma Nursing Management:
* High fowlers (open lungs), O2
* Corticosteroids, bronchodilators
* Assess lung sounds
* Severe asthma – IV Mg (relax smooth muscle, monitor BP )
* Intubate (status asthmaticus)
- High fowlers (open lungs), O2
- Corticosteroids, bronchodilators
- Assess lung sounds
- Severe asthma – IV Mg (relax smooth muscle, monitor BP )
- Intubate (status asthmaticus)
Asthma Drug Therapy
Pnemonic AIM
Albuterol
Impatropium
Methylpredisolone
COPD Progressive and chronic lung disease characterized by long term inflammation and ___________ in the ____________ , which leads to difficulty breathing and shortness of breath
There are 2 classifications of chronic bronchitis and emphysema
scarring in the airways
Chronic Bronchitis –
chronic productive cough and sputum production for >3 months/ 2 consecutive years
* mucus secretion, airway obstruction
Pneumonic BLUE
- B: big and blue skin (cyanosis)
- L: long term productive cough
- U: unusual lung sounds: crackles and wheezes
- E: edema (due to cor pulmonale)
Emphysema- occurs when the alveolar membrane breaks down
- Chronic fatigue
- Dyspnea
- “pink puffers”
Pneumonic PINK
- P: pink skin and pursed lip breathing
- I: increased chest “barrel chest”
- N: no chronic cough (minimal)
- K: keep tripoding
COPD Risk Factors
* SMOKING
* Advanced age
* Occupational exposure, air pollution , dust chemical exposure
* Alpha 1 antitrypsin deficiency
- SMOKING
- Advanced age
- Occupational exposure, air pollution , dust chemical exposure
- Alpha 1 antitrypsin deficiency
COPD Treatment
* Oxygen therapy (NC or bipap)
* Encourage smoking cessation and avoid air pollutant
* Encourage coughing to remove excess mucus
* Monitor all respiratory parameters
* Medications à bronchodilators: relieve bronchospasm
à inhaled steroids: reduce inflammation
à antibiotics: infection * Non pharmacological management
- Oxygen therapy (NC or bipap)
- Encourage smoking cessation and avoid air pollutant
- Encourage coughing to remove excess mucus
- Monitor all respiratory parameters
- Medications à bronchodilators: relieve bronchospasm
à inhaled steroids: reduce inflammation
à antibiotics: infection * Non pharmacological management
____________ : process to stop and prevent bleeding
Hemostasis
- Iron Requirement = ____ mg daily
25
- 2 types of iron
Heme (______ ; body absorbs more) and Non-Heme (_______ source)
*vegetarians develop iron deficiency anemia b/c notgetting enough heme (Meat)
- 2 types of iron
Heme (Meat; body absorbs more) and Non-Heme (plant source)
*vegetarians develop iron deficiency anemia b/c notgetting enough heme (Meat)
Millions of Hgb in 1 RBC
- Each Hgb = ___ hemes/irons
- Each 4 hemes bind to ____
- Body recycles iron (lifespan 120 days)
- Each Hgb = 4 hemes/irons
- Each 4 hemes bind to O2
- Body recycles iron (lifespan 120 days)
Main Storage of Iron = _______
Liver
Hemochromatosis: Iron overload causes _____________
liver failure
Storage
Ferritin & ____________ transport iron to cells for storage
Hemosiderin
Following an Injury -> 3 Processes
- _____________ : leakage of blood by restricting vessel size and pressing endothelial surfaces together (keep
vessel closed to allow for platelet response) - _____________________ : platelet plug o Aspirin is an anti-platelet (good for heart attacks)
- _______________ due to fibrin:
o Fibrin is a protein that forms a fibrous protein to stabilize the platelet plug and trap clotting factors, RBCs and Plts to promote formation
o Fibrinogen: precursor to fibrin and essential for clotting
- Vasoconstriction : leakage of blood by restricting vessel size and pressing endothelial surfaces together (keep
vessel closed to allow for platelet response) - Platelet Aggregation: platelet plug o Aspirin is an anti-platelet (good for heart attacks)
- Coagulation due to fibrin:
o Fibrin is a protein that forms a fibrous protein to stabilize the platelet plug and trap clotting factors, RBCs and Plts to promote formation
o Fibrinogen: precursor to fibrin and essential for clotting
__________ converts Fibrinogen -> Fibrin
Thrombin
_________ : Reduction in either the number of erythrocytes (RBC’s, the quantity of hemoglobin or volume of PRBC’s (hematocrit)
Anemia
Anemia Causes
- _____________ /GI ____________
- __________ Problems (Erythropoietin from kidneys tells bone marrow to produce RBCs)
- Hemolysis: Sickle Cells, Trauma (RBC Destruction)
- Thalassemia: group of disease that decreases RBC production (decrease HgB and RBC)
- Aplastic Anemia: decreased production of RBC, WBC, PLTs
- Mild Anema: 10-12 HgB (asymptomatic)
- Bleeding/GI Bleeding
- Kidney Problems (Erythropoietin from kidneys tells bone marrow to produce RBCs)
- Hemolysis: Sickle Cells, Trauma (RBC Destruction)
- Thalassemia: group of disease that decreases RBC production (decrease HgB and RBC)
- Aplastic Anemia: decreased production of RBC, WBC, PLTs
- Mild Anema: 10-12 HgB (asymptomatic)
Anemia Clinical Manifestations: Manifest Symptoms <___ HgB
- Fatigue
- Dyspnea
- Dizziness
- _______ Hands and Feet (blood keeps extremities warm)
- ______ (indicator of anemia)
- ______________ (heart compensating for low HgB)
Anemia Clinical Manifestations: Manifest Symptoms <7 HgB
- Fatigue
- Dyspnea
- Dizziness
- Cold Hands and Feet (blood keeps extremities warm)
- Pale (indicator of anemia)
- Palpitations (heart compensating for low HgB)
Anemia Diagnostic Tests
- H/H (HgB/HCt is 1:3 ratio)
- Reticulocytes (____ Count)
- ____ (low iron = low HgB)
- Transferrin (transport iron to liver)
- Bilirubin (liver is main iron storing organ)
- H/H (HgB/HCt is 1:3 ratio)
- Reticulocytes (RBC Count)
- Iron (low iron = low HgB)
- Transferrin (transport iron to liver)
- Bilirubin (liver is main iron storing organ)
Anemia Nursing Management
- Correct ______ (if bleeding PRBC -> Surgery)
- Oxygen
- ________ infusion
- IV Fluid Replacement (to increase BP since the pt is bleeding out they have less volume)
- Lifestyle and dietary changes (educate on dieting)
- Fatigue management and safety issues (Fall Risk, Syncope)
- Correct cause (if bleeding PRBC -> Surgery)
- Oxygen
- PRBC infusion
- IV Fluid Replacement (to increase BP since the pt is bleeding out they have less volume)
- Lifestyle and dietary changes (educate on dieting)
- Fatigue management and safety issues (Fall Risk, Syncope)
Iron Deficiency Anemia Etiology:
- Inadequate ______ (not enough Iron)
- Malabsorption (not able to absorb iron)
- _______ Loss
- Hemolysis (RBC destruction)
- Inadequate Diet (not enough Iron)
- Malabsorption (not able to absorb iron)
- Blood Loss
- Hemolysis (RBC destruction)
Iron Deficiency Anemia Nursing Management
- _______ Replacement (PRBC)
- __________ (Iron Replacement: Food or Supplements)
- _______ Replacement: Oral, intramuscular (Z-track) or IV
- Take before food (one hour) with OJ (acid -> enhances iron absorption)
- Liquid stains teeth (use straw)
- Stool is ________ with increased iron intake (make sure to educate patient this is normal)
- Pts will also experience constipation -> offer stool softeners
- Blood Replacement (PRBC)
- Nutrition (Iron Replacement: Food or Supplements)
- Iron Replacement: Oral, intramuscular (Z-track) or IV
- Take before food (one hour) with OJ (acid -> enhances iron absorption)
- Liquid stains teeth (use straw)
- Stool is Black with increased iron intake (make sure to educate patient this is normal)
- Pts will also experience constipation -> offer stool softeners
Iron Deficiency Anemia Clinical Manifestations
- General anemia s/sx
- Production issue -> make less and cells are __________ (Microcytic)
- Pallor
- _________ (inflamed tongue)
- Cheilitis (inflamed lips)
- Headache
- Burning sensation of the ___________
- General anemia s/sx
- Production issue -> make less and cells are smaller (Microcytic)
- Pallor
- Glossitis (inflamed tongue)
- Cheilitis (inflamed lips)
- Headache
- Burning sensation of the tongue
Cobalamin Deficiency (Vitamin B12) Etiology
- GI ___________ (intrinsic factor works in GI)
- _________, Celiac
- Antibiotics
- Seizure Meds
- Long-term use of PPI’s or H2 Blockers (decreases acid essential for intrinsic factor absorption)
- Poor Nutrition
- _____________ Anemia (absence of __________ factor)
- Tetracycline abx (prescribed with vitamin B12 b/c it decreases B12 absorption)
- GI Surgery (intrinsic factor works in GI)
- Crohn’s, Celiac
- Antibiotics
- Seizure Meds
- Long-term use of PPI’s or H2 Blockers (decreases acid essential for intrinsic factor absorption)
- Poor Nutrition
- Pernicious Anemia (absence of intrinsic factor)
- Tetracycline abx (prescribed with vitamin B12 b/c it decreases B12 absorption)
Cobalamin Deficiency (Vitamin B12) Clinical Manifestations
- General ________ S/Sx (Pallor, Fatigued)
- Sore, Red, Beefy and Shiny ________
- Weakness
- ___________ (vit B12 for normal nerve function)
- ___________ , Memory Loss (Severe)
- N/V and abdominal pain
- General Anemia S/Sx (Pallor, Fatigued)
- Sore, Red, Beefy and Shiny Tongue
- Weakness
- Paresthesia (vit B12 for normal nerve function)
- Confusion, Memory Loss (Severe)
- N/V and abdominal pain
Cobalamin Deficiency (Vitamin B12) Nursing Management
- Adequate ___________ intake of B12 (meats and dairy)
- Oral, Parental, intranasal replacement (nothing PO bc not effective in GI)
- Adequate dieatary intake of B12 (meats and dairy)
- Oral, Parental, intranasal replacement (nothing PO bc not effective in GI)
Folic Acid Deficiency
(Vitamin B9-helps make _____ )
RBCs
Folic Acid Deficiency [Vitamin B9] Etiology
- Poor Nutrition
- ____________ problems
- Medications
- Chemo or arthritis drug – _____________
- ____________ Abuse (ETOH decreases absorption of folic acid)
- Poor Nutrition
- Malabsorption problems
- Medications
- Chemo or arthritis drug – Methotrexate
- Alcohol Abuse (ETOH decreases absorption of folic acid)
Folic Acid Deficiency [Vitamin B9] Clinical Manifestations
- General S/Sx of Anemia
- Smooth, Beefy ________
- Prone to Mouth _________
- *No neuro conditions like B12 deficiency
- General S/Sx of Anemia
- Smooth, Beefy Tongue
- Prone to Mouth Sores
- *No neuro conditions like B12 deficiency
Folic Acid Deficiency [Vitamin B9] Nursing Management
- Dietary and Oral Replacement (foliage: ______________ vegetables, grains, OJ, oatmeal, peanuts avocado)
- Dietary and Oral Replacement (foliage: green leafy vegetables, grains, OJ, oatmeal, peanuts avocado)
Sickle Cell Anemia - Genetic disorder of abnormal formation of __________________ inside RBCs
hemoglobin chains
Sickle Cell Anemia
● RBCs form _____ shape (Sickle cell shape) -> Low ____________ capacity (low O2 triggers sickle shape of RBCs)
● RBCs form S shape (Sickle cell shape) -> Low O2 carrying capacity (low O2 triggers sickle shape of RBCs)
Sickle Cell Anemia Etiology
- _________ Disorder
- Predominant in _____________
- Life-long management
- Homozygous Hb SS (inherited HgB S from both parents)
- Formation of abnormal hemoglobin chains
- S-shaped clump in the capillaries
- Genetic Disorder
- Predominant in African Americans
- Life-long management
- Homozygous Hb SS (inherited HgB S from both parents)
- Formation of abnormal hemoglobin chains
- S-shaped clump in the capillaries
Sickle Cell Anemia Conditions that Cause Sickling
- Hypoxia
- ___________ (common)
- Infections
- Venous Stasis
- Low Environmental Body Temperatures (Hypothermia)
- Acidosis
- Strenuous ___________
- Anesthesia (RBC adapt to survive malaria)
- Hypoxia
- Dehydration (common)
- Infections
- Venous Stasis
- Low Environmental Body Temperatures (Hypothermia)
- Acidosis
- Strenuous exercise
- Anesthesia (RBC adapt to survive malaria)
Sickle Cell Anemia Clinical Manifestation
- Sickling Crisis (develop ____________ )
- Chronic _________ (can’t carry O2)
- _______ (sickle cells passing through vessels)
- Organ damage (thrombus)
- Jaundice
- Cholelithiasis
- Sickling Crisis (develop blood clot)
- Chronic Anemia (can’t carry O2)
- Pain (sickle cells passing through vessels)
- Organ damage (thrombus)
- Jaundice
- Cholelithiasis
Polycythemia Vera Etiology
- Disease caused by a _______________ mutation in a single stem cell
- __________ production of red blood cells
- Excessive leukocyte production
- Excessive production of platelets
- Combined = “_________ blood” high viscosity and blood volume -> increased HTN, hyper viscosity, hypervolemia, hyper coagulopathies predisposing pt to clotting or thrombus (RBC+PLT)
- Disease caused by a chromosomal mutation in a single stem cell
- Massive production of red blood cells
- Excessive leukocyte production
- Excessive production of platelets
- Combined = “thick blood” high viscosity and blood volume -> increased HTN, hyper viscosity, hypervolemia, hyper coagulopathies predisposing pt to clotting or thrombus (RBC+PLT)
Polycythemia Vera Clinical Manifestations
- ______ caused by hyper viscosity and hypervolemia (lots of fluid in the body!)
- HTN caused by hyper viscosity and hypervolemia (lots of fluid in the body!)
Polycythemia Vera Nursing Management
- ___________ (only treatment = reduces hematocrit)
- Balance Hydration (Don’t give more _______ , already hypertensive
- Low dose _________ (prevent clotting, inhibits platelet aggregation)
- Hydroxyurea (tells bone marrow to stop producing more RBCs)
- Phlebotomy (only treatment = reduces hematocrit)
- Balance Hydration (Don’t give more fluids, already hypertensive
- Low dose Aspirin (prevent clotting, inhibits platelet aggregation)
- Hydroxyurea (tells bone marrow to stop producing more RBCs)
Polycythemia Vera Common complication
- Stroke or MI ( _______ )
clots
Thrombocytopenia
Platelets are one of the most important components of hemostasis to _______ bleeding and promote clotting
- _________ are Thrombocytes
- Platelets are produced in bone marrow and stored in ________ (Normal: 150K-450K)
Platelets are one of the most important components of hemostasis to stop bleeding and promote clotting
- Platelets are Thrombocytes
- Platelets are produced in bone marrow and stored in spleen (Normal: 150K-450K)
Neutropenia Etiology
- _______ (reduces WBC count) and immunosuppressive therapy (prevents bone marrow producing more WBCs)
- _____________ diseases (attacking WBCs)
- Chemo (reduces WBC count) and immunosuppressive therapy (prevents bone marrow producing more WBCs)
- Autoimmune diseases (attacking WBCs)
Thrombocytopenia Etiology
1) The _____________ doesn’t make enough platelets
OR
2) The body destroys the platelets or body is making platelets without ang reason
1) The bone marrow doesn’t make enough platelets
OR
2) The body destroys the platelets or body is making platelets without ang reason
Neutropenia clinical Manifestations
- Infection (major risk b/c of low _____ , any simple bacteria could be lethal)
- Treat Fever (any number change in temperature take seriously)
- Risk: _______ (once sepsis starts -> septic shock -> death)
- Infection (major risk b/c of low WBC, any simple bacteria could be lethal)
- Treat Fever (any number change in temperature take seriously)
- Risk: Sepsis (once sepsis starts -> septic shock -> death)
Thrombocytopenia Clinical Manifestations
- _________ (Nose Bleed) and Gums Bleeding
- Petechiae (Red pinpoint spots)
- Purpura (larger bruising like areas)
- Ecchymosis (Bruising)
- Prolonged bleeding
- Intracranial Bleeding
- Blood in the Urine
- Dizziness, Faintness
- Tachycardia (b/c of bleeding, compensating for low blood volume)
- Epistaxis (Nose Bleed) and Gums Bleeding
- Petechiae (Red pinpoint spots)
- Purpura (larger bruising like areas)
- Ecchymosis (Bruising)
- Prolonged bleeding
- Intracranial Bleeding
- Blood in the Urine
- Dizziness, Faintness
- Tachycardia (b/c of bleeding, compensating for low blood volume)
Thrombocytopenia
Platelet activation then make a clot -> travels to small capillary beds in skin -> blocking blood flow -> when they burst -> bleeding in skin surface area
Platelet activation then make a clot -> travels to small capillary beds in skin -> blocking blood flow -> when they burst -> bleeding in skin surface area
Neutropenia Nursing Management
- Monitor for S/Sx of _________ (94.1 F -> 94.3 F EMERGENCY)
- Start Abx (Broad Spectrum until cause is known) -> kills most bacteria including gut bactiera (at risk for C.Diff.)
- May need anti-fungals (if fungal infection)
- Neupogen (increase neutrophils = protein to stimulate WBC growth in bone marrow)
- __________ Isolation (keep pt safe from infection)
o Visitors must wear PPE
o No fresh fruits or flowers
o All foods must be cooked
- Monitor for S/Sx of infection (94.1 F -> 94.3 F EMERGENCY)
- Start Abx (Broad Spectrum until cause is known) -> kills most bacteria including gut bactiera (at risk for C.Diff.)
- May need anti-fungals (if fungal infection)
- Neupogen (increase neutrophils = protein to stimulate WBC growth in bone marrow)
- Reverse Isolation (keep pt safe from infection)
o Visitors must wear PPE
o No fresh fruits or flowers
o All foods must be cooked
Cobalamin (Vitamin B12) Function
- Stored in ________
- ________ Failure: Vitamin B12 deficiency
- w/o Cobalamin admin, pt will die in 1-3 years
- Stored in liver
- Liver Failure: Vitamin B12 deficiency
- w/o Cobalamin admin, pt will die in 1-3 years
- w/o Cobalamin [deficiency] admin, pt will die in _________
1-3 years
Vitamin B9-helps make _______
RBCs
Sickle Cell Anemia Nursing Management
- RBC
- LOTS of ______ Meds (Priority)
- O2 (if hypoxic to control suckling)
- Abx (prevent and treat infection)
- _____ Prophylaxis (Lovenox to prevent)
- Rest
- IV Fluids and electrolytes (prevent sickling -> no fluids can cause cells to be sticky)
- _____ cell transplant (only curable tx)
- Patient teaching
- RBC
- LOTS of Pain Meds (Priority)
- O2 (if hypoxic to control suckling)
- Abx (prevent and treat infection)
- DVT Prophylaxis (Lovenox to prevent)
- Rest
- IV Fluids and electrolytes (prevent sickling -> no fluids can cause cells to be sticky)
- Stem cell transplant (only curable tx)
- Patient teaching
Polycythemia Vera
↑____,
↑_____,
↑_____
(_______)
↑RBC,
↑WBC,
↑PLTs
(THICK)
A patient who is receiving methotrexate for severe rheumatoid arthritis develops a megaloblastic anemia. The nurse will anticipate teaching the patient about increasing oral intake of
a. iron.
b. folic acid.
c. cobalamin (vitamin B12).
d. ascorbic acid (vitamin C).
b. folic acid.
Methotrexate use can lead to folic acid deficiency. Supplementation with oral folic acid supplements is the usual treatment. The other nutrients would not correct folic acid deficiency, although they would be used to treat other types of anemia.
Methotrexate use can lead to _________ deficiency.
Methotrexate use can lead to folic acid deficiency.
Which statement by a patient indicates good understanding of the nurse’s teaching about prevention of sickle cell crisis?
- “Home oxygen therapy is frequently used to decrease sickling.”
- “There are no effective medications that can help prevent sickling.”
- “Routine continuous dosage narcotics are prescribed to prevent a crisis.”
- “Risk for a crisis is decreased by having an annual influenza vaccination.”
- “Risk for a crisis is decreased by having an annual influenza vaccination.”
Because infection is the most common cause of a sickle cell crisis, influenza, Haemophilus influenzae, pneumococcal pneumonia, and hepatitis immunizations should be administered. Although continuous dose opioids and oxygen may be administered during a crisis (pain management is a priority), patients do not receive these therapies to prevent crisis. Hydroxyurea (Hydrea) is a medication used to decrease the number of sickle cell crises.
Which intervention will be included in the nursing care plan for a patient with immune thrombocytopenic purpura (ITP)?
a. Assign the patient to a private room.
b. Avoid intramuscular (IM) injections.
c. Use rinses rather than a soft toothbrush for oral care.
d. Restrict activity to passive and active range of motion.
b. Avoid intramuscular (IM) injections.
IM or subcutaneous injections should be avoided because of the risk for bleeding. A soft toothbrush can be used for oral care. There is no need to restrict activity or place the patient in a private room.
Which action will the admitting nurse include in the care plan for a patient who has neutropenia?
a. Avoid intramuscular injections.
b. Check temperature every 4 hours.
c. Omit fruits or vegetables from the diet.
d. Place a “No Visitors” sign on the door.
ANS: B Check temperature every 4 hours.
The earliest sign of infection in a neutropenic patient is an elevation in temperature. Although unpeeled fresh fruits and vegetables should be avoided, fruits and vegetables that are peeled or cooked are acceptable. Injections may be required for administration of medications such as filgrastim (Neupogen). The number of visitors may be limited and visitors with communicable diseases should be avoided, but a “no visitors” policy is not needed.
A patient with immune thrombocytopenic purpura (ITP) has an order for a platelet transfusion. Which information indicates that the nurse should consult with the health care provider before obtaining and administering platelets?
a. Platelet count is 42,000/uL.
b. Petechiae are present on the chest.
c. Blood pressure (BP) is 94/56 mm Hg.
d. Blood is oozing from the venipuncture site.
ANS: A. Platelet count is 42,000/uL.
Platelet transfusions are not usually indicated until the platelet count is below 10,000 to 20,000/L unless the patient is actively bleeding. Therefore the nurse should clarify the order with the health care provider before giving the transfusion. The other data all indicate that bleeding caused by ITP may be occurring and that the platelet transfusion is appropriate.
