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NURS 401 > Week 5: Respiratory And Hematologic Disorders > Flashcards

Week 5: Respiratory And Hematologic Disorders Flashcards

1
Q

Pco2, pH and Po2 changes in older adults

A

pH and Pco2 does not change -> Po2 Declines*

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2
Q

Changes in total lung capacity in older adults

A

Total lung capacity is redistributed..

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3
Q

Residual lung capacity changes in older adults

A

Increases with diminished inspiration and exploratory muscle strength of the thorax.

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4
Q

Auscultation of Smith bibasilar atelectasis

A

Is common d/t incomplete lung expansion

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5
Q

Respiratory System: Normal Age-Related Changes

A
  • Lowered efficiency of gas exchange and reduced ability to handle secretions.
  • Cilia become less responsive and less effective
  • diminished cough reflex and immune response -> high risk for bronchitis and pneumonia
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6
Q

COPD

A

Characterized by persistent and irreversible obstruction of airflow into the lungs.

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7
Q

COPD includes

A

Emphysema and chronic bronchitis

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8
Q

What is the gold standard for diagnosis of COPD?

A

Spirometry

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9
Q

What causes COPD?

A

Caused by inhalation of toxins or pollutants earlier in life such a dust, chemicals and especially tobacco smoke, either directly or indirectly.

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10
Q

Chronic bronchitis is caused by

A

A combination of thickened and I talked bronchial walls, hypertrophy of mucous glands, smooth muscle constriction and excess mucous production which can cause lumen compromise.

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11
Q

COPD symptoms may not appear until

A

50% of lung function has been irretrievable lost.

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12
Q

Most common symptoms of COPD include

A

Wheezing, cough, dyspnea on exertion and increased phlegm production.

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13
Q

Later signs of COPD include:

A
  • Prolonged expiration
  • Barrel chest
  • Hyper-resonance
  • Fingernail clubbing
  • Pursed lip breathing
  • Air trapping
  • Pale lips or nail beds
  • Use of accessory muscles
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14
Q

COPD Complications include

A
  • Exacerbation and remission in symptoms
  • Pneumonia
  • COPD hospitalizations and death
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15
Q

What can signal an emergent COPD exacerbation?

A
  • Spirometry results of less than 150 mL
  • Worsening orthopnea
  • Paroxysmal nocturnal dyspnea
  • Respiration’s >30 per minute
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16
Q

Asthma

A

An inflammatory airway disease closely linked to allergies and viral or bacterial infections.

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17
Q

What can cause asthma?

A
  • Influenced by genetics, environment, and lifestyle.
  • After susceptible person is exposed to an antigen, a cascade reaction occurs, which have effects on airway smooth muscle and mucus secretion but also recruits monocytes, lymphocytes, neutrophils and eosinophils into the cells lining the airways.
  • Repeated exposure potentiates the person’s inflammatory response or desensitizes him or her to the antigen, making them more susceptible.
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18
Q

What are signs and symptoms of asthma?

A

May be less obvious in older adults

  • Wheezing
  • Dyspnea on exertion
  • SOB
  • Nonproductive cough
  • Chest tightness
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19
Q

Symptoms of asthma are usually worse when?

A

Worse at night or in the early morning hours but may being anytime following exposure.

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20
Q

Complications of Asthma include

A
  • Death
  • Thickening of airway wall and peri-bronchial fibrosis
  • Higher risk for lower respiratory infections including pneumonia and prolonged associated debility, than those without.
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21
Q

Hematology: Normal Age-Related Changes

A
  • Reduction in total body water = decreased blood volume
  • Decreased speed with which RBCs are produced in response to stress or illness = slower response to blood loss and anemia.
  • Most WBC’s stay the same, but WBCs important to immunity (neutrophils) decrease in their number and ability to fight bacteria = decreased ability to resist infection.
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22
Q

What are hematological disorders in older adults?

A

RBCs: Anemia
WBCs: Immune, Neutropenia, Leukemia
Platelets: Thrombocytopenia

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23
Q

Hematopoietic Stem Cells

A

Are the stem cells that give rise to blood cells through the process of haematopoiesis.

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24
Q

An aging hematopoietic system can lead to

A

Decline in reserve capacity and decline in formation of blood.

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25
Q

Anemia

A

Deficiency in the number of RBCs

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26
Q

Hemoglobin levels that indicate anemia

A
  • Females: <12

- Males: <13

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27
Q

Hematocrit values that indicates anemia

A

Females: <36%
Males: <41%

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28
Q

WHO Definition of anemia

A

The condition when the number of red blood cells is insufficient to meet the physiological needs.

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29
Q

What is the leading cause of anemia?

A

Iron deficiency and malnutrition (folate and/or vitamin B12 deficiency)

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30
Q

Is anemia a normal part of aging?

A

Not a normal part of aging.

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31
Q

Difference in Hgb among African-Americans and Caucasians

A

African American hemoglobin is 0.5-1.0 g/dL lower than Caucasians

32
Q

Normocytic normochromic anemia

A
  • Blood loss
  • Chronic Diseases
  • Sideroblastic anemia
  • Sickle cell anemia
33
Q

Micro grid Hypochromic Anemia

A

-Hemoglobin synthesis : Iron, B6, copper, lead

34
Q

Macrocyclic (Megaloblastic) Normochromic

A

DNA synthesis: Vitamin B12 (Cobalamin, Folic Acid)

35
Q

What patient history should you get in a patient with anemia?

A
  • Is the patient bleeding?
  • Past medical history of anemia, family history?
  • Alcohol, nutritional questions
  • Liver or renal disease
  • Ethnicity
  • Environmental/work toxins (i.e lead)
36
Q

Anemia: Lab Results

A
  • RBC, Hgb, Hct
  • Mean Corpuscular Volume
  • Reticulocyte Count
37
Q

Mean Corpuscular Volume

A

Tells you more about the size of the RBCs

38
Q

Low MCV

A

Small RBC microcytic (iron deficiency anemia)

39
Q

High MCV

A

Large RBC macrocytic (Vitamin B12 or folate deficiency)

40
Q

Reticulocyte count

A

Measures how fast RBCs called Reticulocyte a (immature RBCs) are made by the bone marrow and released.

41
Q

Signs of Anemia include

A
  • Extreme Fatigue
  • Heart palpitations
  • Loss of appetite
  • Loss of concentration
  • Tachycardia
  • Tachypnea
  • Orthostatic hypotension
  • Pallor, jaundice, priority’s
  • Murmur, chest pain
  • Koilonychia or “spoon nails”
42
Q

Signs of Anemia include

A
  • Splenomegaly, lymphadenopathy
  • Petechiae, ecchymosis
  • Atrophy of tongue papillae
  • Angular chelitis (red, swollen patches in the corners of the mouth)
  • Hemoccult + stool
43
Q

Signs and symptoms of anemia may go unrecognized or mistaken for

A

Normal age changes.

44
Q

Symptoms of Anemia include

A
  • Fatigue
  • Pallor, confusion, ataxia
  • Worsening angina, CHF
  • Decreased O2 delivery
  • Hypovolemia if acute loss
  • Exertional dyspnea, palpitations, lightheaded ness
  • PICA
  • Pagophagia (eating ice)
45
Q

Severe anemia symptoms include

A

Heart failure and angina

46
Q

Iron Deficiency Anemia

A
  • One of the most common anemia’s but not the most common in older adults.
  • Microcytic normocromic.
47
Q

Foods and medications that can inhibit the absorption of iron include:

A
  • Eggs
  • Cocoa, coffee, black tea
  • High oxalate foods (spinach, kale, beets, nuts, chocolate, tea, wheat bran, rhubarb, strawberries)
  • Herbs such as oregano, basil and parsley
  • High calcium foods (milk, yogurt, cheese, sardines, canned salmon tofu, broccoli, almonds, figs, turnip greens and rhubarb)
48
Q

Contributing factors for iron deficiency anemia include

A

Heart failure and vitamin A deficit.

49
Q

The definitive treat for iron deficiency anemia includes

A 
Serum ferritin (measures amount of stored iron.
Low serum ferritin is diagnostic of iron deficiency (<12 ug/L)
50
Q

Management of Iron Deficiency Anemia

A
  • Assess to determine and eliminate cause

- Iron Replacement therapy

51
Q

Iron Replacement Therapy

A

-Iron supplement:
A. oral ferrous sulfate (with vitamin C or orange juice), ferrous gluconate.
B. IV iron-dextran complex, parental iron
C. IM: Use Z track injection technique.

52
Q

Folate and Cobalamin Deficiency

A
  • Megaloblastic anemia (macrocytic normochromic)

- Causes ineffective erythrpoiesis.

53
Q

Cobalamin Deficiency

A
  • Malnutrition
  • Pernicious anemia
  • Gastrectomy
  • Chronic alcoholism
54
Q

Folic acid deficiency

A
  • Alcohol abuse
  • Anorexia
  • Drugs (Methotrexate, anti-seizure)
  • Malabsorption
55
Q

What test is used to check for vitamin B12 deficiency?

A

Schilling Test for B12 Deficiency - parietal cell antibody or intrinsic factory antibody.

56
Q

Management of Vitamin B12 deficiency and pernicious anemia

A

Vitamin B12 injection or nasal

57
Q

Management for folic acid deficiency

A
  • Folate supplement 1 mg daily average dose

- Foods high in folate e.g dark green vegetables

58
Q

Anemia of Chronic Diseases

A

Associated with inflammation, autoimmune infectious disease (malaria, HIV, hepatitis), heart failure, renal disease and cancer.

59
Q

Causes of Anemia of Chronic Diseases

A
  • Reduction of RBC life span
  • Suppress production of erythropoietin
  • Ineffective bone marrow response to erythropoietin
60
Q

What hemoglobin values can indicate the need for blood Transfusion?

A
  • Hgb <10 (CAD)

- Hgb <8 (All patients)

61
Q

Immune Response and Aging

A
  • Aging associated with increased incidence of infectious diseases (influenza and herpes zoster)
  • Higher incidence of bacterial infections (TB, pneumococcal pneumonia)
  • Greater morbidity/mortality and hospitalization
62
Q

How is humoral immunity affected by aging?

A
  • Natural serum antibodies decline with aging.
  • Decline in immunoglobulin (function as antibodies) production
  • Health status influences outcome of antibody response
63
Q

Leukemia

A
  • A group of malignant disorders affecting the blood and blood-forming tissues of bone marrow, lymphatic system and spleen.
  • Fatal if untreated.
  • Accumulation of dysfunctional cells d/t loss of regulation in cell division.
64
Q

Acute Myeloid Leukemia

A

Most common in elderly population

65
Q

Coagulation and Aging

A
  • Old age is a hypercoagulable state

- Thrombotic conditions increase with age because of the increasing plasma fibrinogen and clotting factors.

66
Q

Types of thrombocytopenia include

A
  1. Idiopathic thrombocytopenic purpura
  2. Thrombotic thrombocytopenic purpura
  3. Heparin induced thrombocytopenia
  4. Heparin-induced thrombosis syndrome
67
Q

Idiopathic Thrombocytopenic Purpura

A

Most common

Low levels of platelets due to immune system cells produce antibodies against platelets

68
Q

Thrombotic thrombocytopenic purpura

A

Rare in which blood clots form in small blood vessels resulting in low platelet count.

69
Q

Heparin-induced thrombocytopenia

A

Development of thrombocytopenia due to heparin

70
Q

Heparin-induced thrombosis syndrome

A

Immune-mediated adverse reaction to heparin

71
Q

Diagnostic Studies for Thrombocytopenia

A
  • CBC
  • PT/PTT (check whether blood is clotting properly)
  • Blood smear (check the appearance of platelets)
  • Bone marrow aspiration or biopsy (check if bone marrow is healthy)
  • Ultrasound of spleen
72
Q

Treatment for Thrombocytopenia

A
  • Blood or platelet transfusions
  • Steroids such as prednisone (may slow platelet destruction)
  • No anti-platelet medications
  • Splenectomy if medications are not effective (mostly done for those who have ITP)
73
Q

Platelets below 150,000/uL

A

Abnormal platelet count

74
Q

Platelets below 50,000/uL

A

Bleeding with minimal trauma and prolonged bleeding.
Bleeding precaution
No IM medications

75
Q

Platelets below 20,000/uL

A

Spontaneous bleeding: life threatening

76
Q

Nursing management for platelets below 20,000/uL

A
  • Monitor neuro sign and consciousness
  • Absolute bed rest
  • No IM medications (if blood work, hold at least 5 minutes)
  • Oral care but no toothbrush, no spicy food
  • No rectal temperature.

NURS 401 (26 decks)

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