321 - Exam 3 P. 1-7 (Anemia)

Front 1

Erythropoietin
-where is it secreted from?
-when is it secreted?

Back 1

secreted from the kidneys

secreted in response to low oxygen levels that the kidney detects.

Front 2

Erythropoietin is what?

Back 2

a hormone produced by the kidney that promotes the formation of red blood cells in the bone marrow

Front 3

Erythropoietin can be given in the form of medication which will do what?

Back 3

-increase production of RBCs

Front 4

-The trigger for RBC production is what?

Back 4

an increase in the need for tissue oxygenation.

Front 5

-How does the kidney maintain a normal balance of RBCs?

Back 5

The kidney produces the RBC growth factor, erythropoietin at the same rate as RBC destruction or loss occurs to maintain a constant normal level of circulating RBCs

Front 6

What is a reticulocyte?

-what is the normal count?

Back 6

-is an immature erythrocyte
normal count is 0.5-1.5%

Front 7

Erythrocytes are concave (disc shaped) why?

how long do they live?

Back 7

because they can carry more oxygen (they have more surface area)

- 120 days

Front 8

-What is the function of the spleen?

Back 8

destroys old or imperfect RBCs, breaks down the hemoglobin released from these destroyed cells, stores platelets, and filters antigens.

Front 9

Function of the spleen
-what does it do with iron?

-how does it help the immune system?

Back 9

-the spleen reuses iron
-it is also important for the immune system, it produces lymphocytes and monocytes.

Front 10

How does sickle cell disease cause splenomegaly?

Back 10

-the spleen notices the misshaped RBCs and destroys them. SCD erythrocytes are deformed at 21 days and the spleen can’t break down those erythrocytes early. they might have their spleen removed to help control anemia. it is not diseased, it is just congested

Front 11

Care of splenomegaly

Carefully turning and repositioning, why?

Back 11

because of the pain. the spleen stores platelets, so if the spleen is not working and you are rough with them, you can cause bruising

Front 12

How can splenomegaly cause anemia?

Back 12

the spleen destroys erythrocytes that are age defective

Front 13

How does splenomegaly cause leukopenia?

Back 13

spleen produces lymphs and monos

Front 14

Splenectomy
-make sure you tell all health care providers that you have had the spleen removed
-Risk for infection (what should you do?)
-what should you teach the pt?

Back 14

(use good aseptic and sterile technique when required)
-Pneumonococcal & flu vaccine

Front 15

splenomegaly
-tell me about clotting?

Back 15

•Abnormal clotting (the spleen stores platelets)

Front 16

Anemia is a defined as what?

Back 16

the reduction in either the number of RBCs, the amount of hemoglobin, or the hematocrit (% of RBCs in the blood)

hemoglobin - the part of blood that distributes oxygen from the lungs to tissues in the body.
hematocrit - the measurement of the percentage of red blood cells found in a specific volume of blood.

Front 17

Anemia
-tell me about their skin temperature?

Back 17

-they are often cool to the touch

Front 18

Anemia
-tell me about their heart rate
-what 2 things cause their HR to increase?

Back 18

-tachycardia, increasing with activity and during and immediately after meals

Front 19

CM
•Mild anemia is Hemoglobin of _______gm/dl

Back 19

10 – 14

Front 20

Mild anemia
(2 CM)

Back 20

–Palpitations
–DOE (dyspnea on exertion)
-probably don’t even notice they are anemia

Front 21

Moderate anemia is Hemoglobin of ____________gm/dl

Back 21

6 – 10

Front 22

Moderate anemia
-cardiovascular system? (2)
-respiratory system? (2)

Back 22

–increased palpitations with activity
-heart rate will be elevated and POX will be down (the pt won’t recognize this)

–Dyspnea
–Fatigue

-people notice this / symptoms are more pronounced

Front 23

•Severe anemia is hemoglobin ___________gm/dl

Back 23

< 6

Front 24

Severe anemia
-what happens to the skin (3)?

Back 24

–Pallor (comes from lack of oxygen)

–Jaundice & pruritis (comes from hemoglobin breaking down. it is released into the skin and that causes itchiness)

Front 25

Severe anemia
-eyes?

Back 25

–Retinal hemorrhage, blurred vision

Front 26

Severe anemia

-what happens to the tongue?

Back 26

–Glossitis (inflammation of the tongue), smooth tongue

Front 27

Severe anemia

-cardiac system? (5 CM)

-what happens with ambulation/activity?

Back 27

Tachycardia,
systolic murmurs,
angina,
CHF,
MI (heart is working so hard)

intermittent claudication,

Front 28

Severe anemia

-what happens to the respiratory system? (3)

Back 28

Tachypnea
orthopnea,
dyspnea at rest
(working harder to bring oxygen in)

Front 29

Severe anemia

–HA, & vertigo is due to:

Back 29

(lack of oxygen)

Front 30

Severe anemia

mentally, what happens:

Back 30

– irritability, depression, inpaired thought process

Front 31

Severe anemia

-what happens to the organs?

Back 31

hepatomegaly,
splenomegaly,

Front 32

Severe anemia

-what happens to the bone?

Back 32

–Bone pain (because the bone are trying to produce erythrocytes so they are working over time) causing difficulty ambulating

Front 33

Severe anemia

-what are they sensitive too?

-what about their appetite?

Back 33

Sensitivity to cold

weight loss, lethargy (don’t have enough energy to eat)

Front 34

Iron Deficiency Anemia (hypoproliferative)
-population affected?
-what is this anemia the cause of?

Back 34

-most common anemia world wide because it is a diet related anemia. anyone who is pregnant has an iron related anemia, children have iron related anemia.

Front 35

Iron Deficiency Anemia (hypoproliferative)
--body is not making what?

Back 35

hemoglobin

Front 36

Iron Deficiency Anemia (hypoproliferative)

-adults usually have between 2-6 g of iron. About 2/3 of this iron is contained in hemoglobin and the other 1/3 is stored in the bone marrow, spleen, liver, and muscle.
-what happens first with iron stores in iron deficiency?

Back 36

the iron stores are depleted first, followed by the hemoglobin stores. As a result, RBCs are small (microcytic) and the patient has mild symptoms of anemia, including weakness and pallor.

Front 37

Iron Deficiency Anemia (hypoproliferative) can result from what 4 examples?

Back 37

1) blood loss,
2) poor GI absorption of iron,
3) an inadequate diet.
4) pregnancy

Front 38

Iron Deficiency Anemia (hypoproliferative)

what is the main problem with this anemia?

Back 38

-The problem is a decreased iron supply for the developing RBC.

Front 39

Iron supplements

-we only need _______mg a day
-iron supplements are usually 325 mg and it is given 1-3 times a day. why are we giving 325 mg 3 x a day if we don’t need that much?

Back 39

125 mg/day

Because approximately 1 mg of every 10 – 20 mg of iron ingested is abosrbed in the duodenum

Front 40

Iron
-what is needed for this to absorb?

Back 40

acid (vitamin C)
-give with cup of OJ

Front 41

Iron Deficiency Anemia - CM

-skin? (2)

Back 41

pallor
Nailbed deformity (lack of O2)

Front 42

Iron Deficiency Anemia - CM

-oral cavity?

Back 42

glossitis (smooth beefy red tongue)

cheilitis (lips)

Front 43

Iron Deficiency Anemia - CM

-nuero? (3)

Back 43

•Paresthesias
•Burning sensation of the tongue
•Headache

Front 44

Iron Deficiency Anemia - CM

what does it do to growth and development?

-can cause pica, leading to what?

Back 44

• growth and development delays
•Pica may cause plumbism (lead poisoning)

Front 45

Iron Deficiency Anemia & Children

-What is the correlation?

Back 45

children grow fast (increase of demand in their body)
•increase demands of rapid G & D
•cihldren have iron stores from mother till 4-6 months

Front 46

Children with Iron Deficiency Anemia

-tell me about breastfeeding/formula feeding?

-what does iron do to babies?

Back 46

•infants not fed solid foods after 6 months and fed only breast milk or formula not fortified with Fe causes anemia
(iron constipates babies, irritates their stomach)

Front 47

Children with Iron Deficiency Anemia -

Tell me about cows milk?

Back 47

prior to age 1 if fed more than 24 oz cows milk a day --> GI bleed --> anemia

Front 48

Iron Deficiency Anemia – Diagnoses

What happens to H/H?

Back 48

decreased H/H – you have to have iron to make hemoglobin.

Front 49

Iron Deficiency Anemia – Diagnoses

Serum Fe?

Back 49

•decreased serum Fe (iron)

Front 50

Iron Deficiency Anemia – Diagnoses

TIBC (total iron binding capacity)?

Back 50

increase in TIBC (total iron binding capacity) this is the binding sites for iron in the body on the hemoglobin. if you have decreased serum iron levels, you will have more binding sites. with iron def. anemia you have decreased iron levels and you have more binding sites

Front 51

What is melena?

Back 51

(black tarry stools) if someone is taking an iron supplement, a black tarry stool is seen.

Front 52

Iron Deficiency Anemia – Diet (9 examples of food high in iron)

Back 52

•Egg yolk
•Liver and muscle meats (red meat)
•Dried fruits
•Legumes
•Dark green leafy vegetables
•Whole grain and enriched bread and cereal
•Potatoes
• Kidney beans
• Raisins

Front 53

Iron Deficiency Anemia – Diet

Diet should also include what 3 other things?

Back 53

vitamin C, protein, and folic acid

Front 54

Iron Deficiency Anemia – Diet with Children (3 things you can do)

Back 54

•Iron fortified formula and baby cereals
•For child that drinks a lot of milk and refuses to eat solids – limit milk
•Iron rich foods that can be cut into finger foods

Front 55

Iron Deficiency Anemia – Iron Medication

-What do you make sure not to give?

-where is iron best absorbed?

Back 55

-No enteric coated or sustained release

-absorbed best from duodenum and proximal jejunum (small intestine)

Front 56

Iron Deficiency Anemia – Iron Medication

Tell me about dosage?

Back 56

•Daily dosage 105 – 200 mg elemental Fe (that is the amount that is absorbed)

we can give 1000mg a day but only 5-10mg is actually absorbed so that is why we give 3 doses a day

Front 57

Iron Deficiency Anemia – Iron Medication is best absorbed with what?

-should it be given with food?

Back 57

Best absorbed in acidic environment

give on empty stomach with orange juice,

Front 58

Iron Deficiency Anemia – Iron Medication
-avoid what? (2)

Back 58

dairy products,
antacids,
(anything that will decrease acid production should not be taken with iron).

Front 59

Iron Deficiency Anemia – Iron Medication

What does undiluted iron do?

Back 59

•stains teeth (if you have someone taking liquid iron supplementation they should use it with a straw to get it back in their throat)

Front 60

Iron Deficiency Anemia – Iron Medications

For children, what do you use when administering iron?

Back 60

for children, use a dropper and get it in the back of their throat b/c it stains teeth

Front 61

Iron Deficiency Anemia – Iron Medications given IV

-what should you know about this when giving IV?

Back 61

-make sure you read policy and procedure. you should not just go and hang this. people can have a reaction. usually you give a test dose (25 mL) and wait a little bit to make sure they don’t have a reaction.
-can cause abd pain, allergic reaction, bleeding

Front 62

Iron Deficiency Anemia – Iron Medications

IM (dorsal gluteal site)
-what size needle (inch wise)
-what gauge size?

Back 62

2 – 3 inch,

19 – 20g needle (it has to go deep in the muscle)

Front 63

Iron Deficiency Anemia – Iron Medications

IM (dorsal gluteal site)

-what is unique about the syringe?

Back 63

–0.5 ml air in syringe to clear (follow with air to make sure you are getting the syringe clear. bringing this out can tattoo the skin (black dots)

Front 64

Iron Deficiency Anemia – Iron Medications

IM (dorsal gluteal site)
-what method do you use?
-what do you avoid after injecting?

Back 64

–Z-track
–Don’t massage site (don’t want it leaking out)

Front 65

Iron Deficiency Anemia – Iron Medications

IM (dorsal gluteal site)
-what is the max amount of mL per injection?

Back 65

–No more than 2 ml/injection (it is thick)

Front 66

SE of iron supplements
-what is the big SE?
-intervention?

Back 66

-constipation (teach them to eat fruits and veggies, drink water, exercise) they may even need a stool softener.. test question)

Front 67

SE of iron supplements

Iron (Fe) overload can occur..
5 S/S?

Back 67

abdominal pain
vomiting,
bloody diarrhea,
severe SOB
shock

Front 68

SE of iron supplements
3 other side effects?

Back 68

-GI discomfort
-foul aftertaste
-black stools

Front 69

Pernicious Anemia (Megaloblastic Anemia)
-diet will help with this anemia
(true or false)

Back 69

false, this is not diet related.

Front 70

Pernicious Anemia (Megaloblastic Anemia)

What is the main problem with this anemia?

Back 70

-problem is a lack of vitamin B12 as a result of lack of intrinsic factor (without intrinsic factor, b12 can’t be absorbed).

Front 71

Pernicious Anemia (Megaloblastic Anemia)

Two examples of a pt who may have this anemia?

Back 71

-if someone has there stomach removed, they will have pernicious anemia
-can also occur as a result of aging

Front 72

Pernicious Anemia (Megaloblastic Anemia)

-What is the relationship between Vitamin B12 and folic acid?

Back 72

-Vitamin B12 is necessary to convert folic acid from its inactive form to its active form.
-All cells rely on folic acid for DNA production. (folic acid is necessary for RBC production )

Front 73

large does of folic acid will cause what SE that the pt may be concerned about?

Back 73

turn the pts urine dark yellow

Front 74

Vitamin B12 deficiency causes anemia by inhibiting folic acid transport and reducing DNA synthesis in precursor cells. These precursor cells undergo improper DNA synthesis and increase in size (this type of anemia is called _____________ or ___________ anemia because of the large size of these abnormal cells

Back 74

Megaloblastic or macrocytic

Front 75

__________anemia is a result from failure to absorb Vitamin B12. It can’t be absorbed because of the deficiency of the intrinsic factor (a substance normally secreted by the gastric mucosa) which is needed for intestinal absorption of Vit B12

Back 75

Pernicious

Front 76

Pernicious Anemia - CM

GI system (4)

Back 76

–Sore tongue
–Anorexia,
- N/V
–Abdominal pain

Front 77

Pernicious Anemia - CM

Neuromuscular (3)

Back 77

–Paresthesias
–Ataxia (lack of control over their limbs)
–Muscle weakness

Front 78

Pernicious Anemia - CM

Neuromuscular- what is done to prevent these S/S?

Back 78

injection of Vit B12 helps with these S/S) Vit B12 is needed for normal nerve function

Front 79

Diagnosis of Pernicious Anemia

Shilling test: 0 – 3%
-what do they do?

Back 79

they give the person oral vitamin B12 and they will check their urine to see what their levels are. if a person has pernicious anemia, the level will be high because it is not being absorbed. then they will give it IM and check the urine. the level will be low because in IM it is being absorbed and u r bypassing the intrinsic factor in the stomach)

Front 80

Diagnosis of Pernicious Anemia

What happens to H&H?

Back 80

decraesed

Front 81

Diagnosis of Pernicious Anemia

Vitamine B12 is decreased, which appears as a decreased level of ________

Back 81

 Cobalamin (Vit B12 level)

Front 82

Pernicious Anemia - Care

-What supplementation is given?
-what dose do you want the pt to have?

-what do you teach them?

Back 82

Vitamin B12 (Cyanocobalamin) supplementation
–1000 mg daily for 2 weeks

-(teach them to look at the dose they are getting over the counter because OTC dose is 800mg, not 1000mg)

Front 83

Pernicious Anemia - Care

Vitamin B12 (Cyanocobalamin) supplementation , how long do you take it?

Back 83

injections are given weekly until Hct is normal and then IM injections monthly.
-has to be an injection and can't be given PO because you lack the intrinsic factor which is needed to absorb vit B12

Front 84

-Vit B12 is best absorbed in what route?

Back 84

IM

Front 85

Anemia from Acute Blood Loss / Sudden hemorrhage
CM
-what cardiovascular S/S?

Back 85

–10% - none
–20% - tachy with activity, slight postural hypotension
–30% - tachy with activity, postural hypotension
–40% - CV signs, cold clammy skin
–50% - shock and potential death

Front 86

Acute Blood Loss - CM

H/H value?

Back 86

H&H is normal or high for 2 – 3 days because of hemoconcentration

Front 87

Acute Blood Loss - CM

What happens to H/H when you place the volume lost?

Back 87

When you replace the lost volume, then H/H will be low