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55 Cards in this Set

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Anemia
Anemia is not a specific disease, rather it is a manifestation of a pathologic process
Defined as:
a deficiency in the number of RBC's (erythocytes)
decrease in the quantity of hemoglobin (HGB)
decrease in the volume of packed RBC's (HCT)
Normal Kidney Function
1. Healthy kidney sends a hormone (erythropoietin) to the bone marrow to tell it to produce more red blood cells.
2. Bone marrow produces red blood cells
3. Red blood cells carry oxygen through the bloodstream.
4. Oxygen is made available to the organs throughout the body.
Hematologic Function
Blood carries oxygen to the cells and removes CO2
Removes waste from the GI tract and carries nutrients
Regulates body temperature, acid-base balance
Provides protection from infection and bleeding
Responsible to assist in hormone regulation by transporting hormones.
Review of Hematopoetic System
Kidneys: produce erythropoetin which stimulates RBC production in the bone marrow
Bone Marrow: responsible for the production of the major blood components beginning with the stem cell
Blood Cells
Erythrocytes (RBC) produced in the bone marrow, they have a life span of 120 days
Primary function is transport gases
Plays a role in acid-base balance
Blood Cells
Leukocytes (WBC's) also produced in the bone marrow have a life span of hours to days
Primary function is maintain homeostasis in particular related to infection and inflammation
Types of White Cells
Lymphocytes: B and T cells. Agranulocytes
Granulocytes: polymorphonucleocytes mostly neutrophils (55-80%), also basophils and eosinophils
Monocytes: mature into macrophages (big eaters)
Leukocytes
Granulocytes:
Neutrophils - phagocytosis especially during early phases of inflammation
Eosinophils - Also phagocytosis, allergic reactions
Basophils - also inflammatory response, histamine release, heparin release
Leukocytes
Agranulocytes
Lymphocytes - cellular and humoral immune response
Monocytes - Phagocytosis and cellular immune response
Thrombocytes
Also called platelets primarily function to aid in blood clotting
Also are produced in the bone marrow and may be stored in the spleen
Other structures of the Hematopoetic System
Liver: filters blood and produces clotting factors
Spleen: filters foreign particles including RBC's
-Returns iron to the bone marrow to support RBC production
-Stores platelets
Other structures of the Hematopoetic System
Lymphatic system: returns fluid from the interstitial space to blood
-Active in the immune response to infection and inflammation
-Filters foreign particles
Anemia
Anemia is not a specific disease, rather it is a manifestation of a pathologic process
Defined as:
-a deficiency in the number of RBC's (erythrocytes)
-decrease in the quantity of Hemoglobin (HGB)
-Decrease in the volume of packed RBC's (HCT)
Anemia
Grouped according to morphologic characteristics or etiologic factors
Anemia Etiologic Classification
Decreased RBC production
-Iron Deficiency
-Thalassemias (decreased globulin synthesis)
Defective DNA synthesis
Vitamin B12 deficiency
Folic Acid deficiency
Decreased RBC production
Decreased number of erythrocyte precursors
-Aplastic Anemia
-Leukemia
-Myelodysplasia
-Chronic Disease
Chemotherapy
Blood Loss
Acute
-trauma
-blood vessel rupture
-surgery
Chronic
-gastritis
-menstrual flow
-hemorrhoids
Increased Erythrocyte Destruction
Intrinsic:
-Abnormal Hgb (sickle cell anemia)
-Enzyme deficiency (G6PD)
-Membrane abnormalities (paroxysmal nocturnal hemoglobinuria)
Increased Erythrocyte Destruction
Extrinsic Factors
-physical trauma
-autoimmune disorders
-infectious diseases
NEED TO KNOW!
Modifiable factors to promote Erythrocyte production
Iron: liver, whole grains, lean red meat, egg yolks, fish, dried fruits
Folic Acid: green leafy vegetables, legumes, whole grains, liver
Vitamin B12: red meat, liver
Vitamin C: citrus fruit, green leafy vegetables
-Deep colored berries
NEED TO KNOW!
Modifiable factors to promote Erythrocyte production
Amino Acids: eggs, meat, poultry, legumes, fish, nuts, milk
Vitamin B6: meats, legumes, cornmeal and wheat germ
Supplements
Growth factors
Nursing Assessment
Recent blood loss?
History of chronic disease
Past medical history
Family history
Nutrition history
Recent surgery
Medication use?
-NSAID's
-Aspirin
-Anticonvulsants
-Anticoagulants
-Vitamin and iron supplements
Nursing Assessment: Functional Health Pattern
Health perception: Malaise
Nutritional metabolic: N/V, anorexia, heartburn, dysphagia
Elimination:
Hematuria, melena (black, tarry stools), flatulence, diarrhea, constipation
Nursing Assessment: Functional Health Pattern
Activity exercise: Fatigue, muscle weakness, decreased strength, dyspnea, cough, SOB
Cognitive Perceptual: H/A, abdominal, chest and bone pain, pruritis, sensitivity to cold, paresthesia
Sexuality reproductive: Menorrhagia, male impotence
Objective Data
General: Lethargy, fever, lymphdenopathy
Integumentary: pale, cool skin, petechiae, jaundice, icteric sclera, gingival bleeding
Respiratory: tachypnea
Cardiovascular: tachycardia, postural hypotension, bruits, intermittent claudication
GI: glossitis, red beefy tongue, anorexia, hepatospenomegaly
Objective Data
Neurologic: confusion, impaired judgement, irritability, ataxia, unsteady gait.
Clinical Indices
Hemoglobin (Hgb): important measure of anemia Hgb is responsible for gas transport.
Normal: Males: 13.5-18 g/dL
Females: 12-16 g/dL
Clinical Indices
Hematocrit (Hct) indication of the percentage of RBC's to total volume)
Normal: Males: 40-50%
Females: 38-47%
DON'T NEED TO KNOW FOR TEST!
Clinical Indices
MCV: Mean Corpuscular Volume (relates to the size of RBC's)
microcytic
normocytic
macrocytic
Normal: 80-95mm3
MCHC: Mean Corpuscular Hgb Concentration
-Saturation of RBC's with Hgb
-May be
Hypo
Normo
Normal: 32-36 g/dL
Clinical Indices
MCH: Mean Corpuscular Hgb
-Average weight of Hgb in 1 RBC
-Normal: 27-31
Reticulocyte Count: the number of immature RBC's, an indication of the rate of new RBC in the circulation
.5-2%
Clinical Indices
Serum Iron (fe)
-Measure of iron bound to transferrin, 70% of iron is circulated this way
Normal: Male: 80-180 mcg/dL
Female: 60-160 mcg/dL
Ferritin: an indication of stored iron
Normal: Male: 12-300 ng/mL
Female: 10-150 ng/mL
Clinical Indices
Blood Film (smear)
-examine a thin smear looking for shape, color, size of cells to determine what kind of anemia
Clinical Indices
Total Iron Binding Capacity (TIBC): iron available to bind to transferrin
Normal: 250-460 mcg/dL
Bilirubin: in anemia this is a measure of degree of hemolysis of RBC's
Normal: .3-1.0
Clinical Indices
Serum B12: measures circulating B12, important in evaluating megaloblastic anemias
Normal: 160-960
Serum Folic Acid (folate) indication of nutritional status, important indicator of megaloblastic anemia
Normal 5-25 ng/mL
Anemia
Mild Anemia: Hemoglobin 10-12
Moderate Anemia: Hemoglobin 6-10
Severe Anemia: Hemoglobin <6
Gerontologic Considerations
Anemia is common in older adults
-Gradual reduction in Hct after age 50
Etiology: nutritional, decreased iron absorption
Co-existing conditions make diagnosis difficult, symptoms may be more severe
Treatment Fundamentals (Nurse's Role)
1. Dietary and lifestyle changes
2. Pharmacologic management:
-Oxygen
-Vitamin replacement/iron replacement
-Erythropoetin alfa (Epogen/Procrit), or darbopoetin alfa (Aranesp) considered depending on cause of anemia
-Transfusion
*Note: the above drugs will not work if kidneys are not functioning properly or their iron isn't right.
Iron Deficiency Anemia
Caused by poor diet, blood loss
Over 2 billion affected worldwide
Over 200,00 deaths worldwide/yr.
Most common type of anemia
Most at risk: poor, elderly, young and women
Malabsorption
KNOW THIS SLIDE!
Iron Therapy
Oral iron supplements-Ferrous SO4 is preferred treatment
300 mg PO TID with orange juice (vitamin C)
Don't take with caffeine or antacids (0 absorption)
Best taken between meals
Continue 3-6 months AFTER anemia resolved to restore body's "bank"
**causes constipation and changes color of stool**
Iron Overload
Hematochromatosis: hereditary defect - too much Fe absorbed from GI tract (too many RBC's)
Hemasiderosis: ingestion of too much Fe, especially with alcohol
Accidental overdose: keep out of the reach of children
Nursing Considerations
Nausea, GI distress
Heartburn
Constipation
Dark, tarry-black stools
Staining of teeth with liquid preparation
May be given parenterally or IM
Thalassemia Anemia
Decreased Erythrocyte production
Characterized by thin fragile red blood cells, abnormal Hgb molecule
Hereditary: affects Mediterraneans, Asians, and Central Africans
Over 60 variations: Severity depends on type
NEED TO KNOW!
Thalassemia Major
Homozygous: both genes affected
Profound anemia, poor prognosis
NEED TO KNOW!
Thalassemia Minor
Heterozygous: only 1 gene affected
Mild anemia, life expectancy unchanged
NEED TO KNOW!
Thalassemia Major
Jaundice, cholelithiasis (the presence or formation of gallstones)
Splenomegaly
Lower extremity ulcers
Cardiomegaly
Fatigue
Mongoloid appearance
Anemia depends on type
NEED TO KNOW!
Thalassemia Minor
Thalassemia minor: requires no treatment
Genetic counseling
Possible splenectomy if sequestering red blood cells
Only treatment is blood transfusions, goal to keep Hgb >10
Megaloblastic Anemias
Vitamin B12 deficiencies (Cobalamin)
Folic Acid Deficiency
Drug Induced Suppression of DNA synthesis
Inborn Errors
NEED TO KNOW!
Cobalamin Deficiency
Caused by lack of, or poor absorption of extrinsic factor (EF) B12
Absent intrinsic factor (IF) stomach responsible for B12 absorption
Untreated causes death, delayed treatment results in permanent neurological damage
NEED TO KNOW!
Pernicious Anemia
Intrinsic factor: produced by parietal cells of gastric (stomach) mucosa, required for vitamin B12 absorption
NEED TO KNOW!
Cobalamin Deficiency
Gastric mucosal atrophy (with age)
Malabsorption caused by diseases of small intestine (surgery to stomach or GI tract)
Gastrectomy, small bowel resection
Proton pump inhibitors (decrease absorption of vitamin B12), some chemo.
Dietary deficiency - rare
NEED TO KNOW!
Cobalamin Deficiency
Usually diagnosed in elderly, >60
Family redisposition
Northern European ancestry
Tends to be more severe in African Americans, no known reason
NEED TO KNOW!
Cobalamin Deficiency
Anemia with large immature red cells called megaloblasts
Gastric mucosal changes, anorexia
Neurological manifestations: confusion, paresthesias, gait changes
Cardiovascular: late-heart failure-death from severe anemia
Folic Acid Deficiency
Low serum folate level
Normal schilling test
Megaloblastic anemia
Macrocytic
Normochromo (normal color)
Folic Acid Deficiency
Folic acid replacement (folate)
0.4mg-1mg daily PO, IV, SC, IM
Alcoholics may require up to 5mg daily until anemia resolved
No side effects
Diet teaching: citrus, veggies, whole grains, avoid ETOH
Hemolytic Anemias (Genetic Disorders, RBC destruction)
Sickle cell anemia
Glucose-6-phosphate Dehydrogenase deficiency
Immune hemolytic anemia
Characterized by shorter RBC life spans, increased RBC destruction, fragile RBC's
Anemia of Chronic Disease
Most Common: End Stage Renal Disease
Cancer
Arthritis
Liver Disease
HIV and treatment related
Endocrine disorders: DM