Anemias

Front 1

What is anemia?

Back 1

deficiency of RBCs or hemoglobin

Front 2

Hematocrit values for males and females

Back 2

Males: 40
Females: 38

Front 3

Hemoglobin values for males and females

Back 3

Males: 13.5 g/dL
Females: 12 g/dL

Front 4

What is bilirubin?

Back 4

pigment of hemoglobin

Front 5

How long do RBCs live?

Back 5

120 days

Front 6

What is the pathology of Anemia?

Back 6

Diminished hemoglobin or RBC production
increased red cell destruction
blood loss

Front 7

Clinical manifestations of anemia shown by inadequate RBC volume

Back 7

1. Orthostatic hypotension
2. Thready pulse
3. Oliguria
4. Heart murmur

Front 8

Clinical manifestations of anemia shown by loss of RBC function:

Back 8

1. Progressive weakness and fatigue
2. Dyspnea
3. Chest discomfort
4. Acidosis
5. Headache
6. Vertigo
7. pallor
8. Diminished bowel sounds
9. Constipation
10 difficulty concentrating

Front 9

Clinical manifestations of anemia's compensatory mechanisms for lost RBC Function:

Back 9

1. Tachycardia
2. Tachypnea
3. Cool, clammy skin
4. amenorrhea

Front 10

Hypovolemic Amemia is

Back 10

loss of blood volume due to sudden large volume loss or chronic small volume losses. Caused by trauma, hemorrhage, GI ulcer bleed

Front 11

Acute loss- si/sx of shock

Back 11

1. Extreme pallor
2. tachycardia
3. hypotension
4.decreased urine output
5. loss of consciousness

Front 12

Hypovolemic anemia- Chronic

Back 12

1. Pallor
2. fatigue
3. Chills
4. postural hypotension
5. rapid HR
6. rapid respirations

Front 13

Treatment options for hypovolemic anemia

Back 13

a. if hemorrhaging, apply direct pressure if possible.
frequent VS. report SBP <90, HR >100 or any other signs of shock.
stop bleeding

a) Blood transfusion and fluid volume replacement
b) Treat underlying cause
c) Supplemental iron
d) Oxygen
e) Separate tasks with breaks in between to promote endurance

Front 14

Iron deficiency anemia is smaller (microcytic) RBCs formed without adequate iron stores, caused by

Back 14

!. inadequate dietary intake of iron
2. iron malabsorption
3.. blood loss
4. increased need for RBCs as with rapid growth or pregnancy

Front 15

At what age is it common to see "bottle-fed" infants develop iron deficiency anemia?

Back 15

Around 9 and 24 months. Full term neonate has high hemoglobin level.

Front 16

Most common complications with Iron deficiency anemia:

Back 16

A. Infection and pneumonia
B. PICA- in children may lead to eating non-nutritious things, such as lead-based paint, icechips.
C. over-replacement of iron supplements (iron poisoning)

Front 17

Diagnostic tests for Iron deficiency anemia

Back 17

1. Low hemoglobin levels
2. low hematocrit levels
3. low serum iron levels
4. hemoccult stool sample- positive for occult blood

Front 18

Treatment for iron deficiency

Back 18

1. treat underlying cause
2. IV iron supplements. Observe closely for allergic reactions
3. IM supplements administer using Z-TRACK method
4. Oral liquid dilute with another liquid such as juice, use straw to prevent teeth stain. Give on EMPTY stomach. May turn stool black or green. monitor for iron replacement overdose.
5. Diet rich in Iron

Front 19

Three or more animal (Heme) sources of iron

Back 19

Beef, (red meat), egg yolks, Oysters. Heme is better absorbed by the body

Front 20

Non- heme sources of iron

Back 20

1. enriched and whole grain breads
2. iron-fortified cereals
3. Legumes
4. Nuts

Front 21

What vitamin helps patient absorb non-heme iron?

Back 21

Vitamin C

Front 22

What beverages interfere with absorption of iron?

Back 22

Coffee and tea

Front 23

What does the term "milk baby" refer to?

Back 23

Babies with the propensity to drink NOTHING but milk all the time. Skin very pale, porcelain like, translucent; chubby, get infections frequently

Front 24

Sickle cell anemia is

Back 24

Congenital hemolytic disease resulting from a DEFECTIVE HEMOGLOBIN MOLECULE that causes RBCs to become "sickle-shaped", making them more STICKY AND FRAGILE. Cells clump together, impairing circulation resulting in CHRONIC ILL HEALTH, periodic painful episodes, long term complications, and premature death.

Front 25

What results in anemia?

Back 25

Chronic premature hemolysis.

Front 26

A 27-year old Hispanic woman with sickle cell disease comes to the ER with complaints of joint and back pain, cough, runny nose, and temp of 100 F. Pain level is 7/10
WHAT IS THE LIKELY CAUSE FOR THIS PAINFUL EPISODE?

Back 26

Infection

Front 27

A 27-year old Hispanic woman with sickle cell disease comes to the ER with complaints of joint and back pain, cough, runny nose, and temp of 100 F. Pain level is 7/10.
WHAT QUESTIONS RELATED TO PAIN WOULD YOU ASK THIS PATIENT?

Back 27

Ask if the pain is similar to or different from other episodes
PQRST
PQRST Method for Pain Assessment

P = Provokes
What causes pain?
What makes it better?
Worse?
Q = Quality

What does it feel like?
Is it sharp?
Dull?
Stabbing?
Burning?
Crushing? ( Try to let patient describe the pain, sometimes they say what they think you would like to hear. )
R = Radiates

Where does the pain radiate?
Is it in one place?
Does it go anywhere else?
Did it start elsewhere and now localised to one spot?
S = Severity

How severe is the pain on a scale of 1 - 10?
( This is a difficult one as the rating will differ from patient to patient. )

T = Time

Time pain started?
How long did it last?
Other questions to ask and look for....

Any medication or allergies?
Does it hurt on deep inspiration?
Activity @ onset?
Any history of pain?
Is it the same?
Different?
Any family history of heart disease lung problems, stroke or hypertension?
Check LOC.
Pupils?
JVD?
Midline trachea?
Any recent trauma?

Front 28

A 27-year old Hispanic woman with sickle cell disease comes to the ER with complaints of joint and back pain, cough, runny nose, and temp of 100 F. Pain level is 7/10
WHAT DRUGS BY WHAT ROUTE WOULD YOU EXPECT PATIENT TO RECEIVE?

Back 28

Buprenex (buprenorphine hydrochloride) IV; Nubian , (nalbuphine hydrochloride): Narcotics, IV, IM, SubQ
Essentially, Narcotics.

Front 29

A 27-year old Hispanic woman with sickle cell disease comes to the ER with complaints of joint and back pain, cough, runny nose, and temp of 100 F. Pain level is 7/10
WHAT DIAGNOSTIC TEST WOULD YOU EXPECT TO BE ORDERED FOR THIS PATIENT?

Back 29

CBC
Bilirubin
ABG
UA
ECG
CXR ABD

Front 30

A 27-year old Hispanic woman with sickle cell disease comes to the ER with complaints of joint and back pain, cough, runny nose, and temp of 100 F. Pain level is 7/10.
WHAT NURSING ASSESSMENTS WOULD BE MOST IMPORTANT FOR YOU TO MAKE AT THIS TIME?

Back 30

Full assessment
Neurological assessment
musculoskeltal assessment
abd assessment

Front 31

Long term complications for SCA

Back 31

1. splenic infarction
2. Infections, esp. pneumonia
3. Infarction of major organs, brain, heart, kidney, lungs. and death
4. Renal failure

Front 32

Diagnostic test for SCA

Back 32

1. blood test-presence of HbS-Sickledex test.
2. Hemoglobin electrophoresis-indicates if child has SCA disease or trait. Neonates screened in KY.
3. Low RBCs, elevated WBCs

Front 33

Assessment findings for SCA are AFTER six months after birth.

Back 33

Hemoglobin A (HbA) normally replaces fetal hemoglobin (HbF) about six months after birth. SCA patients have an abnormal form of hemoglobin (hemoglobin S- HbS) which replaces HbF.

Front 34

si/sx of Ischemia from RBC sickling

Back 34

1. Dyspnea
2. joint swelling
3 Aching bones
4. Chest pain
5. Cardiomegaly
6. Hepatomegaly

Front 35

Si/sx of anemia

Back 35

a. chronic fatigue
b. Dyspnea
c. Chest pain
d. infection
e. jaundice or pallor
f. children small for age
g. older child delayed growth and puberty
h. tachcardia
i. hepatomegaly
j. spleenomegaly

Front 36

What is Sickle Cell Crisis ?

Back 36

sickle shaped cells lodge in small blood vessels causing occlusion and ischemia, possibly infarction

Painful crisis most common

Front 37

5 conditions that can trigger a sickle cell crisis

Back 37

Infection, stress, dehydration, and conditions that provoke hypoxia--strenuous exercise, high altitude, cold, and vasoconstrictive drugs--may all provoke periodic crisis.

Front 38

Treatment for SCA

Back 38

a) No well established cure, treat symptoms/ prevent crises
b) Polyvalen pneumococcal and flu vaccines
c) Low dose oral penicillin or other abx
d) Chelating agents remove excess iron from the blood
e) Analgesics (narcotics during crisis)
f) Hydroxyurea, an anticancer agent, destroys the abnormal RBCs and causes the body to produce fetal hemoglobin which will not sickle. Has many adverse effects.
g) Transfusion if sudden decrease in Hb
h) Acute sequestration in spleen traps blood, may require emergency splenectomy
i) Research: Bone marrow transplant has cured a few, gene therapy also being studied. Inhaled nitric oxide may prove successful in treating crisis. IV poloxamer 188 found to improve blood flow, given in first 48 hours of crisis.

Front 39

Nursing Dx for SCA

Back 39

a) Pain (clients are comfort seekers not drug seekers)
b) Risk for infection

Front 40

Nursing Interventions - SCA

Back 40

a) Oxygen
b) Stay with client during crisis
c) Acetaminophen for mild pain, morphine for severe pain
d) Rest
e) Sudden, painful priapism, can be harmful (report to M.D.)
f) Hydration
g) Warm compresses to painful areas NEVER APPLY COLD
h) Elevate swollen joints
i) Antibiotics for infection

Front 41

Teaching for SCA

Back 41

genetic counseling; support groups; avoid triggers; see MD

Front 42

What is Hemolytic Anemia ?

Back 42

chronic premature destruction of erythrocytes

Front 43

What conditions cause Hemolytic Anemia ?

Back 43

a) cardiopulmonary bypass
b) arsenic or lead poisoning
c) malaria
d) infections
e) toxins/ hazardous chemicals
f) production of antibodies that destroy erythrocytes as in blood transfusion reaction

Front 44

Treatment of hemolytic anemia:

Back 44

a) Remove cause
b) Corticosteroids
c) Transfusions
d) Splenectomy if fails to respond

Front 45

What is *Pernicious anemia ?

Back 45

megaloblastic (abnormal large RBCs) anemia r/t deficiency of intrinsic factor(essential for B12 absorption) – genetic predisposition – inherited autoimmune response causing gastric mucosal atrophy where intrinsic factor is produced, stomach surgery or removal of ileum.

Simple answer: a disease in which the red blood cells are abnormally formed, due to an inability to absorb vitamin B12. True pernicious anemia refers specifically to a disorder of atrophied parietal cells leading to absent intrinsic factor, resulting in an inability to absorb B12.
Vitamin B12 is the extrinsic factor in blood and required for the maturation of erythrocytes.

Front 46

Complications (most common) Pernicious anemia –

Back 46

1. permanent neurologic disability including paralysis,
2. confusion/dementia,
3. death;
4. sore mouth [inflammation] (known as stomatitis),
5. sore tongue, [inflammation](known as glossitis)
6. ataxia, (loss of ability to control movements. the loss of the ability to control the movements your body makes)—nero involement
7. numbness/ tingling-nero involvement

Front 47

Diagnostic tests for Pernicious anemia –

Back 47

a. Schilling test positive;
b. decreased hemoglobin levels;
c. decreased RBCs;
d. serum B12 levels <0 .1 micrograms/mL

Front 48

Treatment for Pernicious anemia

Back 48

a. I.M. B12 injections high dose initially (may need supplemental iron as RBCs begin to regenerate); monthly injections for life. Injectable B12 is known as Cyanocobalamin (B12).

Front 49

Nursing Interventions for Pernicious anemia

Back 49

– those with positive schillings test will need IM supplements for (how long?) Life; sore mouth and tongue may make eating painful – provide oral care and oral anesthetics

Front 50

Fall risk increased as a result of vitamin B12 deficiency can cause

Back 50

neurologic damage, which can be irreversible if it continues for long periods without treatment. (long term effect of Pernicious anemia)

Front 51

What is a major dietary source of B12?

Back 51

Red meat

Front 52

What is Folic acid (B9) deficiency anemia ?

Back 52

B. Folic acid (B9) deficiency anemia – a common, slowly progressive megaloblastic (LARGE RBC) anemia – most common cause alcohol abuse suppressing the metabolic effects of folate –

Front 53

additional causes for folic acid (B9) deficiency

Back 53

1. poor diet,
2. impaired absorption,
3. bacteria,
4. prolonged drug therapy (i.e., anticonvulsants, methotrexate) –
5. increased metabolic need (i.e., hemolytic anemia, pregnancy)

Front 54

Diagnostic tests for Folic acid deficiency anemia

Back 54

a) serum folate levels < 4 mg/ml. and
b) macrocytosis (abnormally large RBCs)

Front 55

Treatment for Folic acid deficiency anemia –

Back 55

A. eliminate contributing causes;
B. folic acid supplements;
C. well balanced diet –

Front 56

Identify 6 foods rich in folic acid

Back 56

Fortified breads and cereals, green leafy vegetables, OJ, dried peas and beans

Front 57

Nursing Interventions for Folic acid deficiency anemia

Back 57

1. well balanced diet;
2. provide rest periods & check pulse with activity;
3. good oral hygiene for glossitis (define glossitis: inflammation of the tongue)

Front 58

What is Aplastic anemia ?

Back 58

results from injury to or destruction of stem cells in bone marrow causing anemia, leukopenia, thrombocytopenia (pancytopenia means conditions such as aplastic anemia in which numbers of all marrow-produced blood cells are reduced.) – can be related to drugs (i.e., chloramphenicol, cancer chemotherapy), toxic agents, radiation, infections and autoimmune disorders

Front 59

What does “aplasia” mean?”

Back 59

Failure to develop

Front 60

What is leukopenia?

Back 60

an excessive reduction↓ in the number of white blood cells leukocytes

Front 61

What is thrombocytopenia

Back 61

A lower than normal number of platelets or thrombocytes

Front 62

What is a normal WBC for adults?

Back 62

in males, 5,000-13,000/mm³, in females, 5,000-10,000/mm³

Front 63

What is a normal platelet count for adults?

Back 63

150,000-450,000/mm³

Front 64

Aplastic anemia Complications (most common) –

Back 64

a) life-threatening hemorrhage from the mucous membranes;
b) opportunistic infections

Front 65

Diagnostic tests for Aplastic anemia

Back 65

1.low RBC count,
2. decreased platelet and WBC counts;
3. bone marrow biopsy shows depleted stem cells

Front 66

Aplastic anemia treatment

Back 66

a) eliminate cause;
b) transfusion of RBCs,
c) platelets;
d) corticosteroids if cause is autoimmune;
e) may need oxygen administration

Front 67

Nursing Interventions for Aplastic anemia

Back 67

focus efforts on helping to prevent or manage hemorrhage, infection, adverse effects of drug therapy and blood transfusion reaction.
May require special protective isolation if WBC count very low

Front 68

What are “bleeding precautions?

Back 68

Bleeding precautions are safety measures used to protect you if you have a high risk for bleeding. You are at high risk for bleeding when the platelet count in your blood is low or if your platelets are not working properly

Front 69

What is protective isolation/ reverse isolation/ neutropenic precautions?

Back 69

They reduce exposure to pathogens that are dangerous when immunity is suppressed.

Front 70

To prevent infection in clients with neutropenia:

Back 70

1. Always wash hands before touching client; encourage client to remind everyone else to do the same.
2. Tell client to wash his/her hands before/after eating and using restroom.
3. Encourage client to shower daily.
4. Place mask over client’s mouth and nose if leaving room. Limit time client spends in crowded areas.
5. Ensure no raw fruits/vegs are served.
6. Minimize invasive procedures (schedule all blood work to be drawn at one time; d/c invasive lines ASAP
7. Tell client not to handle cut flowers.