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84 Cards in this Set
- Front
- Back
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Teaching for pt taking iron
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Causes black stools, take with food, drink plenty of H2O
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How big is the spleen?
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11cm. Lies b/w 9th to 12th thoracic ribs
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Hemoglobin lab value
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Men: 14-17
Women: 12-15 |
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Hematocrit lab value
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Men: 42-52%
Women: 35-47% |
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VCM lab value
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80-100
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ESR lab value and what does it signify?
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<30mm/hr and inflammation
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How does a PET scan work?
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Probe slid across abdomen to detect density and borders of abdominal organs. Nuclear tracer substance injected.
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Nursing responsibilities for PET scan
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Pt is npo 4 hours pretest. Diabetics may need med adjustments.
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Nursing responsibility CT scan
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Investigate iodine sensitivity
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Bone marrow biopsy. Where is it most commonly done?
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Hip b/c sternum has chance of piercing the heart.
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Nursing responsibilities...bone marrow biopsy
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Sterile container. Right pt time date and doc. Witness informed consent. Talk to pt b/c it HURTS.
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Position for bone marrow biopsy
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Lateral side lying
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Biggest concerns with bone marrow biopsy
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infection and hemmorhage
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Lymph node biopsy...call the doc if...
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Hurts >1week. S/S of infection. Fluid builup where the node was removed. Numbness (may be nerve damage.)
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Most common sign of anemia
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Fatigue
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Skin appearance in anemia
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pallor, jaundice, pruritis
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Eyes in anemia
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icteric conjunctiva and sclera, retinal hemmorhage, blurred vision
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Mouth in anemia
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glossitis, smooth tongue
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Cardiovascular symptoms in anemia
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tachycardia, intermittant claudication, murmurs, angina
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Pulmonary s/s in anemia
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tachypnea, dyspnea at rest, orthopnea
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neuro s/s anemia
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roaring in ears, impaired thought processes, irritability, vertigo, headache
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musculoskeletal s/s anemia
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bone pain
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general s/s anemia
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sensitivity to cold, weight loss, lethargy
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nursing dx anemia
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fatigue, altered nutrition, ineffective self health management
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What inhibits Fe absorbtion?
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caffiene, antacids, Ca, Ph, Mg
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What is aplastic anemia?
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Pancytopenia
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What causes aplastic anemia?
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Radiation, chemical agents like benzene, infection like hepatitis, and drugs like gold
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Medical emergency with neutropenia
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Low grade fever
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Aplastic anemia nursing actions are directed at preventing...
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infection and hemmorhage.
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Thrombocytopenia nursing dx: impaired oral mucous membrane interventions
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You soft toothbrush, select soft bland nonacidic foods, assist w oral hygiene after eating, avoid use of lemon-glycerin swabs to prevent excessive drying of the mucosa
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Most aplastic anemias are caused by
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auto immune response, so cytoxan and cyclosporine to reduce immune system are used.
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Pernicious anemia is...
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B12 definiciency
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Pernicious anemia is caused by...
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lack of intrinsic factor due to heredity or alcoholism or surgery that impair gastral muscosal secretion of IF.
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What meds can cause pernicious anemia?
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H2-histamine receptor blockers, proton pump inhibitors
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What diseases can cause pernicious anemia?
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Crohn's, diverticulitis, ileitis, chronic atrophic gastritis
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S/S of pernicious anemia
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sore tongue, anorexia, n/v, paresthesias of feet and hands, reduced vibratory and position senses, muscle weakness, impaired thought processes
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What do the RBC look like in pernicious anemia?
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Big and fragile
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Nursing intervention for pernicious anemia...
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Ensure pt is protected from burns and trauma b/c of diminished sensation to heat and pain as a result of neurologic impairment.
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What foods contain folic acid?
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leafy green vegetable and citrus fruits
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How is folic acid lost and cause anemia?
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alcholism, dialysis, anorexia, methotrexate, antiseizure meds
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s/s of folic acid anemia
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smooth beefy red tongue, dyspepsia, NO NEURO S/S (unlike b12 deficiency), folate level <3
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Folic acid deficiency treated by...
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replacement therapy with 1mg/day po. encourage foods like leafy greens and citrus.
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Fe deficiency anemia develops from...
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diet, malabsorption, blood loss, hemolysis, dialysis
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Fe deficiency anemia can be from surgeries to what?
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Duodenum
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Blood loss s/s in stools
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black and tarry from the iron from the rbc in stools
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s/s of Fe deficiency anemia
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pallor, glossitis, cheilitis, headach, paresthesias, burning tongue
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Food sources of Fe
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Liver, muscle meats, eggs, dried fruits, legumes, dark green leafy vegetables, whole grain breads, potatoes
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B12 food sources
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red meat, eggs, enriched grain products
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Folic acid food sources
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green leafy vegetables, liver, meat, fish, legumes, whole grains
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Nutrients needed for anemia...
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B12, folic acid, Fe, B6 (hemoglobin synthesis), amino acids, Vit C (converts folic acid to it's active form and aids in iron absorbtion)
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How do you take Fe pills?
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1 hr before meals with orange juice
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How do you take liquid iron?
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through a straw to avoid tooth discoloration
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When injecting the iron...
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Use seperate needles for withdrawing the solution and for injection b/c it will stain the skin. Use Z-track method.
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Side effects of iron...
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Constipation and black stools
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What precautions do you take with the anemic pt?
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Fall precautions! Tell them to stand and see if they are dizzy.
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Ave lifespan of a RBC is..
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120 days
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Instructions for Schilling test
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1. Don't take meds with B12
2. Collect urine for 24 hours 3. Fast for 12 hours prior to test |
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Who normally gets sickle cell?
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african americans and meditaranian decent persons
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What triggers sickling of cells?
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Low O2 in blod due to viruses, bacteria, high altitude, emotional stress, surgery, blood loss. Dehydration, increase H ion, decreased plasma volume, low body temp.
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How do sickled cells kill you?
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Get caught up in blood vessels leading to vascular occulusion.
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Teaching for pt with sickle cell disease
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Treat infections promptly (b/c infections can trigger sickling episodes), remain hydrated, avoid high altitudes, treat leg ulcers with bed rest antibiotics warm saline soaks mechanical or enzyme debridement and grafts, manage priapism with procardia
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How do you treat a sickling episode?
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Administer O2
Administer fluids and electrolytes Blood transfusions and iron chelation therapy to prevent Fe overload Pain management with continous opiod administration and breakthrough analgesia. Demerol contraindicated b/c high doses lead to accumulation of a toxic metabolite - normeperidine that cuses seizures. |
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Vit needed by sickle cell pts
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Folic acid b/c of chronic hemolysis and increased utilization of folic acid stores
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Treatments for SCD
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bone marrow transplants
vaccinations antibiotics Hydrea (chemo drug that increases fetal hemoglobin) |
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Hemochromotosis S/S
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Enlarged liver and spleen, iron levels increased, bronzed skin
Also, Cirrhosis, diabetes, cardiomyopathy, arthirtis, esticular atrophy. |
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Treatment for hemochromotosis
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remove 500ml of blood each week for 2-3 years.
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Dietary considerations for hemochromotosis
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Avoid foods with iron and vit c, and uncooked seafood.
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What is polycythmia vera?
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Increased production of RBC which increases blood viscosity and volume.
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Complications with polycythmia vera..
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Enlarged liver and spleen, congestion of organs and tissues with blood.
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Polycythmia vera causes
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Primary: genetic
Secondary: Hypoxia driven: high altitude, cardiopulmoanry disease, defective O2 transport Hypoxia independant: renal cysts or tumors, extrarenal tumors |
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How does polycythmia vera kill you?
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Thrombosis
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S/S of polycythmia vera
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Orthopnea, SOB, red complexion, gout (due to increased uric acid levels from RBC destruction), headache, vertigo, itchiness, phlebitis, CLOTS
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Treatment of polycythmia vera
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Phlebotomies, hydration, myelosuppressive drugs (Hydrea, busulfa, melphalan), allopurinol to reduce the number of gout attacks
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Nursing implications for polycythmia vera
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B/c adequate O2 is needed so blood cells aren't over produced, smoking cessation, avoiding high altitudes and COPD control are important. Evaluate fluid I and O during hydration therapy. Collaborate with dietician about nutritional status b/c pt may have GI symptoms of fullness, pain, and dyspepsia. Active and passive leg exercises and ambulation to reduce thrombus formation.
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Normal platelet count
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100,000-450,000
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Not enough platelets is called
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thrombocytopenia
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Main prob with thrombocytopenia is bleeding. Interventions:
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No sharps (IM, IV, SQ).
Soft toothbrushes. Avoid aspirin. Notify doc of black, tarry stools. |
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How to manage a nosebleed
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Put head up and apply firm pressure to the nostrils and bridge of the nose. If the bleeding continues, place an ice bag over the bridge of your nose and nape of your neck. I you are unable to stop a nosebleed after 10 min, call doc.
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Teaching for bleeding (like with thromocytopenia)
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Use electric razors instead of blade.
Don't pluck your body hair. Don't get tattoos or body peicings. Avoid aspirin. Use soft-bristle toothbrush. Don't use alcohol based mouthwash. Keep track of tampons used. |
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How do you stop bleeding in hemophilia?
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Acute: direct pressure, ice, pack with gelfoam or use thrombin
Bleeding in the joints: rest, apply ice, no aspirin |
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Hemophilia s/s
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nosebleeds, prolonged bleeding tendances, hematuria from falls, neuro signs from hematoma compression of nerves, hemarthrosis (bleeding in to the joints which leads to deformities and crippling
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Primary nursing dx with hemophilia
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bleeding
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Hemophilia teaching
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wear gloves when doing household chores to prevent cuts, prevent injuries, when to contact doc
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What is DIC?
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Everything clots until clotting factors are used up. Then, there is uncontrollable bleeding. Clots clog up blood vessels to organs.
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