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64 Cards in this Set
- Front
- Back
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deficiency in # of RBC, quantity of hemoglobin &/or volume of hematocrit
-not a specific disease but a manifestation of pathologic process |
anemia
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causes of anemia
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blood loss
trauma blood vessel rupture menstrual flow gastritis hemorrhoids |
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causes of anemia due to impaired production of RBC
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iron deficiency
Thalassemias B12 deficiency chemotherapy |
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causes of anemia due to increased destruction of RBC
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sickle cell anemia
prosthetic heart valve malaria |
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compensation mechanisms of anemia include:
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oxygen-hemoglobin dissociation curve shifts to the right
blood taken to more vital organs increased COP incr RBC production |
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mild anemia Hb value
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Hb 10-14
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moderate anemia hb value
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Hb 6-10
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severe anemia hb values
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Hb <6
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nsg mgmt anemia
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PMH - dialysis, hepatic disease, ulcers caused by ASA, NSAIDS, anticoagulants, PCN
physical assessment medication use surgery or treatments plan rest & activity to avoid fatigue - GOAL limit visitors, calls, noise check H&H teach foods hi in iron, protein, calories small frequ meals - req less energy check for hypoxemia transfuse prn breathing exercises relaxation techniques, very anxious can't breath |
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Nutrition for erythropoiesis
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B12-red meat, liver
folic acid-green leafy veg, fish, grains vit B6-pork,liver,bananas Fe-liver,eggs,dark green veg amino acids-milk,dairy,chicken vitC-citrus,strawberries, cantalope |
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anemia in the elderly
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common
from chronic disease s/s misleading-feel part of aging -pallor -confusion, ataxia -fatigue -incr angina |
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iron deficiency anemia
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most common chronic disorder in the very young, those on poor diets, women in reprod yrs
malabsorption of iron common after GI surgeries |
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reasons for blood loss-2ml of whole blood has 1 mg of iron
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peptic ulcer
gastritis esophagitis diverticuli hemorrhoids neoplasma lose 45ml of blood via menstruation each month & 22 mg of iron pregnancy due to iron to fetus, delivery, lactation chronic renal failure due to dialysis |
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clinical manifestations of iron deficiency anemia
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pallor
h/a burning tongue paresthesia |
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care of iron deficiency anemia
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treat cause, replace iron, replace blood loss
iron supplements-don't take ER, take 50-100 mg TID or QID take 1 hr before meals & w/OJ to enhance absorption dilute liquid to avoid staining teeth causes black stools give stool softeners/laxatives prn s/e incl heartburn, constipation, diarrhea |
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iron by IM
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change needles to prevent staining skin
leave 0.5 ml air in syringe to clear iron give deep IM in upper outer quadrant of buttocks with a 2-3 inch 19-20G needle z-track do not massage |
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iron by IV
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don't mix or add to solutions
give undiluted over 1 ml/min then flush with NSS |
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thalassemia
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autosomal recessive genetic disorder of inadequate production of normal hb
mediterranean heritage generalized anemia, jaundice, chronic bone marrow hyperplasia leading to thickening of cranium & maxillary cavity, retarded physical & menthal growth transfusion w/IV Desteral to reduce iron overload due to chronic transfusions keep hb @ 10 to prevent enlarging spleen |
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megaloblastic anemia
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caused by impaired DNA synthesis & presence of large RBCs. These RBCs are easily destroyed due to:
cobalamin, folic acid def suppression of DNA synthesis by drugs inborn errors of cobalamin & folic acid metablism malignant blood disorders |
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cobalamin deficiency
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intrinsic factor (IF) a protein from gastric mucosa is not made, from lack of HCl secretion by stomach therefore cobalamin is not absorbed in distal ileum
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pernicious anemia
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when B12 is decr due to lack of IF
dietary def, gastrectomy, malabsorption, family hx seen in pts w/gastrectomy, ileum resection, Crohn's Disease, diverticuli of small intestine, users of long-term H2 histamine receptor blockers (acid reflux) |
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symptoms of pernicious anemia
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tissue hypoxia
sore tongue anorexia, n/v abdominal pain paresthesias of feet & hands impaired though |
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Treatment for cobalamin deficiency
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-give B12 IM 1000ug QID x 2wks, then q week until Hct normal, then q month for life
-Nascobal intranasal q week -will die in 1-3 yrs w/o replacement |
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care for cobalamin deficiency includes
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general anemia care
safety measures due to sensation losses screen for gastric CA teach about need for meds |
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reasons for folic acid deficiency
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-poor nutrition
-malabsorption of small bowel -drugs such as methotrexate, BCP, phenobarbital, Dilantin -alcohol abuse -anorexia -hemodialysis |
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s/s folic acid deficiency
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similar to cobalamin, i.e.
-tissue hypoxia, sore tongue, anorexia, n/v, abdominal pain, -dyspepsia -smooth, beefy red tongue -ABSENCE OF NEUROLOGIC PROBLEMS |
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lab test results for low serum folate level reveal
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normal 3-25 mg/ml
serum cobalamin level normal HCL present in gastrict acid |
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treatment for folic acid deficiency
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1-5 mg PO of folic acid QD & folid acid containing foods (green leafy veggies, legumes, whole grains)
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type of anemia that is caused by an underproduction of RBCs & shortening of their survival
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anemia of chronic disease
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causes of anemia of chronic disease
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-ESRD (end stage renal)
-chronic liver disease -chronic infection -heavy metals & chemo -alcohol abuse -HIV -chronic endocrine diseases (DM, thryoid) |
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how to treat anemia of chronic disease
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-correct underlying cause
-give erythropoietin therapy (Epogen, Procrit) |
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type of anemia that is caused by peripheral blood pancytopenia & hypocellular bone marrow
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aplastic anemia
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origin of aplastic anemia
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congenital or acquired
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ways aplastic anemia is acquired
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ionizing radiation
chemical agents (benzene, insecticides, aresenic, alcohol) viral & bacterial infections medications 70% are idiopathic |
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s/s of aplastic anemia
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-slow progression with
-fatigue -dyspnea -neutropenia -thrombocytopenia -ALL CELL COUNTS ARE LOW -BLEEDING TIME PROLONGED -ELEVATED SERUM IRON & TIBC -BONE MARROW IS HYPOCELLULAR W/YELLOW MARROW (FAT CONTENT) CALLED "DRY TAP" |
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care of aplastic anemia
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based on id & removal of causative agent
-untx have 75% fatality rate -bone marrow transplant <45 yrs old w/o prev blood transfusion matched w/human leukocyte antigen matched donor ->45 yr old w/o HLA matched donor then immunosuppression w/ATG or cyclosporine |
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biggest reasons for acute blood loss
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trauma
complications of OR |
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what occurs w/sudden loss of blood volume
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hypovolemic shock (incr HR, RR incr then decr, decr BP & LOC
-sudden loss can occur postpartum or w/esophageal varices |
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what should you assess for in addition to VS with acute blood loss
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pain -- potential for internal hemorrhage -- cramping
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% of blood loss s/s
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10% loss - no s/s
20% loss - nothing at rest, incr HR w/exercise 30% loss - okay supine BP 40% loss - problems w/BP, CP, CVP |
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types of anemia caused by increased erythrocyte destruction include
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hemolytic anemia
Sickle Cell Disease |
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causes of hemolytic anemia
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-defects in RBCs caused by abnormal hbg
-enzyme def altering glycolysis or RBC membrane abnormalities (IF) -extrinsic factors such as trapping cells in sinuses of liver or spleen, toxins, mechanical injury (prosthetic heart valve) |
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s/s of hemolytic anemia
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jaundice
enlarged liver/spleen |
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treatment of hemolytic anemia
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-Fluids (LR, albumin) - vol expanders
-PRBC -platelets PRN -replace Fe PO or IM |
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inherited, autosomal recessive disorders by presence of abnormal form of hgb in the RBC. Hbg S causes the RBC to stiffen, elongate, taking on a sickle shape due to low O2 levels
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Sickle Cell Disease
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found in infancy or childhood
incurable, fatal by middle age due to renal & pulmonary complications |
Sickle Cell Disease
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most severe type of anemia
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Sickle Cell Disease
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carrier state of sickle cell disease & is mild type of SCD (1 in 10 african amer has this trait)
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Sickle Cell trait
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triggered by low O2 in blood from infection, high altitude, stress, surgery, blood loss, dehydration
initially sickling is reversible w/reoxygenation but becomes irreversible due to cell damage |
Sickling Episodes
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severe, painful acute exacerbation of RBC causing vasocclusive crisis, hypoxia, thrombi formation, tissue ischemia, infarction, necrosis
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sickle cell crisis
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s/s of Sickle Cell Disease
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pallor of mucus membranes
fatigue decr exercise tolerance gray cast to skin jaundice common prone to gallstones pain of hands, joints "Hand-foot syndrome" c/o deep gnawing & throbbing, edema of hands/feet, due to bone infacrction |
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complications of Sickle Cell Disease
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CHF
CV complications, spleen becomes small due to scarring "autosplenectomy" osteoporosis leg ulcers-ankles pneumonia-pneumococcal pulmonary hypertension renal failure heart failure/MI retinal detachment infection major cause of morbidity |
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care of Sickle Cell Disease
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avoid high altitudes
good fluid intake treat infection promptly rest pain mgmt O2 therapy antisickling agents - Droxia (beneficial for some) bone marrow transplant education how to prevent crisis Pneumovac, H Influenza check for hepatitis |
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teaching for Sickle Cell Disease
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about disease (parents/child)
avoidance of dehydration avoidance of altitudes tx resp infections immediately pain control tx anxiety & depression |
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reasons for acquired hemolytic anemia
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-physical destruction of RBC (hemodialysis, heart-lung bypass, prosthetic heart valves)
-antigen-antibody response (blood transfusion reaction or autoimmune response (lupus, leukemia) -infectious agents/toxins (malaria, clostridium) |
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tx for for acquired hemolytic anemia
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remove cause
supportive care corticosteroids splenectomy transfusions |
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production & presence of incr # of RBCs - impairs circulation causing hyperviscosity & hypervolemia
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polycythemia
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info re: polycythemia vera (primary)
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chromosomal mutation
incr in all blood cells insidious in those >50 yrs not preventable avoid smoking avoid high altitudes |
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s/s of polycythemia
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h/a
vertigo tinnitis visual disturbances CHF, chest pain intermittent claudication thrombophlebitis pruritis hemorrhage plethora |
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mgmt of polycythemia
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monitor I&O
avoid fluid overload but hydrate active or passive leg exercises to prevent thrombosis phlebotomy - daily until Hct normal then q 2-3 months removing 500cc/time death due to CVA |
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decrease in platelet < 150,000 due to hereditary, acquired (malignant disorders, myelosuppressive drugs, alcoholism, viral infections)
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thrombocytopenia
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most common in women between 20-40
autoimmune disease, platelets covered with antibody that spleen recognizes as foreign & destroys them, unable to survive the normal 8-10 days, last 1-3 days |
immune thrombocytopenic purpura
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s/s thrombocytopenia
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bleeding
epitaxis gingival petechiae purpura ecchymosis fainting vertigo tachycardia abdominal pain hypotension |
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acute nsg mgmt for thrombocytopenia
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control hemorrhage
use small gauge needles w/ 5-10 min of direct pressure after count menstrual pads (50cc blood soaks a pad) give platelets teach to avoid-suppress or cause abnormal platelet production or aggregation thiazide diuretics, alcohol, estrogen, chemo drugs, ASA, NSAIDS, tylenol, lasix, estrogen, PCN watch ginger, cumin, tumeric, cloves, Vit C&E |
