Med2051 - Test 2

Front 1

What does a peptic ulcer have to do with low complete blood count (CBC)?

Back 1

possible bleeding. lose blood cells

Front 2

What labs do you do prior to surgery and why?

Back 2

CBC, PT, PTT, INR - test for anemia, blood type, number of platelets for clotting factor

Front 3

Lab Values: WBC

Back 3

5,000 - 10,000

Front 4

Lab Values: Platelets

Back 4

150,000 - 450,00
(sometimes 500,000)

Front 5

Lab Values: Hemoglobin (HGB)

Back 5

females 12 - 16
males 14 - 18

Front 6

Lab Values: Hematocrit (HCT)

Back 6

36% - 54% (HGBx3=HCT)

Front 7

Lab Values: pH

Back 7

7.35 - 7.45

Front 8

Lab Values: PaCO2

Back 8

35 - 45

Front 9

Lab Values: PaO2

Back 9

80 - 100

Front 10

Lab Values: HCO3

Back 10

21 - 26

Front 11

Lab Values: SaO2

Back 11

95% - 100%

Front 12

Lab Values: Sodium (Na+)

Back 12

135 - 145

Front 13

Lab Values: Albumin

Back 13

3.4 - 5.4

Front 14

Lab Values: Creatinine (CRT)

Back 14

0.5 - 1.5

Front 15

Lab Values: Blood Urea Nitrogen (BUN)

Back 15

7 - 20

Front 16

Lab Values: Magnesium (Mg+)

Back 16

1.3 - 2.1

Front 17

Lab Values: Potassium (K+)

Back 17

3.7 - 5.2

Front 18

Lab Values: Calcium (Ca+)

Back 18

8.5 - 10.2

Front 19

What happens to blood that has higher viscosity?

Back 19

slow and causes clots - possible emboli or DVT

Front 20

What are the ABC's and why is it needed?

Back 20

Airway, Breathing, Circulation. - for circulating oxygen

Front 21

What will a higher Red Blood Cell (RBC) count do?

Back 21

blood will have higher viscosity (thickness)

Front 22

What labs do you check for possible anemia, iron deficiency?

Back 22

Hemoglobin: females 12-16; males 14-18

Front 23

What does iron deficiency mean? and what lab tests are used?

Back 23

Low in iron.
need Hemoglobin and Hematocrit lab tests to determine iron deficiency

Front 24

What foods are high in iron?

Back 24

green leafy vegetables, organ meats, red meats

Front 25

What causes iron deficiency?

Back 25

can be caused by blood loss, poor GI absorption of iron, and an inadequate diet and is common in women (menses), older adults, and people with poor diets

Front 26

What is pernicious anemia?

Back 26

caused by a deficiency of gastric acid and intrinsic factor which is required for the absorption of vitamin B12.

Front 27

What test to take for pernicious anemia?

Back 27

Schilling Test (measures the absorption of radioactive vitamin B12 as it is excreted in the urine)

Front 28

What position would you place your patient to prepare for bone marrow biopsy?

Back 28

PRONE (drilling a hole in the iliac crest)

Front 29

What is the FIRST nursing action you would do after bone marrow aspiration?

Back 29

apply pressure (stop the bleeding)

Front 30

What is phlebitis?

Back 30

irritation of a vein by chemical, bacterial, or mechanical irritation

Front 31

What are the s/s of phlebitis?

Back 31

monitor for redness, pain or burning, discomfort, warmth, edema, vein induration (hard), red streaks, slowing infusion rate, increased temperature, infection

Front 32

What does the nurse do first when a patient has phlebitis at IV site?

Back 32

remove the IV (since IV caused it, remove the cause)

Front 33

IV flow rate drop factor =

Back 33

V (mL) / T (min) x C (gtt/mL) = R (gtt/min)

Front 34

IV flow rate drop factor SHORTCUT =

Back 34

mL/h / drop factor constant = R (gtt/min)

DROP FACTOR CONSTANTS (divide by 60):
10gtt/mL = 6
15gtt/mL = 4
20gtt/mL = 3
60gtt/mL = 1

Front 35

What could cause a patient who has IV to have infiltration?

Back 35

infiltration is fluid leaking into surrounding subcutaneous tissue usually do to catheter displacement from inadequately taped catheter. CAUSES: improper IV insertion, improper vein selection, irritating infusions, overmanipulation of the IV catheter, improper taping, tape that is too tight

Front 36

Why should you check the glucose levels on a patient with TPN (total parental nutrition)?

Back 36

to make sure that the glucose is not elevated. check glucose every 4-6 hours the first days of administration (hyperglycemia)

Front 37

Why would a post-op patient with a splenectomy (removal of spleen) have abdominal distention?

Back 37

could have internal bleeding, complication, infection. This is a medical EMERGENCY.

Front 38

What patient teaching do you do prior to surgery?

Back 38

AERATION. turn, cough, deep breathe. Spirometer (ventilate lungs) - expand lungs

Front 39

What does eating unusual things have to do with iron deficiency anemia?

Back 39

PICA. craving ice cubes is a sign of iron deficient anemia

Front 40

What foods are high in iron?

Back 40

spinach, broccoli, asparagus, bell pepper, collared greens, mustard greens, red meats, organ meats - liver, heart, kidney, BREAST MILK

Front 41

What are the classic s/s of iron deficiency anemia?

Back 41

pallor (pale skin), pale mucous membranes - conjunctiva, fatigue, sore tongue (GLOSSITUS), spoon shaped nails, weakness, shortness of breath, PICA, pagophagia

Front 42

What are the classic s/s of pernicious anemia (B12 deficiency)?

Back 42

paresthesias (numbness, tingling - fingers, toes, mouth), pallor, jaundice, glossitus, fatigue, weight loss

Front 43

What is B12 deficiency related to?

Back 43

INTRINSIC FACTOR (a substance produced by the parietal cells of the stomach). Intrinsic factor is required for the absorpotion of vitamin B12; without B12 the body inhibits folic acid, a substance needed for RBCs to multiply properly

Front 44

Who is at risk for pernicious anemia?

Back 44

strict vegans (no organ or red meats), chrones disease (bleeding of the intestines), GI disorders, gastrectomy patients

Front 45

What is Cooley's Anemia (Beta Thalassemia)

Back 45

group of HEREDITARY homolytic (break down of RBC's) anemias characterized by a defect in the synthesis of a protein needed for production of hemoglobin and RBCs

Front 46

What group of people is Cooley's Anemia most common in?

Back 46

Mediterranean (greek, italian, turkey, portuguese, africa)

Front 47

What is sickle cell anemia?

Back 47

A congenital hemolytic (breaks down RBCs) anemia that occurs primarily in blacks. Results from a defective hemoglobin molecule that causes the RBC to become sickle shaped (moon). Cells clump together, clogging capillaries and impair circulation resulting in chronic ill health (fatigue, dyspnea on exertion, swollen joints), periodic crises, long-term complications (infarcts, ulcers) and early death

Front 48

What group of people is at risk for sickle cell anemia?

Back 48

Mediterranean and African Americans

Front 49

What is the major s/s of sickle cell anemia?

Back 49

JAUNDICE (affects major organs)

Front 50

What is the priority action for sickle cell crisis?

Back 50

PAIN management (severe abdominal, thoracic, muscular, or bone pain; cells are getting stuck and cause pain)

Front 51

What ethnic group in US has sickle cell anemia?

Back 51

African Americans (1 out of every 500 blacks have sickle cell anemia)

Front 52

Why is pushing fluids important?

Back 52

flush toxins

Front 53

What is the most common blood type?

Back 53

O

Front 54

What is the rarest blood type?

Back 54

AB

Front 55

What blood type is the universal donor?

Back 55

O

Front 56

What kind of blood can O receive?

Back 56

only O

Front 57

What blood type is the universal recipient?

Back 57

AB

Front 58

How long do you have to administer blood products?

Back 58

complete the transfusion within a 2 to 4 hour time frame to avoid bacterial growth

Front 59

Why do we prime an IV tube with normal saline prior to blood transfusion?

Back 59

to lubricate the tube. normal saline is ISOTONIC sodium chloride (NaCl) 0.9%

Front 60

What is the first thing you do when patient has a transfusion and there is a problem or reaction?

Back 60

STOP IT. then send bag and tubing to the lab. take a urine specimen, turn on saline. NOTIFY THE PRIMARY CARE PROVIDER IMMEDIATELY FOR ANY SIGNS OF REACTION

Front 61

What is polycythemia?

Back 61

chronic disorder characterized by increased red blood cell mass, erythrocytosis, leukocytosis, thrombocytosis, increased hemoglobin level, and low or normal plasma volume

Front 62

What are the treatments for Polycythemia?

Back 62

PUSH FLUIDS TO PREVENT CLOTS, therapeutic phlebotomy, myelosuppressive therapy, interferon alfa

Front 63

Why do patients have chest pain with polycythemia?

Back 63

lack of oxygen to heart muscle because the blood is too thick to carry oxygen. Secondary polycythemia is the excessive production of circulating RBCs due to HYPOXIA (smoking, high altitude, COPD), tumor, or disease

Front 64

What is phlebotomy?

Back 64

removal of blood from the vein

Front 65

How is therapeutic phlebotomy a treatment for polycythemia vera?

Back 65

(removal of blood from the vein) to reduce the RBC mass (500mL of blood) removed every other day until HCT is normal. can also push fluids to prevent clots.

Front 66

What precautions should you take when working with a patient with low neutrophils? (low on WBC)

Back 66

WASH HANDS. prevent infection. patient with low neutrophils can get infections

Front 67

Why would a patient with leukemia bruise?

Back 67

Leukemia is a group of diseases caused by malignant proliferation of WBCs; cancer of the bone marrow which lack platelets.

Front 68

What are s/s of infection when looking at urine?

Back 68

cloudy, foul smell, may be bloody, dark, concentrated

Front 69

What are s/s with low platelet count?

Back 69

BRUISING

Front 70

What is hemophelia A?

Back 70

considered the classic form of the disease, results from a congenital deficiency of clotting factor VIII (8)

Front 71

Why can't a patient with hemophelia take aspirin?

Back 71

aspirin will thin out the blood and will cause to bleed more

Front 72

What is Hemarthrosis?

Back 72

condition of bleeding in the joints

Front 73

What is DIC (dissiminated intravascular coagulation)?

Back 73

it is a SECONDARY problem. Occurs as a complication of diseases and conditions that increase rate of clotting. Risk Factors: infections, obstetric complications, cancers, necrosis, heatstroke, shock, poisonous snakebite, cirrhosis, incompatible blood transfusions, severe DVT

Front 74

What drug is given for DIC (dissiminated intravascular coagulation) patients?

Back 74

low molecular weight HEPARIN in early stages to prevent micro-clotting - used only when benefit outweighs the risk. Watch for bleeding

Front 75

a young boy fell earlier and is now complaining of abdominal pain. This boy is a hemopheliac. What is the problem?

Back 75

may have internal bleeding due to lack of clotting factor. this is a medical EMERGENCY. go to ER

Front 76

What labs should you monitor for DIC? (dissiminated intravascular coagulation)

Back 76

PLATELETS, PT, PTT, INR

Front 77

Why do multiple myeloma (cancer in bone marrow) patients need an IV?

Back 77

Hydration needed to prevent renal calculi. increase the fluids to flush out the calcium that is in the blood. Bone is breaking down and calcium is going in the blood.

Front 78

What is lymphedema?

Back 78

a build-up of lympatic fluids in soft tissue that can cause an arm or leg to swell up and become painful (commonly caused by mastectomy)

Front 79

Why should you not draw blood, take BP, or inject anything to an extremity with lymphedema?

Back 79

will make extremity worse. Apply compression pumps, elastic sleeves or stockings to protect from injury

Front 80

Who is at risk for Hodgkin's lymphoma?

Back 80

young adults 15-38, and ages 50 and older

Front 81

What lymph node is affected in the first stage of Hodgkin's disease?

Back 81

painless swelling in one of the lymph nodes (usually the cervical, neck, region) with a history of respiratory infection

Front 82

What is the treatment for Hemophilia A?

Back 82

Intravenous administration of CRYOPRECIPITATE for Hemophilia A or lyophilized FACTOR VIII (8) or IX (9) to increase clotting factor levels and permit normal hemostasis