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90 Cards in this Set
- Front
- Back
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Major Disorders
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-Nutritional Anemia
-Sickle Cell anemia -Pernicious Anemia -Thalassemia -Aplastic Anemia -Polycythemia -Hemophilia -Thrombocytopenia -Multiple Myeloma -Lymphoma -Leukemia |
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Important Points to Consider
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-Anemia is a condition in which the hemoglobin content of the blood is insufficient to satisfy bodily demands
-Usually due to a decrease in the number of circulating RBC's -Depending on the severity of the RBC deficit, anemia may affect any and all major organ systems |
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Major organ Systems
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-Neurological
-Respiratory -Cardiovascular -Gastrointestinal -Musculosketal -urinary -Integumentary |
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Major System Effects of Anemia
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-Headache - Fainting
-Pain - Forgetfulness - Increased Respiratory Rate -DOE - Tachycardia -Palpitations- Angina -CHF - Chronic leg ulcer - Hematuria - Anorexia -Nausea - Splenomegaly -Bone pain - Joint pain -Bone deformity -Fractures - Pallor - Jaundice - Petechiae - Purpura |
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Hematopoiesis
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Blood cell production, Occurs in the bone marrow
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Erythrocytes
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Cells that are responsible for transporting oxygen and carbon dioxide
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Erythropoiesis
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the process of RBC production
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Erythropoietin
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a hormone synthesized and released by the kidney that stimulates the bone marrow to increase erythrocyte production
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Nutritional Anemias
Nutritional Anemias (con't) |
-result from nutrient deficiencies
- disrupt erythropoiesis or hemoglobin synthesis - nutrient deficiency may be related to dietary factors, malabsorption disorders or the body's heightened need for the nutrient |
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Major Types of Nutritional Anemias
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- Iron deficiency anemia
- Folic Acid Anemia - Vitamin B12 Anemia |
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Iron Deficiency Anemia
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-the supply of iron is inadequate for optimal formation of RBC's
- Most common type - the body cannot synthesize hemoglobin without iron - fewer numbers of RBC's, microcytic RBC's, malformed cells |
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Causes of Iron Deficiency Anemia
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-dietary deficiencies
- decreased absorption-chronic diarrhea, gastrectomy, malabsorption syndromes -increased metabolic requirements-pregnancy, lactation - blood loss-menstrual losses, GI bleeding due to ASA use or ulcers |
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Folic Acid Deficiency
Anemia |
-Folic acid is required for DNA synthesis and the normal maturation of RBC's
-Deficiency characterized by fragile, megaloblastic cells |
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At Risk Populations for F.A.D.A.
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-older adults
-alcoholics (suppresses folate metabolism) - clients on TPN -increased metabolic needs-pregnancy, infants -hemodialysis clients -drug induced malabsorption- chemotherapy agents; anticonvulsants |
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Clinical Manifestations of F.A.D.A.
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-symptoms develop gradually as body stores of folate are depleted
-pallor -progressive weakness -fatique-- -shortness of breath -cardiac palpitations |
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Treatments for F.A.D.A.
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folic acid supplements
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What are some folic-acid rich foods?
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green vegs
liver citrus fruits |
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Iron Deficiency Anemia Clinical Manifestations
Iron Deficiency Anemia Clinical Manifestations (con't) |
-in addition to multisystem effects; iron deficiency anemia can produce:
-brittle, spoon shaped nails -cheilosis-cracks at the corners of the mouth -smooth, sore tongue -pica-craving to eat unusual substances such as clay or starch |
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Treatment for I.D.A.
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-iron rich foods
-oral iron preparations -parenteral iron preparations |
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In administring injectable iron (inferon) what should the nurse keep in mind?
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-d/c oral iron
- do not use deltoid muscle - admin deeply in a large muscle - use Z track method - Use a 19-20 g, 1.5-2.0 inch needle - change needle after drawing up med -do not massage injection site -use an air bubble to avoid withdrawing med into subq tissue |
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Name some iron rich foods
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-red meat
-green leafy vegs -fish -liver -whole grains -legumes |
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What information should be included in a teaching plan when oral iron is prescribed for a client?
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-give on an empty stomach
-use straws to prevent discoloration of the teeth -tarry stools are normal -increase dietary sources of iron |
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Vitamin B12 Anemia Pernicious Anemia
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-anemia caused by failure to absorb dietary vit B12
-results from a lack of intrinsic factor |
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Pathophysiology Intrinsic Factor (Pernicious Anemia)
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-a substance secreted by the gastric mucosa
-binds with dietary vit B12 and travels to the ileum where B12 is absorbed -in the absence of intrinsic factor, vit B12 cannot be absorbed into the body - Schilling's test- used to determine the cause of Vit B12 deficiency |
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The Importance of Vitamin B12
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-Necessary for the synthesis of DNA
-Deficiency of Vit B12 impairs cellular division and maturation, especially in rapidly proliferating RBC's - The RBC's are macrocytic, have thin membranes, oval rather than concave - RBC's are unusually fragile, incapable of carrying oxygen and have a shortened life span |
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Additional Vit B12 Deficiencies
Additional Vit B12 Deficiencies (con't) |
-Malabsorption Conditions
-Dietary Factors - Loss of the pancreas or ileum - Chronic gastritis - Gastrectomy - Strict vegetarians |
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Clinical Manisfestations of P. A.
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-gradual development of symptoms
-contributing factor-depletion of the storage of vit B12 |
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Further Clinical Manisfestatins of P.A.
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-Pallor
-slight jaundice -weakness -smooth, sore, beefy red tongue -diarrhea |
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Clinical Manisfestations of P.A. con't
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Paresthesias
Proprioception Caution: these manifestations may progress to difficulties in maintaining balance as a result of spinal cord damage |
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Paresthesias
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altered sensations such as numbness or tingling in the extremities
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Proprioception
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the sense of one's position in space
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Nursing Interventions of V B12 P.A.
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-dietary (meats, eggs, cheese, green leafy vegs, milk)
- vit B12 supplements -Parenteral replacement-for malaborption or pernicious anemia - replacement therapy for life in some cases |
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Sickle Cell Anemia-Pathophysiology
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-a hereditary, chronic form of hemolytic anemia
-characterized by episodes in which RBC's become abnormally crescent shaped - caused by an autosomal genetic defect that results in the synthesis of an abnormal form of hemoglobin (Hb S) |
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Major Factor of Sickle Cell A
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-Sickle Cell crisis
-Characterized by episodes of acute pain triggered by conditions that cause high tissue demands or that alter cellular PH |
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Pathophysiology of S.C. A
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-during conditions causing decreased oxygen tension, the HbS within the RBC's causes them to elongate and become rigid
- cells assume a crescent or sickle shape - sickled cells tend to clump together - obstruct capillary blood flow - ischemia and possible infarction of surrounding tissue results |
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Social Manifestations of S.C.A.
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-most common among people of African descent
- approximately 8% of AA are heterozygous for s.c.a. - 1% of AA are homozygous for the disorder |
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Sickle Cell Trait
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-heterozygous
- inherited one abnormal gene from one parent - asymptomatic unless stressed by hypoxic conditions |
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Sickle Cell Disease
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-Homozygous
-Inherited a defective gene from both parents -At risk for the manifestations of sickle cell anemia -At risk for experiencing sickle cell crisis |
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Diagnostic Test for S.C.A.
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-Hemoglobin electrophoresis-used to determine trait from disease
- Sickle Cell screening test- determines the presence of hemoglobin S |
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Conditions that Trigger a S.C. Crisis
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-Hypoxia
- Low environmental or body temperatures - Excessive exercise - Anesthesis - Dehydration - infections - Acidosis |
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Clinical Manifestation of a S.C. Crisis
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-abrupt onset of intense pain
- usually starts in the abdominal region - chest, back, and joints of the extremities may also be affected - on rare occasions, may localize in the CNS causing seizures or stroke |
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Systemic Manifestations of S.C. (repeated infarcts)
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-heart Murmurs
- CHF - hematuria - Hyperuricemia - hepatomegaly - jaundice - gallstones - bone marrow aplastia -osteomyelitis - ulcers - retinal detachment - vitreous hemorrhage |
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Assessment of S.C. Anemia
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-Hemoglobin electrophoresis- used to id Hb S
- CBC- decreased HCT |
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Interventions for S.C.
Anemia Interventions for S.C. Anemia (con't) |
-no cure
- treatment is supportive - Analgesics - rest - oxygen - blood transfusion - vital signs - monitor CBC - hydration - folic acid supplements to meet the increased metabolic demands of the bone marrow - I & O - Assess pain - pulse oximeter |
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Explain why hydration is a priority in treating sickle cell dx.
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hydration promotes hemodilution and circulation of RBC's through the blood vessels
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Thalassemia
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- inherited disorder
- affects hemoglobin synthesis - alpha or beta chains of the hemoglobin molecule are missing or defective - characterized by deficient hemoglobin production and fragile hypochromic RBC's |
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Social Manifestations of Thalassemia
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-mediterranean descent
-Thailand -Philippines -China |
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Clinical Manifestations of Thalassemia
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-Liver enlargement
- Spleen enlargement - Fx of long bones |
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Treatment of Thalassemia
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-no cure
- genetic counseling |
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Aplastic Anemia
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-referred to as bone marrow depression anemia
- bone marrow fails to produce RBC's - underlying cause is unknown in 2/3 of the cases- referred to as idiopathic aplastic anemia |
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Aplastic Anemia
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-may also follow injury to the stem cells in bone marrow following exposure to radiation or certain chemical substances
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Pathophysiology of Aplastic Anemia
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- anemia results as the bone marrow fails to replace RBC's that have reached the end of life and are destroyed
- cells remaining in the blood are normochromic and normocytic |
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Aplastic Anemia
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may also develop concurrently with infections
- mononucleosis - hepatitis C HIV infection |
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Chemical Substances associated with Aplastic Anemia
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- Benzene
- Inorganic Arsenic - Several Pesticides |
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Clinical Manifestatiosn of Aplastic Anemia
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-Pancytopenia-decreased RBC's, WBC's & Plts
- symptoms can occur at any age - onset can be gradual or sudden |
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Clinical Manifestations of A.A. (con't)
Clinical Manifestations of A.A. (con't) |
- Fatigue
- Pallor of skin or mucous membranes - Progressive weakness - headache - Tachycardia - CHF - Bleeding Problems - Infections |
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Treatment for A.A.
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-remove the causative agent
-blood transfusions - bone marrow transplant |
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Polycythemia
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- characterized by an excessive number of circulating RBC's
- evidenced by an abnormally high total RBC mass |
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Forms of Polycythemia
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- Primary Polycythemia
- Secondary Polycythemia |
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Primary Polycythemia
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-also called polycythemia vera (PV); myeloproliferative disorder
- neoplastic stem cell disorder - overproduction of RBC's and certain WBC's |
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Primary Polycythemia
occurrence/cause |
-rare condition
-most common in Caucasian men of European Jewish ancestry - gradual onset, ages 40-60 - cause unknown - related to hypersensitivity of erythroid stem cells to erythropoietin, the hormone that stimulates RBC production |
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Primary Polycythemia
Manifestations |
-begins without symptoms
- diagnosed during routine blood tests - without trmt-death within 18 months - trmts- survival 12 yrs or longer - cause of death- vascular complications - clinical manifestations related to hypervolemia |
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Primary Polycythemia S&S
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-headaches
- dizziness - tinnitus - splenomegaly - blurred vision - hypertension - cyanosis - plethora (engorged or distended blood vessels) |
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Secondary Polycythemia
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-most common form
- referred to as erythrocytosis - excess erythropoietin - causes vary |
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Causes of Secondary Polycythemia
Causes of Secondary Polycythemia (con't) |
-increase in the secretion of erythropoietin
- prolonged hypoxia- prolonged exposure to high altitudes, COLD - Erythropoietin-secreting tumors - Cushing's syndrome - Renal disorders (long-term hemodialysis) - Morbidly obese |
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Secondary Polycythemia S&S
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-Hypertension
- headache - tinnitus - blurred vision - cyanosis - pruritus - no splenomegaly |
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Treatment of Secondary Polycythemia
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-reducing blood viscosity and volume
- phlebotomy-removing 300 to 500 ml of blood - PV- radiation therapy, chemotherapy to suppress bone marrow function - treat systemic symptoms - i.e. antihistamines for pruritis |
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Nursing Care for Secondary Polycythemia
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-client and family teaching
- hydration -preventing blood stasis - support stockings, elevate lower extremities when sitting - smoking cessation |
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The nurse is caring for a 32 yr old client with pernicious anemia.
Which set of findings should the nurse expect when assessing the client? |
Pallor, tachycardia and a sore tongue. others are anorexia, wgt loss, a smooth beefy tongue, a wide pulse pressure, palpitations, angina weakness, fatigue, and paresthesia of the hand and feet
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A client receiving ferrous sulfate (Fer-iron) therapy to treat an iron deficiency reports taking an antacid frequently to relieve heartburn.
Which instruction should the nurse provide |
Take ferrous sulfate and the antacid at least 2 hrs apart-antacids decrease the absorption of iron
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Which findings are normal?
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150,000 to 300,000 WBC/pul;
4.5 to 5.5, 5,000-10,000 RBC's; and an avg hematocrit of 45% |
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The nurse is preparing to admin a unit of blood to a client who is anemic.
After its removal from the refrigerator, the blood should be admin within: |
4 hrs
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A client is diagnosed with megaloblastic anemia caused by a Vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin-12), 100 mcg I.M. daily.
Which substance influences Vitamin B12 absorption? |
Intrinsic factor, which is secreted by parietal cells in the stomach
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A client must recieve a blood transfusion of packed RBCs for severe anemia.
Which IV fluid should the nurse use to prime the tubing before hanging this bl. product? |
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- - Normal saline solution |
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The nurse is teaching a client with pernicious anemia who requires V B12 replacment therapy. Which statement indicates that the client understand the treatment program
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I'll need an injection of Vitamin B12 every month for life
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The couple with the lowest risk of having a child with sickle cell dx is the one in which the?
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Father is HBA and the mother is HbS-
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A client with pernicious anemia is recieving parenteral Vit. B12 therapy. Which client statement indicates effective teaching about this therapy?
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I will receive parenteral V. B12 for the rest of my life
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A client with anemia has been admitted to the med-surg unit. Which assessment findings are characteristic of iron-deficiency anemia?
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Dyspnea, tachycardia, and pallor-
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Which iron-rich foods should the nurse encourage an anemic client requiring iron therapy to eat?
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Lamb and peaches
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A client has had heavy menstrual bleeding for 6 mths. her gynecologist diagnoses microcytic hypochromic anemia and prescribes ferrous sulfate (Feosol) 300 mg PO daily. Before initiating iron therapy the nurse reviews the client's medical history. Which condition would contraindicate the use of ferrous sulfate?
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Ulcerative colitis
- Conditions that contraindicate the use of ferrous sulfate include, primary hemochromatosis, infectious kidney dx during the acute phase, peptic ulcer, regional enteritis and known hypersensitivity to iron |
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Which nursing diagnosis should the nurse expect to see in a care plan for a client in sickle cell crisis?
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Acute pain related to sickle cell crisis.
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For a patient with iron-deficiency anemia what should the nurse advise the pt to avoid to prevent staining the teeth
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dilute liquid preparations of iron with juice and drink with a straw
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Which of the following refers to an abnormal decrease in white blood cells, red blood cells and platelets?
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Pancytopenia
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Which of the following best describes the function of fibrinogen
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It plays a key role in forming blood clots-
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Of the following hemolytic anemias, which is categorized as inherited?
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Sickle cell anemia, Glucose-6-phosphate dehydrogenase deficiency is an inherited abnormality resulting in hemolytic anemia.
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Which is the symptom of Cooley's anemia, a severe form of beta=thalassemia?
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bronzing of the skin, which is caused by hemolysis of erythrocytes.
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As you prepare to administer an iron preparation, you are aware that iron
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may stain the skin
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A Schilling test is ordered for a client who is suspected of having pernicious anemia. The nurse recognizes that the primary purpose of the Schilling test is to determine the client's ability to
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absorb V B 12
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A Schilling test is ordered for a client suspected of having cobalamin deficiency because of pernicious anemia. The nurse must plan to
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Collect a 24-48 hr urine specimen
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The nurse is reviewing the physician's orders for a client admitted to the hospital with a diagnosis of idopathic autoimmune hemolytic anemia. The nurse anticipates that which of the following would be a component of the prescribed therapies
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corticosteroid meds particulary prednisolone (Prelone). Other treatments that may be prescribed as necessary include splenectomy, transfusions, and occasionally immunosuppressive med.
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