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47 Cards in this Set
- Front
- Back
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Formation of new blood cells Red blood cells (RBCs) White blood cells (WBCs) Platelets |
Hematopoiesis |
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RBCs Manufactured in ___ Immature RBCs are ___ Lifespan is ____
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bone marrow reticulocytes 120 days |
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More than one third of an RBC is made of hemoglobin ____: red pigment, contains iron ____: protein chain
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Heme
Globin |
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____ carry hemoglobin, an iron-rich protein that attaches to oxygen in the lungs and carries it to tissues throughout the body. ____ occurs when you do not have enough red blood cells or when your red blood cells do not function properly. It is diagnosed when a blood test shows a hemoglobin value of ___2___. Normal values for children vary with age. |
Red blood cells Anemia less than 13.5 gm/dl in a man or less than 12.0 gm/dl in a woman |
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Anemias Maturation defects 2 |
Cytoplasmic- abnormal hemoglobin formation Iron or globin issues could be the cause
Nuclear- DNA or proteins synthesis issues B12 or folic acid deficiencies |
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Anemias
Excessive destruction of RBCs (hemolytic anemias) 2 |
Intrinsic RBC abnormalities
Extrinsic mechanisms -Damage such as chemicals/drug/etc. |
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Biosynthetic form of the natural hormone erythropoietin (usually secreted by the kidneys) Used for treatment of anemia associated with end-stage renal disease, chemotherapy-induced anemia, and for anemia associated with zidovudine therapy |
epoetin alfa (Epogen) |
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Longer acting form of epoetin called ___ |
darbepoetin (Aranesp) |
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epoetin alfa (Epogen)
Contraindications: 4 Adverse effects: 9 |
drug allergy, uncontrolled hypertension, head and neck cancers, risk of thrombosis
Hypertension*, headache, fever, pruritus, rash, nausea, arthralgia, cough, and injection site reaction
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Erythropoiesis Stimulating Agents 1 |
1 epoetin alfa (Epogen) |
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Before administering epoetin alfa to a patient in renal failure, it is most important for the nurse to assess which laboratory result? |
Hemoglobin level |
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Rationale: Use of epoetin and darbepoetin is contraindicated in cases of uncontrolled hypertension and when hemoglobin levels are __2__ |
above 10 g/dL for cancer patients and 12 g/dL for renal patients |
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Essential mineral in the body Oxygen carrier in hemoglobin and myoglobin Stored in the liver, spleen, and bone marrow ____ deficiency results in anemia |
Iron |
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Dietary sources: meats, certain vegetables and grains Dietary form must be converted by gastric juices before it can be absorbed |
iron |
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Some foods enhance iron absorption 4 |
Orange juice Veal Fish Ascorbic acid |
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Some foods impair iron absorption 4 |
Eggs* Corn Beans* Cereal products containing phytates
* Also common dietary sources of iron |
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Oral iron preparations are available as 1+3 |
ferrous salts
ferrous fumarate (Femiron), ferrous gluconate, ferrous sulfate (FeSO4) |
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Parenteral Iron 4 |
iron dextran (INFeD, Dexferrum) iron sucrose (Venofer) ferric gluconate (Ferrlecit) ferumoxytol (Feraheme) |
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Administration of _____ alleviates the symptoms of iron-deficiency anemia, but the underlying cause of the anemia should be corrected |
iron |
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Give liquid ____ through a straw, it will stain your teeth permanently Parenterally Give by ztrack method, will stain skin also |
iron |
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Iron: Adverse Effects 5 |
Most common cause of pediatric poisoning deaths Causes nausea, vomiting, diarrhea, constipation, and stomach cramps and pain Causes black, tarry stools Liquid oral preparations may stain teeth Injectable forms cause pain upon injection
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Iron Toxicity Symptomatic and supportive measures 5 |
Suction and maintenance of the airway, correction of acidosis, control of shock and dehydration with intravenous fluids or blood, oxygen, and vasopressors |
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In patients with severe symptoms of iron intoxication, such as coma, shock, or seizures, ____is initiated |
chelation therapy with deferoxamine |
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____ is used in iron overload |
Deferiprone |
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May cause anaphylactic reactions, including major orthostatic hypotension and fatal anaphylaxis Test dose of 25 mg of this is administered before injection of the full dose, and then remainder of dose is given after 1 hour Used less frequently now; replaced by newer products ferric gluconate and iron sucrose |
Iron dextran (INFeD, Dexferrum) |
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Indicated for repletion of total body iron content in patients with iron-deficiency anemia who are undergoing hemodialysis Risk of anaphylaxis is much less than with iron dextran, and a test dose is not required Doses higher than 125 mg are associated with increased adverse events, including abdominal pain, dyspnea, cramps, and itching |
Ferric gluconate (Ferrlecit) |
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It is recommended that the patient remain recumbent for ____after an intravenous injection of iron to prevent drug-induced orthostatic hypotension. |
30 minutes |
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Water-soluble, B-complex vitamin Essential for erythropoiesis |
Folic Acid |
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Folic Acid Primary uses 2 |
Folic acid deficiency During pregnancy to prevent neural tube defects
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Malabsorption syndromes are the most common cause of deficiency |
Folic Acid |
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Should not be used until actual cause of anemia is determined
May mask symptoms of pernicious anemia (b12), which requires treatment other than folic acid Untreated pernicious anemia progresses to neurologic damage |
Folic Acid |
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______ is found in wheats and grains
____ is found in red meat
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Folic acid
Iron |
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The use of folic acid to prevent fetal neural tube defects should be started: 2
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at least 1 month before pregnancy.
and continue throughout early pregnancy to reduce the risk for fetal neural tube defects.
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Used to treat pernicious anemia and other megaloblastic anemias Administered orally or intranasally to treat vitamin B12 deficiency Usually administered by deep intramuscular injection |
Cyanocobalamin |
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Caused by lacking intrinsic factor which is found in the stomach |
vitamin B12 deficiency |
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Assess patient history and medication history, including drug allergies Assess for potential contraindications Assess baseline laboratory values, especially Hgb, Hct, reticulocytes (immature RBC), others Obtain nutritional assessment |
Nursing Implications |
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____are contraindicated in patients with ulcerative colitis, PUD, liver disease, and other GI disorders |
Ferrous salts |
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_____ is contraindicated in all anemias except for iron-deficiency anemia
Iron products are contraindicated in hemolytic anemia and any other anemia not associated with iron deficiency
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Iron dextran |
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Keep away from children because oral forms may look like candy |
Iron Nursing Implications |
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For liquid iron preparations, follow manufacturer’s guidelines on dilution and administration Instruct patient to take liquid iron preparations through a straw to avoid staining tooth enamel |
Nursing Implications |
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Oral forms of iron should be taken between meals for maximum absorption, but may be taken with meals if GI distress occurs Oral forms should be given with juice, but not with milk or antacids
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Nursing Implications |
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Patients should remain upright for 15 to 30 minutes after oral iron doses to avoid esophageal corrosion Patients should be encouraged to eat foods high in iron/folic acid
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Nursing Implications |
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For iron dextran, a small test dose should be given After 1 hour, if no reaction, the remainder of the dose can be given Administer deeply into a large muscle mass using the Z-track method
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Nursing Implications |
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For IV doses of iron dextran, give carefully according to manufacturer’s instructions Have resuscitative equipment available in case of anaphylactic reaction
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Nursing Implications |
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Determine cause of anemia before administering folic acid Administer oral folic acid with food Folic acid may also be given IV and added to total parenteral nutrition solutions
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Nursing Implications |
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Monitor for therapeutic responses -Improved nutritional status -Increased weight, activity tolerance, well-being -Absence of fatigue Monitor for adverse effects
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Nursing Implications |
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The appropriate nursing action when administering iron intravenously is to ____ |
flush the intravenous line with 10 mL of normal saline prior to administering the iron. |
