Chapter 24 Hematology and Renal Emergencies

Question 1

Key Terms

lack of a normal of red blood cells in the circulation

Answer 1

Anemia

Question 2

Key Terms

loss of the normal ability to form a blood clot with internal or external bleeding

Answer 2

Coagulopathy

Question 3

Key Terms

a gravity exchange process for peritoneal dialysis in which a bag of dialysis fluid is raised above the level of an abdominal catheter to fill the abdominal catheter to fill the abdominal cavity and lowered below the level of the abdominal catheter to drain the fluid out

Answer 3

Continuous Ambulatory Peritoneal Dialysis (CAPD)

Question 4

Key Terms

a mechanical process for peritoneal dialysis in which a machine fills and empties the abdominal cavity of dialysis solution

Answer 4

Continuous Cycler-Assisted Peritoneal Dialysis (CCPD)

Question 5

Key Terms

the process by which toxins and excess fluid are removed from the body by a medical system independent of the kidneys

Answer 5

Dialysis

Question 6

Key Terms

irreversible renal failure to the extent that the kidneys can no longer provide adequate filtration and fluid balance to sustain life; survival with ____ usually requires dialysis

Answer 6

End-Stage Renal Disease (ESRD)

Question 7

Key Terms

one cycle of filling and draining the peritoneal cavity in peritoneal dialysis

Answer 7

Exchange

Question 8

Key Terms

bacterial infection within the peritoneal cavity

Answer 8

Peritonitis

Question 9

Key Terms

an infection that begins in the urinary tract and ascends up the ureter into the kidney

Answer 9

Pyelonephritis

Question 10

Key Terms

loss of the kidneys’ ability to filter the blood and remove toxins and excess fluid from the body

Answer 10

Renal Failure

Question 11

Key Terms

an inherited disease in which a genetic defect in the hemoglobin results in abdominal structure of the red blood cells

Answer 11

Sickle Cell Anemia (SCA)

Question 12

Key Terms

a vibration felt on gentle palpation, such as that which typically occurs within an arterial-venous fistula

Answer 12

Thrill

Question 13

Key Terms

a drainage tube placed into the urinary system to allow the flow of urine out of the body

Answer 13

Urinary Catheter

Question 14

Critical Decision Making

DETERMINE IF YOU WOULD REQUEST ADVANCED LIFE SUPPORT FOR THE FOLLOWING PATIENTS AND, IF SO, WHY.

A twenty-nine-year-old patient with sickle cell anemia who has severe pain in his arms and chest.

Answer 14

A twenty-nine-year-old patient with sickle cell anemia and severe pain in his arms and chest could be suffering from acute chest syndrome. Chest syndrome is characterized by shortness of breath and chest pain associated with hypoxia when blood vessels in the lungs become blocked. This patient will benefit from an ALS transport.

Question 15

Critical Decision Making

DETERMINE IF YOU WOULD REQUEST ADVANCED LIFE SUPPORT FOR THE FOLLOWING PATIENTS AND, IF SO, WHY.

A forty-two-year-old patient who recently completed his peritoneal dialysis and complains of severe abdominal pain that is worsened by movement.

Answer 15

A forty-two-year-old patient who recently completed his peritoneal dialysis and complains of severe abdominal pain that is worsened by movement likely does not require an ALS transport unless he develops priority signs and symptoms. He may have developed an infection or infiltration of his peritoneum or catheter. He still requires transport and evaluation in the emergency department.

Question 16

Critical Decision Making

DETERMINE IF YOU WOULD REQUEST ADVANCED LIFE SUPPORT FOR THE FOLLOWING PATIENTS AND, IF SO, WHY.

A fifty-five-year-old female who refused to leave her house to go to her hemodialysis appointments and now complains of severe difficulty breathing, has a rapid pulse, and is anxious.

Answer 16

A fifty-five-year-old female who refused to leave her house to go to her hemodialysis appointments and now complains of severe difficulty breathing, tachycardia, and anxiety definitely needs ALS intervention because of her priority signs and symptoms. She may be suffering from an electrolyte imbalance or kidney failure; the patient could even go into ventricular fibrillation or other lethal rhythm.

Question 17

Critical Decision Making

DETERMINE IF YOU WOULD REQUEST ADVANCED LIFE SUPPORT FOR THE FOLLOWING PATIENTS AND, IF SO, WHY.

A thirty-seven-year-old sickle cell anemia patient who complains of extreme fatigue.

Answer 17

A thirty-seven-year-old sickle cell anemia patient complaining of extreme fatigue likely does not develop signs of acute chest syndrome, high fever, hypoperfusion, or stroke.

Question 18

Short Answer

What is sickle cell anemia?

Answer 18

Sickle cell anemia is an inherited disease in which patients have a genetic defect in their hemoglobin that results in an abnormal structure of the red blood cells.

Question 19

Short Answer

What is “sludging” in a patient with sickle cell anemia?

Answer 19

Patients with sickle cell disease have red blood cells composed of defective hemoglobin that causes them to lose their ability to have a normal shape and compressibility. Instead of normal, doughnut-shaped red blood cells, sickle cell patients have red blood cells that resemble a sickle, or crescent, when observed under a microscope. When these misshapen red blood cells move throughout the bloodstream, they can become clogged in capillaries and organs because of their shape and lack of compressibility. This is known as “sludging”.

Question 20

Short Answer

What is a “thrill”?

Answer 20

Chronic renal failure patients on hemodialysis must have specialized intravascular access sites established to allow for their frequent dialysis treatments. These sites are the surgical connection between an artery and a vein, known as a fistula. Because arteries maintain a much higher pressure than veins, the site will create turbulent blood flow is known as a “thrill”.

Question 21

Short Answer

What is the difference between “hemodialysis” and “peritoneal dialysis”?

Answer 21

In hemodialysis, a patient is connected to a dialysis machine that pumps his blood through specialized filter to remove toxins and excess fluid. This is almost always completed in a local or regional dialysis center. Peritoneal dialysis, in contrast, is typically completed at home. The patient has a permanent catheter implanted through the abdominal wall and into the peritoneal cavity. Several liters of a specially formulated dialysis solution are run into the abdominal cavity and left in place for several hours, where it absorbs waste material and excess fluid; then the fluid is drained back out into the bag and discarded.

Question 22

Short Answer

What are the complications that may be seen if a patient misses a dialysis appointment?

Answer 22

A patient who misses a dialysis appointment is at risk for fluid and toxin buildup in his system. This can manifest with symptoms similar to heart failure. The patient may develop shortness of breath, peripheral and pulmonary edema, and even cardiac rhythm disturbances.