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Nurs 2500 > Class 18 review > Flashcards

Class 18 review Flashcards

1
Q

Blood accounts for ____ of total body weight

A

8%

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2
Q

Whole blood percentage by volume

A

Plasma 55%

Formed elements 45%

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3
Q

Plasma is majority ______

A

water 91%

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4
Q

Formed elements are majority ________

A

Erythrocytes >99%
Platelets <1%
Leukocytes <1%

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5
Q

Hemoglobin (Hg)

A

This test is a measure of the total amount of Hgb in the blood. It is used as a rapid indirect measurement of the red blood cell (RBC) count

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6
Q

Hematocrit (Hct)

A

The Hct is a measure of the percentage of the total blood volume that is made up by the RBCs

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7
Q

Reticulocytes

A

The reticulocyte count is an indication of the ability of the bone marrow to respond to anemia and make RBCs. It is used to classify and monitor therapy of anemias

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8
Q

Serum iron

A

Amount of iron found in hemoglobin

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9
Q

Total iron binding capacity (TIBC)

A

TIBC is a measurement of all proteins available for binding mobile iron

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10
Q

Ferritin

A

The serum ferritin study is a good indicator of available iron stores in the body

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11
Q

Transferrin

A

Iron is bound to a globulin protein called transferrin and carried to the bone marrow for incorporation into hemoglobin/ Transferrin exists in relationship to the need for iron. When iron stores are low, transferrin levels increase, whereas transferrin is low when there is too much iron

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12
Q

Serum B12

A

Blood levels of vitamin B12 help to indicate if there is a vitamin deficiency present impacting RBC production

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13
Q

Folate

A

Blood levels of folate help to indicate if there is a folate deficiency impacting RBC

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14
Q

Mean corpuscular volume

A

We will use this to determine the size of red blood cells

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15
Q

Bilirubin

A

When red blood cells are destroyed they release heme into the blood, this results in increased bilirubin in the body and the patient can appear jaundiced

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16
Q

Summary of life cycle of iron

A

Ferritin: iron stored in mucosal cells (iron plus a protein used to store iron)
Transferrin: iron transport protein for distribution throughout the body (goes either to hemoglobin, liver, or muscle)
Serum iron: the amount of iron found in hemoglobin (70% of most iron in the body)

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17
Q

Three ways that anemia can be classified

A
  1. microcytic anemias (small cells - seen in iron deficiency)
  2. macrocyclic anemias (large cells - seen in vitamin B12 and folic acid deficiencies)
  3. Normocytic anemias (normal cells - blood loss or kidney failure)
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18
Q

Decreased production of red blood cells is typically due to

A

Lack of iron, folic acid, or vitamin B12 in the body OR kidney failure

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19
Q

Increased destruction of red blood cells from…

A

hemolytic anemias

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20
Q

Medications for hematopoiesis and growth factors

A

Erythropoietin
Epoetin Alfa prototype
Darbepoetin alfa

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21
Q

Medications replacing vitamins or minerals in the body that are responsible for RBC production

A

Folic acid
Vitamin B12
Ferrous sulfate

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22
Q

Epoetin Alfa (Eprex) MOA

A

It is a glycoprotein hormone that stimulates the production of RBCs in bone marrow. In response to anemia or hypoxia, circulating levels of erythropoietin rise dramatically, triggering an increase in erythrocyte synthesis. However, because production of erythrocytes requires iron, folic acid, and vitamin B12, the response to erythropoietin is minimal if any of these is deficient

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23
Q

Epoetin Alfa (Eprex) adverse effect

A

hypertension

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24
Q

Epoetin Alfa (Eprex) nursing considerations

A

Hemoglobin level should be measured at baseline and twice weekly thereafter until the target level has been reached and a maintenance dose is established. Complete blood counts with a differential should be done routinely. Blood chemistry should be monitored. Iron should be measured periodically

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25
Q

Darbepoetin Alfa (Aranesp) MOA

A

Is a long-acting analog of epoetin alfa. Both drugs at on erythroid progenitor cells to stimulate production of erythrocytes. It is cleared more slowly than epoetin, that has a longer half-life (49h vs. 18-24h). Administered less frequently. Often for anemia due to CRG and cancer chemotherapy

26
Q

Darbepoetin Alfa (Aranesp) adverse effect

A

hypertension

27
Q

Darbepoetin Alfa (Aranesp) nursing considerations

A

When initiating darbepoetin or changing dosage, the hemoglobin level should be measured weekly until it stabilizes. Thereafter, hemoglobin should be measured at least once a month

28
Q

What does low hemoglobin or low RBCs tell us?

A

anemia or bleeding

29
Q

What does high hemoglobin or low RBCs tell us?

A

polycythemia

30
Q

What does pancytopenia tell us?

A

aplastic anemia or leukemia - something is happening with bone marrow production of RBC/ WBC

31
Q

What does increased WBC tell us?

A

typically infection or stress

32
Q

What do deceased platelets tell us?

A

adverse event of drug therapy, disease, inflammation

33
Q

Anemia critical values

A

<135 in men

<120 in women

34
Q

Hct >30-35%

A

no symptoms

35
Q

Hct 25-30%

A

fatigue, malaise

36
Q

Hct 20-25%

A

SOBOE, dyspnea

37
Q

Hct 15-20%

A

light-headed, confusion

38
Q

Hct <15%

A

death, MI, etc

39
Q

Absolute anemia

A

destruction or loss of RBC

40
Q

Relative anemia

A

fluctuations in plasma volume

41
Q

4 primary reasons why anemia occurs in the body

A
  1. decreased production of red blood cells in the body
  2. destruction of red blood cells in the body
  3. blood loss (acute or chronic)
  4. dilution anemia (relative anemia)
42
Q

Iron-deficiency anemia

A

Microcytic, pale cell
Common
Low iron impedes synthesis of Hgb therefore less O2 transported

43
Q

Etiology of Iron-deficiency anemia

A

1) inadequate dietary intake of iron
2) chronic blood loss from body
3) impaired absorption of iron resulting from gastritis, chronic inflammatory bowel disease, or diarrhea
4) severe liver disease (storage and management)

44
Q

Ferrous sulfate

A

Oral - tablets or liquid formation

  • iron is best absorbed as ferrous sulphate (Fe2+) in an acidic environment
  • take 1 hour before meals
  • vitamin C helps to increase absorption of iron
  • undiluted liquid iron may stain teeth - give diluted through a straw
  • GI side effects: heartburn, constipation and diarrhea
  • stools will become black because GI tract excretes excess iron
45
Q

Kinds of megaloblastic (macrocytic) anemias

A 
Vitamin B12 (cobalamin, Cbl) deficiency anemia
Folic acid (FA, B vitamin) deficiency anemia
46
Q

Megaloblastic (macrocytic) anemia description

A
  • deficiency causes impaired DNA - results in a larger than normal cell
  • abnormalities target the cell for early destruction
  • neuropathy occurs only with B12 deficiency, indicating that additional mechanisms are involved in the CNS
47
Q

B12 deficiency treatment

A
  • if chronic due to malabsorption, then administer intramuscular B12
  • best treated before significant neural symptoms - may not reverse
48
Q

Anemia of chronic disease description

A

Many causes, often chronic inflammation or malignancy

-typically normochromic, normocytic, hypo proliferative, and mild in degree

49
Q

Factors that contribute to hypo proliferative state

A
  1. reduced iron absorption, trapping in macrophages
  2. shorter RBC survival
  3. a decreased response to circulating erythropoietin (elevated with little response)
50
Q

Anemia is common in patients with….

A

Chronic kidney disease where erythropoietin production may be reduced

51
Q

Adverse effects related to RBC colony stimulating drugs

A
  • hypertension
  • cardiovascular events (stroke, myocardial infarction)
  • autoimmune pure red-cell aplasia (severe anemia and a complete absence of erythrocyte precursor cells in bone marrow)
52
Q

Anemias related to RBC destruction

A

Intrinsic hemolytic anemias

Extrinsic hemolytic anemias

53
Q

Hemolytic anemia

A

Caused by premature destruction of RBCs (ie hemolysis)

Mild to life threatening

54
Q

Labs for hemolytic anemia

A
  • low Hct, Hgb, high in reticulocyte count
  • high bilirubin
  • high enzyme lactate dehydrogenase (LDH)
55
Q

Thalassemia

A

Microcytic, pale cell
Inadequate production of normal Hb therefore low RBC production
Absent or reduced globulin protein
Genetic links: mediterranean, south East Asian, Middle East, Africa, China

56
Q

Gene varieties of thalassemia

A

It is autosomal recessive
Thalassemia minor - mild form (1 gene of pair)
Thalassemia major - severe form (both genes in pair)

57
Q

Acute causes of blood loss anemia

A

Trauma

Blood vessel rupture

58
Q

Chronic causes of blood loss anemia

A

Gastritis
Menstrual flow
Hemorrhoids

59
Q

What is first to be noticed with an internal bleed?

A

Low bp, high hr. Delay for dilution of Hgb and Hct

60
Q

Signs of bleeding

A 
Bruising, petechiae
Hematuria
Vomiting blood
Fatigue
Decreased LOC, confusion

Nurs 2500 (16 decks)

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