Anemias

Question 1

What is anemia in general terms?

Answer 1

It is an abnormally low amount of Red Blood Cells (RBCs), and or low amount of Hemoglobin (Hgb) or both

Question 2

What is the cause of Iron (Fe) Deficiency anemia in children, adolescents, & pregnant persons

Answer 2

Inadequate iron intake-is the most common cause

Question 3

What is the common cause of Iron (Fe) Deficiency in post menopausal women and males?

Answer 3

Blood loss from an ulcer

Question 4

Which medications are given to supplement or replenish iron?

Answer 4

Oral Fe supplements, Parenteral iron supplements (Iron Dextran) are ordered for severe anemia

Question 5

How is parenteral iron administered?

Answer 5

Z-track method

Question 6

Describe the procedure for the Z-Track method?

Answer 6

Gently but firmly use your non-dominant hand to pull the skin in one direction away from the site of the injection.
With the exact amount of prepared medication already drawn into a syringe, insert the needle into the injection site at a 90-degree angle to the skin, while continuing to hold the skin with your other hand. Your healthcare provider will tell you how deep to insert the needle.
Slowly and gently depress the plunger of the syringe to inject the medication into the patient’s muscle. Make sure you do not push needle in further while you are pushing the plunger. Continue to hold the skin with your other hand.
Once the syringe is empty, remove the needle by pulling the entire syringe straight out of the muscle in the same angle that it was inserted.
Now release the skin to allow it to return to its original position. Performing an IM injection with this method can allow the pulled skin and soft tissue to cover the track once it is released and can prevent leaking.

Question 7

What lab tests determine anemia?

Answer 7

Complete Blood Count (CBC), Total iron binding capacity (TIBC) & Ferritin (this level determines rather indicates the total iron stores in the body.

Question 8

What food can a nurse teach a patient that is high in iron?

Answer 8

Iron-fortified cereal and breads, fish, poultry, dried peas, & beans

Question 9

If a client or patient has elevated cholesterol and has anemia, what food choices would you advise to avoid?

Answer 9

Red meat & organ meats

Question 10

What are risk factors for anemia?

Answer 10

Trauma, Menorrhagia, GI bleed, Post surgical blood loss ( hemorrhage) chemical or radiation exposure

Question 11

In Pregnancy, Adolescence, & an Infection are times when anemia is at risk True or False

Answer 11

True

Question 12

What type of anemia is the result of vitamin B deficiency?

Answer 12

Pernicious anemia

Question 13

What type of anemia is the result of vitamin B deficiency?

Answer 13

Pernicious anemia

Question 13

What does a person look like with anemia? How would they appear?

Answer 13

Pale, Fatigue, (little or no symptoms in mild cases) in severe anemia dyspnea on exertion, sensitivity to cold, headache, numbness or tingling of extremities.

Question 14

What type of anemia is the result of vitamin B deficiency?

Answer 14

Pernicious anemia

Question 14

What does a person look like with anemia? How would they appear?

Answer 14

Pale, Fatigue, (little or no symptoms in mild cases) in severe anemia dyspnea on exertion, sensitivity to cold, headache, numbness or tingling of extremities.

Question 15

What is Sickle Cell Anemia? Pathophysiology

Answer 15

First, it is a severe hemolytic anemia-The HbS gene causes the hemoglobin molecule to be defective. Hemolytic- means the breakdown of blood cells.

Question 16

The Hbs gene is inherited by whom?

Answer 16

People of African descent, and to a lesser extent people from the Middle East, the Mediterranean area and the aboriginal tribes in India

Question 17

There are several causes, can you name a few?

Answer 17

Tissue hypoxia and necrosis causes a type of sickle cell crisis called the sickle crisis, Next, cold temperature can promote the sickling process which cause vasoconstriction and slows the blood flow and last, splenic infarction-

Question 18

How does a person appear with sickle cell anemia? What are clinical manifestations?

Answer 18

Anemia is always present, Hemoglobin (7-10g/dL), jaundice is present and usually present in the sclerae (white) of the eyes. Enlargement of the bones-the bone marrow expands in children as a compensatory effort to offset anemia, which sometimes leads to enlargement of the bones & facial area

Question 19

What are complications of sickle cell disease?

Answer 19

Infection, Stroke, Renal Failure & Heart failure

Question 20

What is the treatment for sickle cell disease?

Answer 20

Chronic Blood transfusions of Red Blood Cells (RBCs)

Question 21

What is the SUPPORTIVE therapy for persons with sickle cell?

Answer 21

Hydration, Aspirin for mild pain, NSAIDS for moderate pain or in combination with opioid analgesics

Question 22

What is hydroxyurea (Droxia) indicated for ?

Answer 22

Given to reduce sickle cell anemia crisis

Question 23

What class does hydroxurea belong?

Answer 23

Antineoplastic

Question 24

A nurse should handle this drug how?

Answer 24

Wear gloves with extreme care, it may cause cancer

Question 25

A patient or client is admitted with a vaso- occlusive crisis. The patient has sickle cell disease. The patient reports severe abdominal pain on a scale of 1-10, " 10". Which of the analgesic medications are best to administer first? *** Priority*** 1. Morphine Sulfate IV (MSO4) 2. Hydromorphone orally 3. Fentanyl (transdermal patch) 4. Ibuprofen (orally)

Answer 25

1. Morphine Sulfate IV- rationale-when there is a vaso-occlusive event or crisis, a rapid use of parenteral opioids is the appropriate choice for moderate to severe pain ( level 10).

Question 26

A client is admitted with sickle cell disease with splenic sequestration (a sudden drop in B/P & there are too many blood cells trapped in the spleen it is a life-threatening emergency) The blood pressure is 82/44 mmHg, the apical heart rate is 126 beats/min. Which action should a nurse do first?** Priority 1. Draw labs (blood) for a type and cross-match. 2. Complete a head to toe assessment 3. Infuse 250 mL/h normal saline (0.9%) 4. Ask the client about their vaccination history?

Answer 26

3. Infuse 250 mL normal saline (rationale-the client is hypotensive, & it is important to correct the hypovolemia (which is caused by the splenic sequestration)

Question 27

What is the normal Hct & Hgb?

Answer 27

The normal hemoglobin for men- 13.5-17.5 g/dL, women 12.0-15.5 g/dL, The normal hematocrit is in men 41-50%, in women 36-44%.

Question 28

What is considered a dangerously low hematocrit?

Answer 28

Below 35% in women & below 41% in men

Question 29

When is Ferrous Sulfate indicated ?

Answer 29

It is the main treatment for iron deficiency anemia

Question 30

What medication education is important to teach clients about Ferrous Sulfate?

Answer 30

Remind them to have their hemoglobin (Hgb) checked to assess efficacy, vitamin C can increase iron absorption, take iron medications between meals to increase absorption, the stools will appear black to green (this is normal)*** concurrent use of antacids will decrease the absorption of iron medication.