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Nurs 2500 > Class 18 review > Flashcards

Class 18 review Flashcards

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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
Darbepoetin Alfa (Aranesp) MOA
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
Darbepoetin Alfa (Aranesp) adverse effect
hypertension
27
Darbepoetin Alfa (Aranesp) nursing considerations
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
What does low hemoglobin or low RBCs tell us?
anemia or bleeding
29
What does high hemoglobin or low RBCs tell us?
polycythemia
30
What does pancytopenia tell us?
aplastic anemia or leukemia - something is happening with bone marrow production of RBC/ WBC
31
What does increased WBC tell us?
typically infection or stress
32
What do deceased platelets tell us?
adverse event of drug therapy, disease, inflammation
33
Anemia critical values
<135 in men | <120 in women
34
Hct >30-35%
no symptoms
35
Hct 25-30%
fatigue, malaise
36
Hct 20-25%
SOBOE, dyspnea
37
Hct 15-20%
light-headed, confusion
38
Hct <15%
death, MI, etc
39
Absolute anemia
destruction or loss of RBC
40
Relative anemia
fluctuations in plasma volume
41
4 primary reasons why anemia occurs in the body
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
Iron-deficiency anemia
Microcytic, pale cell Common Low iron impedes synthesis of Hgb therefore less O2 transported
43
Etiology of Iron-deficiency anemia
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
Ferrous sulfate
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
Kinds of megaloblastic (macrocytic) anemias
``` Vitamin B12 (cobalamin, Cbl) deficiency anemia Folic acid (FA, B vitamin) deficiency anemia ```
46
Megaloblastic (macrocytic) anemia description
- 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
B12 deficiency treatment
- if chronic due to malabsorption, then administer intramuscular B12 - best treated before significant neural symptoms - may not reverse
48
Anemia of chronic disease description
Many causes, often chronic inflammation or malignancy | -typically normochromic, normocytic, hypo proliferative, and mild in degree
49
Factors that contribute to hypo proliferative state
1. reduced iron absorption, trapping in macrophages 2. shorter RBC survival 3. a decreased response to circulating erythropoietin (elevated with little response)
50
Anemia is common in patients with....
Chronic kidney disease where erythropoietin production may be reduced
51
Adverse effects related to RBC colony stimulating drugs
- 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
Anemias related to RBC destruction
Intrinsic hemolytic anemias | Extrinsic hemolytic anemias
53
Hemolytic anemia
Caused by premature destruction of RBCs (ie hemolysis) | Mild to life threatening
54
Labs for hemolytic anemia
- low Hct, Hgb, high in reticulocyte count - high bilirubin - high enzyme lactate dehydrogenase (LDH)
55
Thalassemia
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
Gene varieties of thalassemia
It is autosomal recessive Thalassemia minor - mild form (1 gene of pair) Thalassemia major - severe form (both genes in pair)
57
Acute causes of blood loss anemia
Trauma | Blood vessel rupture
58
Chronic causes of blood loss anemia
Gastritis Menstrual flow Hemorrhoids
59
What is first to be noticed with an internal bleed?
Low bp, high hr. Delay for dilution of Hgb and Hct
60
Signs of bleeding
``` Bruising, petechiae Hematuria Vomiting blood Fatigue Decreased LOC, confusion ```

Nurs 2500 (16 decks)

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