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NUR 405 (Med Surg II) > Exam 1 Review pt.2 > Flashcards

Exam 1 Review pt.2 Flashcards

(54 cards)

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1
Q

What does a CBC consist of?

A

RBC

H&H

MCV & MCHC

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2
Q

What is hemoglobin?

A

The iron containing pigment of the RBC
(the seats)
(carry O2)

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3
Q

What is important when taking labs into consideration

A

Trending the labs

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4
Q

Causes of anemia

A

Bleeding
Bone marrow failure
Dietary deficiency
Renal disease

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5
Q

Causes for increase H&H

A

Polycythemia (too many RBC’s)

Dehydration

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6
Q

What protein transports iron?

A

Serum transferrin

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7
Q

What protein stores iron?

A

Serum ferritin

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8
Q

What is the most sensitive test to determine iron deficiency anemia

A

Serum ferritin

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9
Q

What test indicates whether the body is attacking its own RBC?

A

Direct coombs

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10
Q

What test is used to screen for antibodies prior to blood transfusion?

A

Indirect coombs

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11
Q

Indications for bone marrow biopsy

A

Unexplained anemia

Thrombocytopenia

Leukopenia

(when we do not know the cause)

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12
Q

Three main causes for anemia

A
  1. Decrease production (iron-b12-folic-kidney-liver)
  2. Blood loss (trauma) (ulcer)
  3. Increase destruction (sickle cell) (medication) (blood transfusion)
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13
Q

Decreased RBC production anemias

A

Iron deficiency
(hgb synthesis)

Cobalamin b12
Pernicious b12
Folic acid deficiency
(Defective DNA synthesis)

aplastic
renal failure
medication
(Decrease number of RBC precursors)

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14
Q

Megaloblastic anemias are caused by

A

Impaired DNA synthesis

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15
Q

What Hgb level is considered severe and will often result in blood transfusion?

A

6 g/dL

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16
Q

Anemia clinical manifestations

A

Weakness
Fatigue
Pallor
Increase HR
Bone pain
Angina
Dyspnea
Increase RR

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17
Q

Clinical manifestations of iron deficiency anemia

A

PALLOR = #1 (loss of demarcation)

Glossitis (tongue)

Cheilitis (lips)

Koilonychia (spoon nails)

Pica

Pagophagia

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18
Q

Iron deficiency morphology

A

Microcytic (small)

Hypochromic (pale)

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19
Q

Who gets cobalamin deficiency anemia

A

Pernicious anemia (no IF)

Hx of bowel surgery

Strict vegans

Alcohol abuse

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20
Q

Cobalamin Deficiency Clinical Manifestations

A

NEUROMUSCULAR
-weakness
-paresthesia
-ataxia
-impaired thought

Abdominal Pain

N/V

Glossitis

Cheilitis

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21
Q

Decrease RBC due to decreases hgb synthesis

A

Iron deficiency anemia

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22
Q

Decreased RBC due to defective DNA synthesis

Study These Flashcards
A

Cobalamin

Pernicious

Folic

23
Q

Aplastic Anemia results in

Study These Flashcards
A

Pancytopenia

Decrease:
Platelets
RBC
WBC

24
Q

Aplastic Anemia Morphology

Study These Flashcards
A

Normocytic normochromic

25
Nursing Implication: Iron supplement
Ferrous Sulfate Absorbed in duodenum (avoid enteric coated or XL) Best in acidic environment take one hour before meals (if possible) (might have to wing) Undiluted liquid will stain May turn stool black Z-track method
26
Before give IV ferrous sulfate we should
give test does because of risk of fatal anaphylaxis
27
ferrous sulfate side effects
Heartburn Constipation Diarrhea
28
epoetin alfa
Many adverse reaction BBW: Discontinue when Hgb >10
29
Relative Polycythemia
Cause by decreased plasma volume / dehydration false high Hct
30
Primary polycythemia
VERA Automine
31
Secondary polycythemia
COPD or High Altitude Body is compensating low O2 levels by make more RBC to transport the O2
32
Polycythemias Clinical Manifestations
Increase Blood Viscosity Increase Blood Volume Hypermetabolism Increase RBC and H&H
33
Most serious complication of polycythemia
Stroke
34
Type and Cross match is also known as
Indirect coombs test
35
Pre transfusion Responsibilities
Asses lab values Verify order Type and Cross match (q 48) Consent form Pre-medicate PRN IV set upt 30 min to start blood once received from blood bank
36
Blood Transfusion IV set up
20 ga or larger IV Y tubing Filter NS (only NS)
37
Transfusion Responsibilities
Assess VS before procedure (baseline) Constant observation first 15 min Assess VS in 15 minutes Take VS q hr and at end 4 hours maximum
38
ABO is a factor when giving
FFP and RBC
39
Platelets
Kept and room temp and good for 1-5 days Bag should be agitated periodically to prevent clumping Given when less than 20,000
40
Signs and Symptoms of Acute Hemolytic Transfusion Reaction
Immediate onset Facial flushing Fever and chills Lower back pain Hemoglobinuria Dyspnea Tachypnea Hypotension Cardiac arrest
41
Febrile Non-hemolytic Transfusion Reaction
Most common S/S -Fever -HA -Flushing -Anxiety -Vomiting -Muscle pain Nursing: -Antipyretic -Re-start order -Leukocyte reduced
42
Mild Transfusion Reaction
S/S: Flushing Itching Urticaria Nursing: Antihistamine Corticosteroid Washed RBC and platelets
43
Severe Allergic Transfusion Reaction
S/S: Anxiety Dyspnea Wheezing Bronchospasm Cardiac Arrest Nursing: CPR O2 Epinephrine Autologous components
44
Bacterial Sepsis Transfusion Reaction
S/S: Rapid onset of chills Vomiting Diarrhea Hypotension Nursing: Blood culture Antibiotics Vasopressors Follow blood bank orders
45
Transfusion Associated Circulatory Overload
S/S: Cough Dyspnea Pulmonary congestion Headache Increase VS JVD Nursing: Diuretics O2 Morphine CXR
46
3 chambers of chest tube
Collection Water seal Suction
47
Chest tube insertion
Provider insert Pre medicate Obtain thoracotomy tray, chest tube, and drainage system Maintain correct position Support
48
A patient with a chest tube should still
Get OOB and aggressive pulmonary toilet
49
What to do if bleeding is noted on a dressing
Mark the edge of area with pen DIT Notify provider if it starts to increase
50
Not tidaling in means
Lungs have re-expanded There is kink or obstruction Suction is one
51
Constant or abnormal bubbling in chest tube could indicate
There is a leak
52
Three reasons why you should ever clamp a chest tube
Trying to determine location of air leak Changing drainage system Provider orders to see what is tolerated
53
PleurX
Used only when symptomatic at home. Wait 2-5 days in between use Benefits: Less hospital trips Patient has control Decrease respiratory complications Safe and easy
54
Chest tube removal
CXR Pre-medicate have patient bear down Airtight dressing

NUR 405 (Med Surg II) (66 decks)

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