Hematologic Assessment, Pain, and Fever

Question 1

What is the average normal temperature for adults?

Answer 1

97.5-99

Question 2

What is the average normal temperature for children?

Answer 2

99

Question 3

What is considered a fever in patients that are “older and colder”?

Answer 3

1.5 degrees above baseline

Question 4

What adjustments need to be made for a rectal temperature?

Answer 4

subtract 0.5- 1 degree for oral temperature

Question 5

What adjustments need to be made for axillary temperature?

Answer 5

add 0.5-1 degree for oral temperature

Question 6

What type of temperatures are most accurate?

Answer 6

tympanic, temporal, oral

Question 7

What is the preferred measurement for children 1-3 months?

Answer 7

rectal, tympanic

Question 8

What is the preferred measurement for children 3 months- 5 years?

Answer 8

axillary

Question 9

What is the preferred measurement for adults?

Answer 9

oral

Question 10

When should fever be referred on?

Answer 10

1. 3 months or younger
2. > 3 months with rectal temp 104
3. fever > 3 days
4. rash/ difficult breathing/ severe pain
5. vomiting >12 hours
6. diarrhea > 2 days
7. > 103
8. cold/flu sx >7 days
9. recurrent
10. immunocompromised
11. pregnant

Question 11

What is acute pain?

Answer 11

</= 1 month

Question 12

What is subacute pain?

Answer 12

1-3 months

Question 13

What is chronic pain?

Answer 13

> 3 months

Question 14

What are single dimension pain assessments?

Answer 14

1. verbal analog scale (1-10)
2. visual analog scale (10 cm line)
3. assessment and frequency (1-3 =mild, 4-6 =moderate)

Question 15

What are multi dimension pain assessments?

Answer 15

1. pain diary /drawing
2. McGill Pain Questionnaire
3. Faces of pain

Question 16

What are signs of acute pain?

Answer 16

tachycardia
tachypnea
sweating
pallor
extreme anxiety

Question 17

What are the best ways to assess pain in the cognitively impaired?

Answer 17

Physiologic indicators
Facial/ body clues
PAINAD (pain assessment in Alzheimer’s disease)

Question 18

What is the suggested amount of daily caloric intake?

Answer 18

25 kcal/kg/day

Question 19

What is a normal BMI?

Answer 19

18.5- 24.9

Question 20

Why is BMI not always accurate?

Answer 20

cannot distinguish between weight from adipose, edema, or muscle

Question 21

What body shape is associated with an increased risk of DM, hyperlipidemia, stroke, and CAD?

Answer 21

apple-shaped body

Question 22

What waist circumference is at an increased risk of DM, hyperlipidemia, stroke, and CAD?

Answer 22

male: >40
female: >35

Question 23

What waist-to-hip ratio is at an increased risk of DM, hyperlipidemia, stroke, and CAD?

Answer 23

male: >0.9
female: >0.8

Question 24

What does a total lymphocyte count of 1200-2000 indicate?

Answer 24

mild malnutrition

Question 25

What does a total lymphocyte count of 800-1200 indicate?

Answer 25

moderate malnutrition

Question 26

What does a total lymphocyte count of <800 indicate?

Answer 26

severe malnutrition

Question 27

What is a CBC with differential?

Answer 27

differential includes analysis of WBCs

Question 28

What is true for all types of anemias?

Answer 28

low RBCs

Question 29

What are RBC indices?

Answer 29

assesses size and Hgb content of the RBC

Question 30

What can cause false elevations in MCV (mean cell volume)?

Answer 30

1. reticulocytosis 2. agglutination of erythrocytes 3. hyperglycemia

Question 31

What is MCH (mean cell hemoglobin)?

Answer 31

percent volume of Hgb per RBC (Hgb/ RBC count)

Question 32

What can cause false elevations of MCH?

Answer 32

hyperlipidemia

Question 33

What is used to confirm iron deficiency anemia and disorders of Hgb synthesis?

Answer 33

MCHC (mean cell hemoglobin concentration)

Question 34

What can be used to identify drug-induced bone marrow suppression and response to vitamin/iron therapy?

Answer 34

reticulocyte counts

Question 35

What indicated variability in RBC width/size?

Answer 35

RBC distribution width

Question 36

What are the causes of macrocytic anemia?

Answer 36

1. B12 deficiency 2. folic acid deficiency 3. drug-induced

Question 37

What are the symptoms of B12 deficiency?

Answer 37

CNS- loss of coordination, tremors, neuropathy GI- glossitis (inflamed tongue), constipation/D

Question 38

What do labs look like for someone who is B12 deficient?

Answer 38

Increased MCV and MCH Decreased B12

Question 39

How is B12 deficiency treated?

Answer 39

IM for 2 months

Question 40

What do labs look like for someone who is folic acid deficient?

Answer 40

Increased MCV and MCH Decreased folic acid

Question 41

What types of drugs can cause macrocytic anemia?

Answer 41

Marrow toxicity- alcohol, antineoplastics, AZT (HIV med) Altered folate metab- anticonvulsants, methotrexate, trimethprim, triamterene Altered B12- colchicine, neomycin

Question 42

What are causes of Microcytic anemia?

Answer 42

1. iron deficiency 2. thalassemia (hereditary)

Question 43

What changes in labs are seen with iron deficiency anemia?

Answer 43

1. low serum ferritin 2. low serum iron 3. high TIBC 4. low transferrin saturation 5. high RDW

Question 44

What are the causes of normochromic anemia?

Answer 44

1. acute blood loss 2. hemolytic anemia 3. anemia of chronic disease

Question 45

What medications can cause extrinsic hemolytic anemia?

Answer 45

methyldopa quinine quinidine penicillin

Question 46

What lab findings indicate hemolytic anemia?

Answer 46

reticulocytosis increased BUN

Question 47

What lab findings indicate anemia of chronic disease?

Answer 47

1. low serum iron 2. low TIBC 3. normal ferritin 4. micro/normocytic