Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MedSurg 1 > Heme > Flashcards

Heme Flashcards

1
Q

Anemia

A

A symptom (not a disease) caused by deficiency in the:

  • # of RBC’s (erythrocytes)
  • quantity of hgb and/ or
  • volume of packed RBC’s (hct)

Caused by:

  • blood loss
  • RBC production problems (bone marrow problem)
  • RBC destruction

Problem: decreased O2 to tissues and organs
-respiratory system is going to show first response when trying to compensate for anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How is anemia classified?

A

Size: MCV (mean corpuscular volume)

  • microcytic: RBC is physically smaller, look at iron deficiency anemia
  • normocytic: normal RBC
  • macrocytic: RBC is larger than it’s supposed to be, folic acid and B12 deficiency

Color: MCH (mean corpuscular hgb)

  • hypochromic: RBC is pale when looked at under the microscope, attributed to iron deficiency anemia
  • normochromic: normal RBC

Or classified by underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Anemia - Elderly

A

elderly are prone to anemia, but being elderly is not a cause of anemia

  • decreased # of stem cells but not decrease in function
  • decreased reserve of any cell type leads to decrease response to illness
  • WBC have decreased immune response to illnesses and therefore more likely to become ill (same with anemia, decreased # of RBC then they are going to have decreased response)
  • Hgb decreases after middle age, reaches lowest point in elderly
  • worse in institutionalized d/t nutritional intake (not as good and elderly don’t absorb as much) and comorbidities.

watch for GI bleed, as elderly are more prone to GI bleeds which can cause anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Anemia: S/O data

A

Pallor (severe anemia0
Cheilitis (infection of lips, swollen red patch in corner of mouth)
Glossitis (infection of tongue, looks smooth and glossy)
HA (not enough O2 to brain)
Pica in children could be caused by Fe def
Decreased appetite - esp in children
Brittle nails
Fatigue (milder symptom)
weakness
Coolness of hands and feet
palpitations and DOE (mild to moderate)
Dyspnea at rest (moderate anemia)
tachycardia, tachypnea, orthostatic hypotension (severe anemia)

may be asymptomatic with mild anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Blood level to check for anemia Hgb:

A 
10-12 = mild anemia
6-10 = moderate 
<6 = severe anemia

blood transfusion given at 8-9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

FA Def Anemia: S/O data

A 
GI Sx:
dyspepsia
anorexia
N/V
abdominal pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

B12 Def Anemia: S/O data

A 
CNS and Neuromuscular Sx:
impaired thinking
confusion
dementia
paraesthesias of hands and feet
decreased sensation
ataxia
muscle weakness
decreased proprioception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Anemia Nursing Dx:

A

activity intolerance r/t fatigue, weakness aeb increased pulse and respirations w/ activity
-outcomes -> tolerate ADL; vitals WNL

imbalanced nutrition r/t poor intake, anorexia aeb wt loss, low serum albumin, Fe
-outcomes -> body wt maintenance or increased Hct and Hgb, Albumin WNL

Hypoxemia r/t decreased hgb aeb dyspnea, decreased O2 sat, cyanosis/pallor
-outcomes -> no dyspnea, O2 sat WNL, skin color pink

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

B12 Def specific Dx:

A

risk for injury d/t muscle weakness and decreased sensation - more susceptible to burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Iron (Fe) Deficiency Anemia: Cause

A

Insufficient Fe for hemoglobin synthesis
microcytic (small RBCs) or decreased RBC production
most common anemia in world (30%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Iron (Fe) Deficiency Anemia: Risk Factors

A

more common in:
children
women in child bearing years (due to period)
populations with increased Fe need (teens and women with pregnancy)
Slow persistent blood loss (GI surgery due to crones disease, malabsorption syndromes like celiacs disease - not absorbing as much nutrients as we need to create healthy RBCs, GI bleed)
Alcoholism
Vegetarianism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Iron Def Anemia: Diagnostic Tests

A

CBC:
decreased hgb and hct
(Hgb: 10-14 = mild, 6-10 moderate, <6 = severe)
decreased MCV
decreased Ferretin <10 (measure iron storage)
decreased retic count (reticulocytes - displays immature RBCs)
decreased Fe
increased TIBC (total iron binding concentration - low in iron so ability to bind iron increases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Iron Def Anemia - S/O data

A

test stool for occult blood called guiac (tells us if pt has GI bleed)
-melena: black appearance d/t iron in stool (means blood is higher in GI tract)
-at least 50-75ml blood loss in order to impact blood supply that we can dx with iron deficiency anemia
UA (dark brown and looking for blood in urine sample)
Endoscopy, colonoscopy (looking for bleed)
menstrual cycle info (average blood loss is 45ML in each cycle, if more than this pt at risk of developing anemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Iron Def Anemia: Plan/ Intervention

A

Medication therapy:

  • ferrous sulfate: 150-200 mg/day 1 hour BEFORE meals to increase absorption, if tolerated (iron can be hard on stomach)
  • take with vitamin C to increase absorption
  • fiber decreases absorption (that’s why you take 1 hour before meals or 2 hours after)
  • if liquid administration - may stain teeth (use straw and can mix with orange juice)
  • takes 2-3 weeks to increase ferretin
  • continue tx for at least 6 months even if you see increase (check labs in 2-3 weeks then 6 months to eval tx)
  • Iv or Im administration d/t poor absorption of or intolerance of po form (usually for most severe cases)
  • pt should also be started on stool softener or laxative as constipation is common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Megaloblastic Anemias:

A

a group of disorders caused by impaired DNA synthesis, characterized by:
-increased size of RBC (macrocytic), cells easily damaged d/t fragile membrane (so enlarged that they are fragile)

Two anemias in this category:

  • folic acid (folate) deficiency
  • pernicious anemia - cobalamin (Vit B12) deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Folic Acid Deficiency

A

anemia d/t inadequate folic acid present for DNA synthesis leading to impaired formation and maturation of RBC

Labs:

  • serum folate <5 mg/ml (abnormal; pt will be or have been dx w/ folic acid anemia)
  • normal range: 5-25 mg/ml
17
Q

Folic Acid Deficiency: Cause/Risks

A
  • Poor nutrition - lacking fruits and veggies, grains (overcooking foods causing rich nutrients to leach out of foods)
  • Malabsorption Syndromes (celiac, crohns)
  • Increased demands during pregnancy and infancy
  • chronic malnutrition such as alcoholism
  • drugs that interfere with absorption (smoking, contraceptive, anti-seizure meds, methotrexate)
  • cancer and RA pts have increased requirement (like pregnancy and infancy, meds cause interference of absorption)
  • dialysis pt - FA is lost during tx
18
Q

Folic Acid Deficiency: P/I

A

correct underlying cause

medication: folic acid replacement therapy
- folate 1 mg po/day up to 5mg if d/t malabsorption for 4 months then MVI with FA 0.4mg qd (if cause can’t be corrected or intake inadequate).

repeat labs q2 weeks for first 4 months than q month until stable

increase nutritional sources of FA

19
Q

Folic Acid Def and B12 Def: Diagnostic Tests

A

decrease hgb, hct
increased MCV major deference with Iron def
normal retic count, Fe, TIBC
Decrease folate (FA Def)
Decrease cobalamin (B12)
if Dx w/ pern anemia going to do gastroscopy and biopsy to r/o gastric Ca
Schilling test - measure absorption of radioactive cobalamin (series of tests)

20
Q

Schillings Test

A

series of tests done to measure absorption:
1st stage: radio labeled b12
2nd stage: IF with B12
3rd stage: two week course of antibiotics
4th stage: to give pt pancreatic enzymes

21
Q

B12 Deficiency:

A

Vitamin B12 is a nutrient that helps keep the body’s nerve and blood cells healthy and helps make DNA

Cobalamin def has several causes and pernicious anemia (autoimmune) is the most common cause

Lack of IF means no absorption of Cobalamin (vit B12)

  • IF normally secreted by parietal cells in gastric mucosa
  • IF lost d/t gastric mucosal atrophy, autoimmune disease, lack of HCL acid (necessary for IF secretion), gastrectomy, small bowel resection involving ilium, IBD’s
  • persons >40yrs
  • esp northern europeans and african americans (at more risk b/c of increased # of people on meds in these populations that decrease gastric acid (H2 blockers, PPIs))
22
Q

B12 Def - P/I

A

Assess for H2 Blocker or PPU use (discontinue use of these meds)
- decrease HCL in stomach (famotidine, ranitidine, omeprazole)
Cobalamin injections:
- 1000mg cobalamin (vitamin B12) Im daily x 2 weeks then weekly until hct normal, then monthly for life
-increase nutritional intake (eat liver - super high in b12)
-disease is fatal if not treated (1-2 yrs)
-if long term neuromuscular problems may be irreversible
-familial predisposition (evaluate for disease if FHx, important to Dx and Tx early b/c of neurological impairment)
-protect against burns and trauma d/t decreased sensation from neurological impairment
-life-long therapy required -compliance issues
-associated with gastric cancer (evaluate with EGD scope b/c higher risk for developing this cancer with b12 def)

23
Q

Anemia of Chronic Disease

A

umbrella term to capture all other types of anemias caused by various diseases and other things going on with pt

many causes:

  • kidney: lack of erythropoietin
  • alcoholism: folic acid def
  • chronic gastritis: blood loss
  • liver disease/hepatitis
  • chronic inflammation/malignancies
  • endocrine disorders - hypothyroidism - associated with anemia

r/o other anemias: check Fe, Ferritin, folate, and cobalamin levels

tx: find cause
- transfusion rare unless severe
- erythropoietin therapy if anemia d/t renal and cancer therapies

24
Q

Neutropenia

A

a reduction in neutrophils (>1000)
predisposes the pt to infection (often pts own flora)
common w/ chemotherapy and immunosuppressive therapy
normal signs of infection may not be present (As immune system isn’t working as well)
-low grade fever VERY significant as it may be only sign of infection
-neutropenic fever (greater than or equal to 38) and a neutrophil count <500 is a medical emergency as pt will not be able to fight off infection.

25
Q

Neutropenia Interventions

A

Blood cultures
Start antibiotic therapy ASAP
Isolation
Education

26
Q

Thrombocytopenia

A

reduction in platelets below 150,000
medical emergency when platelets drop below 10,000 (transfusion can be ordered)

causes:

  • autoimmune disease
  • drugs: chemotherapy, ASA (even low dose 81mg), Plavix, oral contraceptives, heparin
27
Q

Thrombocytopenia: Precautions/Interventions

A

No ASA or other anti-platelet meds
Monitor platelet count (Daily or 2x a day)
Avoid needle sticks or use small needle as possible
no razors
platelet transfusion
neuro checks - risk for stroke (every 4 hours or if there is a change in pt as brain bleeds can be spontaneous)

28
Q

Hemophilia

A

x-linked recessive disorder caused by defective or deficient coagulation factor

2 major forms:
A and B which can be mild to severe (depends on which coagulation factor is deficient)

A= Factor XIII
B = Factor IX

Incidence: 18,000 Americans

  • Hemophilia A = most common 80-85%
  • Rare in females
29
Q

Hemophilia S/O

A

minor trauma may cause:
slow, prolonged, persistent bleeding
delayed bleeding (begins hours to days later)
increased bleeding following oral surgery or injury to gingiva
prolonged spontaneous epistaxis that are difficult to stop
GI bleeding d/t ulcers, gastritis, and trauma
hematuria d/t trauma, infections, or kidney stones
hemarthrosis (bleeding into joints which can be spontaneously developed)

30
Q

Hemophilia S/O Diagnostic Tests

A 
increased PTT
Nl bleeding time
Nl platelets
decrease Factor VIII in hemophilia A
decrease Factor IX in hemophilia B
31
Q

Hemophilia: P/I

A

Goal: prevent and treat bleeding

prevent: referral for genetic testing d/t hereditary nature of disease (need to figure out what type of hemophilia it is and how it can be passed on to children)

replacement therapy: used to tx acute crisis and prophylactically before surgery or dental work or every other day with severe form

  • DDVAP tx mild hemophilia A by increasing factor VIII - administered IV, SQ, or intranasally
  • antifibrinolytic therapy - enhances clot stability
  • recombinant factors (genetically engineered) or clotting factors from blood donations (used during acute phase and may need repeated infusions if bleeding serious or used prophylactically)
32
Q

Hemophilia: Complications of Tx

A

development of inhibitors to factors VIII and IX
infections from transfusion
allergic reactions
thrombosis - factor IX (contains active coagulation factors)

33
Q

Hemophilia: P/T for Acute Situation

A

Follow ICE for topical bleeding
Admin coagulation factor to increase level of deficient factor
Avoid venipunctures, injections if possible (apply pressure for 5 min after)
Hemarthrosis (apply ICE, rest joint to prevent deformity, analgesic (NO ASPIRIN), encourage gentle ROM once bleeding has stopped, but avoid use of limbs or ambulation no weightbearing until dec swelling and increased strength)
Monitor for life threatening complication from hemorrhage (ABCs)
-airway: neck or pharynx injury
-intracranial bleeding: mental status changes
-abdominal pain: may indicate internal bleeding

34
Q

Hemophilia Eduation

A

Education and referral to community resource
advise when need immediate medical attention (head, neck/mouth, abd, joint pina/swelling, skin wounds that require suturing)

Oral hygiene - use soft toothbrush and brush gently

Prevent cuts, abrasions: gloves with outside work, electric razor

Medical alert tag

Importance of F/U care and labs

Non-contact sports (or wear extra padding and helmet and take extra precautions with contact sports)

Children may need to wear helmets

35
Q

Blood Component Therapy

A

Pt receives transfusion of a certain blood cell type, whole blood is rarely given.

Supports pt temporarily, need to resolve underlying problem.

Given separately:

  • PRBC’s
  • Platelets
  • FFP
  • Albumin
  • Cryoprecipates
36
Q

Blood Therapy for those with Religious Concerns

A

Can give:

  • iron supplement
  • folate supplement
  • Epogen (erythropoietin medication) subQ

MedSurg 1 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions