Test #1...Week 2&3 Flashcards
(151 cards)
1
Q
What is hematopoiesis
A
The production of stem cells
2
Q
What is needed for hematopoiesis to be effective
A
We need B 12, iron and folic acid so are bone marrow can rapidly make new healthy cells, help them mature so they are functional
3
Q
What would result if we did not have the essential nutrients for hematopoiesis
A
The cells may be immature and non functional. This can result in the inability to carry the same amount of oxygen and RBCs leading to Anemias
4
Q
What hormone does hematopoiesis respond to
A
Erythropoietin
5
Q
What secretes erythropoietin
A
The kidneys-90%
The liver-10%
6
Q
What stimulates the kidneys to secrete erythropoietin
A
Hypoxia
The kidneys sense hypoxia thus it secretes erythropoietin which then travels to the bone marrow where it interacts with the receptors on the stem cells to increase RBC production (stem cells differentiate into RBCs)
7
Q
What does erythropoietin stimulate
A
Erythropoiesis
The production of RBCs from stem cells & the production of hemoglobin which is needed for the RBC to be functional
8
Q
What is hemoglobin
A
A 4 protein molecule (globulin chain) and
within each globulin chain is a heme molecule and
Within the heme molecule is iron
9
Q
What is iron responsible for
A
Carrying the oxygen & giving the RBC the red color
10
Q
What does Epoetin Alfa do
A
Stimulate erythropoiesis
It is to increase the RBC production amount and hgb which will decrease the need for blood transfusion
11
Q
What is Epoetin Alfa for
A
For pts who do not make enough erythropoietin
Chemo pts
Anemia associated with CKD
12
Q
Could you use Epoetin Alfa in an emergent anemia case
A
No
13
Q
What are key components a pt must have for Epoetin Alfa
A
They must have a functional bone marrow and sufficient iron stores
14
Q
What would iron deficiency anemia do to the effectiveness of Epoetin Alfa
A
It would reduce the effect of the medication b/c you must have sufficient iron stores to keep up with the RBC and heme production
15
Q
What tests can the MD order to check iron levels
A
He can order labs for iron and/or Ferritin levels
16
Q
What is ferritin
A
Iron that is stored in the liver,spleen, skeletal muscles and bone marrow
17
Q
What are adverse effects of Epoetin Alfa
A
Hypertension
18
Q
Why is there a black box warning for Epoetin Alfa
A
Because the AE is HTN which can lead to a cardiovascular or thromboembolic event
19
Q
What do you need to asses when administering Epoetin Alfa
A
-BP before and during
-Monitor hgb and hct
-Signs of CV or thromboembolic events:
Pain in the LE
Signs of stroke (facial droop slurred speech)
Chest pain
Dyspneic
Tachypneic
20
Q
When would you not administer Epoetin Alfa
A
If the hgb was greater than or equal to 10
21
Q
What are the symptoms of anemia
A
Fatigue Weak Sob Pale skin Cold hands/feet Dizzy Headache Possible cognitive issues Chest pain
22
Q
Why might you see an increased heart rate in an anemic pt
A
Because when the heart (and kidneys) sense they are not getting enough oxygen the heart is going to pump faster to compensate for the decreased perfusion
23
Q
what is the MCV and the normal
A
mean corpuscular volume.
- the average size of the RBC
range: 80-100 femtoliter
24
Q
what is indicative of abnormal MCV levels
A
decreased = microcytic cell= iron deficiency increased = microcytic= B12 or folic acid deficiency (these nutrients are needed to make mature cells from hematopoiesis, therefore w/o the cells are large and immature)
25
what is the MCH & normal level
mean corpuscle Hgb
- measures the weight of hgb in the cell in relation to the size.
- 27-34 picograms(pg)
26
what is indicative of abnormal MCH levels
```
decreased = less hgb weight = small size cell
increased = more hgb weight = larger cell
```
27
what is MCHC and the normal level
Mean corpuscular hgb concentration
the proportion of hgb in the RBC
-32%-36% -proportion of RBC that is taken up by hgb
28
if someones labs came back and the MCV & MCHC is low what does that indicate
iron deficiency anemia- the RBC is small and there is less hgb concentration
29
what does it indicate if the MCV is high and the MCHC is normal
Folate anemia or Pernicious anemia
the RBC is large but the hgb % is normal indicating there is a folate or B12 deficiency creating a macrocytic immature cell.
30
for someone who has iron deficiency anemia what will their labs look like
mcv is low and mchc is low. the RBCs are going to be microcytic and hypochromic(d/t the lack of hgb= lack of iron in the RBC)
31
signs and symptoms of Iron deficiency anemia
```
s&s of anemia(sob, chest pain, cold hands & feet, fatigue, dizzy, headache)
sore tongue
brittle nails
"crawling" feeling in legs
RLS
```
32
what can be the cause of iron deficiency anemia
- liver disease (d/t ferritin is stored in the liver, so if the liver is not functioning it will not be able to adequately store ferritin thus reducing the amount of iron stores in the body.
- vegetarians
33
what does iron need to be absorbed
an acidic environment
34
what are sources of iron
```
liver & red meats(highest source)
fish
fortified cereals
lima beans
leafy veggies
dried fruit
```
35
when is it the best time to take an iron supplement
1 hour before or 2 hours after meals
36
what is the issue with taking iron with food
it decreases the absorption of iron 33-50%
37
adverse effect of iron supplements
N/V
constipation
stomach cramps
38
what can you do to decrease GI upset when taking iron supplement
you can take it with food if needed to prevent GI upset. However, Vitamin C increases iron absorption by 30% so you can give the supplement with OJ therefore it decreases the gi upset and increases iron absorption
39
what can happen when you take iron supplement
- stools may turn dark green or black
- decreased absorption w/ antacids and calcium
- increased absorption with Vit C
40
why does iron supplement turn stools black
it is d/t the breakdown of iron and it being excreted
41
what is B12 Important for
- myelin sheath production
| - rapid normal production of RBCs-
42
what does B12 need to be absorbed
It needs Intrinsic factor. It binds with IF in the stomach and it is then absorbed by the ilium then to circulation
43
where is B12 stored
the liver
44
what is the cause of B12 deficiency
the lack of intrinsic factor
..we store B12 in the liver for up to 3-5 years therefore the deficiency is not usually from lack of intake but from the lack of IF
45
what will labs look like with B12 deficiency
macrocytic RBCs = increased MCV level
46
what type of anemia comes from B12 deficiency
megaloblastic anemia
47
what is the source of B12
Meat, fish, poultry, cheese, eggs, fortified cereals and pastas
48
who may be at risk for B12 deficiency
strict vegetarians
49
cause of megaloblastic anemia
most commonly d/t pernicious anemia(lack of IF) not necessarily lack of intake
50
Cause of pernicious anemia
absence of IF
51
why would there be a lack of IF
- gastric resection
- elderly- not enough IF d/t lack of parietal cells
- antacids
- genetic condition-autoimmune condition- body makes --antibodies that attacks IF
- crohns
- ulcerative colitis
52
what are S&S of pernicious anemia (unable to absorb B12 d/t lack of IF-may have enough B12 in body)
s&s of anemia(sob, chest pain, cold hands & feet, fatigue, dizzy, headache)
-numbness, tingling in the hands/feet
-loss of balance
-confusion
-memory loss
-mood disturbances
(neuro/muscular symptoms d/t the inability of formation of myelin sheath)
53
what are s&s of B12 deficiency
s&s of anemia(sob, chest pain, cold hands & feet, fatigue, dizzy, headache)
- numbness in fingers and toes
54
what is cyanocobalamin
complex B12 supplement
55
what forms does cyanocobalamin come in
PO & Parenteral
56
when would you choose to give PO b12 supplement
someone who has B12 deficiency (NOT pernicious anemia)
| give with food to increase absorption
57
why would you give parenteral b12 supplements
to bypass the GI system/liver. You would give it to someone who lacks IF or have malabsorption issues.
58
when would you choose to give a nasal spray B12 supplements
after all symptoms of CNS involvement have resolved.
59
what is folate important for
-cell division and maturation of RBC, WBC & platelets
most needed during pregnancy to reproduce healthy cells for fetal development
-aids in production of heme
60
what type of anemia wills someone have if they have a folate deficiency
megaloblastic anemia.
| the MCV will be increased but the MCHC will be normal
61
what is the most common cause of folate deficiency
- not enough dietary intake
| - chronic alcoholism b/c alcohol interferes with metabolism in the liver
62
what are the symptoms of folate deficiency
s&s of anemia(sob, chest pain, cold hands & feet, fatigue, dizzy, headache)
-mouth sores, swollen tongue
63
sources of folate
leafy greens, fortified cereals, whole grains, nuts and yeast
64
what are chronic conditions inhibiting RBC production
- autoimmune disorders-lupus- builds immunity against body & attacks and destroys body tissues
- alcoholism- interferes w/ folate causing megaloblastic anemia, suppress RBC production
- inflammatory bowel disease- impairs absorption
- gastric resection- reduces surface area-pernicious anemia,
- liver disease- unable to store/metabolize ferritin-iron deficiency anemia
- CKD- decreased erythropoietin production
- osteomyelitis- affects the function of the bone marrow-decreased RBC production
65
what do neutrophils do
help fight off infections particularly those caused by bacteria and fungus
66
what is the ANC
absolute neutrophil count
ANC=WBCx(% of neutrophils + & of bands)
<1000cells/mcL = risk of infection
67
what are bands
immature neutrophils that are released from the bone marrow when the body is rapidly trying to fight off infection. It is released once all neutrophils are used up and the body is sending out immature neutrophils to fight
68
at what temp should you be worried with a neutropenic pt
any temp at or above 100.4
69
what are causes of neutropenia
chemo, bone marrow depression (bone marrow is under attack for some reason
radiation
70
what is filgrastim
hormones that stimulates neutrophils to grow and mature
71
how does filgastim work
it binds to receptors on the stem cells in bone marrow which helps them mature and divide and help them become functional neutrophils
72
what needs to be monitored while pt is on filgastim
the ANC b/c once the ANC gets above 10,000 the filgrastim needs to be d/c'd
73
adverse effects of filgrastim
medullary bone pain, acute respiratory distress
74
what do WBCs differentiate into
granulocytes - basophils, eosinophils, neutrophils (-phills with granules, 2-5 segmented nuclei)
lymphocytes- monocytes, lymphocytes
75
WBC level
45000-10,000cells/mcL
76
what are segs and bands
segs are neutrophils - b/c they have 2-5 segmented neuclei
| bands are immature neutrophils
77
what do neutrophils do
respond to bacterial infections by phagocytosis
78
what stimulates neutrophil production
bacterial infections.
79
what is the lifespan of neutrophils
1-2 days
80
why would you see neutrophil count going down and band count going up
because an ongoing bacterial infection, the neutrophils are running out so the bone marrow is releasing more bands to make up for the fact that there are no longer enough neutrophils left
81
what do monocytes do
considered the 2nd line of defense.
they transform into macrophages
they are phagocytic cells that ingest bacteria, foreign substances and clean up debri, facilitate tissue repair
They are slower to respond to infection but are stronger than neutrophils
82
how long does it take for a monocyte to reach the site of infection
3-7 days but have a longer lifespan than neutrophils
83
what are lymphocytes for
they play a role in the immune response.
| B & T cells
84
B cells do
they are a humoral response- antibodies
they are activated when an antigen encounters a B cell and then b cells divide and secrete antibodies to that specific antigen
85
what do T cells do
they are apart of cell mediated immunity
these cells recognize the antigen, attack and destroy it. They release cytokines (chemical messenger-histamines) that have the ability to stimulate more cells to come to the site of infection
86
what can T cells fight agains
chronic bacterial infections and acute viral infections
87
what is CRP
C-reactive protein
| a protein that is produced by the liver in response to injury and inflammation
88
what does a non specific inflammatory marker mean
it is a blood test that will tell you there is injury or inflammation somewhere in the body but does not tell you where the site is.
89
besides injury and inflammation, why would CRP be elevated
patients with CAD
| or elevated levels is an indication of unstable plaque
90
what is the purpose of C&S
process of identifying pathogens so the MD can prescribe the correct abx
91
what can happen if you do a C&S after a patient starts abx
you may get false negative results
92
when looking at a agar plate with bacteria for a C&S how will you know if the bacteria is sensitive or resistant
if the pathogen is resistant it will grow up to the disk of the abx.
if it is sensitive it will not have any growth thus leaving a ring
93
what is MIC
minimal inhibitory concentration:
the lowest concentration of drug that inhibits the growth of the organism. the lower the MIC means the less drug required to inhibit the growth of the organism
94
what is the purpose of a urinalysis
to diagnose UTI, kidney function and metabolic disease(diabetes)
95
```
what should the characteristics of a urinalysis be
Cautiously
Connie
Offers
Paul
Her
Notes
Lately
```
```
color- should be lighter yellow
clarity- should be translucent
odor-should be aromatic
protein- should be <20mg/dL
hgb-<5 under microscope, neg on dipstick
Nitrite- should be negative
leukocyte esterase- negative dipstick, <5 microscope
```
96
what does protein in the urine indicate
most common indicator of renal disease. also increased in diabetic nephropathy, glomerulonephritis and also d/t stress or extrenuous exercise
97
why would you detect hgb in a urine sample
UTI, kidney issues, trauma, menstration, nephrolithiasis
98
what would nitrite in the urine indicate
it would indicate there is the presence of nitrite creating bacteria- most commonly e. coli
99
why would there be WBC in urine
bacterial infection-leukocyte esterase is an enzyme produced by neutrophils
calculus formation
100
what can cause the urine to be darker in color
infection
| but also some medications as well
101
what is specific to gram positive bacteria
they have a thick cell wall (peptoglycan layer) stain purple
staphylococcus
streptococcus
enterococcus
102
what is specific to gram negative bacteria
they have a complex cell wall but thinner peptoglycan layer, stain pinkish color
E.coli
salmonella
clubsiella
103
what are empiric anti-infectives
a broad spectrum abx. Used when a pathogen is unknown. Used to cover a wide variety of organisms
covers gram + and gram -
104
what are definitive anti-infectives
a narrow spectrum agent. used when we know the pathogen causing the infection.
105
what is the benefits of using a definitive anti-infective over an empiric anti-infective
the definitive is cheaper, and can reduce toxicity and antimicrobial resistance.
106
what type of abx are used for prophylactic measures
a lot that are used are broad spectrum. they are used against the most likely organisms to cause infection
107
what are the 4 common mechanisms of anti-infectives
- interrupt cell wall synthesis
- folate synthesis-disruptions of metabolic synthesis
- interference of nucleic acid synthesis
- interruption with protein synthesis
108
what do beta lactams do and what anti-infective are they
-interference of bacterial cell wall formation: penicillins, cephalosporins, carbapenems, monobactams
bind to specific proteins necessary for bacteria to build its cell walls
109
how do anti-infective act on folate synthesis and what anti-infective are they
disturb the protein synthesis
(Folate is needed for protein synthesis- amino acids, DNA, RNA. )
Sulfonamides, trimethoprim
(bactrim/septra)
110
how do anti-infective act on nucleic acid synthesis and what anti-infective are they
Quinolones inhibit DNA synthesis so the pathogen cannot continue to duplicate
111
how do anti-infective act on protein synthesis and what anti-infective are they
interrupt the process with the transfer of RNA or change the shape of ribosomes(protein builders)
Tetracyclines
ahminoglycosides
macrolides
112
how do beta lactams interfere with bacterial cell wall synthesis
they resemble the chemical peptidoglycan layer of the bacterial cell wall thus the beta lactams prevent the complete cell wall formation and the pathogen is unable to live b/c the cell contents leak out.
113
which abx are the beta lactams
penicillin and cephalosporins
114
what is beta lactamase
an enzyme bacteria began to produce to inhibit the effect of beta lactam abx.
it hydrolyzes the beta lactic ring which prevents the abx from working
115
which abx are the beta lactamase inhibitors
amoxicillin+clavulanic acid (augmentin)
piperacillin + tazobactam (zosyn)
ampicillin + sulbactam (Unasyn)
they have penicillin type abx combined with a beta lactamase inhibitor
116
what is penicillin
bactericidal abx
| NARROW SPECTRUM against GRAM +
117
what infections can penicillins treat
streptococcal and staphylococcal infections
118
why would you give a penicillin abx
pneumonia
gonorrhea
and syphillis strains
119
use caution with who when giving penicillin
with patients that have a hypersensitivity to cephalosporins because cephalosporins and penicillins have the same beta lactam ring structure
120
what drug may penicillins react with
oral contraceptives.
| they may decrease the effectiveness of the contraceptives
121
what are cephalosporins
bactericidal- inhibition of bacterial cell wall synthesis
BROAD SPECTRUM abx.
cover aerobic and anaerobic infections
122
what happens with coverage of gram + & - with each generation of cephalosporins
the level of gram neg coverage increases with each successive generation
123
what is special about 5th generation cephalosporin
effective against MRSA
| extended Gram + effectiveness
124
what are the 1st gen cephalosporins
Cefazolin/cephalexin
- effective against mostly gram + and some gram -
beta lactamase are resistant to 1st Gen
125
what are 1st gen cephalosporins active against
septicemia, UTI, pneumonia, genital infections
126
2nd gen cephalosporins
cefoxitin & cefotetan
| - cover gram + & - and anaerobes
127
what can cefoxitin do that cefotetan not do
cover septicemia
128
adverse effect of 2nd gen cepholosporin
they can enhance the anti-coag effect of warfarin
129
3rd gen cephalosporins
Ceftriaxone & ceftazidime
covers anaerobes
more coverage of gram -, some coverage of gram +
130
what are some indications for 3rd gen cephalosporins
similar to the others- bone joint infections, UTIs, lower respiratory tract, intra abdominal infections, gynecologic, SEPTICEMIA & MENINGITIS
131
which generation is the only generation to cross the blood brain barrier
the 3rd generation of cephalosporins.
| the only generation that can treat meningitis
132
what is an important implementation with 3rd generation cephalosporins
do not administer with LR (calcium infusions)
133
which generations are used for prophylactic measures
generations 1 and 2
134
4th generation cephalosporin
cefepime
| more active against gram - anaerobes
135
why use a 4th generation cephalosporin
more complicated difficult to treat infections d/t the complicated peptoglycan layer on the bacterial cell wall
also better to use against more resistant microorganisms
136
5th generation abx
Ceftaroline
| its a derivative- has some cephalosporin in it.
137
sulfonamide abx
sulfamethoxazole
but normally found combined with trimethoprim.
BROAD SPECTRUM
138
how does sulfonamide abx work
they inhibit the synthesis of folic acid
139
why add trimethoprim to sulfamethoxazole
alone sulfamethoxazole is a bacteriostatic abx. so it just inhibits growth of bacteria.
adding the trimethoprim causes it to become a bacteriocidal thus allowing it to kill the bacteria
140
what are the indications of sulfonamides
prevent UTIs/treat UTIs, bronchitis, otitis media
141
who would you not want to give a sulfonamide abx to and why
someone with megaloblastic anemia
because we need folic acid to mature our RBCs
so we would not want to give a pt something that is going to inhibit that when they already have an issue with immature RBCs
-and pregnant women
142
adverse effect of sulfonamides
crystalluria- monitor w/ BUN and creatinine
| steven johnson syndrome
143
what are nursing interventions for pts who are taking sulfonomides
encourage them to drink plenty of fluids to prevent crystalluria.
you want their urine output to be 1200-1500mL in a 24 hr period
144
what drug interactions does sulfonamides have
increasing the effects of anticoagulants
-K+ sparing drugs (sprionolactione)- sulfonamides have a K+ sparing effect so used in conjunction with sprionolactone can increase the risk of K+ toxicity
145
what are aminoglycosides and what are they used for
Gentamicin-
| narrow spectrum- for serious sytemic infections such as septicemia & meningitis
146
What is Vancomycin used for
Active against Gram + pathogens
IV form= septicemia, MRSA
PO- C-Diff
147
what can IV Vancomycin cause
-necrosis and extravasation at the site
therefore you need to assess the site first for patency and without pain
-Red Man syndrome- caused from giving the abx too quickly
-Hypotension
148
why can't you give IV vancomycin for C-Diff
because when vancomycin is given orally it acts locally in the intestines
the IV vancomycin will not be able to treat the c-diff because it cannot get to the intestines.
149
how long should you monitor pt for red man syndrome
4-10 hrs AFTER the infusion is given
150
what are adverse effects of both Gentamicin and vancomycin
- nephrotoxicity-b/c 90% is excreted through the kidneys (except PO vanc)
- ototoxicity
151
what do you need to monitor during gentamicin and vancomicin
- kidney function- BUN Creatinine
- baseline hearing- then monitor hearing loss, ringing, fullness
- accurate I&O
- assess urine- for any blood- will indicate kidney damage
