TOPIC 6 - anemia & blood transfusions

Question 1

blood disorders

Answer 1

iron deficiency
vitamin B12 deficiency
folic acid deficiency
sickle cell anemia
aplastic anemia

Question 2

anemia is

Answer 2

a deficiency of the number of erythrocytes
change in quantity or quality of Hgb
change in volume of packed RBC (Hct)

Question 3

causes of anemia

Answer 3

blood loss, impaired production of erythrocytes, increased destruction of erythrocytes

Question 4

clinical manifestations are based on

Answer 4

rate at which anemia has evolved
severity
coexisting diseases

Question 5

symptoms of anemia

Answer 5

fatigue, weakness, SOB, lightheadedness, pallor, palpitations, chest pain, angina, MI, dizzy, fainting, rapid HR, glossitis

Question 6

normocytic anemia

Answer 6

aplastic or sickle cell anemia

CAUSES:
aplastic: inherited, leukemia, CKD, something taken into the body
sickle cell: inherited

Question 7

clinical manifestations of sickle cell disease

Answer 7

fever, swelling, tenderness, tachypnea, HTN, nausea, vomiting

Question 8

triggers for sickle cell episodes

Answer 8

hypoxia or deoxygenated RBC caused by:
viral or bacterial infection
high altitude
surgery
blood loss
dehydration
low body temp

Question 9

microcytic anemia

Answer 9

iron deficiency or thalassemia

Question 10

causes and risk factors for iron deficiency

Answer 10

inadequate intake of iron
poor GI absorption
blood loss (most common)

Question 11

causes of thalassemia

Answer 11

inadequate Hgb production which decreases RBC production

Question 12

s/s of thalassemia

Answer 12

physical and mental growth changes, pale and jaundice, splenomegaly, hepatomegaly, cardiomyopathy

Question 13

treatment of thalassemia

Answer 13

blood transfusion and splenectomy

Question 14

macrocytic anemia

Answer 14

vitamin B12 deficient or folic acid deficient

Question 15

foods rich in folic acid

Answer 15

orange juice, romaine, spinach, liver, rice, barley, sprouts, wheat germ, beans, peanuts, broccoli, asparagus, peas, chickpeas, eggs, meats, poultry, milk, shellfish

Question 16

assessment

Answer 16

neuro - increased somnolence, fatigue, headache
resp - dyspnea on exertion, decreased O2
cardio - tachy, murmurs, ortho hypotension
integumentary - pallor, cool to touch, intolerance of cold, brittle nails

Question 17

nursing diagnosis

Answer 17

ineffective tissue perfusion, risk for FVD, acute pain, risk for impaired skin integrity, deficient knowledge, ineffective coping

Question 18

treatments

Answer 18

focus on treating underlying cause, blood transfusions as ordered, iron/B12/folic acid supplements, epoetin alpha injections, routine blood monitoring

Question 19

interventions

Answer 19

cluster and plan activities and rest
exercise program to increase activity intolerance
nutrition plan

Question 20

hemophilia

Answer 20

missing link in the clotting cascade (cant clot)
TYPE A: missing factor VIII
TYPE B: missing factor IX

Question 21

assessments

Answer 21

slow persistent prolonged bleeding, delayed bleeding after minor injuries, uncontrollable hemorrhage, epistaxis, GI bleed, hematuria, kidney failure, splenic rupture, ecchymoses and SQ hematoma, compartment syndrome, neuro (pain, paralysis), hemarthrosis

Question 22

acute interventions

Answer 22

stop the bleeding - direct pressure
admin clotting factors
rest joint if bleeding
assess airway bleeding

Question 23

types of blood products

Answer 23

packed RBC
fresh frozen plasma
platelets
albumin
Rh factor

Question 24

check first (on blood bag)

Answer 24

blood type, name, MRN, exp date, unit #, both RNs document

Question 25

before transfusion

Answer 25

verify order, consent, labs, 20 gauge IV, use 0.9% NaCl to prime tubing, obtain blood, verify again

Question 26

during transfusion

Answer 26

vitals prior to infusion, vitals every 15 min after begin, every hour until completed, use blood transfusion tubing, only 0.9% NS to prime, remain with client 15-30 min of infusion, infuse over 2-4 hours, monitor for reaction

Question 27

possible complications

Answer 27

fluid volume overload, mild allergic reaction, febrile reaction, acute hemolytic reaction