Adult Health I: Anemias - Exam #2

The circulatory system consists of what two (2) separate systems?

(1) Cardiovascular, (2) Lymphatic.

What are three (3) primary functions of blood?

(1) Transport O2/nutrients, (2) Remove waste, and (3) Immune response.

Explain the composition of blood:

91% water and 9% solutes.

True or False?

Blood volume amounts to 6 quarts (5.5L) in the body.

True.

True or False?

Plasma amounts to 50%-55% of blood volume.

True.

What is plasma?

Aqueous liquid with electrolytes.

What is serum?

Serum is plasma without fibrinogen (clotting proteins).

Where are a majority of plasma proteins produced?

A majority of plasma proteins are primarily produced in the liver.

What are three (3) important plasma proteins?

(1) Albumin, (2) Globulins, and (3) Clotting factors.

What are four (4) functions of plasma proteins?

(1) Clotting, (2) Defense, (3) Transport, and (4) Regulation.

Know cellular components: Erythrocytes, Leukocytes, and Thrombocytes.

Know cellular components: Erythrocytes, Leukocytes, and Thrombocytes.

What is the function of the bone marrow (2)?

(1) Produces blood cells, (2) Stores fat.

What are five (5) diagnostic tests?

(1) CBC, (2) Hemoglobin/Hematocrit, (3) Reticulocyte count, (4) Bleeding time, and (5) PT/PTT.

What are reticulocytes?

Reticulocytes are immature RBCs that determine the level of function of bone marrow.

Know Anemia, Polycythemia, Neutropenia/Leukopenia, Thrombocytopenia, Thrombocytosis, and Pancytopenia.

Know Anemia, Polycythemia, Neutropenia/Leukopenia, Thrombocytopenia, Thrombocytosis, and Pancytopenia.

What is hemoglobin?

Protein molecule in RBC that carries oxygen.

What is hematocrit?

Level of RBCs within blood.

What are two (2) treatments for Leukopenia/Neutropenia (2)?

Bone marrow stimulants such as Filgastrim (Neupogen) and Pegfilgastrim (Neulasta).

What is one (1) treatment for thrombocytopenia?

Oprelvekin (Neumega).

True or False?

Oprelvekin (Neumega) is a synthetic interleukin-11 that stimulates platelet production in the bone marrow.

True.

True or False?

Anemia causes a reduction in oxygen transport; Basic problem is hemoglobin deficit.

True.

What are three (3) biologic symptoms of anemia?

(1) Less energy production in cells, (2) Compensation mechanisms, and (3) General signs of anemia.

What are four (4) general signs of anemia?

(1) Fatigue, (2) Pallor, (3) Dyspnea, and (4) Tachycardia.

What are two (2) treatments for chronic anemia?

Erythropoietin Stimulating Agents (ESAs) such as Epoetin (Epogen) and Darbepoetin (Aranesp).

True or False?

Epoetin (Epogen) and Darbepoetin (Aranesp) are man-made erythropoietin.

True.

Individuals with ___________ ___________ failure are often diagnosed with chronic anemia and require Epoetin (Epogen) and Darbepoetin (Aranesp).

Chronic kidney failure.

What are five (5) nursing responsibilities for patients taking Epoetin (Epogen) and Darbepoetin (Aranesp)?

(1) Monitor BP, (2) MI, (3) CVA, (4) DVT, and (5) Seizure.

What is iron deficiency anemia?

Insufficient iron imparis hemoglobin synthesis.

What are four (4) causes of iron deficiency anemia?

(1) Decreased dietary intake of iron, (2) Chronic blood loss, (3) Impaired duodenal absorption, and (4) Severe liver disease.

True or False?

Parenteral forms (IV or IM Z-Track) of iron should only be used in clients who are unable to take oral medications.

True.

True or False?

To prevent staining teeth with oral iron supplements, dilute in juice/water using a straw and rinsing after.

True.

True or False?

Vitamin C increases absoprtion.

True.

What is aplastic anemia?

Impariment or failure of bone marrow.

What is hemolytic anemia?

Excessive destructions of RBCs.

What is pernicious anemia?

Lack of absorption of Vitamin B12 because of lack of intrinsic factor.

Pernicious anemia is characterized by _______ _______, _______ red blood cells.

Very large, immature red blood cells.

What is the treatment of pernicious anemia?

B12 injections.

What is sickle cell anemia?

Abnormal shape/malformation of RBCs that become too large to pass through the microcirculation.

What are three (3) treatments for sickle cell anemia?

(1) Hydration, (2) Pain medication, (3) Monitor O2 and provide supplemental O2 PRN.

True or False?

Regarding sickle cell anemia, multiple infarctions affect brain, bones, and organs.

True.

What is primary polycythemia vera?

Increased production of erythrocytes and other cells

in the bone marrow.

Serum erythropoietin levels are ________ in polycythemia vera.

Low.

What is secondary polycythemia erythrocytosis?

Increase in RBCs in response to prolonged hypoxia.

True or False?

Carbon monoxide poisoning may cause secondary polycythemia erythrocytosis.

True.

What is Leukemia?

Group of neoplastic disorders involving WBCs.

True or False?

Leukemia indicates uncontrolled production of abnormal WBCs in the bone marrow.

True.

What are two (2) types of Leukemias?

(1) Acute and (2) Chronic.

What is Acute Leukemia?

High proportion of immature nonfunctional cells in the bone marrow.

True or False?

Acute Leukemia occurs primarily in children and younger adults.

True.

What is Chronic Leukemia?

Higher proportion of mature cells but with reduced function.

True or False?

Chronic Leukemia occurs primarily in older adults.

True.

What is Multiple Myeloma?

Neoplastic disease that involves increased production of plasma cells in bone marrow.

What is the cause of Multiple Myeloma?

Unknown cause.

How is Multiple Myeloma usually diagnosed?

Increased serum calcium due to bone degradation into the bloodstream.

What does internal bleeding look like (5)?

(1) FVD, (2) hypotension, (3) tachycardia, (4) N/V, and (5) bloody stool.

What does external bleeding look like (3)?

(1) Petechiae, (2) Purpura, and (3) Ecchymosis.

What are two (2) bleeding disorders?

(1) Hemophilia A, (2) Von Willebrand Disease.

What is Hemophilia A?

Spontaneous bleeding into the joints; Most common inherited clotting disorder.

True or False?

Hemophilia A is an X-linked recessive trait; usually manifests in men but carried by women.

True.

What is von Willebrand disease?

Autosomal recessive genetic disease that affects the function of platelets.

What are two (2) treatments for Hemophilia A and Von Willebrand Disease?

(1) Factor VIII, (2) Desmopressin.

What does Desmopressin do?

Helps activate WIllebrand factor and Factor VIII.

Monitor for __________ when giving desmopressin.

Monitor for Hyponatremia.

True or False?

Replace clotting factors, plasma, and blood for bleeding disorders.

True.

What does "Whole Blood" do?

Increases circulating blood volume.

What are Packed Red Blood cells?

Increases the number of RBCs.

What does Platelet Concentrate do?

Increases platelet count to stop bleeding.

What does Fresh Frozen Plasma (FFP) do?

Replaces coagulation factors as a reversal of blood thinning medications.

What do Apheresed Granulocytes do?

Replace neutrophils/granulocytes in the case of severe neutropenia.

What does Albumin (Colloid) do?

Expands circulating blood volume by exerting oncotic pressure; Supports the hemodynamic system (BP).

What are six (6) indications for blood and RBCs?

(1) Pallor, (2) Weakness, (3) SOB, (4) Hypotension, (5) Thready pulse, and (6) Cool-to-touch.

What is shock?

Low BP, poor perfusion, organ failure.

What causes shock (3)?

(1) Hypovolemia, (2) Massive vasodilation, and (3) HF/Bradycardia.

What causes hypovolemia (2)?

(1) Dehydration, (2) Blood loss.

What causes massive vasodilation (2)?

(1) Infection, (2) Inflammation.

What are about five (5) treatments for shock?

(1) 0.9% NS, (2) Blood administration, (3) Vasoconstrictor, (4) Fluids, (5) Treat the underlying cause, etc.

What is one (1) medication used to treat excessive bleeding, hemorrhaging, shock, etc.

(1) Tranexamic Acid (Lysteda).

Which blood type is the universal donor?

O-

Which blood type is the universal recipient?

AB+

What are six (6) nursing responsibilities regarding blood transfusions?

(1) Acquire consent, (2) Assess for FVE, (3) 20-gauge or larger IV catheter, (4) Ensure transfusion is complete at least four hours after blood is taken from blood bank, (5) Use only 0.9% NS to administer with blood, and (6) Change tubing every two units to prevent bacterial sepsis.

True or False?

For whole blood and packed RBCs, about 250mL/unit; infuse within 2-4 hours MAXIMUM.

True.

What are seven (7) complications of blood transfusion?

(1) Anxiety, (2) Rash, (3) Wheezing, (4) Shock, (5) Cardiac arrest, (6) Flushing, and (7) Itching.

What are four (4) nursing responsibilities regarding complications of blood transfusions?

(1) Stop the infusion and immediately notify provider, (2) Administer NS through new tubing, (3) Stay with client and monitor VS/UO, and (4) Notify blood bank/PCP.

What are three (3) important steps of clotting (Thrombus Formation)?

(1) Platelets initiate process; Platelet aggregation, (2) Fibrin formation of a mesh over the platelets, and (3) RBCs are trapped in fibrin mesh.

How do venous clots occur?

Formation begins because of pooling/stasis of blood/lack of movement.

What are four (4) symptoms of a venous thrombus?

(1) Red, (2) Warm, (3) Swollen, (4) Pain that WORSENS WHEN STANDING/WALKING

Understand thrombus vs thromboembolus.

Understand thrombus vs thromboembolus.

How do arterial clots occur?

Damage or plaques in arterial system (smoking, high cholesterol, etc).

What are three (3) symptoms of an arterial thrombus?

(1) Cool, (2) Pale extremity with (3) Pain that gets better when walking.

What are six (6) considerations for anti-clotting medications?

(1) Monitor for signs of bleeding, (2) Monitor for effects of clotting, (3) Check labs, (4) Avoid foods that irritate GI tract, (5) Know foods/supplements that thin/thicken blood, and (6) Encourage foods that soothe the GI tract.

What are three (3) classes of antiplatelet medications?

(1) ADP Inhibitors, (2) Glycoprotein IIb/IIIa receptor antagonist, and (3) Protease-activated receptor-1 antagonist.

What is one (1) example of ADP inhibitor?

(1) Clopidogrel, (2) Prasugrel, and (3) Ticagrelor.

What is one (1) example of Glycoprotein IIb/IIIa receptor antagonist?

(1) Eptifibatide.

What is one (1) example of Protease-activated receptor-1 antagonist?

(1) Vorapaxar.

What is the function of anti-platelet medications such as ADP Inhibitors, Glycoprotein IIb/IIIa receptor antagonist, and Protease-activated receptor-1 antagonist?

Prevention of arterial clot formation.

What is the reversal of anti-platelets?

Platelets.

What are three (3) examples of Direct Thrombin Inhibitors?

(1) Dabigatran, (2) Desirudin, and (3) Argatroban.

What is the function of Direct Thrombin Inhibitors such as Dabigatran, Desirudin, and Argatroban?

Inhibit thrombin from converting fibrinogen to fibrin.

What is the reversal (2) of Direct Thrombin Inhibitors?

(1) Idarucizumab (Praxbind), (2) Fresh Frozen Plasma (FFP).

What is one (1) example of an anticoagulant?

(1) Heparin.