Nursing Theory Exam #2 - Anemia, Hypersensitivity reactions, and GU

what is anemia

deficiency of RBCs or hemoglobin

diagnosis of anemia

CBC, blood smear, reticulocyte count

any disorder of RBCs can lead to

tissue hypoxia

etiology of anemia

acute blood loss, decreased RBC production, increased RBC destruction

moderate anemia levels of hemoglobin

6-10

severe anemia levels of hemoglobin

<6

start blood transfusion with a hemoglobin under

7

neuro symptoms of anemia

dizziness, fatigue, ataxia, weakness, headache

ataxia

impaired coordination

paresthesia

restless legs (tingling)

skin symptoms of anemia

pale, paresthesia, cold hands and feet

CV and respiratory symptoms of anemia

dyspnea, tachycardia, thing blood, palpitations, murmurs

symptoms of anemia in the older adult

fatigue, weakness, ataxia

Pernicious (megaloblastic) anemia cause

cobalamin deficiency bc of lack of intrinsic factor

manifestations of cobalamin deficiency

cognitive issues, weakness, proprioception, GI upset, shiny beefy red tongue

cobalamin deficiency is common in pateints with

gastric issues/ surgeries, smokers, alcohol, vegetarians

treatment of cobalamin deficiency

IM/IV B12 injections

If cobalamin deficiency is left untreated

life expectancy 1-3 years

pancytopenia

not enough blood cells being produced

autoimmune condition where T cells target and destroy hematopoietic stem cells

aplastic anemia

manifestations of aplastic anemia

low wbcs, increased infections, thrombocytopenia (bruising, epistaxis, petechiae

diagnosis of aplastic anemia

CBC and bone marrow test

treatment of aplastic anemia

hematopoietic stem cell transplant (if applicable), immunosuppressive therapy, ongoing blood transfusions

aplastic anemia prognosis

poor if severe

condition where RBC destruction exceeds production

hemolytic anemia

hemolytic anemia resulting from defects in the RBCs

intrinsic

hemolytic anemia resulting from external factors cause damage to RBCs

extrinsic

symptoms of hemolytic anemia

altered kidney function, hepatomegaly, splenomegaly, jaundice

treatment of hemolytic anemia

remove causative agent and supportive care (O2, pain meds, fluids, blood transfusions)

type 1 hypersensitivity reaction

IgE mediated - allergies and anaphylaxis

type 2 hypersensitivity reaction

cytotoxic - antibodies attacking (destroying BCs)

type 3 hypersensitivity reaction

immune complex - autoimmune diseases

type 4 hypersensitivity reactions

delayed (cell mediated)

transfusion reaction that includes itching rash, flushing, mild temp rise

mild reaction

transfusion reaction that has symptoms such as itching, rash, flushing, fever, chills, and headache

febrile nonhemolytic reaction

transfusion reaction involving fever, chills, flushing, flank pain, bloody urine, tachycardia, hypotension

acute hemolytic reaction

transfusion reaction involving tachycardia, fever, chills, flushing, pain, bloody urine, hypotension, bronchospasm, dyspnea, dizziness

anaphylaxis/ severe allergic reaction

transfusion reaction involving edema, SOB, and lung crackles

fluid overload

bladder capacity

600-1000 mL

amount of urine that you should notify the provider about

<30 mL/hr

no pee (less than 100 mL/day)

anuria

little pee (<30 mL/hr)

oliguria

pus in urine

pyuria

nursing assessment of GU

history and meds

patterns

changes or problems

inspect

auscultate

palpate

urine assessment

color, odor, turbidity, ph, specific gravity

ph of urine

5-8

kidney function test that measures urea in blood and fluctuates based on fluid volume

BUN

more reliable kidney function test

creatinine

renal function test that measures filtration rate of glomerulus to see how well kidneys are removing waste and fluids from blood

GFR

nursing interventions for normal urination

maintain voiding habits, encourage fluids, strengthen muscle tone, assist as needed

older adult urinary issues

risk of incontinence, retention, decreased glomerular function, bladder spasms

most common cause of UTI

E. Coli

types of lower UTI

cystitis, prostatitis, urethritis (bladder, prostate, urethra)

upper UTI

pyelonephritis (kidney infection)

causes of UTI besides bacteria

ureterovesical/ urethrovesical reflux

most common risk factor of UTI

catheter

assessment findings of UTI

burning with urination, achy bladder, cloudy or bloody urine, frequency, urgency, low grade fever

symptoms of upper UTI

high fever and flank pain

older adult presentation of UTI

confusion

treatment of UTI

antibiotics

education for UTI

fluids, void every 3-4 hours, azo, no douching, heating pad

UTI that spread to blood stream

urosepsis

symptoms of urosepsis

low bp, dizziness, high HR and RR, kidney infection symptoms

painful bladder syndrome

interstitial cystitis

cause of interstitial cystitis

unknown

symptoms of interstitial cystitis

mimic UTI, extreme frequency (50-60 per day)

treatment of interstitial cystitis

avoid bladder irritants, mange stress, bladder relaxants, PT, Botox or lidocaine

nursing management of IC

assess pain, voiding log, monitor UTI, avoid restrictive clothes, coping skills

urinary tract calculi

kidney stones

nephrolithiasis

kidney stone formation

risk factors for kidney stones

high protein, sodium or calcium, lifestyle factors, metabolic disease, warm climates, genetics

kidney stone too big to pass

> 4 mm

kidney stone assessment findings

flank pain, inability to urinate, nausea and vomiting, cool moist skin, fever, chills, restlessness

kidney stone diagnostics

ct scan, ultrasounds, ua, 24h urine

primary goal of kidney stone treatment

treat the pain infection and obstruction

secondary goal of kidney stone treatment

determine cause and prevent future development

tamsulosin

flomax - smooth muscle relaxer

treatment of kidney stones

antibiotics, tamsulosin, hydration, dietary changes, urologic stent if necessary

life threatening genetic kidney disease that involves fluid filled cysts damaging the kidneys

polycystic kidney disease

assessment findings of PCKD

flank pain, hypertension, protein and blood in urine, palpable, increased infection

treatment for PCKD

slow growth of cysts, prevent infections and stones, dialysis and transplant if possible

nursing assessment of incontinence

skin breakdown, I&O

acute causes of incontinence (DRIP)

delirium, depression dehydration

retention and restricted mobility

infection, inflammation, impaction

pharmaceuticals, polyuria, pain

treatment of incontinence

adjust lifestyle factors, bladder training, PT, meds for urgency or to relax muscles, clamp and incontinence pads

PVR

post void residual

interventions for urinary retention

catheterization, drug therapy (smooth muscle relaxant), surgery

after catheter removal must pee by ___ hours

6

if bladder scan shows greater than 300 mL

straight cath

a catheter placed in kidney to help urine drain

nephrostomy tube

when they take a piece of ilium and sew ureters to it then attach a stoma to drain urine

ileal conduit

make a fake bladder out of intestine w/ valves that you self cath to drain every few hours

continent urinary reservoir

nursing care of urinary diversions

inspect stoma and skin, i&o, education and coping skills, home care education

complications of BPH

acute urinary retention, UTI, renal failure

diagnosis of BPH

digital rectal exam, UA, PVR, ultrasound, MRI, prostate specific antigen level, cystoscopy

management of BPH

drugs - tamsulosin or ED meds

surgery - TURP

after TURP care

assess bleeding, clotting, gi symptoms, neuro assessment, i&o