NUR 425 Exam 2

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What does absolute neutrophil count measure?

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What does absolute neutrophil count measure?

The total number of neutrophils in the blood

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Which lab test is used to monitor the intrinsic pathway?

PTT (partial prothrombin time)

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Which lab test is used to monitor the extrinsic pathway?

PT (prothrombin time)

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aPTT (activated partial thromboplastin time)

30-40 seconds

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INR

1 or less

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PTT (partial prothrombin time)

60-70 seconds

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PT (prothrombin time)

10-13 seconds

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What drug does PT (prothrombin time) monitor?

Warfarin (Coumadin)

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What drug does PTT and aPTT monitor?

Heparin

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Red Blood Cell (RBC) Count

Females: 3.61 - 5.11 million/mm3 (4) Males: 4.21 - 5.81 million/mm3 (5)

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Hematocrit

Females: 36% - 48% (39) Males: 42% - 52% (45)

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Hemoglobin

Females: 11.7 - 15.5 g/dL (13) Males: 14 - 17.3 g/dL (15)

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White Blood Cell (WBC) Count

4.50 - 11.1 103/mm3

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Absolute Neutrophil Count (ANC)

1.5 to 8.0 (1,500 to 8,000/mm3)

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Platelets

150,000 - 450,000/µL

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What does a WBC shift to the left mean?

-Indicates that more immature cells are present in the blood than normal -Occurs with acute infection, inflammation, or some other significant physical stress

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What is anemia?

Occurs when there is a reduction in the oxygen-carrying capacity through either fewer RBCs or a reduction in hemoglobin

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What are symptoms of decreased hematocrit?

-Shortness of breath -Tachypnea -Tachycardia -Pallor -Fatigue -Dizziness

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What are dietary sources of iron?

-Meat (especially red meat) -Dark green leafy vegetables (spinach, broccoli, peas) -Beets -Dried beans -Iron-fortified breakfast cereals and breads -Cream of Wheat -Ingesting citrus fruits such as oranges or grapefruits increases the vitamin C intake and may improve iron absorption

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What are clinical manifestations of iron-deficiency anemia?

-Fatigue -Pallor -Tachycardia -Tachypnea -Glossitis (smooth, shiny tongue) -Koilonychia (spoon-shaped nails)

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How is iron-deficiency anemia diagnosed?

-A complete blood count (CBC) demonstrates decreased hemoglobin and hematocrit levels -Serum ferritin levels less than or equal to 100 ug/L indicate IDA 100% of the time -Additional diagnostic studies to confirm IDA include serum iron, total iron-binding capacity (TIBC), serum transferrin receptors, and mean corpuscular volume (MCV)

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What teaching do you need to provide to a client with iron-deficiency anemia?

-Dietary sources of iron -Immediately report any signs of bleeding, increasing fatigue, or shortness of breath. -Daily iron supplements must be taken as prescribed. -Dangers of lead exposure -Prenatal teaching about iron intake

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What are dietary sources of vitamin B12?

-Meat -Seafood -Eggs -Dairy products

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What are clinical manifestations of vitamin B12 anemia?

-Fatigue -Pallor -Tachycardia -Tachypnea -Shortness of breath -Dizziness -Glossitis -Neurological deficits: •Symmetric paresthesia of feet and fingers •Lhermitte's sign •Confusion •Depression •Impaired taste •Impaired balance •Visual disturbances •Tinnitus

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How is vitamin B12 anemia diagnosed?

-History and physical examination -Vitamin B12 serum assay blood test

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What population is at increased risk of deficiency and may need to take a daily supplement of vitamin B12?

-Long-term vegans/vegetarians -Those of low socioeconomic status

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What are clinical manifestations of folic acid deficiency?

-Fatigue -Gray hair -Mouth sores -Swollen tongue -Forgetfulness -Depression -Appetite loss -Difficulty concentrating -Birth defect -Poor growth

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What are dietary sources of folic acid?

-Dark green vegetables -Dried beans, legumes -Fortified grains (breads, cereal) -Nuts -Bran -Yeast

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What teaching do you need to provide to a client with folic acid deficiency?

-Dietary sources of folate/folic acid -Immediately report any clinical manifestations of fatigue, shortness of breath, dizziness, and confusion. -Prenatal teaching -Need for supplementation

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What teaching do you need to provide to a client with sickle cell anemia?

-Pathophysiology of disease -Infection prevention measures -Avoid cold temperatures and wearing tight, restrictive clothing. -Avoid high altitudes and depressurized airplanes. -Avoid dehydration. -Avoid overexertion. -Maintain activities of daily life within prescribed limitations. -Risk of more frequent sickle cell crises during pregnancy. -Fetal complications -Genetic counseling

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What are risk factors for sickle cell anemia?

-The sickle cell trait (SCT) is a genetic mutation that must be present in both parents in order for this form of the disease to manifest in offspring -Parents who carry this gene have a one in four chance of producing a child with sickle cell anemia -Precipitating factors include dehydration, cold temperatures, infection, and environments with low oxygen tension, such as depressurized airplane cabins and high mountains

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What are clinical manifestations of sickle cell anemia?

-Fatigue -Pallor -Shortness of breath -Vasoocclusion of blood vessels resulting in pain and swelling -Pain usually occurs in the joints, bones, chest, and abdomen -Growth and developmental delays -Hand-food syndrome

<p>-Fatigue -Pallor -Shortness of breath -Vasoocclusion of blood vessels resulting in pain and swelling -Pain usually occurs in the joints, bones, chest, and abdomen -Growth and developmental delays -Hand-food syndrome</p>
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What are priority nursing actions for sickle cell anemia?

-Administer oxygen. -Provide aggressive hydration. -Administer pain medication. -Administer blood transfusions. -Administer antipyretics. -Provide supportive measures.

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What is the treatment for sickle cell anemia crisis?

Hydration Oxygenation (comes first) Pain relief

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What are clinical manifestations of aplastic anemia?

-Decreased RBCs: Fatigue, shortness of breath, tachycardia, pallor, dizziness, and headache -Decreased WBCs: Increased susceptibility to infections, as well as frequent and prolonged infections -Thrombocytopenia: Unexplained and increased incidence of bruising, nosebleeds, gum bleeding, and prolonged bleeding from cuts and other injuries

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What teaching do you need to provide to a client with aplastic anemia?

-Avoid exposure to potential infection (individuals with acute infection, crowded places). -Report all temperature elevations. -Avoid activities with the potential for trauma or injury. -Clinical manifestations of anemia -Nutritional intake

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What are clinical manifestations of thrombocytopenia?

-Easy bruising and petechiae -Bleeding may occur from the nose, around the gums, or from the gastrointestinal tract

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What are priority nursing actions for thrombocytopenia?

-Implement bleeding precautions (RANDI) -Minimize blood loss from lacerations or venipuncture. -Avoid intramuscular injections. -Avoid rectal temperatures, enemas, suppositories, and douches. -Provide a safe environment. -Use minimal inflation when assessing blood pressure. -Minimize blood draws.

<p>-Implement bleeding precautions (RANDI) -Minimize blood loss from lacerations or venipuncture. -Avoid intramuscular injections. -Avoid rectal temperatures, enemas, suppositories, and douches. -Provide a safe environment. -Use minimal inflation when assessing blood pressure. -Minimize blood draws.</p>
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What are safety interventions for thrombocytopenia?

Bleeding precautions

<p>Bleeding precautions</p>
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What are risk factors for leukemia?

-Genetic anomalies -Down's syndrome -Exposure to radiation or benzene -Chemotherapeutic agents and/or radiation therapy -Smoking -White males over the age of 60

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What are clinical manifestations of leukemia?

Anemia: Decreased hemoglobin, fatigue, pallor, weakness, and shortness of breath, as well as bruising, petechiae nosebleeds, and bleeding gums from the decreased number of platelets Neutropenia: Risk for infection, low-grade fevers Thrombocytopenia: Risk for bleeding

<p>Anemia: Decreased hemoglobin, fatigue, pallor, weakness, and shortness of breath, as well as bruising, petechiae nosebleeds, and bleeding gums from the decreased number of platelets Neutropenia: Risk for infection, low-grade fevers Thrombocytopenia: Risk for bleeding</p>
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What are diagnostic tests for leukemia?

-CBC -History and physical examination -Bone marrow biopsy -Genetic testing

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What are priority nursing actions for leukemia?

-Administer chemotherapy as prescribed. -Institute neutropenic precautions. -Prophylactic use of antibiotics, antivirals, and antifungals as ordered -Administer IV antibiotics. -Symptom management (nausea/vomiting/diarrhea, ulcerations of the mouth) -Administer ordered blood products.

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What teaching do you need to provide to a client with leukemia?

-Neutropenic precautions -Clinical manifestations of anemia -Manifestations of thrombocytopenia -Bleeding precautions -Diagnosis of leukemia -Adverse reactions of chemotherapy or radiation -Possibility of sterility

<p>-Neutropenic precautions -Clinical manifestations of anemia -Manifestations of thrombocytopenia -Bleeding precautions -Diagnosis of leukemia -Adverse reactions of chemotherapy or radiation -Possibility of sterility</p>
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What are clinical manifestations for malignant lymphoma?

-Painless swelling of the lymph nodes in the neck, underarm, and groin -Low-grade fevers for no apparent reason -Drenching night sweats -Unexplained weight loss of more than 10% in less than 6 months -Fatigue (known as the "B symptoms") -Generalized pruritus, or itching, with pronounced excoriation from scratching is present in a large percentage of patients presenting with Hodgkin's disease (HD)

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What teaching do you need to provide to a client with malignant lymphoma?

-Disease process -Risk of infection -Maintaining treatment schedules -Encourage frequent rest periods. -Dietary intake -Clinical manifestations of potential complications -Possibility of sterility

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What are clinical manifestations of multiple myeloma?

-Fatigue -Weakness -Bone pain -Recurrent infections -Weight loss -Paresthesia

<p>-Fatigue -Weakness -Bone pain -Recurrent infections -Weight loss -Paresthesia</p>
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What does the nursing assessment include for multiple myeloma?

-Vital signs -Fatigue, pallor, and shortness of breath -Pain -Paresthesias -Intake and output -Serum and urine calcium -Serum blood urea nitrogen (BUN) and creatinine

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What teaching do you need to provide to a client with multiple myeloma?

-Immediately report any clinical manifestations of fatigue, shortness of breath, dizziness, or confusion. -Report any sudden onset of severe pain or new location, especially of back pain, which could indicate a pathological fracture. -Report changes in sensation, increased numbness and tingling, or changes in motor function. -Instruct in the use of nonpharmacological pain management methods, such as music, relaxation, deep breathing, imagery, distraction, and progressive muscle relaxation.

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What effect does renal insufficiency have on RBC count?

Decreases RBC count

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What are examples of potential nephrotoxic substances?

-Antibiotics -Analgesics: NSAIDS -Other medications: ACE inhibitors, benzodiazepines, contrast media, diuretics -Substances: Cocaine, gold, heroin, lead, mercury

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What is anuria?

-Less than 100-mL urine output/24 hr -Clinical significance of abnormal finding: End-stage renal disease, acute renal failure, urinary tract obstruction

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What is dysuria?

-Difficulty or pain with urination -Clinical significance of abnormal finding: Urinary tract infection, cystitis (bladder infection)

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What is enuresis?

-Involuntary urination at night -Clinical significance of abnormal finding: Lower urinary tract disorder

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What is frequency?

-Increase in incidence of voiding, usually urinating only small amounts with each void -Clinical significance of abnormal finding: Bladder inflammation, excessive fluid intake, urinary retention

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What is hematuria?

-Presence of blood in the urine -Clinical significance of abnormal finding: Cystitis or other inflammation in the urinary tract, calculi, cancers of the urinary tract, renal disease, bleeding disorders, medications such as anticoagulants

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What is hesitancy?

-Difficulty starting the flow of urine -Clinical significance of abnormal finding: Urethral obstruction, enlargement of the prostate gland (benign or malignant)

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What is incontinence?

-Inability to voluntarily control micturition -Clinical significance of abnormal finding: Bladder infections, trauma to the external sphincter, neurogenic bladder, trauma to the nerve innervating the urinary tract structures

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What is nocturia?

-Frequent urination at night -Clinical significance of abnormal finding: Heart failure, renal disease, bladder obstruction, consumption of excessive fluids late at night

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What is oliguria?

-Decreased urine output; less than 400-mL urine output/24 hr -Clinical significance of abnormal finding: Shock, end-stage renal disease, acute kidney injury, severe dehydration, blood transfusion reaction

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What is polyuria?

-Increased urine output; greater than 2,000-mL urine output/24 hr -Clinical significance of abnormal finding: Excessive fluid intake, diabetes insipidus, diabetes mellitus, diuretic medications, diuresis phase of chronic renal failure

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What is renal colic?

-Pain radiating to the perineal or groin area -Clinical significance of abnormal finding: Ureter spasm during passage of calculi, ureter obstruction

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What is retention?

-Inability to completely empty the bladder of urine -Clinical significance of abnormal finding: Normal finding briefly after childbirth, pelvic surgery, and removal of indwelling catheter Prolonged/abnormal related to neurogenic bladder, obstruction or stricture of the urethra

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What is urgency?

-Sudden onset of the urge to void immediately -Clinical significance of abnormal finding: Medications, pelvic organ prolapse, cystitis, UTI

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Serum Creatinine

0.5 - 1.2 mg/dL

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Blood Urea Nitrogen (BUN)

8 - 21 mg/dL

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BUN/Creatinine Ratio

10:1 to 20:1

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Uric Acid

3.5 - 8 mg/dL

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Bicarbonate

22 - 26 mEq/L

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Sodium

135 - 145 mEq/L

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Potassium

3.5 - 5.0 mEq/L

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Phosphorus

2.5 - 4.5 mEq/L

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Calcium

8.2 - 10.2 mEq/dL

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Urine Specific Gravity

1.005 - 1.030

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Glomerular Filtration Rate (eGFR)

85 - 110 is ideal

60 normal < 15 can indicate possible kidney failure

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What are clinical manifestations of hyperkalemia?

Cardiac abnormalities -Life-threatening dysrhythmias such as ventricular fibrillation, ventricular tachycardia, or asystole -The initial indication on an ECG is peaked T waves

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What does an increased urine specific gravity indicate?

Dehydration

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What is a nursing intervention for increased urine specific gravity?

Increase fluids for hydration

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What are clinical manifestations of PKD?

-Hypertension -Hematuria -Flank pain -Headaches -Pain in the abdominal area -Manifestations of UTI -Bilaterally enlarged kidneys -Increased abdominal girth -Costovertebral angle tenderness

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What are priority nursing interventions for PKD?

-Diet modification consistent with impaired renal function, specifically low potassium, phosphorus, protein, and sodium -Fluid restriction -Administer antihypertensive agents as ordered. -Administer antibiotics as ordered. -Administer pain medication as ordered.

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How do you use therapeutic communication with a client who has PKD?

-Provide psychosocial support to client and family -Teach the client and family about prescribed treatments

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What are the plan of care goals for a client with PKD?

-Prevent complications -Medication compliance (antihypertensives, antibiotics, etc) -Diet modification -Vital signs within reasonable limits -Absence of infection

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What kind of diet should a client with PKD follow?

-Diet modification consistent with impaired renal function, specifically low potassium, phosphorus, protein, and sodium -Diet modification is essential to prevent severe complications from eating foods high in protein, potassium, and phosphorus that the kidneys cannot excrete adequately -Excess sodium intake can cause fluid retention

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What teaching do you need to provide to a client with PKD?

-Immediately report clinical manifestations of infection. -Follow prescribed dietary restrictions. -Follow prescribed antihypertensive therapy. -Follow prescribed antibiotics for diagnosed UTIs.

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