NRSG2350: MODULE 4 ANEMIA + ONCOLOGY

anemia, MCV interpretation, sickle cell disease, iron/B12/folate deficiencies, aplastic anemia, epoetin alfa, hematologic cancers, and neutropenia.

What is the primary purpose of a red blood cell?

To carry oxygen to tissues through hemoglobin.

Where is oxygen carried within an RBC?

On hemoglobin.

Which mineral is required for hemoglobin synthesis?

Iron.

What happens to oxygen carrying capacity when iron is deficient?

Hemoglobin production decreases, so oxygen carrying capacity falls.

Why are amino acids important to RBC function?

They are needed to synthesize the globin protein portion of hemoglobin.

Where are RBCs produced?

In the bone marrow.

What is the normal lifespan of an RBC?

Approximately 120 days.

Which organ primarily breaks down old RBCs?

The spleen.

Which RBC components are recycled after RBC breakdown?

Iron and amino acids.

What happens to heme after RBC breakdown?

It is converted to bilirubin, which is excreted in bile.

Which organs detect hypoxemia and stimulate RBC production?

The kidneys.

What hormone do the kidneys release to stimulate RBC production?

Erythropoietin.

What does erythropoietin do?

It stimulates the bone marrow to produce more RBCs.

Which two vitamins are essential for normal RBC development and cell division?

Folate or vitamin B9 and vitamin B12.

What is anemia?

A low number of circulating RBCs and/or a low hemoglobin level that impairs oxygen transport.

What does H and H mean?

Hemoglobin and hematocrit.

What does low H and H suggest?

Anemia or blood loss, interpreted with the patient's clinical condition.

Which CBC values did the professor emphasize when identifying anemia?

Hemoglobin and RBC count, with hematocrit also supporting the assessment.

What does MCV stand for?

Mean corpuscular volume.

What does MCV measure?

The average size of RBCs.

What MCV indicates microcytic RBCs?

Less than 80 fL.

What MCV is normocytic?

Approximately 80 to 100 fL.

What MCV indicates macrocytic RBCs?

Greater than 100 fL.

Which anemia is classically microcytic?

Iron deficiency anemia.

Which deficiencies classically cause macrocytic or megaloblastic anemia?

Vitamin B12 deficiency and folate deficiency.

Which types of anemia are commonly normocytic?

Acute blood loss anemia and many chronic disease anemias.

Why does anemia cause fatigue?

Reduced hemoglobin decreases oxygen delivery to tissues.

Why does anemia cause tachycardia?

The heart speeds up to compensate for reduced oxygen carrying capacity.

Why can anemia cause dyspnea?

Tissues receive less oxygen, increasing respiratory demand.

What does dyspnea mean?

Difficulty breathing or shortness of breath.

What does angina mean?

Chest pain caused by inadequate oxygen supply to the myocardium.

Why can severe anemia cause angina?

Reduced oxygen carrying capacity may not meet myocardial oxygen demand.

What skin finding is associated with anemia?

Pallor.

Where can pallor be assessed across different skin tones?

Conjunctivae, oral mucosa, palmar creases, and nail beds.

What early mental-status findings may occur in an older adult with anemia?

Irritability and restlessness.

What compensatory cardiovascular findings may occur with anemia?

Tachycardia, peripheral vasoconstriction, and sometimes increased blood pressure.

What acid-base problem may occur if tissue hypoxia becomes significant?

Metabolic acidosis.

What are the four broad mechanisms of anemia?

Blood loss, hemolysis, defective RBC production, and inadequate RBC production.

Why does the rate of blood loss matter?

Rapid loss can cause hypovolemic shock, while slow loss allows time for compensation.

What type of anemia commonly follows acute whole blood loss?

Normocytic anemia.

[Priority] What is the initial nursing focus in acute major blood loss?

Airway, breathing, circulation, vital signs, mental status, bleeding control, and perfusion.

What is hemolytic anemia?

Anemia caused by premature destruction of RBCs.

What happens to RBC lifespan in hemolytic anemia?

It is shortened.

Why may splenomegaly occur in hemolytic anemia?

The spleen works harder to remove prematurely destroyed RBCs.

How does bone marrow respond to hemolysis?

It increases erythropoiesis and releases more immature RBCs.

Is every hemolytic anemia autoimmune?

No. Autoimmune disease is one cause, but hemolysis can have other causes.

What is sickle cell disease?

An inherited recessive disorder involving abnormal hemoglobin S.

When do RBCs containing hemoglobin S tend to sickle?

When they become deoxygenated.

What causes pain during a vaso-occlusive sickle cell crisis?

Sickled cells obstruct blood flow, causing tissue ischemia.

What are common triggers for sickling?

Infection, illness, stress, physical exertion, dehydration, and low oxygen states such as high altitude.

What is the difference between sickle cell trait and sickle cell disease?

Trait is carrier status with much less hemoglobin S effect; disease produces clinically significant sickling and complications.

What are major complications of sickle cell disease?

Anemia and vaso-occlusion with ischemic pain and organ injury.

[Application] A patient with sickle cell disease develops severe limb pain after dehydration. What process is most likely?

A vaso-occlusive crisis causing ischemia.

[Application] Why is hydration used during a sickle cell crisis?

It reduces blood viscosity and supports circulation.

[Application] When is oxygen appropriate during a sickle cell crisis?

When the patient is hypoxemic or oxygen is otherwise prescribed; oxygen treats hypoxemia.

[Priority] Which sickle cell findings require urgent escalation?

Chest pain, dyspnea, hypoxemia, new neurologic changes, severe infection signs, or impaired perfusion.

What is the brand name listed for hydroxyurea?

Droxia.

Why is hydroxyurea used in sickle cell disease?

To reduce the frequency of painful sickling episodes and serious complications.

What is hydroxyurea's mechanism in sickle cell disease?

It increases fetal hemoglobin, reducing the relative effect and polymerization of hemoglobin S.

What is the therapeutic effect of hydroxyurea?

Fewer vaso-occlusive crises and reduced pain.

What is the major adverse effect of hydroxyurea?

Bone marrow suppression.

Which blood cells may decrease with hydroxyurea?

WBCs, platelets, and RBCs.

What laboratory test is essential during hydroxyurea therapy?

A CBC with blood-cell counts.

When is hydroxyurea contraindicated or used cautiously according to the slides?

With severe anemia or leukopenia.

[Application] A patient taking hydroxyurea has a sharply decreased WBC count. What is the concern?

Bone marrow suppression and increased infection risk.

What is the core defect in iron deficiency anemia?

Insufficient iron reduces heme and hemoglobin production.

What happens to ferritin in iron deficiency?

Ferritin is low because iron stores are depleted.

What are common causes of iron deficiency anemia?

Low intake, increased demand such as pregnancy, and chronic blood loss.

What are classic manifestations of iron deficiency anemia?

Fatigue, pallor, palpitations, dyspnea, angina, and tachycardia.

What are iron-rich animal foods?

Red meat, poultry, seafood, and liver.

What are iron-rich plant foods?

Lentils, spinach, and dried fruits.

Which food did the professor highlight as high in iron?

Chicken liver.

What is the common oral iron medication?

Ferrous sulfate.

What IV iron formulation was listed in the slides?

Sodium ferric gluconate.

What should be taken with oral iron to improve absorption?

Vitamin C or a vitamin C containing drink.

Which foods reduce oral iron absorption?

Calcium-containing foods and milk products.

Which medication classes may reduce iron absorption by lowering stomach acid?

Proton pump inhibitors and H2 blockers.

Which medications may require separation from oral iron?

Levothyroxine and certain antibiotics, plus calcium or antacid products.

What are common adverse effects of oral iron?

Constipation, GI upset, and dark stools.

What stool change is expected with oral iron?

Darkening of the stools.

[Priority] When are dark stools concerning in a patient taking iron?

When they are tarry or accompanied by weakness, dizziness, hypotension, or other bleeding signs.

How can liquid iron staining of teeth be reduced?

Administer toward the back of the mouth or through a straw when appropriate and provide oral care.

How is response to iron therapy evaluated?

CBC, hemoglobin and hematocrit, ferritin, and improvement in symptoms.

[Application] A patient takes ferrous sulfate with milk every morning. What teaching is needed?

Separate iron from milk or calcium because calcium reduces absorption.

[Application] A patient taking oral iron reports constipation and dark stools. What is the best interpretation?

These are common expected effects, but the patient should follow the bowel plan and report signs of bleeding.

What is megaloblastic anemia?

An anemia with enlarged but impaired RBCs, usually from vitamin B12 or folate deficiency.

Which MCV supports megaloblastic anemia?

Greater than 100 fL.

What vitamin is folic acid?

Vitamin B9.

What are common dietary sources of vitamin B12?

Fish, meat, eggs, dairy products, and fortified cereals.

Why are strict vegans at increased risk for B12 deficiency?

Natural B12 sources are primarily foods of animal origin.

What are common dietary sources of folate?

Leafy greens, citrus fruits, beans, fortified cereals, and liver.

What condition is associated with folate deficiency in the slides?

Alcohol use disorder.

Which deficiency can cause paresthesia and neurologic changes?

Vitamin B12 deficiency.

What does paresthesia mean?

Numbness, tingling, or pins-and-needles sensation.

Are neurologic findings classic for isolated folate deficiency?

No. They point more strongly toward vitamin B12 deficiency.

What is pernicious anemia?

Vitamin B12 deficiency caused by failure to produce the factor needed for B12 absorption, classically intrinsic factor.

What medication replaces vitamin B12?

Cyanocobalamin.

Why might high-dose oral B12 be needed?

B12 absorption may be poor.

What parenteral B12 schedule may be required?

IM administration, sometimes monthly, as prescribed.

What medication treats folate deficiency anemia?

Folic acid.