Galen Nur 242 chapter 40 With 100% correct answers 2025-2026 already graded A+

Perfusion

adequate arterial blood flow through the tissues and blood that is pumped by the heart to oxygenate body tissues.

hemoglobin A

Normal adult hemoglobin. The molecule has two alpha chains and two beta chains of amino acids.

hemoglobin S

sickle cell hemoglobin. At least 40% (and often more) of the total hemoglobin is composed of an abnormal beta chain.

hypoxia

deficiency in the amount of oxygen reaching the tissues.

hemolytic

destroying worn-out red blood cells and releasing their hemoglobin for reuse

crises

Periodic episodes of extensive cellular sickling in a patient with Sickle cell disease (SCD)

hypoxemia

deficient amount of oxygen in the blood

teratogenic

known to have potential to cause developmental defects in the embryo or fetus

microcytic

a small red blood cell. Chronic iron deficiency.

macrocytic anemia

A form of anemia characterized by large, immature red blood cells

pernicious anemia

lack of mature erythrocytes caused by inability to absorb vitamin B12 into the bloodstream

intrinsic factor

A substance produced by the mucosa of the stomach and intestines that is essential for the absorption of vitamin B12.

glossitis

inflammation of the tongue. Big beefy red tongue.

paresthesias

Abnormal sensations such as burning, numbness, or tingling

leukopenia

Abnormally low white blood cell count

Thrombocytopenia

low platelet count

pancytopenia

abnormal reduction of all blood cells

warm antibody anemia

autoimmune hemolytic anemia that occurs in warm body temps. May be triggered by drugs, chemicals, or other autoimmune problems.

cold antibody anemia

autoimmune hemolytic anemia that occurs at cold temps.

most common symptom of SCD crisis?

Pain

sickle cell disease

Genetic disorder in which red blood cells have abnormal hemoglobin molecules and take on an abnormal shape. Results in chronic anemia, pain, disability, organ damage, increased risk for infection, and early death as a result of poor perfusion.

conditions that cause sickling

hypoxia, dehydration, infection, venous stasis, pregnancy, alcohol consumption, high altitudes, low or high environmental or body temperatures, acidosis, strenuous exercise, emotional stress, and anesthesia.

repeated vaso-occlusive event (VOE) results in

long term damage to tissues and organs. Most often affected are the spleen, liver, heart, kidney, brain, joints, bones, and retina.

Sickle cell disease

genetic disorder with an autosomal recessive pattern of inheritance.

Occur in people of all races and ethnicities but is most common among African Americans in the U.S.

Sickle cell trait and Sickle cell disease

how to assess for skin changes in a patient with decreased perfusion and anemia.

examine the lips, tongue, nail beds, conjunctivae, palms, and soles of the feet every 8 hours for subtle color changes.

another skin sign of SCD is jaundice. How do you inspect for Jaundice in patients with darker skin?

inspect the roof of the mouth for a yellow appearance. Examine the sclera closest to the cornea to assess jaundice more accurately. Jaundice often causes intense itching.

The hematocrit of patients with SCD

Low between 20% and 30% because of RBC shortened life span and destruction.

WBC in a patient with SCD

Usually high

Imaging assessment in SCD

bone changes occur as a result of chronically stimulated marrow and low bone oxygen levels.

Other diagnostic assessment in patient with SCD

ECG changes document cardiac infarcts and tissue damage. Echocardiograms may show cardiomyopathy and decreased cardiac output (low ejection fraction)

result of poor perfusion and gas exchange from obstructed blood flow in a SCD patient

pain

Hydroxyurea (droxia)

Medication may reduce number of sickling and pain episodes by stimulating fetal hemoglobin production. Drug increases the risk for lukemia. It also suppresses bone marrow function including immunity and regular follow-up to monitor complete blood counts for drug toxicity.

the patient with SCD is at greater risk for

bacterial infection bc of decreased spleen function resulting from anoxic damage

major cause of death in adults with SCD

Acute chest syndrome, in which a vaso-occlusive event (VOE) causes infiltration and damage to the pulmonary system.

Interventions for SCD patient in crisis

assess for adequate perfusion

Hydration

Oxygen (possible ABG/CXR if o2 low)

Transfusion with RBCs

iron deficiency anemia

most common anemia worldwide. It can be a result from blood loss, poor GI absorption of iron, and inadequate diet.

Evaluation for any adult with iron deficiency anemia

abnormal bleeding especially from the GI tract.

symptoms of iron deficiency anemia

pallor, irritability, anorexia, and decrease in activity, fissures at the corner of the mouth; sometimes a slight heart murmur is heard

Vitamin B-12 deficiency anemia results in

failure to activate enzymes that move folic acid into precursor RBCs cells so cell division and growth into functional RBCs can occur.

Causes of vitamin B-12 deficiency

vegan diets or diets lacking dairy products, small bowel resection, chronic diarrhea, diverticula, tapeworm, or overgrowth of intestinal bacteria.

Indications of B-12 deficiency anemia are

pallor, jaundice, Glossitis, fatigue, and weight loss

Symptoms of folic acid deficiency

same as B12 deficiency

-no neurological alterations

common causes of folic acid deficiency

poor nutrition, malabsorption, and drugs.

Second most common cause of folic acid deficiency

Malabsorption syndromes such as Crohn's Disease

Management of Iron deficiency anemia

increase intake of iron from food sources. if iron losses are mild, oral iron supplements are started until the hemoglobin level returns to normal.

Management of B-12 deficiency anemia

teach patient to increase the intake of foods rich in B-12. Vitamin supplements may be prescribed when anemia is severe. Patients who have pernicious anemia are given B-12 injections.

Management of folic acid deficiency anemia

a diet rich in foods containing folic acid and vitamin B-12. May also be managed with folic acid replacement therapy.