nurs320 exam 3

normal Hct

37-47% in females and 40-52% in males

tx for myasthenia gravis

anticholinesterase meds to prevent breakdown of ACh and immunosuppressants

tx for bell's palsy

analgesics and corticosteroids

how long can blood transfusions last?

cannot exceed 4 hrs

ALL manifests in what spots?

testes and CNS

normal WBC range

5,000-10,000/mm3

what does high Hct indicate?

dehydration

what does low Hct indicate?

fluid overload/blood loss

normal Hgb

12-16 in females and 14-18 in males

what does high Hgb indicate?

hypoxia from smoking/high altitudes

what does low Hgb indicate?

blood loss/anemia

ANC formula

[WBC (%segs + %bands)] /100

normal ANC

>1500 mm3

severe neutropenia ANC level

<500 mm3

nursing priority for severe neutropenia

obtain 2 sets of serum cultures

severe neutropenia manifestation

fever (normal infection symptoms are not present due to lack of neutrophils)

6 signs of a transfusion rxn

- fever (NO PYRETICS)
- pruritis
- hives
- swelling
- SOB
- chills

how long do you have to give blood that has just been retrieved?

30 minutes (check IV lines beforehand)

which has a higher risk of infection: plts and frozen plasma?

plts b/c they need to be stored at room temp

how often do you change IV tubing for blood transfusions?

Q2 units to decrease bacterial contamination

therapeutic apheresis

similar to dialysis

splenectomy

splenomegaly causes excessive destruction of blood cells (thrombocytopenia) so removal of the spleen can stop that

nursing education for splenectomy

vaccines, bleeding risk, and thrombosis

antidote for warfarin

Vit K

a pt has high PT and low vWF. what does this indicate?

severe liver dysfxn

what else can cause high PT (other than low vWF)?

Vit K deficiency (Vit K is used to make clotting factors)

how does the liver affect clotting?

liver is the site of clotting factor synthesis

when should you take TKIs?

w/ meals for CML

leukostasis

WBCs >100,000 -> increased blood viscosity -> decreased tissue perfusion

tx for chronic myeloid leukemia/CML

TKIs

polycythemia vera/PV

overproduction of RBCs

essential thrombocythemia/ET

overproduction of plts

vinca alkaloids

drugs that block cell growth

tx for ALL

vinca alkaloids and corticosteroids

cryoprecipitate

can be given to minimize bleeding risk b/c it contains clotting factor 8

tx for APML

ATRA

ATRA

helps to mature WBCs and decreases coagulopathy

complication of ATRA

differentiation syndrome

differentiation syndrome

severe rxn to anti-cancer tx (WBCs >30,000) -> weight gain, SOB, fever, hypotension, liver/kidney dysfxn

tx for differentiation syndrome

steroids and diuretics

how do you dx acute leukemias?

bone marrow aspirate and biopsy

t/f: thrombocytopenic pts can still get shots like normal

false; avoid IM/SQ due to bleeding risk

is acute leukemia characterized by immature or mature WBCs?

immature

what triggers 2ndary polycythemia

hypoxic stimuli

how does hypoxia affect RBCs?

lack of O2 reaching the tissue -> more erythropoietin produced

rituximab

immunosuppressant

AIHA pathologies

- warm (37ºC)
- cold
- certain meds

tx for warm AIHA

corticosteroids to decrease macrophagic activity

tx for cold AIHA

no tx; just stay away from cold temps and always have thermal protection

thalessemia

microcytic and hypochromic (pale) RBCs

where is alpha thalessemia more common?

asia and the middle east

s/s for alpha thalessemia

asymptomatic but cells will still be microcytic

where is beta thalessemia more common?

mediterranean

tx for thalassemia

PRBCs

complications of PRBCs

- anti-RBC antibodies
- infection
- Fe overload

tx for Fe overload

- IV/SQ deferoxamine
- oral deferasirox/deferiprone

nursing education for deferasirox/deferiprone

they can cause diarrhea, abd pain, and n/v, but adherence is necessary

what should you monitor HD pts for?

Fe and folate deficiency

cobalmin

Vit B12

Vit B12 prevention

Cobalamin and fortified soy milk

foods high in folate

- leafy greens
- legumes
- liver

what group is at higher risk for developing Vit B12 deficiency?

vegans/vegetarians

manifestations of megaloblastic anemia

- jaundice
- glossitis
- vitiligo
- neurologic deficits (specific to Vit B12 deficiency, not folate)

nursing education for megaloblastic anemia

- pts w/ glossitis should be eating small, freq meals that are bland, but also high in folic acid and Vit B12
- oral care

what should the nurse monitor for a pt receiving Fe dextran?

signs of hypersensitivity (wheezing/urticaria)

hallmark sign of Fe deficiency anemia

pica

Vit C affect on Fe

Vit C increases absorption of Fe

ferritin

ability to store Fe

transferrin saturation

Fe transportation ability

hyperproliferative anemias include:

- Fe deficiency anemia
- megaloblastic anemia
- kidney disease

hyperproliferative anemia

not enough RBCs being produced

hemolytic anemias include:

- thalessemia
- AIHA
- polycythemia

primary cause of pancreatitis

alcohol

6 s/s of pancreatitis

- necrosis
- ascites
- jaundice
- the 3 Ps
- abd distention
- radiating epigastric pain

pancreatitis results in increased...

amylase and lipase

pancreatitis can be a problem for what specific group?

diabetics (can cause hyperglycemia due to impaired insulin production)

cholecystitis

inflammation of gallbladder wall due to cholelithiasis

cholelithiasis

gallstones

4 s/s of cholecystitis

- + Murphy's sign
- absent bowel sounds
- guarding
- rebound tenderness

+ Murphy's sign

pain upon palpation of RUQ

tx for cholecystitis

- NSAIDs
- antiemetics
- analgesics

diet for cholelithiasis

high fiber, low carb/fat

tests for cholelithiasis

ultrasound of the gallbladder and LFTs

how often do you monitor vitals for cholelithiasis?

≥Q4H

tx for cholelithiasis

- ERCP
- lithotripsy
- cholecystectomy
- T-tube

T-tube

tube placed in common bile duct to help w/ drainage

cirrhosis

permanent scarring of the liver due to chronic inflammation

what should the nurse monitor for a pt w/ cirrhosis?

- PT and INR (bleeding risk due to portal HTN)
- daily weights/abd girth measurements for excess fluid

lactulose

helps get rid of ammonia build up in cirrhosis pts

which types of hep do not have a vaccine?

C and E

which types of hep are oral-fecal?

A and E

req for hep d

hep b

tx for bowel obstruction

- gastric rest
- analgesic
- antiemetic
- stool softeners/enemas/fluids

t/f: nurses can administer a laxative to help relieve constipation from a bowel obstruction

false; it is best to give a stool softener/fluids/enema instead b/c laxatives can make the obstruction worse

assessment of a bowel obstruction

- hyperactive sounds above the obstruction and absence below
- vomiting -> dehydration

4 nursing responsibilities regarding ostomy care

- empty bag when 1/3-1/2 full
- keep skin dry so skin barrier can adhere
- skin barrier should be cut slightly larger than stoma
- wash peristomal skin w/ water and mild soap

tx of PUD

- avoid foods that increase acid secretion (milk and fermented foods)
- avoid caffeine/alc/smoking
- antacids
- PPI
- H2 receptor antagonists
- gastrectomy

5 health care needs for chronic diarrhea

- avoid gas-producing/spicy foods
- bowel rest
- low fiber, high protein/cal diet
- daily weights
- monitor skin

diverticulitis

inflammation of pouches in the intestinal wall caused by trapped contents -> alternating constipation/diarrhea, abd pain in LLQ, rectal bleeding, jelly like stool, flatulence, etc.

diet for diverticulitis

high fiber