EXAM 4

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what drives erythropoiesis

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Medicine

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1

what drives erythropoiesis

oxygen demands

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2

necessary components needed for erythropoiesis

adequate amounts of iron minute amounts of B12 and folic acid all essential amino acids and carbs

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3

sites where drugs impact RBC production

erythropoietin, vitamin B12, folic acid, and iron sites

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4

what is iron deficiency anemia

negative iron balance

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5

who is at risk of iron deficiency anemia

menstruating women pregnant/ nursing women rapidly growing adolescents people with GI bleeding

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6

2 types of megaloblastic anemia

folic acid and B12

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7

causes of folic acid deficiency

increased demand, absorption problems, drugs, malnutrition caused by alcoholism

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8

causes of B12 deficiency

poor diet, increased demand, lack of intrinsic factor in the stomach

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9

what is sickle cell anemia

chronic hemolytic anemia that occurs in African Americans

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10

uses for Epoetin Alfa

anemia associated with chronic renal failure and AIDS

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11

how is Epoetin Alfa administered

SQ injection 3 times a week

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12

action of Epoetin Alfa

acts like natural erythropoietin to stimulate production of RBC in the bone marrow

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13

contraindications of Epoetin Alfa

uncontrolled hypertension, allergy, lactation

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14

adverse affects of Epoetin Alfa

CNS, GI, cardiovascular

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15

important assessments when taking Epoetin Alfa

hx/physical exam/allergies severe hypertension abnormal renal function

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16

general drug names used for iron deficiency anemia

include ferrous or iron in the name

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17

indications for taking iron deficiency anemia drugs

treatment of iron deficiency anemia adjunctive therapy in patients receiving epoetin alpha

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18

action of iron deficiency anemia drugs

elevate serum iron concentration

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19

contraindications with taking iron deficiency anemia drugs

allergy hemolytic anemia normal iron levels peptic ulcers/colitis/regional enteritis

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20

adverse affects of iron deficiency anemia drugs

GI irritation + CNS toxicity with oral meds, stains teeth severe allergic reactions irritation tissue staining phlebitis long term use

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21

main drug interactions with iron deficiency anemia drugs

antacids

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22

food interactions with iron deficiency anemia drugs

eggs, milk, coffee, tea

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23

which vitamin is used to increase iron absorption

vitamin C

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24

risks with taking iron deficiency anemia drugs

GI upset

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25

what are chelating agents used for

metal toxicities

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26

action of chelating agents

binds to metal to help body rid/excrete the metal

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27

2 main types chelating agents used for lead posioning

chemet and calcium disodium edetate

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28

how is folic acid taken

orally

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29

action of folic acid

essential for cell growth and division for production of a strong stoma in RBCs

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30

indications for taking folic acid

treatment of megaloblastic anemia due to nutritional deficiency

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31

assessments for taking folic acid

hx/physical exam/allergy pregnancy/lactation/nasal erosion labs/vitals/orientations

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32

how is Hydroxocobalamin given

injections

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33

action of Hydroxocobalamin

maintains myelin sheath

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34

indications of Hydroxocobalamin

vitamin B12 deficiency

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35

assessment for Hydroxocobalamin

hx/physical exam/allergy pregnancy/lactation/nasal erosion labs/vitals/orientations

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36

action of Hydroxyurea (Droxia)

increase fetal hemoglobin levels produced in bone marrow

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37

what is Hydroxyurea (Droxia) used for

managing sickle cell crisis

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38

how to manage sickle cell crisis

Treat pain control temp prevent + early treat infections pump with IV fluids

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39

contraindications of Hydroxyurea (Droxia)

allergy and severe anemia/leukopenia

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40

adverse affects of Hydroxyurea (Droxia)

 Cytoxic death of cells  GI headache  Dizziness  Disorientation  Fever  Chills/ malaise  Increased risk of cancer

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41

define nutrients

dietary products that undergo chemical changes when ingested and metabolized

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42

effect of nutrition on the tissues

enhances the tissues and creates energy

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43

define malnourishment

body’s essential need for nutrients is not met by nutrient intake

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44

define supplements

dietary products used to provide nutritional support

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45

define enteral nutrition

food and nutrients are delivered via the GI tract through a tube feed

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46

define parenteral nutrition

IV administration of nutrients

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47

when is parenteral nutrition used

when the GI tract isn't working

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48

which feeding is temporary and which one is long term

PPN is temporary, TPN is long term

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49

insertion site for PPN

veins

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50

concentration of dextrose in PPN feedingw

less than 10%

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51

when are TPNs given

when patient is unable to tolerate large fluid goals

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52

adverse affects of TPN and PPN

fluid overload line infections metabolic instability

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53

assessment for NG tube

check for allergies vital signs placement of NG tube weight check order patient tolerance

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54

vein assessment for PPNs

infection and labs

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55

define intravascular fluid

protein rich plasma and large amounts of albumin

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56

define interstitial fluid

little to no protein

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57

define fluid intake

liquids, solid fluids, IV fluids, parenteral fluid

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58

define fluid loss

kidney, emesis, feces, fistulas, drains, GI suction

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59

define insensible loss

cannot be measured, sweat, breathing

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60

define overhydration

water gained exceeds amount of water lost

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61

how does overhydration present

as edema

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62

what is dehydration

water lost exceeds the water gained

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63

what is isotonic dehydration

sodium and water are lost at the same time

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64

example of isotonic dehydration

diarrhea and vomiting

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65

what is hypertonic dehydration

water loss is greater than sodium loss so solutes move outside the cell

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66

example of hypertonic dehydration

sweating

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67

what is hypotonic dehydration

sodium loss is greater than water loss so fluid moves into the cells

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68

examples of hypotonic dehydration

renal insufficiency and inadequate aldosterone secretion

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69

what are crystalloids

Fluids given via IV injection to supply water and sodium to maintain the osmotic gradient between extravascular and intravascular compartments

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70

contents of crystalloids

fluid and electrolytes found in the body, except protein

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71

most common crystalloids

normal saline and lactated ringers

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72

action of crystalloids

manage specific fluid and electrolyte disturbances, promote urine flow

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73

indications of needing crystalloids

acute liver failures burns cardiopulmonary bypass surgery hypoproteinemia renal dialysis shock

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74

pros of crystalloids

cheaper, more available, safer to use

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75

adverse affects of crystalloids

does not stay in blood stream dilution of proteins short lived effects

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76

contraindications of crystalloids

hypernatremia and hyperchloremia

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77

what are colloids

Move fluid from interstitial compartment to plasma compartment by pulling fluid into blood vessels

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78

action of colloids

help pull things in and increase colloid oncotic pressure

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79

indication of colloids

lowered protein levels

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80

pros/cons of colloids

more expensive more likely to promote bleeding less likely to cause edema

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81

what are blood products

biologic drugs

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82

most common blood products

plasma protein fractions fresh frozen plasma packed RBC whole blood

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83

indication of blood products

patient has lost at least 25% of blood severe anemia

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84

pros/cons of blood products

more expensive less available requires human donors

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85

adverse affects of blood products

bad things happen when blood is not a match

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86

contraindications

any solution that is not 0.9% and incompatability with blood types

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87

normal range of potassium

3.5-5

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88

how is potassium obtained

variety of fruits, veggies, fish, meats

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89

how is potassium excreted

through kidneys

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90

symptoms of hypokalemia

hypotension lethargy confusion muscle weakness nausea cardiac irregularities neuropathies paralytic ileus

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91

symptoms of hyperkalemia

fatigue weakness paresthesia palpitations v-fib cardiac arrest

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92

normal range for sodium

134-135

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93

how is sodium obtained

through diet

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94

symptoms with hyponatremia

neuro issues

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95

symptoms of hypernatremia

muscle issues

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96

which gland is most important for diabetes

pancreas

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97

function of hormones

act to increase or decrease the normal metabolic processes of cells when they react with receptor sites

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98

what type of gland is the pancreas

endocrine and exocrine

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99

4 types of islet cells

alpha cells delta cells pancreatic polypeptide cells beta cells

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100

function of beta islet cells

secrete insulin

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