EXAM 4

what drives erythropoiesis

oxygen demands

necessary components needed for erythropoiesis

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

sites where drugs impact RBC production

erythropoietin, vitamin B12, folic acid, and iron sites

what is iron deficiency anemia

negative iron balance

who is at risk of iron deficiency anemia

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

2 types of megaloblastic anemia

folic acid and B12

causes of folic acid deficiency

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

causes of B12 deficiency

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

what is sickle cell anemia

chronic hemolytic anemia that occurs in African Americans

uses for Epoetin Alfa

anemia associated with chronic renal failure and AIDS

how is Epoetin Alfa administered

SQ injection 3 times a week

action of Epoetin Alfa

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

contraindications of Epoetin Alfa

uncontrolled hypertension, allergy, lactation

adverse affects of Epoetin Alfa

CNS, GI, cardiovascular

important assessments when taking Epoetin Alfa

hx/physical exam/allergies
severe hypertension
abnormal renal function

general drug names used for iron deficiency anemia

include ferrous or iron in the name

indications for taking iron deficiency anemia drugs

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

action of iron deficiency anemia drugs

elevate serum iron concentration

contraindications with taking iron deficiency anemia drugs

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

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

main drug interactions with iron deficiency anemia drugs

antacids

food interactions with iron deficiency anemia drugs

eggs, milk, coffee, tea

which vitamin is used to increase iron absorption

vitamin C

risks with taking iron deficiency anemia drugs

GI upset

what are chelating agents used for

metal toxicities

action of chelating agents

binds to metal to help body rid/excrete the metal

2 main types chelating agents used for lead posioning

chemet and calcium disodium edetate

how is folic acid taken

orally

action of folic acid

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

indications for taking folic acid

treatment of megaloblastic anemia due to nutritional deficiency

assessments for taking folic acid

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

how is Hydroxocobalamin given

injections

action of Hydroxocobalamin

maintains myelin sheath

indications of Hydroxocobalamin

vitamin B12 deficiency

assessment for Hydroxocobalamin

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

action of Hydroxyurea (Droxia)

increase fetal hemoglobin levels produced in bone marrow

what is Hydroxyurea (Droxia) used for

managing sickle cell crisis

how to manage sickle cell crisis

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

contraindications of Hydroxyurea (Droxia)

allergy and severe anemia/leukopenia

adverse affects of Hydroxyurea (Droxia)

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

define nutrients

dietary products that undergo chemical changes when ingested and metabolized

effect of nutrition on the tissues

enhances the tissues and creates energy

define malnourishment

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

define supplements

dietary products used to provide nutritional support

define enteral nutrition

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

define parenteral nutrition

IV administration of nutrients

when is parenteral nutrition used

when the GI tract isn't working

which feeding is temporary and which one is long term

PPN is temporary, TPN is long term

insertion site for PPN

veins

concentration of dextrose in PPN feedingw

less than 10%

when are TPNs given

when patient is unable to tolerate large fluid goals

adverse affects of TPN and PPN

fluid overload
line infections
metabolic instability

assessment for NG tube

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

vein assessment for PPNs

infection and labs

define intravascular fluid

protein rich plasma and large amounts of albumin

define interstitial fluid

little to no protein

define fluid intake

liquids, solid fluids, IV fluids, parenteral fluid

define fluid loss

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

define insensible loss

cannot be measured, sweat, breathing

define overhydration

water gained exceeds amount of water lost

how does overhydration present

as edema

what is dehydration

water lost exceeds the water gained

what is isotonic dehydration

sodium and water are lost at the same time

example of isotonic dehydration

diarrhea and vomiting

what is hypertonic dehydration

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

example of hypertonic dehydration

sweating

what is hypotonic dehydration

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

examples of hypotonic dehydration

renal insufficiency and inadequate aldosterone secretion

what are crystalloids

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

contents of crystalloids

fluid and electrolytes found in the body, except protein

most common crystalloids

normal saline and lactated ringers

action of crystalloids

manage specific fluid and electrolyte disturbances, promote urine flow

indications of needing crystalloids

acute liver failures
burns
cardiopulmonary bypass surgery
hypoproteinemia
renal dialysis
shock

pros of crystalloids

cheaper, more available, safer to use

adverse affects of crystalloids

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

contraindications of crystalloids

hypernatremia and hyperchloremia

what are colloids

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

action of colloids

help pull things in and increase colloid oncotic pressure

indication of colloids

lowered protein levels

pros/cons of colloids

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

what are blood products

biologic drugs

most common blood products

plasma protein fractions
fresh frozen plasma
packed RBC
whole blood

indication of blood products

patient has lost at least 25% of blood
severe anemia

pros/cons of blood products

more expensive
less available
requires human donors

adverse affects of blood products

bad things happen when blood is not a match

contraindications

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

normal range of potassium

3.5-5

how is potassium obtained

variety of fruits, veggies, fish, meats

how is potassium excreted

through kidneys

symptoms of hypokalemia

hypotension
lethargy
confusion
muscle weakness
nausea
cardiac irregularities
neuropathies
paralytic ileus

symptoms of hyperkalemia

fatigue
weakness
paresthesia
palpitations
v-fib
cardiac arrest

normal range for sodium

134-135

how is sodium obtained

through diet

symptoms with hyponatremia

neuro issues

symptoms of hypernatremia

muscle issues

which gland is most important for diabetes

pancreas

function of hormones

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

what type of gland is the pancreas

endocrine and exocrine

4 types of islet cells

alpha cells
delta cells
pancreatic polypeptide cells
beta cells

function of beta islet cells

secrete insulin