Podcast
Questions and Answers
A client with mild-moderate iron deficiency anemia is prescribed ferrous sulfate. What instruction should the nurse emphasize regarding medication administration?
A client with mild-moderate iron deficiency anemia is prescribed ferrous sulfate. What instruction should the nurse emphasize regarding medication administration?
- Take the medication with calcium-rich foods to enhance absorption.
- Administer medication with milk to prevent stomach upset.
- Take with antacids to reduce gastrointestinal side effects.
- Administer the medication on an empty stomach. (correct)
A patient receiving IV iron sucrose (Venofer) develops hypotension during the infusion. Which action should the nurse implement first?
A patient receiving IV iron sucrose (Venofer) develops hypotension during the infusion. Which action should the nurse implement first?
- Slow down or temporarily stop the infusion. (correct)
- Administer epinephrine per standing orders.
- Elevate the head of the bed and apply oxygen.
- Administer a bolus of normal saline.
What is a crucial consideration when administering B12 injections to a patient with pernicious anemia?
What is a crucial consideration when administering B12 injections to a patient with pernicious anemia?
- Discontinue once the patient reports improved energy levels.
- Monitor potassium levels due to risk of hyperkalemia.
- Educate the patient that this therapy is lifelong. (correct)
- Administer the injection only when hemoglobin levels drop below 8 g/dL.
A nurse is educating a pregnant patient with a history of alcohol use disorder. What is the most important instruction regarding folic acid?
A nurse is educating a pregnant patient with a history of alcohol use disorder. What is the most important instruction regarding folic acid?
A patient with chronic kidney disease (CKD) is prescribed epoetin alfa. Which laboratory value is most important for the nurse to monitor to ensure the medication's effectiveness?
A patient with chronic kidney disease (CKD) is prescribed epoetin alfa. Which laboratory value is most important for the nurse to monitor to ensure the medication's effectiveness?
Which assessment finding would warrant withholding the administration of epoetin alfa in a patient with chemotherapy-induced anemia?
Which assessment finding would warrant withholding the administration of epoetin alfa in a patient with chemotherapy-induced anemia?
Which action should the nurse prioritize when caring for a patient receiving hydroxyurea for polycythemia vera?
Which action should the nurse prioritize when caring for a patient receiving hydroxyurea for polycythemia vera?
A patient with polycythemia vera who is resistant to hydroxyurea is prescribed ruxolitinib. What education should the nurse provide regarding monitoring for adverse effects?
A patient with polycythemia vera who is resistant to hydroxyurea is prescribed ruxolitinib. What education should the nurse provide regarding monitoring for adverse effects?
Following the administration of Factor VIII to a patient with hemophilia A, the nurse notes urticaria and difficulty breathing. What action should the nurse take first?
Following the administration of Factor VIII to a patient with hemophilia A, the nurse notes urticaria and difficulty breathing. What action should the nurse take first?
A patient with mild hemophilia A is prescribed desmopressin (DDAVP) for bleeding prophylaxis during a dental procedure. What is an important nursing consideration?
A patient with mild hemophilia A is prescribed desmopressin (DDAVP) for bleeding prophylaxis during a dental procedure. What is an important nursing consideration?
A patient with a history of menorrhagia is prescribed tranexamic acid (TXA). Which instruction should the nurse include in patient education?
A patient with a history of menorrhagia is prescribed tranexamic acid (TXA). Which instruction should the nurse include in patient education?
A nurse is providing discharge instructions to a patient with iron deficiency anemia. What dietary recommendation should the nurse include?
A nurse is providing discharge instructions to a patient with iron deficiency anemia. What dietary recommendation should the nurse include?
Which intervention is most important for the nurse to include in the plan of care for a patient experiencing a sickle cell crisis?
Which intervention is most important for the nurse to include in the plan of care for a patient experiencing a sickle cell crisis?
A patient with chronic kidney disease (CKD) and anemia is receiving epoetin alfa. The nurse should monitor for which adverse effect?
A patient with chronic kidney disease (CKD) and anemia is receiving epoetin alfa. The nurse should monitor for which adverse effect?
A nurse is educating a high-risk patient with polycythemia vera about myelosuppressive therapy. What key points should the nurse include?
A nurse is educating a high-risk patient with polycythemia vera about myelosuppressive therapy. What key points should the nurse include?
What is the priority nursing intervention for a patient with Hemophilia A experiencing a joint bleed (hemarthrosis)?
What is the priority nursing intervention for a patient with Hemophilia A experiencing a joint bleed (hemarthrosis)?
Which medication is used as first-line therapy in patients with type 2 diabetes, assuming no contraindications?
Which medication is used as first-line therapy in patients with type 2 diabetes, assuming no contraindications?
What is a critical action the nurse should take when administering insulin?
What is a critical action the nurse should take when administering insulin?
A patient with diabetes is prescribed sitagliptin (a DPP-4 inhibitor). The nurse should educate the patient to monitor for which potential adverse effect?
A patient with diabetes is prescribed sitagliptin (a DPP-4 inhibitor). The nurse should educate the patient to monitor for which potential adverse effect?
Which instruction is most important for the nurse to provide to a patient taking empagliflozin (an SGLT2 inhibitor)?
Which instruction is most important for the nurse to provide to a patient taking empagliflozin (an SGLT2 inhibitor)?
A patient newly diagnosed with diabetes insipidus (DI) is prescribed desmopressin (DDAVP). What teaching point should the nurse emphasize regarding the medication's action?
A patient newly diagnosed with diabetes insipidus (DI) is prescribed desmopressin (DDAVP). What teaching point should the nurse emphasize regarding the medication's action?
A patient with diabetes insipidus is prescribed hydrochlorothiazide. What should the nurse monitor regularly related to this medication?
A patient with diabetes insipidus is prescribed hydrochlorothiazide. What should the nurse monitor regularly related to this medication?
A patient with SIADH is being treated with fluid restriction and IV hypertonic saline (3% NaCl). What assessment finding requires immediate nursing intervention?
A patient with SIADH is being treated with fluid restriction and IV hypertonic saline (3% NaCl). What assessment finding requires immediate nursing intervention?
A patient with severe SIADH is prescribed tolvaptan. What is a crucial nursing consideration when administering this medication?
A patient with severe SIADH is prescribed tolvaptan. What is a crucial nursing consideration when administering this medication?
A patient with hypothyroidism is started on levothyroxine. The nurse knows to teach the patient to promptly report which of the following side effects, as they indicate over-replacement?
A patient with hypothyroidism is started on levothyroxine. The nurse knows to teach the patient to promptly report which of the following side effects, as they indicate over-replacement?
A patient with hypothyroidism is prescribed levothyroxine. What medication teaching is important for a nurse to provide?
A patient with hypothyroidism is prescribed levothyroxine. What medication teaching is important for a nurse to provide?
A nurse is monitoring a patient receiving treatment for hyperthyroidism. Which vital sign change would indicate that the treatment is effective?
A nurse is monitoring a patient receiving treatment for hyperthyroidism. Which vital sign change would indicate that the treatment is effective?
What dietary instruction is most important for a patient prescribed propylthiouracil (PTU)?
What dietary instruction is most important for a patient prescribed propylthiouracil (PTU)?
A patient with Cushing's syndrome is prescribed to taper off corticosteroids . The nurse should teach the patient to monitor for which sign/symptom?
A patient with Cushing's syndrome is prescribed to taper off corticosteroids . The nurse should teach the patient to monitor for which sign/symptom?
A patient with a history of long-term corticosteroid use is diagnosed with adrenal insufficiency. The nurse should educate the patient regarding what emergency action?
A patient with a history of long-term corticosteroid use is diagnosed with adrenal insufficiency. The nurse should educate the patient regarding what emergency action?
A patient with adrenal insufficiency is hypotensive and hyponatremic. What medication does the nurse anticipate administering?
A patient with adrenal insufficiency is hypotensive and hyponatremic. What medication does the nurse anticipate administering?
A patient is being discharged from the hospital after treatment for adrenal crisis. Which education point is most essential for the nurse to emphasize?
A patient is being discharged from the hospital after treatment for adrenal crisis. Which education point is most essential for the nurse to emphasize?
Which symptom would differentiate primary adrenal insuficiency with secondary adrenal insuficiency?
Which symptom would differentiate primary adrenal insuficiency with secondary adrenal insuficiency?
When a patient's lab test results show Na+ <115 mmol/L for fluid overload, which condition could they potentially have?
When a patient's lab test results show Na+ <115 mmol/L for fluid overload, which condition could they potentially have?
For a patient presenting symptoms with neurologic symptoms, what status need to be check?
For a patient presenting symptoms with neurologic symptoms, what status need to be check?
What signs and symptoms are involved with Neurologic Status?
What signs and symptoms are involved with Neurologic Status?
A patient with iron deficiency anemia is prescribed ferrous gluconate. Which counseling point is important regarding the timing of administration with other medications?
A patient with iron deficiency anemia is prescribed ferrous gluconate. Which counseling point is important regarding the timing of administration with other medications?
A patient is prescribed IV iron sucrose (Venofer). Prior to initiating the infusion, which of the following assessment findings would be a contraindication to administering the medication?
A patient is prescribed IV iron sucrose (Venofer). Prior to initiating the infusion, which of the following assessment findings would be a contraindication to administering the medication?
What should the nurse teach a patient receiving cyanocobalamin for pernicious anemia about the duration of therapy?
What should the nurse teach a patient receiving cyanocobalamin for pernicious anemia about the duration of therapy?
A pregnant patient with a history of alcohol use disorder is prescribed folic acid. Which statement indicates that the patient understands the importance of taking this medication during pregnancy?
A pregnant patient with a history of alcohol use disorder is prescribed folic acid. Which statement indicates that the patient understands the importance of taking this medication during pregnancy?
A patient with chronic kidney disease (CKD) is prescribed epoetin alfa. The nurse is reviewing the patient's most recent lab results. Which result would prompt the nurse to collaborate with the provider?
A patient with chronic kidney disease (CKD) is prescribed epoetin alfa. The nurse is reviewing the patient's most recent lab results. Which result would prompt the nurse to collaborate with the provider?
A patient receiving epoetin alfa for chemotherapy-induced anemia has been prescribed an iron supplement. What is the rationale for this combination?
A patient receiving epoetin alfa for chemotherapy-induced anemia has been prescribed an iron supplement. What is the rationale for this combination?
When administering hydroxyurea to a patient with polycythemia vera, the nurse correlates which laboratory result with the drug's therapeutic effect?
When administering hydroxyurea to a patient with polycythemia vera, the nurse correlates which laboratory result with the drug's therapeutic effect?
A patient with polycythemia vera who is resistant to hydroxyurea is started on ruxolitinib. What laboratory parameter would warrant immediate intervention?
A patient with polycythemia vera who is resistant to hydroxyurea is started on ruxolitinib. What laboratory parameter would warrant immediate intervention?
A patient with hemophilia A is receiving Factor VIII. What is the expected outcome?
A patient with hemophilia A is receiving Factor VIII. What is the expected outcome?
For a patient with mild hemophilia A prescribed desmopressin, what should the nurse prioritize monitoring during administration?
For a patient with mild hemophilia A prescribed desmopressin, what should the nurse prioritize monitoring during administration?
A patient with menorrhagia is prescribed tranexamic acid (TXA). Which of the following findings would make the healthcareprovider question the use of this medication.
A patient with menorrhagia is prescribed tranexamic acid (TXA). Which of the following findings would make the healthcareprovider question the use of this medication.
A patient being discharged after hospitalization for is told to take oral iron with Vitamin C, the patient asks what the vitamin C is for. What is the nurse's most appropriate response?
A patient being discharged after hospitalization for is told to take oral iron with Vitamin C, the patient asks what the vitamin C is for. What is the nurse's most appropriate response?
A patient is in sickle cell crisis. In addition to administering prescribed pain medications, what collaborative intervention is essential to manage pain?
A patient is in sickle cell crisis. In addition to administering prescribed pain medications, what collaborative intervention is essential to manage pain?
A patient with anemia secondary to chronic kidney disease (CKD) is scheduled a dose of erythropoiesis-stimulating agent (ESA). Which finding would cause the nurse to question administration?
A patient with anemia secondary to chronic kidney disease (CKD) is scheduled a dose of erythropoiesis-stimulating agent (ESA). Which finding would cause the nurse to question administration?
Patient with polycythemia vera being treated with hydroxyurea. What instruction is most important for the nurse to emphasize?
Patient with polycythemia vera being treated with hydroxyurea. What instruction is most important for the nurse to emphasize?
The nurse is caring for a child with hemophilia A that is experiencing hemarthrosis. What nursing intervention takes priority?
The nurse is caring for a child with hemophilia A that is experiencing hemarthrosis. What nursing intervention takes priority?
A nurse is reviewing the medication list of a patient who is newly diagnosed with type 2 diabetes mellitus and has been prescribed metformin. Which of the following findings should the nurse report to the provider immediately?
A nurse is reviewing the medication list of a patient who is newly diagnosed with type 2 diabetes mellitus and has been prescribed metformin. Which of the following findings should the nurse report to the provider immediately?
To ensure consistent absorption of insulin, the nurse teaches the patient to inject the insulin into which area?
To ensure consistent absorption of insulin, the nurse teaches the patient to inject the insulin into which area?
A patient with type 2 diabetes is started on sitagliptin. What should be included in the education?
A patient with type 2 diabetes is started on sitagliptin. What should be included in the education?
The nurse is providing education to a patient who is newly prescribed empagliflozin. Which of the following statements indicates that the patient understand how to prevent a common adverse effect?
The nurse is providing education to a patient who is newly prescribed empagliflozin. Which of the following statements indicates that the patient understand how to prevent a common adverse effect?
Flashcards
Nursing Management in Hematologic Disorders
Nursing Management in Hematologic Disorders
Identify safe, effective nursing management of pharmacotherapeutic regimes for individuals across the lifespan and their families experiencing chronic hematological disorders.
Hemoglobin/Hematocrit
Hemoglobin/Hematocrit
Hemoglobin/hematocrit indicates the overall health of red blood cells.
Reticulocytes
Reticulocytes
Reticulocytes (young RBCs) provide insight into bone marrow activity.
Transferrin & Ferritin
Transferrin & Ferritin
Signup and view all the flashcards
Anemia Management
Anemia Management
Signup and view all the flashcards
Oral Iron Administration
Oral Iron Administration
Signup and view all the flashcards
IV Iron extravasation
IV Iron extravasation
Signup and view all the flashcards
Cyanocobalamin Indications
Cyanocobalamin Indications
Signup and view all the flashcards
B12 Injection
B12 Injection
Signup and view all the flashcards
ESAs Indications
ESAs Indications
Signup and view all the flashcards
ESA Monitoring
ESA Monitoring
Signup and view all the flashcards
Hydroxyurea use
Hydroxyurea use
Signup and view all the flashcards
Clotting Factor Replacement Indications
Clotting Factor Replacement Indications
Signup and view all the flashcards
Desmopressin (DDAVP)
Desmopressin (DDAVP)
Signup and view all the flashcards
Antifibrinolytics Use
Antifibrinolytics Use
Signup and view all the flashcards
Oral Iron Therapy
Oral Iron Therapy
Signup and view all the flashcards
Sickle Cell Crisis Pain
Sickle Cell Crisis Pain
Signup and view all the flashcards
CKD Anemia Management
CKD Anemia Management
Signup and view all the flashcards
Polycythemia Vera Management
Polycythemia Vera Management
Signup and view all the flashcards
Hemophilia Management
Hemophilia Management
Signup and view all the flashcards
Diabetes Management
Diabetes Management
Signup and view all the flashcards
Diabetes Insipidus Treatment
Diabetes Insipidus Treatment
Signup and view all the flashcards
SIADH treatment
SIADH treatment
Signup and view all the flashcards
Hypothyroidism Management
Hypothyroidism Management
Signup and view all the flashcards
Hyperthyroidism treatment Goals
Hyperthyroidism treatment Goals
Signup and view all the flashcards
Causes of Cushings
Causes of Cushings
Signup and view all the flashcards
Adrenal treatment
Adrenal treatment
Signup and view all the flashcards
Adrenal Crisis
Adrenal Crisis
Signup and view all the flashcards
Study Notes
Learning Objectives
- Recognize safe, effective nursing strategies for managing pharmacotherapeutic regimens in individuals and their families across the lifespan dealing with chronic hematological disorders.
- Choose and prioritize nursing actions, results, and interventions to develop a nursing care plan for a client suffering from chronic hematological disorders.
- Develop a range of collaborative strategies to promote self-management and successful coping mechanisms for individuals and their families across their lives affected by chronic hematological disorders.
Drugs for Anemias
- Iron Therapy: Used to treat anemias
- Cyanocobalamin: Used to treat anemias
- Folate: Used to treat anemias
Important Lab Values for Anemia
- Hemoglobin/Hematocrit: Determines the overall health of red blood cells
- Reticulocytes: Assess young RBCs and provide insight into bone marrow activity.
- Iron: Essential component of hemoglobin
- Transferrin: Evaluates iron metabolism and storage.
- Ferritin: Evaluates iron metabolism and storage.
- Bilirubin: Assesses RBC breakdown.
- Folate: Essential for RBC formation and maturation.
Anemia General Management
- Identifying and treating the underlying cause is essential in managing anemia.
- Drug Therapy
- Nutritional Therapy
- Transfusion of packed RBCs or starting with 0.9% NS IV may be necessary.
Drugs for Anemias: Iron Therapy
- Used for mild-moderate iron deficiency anemia, by increasing iron stores.
- Oral Iron options: ferrous sulfate, ferrous gluconate, ferrous fumarate, heme iron supplements
- Adverse effects: abdominal pain, constipation, and dark stools.
- Drug interactions: antacids and calcium decrease absorption of iron; Iron may decrease the serum concentration of levothyroxine.
- Nursing Considerations: Administer on an empty stomach and with Vitamin C to enhances/facilitate absorption.
- IV Iron options: Iron sucrose (Venofer®)
- Used for severe iron deficiency anemia, iron deficiency where oral therapy is not feasible or is ineffective, and CKD.
- Replenishes iron levels directly.
- Adverse effects: hypotension, anaphylaxis (rare)
- Drug Interactions: Avoid with oral iron, caution with ACE inhibitors because can increase the chance of allergic reactions
- Nursing Considerations: Monitor the IV site for extravasation, reduce infusion rate for hypotension,. Also observe for hypersensitivity reactions during the initial moments of administration.
Drugs for Anemias: Vitamin B12 and Folic Acid
- Indications: Vitamin B12 deficiency anemia, folate deficiency anemia, pernicious anemia, and megaloblastic anemia.
- Examples of medications: Cyanocobalamin (B12) and Folic Acid
- Nursing Considerations:
- B12 IM injection is needed for pernicious anemia and are usually a lifelong therapy.
- Folic acid supplementation is required in pregnancy and alcohol use disorder
- Cyanocobalamin (B12 - IM, oral)
- Used for pernicious anemia and B12 deficiency, by restoring B12.
- Adverse effect of headache.
- Nursing Considerations: IM injection is for pernicious anemia, lifelong therapy
- Folic Acid
- Used for folate deficiency, pregnancy, by replacing folate required for DNA synthesis and RBC maturation.
- Rare adverse effect.
- Drug Interactions: Methotrexate, anticonvulsants (phenytoin, valproate), and sulfa drugs can lower folate levels.
- Nursing Considerations: Essential in pregnancy and for alcohol use disorder.
Hematopoietic Agents
- Erythropoiesis-Stimulating Agents (ESAs)
- Myelosuppressive Agents
Hematopoietic Agents: ESAs
- Erythropoiesis-Stimulating Agents (ESAs) such as Epoetin Alfa (Epogen, Procrit) and Darbepoetin Alfa (Aranesp)
- Indications: Chemotherapy-induced anemia and CKD anemia
- Nursing Considerations:
- Monitor blood pressure and hemoglobin, goal 100-110 g/L
- Iron levels must be sufficient for ESAs to work
- Epoetin Alfa, Darbepoetin Alfa
- Used for chemotherapy-induced anemia and CKD anemia.
- These stimulate RBC production.
- Adverse Effects: HTN and Thrombosis
- Drug Interactions: ACEI & ARBs may diminish the effects, Hormone therapy (androgens).
- Nursing Considerations are that must monitor BP and Hgb, requires adequate iron levels, and has increased clot risk with high-dose use
Hematopoietic Agents: Myelosuppressive Agents
-
Myelosuppressive Therapy reduces the overproduction of RBCs.
- Hydroxyurea is an example. Its used for Sickle Cell Disease (SCD), polycythemia vera (PV), and some leukemias.
- Used to prevent sickling in SCD and reduce RBC production in PV.
- Nursing considerations:
- monitor CBC to assess risk of myelosuppression and infection
- Teratogenic-contraception required
- Takes weeks to work
-
JAK2 Inhibitors
- Used in bone marrow disorders or when hydroxyurea is ineffective for treating PV
- Ruxolitinib (Jakafi) is an example drug.
- Nursing considerations:
- Monitor WBCs (infection risk).
- Monitor CBC because of the risk for bone marrow suppression-anemia, thrombocytopenia
-
Hydroxyurea
- Used for sickle cell disease, polycythemia vera, and chronic myeloid leukemia to reduce sickling in SCD and suppress RBC production in PV.
- Adverse effects of myelosuppression and increased risk of infection,
- Drug interactions: Increased toxicity with myelosuppressive agents
- Ruxolitinib
- Used for polycythemia vera that is resistant to hydroxyurea to reduce abnormal RBC production
- Adverse Effects: myelosuppression and infection.
- Interactions: Immunosuppressants can increase infection risk, CYP3A4 inhibitors like ketoconazole increase drug levels
- Monitor CBC, assess for anemia, thrombocytopenia, and infection.
Hemostatic Drugs
- Clotting Factor Replacement
- Desmopressin (DDAVP)
- Antifibrinolytics
Hemostatic Drugs: Clotting Factor Replacement
- Clotting Factor Replacement medication is used for factor deficiencies and to prevent bleeding.
- Examples:
- Factor VIII → Hemophilia A, von Willebrand disease
- Factor IX → Hemophilia B
- Adverse Effects: Infusion reactions (rash, fever), headache.
- Monitor for inhibitor development, because infusion reactions are possible.
- Desmopressin (DDAVP) used for mild Hemophilia A and Von Willebrand Disease
- Has an adverse effect of hyponatremia
- Has interactions with Carbamazepine, NSAIDs, lithium, demeclocycline, loop diuretics, and glucocorticoids
- Nursing Considerations are to monitor sodium levels, fluid intake, and urine output.
Hemostatic Drugs: Antifibrinolytics
- Antifibrinolytics prevent clot breakdown used for mucosal bleeding, and menorrhagia
- Examples: Tranexamic Acid (TXA) and Aminocaproic Acid
- Adverse Effects: Abdominal pain, headache, back pain, seizures, thrombosis, and hypersensitivity reactions (rare)
- Drug interactions: Increased clot risk if used with estrogen-based contraceptives.
- Nursing considerations: Monitor for signs of hypersensitivity, seizure activity, or thrombosis.
Clinical Application: Iron Deficiency Anemia
- A first-line treatment is oral iron therapy with options like ferrous sulfate and ferrous gluconate
- IV Iron: For malabsorption, severe anemia, or CKD use iron sucrose
- Transfusion: It may be needed for severe symptomatic anemia (Hgb <70 g/L) or acute blood loss that requires urgent correction.
- Nursing Considerations:
- Administer oral iron with Vitamin C for better absorption, avoid calcium & antacids.
- Monitor for GI side effects. Constipation, nausea, black stools; encourage hydration & fiber intake
- Monitor IV iron for hypotension and anaphylaxis risk.
Clinical Application: Sickle Cell Disease
- Managed with both preventive and acute treatments to reduce complications, enhance quality of life, and alleviate pain crises.
- First-line- Hydroxyurea:
- L-glutamine: Reduces oxidative stress and prevents RBC damage. Used for patients who cannot tolerate hydroxyurea
- Crizanlizumab: A monoclonal antibody reduces cell adhesion and prevents vaso-occlusive crises. Given IV infusion monthly.
- Hematopoietic Stem Cell Transplant (HSCT) a possible cure.
- Management of Sickle Cell Crisis
- For pain control give Opioids (morphine, hydromorphone) for moderate-severe pain and NSAIDs for mild-moderate pain.
- During Hydration provide IV fluids to improve RBC flexibility and prevent sickling and vascular occlusion.
- Consider blood transfusions for acute chest syndrome, stroke prevention, and severe anemia.
Clinical Application: Chronic Kidney Disease Anemia Management
- CKD leads to reduced erythropoietin (EPO) production, causing anemia by correcting low RBC production and iron deficiency while minimizing complications (hypertension, thrombosis).
- Erythropoiesis-Stimulating Agents ESAs stimulate bone marrow to increase RBC production but have a slower onset than blood transfusions taking 2–6 weeks.
- Regularly monitor BP, is important because of hypertension
- Do not increase Hgb >110 g/L as this may increase the risk of thrombosis DVT, PE, stroke
- Monitor iron levels
Clinical Application: Polycythemia Vera Management
- Polycythemia Vera (PV) is a myeloproliferative disorder causing overproduction of RBCs, WBCs, and platelets leading to thrombosis. The goal is to reduce RBC overproduction and prevent blood clots.
- Phlebotomy is the first-line treatment with Myelosuppressive Therapy for high-risk patients Hydroxyurea reduces RBC production in bone marrow; Ruxolitinib.
- Adjuvant Therapy: Low-dose aspirin prevents thrombosis
- Encourage hydration & mobility to prevent clots.
Clinical Application: Hemophilia Management
- Hemophilia is a genetic bleeding disorder caused by a deficiency of clotting factors needed for blood clot formation. The treatment focuses on factor replacement, bleeding prevention, and emergency management.
- First-Line: Clotting Factor Replacement Therapy
- Adjunctive Therapies Desmopressin (DDAVP) for mild Hemophilia A which stimulates release of stored Factor VIII. Tranexamic Acid (TXA): For mucosal bleeding.
- Avoid NSAIDs & aspirin, because acetaminophen is recommended for pain relief
- Employ bleeding prevention strategies.
Hemophilia Emergency Management
- Intracranial Hemorrhage (ICH): Presents with severe headache, nausea/vomiting, vision changes, seizures, and altered LOC. Immediate Management includes giving factor immediately, calling rapid response, and sending patient for STAT CT scans.
- Gastrointestinal Bleeding (GI Bleed): Presents black/tarry stools, hematemesis, abdominal pain, and pallor. Immediate Management includes administering factor, IV fluids, monitoring vitals, and preparing for endoscopy.
- Joint Bleed (Hemarthrosis): Presents with joint swelling, warmth, stiffness, and severe pain. Immediate Managementincludes providing a factor, immobilizing the joint, applying ice, and managing the patient's pain.
- Retroperitoneal Bleeding: Presents severe back/flank pain, hypotension, and abdominal distension. Immediate Management includes administering a factor, IV fluids, and monitoring for shock.
- Major Trauma or Surgery: Presents Active uncontrolled bleeding, hypotension, and tachycardia. Immediate Management includes administering a factor, blood transfusion if needed, and preparing for surgery.
Learning Objectives for Endocrine Disorders
- Identify safe and effective nursing management for pharmacotherapeutic regimens for individuals with chronic endocrine conditions.
- Select and prioritize nursing priorities, outcomes, and interventions to create a nursing care plan for a case study of client experiencing chronic endocrine conditions.
- Build a repertoire of collaborative approaches to support self-management and effective coping for individuals experiencing chronic endocrine conditions.
Chronic Endocrine Conditions
- Diabetes Mellitus
- Diabetes Insipidus
- SIADH
- Hypo/Hyperthyroidism
- Cushing's Syndrome
- Adrenal Insufficiency
Diabetes Mellitus Management Review
- Type 1 Diabetes, these patients require lifelong insulin therapy and management is achieved by optimizing insulin dosing and preventing hypoglycemia.
- Type 2 Diabetes that are managed by adjusting medications over time because insulin resistance and beta-cell dysfunction can progress.
- First-Line Therapy is Metformin (if there are no contraindications)
- Lifestyle changes play a major role, including weight loss, diet modifications, and physical activity.
Insulins: Review
- Rapid-Acting Insulin: Ex: Aspart (NovoRapid), Lispro (Humalog), Glulisine (Apidra). Onset: 10-15 min; Peak: 60-90 min; Duration: 3.5-5 hrs
- Short-Acting Insulin: Ex: Regular insulin (Humulin R, Novolin R). Onset: 30 min-1 hr; Peak: 2-3 hrs; Duration: 5-8 hrs
- Intermediate-Acting Insulin: Ex: NPH (Humulin N, Novolin N). Onset: 2-4 hrs; Peak: 4-10 hrs; Duration: 12-18 hrs
- Long-Acting Insulin: Ex: Glargine (Lantus, Basaglar), Detemir (Levemir). Onset: 1-2 hrs; Peak: No peak; Duration: 24 hrs
- Ultra-Long Acting Insulin: Ex: Degludec (Tresiba). Onset is 1 hr. Peak: No peak. Duration: >42 hrs
Oral & Non-Insulin Antidiabetic Agents
- Biguanides such as Metformin decreases hepatic glucose production and increases insulin sensitivity. They can cause GI upset and lactic acidosis, this is given with food and avoid in renal dysfunction (eGFR <30)
- Sulfonylureas such as Gliclazide, Glimepiride stimulate insulin release from the pancreas. They can cause Hypoglycemia; Take with food, monitor for hypoglycemia
- DPP-4 Inhibitors such as Sitagliptin increase incretin hormones and stimulates Insulin. These monitor closely for symptoms of pancreatitis and joint pain.
- SGLT2 Inhibitors include Empagliflozin, Canagliflozin, Dapagliflozin increase glucose excretion in urine. Monitor renal function and encourage hydration.
- GLP-1 Receptor Agonists like Liraglutide reduce thyroid tumor while also secreting insulin with the adverse effect of Nausea, pancreatitis, thryoid tumor which requires it to be subcutaneous.
Nursing Considerations for Chronic Diabetes Management
- Reinforce how to conduct routine glucose monitoring
- Med and SE of medication must be assessed in coordination with blood glucose readings.
- Support lifestyle changes.
- Prevent hypoglycemia - teaching of sx, tx, and need to assess when to call for help.
- Regular screenings must be performed:
- Foot exams
- Eye exams
- Kidney Function test
- BP and lipid control
Diabetes Insipidus (DI)
- Disorder caused by deficient antidiuretic hormone (ADH) leading to excessive urination, and increased thirst.
- Types: Central DI from a lack of ADH production and nephrogenic DI that doesnt respond to the bodies ADH.
- Symtoms: Frequent polyuria, dehydration, and dilute urine.
Management of Diabetes Insipidus
- Goals: restore fluid balance, correct undlerlying causes, and reduce uriantion.
- Tx: Restore flud balance with Thiazide diuretics and NSAIDs
Pharmacologic Treatment of Diabetes Insipidus
- ADH Analog
- mimics ADH to Increase water with water and decreased urine
- Ex: Desmopressin
- SE: Sodium toxicity, water toxicity in kidneys
- Thiazide Diuretics
- induces mild hypovolenia and enhances sodium/ water which will have less out put
- Electrolyte imbalances -- Monitor BP
- NSAIDS- inhibits prostaglandin creation by the body of water with a risk of renal failure
- Monitor BP
Diabetes Insipidus: Nursing Management
- Must monitor BP, urine/ stool in addition to serum levels.
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
- ADH that causes fluid retention and causes hyponatremia.
- Causes:
- CNS disorders
- Lung Cancer
- Symptoms:
- hyponatremia
- weight gain, low urine output, hypertension and neuro issues
Therapeutic Interventions for SIADH
- Goals:
- correct hyponatremia safely
- Monitor for excessive thirst & urination; headache, confusion, nausea, weight gain.
- Must restrict fluids and correct causes
Pharmacologic Treatment of SIADH
- Vasopressin receptor agonists increase fluid overload to a healthy serum
- Ex: Tolvapatan/ Convapatan which blocks ADH in kidneys
- Se: Causes dehydration with liver toxicity
- -- Monitor Sodium Levels
-- Risk of Fluid Overload
- Check electrolytes
- Ex: Loops and diuretics increase risks -- check eletrolytes Strict I&Os & Daily Weights Neurologic Status:
- Confusion, lethargy, muscle cramps
- Seizures, coma
Hypothyroidism
-
Caused by insuf thyroid production of T3 + T4 leading to slowed systems. - Primary: auto destruction of immune system after surgery - Secondary: pituary/ metabolic disfunction
-
Restoring function and preventing future complications - Rest and avoid drugs - Levothyroxine Synchondroid required for the rest of their life
Pharmacological Management of Hypothyroidism
- Restoring function is main part
- Administer Synchondroid and rest and eat well
- Check vitals
- Take right before eating
Hyperthyroidism
- High Thryoid hormones leading to high metabolism levels
- Toxic Over active and swelling
-
- increased appetid
-
- exothalmia
Hyopthyroism Tx;
- Goal must reduce hormone production to prevent tumors and thyroid storms Thinnides, beta blockers, radioactive iodine
- airway and calcium monitoring when post op
Pharmacologic Treatment of Hyperthyroidism
- Anti Throid Meds - Inhibit hormone synthesis to bleed less
- Monitor CBC
- Take weeks to work
Cushing Syndrome:
- Excess cortisol of steroid with immune disfunction
- Steroid Taper
- Monitor blood levels
- Bone Density
- Check sodium levels
Adrenal Insufficiency
- Gland Failure cause by metabolic imbalance and can involve Addison
- Auto in americe or Europe
- Pituitary disfunction
- Bronze skin
- Weakness
- Must have a good balance Must increase salt and intake depending on if needed
Pharmacologic Treatment of Adrenal Insufficiency
- Weight Gain
- Monitor sugars and blood
- Do not quit
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
