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Hematologic Disorders
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Hematologic Disorders

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Questions and Answers

What are the common symptoms of anemia?

Common symptoms of anemia include tiredness, fatigue, pale skin, shortness of breath, and dizziness.

What is hemolytic anemia and how does it affect red blood cells?

Hemolytic anemia is a condition characterized by the destruction of red blood cells, leading to a reduced number of RBCs in circulation.

Describe the role of iron in preventing anemia.

Iron is essential for the production of hemoglobin in red blood cells, which is necessary for transporting oxygen throughout the body.

What distinguishes aplastic anemia from other types of anemia?

<p>Aplastic anemia is distinguished by impairment of bone marrow, resulting in low levels of red blood cells, white blood cells, and platelets, known as pancytopenia.</p> Signup and view all the answers

What are the potential causes of blood loss that can lead to anemia?

<p>Potential causes of blood loss leading to anemia include surgery, trauma, excessive menstruation, or gastrointestinal bleeding.</p> Signup and view all the answers

What is the primary purpose of administering Packed Red Blood Cells (PRBCs) in a clinical setting?

<p>To increase hemoglobin and hematocrit levels when blood counts are low due to conditions like anemia, trauma, or surgery.</p> Signup and view all the answers

Within how many hours must Packed Red Blood Cells (PRBCs) be administered after being removed from the refrigerator?

<p>PRBCs must be given within 4 hours.</p> Signup and view all the answers

In the context of anemia, at what hemoglobin level should a patient be considered for urgent blood transfusion?

<p>A hemoglobin level below 7 g/dL is critical and requires urgent intervention.</p> Signup and view all the answers

What signs and symptoms might indicate a patient is in shock due to low hemoglobin levels?

<p>Signs include clammy skin, pallor, thready pulse, decreased blood pressure, and rapid respiration.</p> Signup and view all the answers

What laboratory results would a nurse anticipate for a patient receiving 1 unit of packed red blood cells if their initial hemoglobin was 8 g/dL?

<p>The nurse would anticipate a subsequent hemoglobin level around 9 g/dL and a hematocrit of approximately 38%.</p> Signup and view all the answers

What is the primary function of leukocytes in the body?

<p>The primary function of leukocytes is to defend the body against infection and foreign substances.</p> Signup and view all the answers

Explain the role of erythropoietin (EPO) in red blood cell production.

<p>Erythropoietin (EPO) stimulates the production of red blood cells in the bone marrow in response to low oxygen levels.</p> Signup and view all the answers

Describe the process of hemostasis.

<p>Hemostasis is the process of blood clotting that stops bleeding through the formation of a fibrin mesh.</p> Signup and view all the answers

What are thrombocytes and their main function?

<p>Thrombocytes, or platelets, are cell fragments that primarily function to plug cuts and prevent bleeding.</p> Signup and view all the answers

How does hemoglobin function in red blood cells?

<p>Hemoglobin binds to oxygen in the lungs and carries it to tissues throughout the body.</p> Signup and view all the answers

What is the primary cause of iron deficiency anemia?

<p>The primary cause of iron deficiency anemia is a lack of iron, which is essential for producing red blood cells.</p> Signup and view all the answers

What symptoms might indicate a severe case of anemia?

<p>Severe anemia can present with symptoms such as extreme fatigue, pale skin, shortness of breath, and dizziness.</p> Signup and view all the answers

Identify one common treatment for iron deficiency anemia.

<p>A common treatment for iron deficiency anemia is the administration of iron-rich foods or iron supplements.</p> Signup and view all the answers

How does chemotherapy contribute to the development of anemia?

<p>Chemotherapy can contribute to anemia by suppressing bone marrow function, which reduces red blood cell production.</p> Signup and view all the answers

What hemoglobin level is considered critically low, often necessitating intervention?

<p>A hemoglobin level below 7 g/dL is considered critically low and may require urgent medical intervention.</p> Signup and view all the answers

What are the two key indicators of kidney function in a BMP panel?

<p>BUN and Creatinine.</p> Signup and view all the answers

What is the normal range for potassium (K+) levels in mEq/L?

<p>3.5 - 5.0 mEq/L.</p> Signup and view all the answers

How does a high level of carbon dioxide (CO2) in the body affect acid-base balance?

<p>It can lead to acidosis.</p> Signup and view all the answers

What treatment option is prioritized for a patient with hyperkalemia?

<p>IV Calcium Gluconate.</p> Signup and view all the answers

Why is monitoring heart function important when dealing with hypokalemia?

<p>Low potassium can severely impact heart function.</p> Signup and view all the answers

What is systemic lupus erythematosus (SLE)?

<p>An autoimmune disorder where the body attacks itself, causing inflammation in the skin, joints, kidneys, and heart.</p> Signup and view all the answers

Which of the following are triggers for systemic lupus erythematosus? (Select all that apply)

<p>Smoking</p> Signup and view all the answers

What is a common sign of lupus?

<p>A butterfly-shaped rash on the cheeks and nose.</p> Signup and view all the answers

Creatinine levels over ______ are considered bad for the kidneys.

<p>1.3</p> Signup and view all the answers

Which medication is a common steroid used in the treatment of lupus?

<p>Prednisone</p> Signup and view all the answers

Most cases of lupus occur in men over the age of 45.

<p>False</p> Signup and view all the answers

Match the medications to their classifications:

<p>Prednisone = Steroid Methotrexate = Immunosuppressant Hydroxychloroquine = Immunosuppressant Infliximab = Immunosuppressant Azathioprine = Immunosuppressant</p> Signup and view all the answers

What should a patient with lupus do when experiencing a fever?

<p>Notify the healthcare provider.</p> Signup and view all the answers

What are the key symptoms associated with a febrile reaction to a blood transfusion?

<p>Flushing, itching, and mild fever are key symptoms of a febrile reaction.</p> Signup and view all the answers

What are the immediate actions a nurse should take for a patient experiencing anaphylactic reaction during a transfusion?

<p>Administer epinephrine and provide airway support immediately.</p> Signup and view all the answers

During a transfusion, what symptoms might indicate circulatory overload?

<p>Difficulty breathing and crackles heard upon auscultation indicate circulatory overload.</p> Signup and view all the answers

What distinguishes hemolytic reactions from other transfusion reactions?

<p>Hemolytic reactions involve the destruction of red blood cells due to incompatibility.</p> Signup and view all the answers

What is the nurse's priority intervention if a patient shows signs of a hemolytic transfusion reaction?

<p>Stop the transfusion immediately and maintain venous access with normal saline.</p> Signup and view all the answers

List and briefly explain the five steps a nurse should follow to safely administer Packed Red Blood Cells (PRBCs).

<ol> <li>Verify the order with another RN; 2. Document vital signs before starting; 3. Check patient name and blood product with a second nurse; 4. Prime tubing with 0.9% sodium chloride; 5. Administer the PRBCs based on facility protocol.</li> </ol> Signup and view all the answers

What role does 0.9% sodium chloride play in the preparation for a PRBC transfusion?

<p>0.9% sodium chloride is used to prime the IV tubing to ensure patency and to avoid hemolysis caused by incompatibility.</p> Signup and view all the answers

Why is it important for two registered nurses to verify the blood product and patient details prior to a transfusion?

<p>This verification process minimizes the risk of errors, such as administering the wrong blood type, which can lead to serious complications.</p> Signup and view all the answers

What is the significance of obtaining and documenting a full set of vital signs before a PRBC transfusion?

<p>Documenting vital signs serves as a baseline for monitoring the patient's response to the transfusion and detecting any adverse reactions early.</p> Signup and view all the answers

Identify two potential symptoms of a febrile reaction and the nurse's immediate action in response.

<p>Fever and chills are potential symptoms; the nurse should immediately stop the transfusion and notify the physician.</p> Signup and view all the answers

What blood type is considered the universal donor and why?

<p>Type O blood is considered the universal donor because it lacks A and B antigens on the surface of its red blood cells, allowing it to be given to any blood type without causing an immune reaction.</p> Signup and view all the answers

Which blood type can receive from all other types and what is this type called?

<p>Blood type AB can receive from all blood types and is called the universal recipient.</p> Signup and view all the answers

If a patient with blood type A receives blood from type B, what reaction could occur?

<p>A hemolytic transfusion reaction could occur, as the anti-B antibodies in type A blood would attack the B antigens introduced by the transfused blood.</p> Signup and view all the answers

Describe one critical action a nurse should take if the wrong blood type is delivered to a patient requiring a transfusion.

<p>The nurse should immediately stop the transfusion and inform the physician to prevent any adverse reactions.</p> Signup and view all the answers

What is one nursing responsibility related to blood transfusions to ensure patient safety?

<p>The nurse must verify the patient's identity and blood product with another registered nurse before administering the transfusion.</p> Signup and view all the answers

What is the primary mechanism of action for glycoprotein receptor inhibitors like Abciximab?

<p>Glycoprotein receptor inhibitors like Abciximab work by blocking the binding of fibrinogen to activated platelets, thereby preventing platelet aggregation.</p> Signup and view all the answers

Why is it important for nurses to assess hemoglobin levels in patients receiving Antiplatelet therapy?

<p>Assessing hemoglobin levels is critical to monitor for potential bleeding complications that may arise from antiplatelet therapy.</p> Signup and view all the answers

In the context of Antiplatelet therapy, what nursing care should be prioritized when monitoring platelets?

<p>Nurses should regularly monitor platelet counts and report any significant decreases to ensure patient safety and adjust treatment as necessary.</p> Signup and view all the answers

What clinical considerations should a nurse take into account when administering Abciximab?

<p>Nurses should assess for signs of bleeding, monitor vital signs, and ensure proper administration techniques are followed to reduce the risk of complications.</p> Signup and view all the answers

How does Abciximab compare to other antiplatelet agents in terms of onset and duration of action?

<p>Abciximab has a rapid onset of action but a relatively short duration compared to some other antiplatelet agents, necessitating careful timing in administration.</p> Signup and view all the answers

What are the common causes of epistaxis in children?

<p>Common causes of epistaxis in children include dry mucous membranes due to environmental factors and trauma like nose picking.</p> Signup and view all the answers

What position should a child be placed in during an epistaxis episode?

<p>The child should sit up and lean forward to prevent blood from flowing down the throat.</p> Signup and view all the answers

Describe a nursing intervention for treating an epistaxis.

<p>A nursing intervention involves having the child pinch their nose tightly below the nasal bone for at least 10 minutes.</p> Signup and view all the answers

How can cold therapy assist in managing epistaxis?

<p>Applying a cold pack to the bridge of the nose can constrict blood vessels, thereby reducing bleeding.</p> Signup and view all the answers

What emotional state should a caregiver aim to maintain for a child experiencing a nosebleed?

<p>The caregiver should aim to keep the child calm and quiet during the episode.</p> Signup and view all the answers

What is the primary role of erythropoietin in the body?

<p>Erythropoietin stimulates the bone marrow to produce red blood cells.</p> Signup and view all the answers

In which condition is erythropoietin typically indicated?

<p>Erythropoietin is indicated for the treatment of anemia.</p> Signup and view all the answers

How does the production of erythropoietin relate to kidney function?

<p>Erythropoietin is produced by the kidneys, and impaired kidney function can decrease its production.</p> Signup and view all the answers

What might be a consequence of erythropoietin deficiency?

<p>A deficiency in erythropoietin can lead to decreased red blood cell production and anemia.</p> Signup and view all the answers

Why is monitoring erythropoietin levels important in patients with chronic kidney disease?

<p>Monitoring erythropoietin levels helps assess the patient's ability to produce red blood cells.</p> Signup and view all the answers

What is the normal range for sodium (Na+) levels?

<p>135 - 145</p> Signup and view all the answers

Calcium (Ca) levels below 9.0 are considered normal.

<p>False</p> Signup and view all the answers

What is a critical creatinine level that indicates kidney problems?

<p>Over 1.3</p> Signup and view all the answers

The normal range for potassium (K+) is __________ mEq/L.

<p>3.5 - 5.0</p> Signup and view all the answers

Match the following lab tests with their associated conditions:

<p>WBC = High = Infection Albumin = Liver RBC = Low = Anemia Glucose = 70 - 110</p> Signup and view all the answers

What is the normal range of white blood cells (WBC) in a CBC test?

<p>5,000 - 10,000</p> Signup and view all the answers

Hemoglobin serves as oxygen carriers on white blood cells.

<p>False</p> Signup and view all the answers

What is the risk level for hemoglobin when it is between 8 and 11?

<p>Risky</p> Signup and view all the answers

The ratio of red blood cells to total blood volume is known as the _____

<p>hematocrit</p> Signup and view all the answers

Match the following components of a CBC with their normal ranges:

<p>White Blood Cells (WBC) = 5,000 - 10,000 Hemoglobin (Hgb) = 12 - 18 Platelets (PLT) = 150,000 - 450,000 Hematocrit (HCT) = 38% - 52%</p> Signup and view all the answers

What is a major consequence of sickle cell anemia on red blood cells (RBCs)?

<p>RBCs have a distorted shape and die sooner</p> Signup and view all the answers

Vaso-occlusive crises in sickle cell anemia occur due to RBCs forming large clots in the blood vessels.

<p>False</p> Signup and view all the answers

What condition is characterized by extreme pain due to lack of oxygen in sickle cell anemia?

<p>sickle cell crisis</p> Signup and view all the answers

Sickle cells offer less ______ to the body compared to normal round cells.

<p>oxygen</p> Signup and view all the answers

Match the following terms with their definitions:

<p>Sickle Cell Anemia = A genetic disorder causing RBC deformation Ischemia = Insufficient blood supply to an organ Vaso-occlusive Crisis = Painful episodes due to blocked blood vessels RBC Lifespan in Sickle Cell = Shortened compared to normal RBCs</p> Signup and view all the answers

What causes sickle cell anemia in red blood cells?

<p>Abnormal hemoglobin that distorts cell shape</p> Signup and view all the answers

Sickle-shaped red blood cells carry more oxygen than normal red blood cells.

<p>False</p> Signup and view all the answers

What is the main consequence of sickle-shaped red blood cells getting clogged in tiny blood vessels?

<p>Ischemia</p> Signup and view all the answers

The distorted shape of red blood cells in sickle cell anemia leads to their quicker ______.

<p>death</p> Signup and view all the answers

Match the following terms related to sickle cell anemia with their descriptions:

<p>Sickle cell = Distorted RBC shape Occlusion = Blockage in blood vessels Ischemia = Low oxygen supply to organs Hemolysis = Destruction of red blood cells</p> Signup and view all the answers

Which of the following is NOT a common symptom of Sjogren’s Syndrome?

<p>Heavy sweating</p> Signup and view all the answers

Sjogren's Syndrome affects men more than women.

<p>False</p> Signup and view all the answers

Name one recommended treatment for alleviating dry eyes in Sjogren’s Syndrome.

<p>Artificial tears</p> Signup and view all the answers

Patients with Sjogren’s Syndrome should avoid _____ soaps to protect their skin.

<p>harsh</p> Signup and view all the answers

Match the symptoms of Sjogren’s Syndrome to their correct descriptions:

<p>Dry Eyes = Result in irritation and discomfort. Dry Mouth = Can lead to dental issues. Joint Pain = Affects mobility and comfort. Dry Skin = Can cause itching and flaking.</p> Signup and view all the answers

Which of the following medications is an antiplatelet agent?

<p>Acetylsalicylic Acid</p> Signup and view all the answers

Clopidogrel and Aspirin are examples of medications that can decrease platelet levels.

<p>False</p> Signup and view all the answers

What is the normal platelet count range in thousands?

<p>150-400</p> Signup and view all the answers

Aspirin is also known as __________ acid.

<p>salicylic</p> Signup and view all the answers

Match the following medications with their key usage:

<p>Aspirin = Anti-platelet therapy Clopidogrel = Used post-PCI Ibuprofen = Pain relief Warfarin = Anticoagulation therapy</p> Signup and view all the answers

What is DIC?

<p>Disseminated Intravascular Coagulation</p> Signup and view all the answers

What happens to the platelets and clotting factors in DIC?

<p>The body uses up all the platelets and clotting factors, resulting in no ability to stop bleeding.</p> Signup and view all the answers

What are the stages of DIC pathophysiology?

<p>Overactive clotting</p> Signup and view all the answers

Where is bleeding commonly seen in DIC?

<p>Beneath the skin, in the nose or mouth, or deep inside the body.</p> Signup and view all the answers

DIC leads to an increase in the ability to stop bleeding.

<p>False</p> Signup and view all the answers

What is the primary cause of hemophilia A?

<p>Lack of clotting factor VIII</p> Signup and view all the answers

Patients with hemophilia are at low risk for excessive bleeding from small injuries.

<p>False</p> Signup and view all the answers

What clotting factor is deficient in hemophilia B?

<p>Factor IX</p> Signup and view all the answers

Hemophilia is an inherited bleeding disorder characterized by the inability to __________ normally.

<p>clot</p> Signup and view all the answers

Match the types of hemophilia with their respective deficient clotting factors:

<p>Hemophilia A = Clotting factor VIII Hemophilia B = Clotting factor IX</p> Signup and view all the answers

What is the initial action a nurse should take when a client with hemophilia develops painful swelling of the knee after bumping their leg?

<p>Apply ice to the knee and elevate the leg</p> Signup and view all the answers

Clients with hemophilia can safely use NSAIDs for pain relief.

<p>False</p> Signup and view all the answers

What should a patient with hemophilia avoid to prevent complications?

<p>Contact sports</p> Signup and view all the answers

Meperidine should be questioned for a client with hemophilia because it is prescribed as _______ mg IM every 4 hours.

<p>75</p> Signup and view all the answers

Match the following treatment recommendations with their purposes:

<p>Ice packs = Help reduce swelling and pain Coagulation replacement factors = Prevent bleeding episodes Elevation of the leg = Decrease pressure on the joints Avoiding NSAIDs = Minimize bleeding risk</p> Signup and view all the answers

What troponin level indicates a possible myocardial infarction (MI)?

<p>0.6</p> Signup and view all the answers

A BNP test is primarily used to assess for trauma to the heart muscles.

<p>False</p> Signup and view all the answers

What does a troponin level greater than 0.5 suggest?

<p>Myocardial infarction (MI)</p> Signup and view all the answers

A high level of troponin in the blood is often associated with ______.

<p>myocardial infarction</p> Signup and view all the answers

Match the following cardiac terms with their meanings:

<p>Troponin = A protein released during heart muscle damage BNP = A marker used to diagnose heart failure MI = Myocardial Infarction Trauma = Injury to the heart muscles</p> Signup and view all the answers

What is the platelet count that defines thrombocytopenia?

<p>150,000</p> Signup and view all the answers

Petechiae is a sign of high platelet levels in the blood.

<p>False</p> Signup and view all the answers

What is considered a major risk level for thrombocytopenia?

<p>100,000</p> Signup and view all the answers

The risk of __________ increases significantly when platelet counts drop to 50,000 or less.

<p>hemorrhaging</p> Signup and view all the answers

Match the following causes of thrombocytopenia with their descriptions.

<p>Immunosuppressants = Medications that weaken the immune response Liver disease = Conditions affecting liver function like cirrhosis ITP = Immune thrombocytopenia purpura</p> Signup and view all the answers

What is a primary cause of secondary polycythemia?

<p>Hypoxemia</p> Signup and view all the answers

Polycythemia vera is characterized by low levels of erythropoietin.

<p>True</p> Signup and view all the answers

What are the two main laboratory results used to diagnose polycythemia?

<p>Hemoglobin and Hematocrit</p> Signup and view all the answers

Increased blood viscosity due to polycythemia can lead to __________ in the brain.

<p>stroke</p> Signup and view all the answers

Match the following manifestations of polycythemia with their effects:

<p>Increased BP = Can lead to hypertension Hepatomegaly = Enlargement of the liver Splenomegaly = Enlargement of the spleen Sluggish blood flow = Increased risk of clots</p> Signup and view all the answers

Which of the following is NOT a sign or symptom of DIC?

<p>Elevated platelet count</p> Signup and view all the answers

DIC occurs as a disease by itself.

<p>False</p> Signup and view all the answers

What is the primary priority in treating DIC?

<p>Treat the underlying cause</p> Signup and view all the answers

In DIC, the level of D-dimer is usually ______, indicating clot risk.

<p>elevated</p> Signup and view all the answers

Match the following treatments of DIC with their purposes:

<p>Fresh Frozen Plasma (FFP) = Replaces deficits in coagulation factors Heparin = Decreases clot formations Packed RBCs = Replaces blood loss Cryoprecipitate = Replaces fibrinogen</p> Signup and view all the answers

How is HIV primarily transmitted?

<p>Infected blood, semen, and vaginal fluids</p> Signup and view all the answers

A person can be infected with HIV but show no symptoms for years.

<p>True</p> Signup and view all the answers

What does a CD4+ T-cell count below 200 cells/mm3 indicate?

<p>AIDS</p> Signup and view all the answers

The virus that causes AIDS is known as __________.

<p>HIV</p> Signup and view all the answers

Match each stage of HIV with its description:

<p>Stage 1 = Flu-like symptoms &amp; high viral replication Stage 2 = No symptoms; virus remains dormant AIDS = CD4+ T-cell count drops below 200 cells/mm3</p> Signup and view all the answers

Which blood component is primarily tested to evaluate potential anemia?

<p>Hemoglobin (Hgb)</p> Signup and view all the answers

A bone marrow biopsy is performed to obtain a definitive diagnosis of cell type and confirm malignancy.

<p>True</p> Signup and view all the answers

What is the expected INR range for a patient undergoing warfarin therapy?

<p>2 to 3</p> Signup and view all the answers

The _____ is responsible for the production of red blood cells, white blood cells, and platelets.

<p>bone marrow</p> Signup and view all the answers

Match the following hematologic tests with their primary purpose:

<p>WBC count = Assess immune system function CBC = Comprehensive blood cell analysis Prothrombin time (PT) = Evaluate blood coagulation Hematocrit (Hct) = Determine blood volume proportion of red cells</p> Signup and view all the answers

What is the primary reason for performing a bone marrow biopsy?

<p>To diagnose causes of blood disorders</p> Signup and view all the answers

Platelet transfusions require matching the client's blood type.

<p>False</p> Signup and view all the answers

What should the client do if they experience excessive bleeding or signs of infection post-bone marrow biopsy?

<p>Report to the provider.</p> Signup and view all the answers

The procedure for a bone marrow biopsy typically lasts about ______ minutes.

<p>20</p> Signup and view all the answers

Match each type of blood transfusion with its description:

<p>Standard donation = Transfusion from compatible donor blood. Autologous transfusions = Client's blood collected for future use. Intraoperative blood salvage = Salvaged blood from the procedure for later reinfusion. Packed RBCs = Used to treat excessive blood loss.</p> Signup and view all the answers

What is the first nursing action to take for a mild allergic transfusion reaction?

<p>Stop the transfusion</p> Signup and view all the answers

What is the maximum time interval that should elapse between the administration of amphotericin B antibiotics and WBC transfusion?

<p>4 to 6 hours</p> Signup and view all the answers

Anemia can sometimes be misdiagnosed as depression in older adult clients.

<p>True</p> Signup and view all the answers

Rh-negative clients can develop antibodies against Rh-positive blood only after sensitization occurs.

<p>True</p> Signup and view all the answers

List two possible findings in a patient experiencing a bacterial transfusion reaction.

<p>Wheezing, hypotension</p> Signup and view all the answers

What should two nurses verify before starting a blood transfusion?

<p>Correct blood product and patient's identification details.</p> Signup and view all the answers

Blood products containing RBCs must be ______ and cross-matched for antigens.

<p>typed</p> Signup and view all the answers

Iron-deficiency anemia occurs mainly due to _____ intake of iron-rich foods.

<p>inadequate</p> Signup and view all the answers

Match the type of transfusion reaction with its cause:

<p>Acute hemolytic reaction = Incompatible blood type or Rh factor Febrile transfusion reaction = Development of anti-WBC antibodies Circulatory overload = Rapid infusion of fluid Allergic transfusion reaction = Previous sensitization to blood products</p> Signup and view all the answers

Match the types of anemia with their causes:

<p>Iron-deficiency anemia = Inadequate intake of iron Pernicious anemia = Vitamin B12 deficiency due to lack of intrinsic factor Aplastic anemia = Bone marrow suppression Hemolytic anemia = Increased RBC destruction</p> Signup and view all the answers

Which of the following is not a characteristic of a clear liquid diet?

<p>Used for long-term nutritional support</p> Signup and view all the answers

Therapeutic nutrition focuses solely on the physiological needs of a client.

<p>False</p> Signup and view all the answers

What type of diet is indicated for clients who do not require dietary restrictions?

<p>Regular diet</p> Signup and view all the answers

A ______ diet consists of foods and liquids that are pureed to a liquid form to meet clients' needs.

<p>blenderized</p> Signup and view all the answers

Match the following types of modified diets to their primary characteristics:

<p>Regular diet = No dietary restrictions, adjusted to individual needs Clear liquid diet = Liquid at room temperature, minimal digestion Full liquid diet = Includes pureed foods and more variety than clear liquids Blenderized liquid diet = Pureed to liquid form, varying consistency</p> Signup and view all the answers

Which of the following medications is an anticoagulant that specifically inactivates factor Xa?

<p>Enoxaparin</p> Signup and view all the answers

Anticoagulant medications do not carry any risk of bleeding.

<p>False</p> Signup and view all the answers

What action should be taken if a patient exhibits heparin toxicity?

<p>Administer protamine sulfate</p> Signup and view all the answers

Low molecular weight heparins prevent deep-vein thrombosis (DVT) in clients who are __________.

<p>postoperative</p> Signup and view all the answers

Match the following anticoagulants with their prototypes:

<p>Heparins = Heparin (unfractionated) Low molecular weight heparins = Enoxaparin Activated factor Xa inhibitors = Fondaparinux Vitamin K antagonists = Warfarin</p> Signup and view all the answers

Which of the following is a nursing action when monitoring patients on Warfarin for potential complications?

<p>Monitor for signs of bleeding</p> Signup and view all the answers

Vitamin K is contraindicated in patients who are pregnant while on Warfarin.

<p>True</p> Signup and view all the answers

What is the expected outcome for aPTT levels when administering Heparin?

<p>60 to 80 seconds</p> Signup and view all the answers

Patients should avoid foods high in vitamin K, such as __________, to maintain consistent anticoagulation effects of Warfarin.

<p>dark green leafy vegetables</p> Signup and view all the answers

Match the medication to its primary action:

<p>Warfarin = Antagonizes vitamin K to prevent coagulation Heparin = Prevents formation of blood clots Vitamin K1 = Promotes synthesis of coagulation factors Enoxaparin = Low molecular weight heparin for anticoagulation</p> Signup and view all the answers

What is the recommended activated partial thromboplastin time (aPTT) level to keep during heparin therapy?

<p>1.5 to 2 times baseline</p> Signup and view all the answers

Heparin should be used with caution in pregnant clients.

<p>True</p> Signup and view all the answers

What should a nurse do if a patient's platelet count falls below 100,000/mm3 while on heparin?

<p>Discontinue heparin administration.</p> Signup and view all the answers

The risk for __________ at the puncture site for spinal or epidural medication administration is increased while taking heparin.

<p>hematoma</p> Signup and view all the answers

Match the following nursing actions with their corresponding nursing focus:

<p>Monitor vital signs = Indicates bleeding signs Assess insertion site for hematoma = Indicates neurological changes Monitor platelet count = Indicates risk of thrombocytopenia Administer protamine = Reverses heparin toxicity</p> Signup and view all the answers

What is the expected INR range when treating acute myocardial infarction or atrial fibrillation with warfarin?

<p>2.0 to 3.0</p> Signup and view all the answers

Dabigatran should be taken with food to reduce gastrointestinal discomfort.

<p>True</p> Signup and view all the answers

What should be monitored regularly for clients prescribed warfarin?

<p>Prothrombin time (PT) and International Normalized Ratio (INR)</p> Signup and view all the answers

Patients taking anticoagulants should avoid __________ and nonprescription medications to prevent adverse effects.

<p>alcohol</p> Signup and view all the answers

Match the following medications to their respective uses:

<p>Dabigatran = Prevention of stroke in atrial fibrillation Bivalirudin = Concurrent use with aspirin for angioplasty Argatroban = Treatment of thrombosis in heparin-induced thrombocytopenia Desirudin = Prevention of DVT post-hip replacement</p> Signup and view all the answers

What are the main types of anemia associated with chronic diseases?

<p>The main types include anemia of chronic diseases such as cancers, renal disease, liver diseases, and autoimmune conditions.</p> Signup and view all the answers

Identify two key assessment findings in a patient with iron-deficiency anemia.

<p>Key findings include pallor and low hemoglobin levels.</p> Signup and view all the answers

What is the primary goal of treating anemia caused by acute blood loss?

<p>The primary goal is to control and address the source of bleeding.</p> Signup and view all the answers

List two dietary recommendations for a patient with iron-deficiency anemia.

<p>Recommendations include increasing oral intake of iron and choosing iron-rich foods.</p> Signup and view all the answers

How do microcytic and hypochromic red blood cells relate to iron-deficiency anemia?

<p>In iron-deficiency anemia, red blood cells are often microcytic (smaller than normal) and hypochromic (less color due to low hemoglobin).</p> Signup and view all the answers

Explain the significance of hemoglobin and hematocrit levels in assessing anemia.

<p>Low hemoglobin and hematocrit levels indicate reduced oxygen-carrying capacity of the blood, which characterizes anemia.</p> Signup and view all the answers

Besides dietary changes, what is another important intervention for iron-deficiency anemia?

<p>Another important intervention is supplementation with iron supplements as prescribed.</p> Signup and view all the answers

What risk factors might increase the likelihood of older adults developing anemia?

<p>Poor diets and chewing difficulties are common risk factors for older adults developing anemia.</p> Signup and view all the answers

What is the purpose of taking iron supplements between meals?

<p>To maximize absorption of the iron supplement.</p> Signup and view all the answers

Why should vitamin C be administered with iron supplements?

<p>Vitamin C increases the absorption of iron in the body.</p> Signup and view all the answers

Name a side effect of iron supplements.

<p>Black stools.</p> Signup and view all the answers

What can result in pernicious anemia?

<p>A deficiency of intrinsic factor necessary for vitamin B12 absorption.</p> Signup and view all the answers

List two assessment findings in a patient with folate-deficiency anemia.

<p>Smooth, beefy red tongue and pallor.</p> Signup and view all the answers

What dietary recommendation should be made to clients with folate-deficiency anemia?

<p>Eat foods rich in folate, like green leafy vegetables and legumes.</p> Signup and view all the answers

What is a common cause of aplastic anemia?

<p>Chronic exposure to myelotoxic agents.</p> Signup and view all the answers

Describe the diagnostic procedure for aplastic anemia.

<p>Bone marrow aspiration.</p> Signup and view all the answers

What is the primary therapeutic focus for aplastic anemia?

<p>Restoring function to the bone marrow.</p> Signup and view all the answers

What can result from a deficiency of vitamin B12?

<p>Macrocytic anemia.</p> Signup and view all the answers

What factors can lead to inadequate absorption of vitamin B12?

<p>Gastric disease or surgery that affects intrinsic factor production.</p> Signup and view all the answers

In the context of sickle cell anemia, what specific resources provided in the text should be referred to?

<p>Refer to Chapter 31 for more information.</p> Signup and view all the answers

Why should liquid iron preparations be taken through a straw?

<p>To prevent staining of the teeth.</p> Signup and view all the answers

What is the significance of immunosuppressive therapy in aplastic anemia?

<p>To suppress the autoimmune response affecting bone marrow.</p> Signup and view all the answers

What is a significant characteristic of the incubation period for HIV infection?

<p>The incubation period for HIV infection can be 10 years or longer.</p> Signup and view all the answers

Name one high-risk group for HIV infection.

<p>Intravenous drug abusers are one high-risk group for HIV infection.</p> Signup and view all the answers

List two common symptoms that may be observed in a person with AIDS.

<p>Common symptoms include weight loss and night sweats.</p> Signup and view all the answers

What is one intervention a healthcare provider should perform for a patient with AIDS?

<p>Provide respiratory support as necessary.</p> Signup and view all the answers

What are two tests used to evaluate the progression of HIV infection?

<p>Tests include Complete Blood Cell Count and measurement of ALT levels.</p> Signup and view all the answers

What is Kaposi’s sarcoma, and how is it related to AIDS?

<p>Kaposi’s sarcoma is a neoplasm characterized by purplish-red lesions and is associated with AIDS.</p> Signup and view all the answers

Describe the importance of monitoring for opportunistic infections in AIDS patients.

<p>Monitoring for opportunistic infections is crucial as they can lead to severe complications and increased mortality.</p> Signup and view all the answers

What psychosocial support might be necessary for patients with AIDS?

<p>Providing emotional support and counseling services is essential for patients with AIDS.</p> Signup and view all the answers

What type of immunity is present at birth and includes barriers like the inflammatory response?

<p>Innate immunity.</p> Signup and view all the answers

How does acquired immunity differ from innate immunity?

<p>Acquired immunity is developed through exposure to pathogens or through immunization, while innate immunity is natural and present at birth.</p> Signup and view all the answers

What does a positive antinuclear antibody (ANA) result typically indicate?

<p>It may be associated with autoimmune diseases like systemic lupus erythematosus (SLE).</p> Signup and view all the answers

What is the purpose of the anti-dsDNA antibody test?

<p>To specifically identify double-stranded DNA antibodies related to systemic lupus erythematosus (SLE).</p> Signup and view all the answers

What is the normal range for CD4+ T-cell counts in healthy individuals?

<p>The normal range is between 500 and 1600 cells/L.</p> Signup and view all the answers

What is the primary intervention for someone experiencing anaphylaxis?

<p>The primary intervention is to quickly assess respiratory status and maintain a patent airway.</p> Signup and view all the answers

How can viral load testing inform the management of HIV?

<p>It measures the presence of HIV RNA in the blood, indicating the level of viral activity and treatment effectiveness.</p> Signup and view all the answers

What are some common symptoms of latex allergy?

<p>Symptoms can range from mild contact dermatitis to severe reactions like bronchospasm and anaphylaxis.</p> Signup and view all the answers

What is a key nursing consideration when performing skin testing for allergies?

<p>Ensure that resuscitation equipment is available due to the risk of anaphylaxis.</p> Signup and view all the answers

What is hypersensitivity in the context of allergies?

<p>An abnormal and exaggerated immune response to substances that usually do not provoke such reactions.</p> Signup and view all the answers

List two interventions for managing symptoms of allergies.

<p>Management may include using antihistamines and applying ointments or creams for local reactions.</p> Signup and view all the answers

What is the distinguishing factor between systemic and cutaneous anaphylaxis?

<p>Systemic anaphylaxis affects the entire body, while cutaneous anaphylaxis is localized to specific areas.</p> Signup and view all the answers

What does the CD4-to-CD8 ratio indicate in HIV patients?

<p>It monitors the progression of HIV, with a normal ratio being approximately 2:1.</p> Signup and view all the answers

How can one identify a specific allergen in a patient?

<p>By using a daily or weekly diary to track exposure and reactions.</p> Signup and view all the answers

What is the role of the p24 antigen assay in HIV testing?

<p>It quantifies the amount of HIV viral core protein in the serum.</p> Signup and view all the answers

Name one common food that may indicate a latex allergy.

<p>Kiwis are commonly associated with latex allergy.</p> Signup and view all the answers

What initial step should be taken before administering skin testing?

<p>Discontinue systemic corticosteroids or antihistamine therapy for 5 days as prescribed.</p> Signup and view all the answers

What should health care providers do if a patient shows signs of anaphylaxis during IV medication administration?

<p>Immediately discontinue the IV medication and start an intravenous line with normal saline.</p> Signup and view all the answers

What information does the viral culture provide in the context of HIV?

<p>It measures the amount of reverse transcriptase activity in the infected patient's blood cells.</p> Signup and view all the answers

What is immunodeficiency?

<p>Immunodeficiency is the absence or inadequate production of immune bodies.</p> Signup and view all the answers

What is one of the primary effects of a positive ANA test?

<p>It may indicate conditions like systemic lupus erythematosus or rheumatoid arthritis.</p> Signup and view all the answers

What lifestyle changes may be necessary for a client with immunodeficiency?

<p>Clients may need to adopt measures to prevent infections and maintain a balanced diet.</p> Signup and view all the answers

Why are nursing considerations critical during HIV testing?

<p>To maintain confidentiality and follow state regulations regarding positive test result reporting.</p> Signup and view all the answers

What does a post-procedure intervention entail after skin testing?

<p>Monitor the client for at least 30 minutes for possible adverse effects.</p> Signup and view all the answers

What is the role of epinephrine in an anaphylactic reaction?

<p>Epinephrine acts quickly to reverse severe allergic reactions by constricting blood vessels and opening airways.</p> Signup and view all the answers

What kind of materials should be used for a patient with a latex allergy?

<p>Nonlatex gloves and latex-safe supplies should be used.</p> Signup and view all the answers

What is a common assessment indicator for someone with immunodeficiency?

<p>Frequent infections can indicate decreased immune function.</p> Signup and view all the answers

Identify two risk factors for developing a latex allergy.

<p>Health care workers and individuals who have had multiple surgeries are at increased risk.</p> Signup and view all the answers

What is the significance of a MedicAlert bracelet for a patient with a latex allergy?

<p>It alerts healthcare providers to the patient's latex allergy in emergencies.</p> Signup and view all the answers

What types of organs can be affected by the fibrin deposits associated with systemic lupus erythematosus (SLE)?

<p>Blood vessels, lymph nodes, gastrointestinal tract, and pleura can be affected.</p> Signup and view all the answers

What are some precipitating factors believed to trigger systemic lupus erythematosus (SLE)?

<p>Medications, stress, genetic factors, sunlight or ultraviolet light, and pregnancy.</p> Signup and view all the answers

Describe what a 'butterfly rash' indicates in a patient with SLE.

<p>The butterfly rash, or malar rash, indicates erythema of the face, typically associated with SLE.</p> Signup and view all the answers

What is the role of hydroxychloroquine in the management of SLE?

<p>Hydroxychloroquine is prescribed to decrease the inflammatory response and manage SLE symptoms.</p> Signup and view all the answers

What is a key assessment finding in scleroderma that distinguishes it from other connective tissue diseases?

<p>Taut and shiny skin that is tight, hard, and thick, losing elasticity.</p> Signup and view all the answers

Name two common gastrointestinal issues faced by individuals with scleroderma.

<p>Dysphagia and gastroesophageal reflux are common gastrointestinal issues.</p> Signup and view all the answers

What is polyarteritis nodosa and its primary effect on the body?

<p>Polyarteritis nodosa is a form of systemic vasculitis causing inflammation of the arteries.</p> Signup and view all the answers

What are some interventions for managing symptoms in a patient with SLE?

<p>Monitor skin integrity, advise on energy conservation, and administer corticosteroids as prescribed.</p> Signup and view all the answers

In the context of lupus nephritis, what laboratory tests should be monitored?

<p>Monitor blood urea nitrogen (BUN) and creatinine levels for signs of renal impairment.</p> Signup and view all the answers

What supportive care measures can assist patients with scleroderma?

<p>Encourage activity as tolerated and use moist heat applications to promote skin flexibility.</p> Signup and view all the answers

Describe the long-term prognosis for polyarteritis nodosa.

<p>The prognosis is generally poor, with renal disorders and cardiac involvement being common causes of death.</p> Signup and view all the answers

What lifestyle changes may help manage and prevent flares in patients with SLE?

<p>Avoiding exposure to sunlight and managing stress are key lifestyle changes.</p> Signup and view all the answers

What strategies should be employed in managing skin integrity for patients with SLE?

<p>Instruct the client to clean their skin gently and apply prescribed ointments and creams.</p> Signup and view all the answers

Which demographic is most commonly affected by pemphigus, a rare autoimmune disease?

<p>Pemphigus typically occurs in middle age to older adults.</p> Signup and view all the answers

What is the primary focus of treatment for autoimmune disorders like Goodpasture’s Syndrome?

<p>The primary focus is on suppressing the autoimmune response with medications such as corticosteroids and plasmapheresis.</p> Signup and view all the answers

Describe the clinical manifestation that indicates pulmonary involvement in Goodpasture’s Syndrome.

<p>Shortness of breath and hemoptysis are key symptoms indicating pulmonary involvement.</p> Signup and view all the answers

What are the general symptoms that can occur following a tick bite in Lyme disease?

<p>Symptoms include a small red pimple that may develop into a ring-shaped rash and flu-like symptoms such as headaches and fatigue.</p> Signup and view all the answers

What should be done immediately after a tick is removed from the skin?

<p>The skin should be washed with antiseptic to clean the area following tick removal.</p> Signup and view all the answers

What is the primary method of prevention against Lyme disease during outdoor activities?

<p>Reducing exposure to ticks by wearing protective clothing and using insect repellents containing DEET.</p> Signup and view all the answers

What are common neurologic complications that can occur in the second stage of Lyme disease?

<p>Meningitis, facial paralysis, and peripheral neuritis are common neurologic complications.</p> Signup and view all the answers

In the third stage of Lyme disease, what progressive condition develops in the joints?

<p>Arthritis progresses, particularly affecting large joints.</p> Signup and view all the answers

What are the key components of supportive care in autoimmune disorders?

<p>Supportive care includes managing symptoms, providing fluid intake, and ensuring proper oral hygiene.</p> Signup and view all the answers

Define the term 'Nikolsky's sign' and its relevance in skin disorders.

<p>Nikolsky’s sign is the separation of the epidermis caused by rubbing the skin, indicating fragile skin conditions.</p> Signup and view all the answers

What is the role of plasmapheresis in managing autoimmune diseases?

<p>Plasmapheresis helps filter the plasma to remove autoantibodies and harmful proteins.</p> Signup and view all the answers

How can smoking influence the risk of developing Goodpasture’s Syndrome?

<p>Smoking is a contributing factor that increases the risk of developing Goodpasture's Syndrome.</p> Signup and view all the answers

What is the significance of leukocytosis and eosinophilia in skin assessments?

<p>Leukocytosis and eosinophilia indicate an inflammatory response and potential allergic reactions.</p> Signup and view all the answers

What is a common symptom associated with dysphagia in autoimmune skin disorders?

<p>Pain and discomfort while swallowing is a common symptom indicating oral lesions.</p> Signup and view all the answers

What antibiotic treatment is preferred for clients allergic to penicillin who are diagnosed with Lyme disease?

<p>Erythromycin is often used for clients who are allergic to penicillin.</p> Signup and view all the answers

What does the term 'opportunistic infections' imply in relation to AIDS?

<p>Opportunistic infections refer to infections that exploit weakened immune systems in AIDS patients.</p> Signup and view all the answers

Study Notes

Anemia Overview

  • Anemia occurs when there are insufficient red blood cells (RBCs) to transport oxygen, leading to tissue hypoxia.
  • Symptoms include fatigue, pale skin, shortness of breath, and dizziness due to lack of oxygen.

Types of Anemia

  • Iron Deficiency Anemia: Linked to inadequate iron intake or absorption.
  • Sickle Cell Anemia: Genetic disorder causing RBC deformation and reduced oxygen capacity.
  • Pernicious Anemia: Vitamin B12 deficiency impacting RBC maturation.
  • Aplastic Anemia: Bone marrow failure leading to reduced production of all blood cell types (pancytopenia).
  • Hemolytic Anemia: Destruction of RBCs, can result from mismatched blood transfusions.

Causes of Anemia

  • Blood Loss: May arise from surgery, trauma, or heavy menstruation.
  • Chemotherapy & Immunosuppressants: These agents can suppress the bone marrow, leading to decreased RBC production.
  • Nutritional Deficiencies: Lack of iron, vitamin B12, and other essential nutrients can contribute, particularly in iron deficiency and pernicious anemia.

Iron Deficiency Anemia - Specific Causes

  • Dietary Sources: Insufficient intake of meat, fish, and poultry.
  • Surgical Interventions: Gastric bypass surgery can impact nutrient absorption.
  • Pregnancy: Increased fetal iron demand can deplete maternal iron stores.
  • Pica: Eating non-nutritive substances, which may interfere with nutritional intake.
  • Common in infants and children due to low dietary iron or excessive milk consumption.

Signs and Symptoms of Anemia

  • Low hematocrit and hemoglobin levels indicate severity.
  • Gastrointestinal Manifestations may include:
    • Stomatitis: Inflammation of the mouth and lips.
    • Glossitis: Inflammation of the tongue.

Pharmacology

  • Medications:
    • Ferrous Sulfate: Oral iron supplement.
    • Iron Dextran: Intravenous or intramuscular iron for severe cases.
  • Stools: Dark or black stools can indicate iron intake but should not confuse with gastrointestinal bleeding.

Treatment Strategies

  • Dietary Management: Encourage consumption of iron-rich and vitamin C-rich foods:
    • Foods High in Iron: Meat, fish, poultry, spinach, and whole grains.
    • Vitamin C Sources: Enhance iron absorption.
  • Infants & Children Specifics:
    • Limit excessive milk intake to prevent nutrient deficiencies.
    • Supplements of iron and vitamin C may be necessary.

Packed Red Blood Cells (PRBC)

  • Whole blood component used to boost hemoglobin and hematocrit (H&H) levels in cases of anemia, trauma, or surgery.
  • Must be administered within 4 hours of removal from refrigeration.
  • Normal hemoglobin range: 12 - 18 g/dL; critical value < 7 g/dL indicates severe need for transfusion.
  • Symptoms of shock include:
    • Pale and clammy skin
    • Rapid respiration
    • Fatigue and weakness
  • Expected lab results after administering 1 unit of PRBC for Hgb of 8 - 11 g/dL: Hgb may rise to 9, Hct to 38%.

Platelets (PLT)

  • Essential for blood clotting; help form scabs and stop bleeding.
  • Indicated for clients with thrombocytopenia (low platelets), typically caused by cancers or certain types of anemia.
  • Thrombocytopenia defined as platelets ≤ 150,000; particularly critical at 50,000, where risk of bleeding becomes deadly.

Fresh Frozen Plasma (FFP)

  • Contains clotting factors that facilitate platelet aggregation to form clots.
  • Administered to patients with low clotting factors, such as those with hemophilia or liver disease (e.g., cirrhosis, hepatitis).
  • Important to differentiate between low platelets and low clotting factors; plate transfusion is ineffective for patients with low clotting factors as they lack the necessary components (clotting factors) to create a stable clot.

Key Blood Components

  • Leukocytes (WBC): White blood cells crucial for immune response.

  • Memory trick: L - Like to Clean helps remember leukocytes' function of cleaning and fighting infections.

  • Erythrocytes (RBC): Red blood cells responsible for oxygen transport in the body.

  • Hemoglobin (HgB): Protein in RBC that carries oxygen.

  • Memory trick: HemOglobin = O2 carriers, emphasizing its role.

  • Erythropoietin (EPO): Hormone that stimulates RBC production.

  • Memory trick: EryTHROpoietin THROws signals to produce more RBCs when oxygen levels are low.

Platelets and Coagulation

  • Platelets (Thrombocytes): Cell fragments crucial for blood clotting. They form a plug to stop bleeding from cuts.

  • Hematopoiesis: The process of blood cell formation, occurring primarily in the bone marrow.

  • Hemostasis: The process of blood clotting which prevents excessive bleeding.

Clot Formation and Breakdown

  • Prothrombin: A protein that is converted to thrombin during the clotting process.

  • Thrombin: An enzyme that converts fibrinogen to fibrin, leading to clot formation.

  • Fibrin Mesh: Forms the structural basis of blood clots by intertwining to trap blood cells.

  • Clot Destruction: After healing, clots retract, and Plasmin degrades fibrin to break down the clot.

Summary of Hemostasis Process

  • Sequence: Prothrombin → Thrombin → Fibrin mesh = Formation of the clot.
  • Clot retraction and breakdown ensure normal blood flow post-injury.

Anemia Overview

  • Anemia implies a deficiency of red blood cells (RBCs) necessary for oxygen transport to tissues.
  • Symptoms include fatigue, paleness, shortness of breath, and dizziness.

Types of Anemia

  • Iron deficiency anemia
  • Sickle cell anemia
  • Pernicious anemia

Anemia Causes

  • Blood loss from surgery, trauma, or heavy menstruation.
  • Chemotherapy and immunosuppressants affecting bone marrow function.
  • Nutritional deficiencies, particularly iron and vitamin B12.

Iron Deficiency Anemia

  • Most prevalent form of anemia globally, resulting from insufficient iron (Fe) for RBC production.

Causes of Iron Deficiency Anemia in Infants & Children

  • Premature birth.
  • Insufficient dietary intake of iron-rich foods.
  • Excessive milk consumption leading to poor iron absorption.
  • Exclusively bottle-fed preterm infants.
  • Adhering to a vegan diet without adequate iron sources.

Treatment of Iron Deficiency Anemia

  • Emphasize high-iron foods such as meat, fish, poultry, spinach, and whole grains.
  • Pair iron-rich foods with vitamin C for enhanced absorption.

Nutritional Recommendations

  • Limit excessive milk intake in children to avoid iron-deficiency.
  • Include fortified breads and cereals in the diet.
  • Incorporate high-iron foods with high vitamin C sources and ensure adequate calcium and vitamin D intake.

Signs & Symptoms

  • Dyspnea (shortness of breath).
  • Pallor (pale skin).
  • Tachycardia (increased heart rate).

Pharmacological Treatments

  • Ferrous Sulfate (oral) for iron supplementation.
  • Iron Dextran (IV/IM) as an alternative delivery method for iron.

Key Points on Iron Supplementation

  • Dark or black stools are a normal side effect of iron supplements, not an indication of gastrointestinal bleeding.
  • Medications should be taken on an empty stomach for better absorption—ideally one hour before meals.
  • Educate parents to recognize the importance of iron-rich foods as children transition to solid diets, noting that fetal iron reserves deplete around 5-6 months.

BMP Panel Overview

  • Basic Metabolic Panel (BMP) measures essential metabolic indicators.
  • Key components: Sodium (Na+), Potassium (K+), Chloride (Cl-), Carbon Dioxide (CO2), Bicarbonate (HCO3), Blood Urea Nitrogen (BUN), Creatinine, and Glucose.

Sodium (Na+)

  • Normal range: 135 - 145 mEq/L; swells the body with fluid.

Potassium (K+)

  • Normal range: 3.5 - 5.0 mEq/L; critical for heart muscle function.
  • High potassium (hyperkalemia) risk includes peaked T waves and ST elevation on ECG.
  • Low potassium (hypokalemia) risk includes flat T waves, ST depression, and U waves.

Chloride (Cl-)

  • Maintains acid-base balance; part of BMP analysis.

Carbon Dioxide (CO2) & Bicarbonate (HCO3)

  • CO2 and HCO3 work together to regulate pH; excessive CO2 can lead to acidosis.
  • Memory aids: "Carbon DiACID" for CO2, "Bicarb Base" for HCO3.

Blood Urea Nitrogen (BUN) & Creatinine

  • BUN normal levels: 7 - 20 mg/dL; elevated over 20 usually indicates dehydration.
  • Creatinine normal level: 0.6 - 1.3 mg/dL; levels above 1.3 suggest kidney injury.

Glucose

  • Normal ranges: 70 - 120 mg/dL; hyperglycemia (over 120) indicates uncontrolled diabetes.
  • Hypoglycemia (60 or below) is critical, needing prompt intervention to prevent brain damage.

Electrolytes and Their Clinical Implications

  • Potassium:

    • High potassium intervention: IV calcium gluconate, 50% dextrose + insulin, Kayexalate, dialysis.
    • Priority monitoring for heart function during treatment.

  • Sodium:

    • Symptoms of low sodium include mental status changes, seizures, and coma - prioritizing patient safety.
    • Symptoms of high sodium include edema, increased muscle tone, and flushed skin.

Calcium and Magnesium

  • Calcium (Ca) Normal Range: 9.0 - 10.5 mEq/L; essential for muscle contraction.

    • High calcium signs include kidney stones, constipation, and "stones, moans, and groans."
    • Low calcium tests: Trousseau’s and Chvostek’s signs.

  • Magnesium (Mg) Normal Range: 1.3 - 2.1 mEq/L; regulates neuromuscular activity.

    • High magnesium leads to decreased deep tendon reflexes (DTR) and risk of ventricular fibrillation.
    • Low magnesium presents with Torsades de Pointes and hyperreflexia.

Clinical Priorities

  • Immediate actions for dangerously high potassium include starting IV insulin and dextrose.
  • Careful administration of potassium with max rates to prevent complications.
  • Recognize symptoms of electrolyte imbalances, relevant to both diagnostics and patient treatment strategies.

Pathophysiology

  • Systemic Lupus Erythematosus (SLE) is an autoimmune disorder causing the body to attack its own tissues.
  • Major inflammation occurs in the skin, joints, kidneys, and heart, leading to potential organ failure, particularly of the kidneys over time.
  • Common triggers include excessive sun exposure, stress (both physical and emotional), smoking, and infections (sepsis).

Causes & Risks

  • The exact cause of SLE is unknown.
  • Most commonly affects women aged 14 to 45.
  • UV radiation from sunlight exacerbates the condition, highlighting the need for sun protection.

Signs & Symptoms

  • Presence of a butterfly-shaped rash across the cheeks and nose.
  • Fever exceeding 100°F, which should be reported to healthcare providers.
  • Joint pain and swelling are common symptoms.

Labs

  • Elevated creatinine levels (above 1.3 mg/dL) indicate kidney dysfunction; levels above 1.3 are considered concerning.
  • Decreased white blood cell count, normal range is 5,000 to 10,000.
  • Inflammation markers may show increased ESR (erythrocyte sedimentation rate) and CRP (C Reactive Protein).

Client Education

  • Important to avoid the "4 Ss":
    • Sun exposure / UV light: Protective measures are crucial.
    • Smoking: Should be completely avoided.
    • Stress: Management of physical and emotional stress is essential.
    • Sepsis / infections: Prompt treatment of infections is vital.
  • Notify healthcare providers immediately in case of fever.

Pharmacology

  • Corticosteroids like Prednisone are used for treatment.
  • Other medications include:
    • Hydroxychloroquine: An immunosuppressant.
    • Methotrexate: Often used in severe cases.
    • Infliximab: Another immunosuppressant option.
    • Azathioprine (brand: Imuran): Immunosuppressant for long-term management.

Types of Transfusion Reactions

  • Febrile Reaction: Mild allergic response; symptoms include flushing, itching, low-grade fever.
  • Anaphylactic Reaction: Severe allergic reaction; symptoms include wheezing, hives, hypotension.
  • Circulatory Overload: Symptoms include dyspnea, crackles in lungs, elevated blood pressure; risk of heart failure.
  • Hemolytic Reaction: Symptoms include hypotension, low back pain, tachycardia, hemolyzed RBCs.

Signs and Symptoms

  • Febrile Reaction:
    • Flushing and itching
    • Generally mild
  • Anaphylactic Reaction:
    • Wheezing and hives
    • Risk of decreased blood pressure
  • Circulatory Overload:
    • Lung crackles and dark urine
    • Shortness of breath and jugular vein distention
  • Hemolytic Reaction:
    • Hypotension and tachycardia
    • Urine specimen may show hemolyzed RBCs

Risk Factors and Actions for Circulatory Overload

  • Potential for heart failure due to excess fluid.
  • Priority actions include:
    • SLOW the transfusion; maximum infusion time is 4 hours.
    • Administer diuretics (e.g., Furosemide) as needed.
    • Elevate head of bed (HOB) to at least 45 degrees for comfort.
    • Monitor vital signs, including heart rate, blood pressure, and respiratory rate.

Management of Hemolytic Reaction

  • Indicators include low back pain and fever; immediate actions are critical.
  • First steps to take upon detection:
    • Stop the transfusion immediately.
    • Hang a new IV set with normal saline (0.9% sodium chloride).
    • Report the incident to a healthcare provider.
    • Assess vital signs and monitor for further complications.
    • Obtain blood and urine specimens for analysis.

Key Considerations

  • Monitor for hyperkalemia; elevated potassium (>5.0) can lead to cardiac issues.
  • Pay attention to ECG changes, such as peaked T waves.
  • Maintain clear communication with the healthcare provider regarding patient status and reactions.

Blood Transfusion Procedures

  • Five Steps of Transfusion:

    • Verify order with two RNs, confirming patient name, blood type, and Rh factor.
    • Obtain and document vital signs prior to starting the infusion.
    • Use an 18 G IV catheter for administration.
    • Prime transfusion tubing with 0.9% sodium chloride (normal saline).
    • Monitor the patient closely for signs and symptoms of transfusion reactions, especially during the first hour.

  • Safe Administration of PRBCs:

    • Always prime tubing with 0.9% sodium chloride before starting a blood transfusion.
    • Monitor vital signs every 15 minutes during the first hour of the transfusion.
    • Confirm blood product type and compatibility with the patient’s blood type with a second nurse.

Autologous Transfusion

  • Definition:

    • Collection and re-transfusion of a patient's own blood, often practiced for patients with religious beliefs (like Jehovah's Witnesses) that prohibit receiving blood from others.

  • Storage and Rejection:

    • Autologous blood can be stored under frozen conditions for up to three years.
    • Because it is the patient’s own blood, it is usually not rejected by the immune system.

Nursing Interventions and Priorities

  • Top Missed Questions in Practice:

    • When administering PRBCs to an anemic patient, ensure a functioning central venous access catheter and verify with two licensed nurses.
    • If a patient develops a high fever and tachycardia during blood infusion, priority actions include stopping the infusion, notifying the provider, and assessing vital signs.
    • For administering synthetic erythropoietin in a chronic renal disease patient, hold the dose if hemoglobin (HgB) is below 10 g/dL.

  • General Nursing Actions:

    • Assess the patient’s hemoglobin and hematocrit levels before blood transfusion.
    • Monitor heart and lung sounds to ensure patient stability.
    • Maintain proper urine output to assess renal function and fluid status.

Blood Types and Rh Factor

  • Main blood types include A, B, AB, and O.
  • Type O is the universal donor, compatible with all blood types.
  • Type AB is the universal recipient, can accept blood from all types.
  • In blood transfusions, type A can only donate to type A and AB; type B can donate to type B and AB.

Rh Factor

  • Rh factor indicates the presence (+) or absence (-) of specific antibodies on blood cells.
  • Rh-positive blood has Rh antigens, while Rh-negative blood does not.
  • An indirect Coombs' test determines blood type's Rh factor to ensure safe transfusions.

Indirect Coombs' Test

  • Used to identify circulating antibodies against red blood cells (RBCs).
  • Essential for compatibility in blood transfusions.

RhoGAM

  • Administered to Rh-negative pregnant women to prevent Hemolytic Disease of the Newborn (HDN).
  • Protects an Rh-negative mother from producing antibodies against an Rh-positive baby.
  • Antibodies from the mother can attack the baby's red blood cells, causing hemolysis.

Key Testing and Nursing Considerations

  • For a patient with AB blood receiving type A blood, proper protocol must be followed during transfusion.
  • Common misconceptions about blood types relevant to patient education and safety in transfusions.

Antiplatelets: Abciximab

  • Abciximab is a glycoprotein (GP) receptor inhibitor, used primarily in the management of acute coronary syndromes.
  • Functions as an antiplatelet agent by preventing platelet aggregation, which reduces the risk of thrombus formation.
  • Administered intravenously, typically in a hospital setting during and after certain cardiac procedures.

Nursing Care Considerations

  • Monitor hemoglobin levels to assess for potential bleeding complications, as lower levels may indicate hemorrhage.
  • Regularly check platelet counts to ensure they remain within a safe range, given the risk of thrombocytopenia associated with this medication.
  • Conduct thorough assessments for signs of bleeding, such as unusual bruising, blood in urine or stool, and prolonged bleeding from cuts.
  • Educate patients on the importance of reporting any signs of bleeding or unusual symptoms promptly.
  • Ensure adherence to protocols for handling and administering the drug, to maximize effectiveness and minimize risks.

Key Terms

  • Hemoglobin: A protein in red blood cells that carries oxygen; important to monitor during therapy to prevent complications.
  • Platelets: Blood cells involved in clotting; critical to assess levels due to the drug’s action on platelet aggregation.

Epistaxis Overview

  • Epistaxis refers to nosebleeds, characterized as acute hemorrhages from the nostril, nasal cavity, or nasopharynx.
  • Commonly results from dry mucous membranes due to environmental factors such as dry air or high altitudes.
  • Can be triggered by trauma, including activities like nose picking or inserting foreign objects into the nose.

Nursing Interventions

  • Position the child by having them sit up and lean forward to minimize swallowing blood and potential aspiration.
  • Apply direct pressure by pinching the nostrils just below the nasal bone to stem the bleeding.
  • Use a cold pack on the bridge of the nose to constrict blood vessels and reduce blood flow.
  • Maintain a calm environment to alleviate anxiety, which may contribute to increased blood pressure and bleeding.

NCLEX Tips

  • Essential actions include having the child pinch their nose closed tightly and setting a timer for 10 minutes to apply consistent pressure.
  • The nurse should encourage keeping calm and avoiding excessive movement or agitation during the process.

HESI Questions Focus

  • Q1 emphasizes proper methods to stop an epistaxis, highlighting the importance of positioning and pressure application.
  • Q2 addresses the nursing actions to take during a bloody nose incident, reinforcing interventions like pinching the nose and timing.

Erythropoietin Overview

  • Erythropoietin (epoetin alfa) is a kidney-produced hormone vital for red blood cell (RBC) production.
  • Its primary function is to stimulate bone marrow activity to enhance RBC synthesis.
  • Essential for maintaining adequate oxygen levels in the blood by increasing hemoglobin levels.

Indications for Use

  • Commonly indicated for treating anemia, characterized by a reduced red blood cell count and lower hemoglobin levels.
  • Frequently prescribed for patients with conditions leading to chronic anemia, such as kidney disease or cancer.

Electrolytes and Minerals

  • Sodium (Na+): Normal range is 135-145 mEq/L; essential for body fluid balance.
  • Potassium (K+): Normal range is 3.5-5.0 mEq/L; crucial for heart muscle function.
  • Chloride (Cl-): Normal range is 97-107 mEq/L; helps maintain acid-base balance.
  • Calcium (Ca): Normal range is 9.0-10.5 mg/dL; important for muscle contraction.
  • Magnesium (Mg+): Normal range is 1.3-2.1 mg/dL; involved in muscle relaxation.

Proteins and Metabolites

  • Albumin: Normal range is 3.5-5.0 g/dL; produced by the liver, important for maintaining oncotic pressure.
  • Creatinine: Levels over 1.3 mg/dL indicate potential kidney dysfunction.
  • Blood Urea Nitrogen (BUN): Normal range is 10-20 mg/dL; assesses kidney function.

Metabolic Indicators

  • Glucose: Normal range is 70-110 mg/dL; low levels (hypoglycemia) can lead to brain damage.

Blood Cell Counts

  • White Blood Cells (WBC): Normal range is 5,000-10,000 cells/mcL; elevated levels suggest infection.
  • Red Blood Cells (RBC): Male range is 4.7-6.1 million/mcL; female range is 4.2-5.4 million/mcL; low levels indicate anemia.
  • Hemoglobin (Hgb): Male normal range is 14-18 g/dL; female range is 12-16 g/dL; levels below 7 g/dL may require blood transfusion.
  • Hematocrit (Hct): Male normal range is 42-52%; female range is 37-47%.

Platelets and Coagulation

  • Platelets (PLTS): Normal range is 150,000-400,000/mcL; important for blood clotting.
  • Prothrombin Time (PT): Normal range is 11-12.5 seconds; used to assess coagulation.
  • Activated Partial Thromboplastin Time (aPTT): Normal range is 30-40 seconds; monitors anticoagulation therapy.

Anticoagulation Therapy

  • Therapeutic Range for aPTT: 46-70 seconds when on anticoagulants.
  • International Normalized Ratio (INR): Normal range is 0.9-1.2; therapeutic range for anticoagulation is 2-3.

CBC - Complete Blood Count

  • Measures components of blood to assess overall health.
  • Key components: White Blood Cells (WBC), Hemoglobin (Hgb), Hematocrit (HCT), and Platelets (PLT).

White Blood Cells (WBC)

  • Normal range: 5,000 - 10,000 cells per microliter.
  • Functions as part of the immune system to fight infections.

Hemoglobin (Hgb)

  • Oxygen carriers in red blood cells.
  • Normal range: 12 - 18 g/dL.
  • Risky range: 8 - 11 g/dL; requires reporting to healthcare provider (HCP) before surgery.
  • Levels below 7 g/dL indicate significant risk and likely need for blood transfusion.

Hematocrit (HCT)

  • Represents the ratio of red blood cells to total blood volume.
  • Normal range: 36 - 54%.
  • Elevated hematocrit indicates dehydration.
  • Decreased hematocrit can result from fluid volume overload, bleeding, anemia, or malnutrition.

Platelets (PLT)

  • Essential for blood clotting; assist in forming scabs and can contribute to dangerous blood clots.
  • High platelet counts may indicate dehydration.

Red Blood Cell Count (RBC)

  • Normal range: 4 - 6 million cells per microliter.
  • Low RBC counts suggest anemia or renal failure.
  • High RBC counts may indicate dehydration.

General Risks and Symptoms

  • Signs of anemia include pale, cool, clammy skin and fatigue, which are key for patient assessments.
  • Patients with gastrointestinal (GI) bleeding may present with abnormal hematocrit levels, necessitating immediate nurse action.

Overall Blood Lab Implications

  • Close monitoring of hemoglobin and hematocrit levels is crucial for patient safety and management during clinical procedures.

Sickle Cell Anemia

  • Red blood cells (RBCs) change from round and plump to a distorted sickle shape, leading to reduced oxygen transport.

  • Misshapen RBCs have a shorter lifespan, resulting in anemia and decreased oxygen delivery to tissues.

  • Sickle cells can obstruct small blood vessels, causing ischemia and pain, known as a vaso-occlusive crisis or sickle cell crisis.

  • Common symptoms include:

    • Sudden one-sided arm weakness
    • Swelling in hands and feet (Dactylitis)
    • New-onset paralysis of extremities

  • Complications:

    • Splenic sequestration crisis can lead to a rapidly enlarging spleen and blood clots.
    • Low blood pressure due to impaired blood flow.

  • Treatment approaches:

    • Hydration through IV fluids to prevent dehydration.
    • Bed rest to minimize energy expenditure.
    • Pain management using patient control analgesia (PCA) pumps.
    • Higher doses of pain medication may be required; consult the healthcare provider.

Pernicious Anemia

  • Caused by the inability of the body to absorb vitamin B12, essential for RBC production.

  • It results from a lack of intrinsic factor in the gastrointestinal tract, necessary for B12 absorption.

  • Common symptoms include:

    • Glossitis: inflamed, red, smooth tongue.
    • Extreme weakness and fatigue.
    • Jaundice: a yellowish tint to the skin.

  • Treatment includes:

    • Administration of vitamin B12 via injection (IM or IV) is essential.
    • Oral supplementation of B12 is ineffective due to absorption issues.

Sickle Cell Anemia

  • Sickle cell anemia alters the shape of red blood cells (RBCs) from round to sickle-shaped, affecting oxygen transport.
  • Misshaped RBCs have a shorter lifespan compared to normal RBCs, resulting in less oxygen being delivered to the body.
  • Sickle cells can obstruct blood flow in small vessels, leading to ischemia and severe pain during vaso-occlusive crises, known as "sickle cell crises."
  • Common signs and symptoms include:
    • One-sided arm weakness
    • Swelling of hands and feet (dactylitis)
    • New-onset paralysis of extremities
  • Complications may include splenic sequestration crisis, characterized by a rapidly enlarging spleen and low blood pressure.
  • Treatment strategies focus on:
    • Hydration using IV fluids
    • Bed rest
    • Regular neurological assessments during crises

Pernicious Anemia

  • Pernicious anemia results from a lack of intrinsic factor, which is necessary for vitamin B12 absorption in the gastrointestinal tract.
  • Clinical manifestations include:
    • Glossitis: inflamed, smooth red tongue
    • Extreme weakness and pallor, indicated by jaundice presenting as pale yellow skin.
  • Vitamin B12 can only be administered via injection (IM or IV) due to absorption issues when given orally.
  • Lifelong vitamin B12 injections might be necessary for patients, especially after total gastrectomy.

Pathophysiology

  • Sjogren’s Syndrome is an autoimmune disorder where the immune system mistakenly attacks the body.
  • It primarily causes dryness in various parts of the body, including skin, eyes, joints, and mouth.

Signs & Symptoms

  • Common symptoms include:
    • Dry eyes (keratoconjunctivitis sicca)
    • Dry mouth (xerostomia)
    • Dry skin, vaginal dryness, and nasal dryness
    • Joint pain and stiffness

Causes & Risks

  • Typically affects individuals with known risk factors, such as:
    • Age over 40 years
    • Women are ten times more likely to be affected
    • Presence of other rheumatic diseases (e.g., rheumatoid arthritis, lupus)

Education

  • Eye Care: Use of artificial tears to alleviate dryness.
  • Nasal Care: Utilize humidifiers to maintain moisture.
  • Skin Care:
    • Avoid harsh soaps and hot showers; use lukewarm water instead.
    • Apply lubricants for vaginal dryness.
  • Oral Care:
    • Regular dental check-ups to monitor oral health.
    • Use artificial saliva or chew gum to stimulate saliva production.
    • Increase fluid intake to combat dryness.

Pharmacology

  • Treatment options include:
    • Immunosuppressants to manage immune response.
    • Hydroxychloroquine (brand: Plaquenil) for symptom relief.
    • Methotrexate (brand: Trexall) to reduce inflammation and immune activity.

Antiplatelets Overview

  • Acetylsalicylic acid (Aspirin) and Clopidogrel are key antiplatelet medications used to prevent clot formation.
  • Antiplatelet therapy is crucial for post-percutaneous coronary intervention (PCI).

Mechanism of Action (MOA)

  • These medications prevent platelets from aggregating, reducing the risk of clots by keeping platelets dispersed.
  • They do not lower platelet counts but reduce the likelihood of them sticking together.

Key Numbers and Monitoring

  • Normal platelet count ranges from 150,000 to 400,000.
  • Notify healthcare provider (HCP) if platelet count is below 150,000; extremely risky if below 50,000.
  • Hemoglobin levels < 7 indicate critical conditions ("Hgb < 7 = HEAVEN").

Indications for Use

  • Aspirin and Clopidogrel are primarily indicated for:
    • Heart:** Myocardial Infarction (MI) prevention
    • Brain: Transient Ischemic Attack (TIA) prevention
    • Extremities: Peripheral Arterial Disease (PAD) prevention
    • Prevention of stent or bypass re-occlusion.

Adverse Effects

  • Key signs of Aspirin toxicity include:
    • Tinnitus
    • Hyperventilation
  • Treatment for toxicity involves administering activated charcoal and notifying HCP.

Patient Care Priorities

  • In cases of low platelet counts:
    • Hold the medication.
    • Question any prescriptions.
    • Notify the healthcare provider.

Memory Aids

  • "Don’t let NCLEX trick you!" with common platelet counts to remember:
    • 75,000 and 40,000 as critical thresholds for action.
  • Aspirin toxicity monitoring emphasizes assessing for tinnitus.

Overview of Disseminated Intravascular Coagulation (DIC)

  • DIC is a critical disorder characterized by excessive activation of blood clotting proteins.
  • It leads to the formation of numerous blood clots throughout the body.

Pathophysiology of DIC

  • Clots obstruct small blood vessels, resulting in organ infarction, which hinders their proper function due to inadequate oxygen supply.
  • The initial overactive clotting phase causes the formation of thrombi, leading to organ damage and failure.

Consecutive Effects

  • As DIC progresses, the body depletes its supply of platelets and clotting factors, which are essential for normal blood clotting processes.
  • The depletion results in a severe coagulopathy, where the body loses its ability to control bleeding.

Clinical Manifestations

  • Widespread bleeding occurs throughout the body as clotting factors and platelets are exhausted.
  • Common bleeding sites include:
    • Skin (petechiae and ecchymosis)
    • Nose (epistaxis)
    • Mouth (gingival bleeding)
    • Internal organs (potentially life-threatening hemorrhage)

Pathophysiological Sequence

  • Initial overactive clotting → leads to thrombi and organ infarcts.
  • Resulting depletion of platelets and clotting factors → incapacity for normal clotting.
  • Final outcome is massive bleeding throughout the body.

Hemophilia Overview

  • Hemophilia is an inherited bleeding disorder characterized by impaired blood clotting.
  • Patients face increased bleeding risks from minor injuries, including small cuts or falls.

Types of Hemophilia

  • Hemophilia A: Caused by a deficiency of clotting factor VIII (8).
  • Hemophilia B: Caused by a deficiency of clotting factor IX (9).

Signs & Symptoms

  • Common symptoms include:
    • Pain, bruising, and petechiae (small red or purple spots on the body).
    • Joint stiffness and lack of mobility.
    • Anxiety related to bleeding risks.

Nursing Care Considerations

  • Nursing Care Plan Concerns:
    • Ineffective tissue perfusion.
    • Potential fluid volume deficits.
  • Important note: Monitor for joint stiffness and pain during assessments.

Treatment Protocols

  • Avoid injections: intravenous (IV), intramuscular (IM), subcutaneous (SQ) are discouraged.
  • Administer coagulation replacement factors as needed.
  • Encourage using ice packs and elevating the affected area to manage symptoms.

Emergency Response

  • For acute injuries, apply ice to the affected area and elevate to reduce swelling.

Medication Considerations

  • Caution against using Meperidine for severe pain in patients with hemophilia due to bleeding risk.

Patient Education and Safety

  • Recommended precautions:
    • Wear a medical alert bracelet consistently.
    • Avoid over-the-counter aspirin, which increases bleeding risk.
  • Vaccination Guidance:
    • Administer vaccines via the subcutaneous route using the smallest needle possible.

Hemophilia Overview

  • Hemophilia is an inherited bleeding disorder characterized by the inability of blood to clot properly, leading to an increased risk of excessive bleeding from minor injuries.
  • Two main types:
    • Hemophilia A: Caused by a deficiency in clotting factor VIII.
    • Hemophilia B: Caused by a deficiency in clotting factor IX.

Symptoms and Associated Concerns

  • Common symptoms include:
    • Pain, bruising, and petechiae (small red or purple spots on the body).
  • Key nursing care concern:
    • Ineffective tissue perfusion due to potential bleeding complications.

Treatment Protocols

  • Avoid injections, including intravenous (IV), intramuscular (IM), and subcutaneous (SQ) routes to minimize bleeding risk.
  • Administer coagulation replacement factors to help with clotting.
  • Immediate care for joint swelling involves:
    • Applying ice to the affected area.
    • Elevating the injured limb.

Pain Management

  • Avoid NSAIDs like aspirin, which can exacerbate bleeding risk.
  • Do not use razors or engage in contact sports due to the risk of injury.

Education and Patient Considerations

  • Patients need to be educated on avoiding high-risk activities and medications.
  • An indication for further teaching includes misconceptions about engaging in contact sports for exercise.

Kaplan and HESI Questions Insights

  • For caregivers of patients with hemophilia:
    • Initial response to swelling from injury should include ice application and limb elevation.
    • When reviewing medications, question the appropriateness of meperidine use due to its potential risks.

Nursing Care Implications

  • Patient assessment involves monitoring for signs of bleeding, pain management, and ensuring effective treatment protocols are followed.
  • Continuous education is vital to ensure patient safety and understanding of the condition.

Cardiac Labs Overview

  • Troponin Levels: Troponin levels greater than 0.5 ng/mL indicate myocardial infarction (MI).
  • Myocardial Infarction (MI): Also known as a heart attack, characterized by damage to the heart muscle due to lack of blood flow.
  • BNP (B-type Natriuretic Peptide): Elevated BNP levels are indicative of heart failure, providing additional context for cardiac assessment.
  • Heart Trauma: Trauma to heart muscle can influence troponin and other cardiac lab results, making it essential to evaluate history and clinical signs.

Thrombocytopenia Overview

  • Defined as low platelet count: ≤ 150,000 platelets/mm³.
  • Normal platelet range: 150,000 - 400,000 platelets/mm³.
  • Major risk threshold: 100,000 platelets/mm³.
  • Deadly threshold: 50,000 platelets/mm³ or less.

Signs and Symptoms

  • High risk for hemorrhaging; even minor injuries can lead to significant bleeding.
  • Common symptoms include:
    • Bleeding gums.
    • Petechiae: tiny red-brown-purple spots on the skin.

Causes of Thrombocytopenia

  • Immunosuppressants use.
  • Liver diseases such as hepatitis or cirrhosis.
  • Immune thrombocytopenic purpura (ITP).

Complications

  • Increased risk for injury and bleeding.

Nursing Priorities and Interventions

  • Main nursing diagnosis: Risk for injury.
  • Hold medications that affect bleeding, particularly:
    • Heparin.
    • Aspirin.
    • Clopidogrel.
    • Enoxaparin.
  • Considerations for labor and epidural due to bleeding risks associated with low platelet counts.

Laboratory Considerations

  • Monitor laboratory values:
    • WBC count: 3,000/mm³.
    • Hemoglobin: 9.5 g/dL.
    • Platelets: 68,000/mm³.
  • Notify healthcare provider concerning critical lab results:
    • Platelet counts dropping (e.g., 45,000/mm³).

Critical Thinking for NCLEX

  • Anticipate questions regarding priority nursing actions based on laboratory values and risks associated with thrombocytopenia.
  • Consider potential complications based on platelet levels when making nursing decisions.

Definition of Polycythemia

  • Polycythemia is characterized by an increased production of red blood cells (RBCs) in response to hypoxia (low oxygen levels).
  • Excess RBCs lead to hyperviscosity of the blood, which can result in complications like blood clots.

Types of Polycythemia

  • Polycythemia Vera

    • It is a neoplastic condition (related to cancer) causing high RBC production.
    • Associated with low erythropoietin levels.

  • Secondary Polycythemia

    • Triggered by hypoxemia (low blood oxygen), resulting in increased RBCs.

Diagnosis

  • Primary diagnostic criteria include:
    • Elevated hemoglobin (HgB) levels.
    • Increased hematocrit (HcT) readings.
    • Hypercellularity in bone marrow.
    • Hyperuricemia (high uric acid levels in the blood).
  • Communication of elevated H&H results to healthcare providers is crucial.

Symptoms and Manifestations

  • Increased blood pressure (BP).
  • Hepatomegaly: enlargement of the liver.
  • Splenomegaly: enlargement of the spleen.
  • Sluggish blood flow, akin to traffic jams in the vessels, heightens the risk of strokes (Cerebrovascular Accident - CVA).

Pathophysiology

  • Disseminated Intravascular Coagulation (DIC) is a severe condition characterized by rapid onset.
  • It leads to simultaneous bleeding and clotting, resulting in organ failure.
  • Abnormal clot formation depletes clotting factors, preventing the body from stopping bleeding.

Causes

  • DIC is a complication rather than a standalone disease, triggered by various underlying conditions:
    • Infection & Sepsis: Blood infections that overwhelm the body's systems.
    • Major Trauma: Significant injuries that can initiate DIC.
    • Shock: Severely low blood pressure affecting circulation.
    • Cancer & Neoplastic Diseases: Tumors that can cause abnormal clotting.
    • Obstetric Complications: Issues during pregnancy or childbirth that can lead to DIC.

Signs & Symptoms

  • Symptoms arise from both excessive bleeding and clotting:
    • Severe Bleeding: Widespread bleeding seen as petechiae (small purple spots), purpura, and bleeding from gums, eyes, and nose (epistaxis).
    • Hematuria: Blood in urine.
    • Melena: Dark, tarry stools indicative of gastrointestinal bleeding.
  • Blood Clots can manifest in various forms:
    • Cerebrovascular Accident (CVA): Stroke symptoms include unilateral weakness, slurred speech, and facial droop.
    • Myocardial Infarction (MI): Chest pain and sweaty symptoms signify a heart attack.
    • Pulmonary Embolism (PE): Difficulty breathing due to clots in the lungs.
    • Deep Vein Thrombosis (DVT): Swelling of one leg, indicating clot presence.

Treatments

  • The primary focus is on treating the underlying cause of DIC.
  • Additional supportive treatments may include:
    • Blood Transfusions: To replace lost blood volume.
    • Packed Red Blood Cells (RBC): Specifically to address blood loss.
    • Fresh Frozen Plasma (FFP): Replaces depleted coagulation factors.
    • Platelets: To help restore normal platelet counts.
    • Cryoprecipitate: For replacing fibrinogen in the blood.
    • Heparin: Administered to reduce further clot formation.

Education & Interventions

  • Ongoing monitoring for signs of bleeding is crucial.
  • Avoid cleaning clot formations; manage carefully.
  • Instructions to patients include:
    • Preferring electric razors to prevent cuts.
    • Using soft-bristle toothbrushes and avoiding vigorous brushing.
    • Halting flossing to reduce gum injury risks.

Labs

  • Important lab findings indicative of DIC include:
    • Prolonged Clotting Time: Increased PT, aPTT, and INR values.
    • Decreased Platelets: Normal platelet count should range between 150,000 to 400,000.
    • Elevated D-dimer: Suggestive of increased clot formation.

Pathophysiology & Causes of HIV

  • HIV targets the immune system, leading to potential progression to AIDS if untreated.
  • Transmission occurs through infected blood, semen, vaginal fluids, unprotected sex, blood transfusions, sharing needles, and from mother to child during pregnancy.
  • The virus primarily infects and destroys CD4+ T-helper cells, crucial for fighting infections.
  • HIV is classified as a retrovirus, using RNA for its genetic material instead of DNA.

Signs & Symptoms

  • Initial flu-like symptoms may appear within weeks, including:
    • Fatigue
    • Fever and night sweats
    • Sore throat
    • Weight loss
    • Diarrhea
  • After initial symptoms, the individual may remain asymptomatic until the disease progresses to AIDS.

Stages of HIV to AIDS

  • Stage 1: HIV Primary Infection

    • Initial infection may result in false negative HIV test results.
    • High levels of viral replication occur, significantly reducing CD4+ T-cell counts.
    • After stabilization of viral load, symptoms may disappear, marking a dormancy period until CD4+ levels decline.

  • Stage 2: AIDS

    • AIDS diagnosis occurs when CD4+ T-cell counts fall below 200 cells/mm³.
    • Characterized by frequent infections due to decreased immunity as CD4+ levels drop.

Hematologic Assessment and Diagnostic Procedures

  • Hematologic assessments evaluate blood function via indicators like erythrocytes (RBCs), leukocytes (WBCs), platelets, and coagulation times.
  • Diagnostics help determine disease presence and treatment efficacy.
  • Bone marrow produces various blood cells; a biopsy assesses its functionality.

Blood Collection and Testing

  • Key tests for blood components include:
    • RBC count
    • WBC count
    • Mean Corpuscular Volume (MCV)
    • Mean corpuscular hemoglobin (MCH)
    • Total Iron-Binding Capacity (TIBC)
    • Iron levels
    • Platelet count
    • Hemoglobin (Hgb)
    • Hematocrit (Hct)
    • Coagulation studies: Prothrombin time (PT), Partial thromboplastin time (aPTT), International normalized ratio (INR), D-dimer, Fibrinogen, Fibrin degradation products
  • Complete Blood Count (CBC) encompasses RBC, WBC, MCV, MCH, Hgb, and Hct.

Anemia Indicators

  • A hemoglobin level of 10 g/dL indicates potential anemia, below the normal reference range.

Nursing Considerations for Procedures

  • Pre-procedure:
    • Use standard precautions for blood collection and handling.
  • Intraprocedure:
    • Collect coagulation study samples at specific intervals and send to the lab immediately.
    • Adjust anticoagulant doses based on results.
  • Post-procedure:
    • Results are typically available within 24-72 hours.
    • Report abnormal findings to the provider for intervention.

Bone Marrow Aspiration/Biopsy

  • A biopsy assesses cell type and rules out malignancy.
  • Indicated for diagnosing blood disorders, leukemia, infections, or staging cancers.

Nursing Actions

  • Pre-procedure:
    • Obtain informed consent and position the client appropriately.
    • Explain the procedure, including sensations during biopsy.
  • Intraprocedure:
    • Administer sedatives if prescribed; ensure sterility during the procedure.
  • Post-procedure:
    • Apply pressure and a sterile dressing at the biopsy site.
    • Monitor for infection or excessive bleeding.
    • Ice may be applied to minimize discomfort.

Blood Transfusion Types

  • Standard donation: Compatible donor blood.
  • Autologous transfusions: Patient’s pre-collected blood for future use.
  • Intraoperative blood salvage: Collection of blood lost during surgery for later reinfusion.

Indications for Transfusion

  • Packed RBCs for excessive blood loss, anemia, and kidney failure.
  • Fresh frozen plasma for coagulation deficiencies.
  • Platelets for thrombocytopenia.
  • Albumin for burns or hypoproteinemia.

Nursing Actions for Transfusions

  • Assess for compatibility issues and obtain consent.
  • Monitor vital signs before and throughout transfer, especially in older adults.
  • Dispose of blood administration sets per policy.

Complications of Transfusions

  • Acute Hemolytic Reaction: Can occur from incompatible blood; symptoms include chills, fever, and hypotension.
  • Febrile Transfusion Reaction: Anti-WBC antibodies; results in fever and chills.
  • Allergic Reaction: Ranges from mild itching to severe anaphylaxis.
  • Bacterial Reaction: Symptoms include wheezing and hypotension due to contaminated blood.
  • Circulatory Overload: Linked with rapid transfusions; may lead to pulmonary edema, especially in older adults.

Anemia Overview

  • Characterized by low RBCs, hemoglobin, or hematocrit affecting oxygen delivery.
  • Iron-deficiency anemia prevalent among children, adolescents, and pregnant individuals.

Causes of Anemia

  • Blood loss, inadequate RBC production, or increased destruction.
  • Deficiencies in folic acid, iron, vitamin B12, erythropoietin.

Health Promotion and Disease Prevention

  • Iron-rich diets or supplements recommended for menstruating and pregnant women.
  • Encourage intake of folate-rich foods.

Risk Factors for Anemia

  • Includes chronic blood loss, trauma, chemotherapy, dietary deficiencies, and age-related factors.
  • Older adults may misinterpret anemia as depression or weakness, increasing the need for careful assessment.

Expected Findings in Anemia

  • Symptoms may include pallor, fatigue, dyspnea, and numbness in extremities.
  • Physical assessment may reveal shortness of breath, tachycardia, and cognitive symptoms like dizziness.

Laboratory Tests

  • CBC count is crucial for evaluating anemia and overall blood health.### Hemoglobin and Hematocrit
  • Hemoglobin (Hgb) is responsible for transporting oxygen and carbon dioxide in the blood, serving as an indicator of the blood's oxygen-carrying capacity.
  • Hematocrit (Hct) measures the percentage of red blood cells (RBCs) in relation to total blood volume.

RBC Indices and Anemia

  • Mean Corpuscular Volume (MCV) assesses the size of RBCs:
    • Normocytic: Normal size
    • Microcytic: Smaller than normal
    • Macrocytic: Larger than normal
  • Mean Corpuscular Hemoglobin (MCH) quantifies the amount of Hgb per RBC:
    • Normochromic: Normal Hgb content
    • Hypochromic: Reduced Hgb content
  • Mean Corpuscular Hemoglobin Concentration (MCHC) indicates Hgb percentage relative to cell size.

Iron Studies

  • Total Iron-Binding Capacity (TIBC) measures proteins binding iron, with transferrin being the primary carrier.
  • Ferritin reflects total iron stores; low iron with elevated TIBC suggests iron-deficiency anemia.

Laboratory Tests for Disorders

  • Hemoglobin electrophoresis separates normal from abnormal Hgb to diagnose conditions like thalassemia and sickle cell disease.
  • Schilling test measures vitamin B12 absorption, differentiating between malabsorption and pernicious anemia.

Diagnostic Procedures

  • Bone marrow aspiration/biopsy diagnoses aplastic anemia, where the marrow fails to produce adequate blood cells.

Patient-Centered Care: Nursing Considerations

  • Promote dietary intake of deficient nutrients (iron, vitamin B12, folic acid).
  • Monitor oxygen saturation for potential oxygen therapy.
  • Administer medications timely for optimal absorption; educate about energy conservation and dizziness risks.

Medications for Anemia

  • Iron Supplements:
    • Ferrous sulfate, ferrous fumarate, ferrous gluconate replenish blood iron levels; parenteral iron (iron dextran) is reserved for severe cases.
  • Erythropoietin (Epoetin alfa): Stimulates RBC production; monitor blood pressure and Hgb/Hct levels bi-weekly.

Vitamin B12 and Folic Acid Supplementation

  • Vitamin B12 (cyanocobalamin) is crucial for converting folic acid to its active form; administration route depends on absorption capability.
  • Folic acid supports new RBC production; large doses can mask vitamin B12 deficiencies.

Therapeutic Procedures

  • Blood transfusions are indicated for significant anemia symptoms, improving blood-cell counts rapidly but posing infection risks.

Complications in Anemia Management

  • Heart failure risk increases from low Hct; heart compensates by working harder, showing symptoms like tachycardia and palpitations.
  • Coagulation disorders affect bleeding and clotting ability, with coagulopathy indicated by abnormal bleeding patterns.

Coagulopathies Overview

  • Idiopathic Thrombocytopenic Purpura (ITP): Autoimmune disorder leading to decreased platelet lifespan; may cause severe bleeding.
  • Thrombotic Thrombocytopenic Purpura (TTP): Platelet aggregation causing insufficient circulation; can lead to organ failure and has a high mortality rate.
  • Disseminated Intravascular Coagulation (DIC): Life-threatening condition with simultaneous clotting and bleeding risks.
  • Hemophilia: Genetic disorder causing bleeding due to factor deficiencies; commonly diagnosed in early childhood.

Laboratory and Assessment Findings

  • Hemoglobin and platelet levels are crucial for diagnosing coagulopathy:
    • Expected hemoglobin: Males 14-18 g/dL, Females 12-16 g/dL.
    • Normal platelet count: 150,000-400,000 mm³.

Nursing Responsibilities

  • Monitor for bleeding and organ failure indications; assess vital signs and laboratory values for clotting factors.
  • Administer bleeding precaution measures; educate patients about avoiding Valsalva maneuvers.

Medications for Coagulopathies

  • ITP: Corticosteroids and immunosuppressants recommended.
  • TTP: Antiplatelet drugs and immunosuppressive therapies are beneficial.
  • HIT: Direct thrombin inhibitors are used to manage low platelet counts.
  • DIC: Heparin can reduce microclots and restore clotting factors.

Therapeutic Interventions for Specific Disorders

  • Plasma exchange is utilized for TTP; splenectomy is a consideration in unresponsive ITP cases.

Therapeutic Nutrition

  • Therapeutic nutrition involves modifying diets to treat diseases and meet individual client needs.
  • Modifications may include adjusting caloric intake, specific nutrients, food omissions, and food consistency.
  • It addresses both physiological and psychological needs, making meals a positive experience for clients.
  • Collaboration between nurses and dietitians is essential for nutritional concerns.

Types of Modified Diets

  • Regular Diet

    • Suitable for clients with no dietary restrictions; adapted for age-specific nutritional needs.
    • Often includes self-select menus to accommodate personal and cultural preferences.

  • Clear Liquid Diet

    • Comprises liquids without residue; aids in hydration and reduces gastrointestinal load.
    • Acceptable items include water, tea, clear juices, broth, and gelatin.
    • Not nutritionally adequate for long-term use; primarily used in acute conditions and pre-procedural preparation.

  • Full Liquid Diet

    • Contains foods that are liquid at room temperature, like strained cereals and plain ice cream.
    • Provides more nutritional support than clear liquids but may require supplementation beyond three days.
    • Indicated for postoperative recovery and acute gastrointestinal issues.

  • Blenderized Liquid (Pureed) Diet

    • Includes pureed liquids and foods, adjusted for calorie and nutrient content to meet client requirements.
    • Enhancements like broth or cream can boost caloric intake.
    • Used for clients with swallowing difficulties or after oral surgery.

  • Soft (Bland, Low-Fiber) Diet

    • Features low-fiber, easily digestible foods; avoids raw fruits, vegetables, and gas-forming items.
    • Beneficial for clients transitioning between diets and those with gastrointestinal issues.
    • Might lead to constipation due to low fiber content.

  • Mechanical Soft Diet

    • Regular diet modified for texture, suitable for those with chewing challenges.
    • Includes foods requiring little chewing; often supplemented with extras for caloric enhancement.
    • Excludes hard-to-chew foods, supporting clients with dental issues or swallowing impairments.

  • Dysphagia Diet

    • Prescribed for clients with swallowing impairments; symptoms include drooling and choking.
    • Utilizes the International Dysphagia Diet Standardisation Initiative (IDDSI) framework for consistency and texture levels.

Levels of Liquid Consistencies

  • Level 0 (Thin): Liquids that flow easily, drinkable through a cup or straw.
  • Level 1 (Slightly Thick): Thicker than water, still sippable through a straw.
  • Level 2 (Mildly Thick): Requires spooning; thick, does not hold shape when poured.
  • Level 3 (Moderately Thick): Smooth, lump-free liquids; drinkable from a cup or spoon.
  • Level 4 (Extremely Thick): Maintain shape, need a spoon for eating, non-sticky.

Levels of Solid Textures

  • Level 3 (Liquidized): Consistency similar to moderately thick liquids.
  • Level 4 (Pureed): Creamy, lump-free texture ideal for those who cannot chew.
  • Level 5 (Minced and Moist): Soft lumps, easily mashed with the tongue.
  • Level 6 (Soft and Bite-Sized): Soft, semi-solid foods easy to chew and swallow.
  • Level 7 (Easy to Chew/Regular): Near-normal foods, variances in texture acceptable.

Nursing Assessment and Interventions

  • Regularly assess clients through daily weights and lab tests to evaluate nutritional status.
  • Document and observe nutritional intake; perform caloric counts if necessary.
  • Provide education on diet therapy, considering the client's hunger, appetite, and nausea.
  • Gradual dietary progression is essential post-surgery, monitoring for return of bowel function before advancement.
  • Collaboration with dietitians is important for tailored dietary planning.

Overview of Coagulation Modifying Agents

  • Pharmaceutical agents that modify coagulation are used to prevent clot formation or dissolve existing clots.
  • These medications modify the clotting cascade, preventing platelet aggregation and impacting blood flow.
  • All agents carry a significant risk of bleeding, with a primary goal of improving circulation and preventing further tissue damage.

Groups of Coagulation Modifying Agents

  • Classes include oral and parenteral anticoagulants, antiplatelet medications, and thrombolytic agents.
  • Key anticoagulants: heparins, vitamin K antagonists, direct thrombin inhibitors, and direct factor Xa inhibitors.

Anticoagulants

Heparins

  • Prototype Medication: Unfractionated Heparin
  • Low Molecular Weight Heparins (LMW): Enoxaparin and Dalteparin
  • Activated Factor Xa Inhibitor: Fondaparinux
Expected Pharmacological Action
  • Heparin activates antithrombin, indirectly inactivating thrombin and factor Xa.
  • LMW heparins and fondaparinux primarily inactivate factor Xa.
Therapeutic Uses
  • Heparin: Treats evolving stroke, pulmonary embolism, massive deep-vein thrombosis, adjunct in open heart surgery, and DIC.
  • LMW heparins: Prevent DVT in postoperative clients, treat DVT, PE, and related complications.
  • Fondaparinux: Prevents DVT and PE postoperatively, treats acute DVT or PE with warfarin.
Complications (Heparin)
  • Toxicity: Administer protamine to neutralize heparin; monitor for signs of hemorrhage and adjust treatment accordingly.
  • Epidural/Spinal Hematoma: Increased risk during spinal/epidural anesthesia; monitor for neurological changes.
  • Heparin-induced Thrombocytopenia: Low platelet count causing increased thrombi; substitute with non-heparin anticoagulants.
  • Hypersensitivity Reactions: Can cause chills, fever, or hives; pre-test with small dose.

Client Education

  • Advise monitoring for bleeding signs and avoiding NSAIDs/aspirin.
  • Educate on self-administration techniques and proper injection site care.

Vitamin K Antagonists

Warfarin

  • Prototype Medication: Warfarin
Expected Pharmacological Action
  • Warfarin antagonizes vitamin K, inhibiting the synthesis of coagulation factors VII, IX, X, and prothrombin.
Therapeutic Uses
  • Prevents venous thrombosis, PE, and thrombotic events in atrial fibrillation, prosthetic heart valves, and reduces recurrent TIA/MI risk.
Complications
  • Hemorrhage: Monitor vital signs and bleeding manifestations; administer vitamin K1 for toxicity.
  • Hepatitis: Monitor liver enzymes, assess for jaundice.

Client Education

  • Clients should maintain consistent vitamin K intake, observe for bleeding, and report any adverse effects to their provider.
  • Administration is typically oral, once daily; monitor PT and INR levels.

Direct Thrombin Inhibitors

Dabigatran

  • Prototype Medication: Dabigatran
Expected Pharmacological Action
  • Directly binds and inhibits thrombin, preventing thrombus formation.
Therapeutic Uses
  • Prevents stroke/embolism in non-valvular atrial fibrillation; treats/controls DVT and PE.
Complications
  • Bleeding: Report severe bleeding; idarucizumab can be used as an antidote.
  • GI Effects: Nausea, reflux; advise taking with food.

Direct Factor Xa Inhibitors

Rivaroxaban and Apixaban

  • Provide selective, direct inhibition of factor Xa, preventing thrombin formation.
Therapeutic Uses
  • Primarily for stroke prevention in patients with atrial fibrillation.

Contraindications and Precautions

  • Use anticoagulants cautiously during pregnancy, particularly warfarin; contraindicated in active bleeding or allergy.
  • Monitor for interactions with drugs that affect bleeding risk.

Nursing Administration

  • Ensure correct dosing and monitor necessary laboratory values regularly.
  • Client education essential for understanding potential side effects and drug interactions, especially bleeding risks.### Prevention and Treatment of DVT and PE
  • Postoperative Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) risk is elevated after hip or knee replacement surgeries.
  • Treatment for DVT or PE not related to orthopedic interventions requires a different management approach.
  • Common complications include various forms of bleeding (GI, GU, cranial, retinal, and epidural).

Nursing Actions and Monitoring

  • Educate clients to recognize and report bleeding, bruising, headache, or eye pain.
  • Regularly monitor hemoglobin and hematocrit levels for indications of bleeding.
  • An epidural catheter should be removed at least 18 hours after the last dose of anticoagulant and rivaroxaban should be resumed 6 hours post-removal.

Medication Reversal

  • For rivaroxaban (apixaban) reversal, andexanet alfa is used; idarucizumab is used for dabigatran.
  • Dialysis is ineffective for removing these medications from the bloodstream; activated charcoal can help limit absorption.

Liver Function Monitoring

  • Monitor liver enzymes (ALT, AST, GGT) during treatment.
  • Report any elevations in liver function tests to the healthcare provider.

Contraindications and Precautions

  • Rivaroxaban should only be used in pregnancy when the benefit outweighs risks.
  • Contraindicated in clients with allergies to rivaroxaban, active bleeding, severe kidney impairment, and significant liver impairment.
  • Monitor patients on anticoagulants and antiplatelets closely for interactions.

Drug Interactions

  • Itraconazole and similar drugs can increase rivaroxaban levels, heightening bleeding risk; monitor closely.
  • Rifampin and certain anticonvulsants can decrease rivaroxaban levels; ensure therapeutic efficacy is tracked.
  • Herbs like feverfew and garlic may increase bleeding risk.

Antiplatelet Medications

  • Aspirin, clopidogrel, abciximab, and dipyridamole are major classes, each with specific therapeutic uses targeting clot prevention.
  • Aspirin can cause GI distress; use enteric-coated tablets and take with food to minimize effects.

Complications of Antiplatelet Therapy

  • Aspirin may lead to hemorrhagic stroke, prolonged bleeding time, and tinnitus.
  • Clopidogrel and abciximab share risks for bleeding and thrombocytopenia; monitor closely for symptoms.

Thrombolytic Medications

  • Alteplase (tPA) dissolves clots rapidly; most effective if administered within 3 hours of symptoms.
  • Monitor for significant bleeding risks with thrombolytics including GI, GU, and cerebral bleeding.

Blood Product Administration

  • Whole blood and components are vital in acute blood loss and hypovolemia.
  • Common reactions to transfusions include acute hemolytic reactions and febrile nonhemolytic reactions.
  • Blood type and Rh compatibility must be established prior to transfusion to avoid hemolytic reactions.

Client Education

  • Teach clients about monitoring for adverse effects related to anticoagulants and antiplatelets.
  • Discuss the importance of reporting any signs of unusual bleeding or bruising.
  • Stress the need for careful management and monitoring when taking multiple medications that affect bleeding risk.### Blood Transfusion Reactions
  • Sudden chills, headache, flushing, anxiety, muscle pain: Monitor for an increase of at least 1°C (2°F) from baseline; stop transfusion if reactions occur and notify the provider.
  • Anaphylactic reactions: Symptoms include anxiety, urticaria, wheezing, shock, and potential cardiac arrest; manage by stopping the transfusion, maintaining IV access with 0.9% sodium chloride, and having epinephrine ready.
  • Mild allergic reactions: Typically involve flushing and urticaria; may administer washed red blood cells in at-risk patients. For mild reactions, consider antihistamines and slow transfusion restart.
  • Circulatory overload: Symptoms include cough, shortness of breath, crackles, hypertension, and distended neck veins. Monitor closely, especially in older adults; transfusions should occur slowly, and diuretics may be administered.
  • Sepsis: Rapid onset of chills, fever, vomiting, hypotension, and shock. Inspect blood products for abnormalities and initiate treatment promptly, including blood cultures and antibiotics.
  • Hyperkalemia: Risk associated with blood cell lysis, particularly in older products; monitor potassium levels and notify the provider if abnormal.
  • Transfusion-associated graft-versus-host disease: Rare but can occur 1-2 weeks post-transfusion, characterized by nausea, vomiting, weight loss, and thrombocytopenia; prevention involves using irradiated blood products.

Nursing Administration Protocols

  • Baseline assessments: Conduct laboratory testing (Hgb, Hct, etc.) and verify prescription and consent prior to transfusion.
  • Vital sign monitoring: Check every 15 minutes during transfusion, then hourly; monitor existing IV site and maintain a patent line with 0.9% sodium chloride.
  • Transfusion completion criteria: Blood products should be infused within specific time limits (e.g., Whole Blood: 2-4 hours; Platelets: 15-30 minutes/unit).
  • Documentation: Record type of blood product, transfusion volume, start/completion times, vital signs, and any adverse effects.
  • Use of appropriate equipment: A 20-gauge or larger IV catheter is necessary, along with blood filters as per protocols.

Considerations for Specific Populations

  • Older adults: Greater risk for fluid overload; transfusions should be conducted slowly over extended times.
  • Massive transfusions: Greater than or equal to total blood volume replacement in 24 hours; regular monitoring of electrolytes and blood components required.
  • Autologous transfusions: Pre-donation of blood allows individuals to receive their own blood post-surgery, reducing the risks of reactions.

Immunology and Vaccination

  • Active vs. Passive Immunity: Active immunity is long-lasting and develops from exposure to antigens. Passive immunity is temporary, such as antibodies transferred from mother to infant or via immune globulins.
  • Recommended Vaccines: Vaccination schedules outlined by the CDC, including DTaP, MMR, and hepatitis vaccines; schedules may differ based on age.
  • COVID-19 vaccination: Guidelines specify age-based recommendations for mRNA and viral vector vaccines.
  • Human Papillomavirus (HPV) Vaccine: Important for preventing certain cancers; recommended for adolescents, with a series of doses required.

Complications and Precautions

  • Contraindications: Anaphylactic reactions to previous vaccines prevent future administrations; live virus vaccines are contraindicated in severely immunocompromised patients.
  • Vaccine Schedule Adherence: Follow the specified immunization schedules and ensure accurate documentation for effective patient care.

Anemia

  • Condition characterized by insufficient healthy red blood cells or hemoglobin.
  • Common causes include acute blood loss, faulty red blood cell production, and destruction of red blood cells.
  • Main types include anemia from acute/chronic blood loss, chronic diseases (e.g., cancers, renal disease), nutritional deficiencies (iron, folate, or vitamin B12), and hereditary anemias (sickle cell anemia and thalassemia).
  • Treatment focuses on the underlying cause and varies by type of anemia.
  • Symptoms include fatigue, pallor, weakness, shortness of breath, tachycardia, and chest pain.

Iron-Deficiency Anemia

  • Results from depleted iron stores affecting hemoglobin production.
  • Often caused by blood loss, dietary inadequacy, or gastrointestinal malabsorption.
  • Symptoms include pallor, weakness, microcytic red blood cells, and low hemoglobin/hematocrit levels.
  • Management includes dietary changes, iron supplements, and possible intravenous or intramuscular iron administration.

Vitamin B12–Deficiency Anemia

  • Macrocytic anemia due to inadequate vitamin B12 intake or absorption.
  • Commonly caused by pernicious anemia, which involves a lack of intrinsic factor from gastric mucosa.
  • Symptoms include severe pallor, fatigue, weight loss, a smooth red tongue, and paresthesias.
  • Treatment involves dietary intake of vitamin B12, with injections for intrinsic factor deficiency.

Folate-Deficiency Anemia

  • Macrocytic anemia characterized by larger and oval-shaped red blood cells from folate deficiency.
  • Causes include dietary inadequacy, malabsorption syndromes, and conditions increasing folate requirements.
  • Symptoms include dyspepsia, pallor, fatigue, and tachycardia.
  • Management includes dietary adjustments and folate supplementation.

Aplastic Anemia

  • Deficiency of all formed blood elements due to bone marrow development failure.
  • Can be primary (genetic) or secondary (acquired).
  • Diagnosis confirmed through bone marrow aspiration showing fatty changes.
  • Symptoms include pancytopenia, weakness, and fatigue.
  • Treatment focuses on restoring bone marrow function, often through immunosuppressive therapy or transplantation.

Immune System Overview

  • Protects against microorganisms, eliminates damaged cells, and maintains internal balance.
  • Involves T and B lymphocytes for cellular and humoral immunity, with distinct roles.
  • Immune responses can be immediate (humoral) or delayed (cellular), with unique applications against infections and autoimmune issues.

Immunodeficiency

  • Defined as inadequate immune body production and can be congenital or acquired.
  • Assessment includes frequent infections, nutritional status, and medication history.
  • Interventions focus on infection prevention, nutritional support, and use of aseptic techniques.

Anaphylaxis

  • Serious hypersensitivity reaction causing rapid release of histamine.
  • Immediate assessment of the airway and vital signs is critical.
  • Emergency interventions include discontinuation of suspected triggers and administration of oxygen and epinephrine.

Latex Allergy

  • Hypersensitivity to latex from natural rubber proteins.
  • Symptoms may vary from mild dermatitis to severe anaphylaxis.
  • Risk factors include healthcare workers and those with multiple surgeries.
  • Assessment involves careful evaluation of exposure and patient history.

Autoimmune Diseases

  • Characterized by the immune system attacking the body's cells and tissues.
  • The underlying cause is often complex and may involve genetic and environmental triggers.### Autoimmune Diseases Overview
  • Autoimmune diseases arise when the body fails to recognize its own cells as part of itself.
  • These diseases can impact collagenous tissues, leading to various health complications.

Systemic Lupus Erythematosus (SLE)

  • A chronic and progressive systemic inflammatory disease that can lead to organ failure.
  • Characterized by deposition of connective tissue and fibrin in blood vessels and organs, resulting in inflammation and necrosis.
  • No known cure, but patients can experience remissions through effective management.

Causes

  • Unknown origin, potentially linked to genetic defects in immune mechanisms.
  • Precipitating factors include medications, stress, exposure to sunlight, and pregnancy.
  • Discoid lupus can manifest as a rash but resolves upon discontinuation of causative medication.

Assessment

  • Look for malar rash (butterfly rash), discoid rashes, oral ulcers, fever, fatigue, and photosensitivity.
  • Blood tests may reveal anemia, positive antinuclear antibodies, and elevated inflammatory markers (ESR, C-reactive protein).

Interventions

  • Maintain skin integrity and provide oral care; use mild soaps.
  • Administer corticosteroids, nonsteroidal anti-inflammatory drugs for pain control.
  • Encourage energy conservation and monitor for signs of renal impairment.
  • Avoid sunlight exposure and monitor for potential organ involvement.

Scleroderma (Systemic Sclerosis)

  • A chronic connective tissue disease affecting various organs characterized by inflammation and fibrosis.
  • Leads to skin hardening, vasculopathy, and potentially severe internal complications.

Assessment

  • Symptoms include muscle weakness, pitting edema, tight and shiny skin, dysphagia, and decreased joint mobility.

Interventions

  • Encourage activity as tolerated, maintain stable room temperature.
  • Provide smaller meals and support for esophageal issues if present.
  • Monitor for symptoms as major organs become affected and provide emotional support.

Polyarteritis Nodosa

  • A form of systemic vasculitis causing inflammation of the arteries in various organs, particularly the kidneys and heart.
  • The cause remains unknown, and it often leads to severe health complications.

Assessment

  • Typical symptoms include malaise, low-grade fever, severe abdominal pain, and bloody diarrhea.

Interventions

  • Treatment similar to SLE, focusing on managing symptoms and inflammation.

Pemphigus

  • A rare autoimmune condition causing skin blistering, primarily affecting middle-aged to elderly persons.
  • Symptoms can be severe and potentially fatal without treatment.

Assessment

  • Observe for fragile skin lesions, dysphagia, and Nikolsky’s sign (skin separation upon touch).

Interventions

  • Supportive care, oral hygiene, soothing baths, and administration of antibiotics and steroids.

Goodpasture’s Syndrome

  • A rare autoimmune disorder characterized by autoantibodies against glomerular and alveolar basement membranes.
  • Primarily affects young adults with a history of smoking.

Assessment

  • Key symptoms include shortness of breath, hemoptysis, decreased urine output, and signs of renal involvement.

Interventions

  • Focus on suppressing the autoimmune response with medications and plasmapheresis.

Lyme Disease

  • Caused by Borrelia burgdorferi through tick bites, leading to inflammatory responses and possible autoimmune mechanisms.

Assessment

  • Symptoms can vary; not all patients develop the characteristic rash.

Interventions

  • Prompt tick removal and initiation of antibiotic therapy (doxycycline, cefuroxime) as appropriate; prevention includes protective clothing and insect repellents.

Acquired Immunodeficiency Syndrome (AIDS)

  • Caused by HIV, which attacks T cells, resulting in increased susceptibility to infections and neoplasms.
  • It is a chronic illness with a long incubation period.

Assessment

  • Look for flu-like symptoms, weight loss, and opportunistic infections (e.g., Pneumocystis pneumonia, Kaposi’s sarcoma).

Interventions

  • Provide respiratory and psychosocial support, monitor infection signs, and maintain optimal nutrition and hydration.

Key Monitoring

  • Regular blood tests to evaluate the progression of autoimmune diseases, renal function, and signs of infection are crucial for effective management and treatment strategies.

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Related Documents

1. Anemia Types & Irone Def. Anemia .pdf
1. Blood Product Admin.pdf
1. Hemo Terminology.pdf
1. Iron Deficiency Anemia.pdf
1. Labs - BMP Panel & Electrolytes .pdf
1. Lupus.pdf
1.2 Transfusions Reactions & Priority Interventions.pdf
1.3 Blood Transfusion & Autologous Transfusion.pdf
1.4 Blood Types & Rh Factor.pdf
2. Abciximab_new.pdf
2. Epistaxis.pdf
2. Erythropoietin.pdf
2. Lab Values Card.pdf
2. Labs - CBC .pdf
2. Sickle Cell & Pernicious Anemia .pdf
2. Sickle Cell Anemia & Pernicious Anemia.pdf
2. Sjogren's Syndrome.pdf
3. Acetylsaliylic & Clopidogrel .pdf
3. DIC- Disseminated Intravascular Coagulation.pdf
3. Hemophilia.pdf
4. Hemophilia.pdf
4. Labs - Cardiac & ABG 2.pdf
4. Thrombocytopenia.pdf
6. Polycythemia.pdf
DIC .pdf
HIV .pdf

Description

This quiz covers the overview and various types of anemia, including iron deficiency anemia, sickle cell anemia, and more. Learn about the symptoms, causes, and effects of anemia on the body. Test your knowledge on this important health topic.

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