75 Questions
What is the result of osteoclasts breaking down bone cells in multiple myeloma?
An increase in blood calcium levels
Which of the following is NOT a symptom of agranulocytosis?
Joint pain
What is the term for a decrease in the production of all blood cells, including red blood cells, white blood cells, and platelets?
Pancytopenia
What is the primary goal of medical management in disseminated intravascular coagulation (DIC)?
Correct the underlying cause
Which of the following is a nursing management intervention for a patient with thrombocytopenia?
Applying pressure to bleeding sites
What is the term for a condition where the bone marrow produces abnormal plasma cells, leading to bone destruction and anemia?
Multiple myeloma
Which of the following is a diagnostic finding for aplastic anemia?
Bone marrow aspiration
What is the primary goal of nursing management for a patient with hemophilia?
Minimizing bleeding
What is the term for a condition where the spleen destroys platelets, leading to a decrease in platelet count?
Thrombocytopenia
Which of the following is a medical management intervention for disseminated intravascular coagulation (DIC)?
Heparin therapy
Which of the following is NOT a compensatory mechanism for the lost red blood cell (RBC) function in anemia?
Orthostatic hypotension
What is the cause of sickle cell anemia?
Hemoglobin A is replaced by Hemoglobin S
Which of the following symptoms is most indicative of iron deficiency anemia?
Reduced energy and feeling cold all the time
Which diagnostic test is used specifically for diagnosing sickle cell anemia?
Sickledex test
Which of the following is not an intervention for a client with hypovolemic anemia?
Administer prescribed analgesics
What is the primary cause of hypovolemic anemia?
Sudden loss of large volume of blood or chronic loss of small amounts of blood
Which management strategy is specifically for treating iron deficiency anemia?
Foods high in iron
What symptom is a common finding in clients with chronic hemolytic anemia related to sickle cell disease?
Jaundice
Which assessment finding would most likely indicate inadequate RBC volume?
Oliguria
Which of the following is an appropriate nursing diagnosis for a patient with hypovolemic anemia?
Imbalanced Body Temperature
Which diagnostic test is used to differentiate Pernicious Anemia?
Schilling test
What medical management is appropriate for a patient with Cooley’s anemia?
Iron chelation therapy
Which nursing management technique is recommended for a patient experiencing Permanent neurologic deficit due to Pernicious Anemia?
Encourage and assist with ambulation
What is the primary medical intervention for managing Erythrocytosis in Polycythemia Vera?
Phlebotomy
Which clinical finding is associated with hemolytic anemia?
Jaundice
Which of the following is NOT a finding in Folic Acid Deficiency Anemia?
Jaundice
What assessment finding is expected in a patient with chronic premature erythrocyte destruction?
Enlarged spleen
What specific symptom is associated with Thalassemia?
Bronzing of the skin
Which symptom is common in patients with Pernicious Anemia?
Numbness and tingling in arms and legs
Which diagnostic finding is typical in Polycythemia Vera?
Elevated blood cell count
What is a common medical management strategy for Thalassemia?
Frequent blood transfusions
Which diagnostic test is specifically used to diagnose Pernicious Anemia?
Schilling test
Which of the following is a significant finding for a patient with Polycythemia Vera?
Reddish-purple face and lips
What is a critical nursing management strategy for a patient diagnosed with Leukocytosis?
Monitor platelet counts
Which medical management approach is appropriate for Hemolytic Anemia?
Corticosteroids
What intervention is crucial for managing Pernicious Anemia with neurologic deficits?
Administering vitamin B12 injections
Which assessment finding would most likely be seen in a client with Chronic Premature Erythrocyte Destruction?
Enlarged spleen
What is a primary nursing management strategy for a patient with Folic Acid Deficiency Anemia?
Teaching: diet and rest promotion
What medical management technique is used to handle rapid blood cell proliferation in Polycythemia Vera?
Phlebotomy
What is a common assessment finding for Pernicious Anemia?
Dyspnea with minimal exertion
Which symptom would most likely be indicative of decreased red blood cell function?
headache
What is a common compensatory mechanism for anemia?
amenorrhea
Which medical management option is most appropriate for hypovolemic anemia resulting from chronic blood loss?
Iron supplementation
What is a significant nursing intervention for a client with hypovolemic anemia?
Monitoring intake and output
Which symptom is less likely to be observed in cases of iron deficiency anemia?
Increased energy
In the context of sickle cell anemia, which diagnostic test is used to detect the presence of hemoglobin S?
Hemoglobin electrophoresis
What is an appropriate nursing diagnosis for a patient experiencing a sickle cell crisis?
Risk for infection
Which of the following is specifically a medical intervention for managing a sickle cell crisis?
Narcotic analgesia
Which of these findings is not typical in the assessment of iron deficiency anemia?
High hemoglobin levels
What is a primary cause of hypovolemic anemia?
Sudden large blood loss
What is the distinguishing appearance of osteolytic tumors in bones caused by multiple myeloma?
Punched-out or honeycombed appearance
Which initial medical management is suggested for agranulocytosis?
Human granulocyte colony-stimulating factor
What is a common clinical sign of thrombocytopenia?
Purpura
What precaution should be taken for a patient with agranulocytosis?
Protective isolation with visitor restrictions
Which symptom is NOT typically associated with aplastic anemia?
Hypertension
In the management of Disseminated Intravascular Coagulation (DIC), which treatment is used to control severe bleeding?
Platelet replacement and cryoprecipitate
What is the primary nursing management goal for a patient with hemophilia?
Preventing trauma and minimizing bleeding
What is a typical diagnostic finding in a patient with coagulopathies caused by thrombocytopenia?
Purple or reddish skin spots (purpura)
Which intervention is NOT commonly associated with nursing management of multiple myeloma?
Encouraging daily jogging
Which symptom is a major indicator of Disseminated Intravascular Coagulation (DIC) in a patient?
Tachycardia and petechiae
What is the primary goal of medical management in Hemolytic Anemia?
Removing the cause of anemia
What is the characteristic of Thalassemia?
Hereditary hemolytic anemia
What is the primary nursing management strategy for a patient with Folic Acid Deficiency Anemia?
Teaching oral hygiene and promoting rest
What is the characteristic of Erythrocytosis in Polycythemia Vera?
Rapid proliferation of blood cells
What is the primary medical management strategy for Leukocytosis?
Administering antineoplastic drugs
What is the primary consequence of osteoclasts breaking down bone cells in multiple myeloma?
Hypercalcemia and bone lesions
What is the primary goal of medical management in aplastic anemia?
To eliminate the causative agent and promote bone marrow recovery
Which of the following is a characteristic of disseminated intravascular coagulation (DIC)?
Depletion of clotting factors
What is the primary goal of nursing management in hemophilia?
To prevent bleeding and manage pain
What is the primary cause of thrombocytopenia?
Increased platelet destruction by the spleen
Which intervention is crucial in managing pain for a patient with sickle cell anemia during a crisis?
Providing narcotic analgesia
A patient with iron deficiency anemia is most likely to experience which of the following symptoms?
Fatigue and a rapid heart rate even at rest
What is a significant assessment finding in a patient with hypovolemic anemia?
Extreme pallor and chills
Which diagnostic test is used to confirm the presence of sickle-shaped erythrocytes in a patient suspected of having sickle cell anemia?
Hemoglobin electrophoresis
Which assessment finding is specifically associated with the compensatory mechanisms for lost RBC function in anemia?
Cool, clammy skin
Study Notes
Anemia
- Anemia: a deficiency of erythrocytes or hemoglobin
- Causes: blood loss, inadequate erythrocyte production, destruction of formed RBCs
- Assessment Findings:
- Inadequate RBC volume: orthostatic hypotension, thready pulses, oliguria, heart murmur
- Compensatory mechanisms for lost RBC function: tachycardia, tachypnea, cool, clammy skin, amenorrhea
- Decreased RBC function: dyspnea, chest discomfort, acidosis, headache, vertigo, pallor
Hypovolemic Anemia
- Causes: sudden loss of large volume, chronic loss of small amounts of blood
- Assessment Findings:
- Extreme pallor, tachycardia, hypotension, reduced urine output, altered consciousness, fatigue, chills, rapid respiratory rate
- Medical Management:
- Blood transfusions: treating underlying condition or chronic blood loss
- Administration of oral, IV, or IM iron: restore hemoglobin
Iron Deficiency Anemia
- Iron Deficiency Anemia: insufficient iron to produce hemoglobin
- Assessment Findings:
- Reduced energy, feel cold all the time, fatigue and dyspnea with minor physical exertion, rapid heart rate even at rest, decreased hemoglobin, hematocrit, and serum iron levels
- Medical Management:
- Foods high in iron, Blood transfusion
- Nursing Management:
- Increase iron intake, collaborate with dietitian, administer iron supplement (IM Z-track)
Sickle Cell Anemia
- Sickle Cell Anemia: Hemoglobin A is replaced by Hemoglobin S; sickle- or crescent-shaped erythrocytes from inadequate oxygen supply to blood
- Hereditary; sickle cell crisis
- Chronic hemolytic anemia
- Assessment Findings:
- Jaundice, tachycardia, dyspnea, cardiomegaly, and dysrhythmias; stroke, acute chest syndrome
- Diagnostic Findings:
- Sickledex test; hemoglobin electrophoresis
- Medical Management:
- Supportive treatment: regular blood transfusions; bone marrow transplantation; prophylactic antibiotic therapy
- Sickle cell crisis: narcotic analgesia, O2, bed rest, IV fluids, meds
Other Anemias
- Hemolytic Anemia: Chronic premature erythrocyte destruction
- Assessment Findings:
- Jaundice, enlarged spleen, shock
- Medical Management:
- Removing the cause; corticosteroids; blood transfusions
- Surgical Management:
- Splenectomy
- Nursing Management:
- Health history, supportive care, medication, teaching measures of self-care, arrange follow-up evaluations
Thalassemias
- Thalassemias: hereditary hemolytic anemia
- Types: alpha-thalassemias, beta-thalassemias
- Assessment Findings:
- Cooley's anemia: bronzing of the skin
- Medical Management:
- Symptomatic, frequent transfusions, iron chelation therapy
- Nursing Management:
- Bed rest, protect from infection, closely monitor blood transfusion
Pernicious Anemia
- Pernicious Anemia: lack of intrinsic factor necessary for absorption of vitamin B12
- Degenerative changes in nervous system
- Secondary to surgical removal of stomach or small bowel resection
- Assessment Findings:
- Stomatitis, glossitis, digestive disturbances; diarrhea; dyspnea with minimal exertion, jaundice, irritability, confusion, depression, numbness and tingling in arms and legs, ataxia
- Diagnostic Findings:
- Blood and bone marrow studies; Schilling test, blood smear
- Medical Management:
- IM vitamin B12
- Physical therapy for permanent neurologic deficits
- Nursing Management:
- Glossitis and stomatitis: soft, bland diet; small, frequent meals; oral care
- Permanent neurologic deficit: encourage and assist with ambulation, supervision
- Teaching: administration of vitamin B12; diet
Folic Acid Deficiency Anemia
- Folic Acid Deficiency Anemia: immature erythrocytes; insufficient dietary intake of foods rich in folic acid
- Assessment Findings:
- Severe fatigue, sore and beefy-red tongue, dyspnea, nausea, anorexia, headaches, weakness, light-headedness
- Diagnostic Findings:
- Schilling test
- Medical Management:
- Folic acid supplements; balanced diet
- Nursing Management:
- Teaching: diet, oral hygiene, rest promotion
Erythrocytosis
- Polycythemia vera: increase in circulating erythrocytes and leukocytes
- Rapid proliferation of blood cells produced by the bone marrow; cause is unknown
- Assessment Findings:
- Reddish-purple face and lips, fatigue, weakness, exertional dyspnea
- Diagnostic Findings:
- Elevated blood cell count, platelets and WBC counts elevated, abnormal serum K+ and uric acid
- Medical Management:
- Phlebotomy, radio phosphorus, and radiotherapy
Leukocytosis
- Leukocytosis: proliferation of leukocytes, usually in immature form
- Four types according to dysfunctional bone marrow stem cell line (Acute and Chronic forms of lymphocytic and myelogenous leukemia)
- Precipitating factors: genetic correlation
- Assessment Findings:
- Severe anemia, infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes, internal or external bleeding
- Medical Management:
- Antineoplastic drugs, transfusions, Transplantation: bone marrow; stem cell
- Nursing Process:
- Assessment: history of symptoms; physical assessment, laboratory results; assess neutrophil
- Diagnosis and Planning:
- Risks: infection, hemorrhage, activity intolerance, disturbed body image, anxiety, and fear
- Interventions:
- Monitor platelet counts, assess for signs of bruising and petechiae; report hematuria or epistaxis (nosebleed)
- Acknowledge client's anxieties and fears, reassure PT
Multiple Myeloma
- Multiple Myeloma: malignancy involving plasma cells
- Osteoclasts break down bone cells, resulting in increased blood calcium and pathologic fractures
- Osteolytic tumors: "punched-out" or "honeycombed" appearance in bones
- Assessment Findings:
- Bone Pain, infection, symptoms of anemia, bruising, nosebleeds, renal calculi
- Diagnostic Findings:
- Skeletal radiographic studies: bone lesions; increased serum calcium levels, bone marrow aspiration
- Medical Management:
- Steroids, anticancer drugs, antibiotics
- Analgesics, blood transfusions
- Back braces, body casts
- Surgical Management: transplantation: bone marrow; stem cell
- Nursing Management:
- Assess pain, signs of infection (increased WBC, Fever), fatigue, bleeding, thrombus formation, urine
- Analgesics, ambulation (caution-fracture), fluid intake I&O, safety, Prevent infection
Agranulocytosis
- Agranulocytosis: decrease in production of granulocytes
- Neutrophils, Basophils, Eosinophils
- Assessment Findings:
- Fatigue, fever, chills, headache, opportunistic infections
- Medical Management:
- Remove cause; drugs: human granulocyte colony-stimulating factor
- Nursing Management:
- Drug assessment, protective isolation (neutropenic); visitor restriction–NO flowers, fruit
Aplastic Anemia
- Pancytopenia: Aplastic Anemia: pancytopenia: numbers of all cells reduced
- Causes: autoimmune, exposure to toxic chemicals, radiation, drug therapy
- Assessment Findings:
- Weakness, fatigue, opportunistic infections, Unusual bleeding, petechiae, ecchymosis
- Enlarged spleen/abdominal pain
- Diagnostic Findings:
- CBC- blood cell count; bone marrow aspiration
- Medical Management:
- Withdrawal of causative agent, Transfusions, antibiotics, corticosteroids, Transplantations: bone marrow; autologous stem cell
- Nursing Management:
- History, physical assessment, symptoms, Infection prevention measures/isolation
- Nutrition; modify oral hygiene, Monitoring of blood transfusion
Coagulopathies
- Thrombocytopenia: platelet manufacture by bone marrow is decreased or platelet destruction by the spleen is increased (Splenomegaly)
- Causes: leukemia; malignant blood diseases, severe infections
- Assessment Findings:
- Purpura (purple/reddish), bleeding, internal hemorrhage (GI)
- Medical Management:
- Eliminate cause; corticosteroids, transfusions
- Surgical Management: splenectomy
- Nursing Management:
- Manage/minimize bleeding: Apply pressure/tourniquet, ADR; taper corticosteroid dosage/frequency
Hemophilia
- Hemophilia: clotting factor; inherited: mother to son
- Assessment Findings:
- Oozing; severe bleeding, bleeding in joints
Anemia
- Anemia: a deficiency of erythrocytes or hemoglobin
- Causes: blood loss, inadequate erythrocyte production, destruction of formed RBCs
- Assessment Findings:
- Inadequate RBC volume: orthostatic hypotension, thready pulses, oliguria, heart murmur
- Compensatory mechanisms for lost RBC function: tachycardia, tachypnea, cool, clammy skin, amenorrhea
- Decreased RBC function: dyspnea, chest discomfort, acidosis, headache, vertigo, pallor
Hypovolemic Anemia
- Causes: sudden loss of large volume, chronic loss of small amounts of blood
- Assessment Findings:
- Extreme pallor, tachycardia, hypotension, reduced urine output, altered consciousness, fatigue, chills, rapid respiratory rate
- Medical Management:
- Blood transfusions: treating underlying condition or chronic blood loss
- Administration of oral, IV, or IM iron: restore hemoglobin
Iron Deficiency Anemia
- Iron Deficiency Anemia: insufficient iron to produce hemoglobin
- Assessment Findings:
- Reduced energy, feel cold all the time, fatigue and dyspnea with minor physical exertion, rapid heart rate even at rest, decreased hemoglobin, hematocrit, and serum iron levels
- Medical Management:
- Foods high in iron, Blood transfusion
- Nursing Management:
- Increase iron intake, collaborate with dietitian, administer iron supplement (IM Z-track)
Sickle Cell Anemia
- Sickle Cell Anemia: Hemoglobin A is replaced by Hemoglobin S; sickle- or crescent-shaped erythrocytes from inadequate oxygen supply to blood
- Hereditary; sickle cell crisis
- Chronic hemolytic anemia
- Assessment Findings:
- Jaundice, tachycardia, dyspnea, cardiomegaly, and dysrhythmias; stroke, acute chest syndrome
- Diagnostic Findings:
- Sickledex test; hemoglobin electrophoresis
- Medical Management:
- Supportive treatment: regular blood transfusions; bone marrow transplantation; prophylactic antibiotic therapy
- Sickle cell crisis: narcotic analgesia, O2, bed rest, IV fluids, meds
Other Anemias
- Hemolytic Anemia: Chronic premature erythrocyte destruction
- Assessment Findings:
- Jaundice, enlarged spleen, shock
- Medical Management:
- Removing the cause; corticosteroids; blood transfusions
- Surgical Management:
- Splenectomy
- Nursing Management:
- Health history, supportive care, medication, teaching measures of self-care, arrange follow-up evaluations
Thalassemias
- Thalassemias: hereditary hemolytic anemia
- Types: alpha-thalassemias, beta-thalassemias
- Assessment Findings:
- Cooley's anemia: bronzing of the skin
- Medical Management:
- Symptomatic, frequent transfusions, iron chelation therapy
- Nursing Management:
- Bed rest, protect from infection, closely monitor blood transfusion
Pernicious Anemia
- Pernicious Anemia: lack of intrinsic factor necessary for absorption of vitamin B12
- Degenerative changes in nervous system
- Secondary to surgical removal of stomach or small bowel resection
- Assessment Findings:
- Stomatitis, glossitis, digestive disturbances; diarrhea; dyspnea with minimal exertion, jaundice, irritability, confusion, depression, numbness and tingling in arms and legs, ataxia
- Diagnostic Findings:
- Blood and bone marrow studies; Schilling test, blood smear
- Medical Management:
- IM vitamin B12
- Physical therapy for permanent neurologic deficits
- Nursing Management:
- Glossitis and stomatitis: soft, bland diet; small, frequent meals; oral care
- Permanent neurologic deficit: encourage and assist with ambulation, supervision
- Teaching: administration of vitamin B12; diet
Folic Acid Deficiency Anemia
- Folic Acid Deficiency Anemia: immature erythrocytes; insufficient dietary intake of foods rich in folic acid
- Assessment Findings:
- Severe fatigue, sore and beefy-red tongue, dyspnea, nausea, anorexia, headaches, weakness, light-headedness
- Diagnostic Findings:
- Schilling test
- Medical Management:
- Folic acid supplements; balanced diet
- Nursing Management:
- Teaching: diet, oral hygiene, rest promotion
Erythrocytosis
- Polycythemia vera: increase in circulating erythrocytes and leukocytes
- Rapid proliferation of blood cells produced by the bone marrow; cause is unknown
- Assessment Findings:
- Reddish-purple face and lips, fatigue, weakness, exertional dyspnea
- Diagnostic Findings:
- Elevated blood cell count, platelets and WBC counts elevated, abnormal serum K+ and uric acid
- Medical Management:
- Phlebotomy, radio phosphorus, and radiotherapy
Leukocytosis
- Leukocytosis: proliferation of leukocytes, usually in immature form
- Four types according to dysfunctional bone marrow stem cell line (Acute and Chronic forms of lymphocytic and myelogenous leukemia)
- Precipitating factors: genetic correlation
- Assessment Findings:
- Severe anemia, infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes, internal or external bleeding
- Medical Management:
- Antineoplastic drugs, transfusions, Transplantation: bone marrow; stem cell
- Nursing Process:
- Assessment: history of symptoms; physical assessment, laboratory results; assess neutrophil
- Diagnosis and Planning:
- Risks: infection, hemorrhage, activity intolerance, disturbed body image, anxiety, and fear
- Interventions:
- Monitor platelet counts, assess for signs of bruising and petechiae; report hematuria or epistaxis (nosebleed)
- Acknowledge client's anxieties and fears, reassure PT
Multiple Myeloma
- Multiple Myeloma: malignancy involving plasma cells
- Osteoclasts break down bone cells, resulting in increased blood calcium and pathologic fractures
- Osteolytic tumors: "punched-out" or "honeycombed" appearance in bones
- Assessment Findings:
- Bone Pain, infection, symptoms of anemia, bruising, nosebleeds, renal calculi
- Diagnostic Findings:
- Skeletal radiographic studies: bone lesions; increased serum calcium levels, bone marrow aspiration
- Medical Management:
- Steroids, anticancer drugs, antibiotics
- Analgesics, blood transfusions
- Back braces, body casts
- Surgical Management: transplantation: bone marrow; stem cell
- Nursing Management:
- Assess pain, signs of infection (increased WBC, Fever), fatigue, bleeding, thrombus formation, urine
- Analgesics, ambulation (caution-fracture), fluid intake I&O, safety, Prevent infection
Agranulocytosis
- Agranulocytosis: decrease in production of granulocytes
- Neutrophils, Basophils, Eosinophils
- Assessment Findings:
- Fatigue, fever, chills, headache, opportunistic infections
- Medical Management:
- Remove cause; drugs: human granulocyte colony-stimulating factor
- Nursing Management:
- Drug assessment, protective isolation (neutropenic); visitor restriction–NO flowers, fruit
Aplastic Anemia
- Pancytopenia: Aplastic Anemia: pancytopenia: numbers of all cells reduced
- Causes: autoimmune, exposure to toxic chemicals, radiation, drug therapy
- Assessment Findings:
- Weakness, fatigue, opportunistic infections, Unusual bleeding, petechiae, ecchymosis
- Enlarged spleen/abdominal pain
- Diagnostic Findings:
- CBC- blood cell count; bone marrow aspiration
- Medical Management:
- Withdrawal of causative agent, Transfusions, antibiotics, corticosteroids, Transplantations: bone marrow; autologous stem cell
- Nursing Management:
- History, physical assessment, symptoms, Infection prevention measures/isolation
- Nutrition; modify oral hygiene, Monitoring of blood transfusion
Coagulopathies
- Thrombocytopenia: platelet manufacture by bone marrow is decreased or platelet destruction by the spleen is increased (Splenomegaly)
- Causes: leukemia; malignant blood diseases, severe infections
- Assessment Findings:
- Purpura (purple/reddish), bleeding, internal hemorrhage (GI)
- Medical Management:
- Eliminate cause; corticosteroids, transfusions
- Surgical Management: splenectomy
- Nursing Management:
- Manage/minimize bleeding: Apply pressure/tourniquet, ADR; taper corticosteroid dosage/frequency
Hemophilia
- Hemophilia: clotting factor; inherited: mother to son
- Assessment Findings:
- Oozing; severe bleeding, bleeding in joints
Anemia
- Anemia: a deficiency of erythrocytes or hemoglobin
- Causes: blood loss, inadequate erythrocyte production, destruction of formed RBCs
- Assessment Findings:
- Inadequate RBC volume: orthostatic hypotension, thready pulses, oliguria, heart murmur
- Compensatory mechanisms for lost RBC function: tachycardia, tachypnea, cool, clammy skin, amenorrhea
- Decreased RBC function: dyspnea, chest discomfort, acidosis, headache, vertigo, pallor
Hypovolemic Anemia
- Causes: sudden loss of large volume, chronic loss of small amounts of blood
- Assessment Findings:
- Extreme pallor, tachycardia, hypotension, reduced urine output, altered consciousness, fatigue, chills, rapid respiratory rate
- Medical Management:
- Blood transfusions: treating underlying condition or chronic blood loss
- Administration of oral, IV, or IM iron: restore hemoglobin
Iron Deficiency Anemia
- Iron Deficiency Anemia: insufficient iron to produce hemoglobin
- Assessment Findings:
- Reduced energy, feel cold all the time, fatigue and dyspnea with minor physical exertion, rapid heart rate even at rest, decreased hemoglobin, hematocrit, and serum iron levels
- Medical Management:
- Foods high in iron, Blood transfusion
- Nursing Management:
- Increase iron intake, collaborate with dietitian, administer iron supplement (IM Z-track)
Sickle Cell Anemia
- Sickle Cell Anemia: Hemoglobin A is replaced by Hemoglobin S; sickle- or crescent-shaped erythrocytes from inadequate oxygen supply to blood
- Hereditary; sickle cell crisis
- Chronic hemolytic anemia
- Assessment Findings:
- Jaundice, tachycardia, dyspnea, cardiomegaly, and dysrhythmias; stroke, acute chest syndrome
- Diagnostic Findings:
- Sickledex test; hemoglobin electrophoresis
- Medical Management:
- Supportive treatment: regular blood transfusions; bone marrow transplantation; prophylactic antibiotic therapy
- Sickle cell crisis: narcotic analgesia, O2, bed rest, IV fluids, meds
Other Anemias
- Hemolytic Anemia: Chronic premature erythrocyte destruction
- Assessment Findings:
- Jaundice, enlarged spleen, shock
- Medical Management:
- Removing the cause; corticosteroids; blood transfusions
- Surgical Management:
- Splenectomy
- Nursing Management:
- Health history, supportive care, medication, teaching measures of self-care, arrange follow-up evaluations
Thalassemias
- Thalassemias: hereditary hemolytic anemia
- Types: alpha-thalassemias, beta-thalassemias
- Assessment Findings:
- Cooley's anemia: bronzing of the skin
- Medical Management:
- Symptomatic, frequent transfusions, iron chelation therapy
- Nursing Management:
- Bed rest, protect from infection, closely monitor blood transfusion
Pernicious Anemia
- Pernicious Anemia: lack of intrinsic factor necessary for absorption of vitamin B12
- Degenerative changes in nervous system
- Secondary to surgical removal of stomach or small bowel resection
- Assessment Findings:
- Stomatitis, glossitis, digestive disturbances; diarrhea; dyspnea with minimal exertion, jaundice, irritability, confusion, depression, numbness and tingling in arms and legs, ataxia
- Diagnostic Findings:
- Blood and bone marrow studies; Schilling test, blood smear
- Medical Management:
- IM vitamin B12
- Physical therapy for permanent neurologic deficits
- Nursing Management:
- Glossitis and stomatitis: soft, bland diet; small, frequent meals; oral care
- Permanent neurologic deficit: encourage and assist with ambulation, supervision
- Teaching: administration of vitamin B12; diet
Folic Acid Deficiency Anemia
- Folic Acid Deficiency Anemia: immature erythrocytes; insufficient dietary intake of foods rich in folic acid
- Assessment Findings:
- Severe fatigue, sore and beefy-red tongue, dyspnea, nausea, anorexia, headaches, weakness, light-headedness
- Diagnostic Findings:
- Schilling test
- Medical Management:
- Folic acid supplements; balanced diet
- Nursing Management:
- Teaching: diet, oral hygiene, rest promotion
Erythrocytosis
- Polycythemia vera: increase in circulating erythrocytes and leukocytes
- Rapid proliferation of blood cells produced by the bone marrow; cause is unknown
- Assessment Findings:
- Reddish-purple face and lips, fatigue, weakness, exertional dyspnea
- Diagnostic Findings:
- Elevated blood cell count, platelets and WBC counts elevated, abnormal serum K+ and uric acid
- Medical Management:
- Phlebotomy, radio phosphorus, and radiotherapy
Leukocytosis
- Leukocytosis: proliferation of leukocytes, usually in immature form
- Four types according to dysfunctional bone marrow stem cell line (Acute and Chronic forms of lymphocytic and myelogenous leukemia)
- Precipitating factors: genetic correlation
- Assessment Findings:
- Severe anemia, infections, fatigue, easy bruising, fever, enlarged spleen and lymph nodes, internal or external bleeding
- Medical Management:
- Antineoplastic drugs, transfusions, Transplantation: bone marrow; stem cell
- Nursing Process:
- Assessment: history of symptoms; physical assessment, laboratory results; assess neutrophil
- Diagnosis and Planning:
- Risks: infection, hemorrhage, activity intolerance, disturbed body image, anxiety, and fear
- Interventions:
- Monitor platelet counts, assess for signs of bruising and petechiae; report hematuria or epistaxis (nosebleed)
- Acknowledge client's anxieties and fears, reassure PT
Multiple Myeloma
- Multiple Myeloma: malignancy involving plasma cells
- Osteoclasts break down bone cells, resulting in increased blood calcium and pathologic fractures
- Osteolytic tumors: "punched-out" or "honeycombed" appearance in bones
- Assessment Findings:
- Bone Pain, infection, symptoms of anemia, bruising, nosebleeds, renal calculi
- Diagnostic Findings:
- Skeletal radiographic studies: bone lesions; increased serum calcium levels, bone marrow aspiration
- Medical Management:
- Steroids, anticancer drugs, antibiotics
- Analgesics, blood transfusions
- Back braces, body casts
- Surgical Management: transplantation: bone marrow; stem cell
- Nursing Management:
- Assess pain, signs of infection (increased WBC, Fever), fatigue, bleeding, thrombus formation, urine
- Analgesics, ambulation (caution-fracture), fluid intake I&O, safety, Prevent infection
Agranulocytosis
- Agranulocytosis: decrease in production of granulocytes
- Neutrophils, Basophils, Eosinophils
- Assessment Findings:
- Fatigue, fever, chills, headache, opportunistic infections
- Medical Management:
- Remove cause; drugs: human granulocyte colony-stimulating factor
- Nursing Management:
- Drug assessment, protective isolation (neutropenic); visitor restriction–NO flowers, fruit
Aplastic Anemia
- Pancytopenia: Aplastic Anemia: pancytopenia: numbers of all cells reduced
- Causes: autoimmune, exposure to toxic chemicals, radiation, drug therapy
- Assessment Findings:
- Weakness, fatigue, opportunistic infections, Unusual bleeding, petechiae, ecchymosis
- Enlarged spleen/abdominal pain
- Diagnostic Findings:
- CBC- blood cell count; bone marrow aspiration
- Medical Management:
- Withdrawal of causative agent, Transfusions, antibiotics, corticosteroids, Transplantations: bone marrow; autologous stem cell
- Nursing Management:
- History, physical assessment, symptoms, Infection prevention measures/isolation
- Nutrition; modify oral hygiene, Monitoring of blood transfusion
Coagulopathies
- Thrombocytopenia: platelet manufacture by bone marrow is decreased or platelet destruction by the spleen is increased (Splenomegaly)
- Causes: leukemia; malignant blood diseases, severe infections
- Assessment Findings:
- Purpura (purple/reddish), bleeding, internal hemorrhage (GI)
- Medical Management:
- Eliminate cause; corticosteroids, transfusions
- Surgical Management: splenectomy
- Nursing Management:
- Manage/minimize bleeding: Apply pressure/tourniquet, ADR; taper corticosteroid dosage/frequency
Hemophilia
- Hemophilia: clotting factor; inherited: mother to son
- Assessment Findings:
- Oozing; severe bleeding, bleeding in joints
This quiz covers the medical-surgical aspects of anemia, including its causes, assessment findings, and compensatory mechanisms. It also touches on the symptoms of anemia and its effects on the body.
Make Your Own Quizzes and Flashcards
Convert your notes into interactive study material.
Get started for free
