Cardio, Respi, Hema Disorders PDF

Cardiovascular Disorders Stroke Volume Review of Anatomy and Physiology Three (3) principal components The heart is the major circulatory organ of the body. (1) Preload It roughly weighs 300 grams and is divided between...

Cardiovascular Disorders Stroke Volume Review of Anatomy and Physiology Three (3) principal components The heart is the major circulatory organ of the body. (1) Preload It roughly weighs 300 grams and is divided between the amount of blood filling the blood during two general systems: relaxation, i.e., the amount it stretches; Left Side (2) Afterload the part of the heart that pumps blood into the amount of blood left in the heart after systemic circulation. contraction, which increases Right Side as resistance increases; the part of the heart that pumps blood into (3) contractility pulmonic circulation. the ability of the heart to contract. The heart is composed of four chambers and four These volumes are all connected. In cases of valves: vasoconstriction, total peripheral resistance Right Atrium increases. In cases of vasodilation, blood pressure, receives blood from the superior and inferior cardiac output, and resistance all decrease. vena cavae, being the terminal point of systemic Abnormalities circulation. Blood from this chamber passes Hypertension through the tricuspid valve to move to the right is the elevation of blood pressure. Treatment ventricle. uses vasodilators, which decrease cardiac Tricuspid Valve output, preload, afterload, contractility, and total Right Ventricle peripheral resistance. receives blood from the right atrium, and sends Shock blood into pulmonic circulation through the results in decreased tissue perfusion from pulmonic valve. decreased blood flow. Treatment Pulmonic Valve uses vasopressors/vasoconstrictors to raise Left Atrium cardiac output. receives freshly oxygenated blood from the Examples: pulmonic arteries, and sends blood into the left o dopamine, dobutamine, livufed. ventricular Blood pressure is measured Mitral Valve as systolic over diastolic pressure. Systolic pressure Left Ventricle is denoted by the first Korotkoff sound, produced by the most muscular chamber, as it is the chamber contraction of the ventricles. Diastolic pressure is the responsible for pumping blood out into systemic remaining pressure once the heart becomes relaxed circulation. and the ventricles refill. Aortic Valve Heart Sounds Blood Pressure The heart sounds are auscultated with a stethoscope. is the total pressure used to circulate blood Best Side of Stethoscope for Detection throughout the body. It is calculated Diaphragm Bell with CO×TPR (total peripheral resistance). S1 & S2 S3, S4 and murmurs Cardiac output S1 (Systole) is the total volume of blood pumped by the heart the sound created by the closure of the within one minute. The normal CO is 4 to 8 atrioventricular valves (Tricuspid, Mitral). liters/min. It is the product of heart S2 (Diastolic) rate (number of strokes in a minute) and stroke the sound created by the closure of the volume (amount of blood pumped with one semilunar valves (Pulmonic, Aortic). stroke). S3 (Ventricular Gallop) an abnormal heart sound heard in heart failure. S4 (Atrial Gallop) Murmurs A common complication of VHDs is endocarditis. This the sound blood makes when flow becomes is regularly caused by streptococcus viridans (normal turbulent, such as in valvular heart disease gingival flora) and staphylococcus aureus. If (VHD). endocarditis occurs, Penicillin G is the drug of choice Valvular Heart Diseases & Endocarditis as an antibiotic. Valvular heart disease As S. viridans is a major cause of native valve is any disease in which the valves of the heart endocarditis, the patient teaching prioritized is become damaged, resulting in the inability of to avoid vigorous brushing and to utilize an valves to close (regurgitation) where blood can electric toothbrush rather than a manual one. flow backwards and impair circulation. This may As with all infection-prone diseases, maintain also result in stenosis, where valves fail to open aseptic technique, especially when handling completely, limiting throughput. Both of these highly invasive contraptions such as central lines. cause turbulent blood flow, which can be Valvular heart disease is highly embolic. Among detected as murmurs auscultated with the bell its severe complications are cerebral embolisms. of the stethoscope. Other visible manifestations such as Roth Murmur Types spots, Janeway lesions, and Osler nodes are all due to emboli. The patient should wear anti- Murmurs caused by mitral stenosis (rumbling) embolic stockings if possible. Potential emboli or aortic regurgitation (blowing) are diastolic are not massaged or manipulated to avoid murmurs— murmurs heard during diastole. dislodging them. A free-roaming embolus may Those caused by mitral regurgitation (blowing) become an pulmonary embolism or worse. or aortic stenosis (harsh) are systolic murmurs— murmurs heard during systole. Pericarditis Additionally, a systolic click is found in mitral An inflammation of the pericardial sac, a covering of valve prolapse (MVP). the heart. Diastolic Murmurs Systolic Murmurs Etiology Mitral Stenosis (rumbling) Mitral Regurgitation (blowing) viral infection, Dressler’s syndrome (post-MI), Aortic Regurgitation (blowing) Aortic stenosis (harsh) neoplasms, renal failure, radiation, and Monitor heart sounds, cardiac output, and signs connective tissue diseases. of endocarditis. A 2D ECHO can be used to Clinical Findings monitor the heart’s valvular structures and its pain aggravated by inspiration is the most contractions (ejection fraction) common symptom, and relieved with sitting or Surgical valve replacement may be done. leaning forward. Infection results in leukocytosis, Afterwards, anticoagulants are used to prevent fever, and malaise. thrombus formation. o A characteristic sign of pericarditis is Anticoagulants a pericardial friction rub upon auscultation. This is a class of drugs that prevent the formation of o ECG shows ST elevation. blood clots. Nursing Diagnosis Common Examples Pain heparin, warfarin, and enoxaparin Risk of Decreased Cardiac Output Antidotes Risk of Ineffective Breathing related to Pain are used for bleeding related to anticoagulant Management use. treat the cause of the pericarditis. Antidote Medication 1st to Assess Protamine Sulfate Heparin Monitor PTT Pain: NSAIDs, analgesics Vitamin K Warfarin Monitor PT & INR Monitoring for cardiac tamponade: diminished Types of Anticoagulants heart sounds, jugular venous distention, pulsus Oral antithrombin inhibitors (Dabigatran) paradoxus, narrowed pulse pressure Novel (new) oral anticoagulants (NOACs) include Apixaban, Edoxaban, Rivaroxaban  Digoxin, an inotropic, improves the contractility Medical Treatment of the heart. pericardiocentesis, aspiration of the pericardial Digoxin contents if pericardial effusion occurs; dialysis is The therapeutic window of Digoxin is narrow, making renal failure is the cause of pericarditis (uremia) it prone to toxicity. In normal use, it should remain Pericardial Effusion between 0.5 to 2.0 ng/mL. Potassium is also a The pericardial sac normally only contains ~20 mL of consideration for digoxin therapy— the receptors for fluid. In cases of inflammation, infection, or other digoxin are also receptors for potassium. If the disease processes, this fluid can accumulate and patient has low potassium, the amount of open cause pericardial effusion. In severe cases, large receptors for digoxin is greater, and poses a higher volumes of fluid can cause cardiac tamponade. Heart risk for toxicity than in normal patients. sounds can become diminished, but a pericardial Signs of Toxicity friction rub may be heard. Anorexia, Nausea and Vomiting Heart Failure Blurred vision, green halos is the loss of function of the heart, being unable Bradycardia to pump blood out into pulmonic (right-sided) or Nursing Management systemic circulation (left-sided). monitor the client’s weight daily. A sign of failing Etiology circulation is the onset of edema, which results myocardial infarction, incompetent valves, in sudden weight gain. cardiomyopathy (or any other disorders that o Decrease the heart’s workload; provide affect the muscular layer of the heart). periods of rest with any activity. Right-Sided Heart Failure (RSHF) features o Position the client in a semi-fowler’s or a distended neck vein (backing up of the orthopneic position to facilitate breathing SVC), edema (congestion of systemic and circulation. circulation), hepatomegaly (backing up of the Coronary Artery Diseases IVC), and jaundice. The aorta branches off into the right coronary o Diet: low Na+, fluid limitation artery and left coronary artery. The main problem Left-Sided Heart Failure (LSHF) features pink involved with coronary artery diseases frothy sputum, crackles, orthopnea (positional is atherosclerosis. It is the hardening or stenosis of dyspnea), and paroxysmal nocturnal dyspnea vasculatures as a result of the build-up of plaque, and from congestion of pulmonic circulation. results in decreased perfusion. An imbalance Diagnostic Evaluation: between oxygen demand and supply CXR to visualize cardiomegaly produces ischemia, which can be visualized as ST 2D ECHO to evaluate decrease in ejection depression in an ECG, which can eventually result fraction (proportion of blood volume pumped in myocardial infarction, which can be visualized as out of the heart with each stroke) and increased ST elevation in an ECG. CVP (for RSHF) Lead Placement Management: mn. 3Ds The following are the corresponding leads to which Diuretics to reduce pulmonary congestion. wall of the heart is being detected: These include loop diuretics (Furosemide, II, III, AVF: inferior wall Bumetanide) which lower serum potassium. I, AVL: lateral wall Determine potential potassium imbalance in V1, V2: septal wall patients taking diuretics. The same caution is V3, V4: anterior wall applied with potassium-sparing diuretics, which V5, V6: lateral wall can result in hyperkalemia instead. AVR: no specific view Vasodilators reduce total systemic resistance, allowing the heart to pump better by reducing the preload.  Coronary Artery Sources Beta-Blockers The Right Coronary Artery supplies the inferior (-olols) wall. produces wheezing; given in caution to patients The Left Coronary Artery supplies the anterior, with COPD and asthma septal, and lateral walls. Calcium Channel Blockers Unipolar Precordial Leads (-dipines, Verapamil, Diltiazem) V1: 4th ICS, Right Sternal Margin produces edema Antiplatelets V2: 4th ICS, Left Sternal Margin inhibit the aggregation of platelets. This is V3: Midway between V2 and V4 primarily aspirin, but can also be clopidogrel V4: 5th ICS, MCL (Plavix) or dipyrimadole. Because of its nature, V5: AAL on the same level as V4 monitor the patient for bleeding. V6: MAL on the same level as V4 Anticoagulants Lead Axes as discussed earlier. Bleeding is also managed. The two leads to consider for axis deviation is Lead Analgesics I and Lead AVF. If both are positive, the axis remains are used due to the pain experienced by the normal. client. In myocardial infarction, morphine is Lead I Lead AVF Axis Positive Positive Normal used. Positive Negative Left Myocardial Infarction Negative Positive Right The death of the myocardial layer of the heart, most Negative Negative Extreme Axis Deviation commonly caused by coronary artery disease. This is Angina Pectoris known as a heart attack. Angina pectoris is chest pain caused by hypoxia of Risk Factors the cardiac muscles. The pain is a substernal pain non-modifiables such as race, age, gender; and radiating to the left arm. modifiables (mn. SAHOD) smoking, (a) high Types chlosterol, hypertension, obesity, diabetes Stable Angina mellitus angina produced by exertion, and relieved by o Dyslipidemia is an abnormal level of lipids in rest or the use of nitrates (nitroglycerin). The the blood. Normally, total cholesterol should pain is predictable and consistent. remain under 200 mg/dL, triglycerides Unstable Angina should remain under 150 mg/dL, and LDLs angina that cannot be relieved by rest and should remain under 100 mg/dL. HDLs, the nitrates, and progresses in severity and “good cholesterol”, should be above 40 frequency. It is also known as a pre-infarction mg/dL. angina. Clinical Manifestations Variant/Prinzmetal’s Angina the main manifestation is crushing, substernal angina that appears most frequently during rest, pain that may radiate to the jaw, neck, or left caused by vasospasm. arm, which cannot be relieved by rest or Medications for Angina nitroglycerine. Impaired perfusion results Nitrates in cold, clammy skin; anxiety and a sense of a vasodilator that reduces preload and impending doom; restlessness; afterload— commonly nitroglycerin. It is given at and diaphoresis. most three times every five minutes. It is Diagnostic Examination delivered sublingually via spray or transdermally ECG via patch. Nitroglycerin is photosensitive (place an ST Elevation in an ECG reading is them in an amber container) and expire within characteristic of myocardial infarction. Prior to six months. injury, ischemia produces T-wave inversion and  after injury, necrosis produces abnormal Q o ventricular tachycardia, ventricular waves. fibrillation— treated with defibrillation, except Blood Tests for ventricular tachycardia with pulse. Troponin T, I (MI- Recurrent chest discomfort specific), CKMB, Myoglobin (earliest), Respiratory Disorders and Lactate Dehydrogenase (LDH; late to The respiratory process begins with the nose down appear). to the trachea (upper respiratory tract), and to the bronchi, bronchioles, and alveolar sacs (lower respiratory tract). It is responsible for the intake of oxygen to sustain life, and for the removal of carbon dioxide as waste. Alterations in its function, whether restrictive or obstructive, can become life- threatening if unmanaged. Monitoring Normal Description Found At Breath Sound Tracheal Harsh breath sounds Level of the trachea Bronchial High-pitched breath sounds Level of the bronchi Management Bronchovesicular Medium-pitched breath sounds Level of the scapula (mid-lung field) the MONA mnemonic (Morphine, Oxygen, Vesicular Low-pitched breath sounds Level of the lower lobes of the lung Nitroglycerine, Aspirin) Abnormal Description Found In is apparently outdated, with only aspirin as Breath Sound Rales Discrete, non-continuous breath remaining relevant and clearly beneficial for sounds produced by moisture of the treatment. Aspirin is part of the reperfusion tracheobronchial tree. Heart best during inspiration. therapy necessary for recovering homeostasis in Crackles A coarse form of rales, indicating Pulmonary edema the presence of fluid in the lungs Pneumonia the coronary arteries. These Inflammation include thrombolytics such as streptokinase. Ronchi ”Popping” breath sounds produced by secretions obstructing the airway As usual, monitor for bleeding when using Wheezes Continuous, musical breath sounds Asthma - Wheezes on inspiration: stridor Bronchoconstriction medications that reduce the clotting ability of the - Wheezes on expiration: asthma blood. - If using morphine, Naloxone (Narcan) Friction Rub Crackling, grating sounds Pericarditis originating from inflamed pleura. Pleurisy should be prepared in case of oversedation. - The Find the type of acid-base imbalance, and nurse assists in percutaneous transluminal its classification: coronary angioplasty (PTCA), where a balloon or pH: 7.35 - 7.45. Lower than normal is acidosis, higher stent opens up an occluded blood vessel is alkalosis. and coronary artery bypass graft (CABG) surgery CO₂: 35 - 45. Lower than normal is alkalosis, higher is where an extra blood vessel (either saphenous acidosis. vein, internal mammary artery, or radial artery) HCO₃-: 22 - 26. Lower than normal is acidosis, higher is used to bypass the occluded artery is alkalosis. Patient Teaching Whichever of the CO₂ (respiratory) Preoperatively, teach the client about the and HCO₃- (metabolic) readings agree with the pH importance of avoiding vigorous coughing, deviation is the result. If both agree, it performing leg exercises (embolus prophylaxis), and is combined or mixed. exercising incentive spirometry to maintain lung Find the level of compensation achieved: function. Postoperatively, monitor the client for signs of infection. Fully Compensated read the pH. If it is normal, full compensation is Complications achieved. Identify which region the pH is closer to Cardiogenic shock even in the normal range. Determine the match from Arrhythmia CO2 or HCO3 to differentiate respiratory from metabolic pH imbalance. Partially Compensated Low Grade Afternoon Fever, read the pH. If none of the values are normal, the pathognomonic sign of TB. compensation is partial. Same rules as before are Anorexia, Weight Loss observed. Night Sweats Uncompensated Diagnostic Examination if one of CO₂ or HCO₃- is normal, but the pH is Screening: Mantoux Test abnormal, no compensation has been achieved. a PPD sample injected intradermally (skin test). A Pneumonia positive result indicates exposure. The inflammation of the lungs. Most commonly caused o Healthy individuals test positive if the skin test by Streptococcus pneumoniae in adults. In children aged returns an induration of 10 mm or more. 6 months to 6 years old, the most common cause o Immunocompromised individuals test positive is Haemophilus influenzae serotype B. with only 5 mm or more. Etiological/Risk Factors Confirmatory: Sputum Culture, or GeneXpert (uses smoking, air pollution, immunocompromisation sputum sample, faster) (e.g., AIDS, chemotherapy, dialysis patients). Determine Extent of Lesions: CXR (mild, moderately Clinical Manifestations advanced, far advanced) green to rusty sputum (pathognomonic), dyspnea, Medical Management: (mn. RIPES) fever, pleuritic chest pain (pain upon used for 6 months. coughing/breathing), rales, crackles. Rifampicin: red-orange secretions Diagnostic Evaluation Contact lenses can be stained if worn by the patients. CXR (confirmatory), CBC (elevated WBC), Sputum Recommend the use of eyeglasses. GS/CS Isoniazin Management results in numbness/paresthesia. Requires Pyridoxine (Vitamin B6) to offset oxygen therapy, force fluids (liquefy secretions), numbness. nebulize, suctioning as necessary Pyrazinamide Drug of choice: amoxicillin; alternatively, increases uric acid— avoided for patients with gouty azithromycin arthritis. Nursing Interventions Ethambutol positioning, deep breathing and coughing exercises, causes optic neuritis; blurring vision. Color CPT discrimination (red-green) is affected. Types of Pneumonia Streptomycin Community Acquired Pneumonia (CAP) IM ANST; (mn. SON) sensorineural hearing loss. The Hospital Acquired Pneumonia (HAP) drug is ototoxic and nephrotoxic (check creatinine). Ventilator Acquired Pneumonia (VAP) COPD Pulmonary Tuberculosis Patient Teaching Discovered by Robert Koch, giving it the name “Koch’s The two universal risk factors for COPD disease”. It is caused by Mycobacterium tuberculosis is smoking and air pollution. This is applicable to Risk Factors (mn. MOAI, as in this guy ) both chronic bronchitis and emphysema. Let the Malnutrition patient make lifestyle changes to avoid these risk Overcrowding factors. Alcoholism Always teach the patient about pursed lip breathing, Immunocompromised or Ingestion of Infected which prevents air trapping. In this type of Unpasteurized Bovine Milk breathing, exhalation lasts longer than inhalation. Clinical Manifestations: (mn. PLAN) Chronic Bronchitis Productive Cough Blue boater; problems with the constriction of airway due to inflammation, which also increases mucus production due to mucus gland growth. Clinical Manifestations Wheezing on Expiration chronic coughing— more than three months in two Management consecutive years. High Fowler’s Positioning or Tripod during dyspnea ABG Enforce complete bed rest respiratory acidosis Administer medications as ordered: bronchodilators Nursing Management (causes palpitation, avoid stimulants e.g. caffeine), Low inflow O2 (less than 6) to prevent the loss of hypoxic steroids (increases (mn. BNG) BP, Na, Glucose, and drive. decreases Potassium. Feed the patient with banana or avocado) Management: (mn. CAMB) Metered Dose Inhaler (MDI) with a maintenance Corticosteroids (as an antiinflammatory) drug used to prevent exacerbation. Antimicrobials (if pneumonia occurs) Pneumothorax Mucolytics/Expectorants Pneumothorax is the accumulation of air in the pleural Bronchodilators: Salbutamol, Ventril; space. The normally negative pressure present in the avoid stimulants because of palpitation as a side space becomes positive and acts on the lungs, preventing effect. it from expanding. Emphysema Etiology Pink puffer; problems with (mn. IBA) inelasticity of Spontaneous pneumothorax alveoli, barrel chest (increased anteroposterior chest diameter due to air trapping), and air trapping. Highly COPD (Secondary pneumothorax) related to smoking. Catamenial pneumothorax Risk Factors Clinical Manifestations smoking, alpha-1 antitypsin deficiency, air pollution Dyspnea Dullness Clinical Manifestations Decreased chest expansion Productive Cough Diminished breath sounds Dyspnea at rest Tracheal Deviation (pathognomonic) towards the Rales, Crackles, Rhonchi unaffected side found in tension pneumothorax. Barrel Chest d/t Air Trapping Tension Pneumothorax, where a hole is punctured Diagnostic Examination by a mechanical ventilator into the pleural space. ABG, also respiratory acidosis; CXR (overinflation) Diagnostic Examination Management: (mn. FLA, CAMB) CXR reveals inflation of the pleura. ABG reveals Force Fluids respiratory acidosis. Low Inflow O2 (prevent loss of hypoxic drive) Management Administer medications as ordered Thoracentesis may be the primary form of Corticosteroids management if mild. Antibiotics: if pneumonia occurs If moderate to severe, a CTT (chest tube Mucolytics/Expectorants thoracostomy) may be required. Bronchodilators Nursing Management Bronchial Asthma if a CTT is attached to a water-sealed drainage, A reversible inflammatory lung condition due to monitor fluctuations (should fluctuate, otherwise hypersensitivity to allergens. Bronchoconstriction obstruction or re-expansion of the lungs may have occurs, restricting breathing. occurred) and bubbling (should be intermittent, Risk Factors otherwise an air leak may be present). Family History Chest Injuries Clinical Manifestations: (triad for asthma) Rib Fractures Cough resulting from direct blunt chest trauma, often from Dyspnea vehicular accident victims. The pathognomonic sign  of rib fractures is pain on the site of injury White Blood Cells exacerbated upon inspiration. forefront immunologic agents. Management: surgery is not required. Ribs unite Normal: 5,000 to 10,000 spontaneously. Decreased WBC is termed as leukopenia. Maintain high fowler’s and monitor for respiratory o Avoid crowded places, limit visitors, and observe depression. hand hygiene and the use of personal protective Flail Chest equipment. resulting from direct blunt chest trauma that o Diet for patients with leukopenia: low-residue damages two or more ribs. The pathognomonic sign low-fiber high-protein diet. is paradoxical breathing, where inhalation reduces o Reverse isolation for patients. chest size and vice versa. Increased WBC is termed as leukocytosis. This Hematologic Disorders suggests an active bacterial infection. Blood is a specialized organ that exists in a fluid state. It Platelets is composed of plasma and blood cells. It makes up 7% platelets are important for clotting. They have a to 10% of the human body (~5 to 6 L). It is created in normal lifespan of 10 days. the red bone marrow (hematopoiesis). One of the vital o Normal: 150,000 to 450,000. functions of blood is for oxygenation as it carries oxygen o Thrombocytopenia poses a risk for bleeding as into the body, and carbon dioxide out of it. It also the body is unable to clot wounds. contains nutrients, foreign bodies, and various cells that o Thrombocytosis produces a risk of excessive all function to aid the human body. clotting. Blood Cells and Indices Red Blood Cells are the primary carriers of oxygen into the body and carbon dioxide out of the body. They have a normal lifespan of 120 days. These give the blood its distinct color, and make up a large percent of the Blasts composition of blood (see Hematocrit below). The Erythrocytes carry more oxygen than reticulocytes, red blood cells are analyzed and “indexed” with RBC and thrombocytes are able to clot better than indices. These values include: megakaryocytes. Similarly, blasts are unable to Hematocrit match leukocytes in immunologic ability. However, the ratio between blood volume and RBC volume. these are exactly the cells that are produced Normally 30% to 40%. Increase in Hct indicates FVD, excessively in leukemia, which then “drown out” decrease in Hct indicates FVE. other cells. In such a case, despite a high white blood Mean Corpuscular Volume cell count, the immune system is impaired. the size of the RBC. This value determines the Nutritional Anemias presence of microcytic, normocytic, or macrocytic Iron-Deficiency Anemia (IDA) RBC. is produced by a decrease in iron supply. o Normocytic Anemia occurs in CKD/RF Anemia. Causes o Microcytic Anemia occurs in Iron Deficiency bleeding, nutritional deficiencies Anemia. Diet High in Iron o Macrocytic Anemia occurs in Megaloblastic Anemia. Meat, Seafoods, Eggs, Liver, Fish (Meat SELF), and Hemoglobin Dark Green Leafy Vegetables. Iron is best absorbed with Vitamin C. Ferrous sulfate is best taken with an is found within RBCs. Lowered Hgb is called anemia, empty stomach. Stool may appear dark green or and elevated Hgb is called polycythemia (found in black. smokers). Anemia patients display pallor, fatigue, and palpitations. o Normal Female Volume: 12 to 14 grams/deciliter o Normal Male Volume: 14 to 16 grams/deciliter Diagnostics Avoid high altitudes and cold environments. microcytic hypochromic anemia and decreased Encourage hydration. serum ferritin. Pathognomonic sign: koilonychia; Definitive Diagnosis spoon-shaped nails. hemoglobin electrophoresis Administration of Iron Supplements Pain is the most important nursing diagnosis, 300 – 325 mg TID oral 1 hour before meal. For liquid especially as a symptom of crisis. An opioid form, use straw; deep IM, use Z-track. Include (morphine) may be required. Vitamin C to facilitate absorption. mn. SICKLE: Jaundi(s)ce, Avoid (i)nfection (triggers Megaloblastic Anemia crisis), (C)rescent-shaped RBC, (K)Crisis and Pain, further divided into Vitamin B9 (FADA) and Vitamin (Lahi) Hereditary, (E)ncourage hydration (3L/day to B12 (Pernicious Anemia) deficiency. These vitamins avoid clotting) are important in the production of DNA in RBCs. mn. HOPIA: Hypoxia, high altitudes, opioid (morphine), pain, infection, adequate hydration Diagnostics Complications Macrocytic Anemia. Pathognomonic Sign of Beefy Red Tongue; Glossitis. Decreased hemoglobin, pulmonary hypertension, priapism, impotence, decreased DNA synthesis, but increased MCV. infection, strike, acute chest syndrome FADA Jaundice those at risk for Vitamin B9 deficiency are alcoholics Hemoglobin is released when the RBC is lysed, and and those in pregnancy or dialysis. Some drugs (e.g. releases Heme, which converts to bilirubin, which leads Methotrexate) may also cause FADA. to the jaundiced presentation of patients with hemolytic Pernicious Anemia anemia (e.g. sickle cell anemia, malaria). those at risk for Vitamin B12 deficiency are those Aplastic Anemia who had a Billroth I or II procedure (it removes the IF an idiopathic disorder resulting in insufficient necessary to absorb Vitamin B12). production of blood cells. Diagnostic Picture If determined as autoimmune, this is treated by Glossitis/Beefy Red Tongue, and Paresthesia. 24- removing antibodies (splenectomy) or hour urine for Schilling Test. immunosuppression (steroids). If necessary, These patients require a life-long monthly replacement of damaged bone marrow tissue with administration of Vitamin B12. a bone marrow transplant may be done. Diet for B12: eggs, meat, poultry, shellfish, milk, and Diagnostic Picture milk products, citrus, legumes pancytopenia; risk for infection, bleeding, and the 3 Non-Nutritional Anemia Ps of anemia. Anemia of Renal Failure Nursing Interventions decreased blood oxygen signals to the kidneys to avoid caffeine produce erythropoietin, a hormone that stimulates provide rest for fatigue the red bone marrow to produce red blood cells. prevent infection However, in renal failure, erythropoietin is prevent bleeding insufficient, decreasing RBC production. This results o avoid rigorous activities, NSAIDs, Aspirin, etc. in Normocytic Anemia. Management Epogen, a synthetic erythropoietin, is given to patients with RF to manage anemia. It is given thrice a week subcutaneously. If severe, blood transfusion may be necessary. Sickle Cell Anemia triggered by hypoxia and the HbS gene is inherited in the African Race.