Assessment of Hematological System

The nurse is assessing a client for hematologic risks. Which health history question would the nurse ask to determine if the risk cannot be reduced or eliminated? a. "Where do you work?" b. "Tell me what you eat in a day." c. "Does anyone in your family bleed a lot?" d. "Do you seem to have excessive bleeding or bruising?"

"Does anyone in your family bleed a lot?" To determine if hematologic risks exist while obtaining a health history from a client, the nurse asks if anyone in the client's family bleeds a lot. An accurate family history is important because many disorders that affect blood and blood clotting are inherited. Genetics cannot be changed.Work habits can be a risk, such as working near radiation, but these are behaviors that can be changed. Diet can affect risk, but it is a health behavior that can be changed.Excessive bleeding or bruising is a symptom, not a risk.

A client on anticoagulant therapy is being discharged. Which statement by the client indicates an understanding of the anticoagulants drug action? a. it will thin my blood b. it is used to dissolve blood clots c. it should prevent my blood from clotting d. it might cause me to get injured

"It should prevent my blood from clotting." The statement that shows the client understands anticoagulant drug action is, "it will prevent my blood from clotting." Anticoagulants work by interfering with one or more steps involved in the blood clotting cascade. Thus, these agents prevent new clots from forming and limit or prevent extension of formed clots.Anticoagulants do not cause any change in the thickness or viscosity of the blood.Anticoagulants do not dissolve clots, fibrinolytics do. Anticoagulants do not cause more injuries but may cause more bleeding and bruising when the client is injured.

A client with a low platelet count asks the nurse, "Why are platelets important?" Which statement is the nurse's best response? a. "Platelets will make your blood clot." b."Your platelets finish the clotting process." c. "Blood clotting is prevented by your platelets." d. "The clotting process begins with your platelets." Submit

"The clotting process begins with your platelets." The nurse's best response to why platelets are important is that, "The clotting process begins with your platelets." Platelets begin the blood clotting process by forming platelet plugs, but these platelet plugs are not clots and cannot provide complete hemostasis.Platelets do not clot blood but are a part of the clotting process or cascade of coagulation. Platelets do not prevent the blood from clotting. Rather they function to help blood form clots. Platelets do not finish the clotting process, they begin it

A client with anemia asks the nurse, "Do most people have the same number of red blood cells?" Which is the nurse's best response to the client? a. "Yes, they do." b. "No, they don't." c."The number varies with gender, age, and general health." d. "You have fewer red blood cells because you have anemia."

"The number varies with gender, age, and general health." The nurse's best response to the client with anemia about most people having the same number of blood cells is, "The number varies with gender, age, and general health." This statement is the most educational and reasonable response to the client's question.Responding "yes, they do." and "no, they don't." are not educational statements. Although telling the client that people do not have the same number of RBCs is true, it is not informative, and there is a better answer. While it may be true that the client has fewer red blood cells because of anemia, it does not answer the client's general question.

The nurse is teaching a client about what to expect during a bone marrow biopsy. Which statement by the nurse accurately describes the procedure? a. "The doctor will place a small needle in your back and will withdraw some fluid." b. "You will be sedated during the procedure, so you will not be aware of anything." c. "You may experience a crunching sound or a scraping sensation as the needle punctures your bone." d. "You will be alone because the procedure is sterile; we cannot allow additional people to contaminate the area." Submit

"You may experience crunching sound or a scraping sensation as the needle punctures your bone." When describing a bone marrow biopsy procedure to a client, it is accurate to describe a crunching sound or scraping sensation when the needle punctures the bone. Proper expectations minimize the client's fear during the procedure.A very large-bore needle is used for a bone marrow biopsy, not a small needle, and the puncture is made in the hip or in the sternum, not the back. A local anesthetic agent is injected into the skin around the site. The client may also receive a mild tranquilizer or a rapid-acting sedative (such as lorazepam [Ativan]) but will not be completely sedated. The nurse, or sometimes a family member, is available to the client for support during a bone marrow biopsy. The procedure is sterile at the site of the biopsy, but others can be present without contamination at the site.

The patient is Joe, a 28-year-old man with Down Syndrome who lives at home with his parents. His blood cell counts are all abnormal, and the next diagnostic test scheduled is a bone marrow aspiration. Joe can read at a 4th grade level and is very friendly; however, he is afraid of needles and had to be restrained during the venipuncture for blood testing. 1. From whom should informed consent be obtained for the procedure, Joe or his parents? 2. Should anyone explain to Joe what the procedure entails? Why or why not? 3. Who is responsible for obtaining the informed consent? 4. If Joe says he does not want the test but his parents insist that he have it, what if any, ethical principles may be violated? (If necessary, review the ethical principles in chapter 1.) 5. What members of the interprofessional team could provide guidance in this situation?

1. From whom should informed consent be obtained for the procedure, Joe or his parents? ANS: The right to make one's own decisions about medical care requires the capacity to understand and evaluate options and the freedom from coercive forces that might restrict choices. In Joe's case, as with children, his cognitive limitations make him unable to fully comprehend the medical facts and the possible treatment options. Therefore, consent should be obtained from his parents. Although there is no legal basis for one adult to make decisions for another without court authorization in the form of guardianship, it is accepted practice for next-of-kin family members to authorize medical care. Because Joe's decreased cognition establishes a lack of capacity for decision-making, his parents, as the closest family members, have the authority to authorize or refuse suggested medical interventions. However, the nurse can provide helpful guidance in suggesting to his parents that they consider petitioning the court of formal guardianship, which might be helpful in other kinds of decisions, such as signing a lease for an apartment, obtaining social security benefits or health insurance. 2. Should anyone explain to Joe what the procedure entails? Why or why not? ANS: Yes, Joe has more than enough cognition to know that something is going to be done to him and should have the procedure explained to him. 3. Who is responsible for obtaining the informed consent? ANS: The health care professional who is performing the test is responsible for obtaining consent from Joe's parents. 4. If Joe says he does not want the test but his parents insist that he have it, what if any, ethical principles may be violated? (If necessary, review the ethical principles in chapter 1.) ANS: While Joe does not have either a legal or a moral right to make an autonomous and independent decision, his wishes do have moral weight and should be taken in to account. It is best to obtain his "assent," which means that he agrees to the test. The practice of relying on surrogates (e.g., family members) for medical decision-making rests on several assumptions. First, family members generally have knowledge of patient values and preferences and thus can represent what the patient would choose if able. Respecting family decisions thus indirectly respects patient values. Second, we assume family members are committed to the best interests of the patient, reflecting the principle of beneficence. Third, close family members often have responsibility for the care of the patient after discharge; thus they have valid interests that can generate duties of health care professionals to consider their choices. In explaining the procedure to Joe, and knowing his fear of needles, discuss with Joe, his parents, and the professional performing the test the possibility of procedural sedation. 5. What members of the interprofessional team could provide guidance in this situation? ANS: A variety of health care professionals can provide some help in this situation. Joe's long-time health care provider, whom Joe knows and trusts, could be critical to the success of Joe's cooperation. A member of the hospital's ethics committee can help staff come to terms with (perhaps) having to do something Joe opposes. Pastoral care or clergy (the hospital's or the family's own spiritual advisor can be a calming influence at this time.

Mean corpuscular volume (MCV)

80-95 fL Increased levels: indicate macrocytic cells, possible anemia. Decreased levels: indicate microcytic cells, possible iron deficiency anemia

After reviewing the laboratory test results, the nurse calls the primary care provider about which client? a.A 52-year-old who had a hemorrhage with a reticulocyte count of 0.8% b.A 49-year-old with hemophilia and a platelet count of 150,000/mm3 (150 × 109/L) c. A 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm3 (1.5 × 109/L) d. A 44-year-old prescribed warfarin (Coumadin) with an international normalized ratio (INR) of 3.0 Submit

A 46-year-old with a fever and a white blood cell (WBC) count of 1500/mm3 (1.5 × 109/L) The nurse calls the PCP about a 46-year-old client with a fever and a WBC of 1500/mm3 (1.5 × 109/L). This client is neutropenic and is at risk for sepsis unless interventions such as medications to improve the WBC level and antibiotics are prescribed.An elevated reticulocyte count in the 52-year-old is expected after hemorrhage. A platelet count of 150,000/mm3 (150 × 109/L) in the 49-year-old is normal. The INR of 3.0 in the 44-year-old indicates a therapeutic warfarin level.

The nurse is starting the shift by making rounds. Which client would the nurse assess first? a. A 52-year-old who just had a bone marrow aspiration and is requesting pain medication b. A 59-year-old who has a nosebleed and is receiving heparin to treat a pulmonary embolism c. A 47-year-old who had a Rumpel-Leede test and asks the nurse to "look at the bruises on my arm" d. A 42-year-old with a diagnosis of anemia who reports shortness of breath when ambulating down the hallway Submit

A 59-year-old who has a nosebleed and is receiving heparin to treat a pulmonary embolism After rounds, the nurse would first assess the 59-year-old client who has a nosebleed and is getting heparin to treat a pulmonary embolism. The client with the nosebleed may be experiencing the bleeding as a result of excessive anticoagulation and must be assessed first for the severity of the situation.The client waiting for pain medication would be next on the nurse's "to do" list. Making clients wait for pain medication is not desirable, but in this scenario, the client who is bleeding is the higher priority. The client who had a Rumpel-Leede test and the client with anemia are more stable and can be assessed later. The Rumpel-Leede test is a tourniquet test used to determine the presence of vitamin C deficiency or thrombocytopenia.

The nurse is caring for a group of hospitalized clients. Which client is at highest risk for infection and sepsis? a. A client with hemolytic anemia b. A client with cirrhosis of the liver c. A client who had an emergency splenectomy d. A client with recently diagnosed sickle cell anemia Submit

A client who had an emergency splenectomy The client who is at the highest risk for infection and sepsis is the client who had an emergency splenectomy. Removal of the spleen causes reduced immune function. Without a spleen, the client is less able to remove disease-causing organisms and is at increased risk for infection.A low red blood cell count with hemolytic anemia can contribute to a client's risk for infection, but this client is more at risk for low oxygen levels and ensuing fatigue. The liver plays a role in blood coagulation, so this client is more at risk for coagulation problems than for infection. Sickle cell anemia causes pain and discomfort because of the changed cell morphology, so acute pain, especially at joints, is the greatest threat to this client.

Which client does the medical unit charge nurse assign to a licensed practical nurse (LPN)/licensed vocational nurse (LVN)? a. A client with chronic microcytic anemia associated with alcohol use b. A client scheduled for a bone marrow biopsy with conscious sedation c. A client with a history of a splenectomy and a temperature of 100.9°F (38.3°C) d. A client with atrial fibrillation and an international normalized ratio of 6.6

A client with chronic microcytic anemia associated with alcohol use The medical unit charge nurse assigns the LPN/LVN a client with chronic microcytic anemia related to alcohol use. Chronic microcytic anemia is not considered life-threatening and is within the skill level of an LPN/LVN.The client with a bone marrow biopsy with conscious sedation, a history of splenectomy and a temperature, and atrial fibrillation require more complex assessment or nursing care and would be assigned to RN staff members.

1. What is the most important precaution for the nurse to teach a client whose platelet counts usually range between 50,000 to 60,000/mm3 (50 × 109/L to 60 × 109/L)? a. "Drink at least 3 liters of fluid daily." b. "Take a multiple vitamin that contains iron." c. "Avoid aspirin and aspirin-containing drugs." d. "Increase your intake of dark green, leafy vegetables."

ANS: C The normal range of platelets for a healthy adult is 150,000 to 400,000/mm3 (150 × 109/L to 400 × 109/L). This client's platelets are low enough that prolonged bleeding can occur in response to minor trauma. Thus, the client should do nothing that causes platelets to reduce further or lose function. Aspirin is an irreversible platelet inhibitor. Even one dose of aspirin can greatly reduce the function of this client's already low numbers of platelets and greatly increase the risk for excessive bleeding. Neither increased iron nor increased vitamin K (in dark green, leafy vegetables) would improve this client's platelet status. Increasing fluid would not affect this client's ability to form a platelet plug or clot appropriately.

1. With which client will the nurse apply pressure to an injection site for 5 minutes because of an increased risk for bleeding? a. 28-year-old who has had type 1 diabetes for 15 years b. 42-year-old newly diagnosed with type 2 diabetes c. 58-year-old with chronic hypertension and heart failure d. 62-year-old with extensive liver damage from cirrhosis

ANS: D The liver is critically important in blood clotting because it produces a number of the clotting factors. Whenever liver function is reduced, such as with liver damage from cirrhosis, the production of clotting factors is below normal and the risk for bleeding greatly increases, even after the minor trauma of an intramuscular injection.

Pigment loss and skin yellowing are common changes associated with what?

Aging Pallor in an older adult may not be a reliable indicator of anemia. Laboratory testing is required. Yellow-tinged skin in an older adult may not be a reliable indicator of increased serum bilirubin levels. Laboratory testing is required

1. The nurse performing a hematologic assessment on an older adult client identifies the following findings. Which ones does the nurse associate with age-related changes rather than a specific hematologic problem? (Select all that apply.) a. Bleeding gums b. Dry skin on distal extremities c. Pale lips d. Smooth tongue e. Sparse pubic hair f. Bright yellow-tinged sclera

Answer B, E Skin on older adults dries with aging and loses color. Color loss makes skin appear pale or slightly yellow-tinged, which is not jaundice; however, bright or dark yellow sclera usually indicate jaundice and should be investigated further. Hair everywhere decreases in thickness and turns gray. Pubic hair loss is common. Bleeding gums are never considered normal and can indicate a periodontal or hematologic problem. Although skin becomes more pale, lips should retain a deep red color. The normal tongue has bumps and shallow creases, even in older adults. A smooth tongue is an indicator of some types of anemia.

Skin dryness may indicate what?

Any of a number of hematologic disorders. or Aging Skin moisture is not usually a reliable indicator of an underlying pathologic condition in the older adult.

A client has a bone marrow biopsy performed. What is the priority postprocedure nursing action? a. Inspect the site for ecchymosis b. Apply pressure to the biopsy site c. Send the biopsy specimens to the laboratory d. Teach the client to avoid vigorous activity

Apply pressure to the biopsy site The priority postprocedure action after a bone marrow biopsy would be to stop bleeding by applying pressure to the site.Inspecting for ecchymosis, sending specimens to the laboratory and teaching the client about activity levels will be done after hemostasis has been achieved.

Which task does the nurse delegate to unlicensed assistive personnel (UAP) who is assisting with the care of a female client with anemia? a. Monitor the oral mucosa for pallor, bleeding, or ulceration b. Ask about the amount of blood loss with each menstrual period c. Check for sternal tenderness while applying fingertip pressure d. Count the respiratory rate before and after ambulating 20 feet (6 m)

Count the respiratory rate before and after ambulating 20 feet (6 m) Counting the respiratory rate before and after ambulation is within the scope of practice for a UAP. The UAP will report this information to the RN.Monitoring oral mucosa requires skilled assessment techniques and knowledge of normal parameters, asking the client about the amount of blood loss with each menstrual period, and checking for sternal tenderness would be done by the RN.

When Patients have darker skin, how do you identify BRUISES?

Darker areas of the skin, Palpate for slight swellings or irregular skin surfaces Ask the patient about pain when skin surfaces are touched lightly or palpated,

Normal Hct female and male

F: 27-47% M: 42-52% Decreased levels: indicate possible anemia or hemorrhage. Increased levels: indicate possible chronic hypoxia or polycythemia vera

Normal RBCs for females and males

F: 4.2-5.4 million/mL M:4.7-6.1 Decreased levels: indicate possible anemia or hemorrhage. Increased levels: indicate possible chronic hypoxia or polycythemia vera

Which Clotting Factor, when activated, activates factor X to convert prothrombin to thrombin?

Factor 9 A lack of factor IX causes hemophilia B. Synthesis is vitamin K-dependent.

Which factor is converted to fibrin by the enzyme thrombin?

Factor I. Fibrinogen Individual fibrin molecules form fibrin threads, which are the mesh for clot formation and wound healing

Which Clotting Factor is the inactive thrombin?

Factor II: Prothrombin Prothrombin is activated to thrombin by clotting factor X? Activated thrombin converts fibrinogen (clotting factor I) into fibrin and activates factors V and VIII. Synthesis is vitamin K-dependent.

Which Clotting Factor interacts with factor VII to initiate the extrinsic clotting cascade.

Factor III: Tissue Fibrinogen

Which Clotting Factor is a divalent cation?

Factor IV: Calcium Calcium is a cofactor for most of the enzyme-activated processes required in blood clotting. Calcium enhances platelet aggregation and makes red blood cells clump together

Which Clotting Factor is a cofactor for activated factor X?

Factor V: Proaccelerin Factor X, which is essential for converting prothrombin to thrombin?

Which Clotting Factor activates factors IX and X?

Factor VII: Proconvertin Factors IX and X are essential in converting prothrombin to thrombin. Synthesis is vitamin K-dependent.

Which Clotting Factor, together with activated factor IX, activates factor X?

Factor VIII: Antihemophilic factor. Factor VIII combines with von Willebrand's factor to help platelets adhere to capillary walls in areas of tissue injury. A lack of factor VIII results in classic hemophilia (hemophilia A).

Which Clotting Factor, when activated, converts prothrombin into thrombin?

Factor X: Stuart-Prower factor Synthesis is vitamin K-dependent.

Which Factor, when activated, assists in the activation of factor IX.

Factor XI: Plasma thromboplastin antecedent However, a similar factor must exist in tissues. People who are deficient in factor XI have mild bleeding problems.

Which Clotting Factor is critically important in the intrinsic pathway for the activation of factor XI.

Factor XII: Hageman factor

Which Clotting Factor assists in forming cross-links among the fibrin threads to form a strong fibrin clot?

Factor XIII: Fibrin-stabilizing factor

What is the name of Factor VI?

Got you! There is no Factor VI involved in Blood Clotting. Factor VI is an artifact.

Is the difference in RBCs between women and men greater or smaller during menstrual years?

Greater

The nurse is assessing the nutritional status of a client with anemia. How does the nurse obtain information about the client's diet? a. Uses a prepared list and finds out the client's food preferences b. Asks the client to rate his or her diet on a scale of 1 (poor) to 10 (excellent) c. Has the client write down everything he or she has eaten for the past week d. Determines who prepares the client's meals and plans an interview with him or her Submit

Have the client write down everything he or she has eaten for the past week The best way for the nurse to assess an anemic client's diet is to have the client write down everything he/she has eaten in the last week. Having the client provide a list of items eaten in the past week is the most accurate way to find out what the client likes and dislikes, as well as what the client has been eating. It will provide information about "junk" food intake, as well as protein, vitamin, and mineral intake.Determining food preferences from a prepared list provides information about what the client enjoys eating, not necessarily what the client has been eating. For instance, the client may like steak but may be unable to afford it. Rating scales are good for subjective data collection about some conditions such as pain, but the subjectivity of a response such as this does not provide the nurse with specific data needed to assess a diet. Interviewing the food preparer is time-consuming and poses several problems, such as whether a number of people are preparing meals, or if the client goes "out" for meals.

A newly admitted client has an elevated reticulocyte count. Which condition does the nurse suspect in this client? a. Leukemia b. Aplastic anemia c. Hemolytic anemia d. Infectious process Submit

Hemolytic anemia The nurse suspects that the client has hemolytic anemia. An elevated reticulocyte count in an anemic client indicates that the bone marrow is responding appropriately to a decrease in the total red blood cell (RBC) mass and is prematurely destroying RBCs. Therefore, more immature RBCs are in circulation.A low white blood cell count is expected in clients with leukemia. Aplastic anemia is associated with a low reticulocyte count. A high white blood cell count is expected in clients with infection.

The nurse is assessing an adult client's endurance in performing activities of daily living (ADLs). What question would the nurse ask the client? a. "Can you prepare your own meals every day?" b. "How is your energy level compared with last year?" d. "Has your weight changed by 5 pounds (2.3 kg) or more this year?" e. "What medications do you take daily, weekly, and monthly?"

How is your energy level compared with last year?" The question the nurse needs to ask the client about endurance in performing ADLs is "How is your energy level compared with last year"? Asking the client how his or her energy level compares with last year is an activity exercise question that correctly assesses endurance compared with self-assessment in the past. It is most likely to provide data about the client's ability and endurance for ADLs.The client may never have been able to prepare his or her own meals, and the ability to prepare meals does not really address endurance. The question about weight change addresses nutrition and metabolic needs, rather than ADL performance. The question about how often the client takes medication addresses nutrition and metabolic needs and focuses on health maintenance through the use of drugs, not on the client's ability to perform ADLs.

Do women have lower or higher red blood cell counts than do men at all ages?

Lower

Thickened or discolored nails that make viewing color of nail beds impossible may indicate what?

Normal Nail Changes in Older Adult

The nurse is teaching a client who is preparing for discharge after a bone marrow aspiration. The nurse provides which discharge instructions to the client? a."Inspect the site for bleeding every 4 to 6 hours." b."Place an ice pack over the site to reduce the bruising." c."Avoid contact sports or activity that may traumatize the site for 24 hours." d. "Take a mild analgesic, such as two aspirin, for pain or discomfort at the site."

Place an ice pack over the site to reduce the bruising." Discharge instructions after a bone marrow include placing an ice pack over the site to reduce bruising. Ice to the site will help limit bruising and tissue damage during the first 24 hours after the procedure.The client must carefully monitor the site every 2 hours for the first 24 hours after the procedure. Contact sports and traumatic activity must be excluded for 48 hours, or 2 days. A mild analgesic is appropriate, but it needs to be aspirin-free. Acetaminophen (Tylenol) would be a good choice.

The nurse is reviewing complete blood count (CBC) data for a 76-year-old client. Which decreased laboratory value would be of greatest concern to the nurse because it is not age-related? a. Hemoglobin level b. Red blood cell (RBC) count c. Platelet (thrombocyte) count d. White blood cell (WBC) response

Platelet (thrombocyte) count The decreased laboratory value of the greatest concern to the nurse is the 76-year-old client's platelet count. Platelet counts do not generally change with age.Hemoglobin levels in men and women fall after middle age. Iron-deficient diets may play a role in this reduction. Total RBC and WBC counts (especially lymphocyte counts) are lower in older adults. The WBC count does not rise as high in response to infection in older adults as it does in younger people.

Hematologically What should you assess women for who are hospitalized for any reason?

RBC adequacy

Which task does the nurse delegate to unlicensed assistive personnel (UAP)? a. Refer a client with a daily alcohol consumption of 12 beers for counseling b. Obtain a partial thromboplastin time from a saline lock on a client with a pulmonary embolism c. Report any bleeding noted when catheter care is given to a client with a history of hemophilia d. Perform a capillary fragility test to check vascular hemostatic function on a client with liver failure Submit

Report any bleeding noted when catheter care is given to a client with a history of hemophilia The task the nurse delegates to the UAP is to report any bleeding when catheter care is given to a client with a history of hemophilia. Reporting findings during routine care is expected and required of unlicensed staff members.Referring a client for alcohol counseling, drawing a partial thromboplastin time, and performing a capillary fragility test are more complex and would be done by licensed nursing staff.

When Patients have darker skin, where is it easiest to see JAUNDICE?

Roof of the mouth

Skin color changes, especially pallor and jaundice, are associated with what?

Some hematologic disorders Yellow-tinged skin in an older adult may not be a reliable indicator of increased serum bilirubin levels. Laboratory testing is required

Where should you never palpate a person with a suspected hematologic problem?

Splenic area of abdomen An enlarged spleen ruptures easily and can lead to hemorrhage and death.

When Nails are affected by Hematological disorder or aging, how should you change your assessment?

Use another body area, such as the lip, to assess central capillary refill.

A client is scheduled for a bone marrow aspiration. What is the priority nursing action before this procedure is performed? a. Hold the client's hand and ask about concerns. b. Review the client's platelet (thrombocyte) count. c. Verify that the client has given informed consent. d. Clean the biopsy site with an antiseptic or povidone-iodine (Betadine). Submit

Verify that the client has given informed consent. The priority nursing action before a scheduled bone marrow aspiration is done is for the nurse to verify that the client has been given informed consent. A signed permit must be on the client's chart.Cleaning the biopsy site is done before the procedure, but this is not done until consent is verified. Cleaning the site will be done just before the procedure is performed. Holding the client's hand and offering verbal support may be done during the procedure, but the procedure cannot be completed until the consent is signed. Reviewing the client's platelet count is not imperative.

A client with anemia asks the nurse, "Why am I feeling tired all the time?" What is the nurse's best response? a. "You are not getting enough iron." b. "When you are sick you need to rest more." c. "How many hours are you sleeping at night?" d. "Your cells are delivering less oxygen than you need."

Your cells are delivering less oxygen than you need." The nurse's best response to the client complaining about feeling tired all the time is "Your cells are delivering less oxygen than you need." The single most common symptom of anemia is fatigue, which occurs because oxygen delivery to cells is less than is required to meet normal oxygen needs.While it may be true that the client isn't getting enough iron, it does not relate to the client's fatigue. The statement about the client needing rest because of being sick is simply not true. Although assessment of sleep and rest is good, it does not address the cause related to the diagnosis.

Progressive loss of body hair is a normal facet of what?

aging A relatively even pattern of hair loss that has occurred over an extended period is not significant. Older adults also have decreased pubic hair as a result of age-related hormone changes.

Besides menses, what causes the difference in RBCs between men and women?

blood dilution caused by fluid retention from female hormones.

Normal Hgb female and male

f: 12-16 m:14-18 g/dL Decreased levels: indicate possible anemia or hemorrhage. Increased levels: indicate possible chronic hypoxia or polycythemia vera

Nail bed finding of pallor or cyanosis may indicate what?

hematologic disorders

When Patients have darker skin, where is it easiest to see PALLOR and CYANOSIS?

oral mucous membranes and conjunctiva of the eye

When Patients have darker skin, where is it easiest to see PETECHIAE?

palms of the hands or soles of the feet

Thin or absent hair on the trunk or extremities may indicate what?

poor PERFUSION to a particular area.