Anemia: Exam 2
Iron deficiency symptoms
*Early in disease, no symptoms* Later symptoms: -Pallor -Glossitis: inflammation of tongue -Chelitis: inflammation of lips -Headache -Burning sensation of the tongue
What chronic diseases cause anemia?
*Due to ↑ serum ferritin + iron stores* -cancer -autoimmune diseases -infectious diseases (HIV, Hepatitis, Malaria) -HF -Chronic inflammation -GI bleeds
Blood circulation overload (cause + symptoms)
*Fluid administered faster than circulation accommodates* -Hypertension, tachycardia, acute respiratory distress, edema, crackles, distended neck veins
Aplastic anemia symptoms
*Gradual* -general symptoms of anemia -neutropenia (low WBC): causing infection -temp above 100 (low grade fever) -thrombocytopenia
Severe anemia symptoms
*Hbg <6* -pallor, jaundice, pruritus -blurred vision, retinal hemorrhage -glossitis, smooth tongue -tachycardia, angina, intermittent claudication, MI, murmur -tachypnea, orthopnea, dyspnea at rest -anorexia, difficulty swallowing, sore mouth -bone pain -severity to cold, weight loss
A patient with O+ blood received A+ blood. The patient is at risk for what reaction?
*Hemolytic transfusion reaction* -more severe reaction -flank pain
Mild anemia symptoms (2)
*Hgb: 10-12, little symptoms* -palpitations -exertional dyspnea
Moderate anemia symptoms (3)
*Hgb: 6-10* -increased palpitations, dyspnea, fatigue
Acute Hemolytic Reaction (cause + symptoms)
*Incompatible whole blood* -chills, fever, LOW BACK/FLANK PAIN, tachycardia, tachypnea, hypotension!
Macrocytic normochromic anemia & causes
*Large cell, normal color* -Large cells = fragile = more likely to break -Ex: cobalamin deficiency (vitamin B12), folic acid deficiency, liver disease
Normocytic anemia (3 causes)
*Normal looking cells, just small number of RBC* -Ex: acute bleed, chronic renal disease, cancer
Aplastic anemia (what is it, risks)
*Peripheral blood pancytopenia (decrease) + hypocellular bone marrow* -Pt unable to make WBC, RBC, or platelets -Infection + bleeding risk -Treat like cancer patient -caused from environment
Administration of Iron IM
-use separate needles when drawing up vs injecting medication so you don't stain the skin -Z track method -Do not massage as it stains skin
Aplastic anemia labs
-↓ hemoglobin, WBC, platelets -bone marrow is hypocellular + yellow = "Dry Tap" meaning increased fat content
Ferrous Sulfate (disease, side effects, interventions)
*Prevents/Treats iron deficiency anemia by elevating iron concentration* -iron absorption decreased if taken with antacid, tetracyclines, cimetidine (space 2 hours apart) -side effects: GI issues of constipation!, anorexia, n/v, diarrhea, CNS toxicity, black/dull stool -take 1 hour before meals + take with vitamin C
Febrile Reaction (cause + symptoms)
*Sensitivity to donor WBC, plts* -Chills, fever, headache, flushing, anxiety
Anaphylactic/Severe Allergic Reaction (cause + symptoms)
*Sensitivity to donor plasma* -Anxiety, itching, uricaria, wheezing progressive cyanosis leading to shock and possible cardiac arrest
Microcytic hypochromic anemia & cause
*Small cell, pale color* -Ex: iron deficiency anemia, lead poisoning
Colbalamin Deficiency causes
*vitamin B12 deficiency* -Caused by pernicious anemia: absence of instrinsic factor from gastric mucosal atrophy or auto immune destruction -Can also be caused by GI surgery, crohn's disease, ileitis, celiac disease, excessive alcohol use, excessive ingestion of hot tea, smoking
Folic Acid Deficiency symptoms
-*ABSENCE of neurologic involvement* -GI disturbances: dyspepsia, stomatitis, diarrhea, flatulence, smooth/beefy red tongue
Colbalamin Deficiency symptoms
-*neuromuscular weakness*, paresthesia of feet/hands, confusion, reduced vibratory + position senses, ataxia, impaired thought process (mistaken for dementia) -sore tongue, shiny tongue, anorexia, n/v, abd pain
Blood transfusions
-0.9% NaCl ONLY thing given with blood -Given with a filter -Give through 22 gauge or larger into free flow IV -Smaller needles used for platelets -Y setup with micro-aggregate filter -Administer with NSS (anything else will cause RBC hemolysis) -No other medication give through same tubing
Administering blood transfusion
-Before picking up blood get baseline vitals, get saline set up -Identify recipient + donor at bedside with 2 RNs -Blood must be administered within 30 minutes of leaving blood bank -Never store blood in unit fridge -First 15 min/50ml the nurse stays with patient -Warming device may be used -2ml per minute -Max length of picking up blood to end of administration: 4 hours -Vitals: first 15 min, then every 30 min, then 1 hour after transfusion
Colbalamin Deficiency Treatment
-Discourage diet high in vitamin b12 -Parenteral administration of cobalamin, daily injection for 2 weeks then monthly injection (cyanocobalamin) -Cyanocobalamin can also be given with nasal spray
Iron Supplements
-Dose is 3-4 per day with 50-100mg -Best absorbed in ACID environment, take 1 hour prior to meals or with orange juice/tomatoes/vitamin C -do NOT take with milk -if given in liquid format, dilute liquid so you don't stain teeth, use straw -monitor liver in patients taking iron long term
Iron Deficiency Anemia Treatment
-Encourage diet high in iron -Medications: Iron Dextran or Ferrous sulfate/furmarate/gluconate
Foods high in folic acid
-Green leafy veggies (including lettuce) -Legumes -Enriched grains/cereals -Orange juice -Peanuts -Fish
Aplastic anemia treatment (2)
-Hematopoietic stem cell transplant + immunosuppressive therapy!!!
Treatment of acute blood loss
-IV fluids: Dextran, albumin, LR (hypertonic solution) -supplemental iron for 2-3 months -only give temporary support of blood until underlying problem is resolved
Foods high in iron
-LIVER (not for HF patients) -Beef, turkey, pork, chicken -Fish -Eggs -Legumes -Beans -Dark green leafy veggies -Whole grain bread/cereal
Autodonation or elective phlebotomy
-Person donated blood before a planned surgical procedure -Can be frozen and stored up to 10 years -Used a lot for elective orthopedic surgery or for rare blood types
Causes of anemia
-Renal disease -Blood loss (trauma, hemorrhage) -increased RBC destruction (sickle cell, medications)
Iron Deficiency Anemia population & causes
-Seen in very young children & women in reproductive years- -inadequate dietary iron intake -malabsorption -blood loss -pregnancy -chronic renal failure
Colbalamin Deficiency Labs (3)
-Serum colbalamin levels reduced -Serum folate level normal -large RBC
Folic Acid Deficiency labs (2)
-Serum folic acid is low -Serum cobalamin normal
Indication for giving packed RBCs (2)
-Severe/Symptomatic anemia -Acute blood loss
What should the nurse do if the patient starts reacting to blood?
-Stop transfusion immediately -Maintain patient IV line with saline -Notify blood bank + HCP -Recheck identifying tags -Monitor vitals + urine output -Treat symptoms with HCP order -Save blood bag + tubing for testing -*Collect blood + urine specimens to evaluate hemolysis*
Iron Deficiency Anemia Labs (3)
-TIBC elevated -H&H: decreased -Serum iron: decreased
Teaching tips for a patient with thrombocytopenia
-Use electric razor for shaving -Use soft toothbrush -Avoid aspirin products -Avoid vigorous blowing of nose -Avoid skin punctures
Indication for giving frozen RBCs
-autotransfusion -pts with previous febrile rxns to transfusions -rare
Indication for giving platelets
-bleeding from thrombocytopenia -platelet levels <10-20,000
Folic Acid Deficiency Treatment
-give oral folic acid (1mg/day) -encourage folic acid for pregnant woman -diet high in folic acid
Indication for giving albumin (2)
-hypovolemic shock -hypoalbuminemia
Folic Acid Deficiency causes
-poor nutrition -malabsorption syndrome -drugs (methotrexate, oral contraception, anti-seizure meds) -alcohol abuse -anorexia -hemodialysis
A client with iron deficiency anemia is refusing to take the prescribed oral iron medication because the medication causes nausea; the client is also constipated. What actions should the nurse take? Select all that apply. 1. Suggest the client use ginger when taking the med 2. Ask the client what is causing the nausea 3. Tell the client to use stool softeners to minimize constipation 4. Offer to administer medication IM 5. Suggest the client take the med with orange juice
1, 2, 5 -n/v are common side effect of oral iron -do not use stool softeners for clients with iron deficiency anemia, instead promote high fiber diet -IM is only done if other approaches aren't effective
The nurse is teaching a client with iron deficiency anemia about the diet to follow after discharge. What food should be included? 1. eggs 2. lettuce 3. citric fruit 4. cheese
1. eggs -other foods include muscle meats, fish, enriched whole grains
Symptoms of acute blood loss: 10% 20% 30% 40% 50%
10% - 500ml: none 20% - 1000ml: no signs at rest, tachycardia w exercise, slight postural hypotension 30% - 15000ml: normal spine bp + hr at rest, postural hypotension + tachycardia with exercise 40% - 2000ml: low bp, central venous pressure, cardiac output at rest, rapid/thready pulse, cold, clammy skin 50% - 25000ml: shock + death
The nurse is developing a teaching plan for the client with aplastic anemia. Which is MOST important to include in the plan? 1. Eat animal protein + dark green, leafy veggies every day 2. Avoid exposure to others with acute infection 3. Practice yoga + meditation to decrease stress 4. Get 8 hours of sleep a night, take naps during the day
2. Avoid exposure to others with acute infection -these patients are severely immunocompromised + at risk for infection and possible death due to bone marrow suppression
A client with pernicious anemia is receiving vitamin b12. The nurse should evaluate the client for which expected outcome of vitamin b12? 1. increased energy 2. healed tongue + lips 3. absence of paresthesias 4. improved clotting time
3. absence of paresthesias -primary symptoms is paresthesias of hands + feets
The nurse should intrust the client with vitamin B12 deficiency to eat which foods to obtain the best supply of vitamin B12? 1. whole grains 2. green leafy vegetables 3. meats + dairy products 4. Broccoli and brussel sports
3. meats + dairy products
A client is afraid of receiving vitamin b12 injections because of potential toxic rxns. Which is the nurse's best response to relieve these fears? 1.Vitamin b12 will cause ringing in the ears before a toxic level is reached 2. Vitamin b12 may cause a very mild rash 3. Vitamin b12 cause mild nausea but nothing toxic 4. Vitamin b12 is generally free of toxicity b/c its water soluble
4. Vitamin b12 is generally free of toxicity b/c its water soluble -4. vitamin b12 is nontoxic
What is anemia?
Deficiency in number of RBC, quantity + quality of hemoglobin, and/or volume of hematocrits -can lead to tissue hypoxia
When obtaining assessment data from a patient with a microcytic, hypochromic anemia, the nurse would question the patient about
Dietary intake of iron
Hemoglobin Hematocrit WBC RBC Platelets
Hemoglobin: 12-18 Hematocrit: 37-52% WBC: 5-10,000 RBC: 4.2-6.1 Platelets: 150-400,000
What blood reaction is the worst?
Hemolytic reaction -Flank/back/abdominal pain -Hypotension
Hemoglobin levels to determine anemia Mild Moderate Severe
Mild: 10-12 -pt unaware Moderate: 6-10 -symptoms arise Severe: <6 -medical emergency
Blood compatibility
O+ can get O+ or O- O- can only get O- A+ can get A+,A-,O+,O- A- can get A-,O- B+ can get B+,B-,O+,O- B- can get B-,O- AB+ can get any AB- can get AB-,B-,A-,O- cannot give positive blood to a negative patient -negatives can only receive negatives -positives can receive positives + negatives
Megaloblastic Anemia (2 causes)
Presence of large RBC & abnormal RBC -easily destroyed -Caused by cobalamin (vitamin B12) deficiency + folic acid deficiency
You're providing discharge teaching to a patient about pernicious anemia. Which statement by the patient indicates they did NOT understand the teaching? a. "Pernicious anemia is caused by not consuming enough vitamin b12" b. "Pernicious anemia causes the RBCs to appear very large" c. "Treatment for pernicious anemia includes intramuscular infections of b12" d. "A red, smooth tongue can be a sign of pernicious anemia"
a. "Pernicious anemia is caused by not consuming enough vitamin b12" Pernicious anemia is caused by a lack of intrinsic factor to ABSORB the vitamin b12
When a client is diagnosed with aplastic anemia, the nurse monitors for changes in which of the following physiological functions? a. Bleeding techniques b. Intake + Output c. Peripheral sensation d. Bowel function
a. Bleeding techniques -Due to decreased RBC, WBC, Platelets
The physician orders a patient with iron-deficiency anemia a blood smear test to asses the quality of the RBCs. How would the RBCs appear if the patient had iron-deficiency anemia? a. Hyperchromic + macrocytic b. Hypochromic + microcytic c. Hyperchromic + macrocytic d. Hypochromic + microcytic
b. Hypochromic + microcytic -small and pale
When discussing appropriate foods for a patient who has iron deficiency anemia + follows a low cholesterol diet, the nurse would encourage a. Eggs + muscle meats b. Nuts + cornmeal c. Milk + milk products d. Legumes + dark leafy greens
b. Nuts + cornmeal
Indication for giving fresh frozen plasma
bleeding caused by deficiency in clotting factors
A patient is admitted with iron deficiency anemia + has been recieving iron supplementation. The patient voices concern about how their stool is dark black. As the nurse, how would you proceed? a. Notify the HCP b. Hold the next dose of iron c. Reassure patient this is a normal side effect of iron supplements e. No action is needed
c. Reassure patient this is a normal side effect of iron supplements -If the stool would be shiny, indicates GI bleed
Autotranfusion
collecting and storing one's own blood to use to replace blood loss during surgery -avoid incompatibility/allergic rxns -collecting time not longer than 4 hours then reinfusing it
A client with iron deficiency anemia is scheduled for discharge. Which instruction about prescribed ferrous sulfate therapy should the nurse include in the teaching plan? a. Take the medicine with an antacid b. Take the medication with milk c. Take the medication with cereal d. Take the medication on an empty stomach
d. Take the medication on an empty stomach
What is thrombocytopenia vs neutropenia
thrombocytopenia: low platelets, increases bleeding neutropenia: low neutrophils/WBC, immunosuppressed
