Exam 4

After discussing management with a patient diagnosed with pernicious anemia which statement indicated an understanding?

"I will need B12 injection for the rest of my life"

What causes Iron-deficiency anemia?

- Chronic bleeding ulcer - Heavy Periods - Pregnancy - Alcohol abuse

Interventions to prevent health care-associated infections include (select all that apply)

- Following hand-washing protocols - Decontaminating equipment used for patient care

For cobalamin anemia, what would the nurse consider for symptoms?

- GI manifestations such as sore tongue - Neuromuscular manifestations such as paresthesia in hands and feet

Nursing interventions for a patient with severe anemia from peptic ulcer disease include; Select all that apply

- Instructions for high-iron diet - Monitoring stools for occult blood

Factors associated with an increase in reemerging infections include (select all that apply)

- International travel - Poor immunization rates - Poor sanitation standards - Not completing a full course of antibiotics

Which factors place the patient at increased risk for severe COVID-19? (Select all that apply)

- Obesity - Cigarette smoking - Chronic Kidney Disease

When working with a patient who has suspected tuberculosis, the nurse would

- Place the patient on airborne precautions

When teaching a patient about taking iron supplements what should the nurse include in the teaching? Select all that apply

- Take with Vitamin C - Stools will be a dark color - Take on an empty stomach

In a person having an acute rejection of a transplanted kidney, what would help the nurse understand the course of events? (select all that apply)

- acute rejection can be treated with mycophenolate. - Repeated episodes of acute rejection can lead to chronic rejection - Acute rejection is common after a transplant and can be treated with drug therapy

What is the nursing care for patients with thrombocytopenia?

- assess signs of internal/external bleeding - administer medications, blood products or platelet transfusions - educate patient to avoid NSAIDS because they can increase the risk for bleeding - monitor for signs of infection - nutrition and lifestyle education initiate bleeding precautions

What is hemolytic anemia?

- destruction or hemolysis of RBC at a rate that exceeds production, - caused by problems intrinsic or extrinsic to the RBC - blood death, happens faster then making RBC - jaundice occurs due to RBC burst all at once - enlargement of spleen and liver

Signs and symptoms of anemia

- pale - jaundice - pruritus HF - pulmonary congestion - edema, ascities - murmurs and bruits - paresthesia - GI disorders and bleeding - fatigue

What is thalassemia major?

-LIFE THREATENING - pale and jaundiced - symptoms develop by age 2 - RBC production is bone marrow is stimulated by decreased O2 carrying capacity of the blood - thrombosis - HTN - pulmonary disease - problem with production of hemaglobin

what are some iron rich foods?

-Lean beef - turkey, pork, chicken, fish, legumes, dark green leafy vegetables, whole grain, enriched bread, cereals, and beans

What is cobalamin (B12) deficiency?

-Takes a long time to show -Usually (95%) due to decreased absorption ability. Injection of B12 is needed. -Pernicious anemia due to lack of intrinsic factor (inadequate absorption).

what is pernicious anemia?

-it causes cobalamin deficiency - its caused by absense of intrinsic factor - weakened stomach lining - most common in northern european and african - body doesn't produce enough cobalamin

What level is mild Hemoglobin?

10-12

Which patient is at highest risk for aplastic anemia?

32 year old with septic shock from an infected PICC line.

A patient with recent diagnosis of anemia wants to know how long the minimum is they have to take iron supplements. The nurse is aware the best answer to this question is:

6 months - The life span of a RBC is 120 days. Can recheck a level in 120 days.

What level is moderate Hemoglobin?

6-10

What level is severe Hemoglobin?

<6

What causes anemia?Select all that apply

A. Decreased RBCs B. Increased RBC destruction C. Blood Loss D. Missing elements for RBC construction F. Specific disease processes

What subjective data will help the nurse identify patients at risk for Anemia? Select all that apply:

A. Family member with sickle cell anemia - Genetics B. Vegetarian that does not eat protein of any sort - Lack of iron in the diet C. A female with heavy periods that last for 8 days - High risk group D. A patient taking Metformin - B12 deficiency E. A child that has PICA and eats clay. - Causes anemia F. A patient receiving chemotherapy. - All Blood cells can be effected G. A patient that drinks 4 beers per night. - Alcohol causes low folate and thiamine deficiency

Recognize reaction; stop trigger Airway support, prevention of spread when possible, O2, IV access (IVBenadryl= antihistamine), epinephrine - vasoconstriction, nebulized albuterol- bronchodilator), diphenhydramine -steroids- help inflammation - Treat for shock, treat with fluid, support airway, - Prepare for possible intubation or tracheostomy; support airway by intubating These interventions are for what reaction?

Anaphylactic

Which type of immunity will clients acquire through immunizations with live or killed vaccines?

Artificial, active

Association between Human Leukocyte Antigen (HLA) antigens and diseases is most often found in what disease conditions?

Autoimmune disorders

What anemia would you consider when the patient comes into the emergency room who is taking metformin and has strange sensations to hands and feet with tongue red and swollen?

B12 Cobalamin deficiency

What type of anemia is more likely with a patient that has had a gastric bypass?

B12 deficiency - Gastric bypass patients have absorbancy problems

A patient with a low number of monocytes would have a decreased ability to?

Capture antigens by phagocytosis and present them to lymphocytes

What causes normocytic, normochromic with normal MCV & MCH levels

Chronic disease - with chronic disease the cells are normal and the MCV and MCH levels are normal.

A patient who is on antibiotic therapy visits the primary health care provider with severe diarrhea. The primary health care provider diagnoses the patient with antibiotic-induced diarrhea. Which microorganism causes antibiotic-induced diarrhea?

Clostridium difficile

When obtaining assessment date from a patient with mycrocytic, hypochromic anemia, the nurse would ask the patient about

Diet intake of iron

The most common cause of secondary immunodeficiencies is

Drugs

In a severely anemic patient, the nurse would expect to find

Dyspnea and increased heart rate

The nurse would be alerted to possible anaphylactic shock after a patient has received IM penicillin by the development of

Edema and itching at the injection site

A patient is undergoing plasmapheresis for treatment of systemic lupus erythematosus. The nurse explains that plasmapheresis is used in treatment to

Exchange her plasma that contains antinuclear antibodies with a substitute fluid

T or F Anemia is a disease process.

False anemia is a symptom of something that causes decreased blood cells

What are the symptoms of anemia? Fill in the blank. List symptoms of anemia and why they are happening. What are the symptoms of anemia?

Fatigue - Not enough O2 to the tissues including the brain. SOB - The lungs work harder to add oxygen to the body. Pallor - The skin is the last place that blood supply with go. Cold - same as above Palpitations - Heart murmur Angina - chest pain from lack of O2 and increase in work of the heart to get more oxygen circulating. Pruritis - Bilirubin or byproducts from RBC break down Jaundice - Liver dysfunction

What is a sign of thalassemia in a child?

Frontal bossing

which condition would the nurse assess for in a 70-year-old patient who has anemia and poor intestinal iron absorption?

Gastrointestinal bleeding

The nurse is reading a CBC and is aware that decrease in what element is used to determine anemia severity?

Hemoglobin

What is included on a cbc lab test?

Hemoglobin, hematocrit, erythrocytes count, RBC indices, leukocyte WBC, differential white cell count. Measure total amt of total Hemoglobin in blood.

What accurately describes rejection after transplantation?

Hyperacute reaction can be avoided if crossmatching is done before transplantation

Newborns are protected for the first three months of life from bacterial infections because of the maternal transmission of

IgG

what is type 2 cytotoxic and cytolytic?

IgG or IgM directly binds to antigens on cell surface, cellular destruction results, destroys cells, goodpasture syndrome can affect farmers exposed to pesticide are more at respiratory distress

The nurse tells a friend who asks him to administer his allergy shots that

Immunotherapy should only be administered in a setting where emergency equipment and drugs are available

what are some B12 rich foods?

Meat, eggs, enriched grain products, milk and dairy foods, fish (especially salmon)

A mother is concerned that her newborn will be exposed to communicable diseases after she is discharged. While teaching the mother ways to decrease the risk of infection, what type of immunity should the nurse explain was transferred to her baby through the placenta?

Natural, Passive

What are the best foods for iron deficiency anemia?

Omelet with steak

Which assessment findings would the nurse associate with severe anemia?

Pallor

A patient develops flushing, rash, and pruritus during an IV infusion of vancomycin [Vancocin]. Which action should a nurse take?

Reduce the infusion rate ** the nurse would void the trigger, so they would slow it down. If it's too fast, that risks red man syndrome 2nd would be benadryl

In a type 1 hypersensitivity reaction the primary immunologic disorder appears to be

Release of chemical mediators from IgE-bound mast cells and basophils

A surgical unit's quality improvement committee notes the number of new catheter-associated urinary tract infections (CAUTIs) has increased over the past six months. The nurse understands that this means:

There is a need to review unit practices

A nurse administers trimethoprim-sulfamethoxazole (Bactrim) to a client diagnosed with a UTI. What should the nurse monitor to determine the therapeutic effectiveness of the drug?

WBC count *breath sounds wouldn't tell us anything, hemoglobin level is not relevant, and consistency of stool wouldn't help us. If WBC is high, it means that they are still trying to fight off the infection, which is not good. We want WBC to be low.

uti in pt with foley catheter - avoiding use or urinary cathetor - using aseptic technique for insertion and maintence - daily assessment of the presence and need for indwelling urinary catheters - keep the drainage bag below the level of the patients bladder, with gravity

What is the bundle for prevention of catheter-associated urinary tract infection?

new pneumonia occuring usually after 48 hours after intubation - elevate the HOB to 30 and 45 degrees, constatntly reposition patient - daily assessment of readinesss to extubate - daily oral care with chlorhexidine

What is the bundle for the prevention of ventilator-associated pneumonia?

PICC lines are more at risk for bloodstream infection - daily checks - prompt removal of unnecessary lines - disinfection prior to manipulation of the line, septic - daily chlorhexidine washes - disinfect catheter hubs, ports, and connectors

What nursing bundle is included in central line associated bloodstream infection?What would u do?

Which patient is most likely to experience anemia related to an increased destruction of red blood cells?

a 23 year old with sickle cell disease

Type of immunity? - immunizations with antigens (ex. vaccines for chickenpox, measles, mumps) - vaccines

acquired active artificial

What type of immunity? - natural contact with antigen through actual infection (ex. chicken pox, measles, mumps) - disease/antigen that YOU have undergone urself

acquired active natural

what type of immunity? - injection of serum with antibodies from one person (ex. injection of hepatitis B immune globuling) to another person who does not have antibodies - using someone else's antibodies

acquired passive artificial

What type of immunity? - transplacental and colostrum transfer from mother to child ex: maternal immunoglobulins passed to baby - breastfeeding - antigens/disease that you received from your mom

acquired passive natural

which action will the nurse include in the plan of care for a patient who has thalassemia major?

administer chelation therapy

What is type 3 hypersensitivty?

autoimmune disease, tissue damage results from antigen antibody complex, attacks joints, common sites are kidneys, skin, joints, vessels, and lungs

The nurse is caring for a patient with Hodgkins disease who has developed thrombocytopenia, The nurse will monitor for?

bleeding

what is type IV delayed hypersensitivity?

cell mediated immune response, t lymphocutes attack antigens or release cytokines, macrophages release enzymes can cause tissue destruction

Which pathophysiology is the cause of anemia in a patient with chronic kidney disease (CKD)?

decreased production of erthropoietin

Which assessment finding should the nurse caring for a patient with thrombocytopenia communicate immediately to the HCP?

difficulty to arouse

what is included in contact precaution?

direct or indirect contact, gloves, gown, mask, and eye protection, disposable stethoscope

What reaction occurs with a Ige response?

first exposure to allergen, anaphlaxis occurs within minutes assess airway - itching - wheal, hives. angioedema (swelling in airway)

What is droplet precautions?

infection transmittable through air, gown, mask, gloves, eye protection

What is airborne precautions?

infection transmitted through airflow - gloves, gown, N95, isolation room, eye wear

What type of immunity is this? - present at birth - first line of defense

innate immunity

After noting that a patient with leukemia has thrombocytopenia, which action will the nurse plan to take?

inspect skin for bruising and petechiae

The patient has a smooth, reddened tongue and ulcers at the corners of the mouth. Which lab result would the nurse expect?

low hemoglobin

A client has been admitted with a UTI. The nurse receives a urine culture and sensitivity report that reveals the pt has VRE. After notifying the HCP, which action should the nurse take to decrease the risk of transmission to others?

move the patient to a private room ** VRE is a contagious infection of the urine. A nurse would be using contact precaution with this patient.

What does WBC determines?

number of circulating WBC per cubic milliliter of whole blood

What is aplastic anemia?

rare condition caused by failure of blood cell production due to destruction of bone marrow cells - decrease in RBC, WBC, and platelets

when WBC count is high, what does that mean?

there is an infection

What is standard precaution?

wash hands, and wear gloves