Med-Surg (Anemias EAQ)
A client is seen in the clinic with sickle cell anemia. The hemoglobin range that is expected to be seen in this client in sickle cell crisis would be:
In sickle cell crisis, hemoglobin values are usually in the 6--8g/100 mL range showing many sickle shaped cells, and the client also will have a low oxygen level.
A nurse is developing a teaching plan for a child who has anemia as a result of inadequate nutrition. In addition to iron, which nutrients should the nurse include that are necessary for red blood cell synthesis? Select all that apply.
Protein is essential for the synthesis of blood proteins, albumin, fibrinogen, and hemoglobin. Vitamin C (ascorbic acid) influences the removal of iron from ferritin (making more iron available for the production of heme) and influences the conversion of folic acid to folinic acid
The student nurse demonstrates correct understanding of anemia related to chronic disease with which statement?
Red blood cells appear normal in size and color; however, there is a decreased amount produced
A client is seen in the clinic with sickle cell anemia. A brief explanation for this condition is:
Sickle cell anemia is abnormally shaped red blood cells that form a rod shape.
A nurse is caring for two clients; one has polycythemia and the other has prolonged anemia. What do these clients have in common?
Increased cardiac workload With anemia, the heart works harder to compensate for the reduced oxygen-carrying ability of the blood. With polycythemia, the heart works harder to propel more viscous blood through the circulatory system.
A client with upper gastrointestinal (GI) bleeding develops mild anemia. What should the nurse expect to be prescribed for this client?
Iron is needed in the formation of hemoglobin. The client's anemia is caused by GI bleeding, not impaired red blood cell (RBC) production.
The nurse is caring for a client with iron deficiency anemia that has decreased hemoglobin and hematocrit levels. The nurse expects to identify what other abnormal laboratory level?
Increased total iron-binding capacity (TIBC) TIBC may be elevated from 350 to 500 mg/dL (expected range is 250 to 350 mg/dL) because the RBCs are compensating for the iron deficiency.
A client with a diagnosis of anemia is receiving packed red blood cells. What is the most important action by the nurse when administering the transfusion?
Monitoring the client's response, particularly within the first 10 minutes
A nurse assesses for the development of pernicious anemia when a client has a history of:
Partial gastrectomy. Removal of the fundus of the stomach destroys the parietal cells that secrete intrinsic factor (needed to combine with vitamin B12 preliminary to its absorption in the ileum).
What should the plan of care include to minimize the potential for a sickling episode in a child with sickle cell anemia?
Promoting adequate oxygenation Low oxygen tension may precipitate sickling; therefore adequate oxygenation is desirable.
A 12-year-old child with sickle cell anemia is admitted during a vaso-occlusive crisis. What is the priority of care for this child?
Relieving pain A vaso-occlusive crisis is accompanied by severe pain because the clumped red blood cells block small vessels. Swollen limbs are painful and should not be exercised during a pain episode
A nurse concludes that the teaching about sickle cell anemia has been understood when an adolescent with the disorder states:
"I'll start to have symptoms when I drink less fluid." Dehydration precipitates sickling of red blood cells and therefore is a major causative factor for painful episodes associated with sickle cell anemia.
The nurse is completing an assessment on a couple seeking genetic counseling for sickle cell anemia. Both prospective parents carry sickle cell traits. The nurse recognizes that the couple has what chance of having a child who develops the disease?
25%
A transfusion of packed red blood cells is prescribed for a client with anemia. List the following actions in the order in which they should be performed by the nurse.
A client must sign a consent for the transfusion before the procedure; clients have the right to refuse. Vital signs should be obtained immediately before the transfusion to serve as a baseline for comparison if a reaction is suspected. Two nurses must verify that the numbers, ABO type, and Rh type on the blood label and laboratory record match before hanging the transfusion to minimize risk of transfusion reactions. Clean gloves must be worn before inserting the spike of the blood administration set. The transfusion is run slowly for the first 15 to 20 minutes, but only after other steps have been completed.
An adolescent who has sickle cell anemia is recovering from a painful episode. What does the nurse see as the priority issue for this adolescent?
Alteration in body image resulting from skeletal deformities The adolescent is concerned with body image and fears change or mutilation of body parts. The occlusions in the microvasculature associated with sickle cell anemia can cause bone deformities. Restriction of movement is not a major problem because when the pain is relieved and the crisis is over, activity is resumed.
A nurse is teaching the parents of an adolescent with iron-deficiency anemia how to administer oral iron to their child. What instructions should be included in the lesson? Select all that apply
Anticipate that stools tend to be blackish-green. Give the medication with a glass of orange juice. Use a needleless syringe to administer the medication Iron thickens the consistency of stools and may turn stools a blackish green. Citrus juices contain vitamin C and are acidic, meaning that they increase the absorption of iron. Direct contact with iron stains the teeth; use of a needleless syringe permits accurate dosing and limits exposure of the teeth to the medication. The child will not experience photosensitivity when undergoing iron therapy. The medication should be taken between meals because it is best absorbed in an environment that has a low pH.
pregnant client with sickle cell anemia visits the clinic each month for a routine examination. What additional assessment should be made during every visit? Select all that apply.
Evidence of urinary tract infection Presence of hyperemesis gravid arum Pregnant clients with sickle cell anemia are particularly vulnerable to infections, especially of the genitourinary tract; the examination of urine specimens should be performed frequently. A client with sickle cell anemia should always be monitored for hydration, so assessment for dehydration from vomiting due to hyperemesis gravidarum is of high concern
A practitioner prescribes supplemental oral iron therapy for a child with iron-deficiency anemia. What side effect should the nurse tell the parents to anticipate?
Greenish-black stool
A client had part of the ileum surgically removed. Why is it necessary for the nurse to monitor the client for clinical indicators of anemia?
The hemopoietic factor is absorbed in the ileum Vitamin B12 (extrinsic factor) combines with intrinsic factor, a substance secreted by the parietal cells of the gastric mucosa, forming hemopoietic factor. Hemopoietic factor is absorbed in the ileum, from which it travels to bone marrow and stimulates erythropoiesis.
A client with a tentative diagnosis of pernicious anemia is scheduled for a Schilling test. Which body process associated with vitamin B12 is assessed with the Shilling test?
With the Schilling test, radioactive vitamin B12 is administered, and its absorption and excretion are ascertained.
A nurse provides teaching regarding vitamin B12 injections to a client with pernicious anemia. The nurse concludes that the teaching was understood when the client states, "I must take the drug:
Because the intrinsic factor does not return to gastric secretions even with therapy, B12 injections will be required for the remainder of the client's life. The drug must be taken on a regular basis for the rest of the client's life.
The nurse is helping an adolescent with iron-deficiency anemia make breakfast meal choices. Which foods should the nurse suggest?
Bowl of raisin bran
While counseling the parents of an adolescent with anemia related to an inadequate diet, a nurse explains that several different nutrients, including protein, iron, and vitamin B12, are involved. What other nutrient should the nurse include in the teaching?
Folic acid acts as a necessary coenzyme in the formation of heme, the iron-containing protein in hemoglobin.
A 10-year-old child with sickle cell anemia is admitted to the unit in vaso-occlusive crisis (VOC). After the child has been given the prescribed analgesic, which intervention is the priority to minimize the effects of the crisis?
IV FLUIDS During a VOC bedrest is preferred, with the only exercise being passive range of motion. Because the kidneys of children with sickle cell anemia do not concentrate urine as well as do healthy kidneys, it is important to maintain adequate hydration. Hydration with IV fluids supplementing oral fluids can minimize the occurrence of a crisis because hemodilution helps prevent sickling.
A client has been experiencing extreme fatigue lately. The nurse suspects anemia and examines the client to identify additional clinical manifestations to support this inference. What locations on the client's body should the nurse assess? Select all that apply.
Nail beds lose their pink coloration because of reduced hemoglobin. A reduced amount of hemoglobin decreases pink color of the lining of the eyelids. Palms of the hands will become pale because of the decreased hemoglobin. Sclera is observed for signs of jaundice, not anemia
A 16-year-old girl with sickle cell anemia is experiencing a painful episode (vaso-occlusive crisis) and has a patient-controlled analgesia (PCA) pump. She complains of pain (5 on a scale of 1 to 10) in her right elbow. The nurse observes that the pump is "locked out" for another 10 minutes. What action should the nurse implement?
Placing the prescribed as-needed warm, wet compress on the elbow Vasodilation should help reduce pain from cellular clumping; applying a warm, wet compress will address the pain until the pump can be activated.
Parents of a child with sickle cell anemia ask about their child taking iron supplements to help treat the anemia. What would be the best response?
Taking supplements will not help with this condition. Taking iron supplements will not help. Sickle cell anemia is not caused by too little iron in the blood; it's caused by not having enough red blood cells. Taking iron supplements could cause harm, because the extra iron builds up in the body and can damage organs.
A 10-year-old child who has sickle cell anemia is admitted to the hospital with a vaso-occlusive painful episode. The nurse manager plans to place the child in the same room as a child with the diagnosis of:
Thalassemia Thalassemia is a hemolytic anemia that is not communicable. Roommates with infectious diseases should be avoided because a child with sickle cell anemia is susceptible to infections. These childrens' spleens become infarcted and are gradually replaced by fibrous tissue by 5 years of age. The spleen filters bacteria, thereby triggering phagocytosis; without a functioning spleen and therefore this trigger, these children are prone to infection