exam 6 anemia
which statement by an adolescent about sickle cell anemia would cause the nurse to conclude that the teaching has been understood? - "ill start to have symptoms when i drink less fluid" - "ill start to have symptoms when i have fewer platelets" - "ill start to have symptoms when in decrease the iron in my diet" - "ill start to have symptoms when i have fewer WBC"
- "ill start to have symptoms when i drink less fluid"
when both parents have sickle cell trait, what is the chance that a child will have sickle cell disease? - 25% - 50% - 75% - 100%
- 25%
transfusion reactions and complications
- febrile non hemolytic reaction (most common) - acute hemolytic reaction - allergic reaction - transfusion associated circulatory overload (TACO) - bacterial contamination - transfusion related acute lung injury (TRALI) - delayed hemolytic reaction - disease acquisition - long-term transfusion therapy
a child with iron deficiency anemia is prescribed oral iron therapy. anticipatory guidance regarding which side effect would the nurse provide? - bloody stool - orange urine - greenish black stool - staining of the mouth
- greenish black stool
assessment of the patient with anemia
- h&p - lab data - clinical manifestations - nutritional assessment - meds (can lead to cell destruction) - cardiac and GI assessment - blood loss: menses, potential GI loss (black tarry stool) - neurological assessment
the parents of a child with sickle cell anemia tells the nurse, " we have never had any symptoms of SCA and do not understand why our child has this problem." which information will the nurse include when teaching the parents? - SCA is caused by a random genetic mutation with no known cause - people who are carriers of SCA may no have symptoms but all of their children will have SCA - if both parents are carriers of SCA, there is a 25% chance that offspring will have SCA - when a child is born with SCA, genetic testing of both parents is needed to determine if they have sickle cell trait
- if both parents are carriers of SCA, there is a 25% chance that offspring will have SCA
acquired hemolytic anemia
- immune hemolytic anemia - hemolytic transfusion reaction - mechanical damage - drugs, chemical, toxins, and venoms
folic acid deficiency anemia causes
- inadequate dietary intake (lack of folic acid rich foods) - increased metabolic requirements - folic acid malabsorption and impaired metabolism
who is at risk for iron deficiency anemia?
- infants (premature, low birth weight) - pregnancy - children (not consuming iron rich foods) - vegans and vegetarians
bone marrow aspiration prep
- informed consent - do not give any anticoagulants, aspirin, heparin, or anti-platelets
which cause of anemia would the nurse recognize as the most common of anemia in 1 yo? - thalassemia - lead poisoning - iron deficiency - sickle shape of blood cells
- iron deficiency
hypo-proliferative anemias
- iron deficiency anemia - megoblastic (cobalamin def. and folic acid def.) - aplastic anemia - chronic disease anemia
pulmonary htn treatment
- meds - oxygen
which medication can cause hemolytic anemia? - famotidine - methyldopa - levothyroxine - ferrous sulfate
- methyldopa
which discharge education would the nurse provide the parent of a 3 yo child with thalassemia? - minimize the risk of infection - offer frequent iron rich meals - encourage increased fluid intake - restrict activity, allowing only quiet play
- minimize the risk of infection
G6PD symptoms
- most are asymptomatic - post exposure may develop hemoglobinuria, jaundice, dark urine, back pain
when performing a focused assessment on a client with a possible diagnosis of iron deficiency anemia, which locations would the nurse examine? SATA - sclera - nail beds - conjunctivae - palms of hands - bony prominences
- nail beds - conjunctivae - palms of hands
sickle cell trait
- one of two parents pass on the sickle cell gene - the child will have the sickle trait - the child will make both normal and sickle Hgb - usually asymptomatic - they are carriers
vitamin b12 deficiency treatment
- oral supplementation - vit b12 injections
which parent education would the nurse provide when teaching an infants parents about the major cause of iron-deficiency anemia? - blood disorders - overfeeding of milk - lack of adequate iron reserves from the mother - intro of solid foods too early for adequate absorption
- overfeeding of milk
symptoms of sickle cell disease
- pain - anemia - jaundice - cardiac symptoms - thrombosis - infection - edema in hands and feet
sickle cell crisis medical management
- pain management (dilaudid iv, SHOULD BE SCHEDULED) - adequate hydration - supplemental oxygen (want to maximize oxygen in those healthy rbc) - non-pharmalogical measures (comfort, apply heat)
which condition in a clients history would lead the nurse to assess for the development of pernicious anemia? - acute gastritis - DM - partial gastrectomy - unhealthy dietary habits
- partial gastrectomy
vitamin b12 deficiency (pernicious anemia) causes
- poor absorption from GI tract - absence of intrinsic factor: pernicious anemia
iron deficiency anemia causes
- poor dietary intake - GI bleeding - malabsorption - pregnancy
foods rich in iron
- red meats (easiest for the body to absorb) - tuna and salmon - eggs - tofu - enriched grains - dried beans, peas, and fruits - leafy green vegetables - iron fortified breakfast cereals
a child with sickle cell anemia is admitted to the pediatric unit in a vasoocclusive crisis. which interventions would be implemented after the pain is under control? SATA - antibiotics - rehydration - o2 therapy - nutritional supplements - psychological counseling
- rehydration - o2 therapy
a 12 yo child with sickle cell anemia is admitted during a vassooclusive crisis. which is the priority of care for this child? - relieving pain - exercising joints - increasing urine output - improving respirations
- relieving pain
potential problems or anemia
- respiratory - perfusion - fatigue - nutrition - fall
which dietary choices by a client with iron deficiency anemia indicate that the nurses dietary teaching has been effective? SATA - scrambled eggs - baked potato - steamed carrots - spinach salad - dried apricots - sliced oranges
- scrambled eggs - baked potato - spinach salad - dried apricots
vitamin b12 deficiency symptoms
neurological symptoms: numbness tingling, parasthesis
what is the primary treatment fro iron deficiency anemia?
oral iron supplementation
the nurse is teaching the parents of a child who is prescribed iron supplements for iron-deficiency anemia. which food would the nurse encourage to provide to enhance absorption of iron? - cereal - spinach - whole milk - orange juice
orange juice
immune hemolytic anemia
our immune system is attacking our own cells
hemolytic anemia cells
pale, small and fragile
what do the cells look like in iron deficiency anemia?
pale, small, irregular size and shape
aplastic anemia symptoms
pale, weak, fatigue, malaise, SOB, tachycardia, unexplained bruising and bleeding
what would the nurse include in the plan of care to minimize the potential for a sickling episode in a child with sickle cell anemia? - providing an iron rich diet - ensuring hemoconcentration - enforcing periods of quiet play - promoting adequate oxygenation
promoting adequate oxygenation
a child with beta thalassemia (cooley anemia) is admitted to the ambulatory care unit for a transfusion. which instruction would the nurse include in the plan of care? - encourage fluids - restrict activities - protect from infections - offer small meals frequently
protect from infections
haptoglobin
protein that binds with free floating hemoglobin
what are the blood/peripheral smears looking for?
red blood cells, white blood cells, and platelets
measures the amount of RBC variation in volume and size
red cell distribution width (RDW)
bacterial contamination
s/s: infection, fever, chills, tachycardia
how long does it take for our iron to build up?
several weeks to months
what is the most severe for of sickle cell disease?
sickle cell anemia
is vitamin b12 deficiency slow or fast progressing?
slow, happens over a long period of time
side effects of thalassemia major
splenomegaly, bronze colored, chronic hypoxia
patients who have a history of CHF; SOB, labored breathing (stop transfusion, assess (may hear crackles))
transfusion associated circulatory overload
happens 2-6 hours post-transfusion (delayed reaction); hypoxic, SOB, hypotension; most common cause of death associated with blood transfusions
transfusion related acute living injury (TRALI)
t/f: about 30 % of patients that take metformin are anemic
true
t/f: as the ferritin level drops our iron stores are dropping which will lead to anemia
true
t/f: normal or high reticulocyte count indicates that our bone marrow is doing its job and making red blood cells
true
t/f: several doses of IV iron supplementation are necessary to bring iron to appropriate level
true
t/f: when a pt has a history of CAD they may be more symptomatic then other patients (may transfuse sooner)
true
which labs are necessary to make healthy red blood cells?
vitamin b-12 and folate
when would we give IV supplementation?
when the pt is acutely symptomatic
how is an oral iron supplement best taken?
with orange juice (vitamin c)
when do symptoms begin to appear in sickle cell anemia?
within the first 6 months of life
is aplastic anemia common?
No, it is rare
what is the largest cause of ESRD?
diabetes
what should you ensure to do when taking ferrous sulfate and ferrous gluconate?
drink out of a straw so it doesnt stain your teeth
why do target cells have a bulls eye appearance?
due to lack of hemoglobin in the cell
certain triggers lead to crisis in sickle cell anemia
emotional traumatic events, fever, dehydration, exposure to cold, physical exertion
immune hemolytic anemia
exposure of erythrocytes alloantibodies (our body is attacking our own rbcs)
circulatory overload treatment
furosemide (20 mg iv)
looking at the amount of hemoglobin available to transport the oxygenated blood
hemoglobin level
desferal toxic metal
iron
what is the most common anemia?
iron deficiency anemia
hemochromatosis
iron overload
blood transfusion complications
iron overload, poor venous access, infections
iron deficiency anemia treatment
iron supplements (oral and IV) and dietary therapy
folic acid deficiency cells
large, irregular shaped
which lab can interfere with red blood cell production?
lead
pretty common, plasma protein in the blood, itching, developed rash, hives
allergic reaction
acute chest syndrome causes
- atypical bacteria (chlamydia pneumonia, mycoplasm pneumoniae) - viruses (respiratory syncytial virus and parvovirus) - pulmonary infarction, pulmonary thromboembolism
disease acquisition
rare, hep b and c, graft vs. host disease
what changes are common when taking desferal?
rash and vision changes
chelation therapy
removes excess iron from the body - DEFEROXAMINE (DESFERAL)
secondary hemochromatosis
result of too much iron from supplementation
immature red blood cells
reticulocyte count
which foods will the nurse include when suggesting dietary sources of iron to a client with anemia? SATA - raw carrots - boiled spinach - dried prunes - brussel sprouts - asparagus spears
- boiled spinach - dried prunes
which parental statements would the nurse recognize as indicating the need for further education about iron supplements for their preschooler? SATA - "we will mix the iron with milk to enhance absorption" - "we will mix the iron with black tea to enhance absorption" - " we will mix the iron with orange juice to enhance absorption" - " we will avoid giving our child green tea because it can decreaseabsorption" - " we will avoid feeding our child tomatoes because they can decrease absorption"
- "we will mix the iron with milk to enhance absorption" - "we will mix the iron with black tea to enhance absorption"
acute chest syndrome treatment
Blood transfusion antibiotics bronchodilators possible mechanical ventilation
acute chest syndrome symptoms
Chest pain, fever, SOB (inform physician so they can order chest x-ray)
what is the most common cause of iron deficiency anemia?
GI bleeding
what can oral iron supplementation cause?
GI distress (constipation)
G6PD labs
HIGH retic count
which antibody is responsible for immune hemolytic anemia?
IgG
RBC indices
MCV, MCH, MCHC, RDW
What is made in the bone marrow?
RBC, WBC, platelets
blood loss anemia
acute and chronic blood loss
the most dangerous reaction; due to incompatibility; quick onset (like a anaphylatic reaction); chest pain, low back pain, fever, hypotension, tachycardia
acute hemolytic reaction
what can acute chest syndrome progress to?
acute respiratory distress syndrome and death
sickle cell disease
a group of inherited red blood cell disorders
Total Iron Binding Capacity (TIBC) or transferrin level
a protein needed to bind the iron
ferritin
a reflection of the stored iron
febrile reaction management
acetaminophen (1000 mg) and run again
what should you avoid taking oral iron supplements with?
dairy products or antacids
occurs shortly after infarction; body temp increases (stop the blood, assess the pt, then notify physician)
febrile non hemolytic reaction
IV iron supplements
ferrous gluconate and iron sucrose
what are the two iron supplements?
ferrous sulfate and ferrous gluconate
which abnormal lab value will the nurse expect when caring for a client with deficiency anemia? - macrocytic red blood cells - thrombocytopenia - decreased folate levels - increased total iron binding capacity
increased total iron binding capacity (TIBC)
hydroxyurea
increases fetal hgb production in the bone marrow and dilutes the formation of abnormal hbg S - most common
what does a bone marrow aspiration do?
lets us know if there is a defect in red blood cell production
how is an oral iron supplement best absorbed?
on an empty stomach
G6PD cells
stain with reveal heinz body, bite cells
t/f: HbS gene causes hemoglobin molecule to be defective
true
hemolytic transfusion reaction
we received blood from someone and our body is attacking that blood
which lab test result would the nurse expect to be decreased in a client with iron deficiency anemia? - ferritin level - plt - wbc - total iron binding capacity
- ferritin level
vitamin b12 oral supplementation
- fish - shell fish - dairy - red meat - poultry - eggs
chronic blood loss
- gastric ulcer - tumor - polyp - menorrhagia
pulmonary htn nursing assessment
- h&p - review of systems - pain assessment - lab data
medical treatment for sickle cell crisis
- hematopoietic stem cell transplant - pharmacologic therapy - blood transfusion
lab testing for sickle cell crisis
- hemoglobin: baseline might be lower - reticulocyte count: elevated - peripheral blood smear: presence of sickle shaped cells and target cells - abnormal liver function tests with elevated bilirubin
pharmalogical therapy for sickle cell pain
- hydroxyurea - arginine
nursing management for reactions
- stop - assess - notify - return - treat
how is anemia diagnosed?
- symptoms - h&p - labs (CBC, H/H, RBC) - diagnostic studies
common risk factors of megaloblastic anemia
- alcoholism - elderly - pregnant - vegans - malabsorptive syndromes
mechanical damage
valve replacement
what could cold temperatures cause?
vasoconstriction
lymphadenopathy
enlarged lymph nodes
hepatomegaly
enlargement of the liver
splenomegaly
enlargement of the spleen
folic acid deficiency anemia labs
- LOW H/H - LOW folate level - HIGH MCV
iron deficiency anemia labs
- LOW RBC - LOW retic count - LOW iron level - LOW ferritin level - HIGH TIBC
vitamin b12 deficiency labs
- LOW b12 - HIGH MCV
thalassemia labs
- LOW h/h - HIGH iron levels - LOW mcv levels - HIGH bilirubin
immune hemolytic anemia labs
- LOW h/h - HIGH retic count - HIGH bilirubin - LOW OR ABSENT haptoglobin
aplastic anemia labs
- LOW rbc - LOW wbc - LOW platelets
hemolytic anemia labs
- LOW rbcs - HIGH bilirubin - LOW h/h - HIGH retic count - LOW haptoglobin - LOW mcv
which intervention is used by a nurse caring for an adolescent child with sickle cell anemia? - teaching the family how to limit sickling episodes - preparing the child for occasional blood transfusions - educating the family about prophylactic medications - explaining to the child how excess oxygen causes sickling
- teaching the family how to limit sickling episodes
inherited hemolytic anemia
- thalassemia (alpha and beta) - glucose 6 phosphate dehydrogenase deficiency - sickle cell anemia
acute blood loss
- trauma - surgery - hemorrhage
folic acid deficiency anemia treatment
- dietary modifications - oral supplementation - treat underlying cause
hemolytic reaction treatment
stop, assess, call physician, once we receive order we have to remove everything from pt, pack it up and return to blood bank (all new tubing and normal saline)
thalassemia cells
target cells (bulls eye appearance), pale (hypochromic), small (microcytic)
prevention or early recognition of crisis
- seek immediate attention for ANY febrile illness - encourage adequate fluid intake daily - avoid temperatures TOO COLD - avoid overexertion or stress - contact physician promptly if you suspect a crisis - obtain vaccinations
iron studies tell us about the body's ability to store and transport iron and consists of:
- serum iron - ferritin - total iron binding capacity or transferrin level
folic acid deficiency anemia symptoms
- smooth, sore red tongue - mild diarrhea - pale skin- specifically mucous membranes
pulmonary htn symptoms
- sob - fatigue - chest pain - syncope symptoms rarely occur until damage is irreversible
hemochromatosis symptoms
- splenomegaly - bronze colored skin - could lead to organ damage
sickle cell crisis complications
- stroke - renal failure - impotence - heart failure - retinal infarction - PULMONARY HYPERTENSION - ACUTE CHEST SYNDROME
which clinical signs of hydration would the nurse assess in a toddler experiencing a sickle cell crisis? SATA - turgor of tissue - edema of the ankles - specific gravity of urine - amount of urinary output - texture of mucous membranes
- turgor of tissue - texture of mucous membranes
lab testing for anemia
- vitamin b-12 - folate - lead levels
which response will a nurse give to the parents of a child with sickle cell anemia who ask about their child taking supplements to help treat the anemia? - taking supplements will not help with this condition - it is advised that iron be taken with orange juice to aid in absorption - an over the counter multivitamin with iron should meet the needs of the child - it is advised that liquid iron supplements be given through a straw to prevent staining the teeth
- taking supplements will not help with this condition
three types of sickle cell crisis
- acute vaso-occlusive crisis - aplastic crisis - sequestratian crisis
which action would the nurse take ext when a 78 yo client comes to the health clinic presenting with fatigue, and lab results indicate hematocrit of 02% and hemoglobin of 10.5%? - conduct a complete nutritional assessment of the client - plan to teach the client about taking daily iron supplements - schedule the client to return to have the test repeated in 3 months - explain that milk anemia is an unexpected response to the aging process
- conduct a complete nutritional assessment of the client
which nursing intervention is most important in the care of an infant with iron deficiency anemia? SATA - conserving the infants energy - protecting the infant from infection - teaching the parents about nutrition - telling the parents to offer small, frequent feedings - instructing the parents to increase the amount of milk offered
- conserving the infants energy - protecting the infant from infection - teaching the parents about nutrition
blood loss anemia treatment
- correct or control the cause - transfusion of PRBCs (depending on severity) - pts less than 7! cardiac going to infuse a little sooner
foods high in folic acid
- dark leafy greens - citrus fruits - sunflower seeds - liver - seafood - eggs - fortified cereal
aplastic anemia causes
- decrease in or damage to marrow stem cells - 50% unknown cause - acquired: radiation, chemicals, viral infections, chemotherapy, autoimmune
what is anemia caused by?
- defect in production of RBCs - excess destruction of RBCs - blood loss
how long is IV iron given over?
3-4 hours (IV piggy back)
who is sickle cell anemia most common in?
African Americans
what should patients stay away from in a sickle cell crisis?
COLD TEMPERATURES
lower than normal hemoglobin and fewer than normal circulating erythrocytes; a sign of an underlying disorder
anemia
hypoproliferative anemia
low production of rbc
a measure of the average weight of hemoglobin in individual erythrocytes
mean corpuscular hemoglobin (MCH)
thalassemia major
to survive the child required ongoing medical attention, blood transfusions, and iron removal
a measure of the average volume of RBCs
mean corpuscular volume (MCV)
immune hemolytic anemia cells
microcytic spherocytes
Beta thalassemia
minor, intermedia, and major
acute vaso-occlusive crisis
most common VERY PAINFUL
iron deficiency anemia symptoms:
- extreme weakness - fatigue - CP - tachycardia - SOB - pale skin - brittle - spoon shaped nails - angular cheilitis - PICA
immune hemolytic anemia symptoms
- fatigue - dizziness - jaundice - splenomegaly, hepatomegaly and lymphadenopathy
clinical manifestations of anemias
- fatigue, weakness, malaise - pallor or jaundice - cardiac and respiratory symptoms: angina, tachycardic, tachypneic - tongue changes: red beefy tongue - nail changes: dry rigid nails - angular cheilitis - pica
which iron rich foods would the nurse recommend for a toddler diagnosed with iron deficiency anemia? SATA - carrots - chicken - broccoli - lean steak - whole milk
- chicken - broccoli - lean steak
sickle cell average lifespan
10-20 days
managing sickle cell pain
A: assess the pain B: believe the patients report of pain C: complications or cause of pain D: drugs and distraction E: environment F: fluids
arginine
antisickling properties and enhances nitric oxide availability
allergic reaction treatment
benadryl, steroids, antihistamine and run again
an adolescent child with sickle cell anemia is admitted to the pediatric unit during a vaso-occlusive crisis. which pathophysiology is correct? - severe depression of the circulating thrombocytes - diminished rbc production by the bone marrow - pooling of blood in the spleen with splenomegaly as a consequence - blockage of small blood vessels as a result of clumping of rbcs
blockage of small blood vessels as a result of clumping of rbcs
how do you identify cells?
blood/peripheral smears
diagnostic testing for anemia
bone marrow aspiration and biopsy
aplastic anemia treatment
bone marrow transplant, blood transfusion, and immunosuppresive meds
sequestration crisis
buildup of sickle cell will lead to infarction
care of the patient with anemia
major goals include maintenance of oxygenation (airway!) and adequate tissue perfusion (circulation), decreasing fatigue, adequate nutrition, compliance with prescribed therapy, and absence of complications
aplastic crisis
caused by an infection that triggers a crisis
hemochromatosis treatment
chelation therapy
pulmonary htn
common sequela of sickle cell disease
long term transfusion therapy
complication: iron overload which can lead to fibrotic organ failure
pica
compulsive eating of nonnutritive substances such as clay or ice
serum iron
concentration of iron
angular cheilitis
cracks at the corner of the mouth
the average concentration of hemoglobin in erythrocytes
mean corpuscular hemoglobin concentration (MCHC)
a child with sickle cell anemia is admitted to the unit in vasoocclusive crisis (VOC). after the child has been given the prescribed analgesic, which intervention is the priority to minimize the effects of the crisis? - isotonic exercises - intravenous fluids - oxygen by nasal cannula - cold compress to affected areas
intravenous fluids
what can pulmonary htn lead to?
death
decreased blood flow equals:
decreased oxygenation
which medication is most beneficial to the client with sickle cell anemia receiving a blood transfusion regimen and experiencing cardiac dysrhythmias due to iron overdose toxicity? - deferasirox - deferiprone - deferoxamine - ferrous gluconate
deferoxamine
what is megaloblastic anemia caused by?
deficiency in vitamin B12 or folic acid
can have reaction about 2 weeks post transfusion; very severe; destruction of RBCs (why its important to educate pt on s/s)
delayed hemolytic reaction
how is desferal given?
given IM, subq, or IV
looking at the volume percentage of RBCs
hematocrit level
what type of anemia is sickle cell anemia?
hemolytic anemia
G6PD treatment
identify and remove cause (pt just needs to know what caused it so they can avoid the future)
when do we take vit b12 injections?
if we dont have an intrinsic factor; HAVE TO TAKE FOR LIFE
IV iron supplementation action:
increases serum iron concentration
iron supplementation action:
increases serum iron concentration
sickle cell crisis could eventually lead to
infarction and ischemia
primary hemochromatosis
inherited
hemolytic anemia
inherited or acquired
glucose 6 phosphate dehydrogenase anemia
inherited, the source of the abnormality
