NUR 328 EXAM 3: ANEMIA

Classic anemia symptoms

-Fatigue -Weakness -Dyspnea -Pallor

Vitamin B12 (Cyanocobalamin)

-Replacement therapy -treatment of megaloblastic anemia -nasal spray

methylphenidate

-Timing varies according to medication and purpose -CI: anxiety, cardiac disease, and pregnancy -Caution: hx of seizures, substance dependency, hypertension -AE: nervousness, insomnia, dizziness, HA, blurred vision, HTN, irregular heart beat, and chest pain DI: MAOis, TCAs, phenytoin

anemia

-disorder involving too few red blood cells (RBCs) or ineffective RBCs that can alter the blood's ability to carry oxygen -Reduced oxygen-carrying capacity-hypoxemia

pernicious anemia:

-type of megaloblastic anemia characterized by lack of vitamin B12 secondary to low production of intrinsic factor by gastric cells -vitamin B12 must be replaced by IM injection or nasal spray because it cannot be absorbed through the gastrointestinal tract

schedule an appointment to measure hemoglobin twice a week for at least 2 to 6 weeks.

A 67-year-old man who is being treated for prostate cancer is taking epoetin alfa. The nurse will instruct the patient to:

VITAMIN K

A nurse is caring for a client receiving warfarin therapy. The nurse instructs the client and family that certain foods must be ingested in moderation because of the possible interference with the effect of the therapy. Which foods must be taken in limited quantity?

Assess prothrombin time (PT) and INR.

A nurse is caring for a patient receiving the anticoagulant drug warfarin. What pre-administration assessments should the nurse perform before administering the drug to the patient?

HEPARIN

A postsurgical client possesses numerous risk factors for venous thromboembolism, including a previous deep vein thrombosis. What drug would the nurse anticipate administering while this client recovers in the hospital?

B. acute MI within the last 3 hours.

A thrombolytic agent could be safely used in A. CVA within the last 2 months. B. acute MI within the last 3 hours. C. recent, serious GI bleeding. D. obstetrical delivery

Ferrous Sulfate

Action: -elevate the serum iron concentration -then either converted to hemoglobin or trapped in reticuloendothelial cells for storage and eventual release and conversion into a usable form of iron for RBC production

Epoetin alfa

Action: acts like the natural glycoprotein erythropoietin to stimulate the production of RBCs in the bone marrow

Vitamin B12 (Cyanocobalamin)

Adverse effects: -HYPOkalemia -Hydroxocobalamin has been associated with itching, rash -peripheral edema -heart failure -nasal irritation

C. vasoconstriction, platelet aggregation, and conversion of prothrombin to thrombin

Blood coagulation is a complex reaction that involves A. vasoconstriction, platelet aggregation, and plasminogen action. B. vasodilation, platelet aggregation, and activation of the clotting cascade. C. vasoconstriction, platelet aggregation, and conversion of prothrombin to thrombin. D. vasodilation, platelet inhibition, and action of the intrinsic and extrinsic clotting cascades

Ferrous Sulfate

Contraindications: -Hemochromatosis (excessive iron) -hemolytic anemias, -normal iron balance

Epoetin alfa

Indication: -anemia -anemia associated with renal failure and for patients on dialysis -anemia associated with AIDS therapy -for anemia associated with cancer chemotherapy when the bone marrow is depressed and the kidneys may be affected by toxic drugs

ferrous sulfate

Iron Preparations PT drug

Folic Acid

Should be combined with B12 Prevents neural tube defects during pregnancy Used with alcohol use disorder AE- bronchospasm DI- large doses may decrease affects of anticonvulsants

VITAMIN K

The nurse is caring for a 73-year-old client receiving warfarin. When the nurse performs the initial shift assessment, the nurse observes blood in the client's urinary drainage bag. After reporting the observation to the physician, which substance will the nurse likely administer?

Iron supplement

The nurse is caring for a client who is receiving epoetin alfa. What adjunct treatment will the nurse expect the health care provider to order for this client?

for treatment of anemia associated with renal failure.

The nurse would expect the physician to prescribe epoetin alfa (Epogen) as the drug of choice A. for acute blood loss during surgery. B. to replace blood loss from traumatic injury. C. for treatment of anemia during lactation. D. for treatment of anemia associated with renal failure.

TRUE

Warfarin typically takes 3 days to achieve its onset of action.

B. to decrease the production of vitamin K clotting factors in the liver.

Warfarin, an oral anticoagulant, acts A. to directly prevent the conversion of prothrombin to thrombin. B. to decrease the production of vitamin K clotting factors in the liver. C. as a catalyst in the conversion of plasminogen to plasmin. D. immediately, so it is the drug of choice in emergency situations

aPTT

What laboratory value will the nurse prioritize when providing care for a client prescribed intravenous heparin?

"I should use aspirin to control my arthritis pain."

While preparing a client for discharge, the nurse teaches about the proper use of warfarin, which has been prescribed by the physician. Which statement by the client indicates that additional teaching is required?

ferrous sulfate

interactions: -absorption decreases preparations are taken with antacids, tetracyclines(spaced at least 2 hours apart) -decrease anti-infective if these drugs are taken because of a decrease in absorption (should be administered at least 2 hours apart)

-deferasirox tftr -deferiprone -deferoxamine mesylate

medications for iron toxicity

Epoetin alfa

take IV or Sub-Q

Central Nervous System Stimulants

-Used clinically to treat both attention deficit disorders and narcolepsy -Calm hyperkinetic children and help them focus -Redirect and excited the arousal stimuli from the reticular activating system -RAS - deep in the brain stem -Lots of different drugs -Older drugs have more systemic side effects -Newer drugs are more centrally acting and don't have the side effects that the older drugs have

Iron deficiency anemia

-low RBC count with low iron available because of high demand, poor diet, or poor absorption; treated with iron replacement -Most common type of anemia worldwide -Nutritional iron deficiency -Metabolic or functional deficiency -Manifestations when serum Hgb decreased to 7 or 8 gm/dl

Ferrous Sulfate

Adverse effects: -Staining (skin/teeth) -Hypotension -Iron toxicity (causing coma and even death) -anaphylactic reactions

Epoetin alfa

Adverse effects: -headache -HTN -edema -Chest Pain -fatigue -asthenia -dizziness -potential for serious seizures

D. I need to inject this drug IM every 5 to 10 days.

After teaching a patient with pernicious anemia about vitamin B12 therapy, which patient statement would indicate that the teaching was successful? A. I can take this pill with breakfast. B. I should take this pill at bedtime. C. I need to inject this drug subcutaneously every day. D. I need to inject this drug IM every 5 to 10 days.

Ferrous Sulfate

Indications: -these preparations need to be supplemented with adequate dietary intake of iron -help these patients regain a positive iron balance -treatment of iron deficiency anemias and may also be used as adjunctive therapy in patients receiving an erythropoiesis-stimulating drugs

Uncontrolled hypertension

The patient is being prescribed epoetin alfa for the treatment of anemia related to the renal failure. The patient also has a history of diabetes mellitus, uncontrolled hypertension, osteoarthritis, and hypothyroidism. Which of these conditions should the nurse bring to the physician's attention prior to administering the medication?

BP

A client has been receiving regular doses of epoetin alfa for several weeks, and the home care nurse has been monitoring the client's condition closely. When taking the client's vital signs, the nurse should pay particular attention to what assessment datum?

ORAL

A client is to receive clopidogrel. The nurse would expect to administer this agent by which route?

Epoetin alfa

Contraindications: -uncontrolled hypertension -Preg. Cat C

TRUE

Cyanocobalamin is a vitamin B12 in a nasal formulation.

C. has its effects reversed with the administration of protamine sulfate.

Heparin reacts to prevent the conversion of prothrombin to thrombin. Heparin A. is available in oral and parenteral forms. B. takes about 72 hours to have a therapeutic effect. C. has its effects reversed with the administration of protamine sulfate. D. has its effects reversed with the injection of vitamin K.

Heparin

TA-Blocks thrombin to prothrombin I-Prevents formation of clots and getting bigger Half-life: 90 minutes (safest to use in pregnancy) CTI- pork allergies (DERIVATIVES IN PORK; MUSLIMS COULD NOT TAKE) -Safest in pregnancy -Subcutaneous/IV Not absorbed PO (destroyed by gastric acid) AE-HITT, thrombocytopenia (platelet labs) DI-AC, PCN, (Antihistamines, Digoxin, nicotine, NTG; decrease effect) Labs: PTT (45-70) Antidote: protamine sulfate*****

Increased RBC count

The pharmacology class learns that epoetin alfa is an immunosuppressant drug that is designed to have what expected outcome?

TRUE

There is a risk of antibody production with the use of epoetin.