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What is the definition of anemia?
Abnormally low number of circulating RBC’s, hemoglobin concentration or both – resulting in a lack of O2 to the cells,
What are the usual causes of anemia?
- inadequate production of RBC
- increased destruction of RBC
- poor nutrition
- blood loss
- Insufficient or defective Hgb
What is the pathophysiology of anemia?
- Altered DNA synthesis
- Bone marrow failure
- Increased RBC loss or destruction
What are some general sx of anemia?
- Pale skin
- nail beds
- lack of red blood cells
- poor circulation
- Angina, fatigue
- DOE, (short of breath on excertion)
- night cramps
- bone pain
- Cerebral hypoxia
- Heart failure
- Signs of circulatory shock
What are some signs of Cerebral hypoxia?
- dim vision,
What are some signs of circulatory shock?
- rapid blood loss
- low bp,
- dec LOC
- decreased UO (urine output)
Why is bone pain associated with anemia?
bone marrow working harder to put out rbc so bone pain and joint pain
Name the 2 categories of anemia.
- 1. blood loss anemia
- 2. nutritional anemia
Describe acute blood loss anemia.
- could be GI bleed
- circulating RBCs are normal size, shape, color
- Normocytic anemia
- normochromic anemia
Define normocytic anemia.
characterized by red blood cells that are normal in size and usually also in hemoglobin content
Define normochromic anemia.
an anemia marked by reduced numbers of normochromic red blood cells in the circulating blood
Describe chronic blood loss anemia.
- iron deficiency anemia
- RBCs are microcytic (small)
- hypochromic (pale)
- low production from bone marrow
Describe nutritional anemia.
- Affect RBC formation
- Vit B12 and folate play big role in RBC development
- can't make rbc
What causes nutritional anemia?
- inadequate diet,
- increased need,
- GI disorders ,
- ulcerative colitis,
- mal absobtioin
Name 3 types of nutritional anemia.
- 1. iron deficiency anemia
- 2. vitamin B12 anemia (pernicioius is on type)
- 3. folic acid deficency anemia
What is the most common type of nutritional anemial?
iron deficiency anemia
Who is at greatest risk for iron deficiency anemia?
What is irondeficiency anemia?
inadaquate intake of iron
What causes iron defieciency anemia?
- inadequate intake,
- chronic bleeding, ie: gi inflammation, heavy periods
What are the results of nutritional anemia?
- fewer number of RBC’s,
- microcytic cells,
- hypochromic cells,
- malformed cells
What are the specific symptoms of nutritional anemia?
- brittle nails
- spoon shaped nails
- mouth cracked at the corners
- tongue smooth sore
- eating habits unsual i.e. pica
What is the treatment for nutritional anemia?
several months of oral iron supplement along with vitamin C to help absorption
What are some food sources rich in iron?
- organ meats,
- foritfied grains,
- fortified cream of wheat,
Name 1 type of vitamin B12 anemia?
Describe the RBC in someone w/ B12 anemia.
- RBCs are:
- 1. Macrocytic
- 2. misshaped
- 3. fragile
- 4. short life span
What are the causes of vitamin b12 anemia?
- 1. Failure to absorb dietary Vit B12 d/t lack of intrinsic factor (pernicious anemiaoral meds won't help) Occurs in clients who have stomach or ileal resections,
- 2. loss of pancreatic secretions,
- 3. chronic gastritis (may be due to alcohol),
- 4. strict vegetarians.
What are the symptoms of vitamin B12 deficiency anemia?
- 1. Gradual onset neuro problems:
- numbness and tingling in extremities
- difficulty w/ propriception and balance
- 2. Tongue smooth sore, glossitis, (beefy tongue)
- 3. Mouth corner of mouth
What are the tx for vitamin B12 deficiency anemia?
- 1. must haveearly intervention to reverse sx
- 2. increase intake of meats, eggs, dairy, suppliments
- 3. Parenteral Vit B12 shots for lack of intrinsic factor
What are some food sources for vitamin B12?
Describe the RBC in folic acid deficiency anemia.
- RBC are:
- 1. Fragile
- 2. megaloblastic cells – large, immature
What are the causes of folic acid deficiency anemia?
- 1. Inadequate intake,
- chronically malnourished ie: etoh, drugs, pregnant, chemo
- 2. Increased needs
- i.e. pregnant
What are the symptoms of folic acid deficiency anemia?
- 1. develop gradually
- 2. no neuro sx
- 3. pale,
- 4. sob,
- 5. palpatation,
- 6. tognue, mouth etc.
What is the treatment for folic acid deficiency anemia?
- 1. diet supplements
- 2. diet
- Sources - green leafy veggies, fruits, cereals, meats
What are hemolytic anemias?
- 1. premature breakdown of RBCs
- 2. normocytic & normochromic RBCs, but they don't last long
What are the 2 causes hemolytic anemia?
- 1. intrinsic
- inside RBC
- genetic, sickel cell
- 2. Extrinsic
- outside RBC
- drug abuse, burns, radiation
What is the treatment for hemolytic anemia?
treat what is causing the problem
Name one type of hemolytic anemia.
sickle cell anemia
Describe sickly cell anemia
- 1. chronic hemolytic anemia
- 2. hereditary,
- 3. characterized by episodes of sickling of RBC crescent shaped
Who gets sickle cell anemia?
- 1. Most common among persons of African descent
- 2. mediterranean
- 3. india
5. How is sickle cell anemia dxed?
blood test for the abnormal gene
What are the s/s of sickle cell anemia?
- 1. S/S same as above
- unique to sickle cell anemia
- 1. sickling,
- 2. painful,
- 3. clots,
- 3. irritable,
- 4. decreased circulation
- 5. occlusion,
- 6. ischemia,
- 7. infarction,
- 8. spasms,
- 9. chest pain
- 10. fever
What is a sickle cell crisis?
- rbc’s get stuck, clot,
- decreased O2 to area,
- severe pain.
What are some contributing factors to sickle cell anemia crisis?
- increased demand for O2
Describe aplastic anemia.
- 1. auto immune
- 2. bone marrow failure results in pancytopenia
What is pancytopenia?
- lack of normal cells in all componants of blood
- i.e. RBC, WBC, platelets
What are the causes of aplastic anemia?
- 1. idiopathic (50%),
- 2. radiation,
- 3. chemo,
- 4. exposure to chemicals,
- 5. med,
- 6. viral infections, (mono, hep c, hiv)
What are the sx of aplastic anemia?
- 1. Pallor
- 2. fatigue,
- 3. HA,
- 4. DOE
- as well as other typical anemia sx
- vary w/ severity increase
What are some risks with aplastic anemia?
- 1. chance of bleeding as platelets are down,
- 2. infection, wbc down
- 3. lack of O2 as RBC is down
What is MCV?
average amount of space occupied by each blood cell, (volume)
What are some treatments sof aplastic anemia?
- 1. Remove causative agent,
- 2. blood transfusions,
- 3. bone marrow transplant – may or may not be successful
What are some dx tests for anemias?
- 1. CBC – what does this include? which wbc is abnormal?
- B2. Iron levels & TIBC (total iron binding capacity):
- 3. Serum ferritin-another iron testindicative of malnutrition in elderly
- 4. Sickle cell test: screening for sickle cell
- 5. Bone marrow examination:
What are some nursing implications for pts taking iron supplemnents?
- A. Iron supplements – do teaching!
- 1. take on empty stomach if possible
- 2. changes color of stool
- 3. increase intake of dietary iron
- 4. don't take iron w/ dairy, bran, coffee, tea, red wine, 5. overdose of iron toxic to young children
- 6. multi vitamins have iron – be safe
- 7. med may need to be taken for many months
What is a drug for sickle cell anemia?
How is vitamin B12 taken?
- Vitamin B12 parentally,
What do pregnant women, pts with sickl cell anemia and viamin B12 anemia need?
- Folic acid
- Usually oral, frequently combined hydroxyurea
What is hydroxyurea used for?
- for SCD to prevent crisissickle cell disease,
- folic acid deficiency
Microscope examination of a blood smear, fecal occult blood test
Chronic blood loss
sudden loss of blood
Acute blood loss
CBC, bone marrow biopsy
Serum iron, Transferrin iron binding capacity, Serum ferritin level
CBC, Vitamin B12 level, Methylmalonic acid (MMA) level, Homocysteine level, Schilling test, Red blood cell, folate level, Gastrin level, Intrinsic factor assay, Bone marrow staining
Vitamin B12 deficiency
HemoglobinMean corpuscular volume (MCV) will be larger than normal Color of the red blood cell—will be normal, serum folic acid
Folice Acid deficiency
Hemoglobin electrophoresis blood test for abnormal sickle cell gene