Med/surge chapter 32

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Med/surge chapter 32
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Med/surge chapter 32
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  1.  Define Anemia
    p 615 reduction in the nuber of red blood cells or the quality of hemoglobin in the blood.
  2. Define Ecchymosis
    Pg 610 More commonly known as a bruise. Ecchymoses are larger purpleish ares of skin resulting from a larger ammount of blood leaking outside the blood vessels.
  3. Define Hemostasis
    Pg. 605 Tendency of the biologic system to maintain stability of the internal environment while continually adjusting to changes for nessisary survival. (control of bleeding)... {Oxygenation and Hemostasis are the Primary functions of the hematologic system}
  4. Define Orthostatic vital sign changes
    pg 609 Changes in the vital signs as a person moves from lying to sitting to standing position in which the pulse increases by 20 beats per minute and the blood preasure decreases by 20 mm Hg. indicating that the patient is Hypovolemic.
  5. Define Oxygenation
    Pg. 605 The transport of oxygen from the lungs to the tissues.{Oxygenation and Hemostasis are the Primary functions of the hematologic system}
  6. Define Petechiae
    Pg. 609 Small (1 to 3 mm), red reddish purple spots in the skin resulting from blood capalaries breaking and leaking small amounts of blood into the skin. Petechaie are often mistaken for skin rash.
  7. Define Purpura
    Pg. 610 The result of larger blood vessels breaking. Larger than petechiae -- usually 3 mm or more. Purpura can suggest a lov platlette count, or a problem with clotting factors in the blood.
  8. Define Universal Donor
    Pg. 612 Person with type O blood. .. because their blood does not carry any A, B, of Rh antigens and can safely be given to anyone
  9. Define Universal Recipiant
    Pg. 612 Those with type AB+ blood-- because their blood contains the type A, B, and Rh antigens. they can safely recieve any blood type.
  10. What is monitored by a PT, PTT, and Bleeding time test? (Pg. 610)
    PT (Prothrombin time) and PTT (Partial Thromboplastin time) and Bleeding time  tests are used to monitor Function of clotting factors. 
  11. Why would PT, PTT, and Bleeding time tests be used? (pg. 610)
    The PT test (Prothrombin time) is used to minitor the theripy of patients who are taking heprin or warfarin (coumadin) to anticoagulate the blood.
  12. Medications that are given to stimulate Production of RBC's -- what are they called, and name a few (pg.614)
    • Colony - Stimulating factors (Naturally occuring hormones that stimulate bone marrow to produce more blood cells.)
    • Erythropotietin (Epogen) and darbepoetin (Aranesp) stimulate bone marrow to produce more RBC'c
    • ....oprelvekin (Neumenga) stimulates the bone marrow to produce more platelettes
  13. Symptoms of a patient that may be having a sickle cell crisis. (Pg. 618)
    • Simptoms vary depending on where the circulation is blocked by the sickle cells.
    • commonly simptoms include
    • Circulation to the chest, abdomen, bones, joints, bone marrow, brain or penis may be compramised.
    • with tissue obstructed, hypoxia ((hypoxia is when body as a whole (generalized hypoxia) or a region of the body (tissue hypoxia) is deprived of adequate oxygen supply.)) occures, causing savier pain.))
    • Patients in a sickle cell crisis often have a feaver.
  14. Nursing interventions for Sickle cell anemia (pg 619 box)
    • Acute Pain
    • Give Pain meds as perscribed.
    • asess affects, and notify phasician if pain is not relieved.
    • Closely monitor the patient's pain level and medication
    • Anxiety
    • Respong quickly to patients needs
    • listen closely to the patient
    • use touch to convey concern
    • Risk For Injury
    • Assist patient in and out of bed when permitted.
    • have her sit on her bed and exersize her legs before rising.
    • Check blood preassure in sitting, standing and lying positions.
    • Advise her to sit and lower her head if she is feeling dizzy.
    • Risk For Difficient fluiid
    • Administer intervenous fluids as ordered
    • teach patient the imporntance of adequate fluid intake
    • weigh patient daily to asses fluid status
    • Monitor I's and O's
    • Innafective self health management
    • Asess what the patient knows about sickle cell disease, initiate teaching once the crisis has resolved
  15. What is Pernicioius anemia
    Pernicious Anemia occures when a person does not absorb vitimin B12 from the stomach. (the person may lack intrinsic factor, a substance made in the stomach which is essential for B12 absorption. this can be an after efect from a gastrectomy, where a patient has had part of the stomach removed, and so cannot make intrinsic factor.
  16. What you should encourage a patient to incorperate into their care plan when discharged with Pernicious anemia
    pg. 617
    Sence a patient with Pernicious anemia cannot aborm B12, Monthly intermuscular injections of B12 are required
  17. What item would be low in  a lab to indicate iron deficiancy anemia? pg 617
    in addition to low RBC count, low Hb value, and low HTC, patients with iron deficiancy anemia will have low serum iron level, low ferritin level and a high TIBC
  18. What Nursing inter ventions should be taught about Iron replacing drugs
    Nurses can suggest incorperating foods with high Iron into the diet.
  19. Know the difference between Polycythemia Vera, Aplastic anemia, Autoimmune hemolytic Anemia, Iron Deficiency Anemia, Sickle Cell Anemia, Pernicious Anemia Pg 615 - 617
    • Polycythemia Vera
    • A condition in which too many RBC's are produced. The increased number of RBC's makes the blood more Viscious, thicker so that it does not circulate Freely through the body.
    • Aplastic anemia:
    • Patients with Aplastic anemia have more than a low RBC count; they also have a low WBC count and Platelet counts, Because their bone marrow is not making any of these cells.
    • Autoimmune hemolytic Anemia:
    • Bone marrow makes adequate amount of blood cells. But they are destroyed once they are released into circulation.
    • Iron Deficiency Anemia
    • results from a diet too low in iron- from the body not absorbing enough iron through the GI tract. As a result, the body does not have enough iron to make an adequate amount of HB.
    • Sickle Cell Anemia
    • Normaly disk - shaped RBC's become sickle shaped. these mishappen blood cells are much more fragile than normal RBC's as a result, they easily rupture when assingthrough small cappalaries, resulting in anemia
    • Pernicious Anemia
    • occures when a person does not absorb vitimin B12 from the stomach. (the person may lack intrinsic factor, a substance made in the stomach which is essential for B12 absorption. this can be an after efect from a gastrectomy, where a patient has had part of the stomach removed, and so cannot make intrinsic factor.
  20. what are symptoms that a patient may have, who has Polycythemia Vera pg. 615
    Headache, dizzyness, ringing in the ears, blurred vission and a ruddy (reddish) complection
  21. What are some causes of aplastic anemia,
    and what would be imporntant to doccunment during assesment pg 616
    Certain drugs, such as streptomyocin, and chaloramphenol as well as exposure to toxic chemicals can cause Bone marrow failure. yet in many cases the true cause is never identified.Symptoms include, pallor, extreme extreme fatigue, tachycardia, shoortness of breath hypotension, shortness of breath and/or spontaneous bleeding that doesent reslolve.
  22. What different  Nursing diagnosis should be used for diseases of the hemotological system? Pg. 619, 622
    • Acute Pain, R/T sickle cell crisis/  Bleeding into closed spaces, creating pressure on the nerves
    • Anxiety R/T hospitalization/pain/
    • Risk for injury R/T orthostatic hypo tension/bleeding
    • Risk for deficient fluid volume, R/T inadequate intake / loss of fluid
    • Ineffective self health management R/T lack of knowlege of the disease process and self care
  23. normal Lab values for platelet counts Pg. 610
    140,000 to 440,000 platelets/MM3 of blood
  24. What is hemophilia
    genetig disease in which the effected person lacks some of the blood clotting factors normally found in plasma.
  25. What is the life span of RBC's  PG 606
    About 120 days
  26. What changes would you see in a Patient who has a Hematologic disorder? Pg 607
    • integumetary
    • change in skin color, dryness, puritus, brittle fingernails or toenails
    • neurologic
    • dizziness, virtigo, confusion, pain, headache, mental status changes, changes in vision
    • respirtory
    • epistaxis, hemoptysis, dyspea
    • cardiovascular
    • palpitations, chest pain, dizziness or fainting with position changes
    • gastrointestinal
    • changes in eating habits, nausea, vomitting, bleeding and pain, blood in stool
    • genitourinary
    • blood in urine, heavy mensis in women
    • musculoskeletal
    • numbness or pain in bones or joints
    • endocrine
    • fatigue, cold intolerance
    • functional assessment
    • occupation and hobbies, self concept, activities and experience, sleep and rest, nutrition, interpersonal relationships, coping and stress, perception of health
    • vital signs
    • tachycardia, tachypnea, hypotension, orthostatic vital sign changes
    • general survey
    • responsiveness, mood, expression, posture
    • skin
    • color, dryness, brittle fingernails and toenails, bruising, petechiae, purpura, ecchymoses
    • head and neck
    • bleeding, cracking at corners of mouth
    • thorax
    • respiratory rate, breath sound, heart rate
    • abdomen
    • liver enlargement, stool guaiac test, dipstick urine sample for blood
  27. What is DIC, and what causes it? Pg 621
    DIC is Disseminated Intravascular Coagulation. Meaning that nlood clotting is abnormally increased. It occures when over stimulaton of the normal coagulation cascade result in simoltaneus thrombosis and hemorrhage. DIC is alawys secondary to to another pathogenic process, such as overwhelming sepsis, shock, overwhelming trama, crush injuries, burns, cancer, acute tumor lysis syndrome, or obestric complications such as abruptio placentae, or fetal demise (death)
  28. How is Hemophila treated? Pg 621
    no cure exists for hemophilia, so treatment is symptomatic. The physician frequently prescribe a transusion of FFP, of cryoprecipitate, or both. RBC transfusions are frequently used to replace blood from profuse bleeding to which hemophiliacs are prone. intervenious morphine is often used to control pain.
  29. What factors are a precursor to DIC Pg. 621
    • overwhelming sepsis,
    • shock,
    • overwhelming trama,
    • crush injuries,
    • burns,
    • cancer,
    • acute tumor lysis syndrome,
    • obestric complications such as abruptio placentae, or fetal demise (death)
  30. Signs and Symptoms of Thrombocytopenia pg 621
    • ((Thrombocytopenia is a condition in which a person has too few platletes circulating in the blood. which may be caused because not enough platelets are being made, or becaue too many are being destroyed))
    • Petechaie
    • purpua
    • gingival bleeding
    • epitaxis (nose bleeds)
    • or any other unusual of prolonged bleeding.
  31. What things should we a nurse teach a patient about Iron deficiency anemia? (pg 617)
    • Suggest incorporating Foods high in iron into his/her diet.
    • some examples of these are, liver, oysters, red meats, fish, legumes, dark green vegetables, and iron enriched whole grain breads and cereals.
  32. Signs and symptoms of transfusion reaction, and what should the nurse do? Pg. 615
    • hemolytic
    • symptoms fever, chills, nausea, dyspnea, chest pain, backpain, hypotension
    • treatment stop transfusion, notify physician immediately, be prepared to provide supportive therapy to maintain heart rate and blood pressure
    • anaphylactic
    • symptoms urticaria, wheezing, dyspnea, hypotension
    • treatment stop transfusion, notify physician immediately, be prepared to provide epinephrine and steroid therapy
    • febrile
    • symptoms fever and chills
    • treatment stop transfusion, notify physician immediately
    • circulatory overload
    • symptoms cough, frothy sputum, cyanosis, decreased blood pressure
    • treatment stop transfusion, call for help, be prepared to administer oxygen and/or furosemide (Lasix)
    • delayed hemolytic reaction
    • symptoms unexplained fever, unexplained decrease in hemoglobin and hematocrit
    • treatment most delayed reactions require no treatment

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