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why would a pt. w/ peptic ulcer have lower values on a CBC (complete blood count)?
peptic ulcer cause internal bleeding leading to a low blood count
what labs should be done prior to surgery & why?
PT, PTT, INR, CBC to check for clotting/infections
what happens to the blood when it has a high viscosity?
- becomes too thick & forms a clot
- *needs more fluid
what are the ABC's of life?
airway, breathing, circulation & safety
what lab should be monitored for a pt. w/ non-hodgkin's lymphoma [a group of malignant diseases originating in lymph nodes & other lymphoid tissues]?
- WBC's (normal values: 5,000-10,000)
- *CBC detects anemia
which diagnostic test is done to confirm pernicious anemia [caused by a deficiency of gastric acid & intrinsic factor (a substance produced by the parietal cells of the stomach)--intrinsic factor is required for the absorption of vitamin b12; w/o b12 the body inhibits folic acid, a substance needed for RBC's to multiply properly; this leads the production of large RBC's (macrocytic, megaloblastic, increased MCV)]?
- schilling test [measures the absorption of radioactive vitamin b12 as it is excreted in the urine]; gastric analysis & megaloblastic anemia profile.
- *schilling test: 24 hr urine collection that requires a radiopaque dye
which lab test is done to check for a possible iron deficiency anemia [can be caused by blood loss, poor GI absorption of iron & an inadequate diet & is common in women (menses), older adults, & people w/ poor diets]?
diagnostics include peripheral blood counts w/ low RBC's, H&H levels, low serum iron & low serum ferritin
s/s of iron deficiency anemia?
monitor for weakness, fatigue, pallor, glossitis [sore red tongue], SOB, spoon-shaped nails, pica & pagophagia [eating strange things]
in what position is the pt. put in for a bone marrow biopsy [solid tissue & cells are obtained by coring out an area of bone marrow w/ a large bore needle]?
prone to access the posterior iliac crest
what nursing interventions are done following a bone marrow biopsy?
VS, apply pressure dressing, monitor for bleeding & infection, medicate for pain
s/s of phlebitis [irritation of a vein by chemical, bacterial/mechanical irritation]?
monitor for redness, pain/burning, discomfort, warmth, edema, vein induration (hard), red streaks, slowing infusion rate, elevated temp., infection
what nursing interventions are done for phlebitis?
- do not use arm w/ IV for BP/phlebotomy
- do not use hand veins in older adults who have lost SQ tissue
- do not use hand veins for vesicant med.
- use a hand board for sites affected by the motion of a joint
- apply direct pressure w/ gauze sponge when removing; cool compresses; elevation is optional; do not start new IV in same extremity
- *stop infusion immediately, remove catheter, apply warm moist compresses
what causes an IV infiltration [fluid leaking into the surrounding SQ tissue]?
catheter displacement from an inadequately taped catheter
why do you check glucose levels before doing anything to a pt. who is on a TPN [total parenteral nutrition: hypertonic IV solution that provides complete nutrition to a client to prevent/correct nutritional deficiencies]?
TPN can cause hyperglycemia b/c the solution is going straight to the blood stream instead of being metabolized
what can cause abd pain for a pt. who just had a splenectomy?
internal bleeding (check abd girth)
pt. teaching prior to a splenectomy?
how to splint, cough & deep breathe
what is the most common cause of iron deficiency anemia?
blood loss, poor GI absorption of iron, & an inadequate diet & is common in women (menses), older adults, & people w/ poor diets
s/s of pernicious anemia?
monitor for pallor, jaundice, glossitis (smooth sore, beefy-red tongue), fatigue, wt. loss, paresthesias (numbness & tingling)
is cooley's anemia (beta-thalassemia) inherited?
- yes, a group of hereditary hemolytic (break down the RBC's) anemias characterized by a defect in the synthesis of a protein needed for production of hgb & RBC's
- *most common in people of mediterranean ancestry (italian & greek)
what complications does sickle cell anemia [a congenital hemolytic (breaks down RBC's) anemia that occurs primarily in blacks; results from a defective hgb molecule (hgb s) that causes the RBC to become sickle shaped] present?
cells clump together, clogging capillaries & impair circulation resulting in chronic ill health (fatigue, dyspnea on exertion, swollen joints), periodic crisis, long-term complications (infarcts, ulcers); & early death
pt. teaching to prevent sickle cell anemia crisis?
drink lots of fluids, avoid: infection, overexertion, stress, cold weather, ingestion of alcohol, smoking
besides O2, what else is of priority care w/ a sickle cell anemia crisis?
analgesics (opioids) for severe pain
why is pushing fluids important w/ a sickle cell anemia crisis?
to move the cells around & carry O2 (promotes perfusion)
what is the most common blood type?
O (universal donor)
what is the rarest blood type?
AB (universal recipient)
normal H&H levels for men & women?
- men: hgb (14-18); hct (42-52)
- women: hgb (12-16); hct (37-47)
how long does a blood transfusion take?
why is an IV tube primed w/ saline prior to infusion?
lubricates to prevent solution from sticking
what is the 1st thing you do if a pt. has a reaction to the transfusion?
what is polycythemia vera?
- chronic disorder characterized by increased RBC mass, erythrocytosis, leukocytosis, thrombocytosis, increased hgb level & low/normal plasma volume
- *aka primary polycythemia, erythemia/polycythemia rubra vera
how does pushing fluids help polycythemia vera?
why does polycythemia vera cause angina?
diminished blood flow & thrombocytosis leads to intravascular thrombosis
tx for polycythemia?
push fluids & administer nitroglycerin to dilate blood vessels
therapeutic phlebotomy for polycythemia vera?
removal of blood from the vein to reduce the RBC mass (500 mL of blood removed every other day until the hct is normal)
why would a pt. w/ leukemia be more prone to bruises?
lack of platelets, WBC's & RBC's
why is handwashing a precaution for a pt. w/ neutropenia?
handwashing lowers the risk of the pt. getting an infection due to their suppressed immune system
s/s of infection?
- aches & pains
- cloudy urine
- glassy/red eyes
- increased WBC's
s/s of low platelet count?
- bleeding, bruising
what is hemophilia?
hereditary bleeding disorder that results from a deficiency of specific clotting factors
pathophysiology of hemophilia?
hemophilia is an x-linked recessive genetic disease causing abnormal bleeding b/c of specific clotting factor VIII & IX leading to excessive bleeding when clotthing factors are reduced by more than 75%
why can't a pt. w/ hemophilia not take aspirin?
they will bleed to death
what do you do when a hemophiliac child falls & later c/o abd pain?
bring child to hospital (might have internal bleeding)
why would a pt. w/ a disseminated intravascular coagulation (DIC) recieve heparin?
low-molecular wt. heparin is given in the early stages to prevent micro-clotting
which labs are monitored for a pt. w/ a disseminated intravascular coagulation?
- (decreased) serum platelet count
- (decreased) serum fibrinogen level
- PT, PTT & INR
- (decreased) clotting factors V & VIII
- (positive) D-dimer test
- peripheral blood smear shows schistocytes
which (factors) components aid in clotting?
clotting factors VIII & IX; calcium
what do you tell a mother w/ a hemophiliac son concerned about her 2 daughters having the same prob.?
they may be carriers, but will not have it
a pt. w/ acute lymphocytic leukemia would be placed in what type of isolation?
how long does blood last when unrefridgerated?
normal ranges of the following:
H&H for men & women?
total iron-binding capacity (TIBC)?
prothrombin time (PT)?
partial thromboplastin time (PTT)?
international normalized ration (INR)?
- RBC = 4-6 million/mm
- WBC = 5,000-10,000/mm
- platelet count = 150,000-400,000/mm
- H&H for men = hgb (14-18 g/dL); hct (42%-52% [3 times the hgb])
- H&H for women = hgb (12-16 g/dL); hct (37%-47%)
- TIBC = 250-460 mcg/dL
- bleeding time = 1-9 min.
- PT = 11-13 sec.
- PTT = 1.5-2.0 (times normal values)
- INR = 0.7-1.8