Quiz 1 Blood and IV

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twntwo
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70354
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Quiz 1 Blood and IV
Updated:
2011-03-03 15:59:33
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Prov advanced med surg
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Prov 5
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  1. Hypoproliferative anemia
    • defect in production of RBCs
    • bone marrow cannot produce adequate number of erythrocytes
  2. Hemolytic anemia
    • excess destruction of RBCs ->
    • release of hemoglobin from erythrocytes into plasma ->
    • tissue hypoxia ->
    • erythropoietin production ->
    • hemoglobin broken down and excreted in bile as bilirubin
  3. Where is erythropoietin produced?
    • The kidney
    • (renal failure -> anemia)
  4. Megaloblastic anemia
    • vitamin B12 deficiency or folic acid deficiency
    • vitamin B12 deficiency is called pernicious anemia
  5. Myelodysplastic syndrome (MDS)
    • abnormal development (dysplasia) of blood cells (usually erythrocytes)
    • cells die while waiting to be released, so fewer cells in circulation
    • cells are also not very functional
    • increased risk for infection and bleeding
    • neutropenic precautions
  6. Sickle cell anemia
    • treat with BMT
    • Hydrea (increased hemoglobin)
    • Arginine (antisickling)
    • chronic RBC transfusions
    • daily folic acid replacements
  7. Thalassemia
    hypochromia, microcytosis, hemolysis and anemia
  8. Osmolarity
    • Amount of substance in a liter of solution
    • plasma osmolarity is between 275-295 mOsm/L
  9. Crystalloid vs. colloid
    • crystalloid: fluids that are clear (hypo/hyper/iso)
    • colloid: fluids with protiens or startch (blood products). Always hypertonic, plasma expander, watch for increased BP, dyspna, and bounding pulse
  10. Isotonic fluids
    • use for volume expander
    • watch for fluid overload in cardiac patients
  11. Hypotonic vs. hypertonic
    • hypotonic: cells swell (O)
    • hypertonic: cells shrink
  12. Normal saline uses
    • shock
    • blood transfusions
    • *can lead to fluid overload in cardiac patients
  13. Lactated Ringers uses
    • dehydration
    • burns
    • fluid/acute blood loss
    • *contains potassium and calcium
    • *caution for liver and renal pts
  14. 0.45% Sodium Chloride uses
    • cellular dehydration d/t diuresis
    • hypertonic dehydration
    • slow rehydration
    • *electrolyte imbalance may occur
  15. D5LR uses
    • hypovolemic shock
    • hemorrhagic shock
    • *caution with renal or cardiac
    • *monitor for fluid overload
  16. D5 1/2NS uses
    • heat exhaustion
    • diabetes
    • TKO w/ renal and cardiac pts
  17. When to call the physician with a central catheter:
    • temp of 100.5
    • chills, dyspnea, dizziness
    • site irritation (pain, leaking, bleeding)
    • swelling in neck, face, chest or arm
    • change in length of external cath
  18. Risks of supported nutrition (TPN, enteral)
    • infection (TPN)
    • aspiration (enteral)
    • hyperglycemia
    • electrolyte balance, diarrhea
    • "refeeding syndrome": severe electrolyte imbalance when restarting nutrition after nearly starving. Manifested by hypophosphatemia
  19. Care of a pt with enteral nutrition
    • monitor for abdominal distention
    • monitor for presence of BS
    • >30 degrees during feeings and following feeding for at least 1 hour
    • oral care
  20. Packed red blood cell (PRBC) rationale for transfusion
    • hypocolemia
    • symptomatic anemia
    • surgery
    • *creates an increase in RBC mass
    • *20 gauge needle or bigger
    • *stay with pt for 15 min
  21. Platelet rational for transfusion
    • bleeding dur to a severe decrease in platelets
    • *stay with pt for 15 min
  22. Plasma rationale for transfusion
    • administered in bleeding patients with coagulation deficiencies
    • *includes coagulation factors
    • *stay with pt for 15 min
  23. Febrile nonhemolytic reaction of blood transfusion
    • most common
    • caused by antibodies to donor leukocytes
    • chills, fever 2 hrs after start of transfusion
    • use leukocyte filter, antipyretics
  24. Acute hymolytic reaction to blood transfusion
    • PREVENTABLE d/t incompatible blood
    • fever, chills, pain, nausea, chest discomfort, etc
    • tx - d/c transfusion, maintain blood volume and renal prefusion, prevent DIC
  25. Transfusion-related acute lung injury (TRALI) reaction to blood transfusion
    • antibodies in donor plasma stimulate recipient's leukocytes, leukocytes aggregate and damage lungs
    • pulmonary edema w/in 4 hours after transfusion
    • fever, chills, acute respiratory distress, bilateral inflitrates
    • tx - 02, intubation, diruetics
  26. Nursing management of blood transfusion reaction
    • d/c transfusion
    • IV NS in a new tubing
    • assess vitals, resp, LOC
    • notify MD, blood bank
    • return bag to bank
    • document
  27. Bone marrow biopsy pt care
    • small area anesthetized, might feel sharp pain
    • monitor for bleeding (BP, pulse, site, CBC)
    • monitor for infection (WBC count, temp)
  28. Red blood cell structure
    • erythrocyte
    • responsible for carring oxygen
    • hemoglobin attaches O2 to RBCs, aided by iron, vit B12, vit B6, and folic acid
  29. Hematocrit
    % of blood occupied by RBCs
  30. Mean cell volume (MCV)
    average cell size
  31. Mean cell hemoglobin (MCH)
    average amount of hemoglobin
  32. Mean cell hemoglobin concentration (MCHC)
    average concentration of hemoglobin per unit volume of an average RBC
  33. RBCs normal range
    4.2-6.2 million
  34. WBC normal range
  35. Hematocrit normal range
    42-48%
  36. Hemoglobin normal range
    12-16.5g/dl
  37. Polycythemia
    excessive circulating erythrocytes
  38. Neutropenic precautions
    • proper hygeine (cleaning)
    • equipments stays in pt's room
    • no live vaccines
    • reverse precautions
    • (p. 931)
    • *neutropenia
  39. Leukemia
    • malignant proliferation of WBC (lymphocytes or myeloid)
    • malignant cells found in peripheral blood
    • anemia, infection, bleeding, weakness, and fatigue
    • leukocyte count, ANC, hematocrit, platelets, electrolytes
  40. Lymphoma
    • malignant neoplasm of lymphocytes in lymph nodes and organs that grow into nodular masses
    • no malignant cells found in peripheral blood
    • Hodgkin's (curable)
    • Non-Hodgkin's (prognosis varies)
  41. Polycythemia vera
    • chronic, overproduction of RBC, WBC, and platelets; spleenomegaly
    • occurs in old, Jewish men
    • increased blood volume and viscosity
    • hypercoaguable
    • *risk for thrombosis
  42. Thrombocytopenia
    • platelet count less than 100,000/mm3
    • significant hemorrhage possible at 50,000
    • spontaneous bleeding possible at 10-15,000
    • petechiae, ecchymosis, frank bleeding
    • congenital or acquired
    • cause: ASA, heparin, GPIIb/IIIa Inhibitors
    • tx: Neumega
  43. Heparin induced thrombocytopenia (HIT)
    • platelets aggretate 5-10 after treatment
    • causes arterial and venous thrombosis
    • tx - direct thrombin inhibitor and warfarin
    • never give heparin ever again
  44. Disseminated intravascular coagulation (DIC)
    • uncontrolled activation of clotting factors->
    • lots of clots ->
    • clotting factors depleted ->
    • massive hemorrhage
    • triggered by trauma, shock, burns, surgery
  45. Erythropoietin
    • Epogen, Procrity, Aranesp
    • stimulates production of RBCs and hemoglobin
    • treats anemia
    • monitor for seizures
    • monitor BP; severe hypertension
  46. Colony stimulating factos
    (as a medication)
    • Neupogen, Neulasta, Leukine
    • stimulate production of WBCs
    • reduce time pt is vulnerable for infection
    • treats neutropenia
    • immunocompromised d/t chemo, transplant
  47. Anticoagulation/Antiplatelets
    • GPIIb/IIIa Inhibitors
    • ADP blockers-theinopyridine
    • warfarin [antagonist = vit. k]
    • heparin
    • fibrinolytics/thrombolytics (clot buster)
  48. Haptoglobin
    • protein that removes free hemoglobin from the blood
    • (serum test for anemia)

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