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NU 335A - Exam 3 Study Guide.
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NU 335AExam 3 Study Guide:
Heme, Endo, GI, GU, Neuromuscular,
and Musculoskeletal Disorders
Hematology:
Sickle Cell Crisis: cause, sx/sx, treatment, complications, nursing considerations
- cause: RBCs are destroyed- spleen enlarged from congestion of sickled cells; splenic
sinuses infarcted and gradually are replaced with scar tissue (fibrotic)
- signs and symptoms: pain in area of involvement
extremities: sickle cell dactylitis
abdomen: severe pain-sometimes mistaken for appendicitis
cerebrum: stroke, visual disturbances
chest: pneumonia-like symptoms, burn episodes of pulmonary disease (ACS)
liver: obstructive jaudince, hepatic coma
kidney-hematuria
genitals: priapism (painful, extended) penile erection
- Nursing considerations:
supportive, symptomatic, specific, and curative
bed rest
hydration
electrolyte replacement (hypoxia results in metabolic acidosis)
blood replacement (may need chelation-Why?)
antibiotic therapy to treat any infection
hydroxy urea
hematopoietic stem cell transplantation is the only potential cure
pain management
Hemophilia: cause, sx/sx, treatment, complications, nursing considerations
- types: hemophilia A (Classic) factor VII deficiency which is most prevalent; hemophilia B
(Christmas disease) factor IX deficiency
- causes: X-linked genetic disease; mother with hemophilia passes on trait to the son;
gene mutation in 1/3 of cases
- sx/sx: subcutaneous and intramuscular hemorrhages
hemarthrosis: bleeding into joint cavities (mostly knees, elbows, ankles)
bony changes and crippling deformities occur after repeated bleeding episodes over
several years
, spontaneous hematuria
bleeding into any cavity can be dangerous or deadly
GI bleeding
intracranial hemorrhage
anemia
epistaxis: not as frequent as other hemorrhage
- treatment: replacement of missing clotting factor; treatment needs to begin
immediately; family members are taught to do venipuncture at home to children over 2-
3 years of age; children 8-12 years old are taught to self-administer; never make a
hemophilia patient wait to be treated
factor VIII concentrates
DDVAP-synthetic vasopressin increases plasma factor VIII
Corticosteroids for hematuria, acute hemarthrosis and chronic synovitis
RICE: for hemarthrosis
- complications: hemorrhage; inability to stop the bleeding
- nursing considerations: never give IM injection except with pretreatment; never perform
invasive procedures without pretreatment of clotting factor; avoid arterial punctures;
decrease risk of injury; medical alert bracelet; genetic counseling; foster independence;
refer family to national hemophilia foundation and world federation of hemophilia
- nursing considerations in acute bleeding:
apply pressure and administer factor- Hem A= Factor VIII; Hem B= factor IX
immobilize
elevate
apply ice pack
Fe Deficiency Anemia: cause, sx/sx, treatments, who?, nursing education
- cause: inadequate supply caused by
- deficient dietary supply
rapid growth rate
excessive milk intake, exclusive breast feeding after 6 months, delayed addition of
solid foods
- inadequate iron stores at birth
low birth weight, prematurity, multiple births
mom severely anemic
fetal blood loss
- iron inhibitors:
phytates: (grains, nuts, legumes, & maize), phosphates (poultry, fish, nuts, beans, &
dairy), or Oxalates (spinach, bran flakes, beets, potato chips, French fries, nuts, & nut
butters)
gastric alkalinity
, - malabsorption disorders
lactose intolerance
inflammatory bowel disease
- chronic diarrhea
- blood loss: acute or chronic hemorrhage
- excessive demands for iron required for growth
prematurity
adolescence
pregnancy
- sx/sx: pallor, pica, fatigue, tachycardia, tachypnea, lethargy, irritability
- treatments:
- 3-6 mg of elemental iron per kilogram per day
give in 2-3 divided doses b/w meals
vitamin C containing food or juice aids absorption
should see an increased hematocrit & RBC count in 1 month
- who?: ELBW and VLBW infants; children going through maturity or puberty
- nursing education: warn about: black, tarry stools; keep iron out of reach of children;
stains teeth; overdose can be fatal
Endocrinology:
Type 1 diabetes: who?, sx/sx, treatments, complications, education
- pancreatic beta cells destroyed; insulin deficiency; insulin is essential to push glucose
into cells to be metabolized. otherwise, the body uses available stores of protein and
fats; the body is actually starving even though there is plenty of glucose in the blood
stream
- who?: most often occurs in young children aged less than 20 years; peaks between 4-6
years of age and then at adolescence 10-14 years of age for new cases
- sx/sx: 3 P’spolyphagia, polyuria, polydipsia; weight loss, enuresis or nocturia,
shortened attention span, irritability, lowered frustration tolerance, dry skin, blurred
vision, poor wound healing, fatigue, flushed skin, HA, frequent infections, hyperglycemia
(elevated blood glucose levels, glucosuria), diabetic ketosis (ketones and glucose;
dehydration in some cases), diabetic ketoacidosis (dehydration; electrolyte imbalance;
acidosis; deep, rapid breathing kussmaul respirations)
- complications:
- diabetic ketoacidosis-life threatening
severe lack of insulin- no glucose available for cellular metabolism
body chooses alternate energy sources
fats break down into fatty acids
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