NURS 4700 NURSING CONCEPTS
AND INTERVENTIONS FOR THE CARE
OF ADULTS EXAM 2 STUDY GUIDE
MARQUETTE UNIVERSITY
, Adult 2 Exam 2 S
Risk for Injury:
Hematologic Disorders (8)
Anemia: Clinical manifestations, complications. Collaborative care of various types of
anemia, nutrition
• Definition: low RBC, Hgb, Hct
o Normal values:
▪ RBC: 4.7-6.1
▪ Hct: 37-51
▪ Hgb: 12.6-17.4
• Causes: blood loss, impaired production, increased destruction of erythrocytes (RBCs)
o Tissue hypoxia
• Manifestations
o Levels
▪ Mild: Hgb 10-12 g/dl
▪ Moderate: Hgb 6-10 g/dl
▪ Severe: Hgb less than 6 g/dl
▪ 8 = fate
o Integumentary changes: pallor, jaundice, pruritus
▪ If suspect jaundice, check liver fxn tests
o Cardiopulmonary changes: heart compensating (increased HR), low blood viscosity
can lead to murmurs
• Gerontologic: common in older adults (after 70)
o Rt renal impairment, chronic diseases, poor diet
o Sx unrecognized or mistaken for normal aging changes: pallor, ataxia, confusion,
fatigue
• Diagnostics: CBC (hgb, hct, mcv, mchc, reticulocytes)
o Reticulocytes: immature RBCs; MCV: mean corpuscular volume; MCHC: mean
corpuscular Hgb concentration
o Diagnosed based on CBC, reticulocyte count, and blood smear
o Iron studies, serum b12 level, serum folate, stool guaiac test
• Anemia types dt decreased erythrocyte production
o Iron deficiency, megaloblastic (b12 or folic acid deficiency)
• Iron deficiency anemia (microcytic)
o At-risk groups: very young, elderly, poor diet, women of reproductive age
o Etiology: inadequate dietary intake; iron absorption altered (duodenum); blood loss
(GI/GU, hemodialysis)
▪ Labs
• Decreases: Hgb/Hct, MCV, serum iron
, • Normal: b12, folate
o Collaborative care: tx underlying cause; iron replacement
▪ Good nutrition: liver, muscle meats, dried fruits, legumes, dark leafy veggies,
whole grains, beans, eggs (all high in iron)
▪ Blood transfusion of packed RBCs
o Medication
▪ Iron supplements
• Oral – inexpensive, convenient: best absorbed before meals in acidic
enviro (OJ); liquid iron stains teeth (dilute and use straw)
o SE: heartburn, constipation (give stool softener, increase
fiber), diarrhea, black stools
o Vitamin C enhances oral form OJ
• Parenteral iron (IV or IM, IM may stain skin): indications:
malabsorption or oral iron intolerance, higher dose, poor pt.
compliance with oral
**take with food if cause GI upset
• Megaloblastic – cobalamin (b12) deficiency
o Gastric system: missing protein needed for absorption
▪ Common cause: gastric mucosa not secreting intrinsic factor: pernicious
anemia
o Other cause: GI alterations (Sg, chronic diseases), chronic alcoholics, long-term
users of H2-histamine receptor blockers or PPI, strict vegetarians
o S/S develop slowly from tissue hypoxia
▪ GI: sore/red tongue (lack of o2), anorexia, nausea, abd. pain
▪ Neuromuscular manifestations: tingling in hands/feet, confusion, weakness,
paresthesia, decreased vibratory and position senses, ataxia, muscle
weakness, impaired thinking
o Tx: cobalamin (parenteral or intranasal) – cannot give orally bc no absorption
▪ Lifelong if no GI absorption (diet not effective)
▪ Neuromuscular may improve
▪ Without supplement can die in 1-3 years
▪ 1000 mcg/day IM for 2 weeks then weekly
▪ B12 foods: meats, liver, eggs, milk (dairy), fish
• Megaloblastic – folic acid deficiency
o S/s: similar to cobalamin deficiency
▪ Absence of neuro symptoms!!!!
o Common causes: dietary deficiency/malabsorption syndromes, drugs, increased
requirement, alcohol abuse/anorexia, hemodialysis loss
o Tx: folic acid supplement (can give PO)
