Summary
Summary NSG 331/431 Exam 4 Study Guide
- Course
- Med-Surg NSG 331
- Institution
- Marian University
Detailed Exam 4 Study Guide for NSG 331/431.
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431 Exam 4 Hematologic and EndocrineModule 7- Care of the Adult with Hematologic Disorders -Approx. 23 questions
Chapter 13
Chapter 14
-Pgs. 216-230
Chapter 29
Chapter 30
-Pgs. 606-616
622-626
628-630
Anemia (Ch. 29 &30---approx. 2 Qs each type)
Deficiency in the number of erythrocytes (RBCs), the quantity or quality of hemoglobin, and/or
volume of packed RBCs (hematocrit
Etiology
Primary hematologic problems or develop as a secondary consequence of diseases or
disorders of other body systems
Commonly d/t blood loss, impaired production of RBCs, or increased destruction of RBCs
Diagnosis
CBC
Reticulocyte count
Peripheral blood smear
(Possible Findings)
Manifestations of Anemia
Mild (Hgb 10-12)----occur because of underlying disease or as a compensatory response to
exercise
- palpitations
- mild to no fatigue
- exertional dyspnea
, Moderate (Hgb 6-10)----increase in cardiopulmonary symptoms (at rest and during activity)
- increased palpitations/bounding pulse
- fatigue
- dyspnea
- “roaring in ears”
Severe (Hbg <6)----impacting multiple body systems
- tachycardia/ increased pulse pressure, angina, HF, MI, intermittent claudication
- ocular issues
- dysphagia/sore mouth/anorexia
- hepato-, splenomegaly
- sensitivity to cold
- weight loss
- lethargy
- pallor/jaundice (d/t hemolysis of RBCs and increase bilirubin)/puritus (d/t hemolysis w/
increase serum and bile salt)
- glossitis/smooth tongue
- bone pain
- tachypnea/orthopnea, dyspnea at rest
- HA/vertigo/irritability/depression/impaired thought process
Nursing Interventions
***GOAL: correcting the cause of anemia
Blood transfusions
Drug therapy (erythropoietin, vitamin supplements)
O2 supplementation
Dietary & lifestyle changes
Alternating rest and activity periods (for pts. w/ fatigue)
Monitor cardiorespiratory response to activity
Gerontologic Considerations
- Modest decline in Hgb of about 1 g/dL in men> 70
- Minimal decline in Hgb of about 0.02 g/dL in women>70
- Anemia is NOT a normal finding in older adults
- May be due to underlying cause
- When no underlying cause identifiedr/t cytokine dysregulation w/ aging
- May go unrecognized in older adult r/t to symptomatic similarities to normal signs of aging
,Pernicious Anemia (cobalamin deficiency (Vit B12) ---typically occurs later in life (around 40-
60 y.o.)
----decrease in RBCs r/t improper intestinal absorption of B12 (from lack of intrinsic factor)
Morphologic Classification: Macrocytic, normochromic (MCV >95, MCH >31)
Etiology
Parietal cells of gastric mucosa fail to secrete optimal IF due to gastric mucosal atrophy
or autoimmune destruction of parietal cells, decreasing cobalamin absorption in the
distal ileum
Impaired parietal cells also cause a decreased level of HCL acid in the stomach (an
acidic environment in the stomach is required for secretion of IF)
Occurs commonly in patients with GI surgery; patients with small bowel resections
involving the ileum; patients with Crohn’s disease, ileitis, celiac disease, diverticula, or
chronic atrophic gastritis---loss of IF-secreting gastric mucosal cells or impaired
absorption of cobalamin in distal ileum
Can also be due to excessive alcohol or hot tea ingestion, smoking, long term H2 blocker
and PPI use, and strict vegan diets
Familial predisposition is common
Clinical Manifestations (insidious onset---tales several months for manifestations to develop)
General anemia manifestations
PLUS….
(Pernicious Anemia Specific Symptoms)
- Sore, red, beefy, and shiny tongue
- Anorexia, N/V, abdominal pain
- Weakness, paresthias of hands/feet, reduced vibratory and position senses, ataxia
- Impaired thought processes ranging from confusion to dementia
Treatments
Parenteral vitamin B12 (cyanocobalamin, hydroxocobalamin) or intranasal
cyanocobalamin is needed when IF is lacking or if absorption is impaired (dietary intake
is NOT enough) ----W/O patient will die in 1-3 years
-----1000 mcg/day of cobalamin IM for 2 weeks weekly until Hgb normalmonthly
for life
High-dose oral cobalamin or sublingual cobalamin are options for those in whom Gi
absorption is intact
Nutrition
Meat, eggs, enriched grain products, milk and dairy foods, fish (esp. salmon)
Education
Educate on importance of reducing injury from decreased sensitivity to heat and pain
from neurologic impairment
Neuromuscular complications may not be reversible and physical therapy may be required
, Iron Deficiency Anemia (MOST COMMON)
-----decreased RBC production/decreased hemoglobin synthesis
Morphologic Classification: Microcytic, hypochromic (MCV <80 MCH <27)
Etiology
Inadequate dietary intake (iron intake requirements higher in menstruating or pregnant
women)
Malabsorption (d/t GI surgery of duodenum or malabsorption syndromes)
Blood loss (from GI or GU systems---peptic ulcers, gastritis, esophagitis, diverticula,
hemorrhoids, cancer, menstrual bleeding, postmenopausal bleeding)
---Avg. menstrual blood loss is 45 mL causes loss of 22 mg of iron
---Loss of 50-75 ml in upper GI tract is enough for melena to present
Hemolysis
Dialysis
Clinical Manifestations
In early course, patient may be asymptomatic
As disease progresses, general manifestations of anemia may develop
(Iron-Deficiency Specific Symptoms)
- Pallor
- Glossitis (inflammation of the tongue)
- Cheilitis (inflammation of the lips)
- HA, paresthesia, burning sensation of tongue
Treatments----treat underlying problem causing iron loss or reduced intake/poor absorption
Iron replacement
Nutritional sources of iron
---if nutrition is adeqaute, increasing iron intake by dietary means may not be
enoughoral or parenteral iron supplements
If iron deficiency is from acute blood losstransfusion of packed RBCs
Medications
Oral iron (ferrous sulfate or ferrous gluconate)
----150-200 mg daily of elemental iron taken in 3-4 doses (each dose between 50 and 100
mg) ***325 mg tablet of ferrous sulfate contains 65 mg of elemental iron***
---taken an hour before meals w/ vitamin C or orange juice (gastric AE may require taking
w food)
---liquid iron should be diluted and ingested through straw
---stay upright for 30 mins after taking
---black stool is normal---may require stool softeners or laxatives
IM or IV iron (iron dextran, sodium ferrous gluconate, iron sucrose)
---indicated for malabsorption patients or patients with intolerance to oral iron, or when a
need for iron is greater than the oral limits
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