Hematology NUR 438 Exam 2 Questions and Correct Answers
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Course
NUR 438
Institution
NUR 438
Defect in function: iron deficient anemia patho -insufficient production: nutrition deficiency -iron required to produce hgb with dec stores which dec hgb and oxygen carrying capacity of blood -enhances leakage of plasma proteins, which dec serum proteins, albumin, gamma globulin, and transferrin w...
Hematology NUR 438 Exam 2 Questions
and Correct Answers
Defect in function: iron deficient anemia patho ✅-insufficient production: nutrition
deficiency
-iron required to produce hgb with dec stores which dec hgb and oxygen carrying
capacity of blood
-enhances leakage of plasma proteins, which dec serum proteins, albumin, gamma
globulin, and transferrin which inc infection risks
-appears at ages 2-3 mo (pre-term) and 5-6 mo (fullterm) due to loss of iron stores from
birth
-older child vegetarian/other diets lacking in fe or impaired absorption (high gastric ph)
and inc demands d/t growth
Cm of iron deficiency anemia ✅s/s are vague and depend on degree/length of
deficiency
-pallor
-fatigue
-tachycardia
-impaired neurocognitive function
-under/overweight
-infant poor muscle development
Labs/dx of ida ✅-dec hgb, hct, mcv, and mch (microcytic and hypochromic rbcs)
-iron studies: inc total iron binding capacity and dec serum iron and ferritin
Med mgmt of ida ✅-iron supplement
-liquid med admin teaching: syringe to back of mouth or straw to prevent teeth staining,
admin with acidic juice or un empty stomach to promote absorption, often done w food
due to gastric upset
-do not give with ca supplements and milk as it dec absoprtion
-stools may become tarry green or black
Mgmt of ida ✅-diet rich in iron
-monitor labs, anc, and vit d to understand infection risks
-routine cbc to screen for anemia and monitor tx effectiveness
Quality outcomes for ida ✅-early recognition of s/s
-appropriate intake of milk, iron fortified formulas, and introduction of solids
-adherence to oral iron supplements with proper admin
-hgb increase in 1 mo and anemia resolves in 6 mo
, Nursing dx for ida ✅-risk for infection/sepsis
-nutrition < body requirements
Sickle cell anemia patho ✅autosomal recessive disorder, normocytic, normochromic
condition of inc rbc destruction
-normal hgb a replaced with hgb s
-hgb s: more flexible, collapse and sickle under stressors like dehydration, hypoxia, or
acidosis. Become rigid and sickle shaped and often stick together to obstruct. Leads to
dec bf to tissue and vasoocclusive crisis
Cm of vaso-occlusive crisis ✅-extremities: painful swelling of hands, joint, feet
-abdomen: severe pain and can cause splenomegaly (dec function inc infection)
-cerebrum: stroke, low incidence, change in neuro status, severe ha, seizures
-acute chest syndrome: chest pain, fever, dec o2 sats, cough, inc rr and wob
-liver: obstructive jaundice, hepatomegaly
-kidney: hematuria
General cm of sickle cell ✅-growth retardation
-delayed sexual maturation
-fatigue (adolescent)
Labs/dx for sickle cell ✅-ct/mri for stroke concern
-cxr for acs
-cbc: low rbc, hgb, hct, w low normal mcv/mch
-inc retic count
Med mgmt of sickle cell ✅-dec infection risk w/ prophylatic abx and vaccines
-rbc production: folic acid daily
-paint mgmt: multimodal analgesia, opioid for severe pain, nsaid, and tylenol
-meperidine is contraindicated d/t build up of metabolites which inc seizure risk
Mgmt of sickle cell ✅-hydration via iv/oral, electrolyte replacement, hypoxia from
metabolic acidosis promotes sickling
-bedrest to dec energy expenditure and improve o2 utilization
-supplemental o2 has no valyes unless hypoxic and can depress bone marrow which
worsens anemia
Quality outcomes for sickle cell ✅-early recognition of s/s
-deoxygenation minimized, hypoxia prevented if surgery needed
-crisis prevented/quickly managed
-stroke prevented or prompt s/s recognition
-prophylatic penicillin regimen followed for life and vaccines such as pneumococcal, flu
b, and meningococcal
Nursing dx for sickle ✅-alt tissue perfusion: peripheral f/e imbalance
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