NUR 6121 Advanced Nursing II 2024 – 2025
William
NUR 612 Paterson
Adv Nursing University
2 Exam 1 Review
New Jersey
Study GuideNUR
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6121 ADVANCED NURSING II
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Course Title and Number: NUR 612 ADVANCED
NURSING II
Exam Title: NUR 612 Exam
Exam Date: Exam 2024- 2025
Instructor: [Insert Instructor’s Name]
Student Name: [Insert Student’s Name]
Student ID: [Insert Student ID]
Examination
180 minutes
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Study Guide Exam #1
Hematology and Infectious Disorders
Anemia
• It is not a disease but a sign/symptom of an underlying disorder
• Low Hgb (<12 g/dl in women, 14 <14 g/dl in men)
• Decreased RBC production, increased RBC destruction, and blood loss
• It is important to identify underlying conditions or cause
• Hemoglobin: HGB is the protein molecule in red cells that carries oxygen
• Hematocrit: HCT is the proportion by volume of the blood that consists of RBCs
• Mean Corpuscular Hemoglobin MCH
o MCH is the amount of Hgb in RBCs
o 27-34 pg
o Hypochromic anemia
o Hyperchromic anemia
• Mean Corpuscular Volume MCV
o Size of average RBC, able to categorize anemia based on size
o Microcytic Anemia <80 (80-100 fl)
▪ Fe deficiency
▪ Thalassemia
▪ Anemia of Chronic Disease (ACD) - occasionally
o Normocytic < 80-100
▪ Acute blood loss
▪ ACD – including renal failure
o Macrocytic Anemia
▪ Megaloblastic anemia – b12 or folate deficiency
• Red Cell Distribution Width RDW
o Measures variability of the RBC size
o Normal: Homogenous RBC size
▪ ACD, renal insufficiency, liver disease, ETOH
o Increased: Heterogeneous RBC size
▪ IDA (11.5-15)
• Iron Deficiency Anemia IDA
o Most common cause of anemia
o Most common nutritional deficiency
o Most common cause is chronic blood loss
▪ Menorrhagia, GI bleed, NSAID/ASA
▪ In women, include menstrual hx – menorrhagia or pregnancy
o Also caused by
▪ Inadequate diet
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▪ Malabsorption: Celiac, H pylori, Gastric bypass
▪ Increase iron requirements (pregnancy)
▪ Extreme athletes
o May not show symptoms until anemia is severe (Hgb < 6 g/dl)
o IDA can cause symptoms with Hgb <11 g/dl
o Most common presentation: Fatigue, mild dyspnea and mild exercise intolerance
o Moderate to severe anemia: Marked dyspnea, activity intolerance, pallor, tachycardia
o Elderly patients may present with exacerbation of comorbidities: Dementia,
chest pain, HF
o Differential Dx
▪ Thalassemia, Beta/Alpha
• Genetic disorders in which the normal ratio of alpha globin to beta
globin production is disrupted due to a disease-causing variant in
one
or more of the globin genes
• Africa (beta), Asia and the Mediterranean region
• Types: Genotype (alpha/beta); phenotype (minor, intermedia or major)
• Labs
o RDW normal
o Retic count increased
o Ferritin normal
o High-performance liquid chromatography (HPLC)/
Hgb electrophoresis – diagnostic standard
o Globin gen – diagnostic confirmation
o Pre-conception and pre-natal testing and counseling
▪ Non-anemia diff dx
• Hypothyroidism
• Pregnancy
• Uterine fibroids
o Ferritin
▪ Iron stores
▪ Earliest lab abnormality
▪ Most accurate test to diagnose IDA
▪ Women 12-150 ng
▪ Men 15-300 ng
▪ Decreased: IDA
▪ Increased: ACD, sideroblastic anemia
▪ In chronic states of inflammation <50 ng is considered IDA
o Other iron studies
▪ Serum iron
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• Circulating iron
• Decreased
▪ TIBC- Total iron binding capacity
• Serum transferrin
• Increased
▪ TSat- Transferring Sat
• Ratio between serum Iron and TIBC
• Decreased
o Other tests (usually not necessary)
▪ Reticulocyte count: New immature RBCs (1%)
• Decreased
▪ Peripheral smear: Provides information of count and morphology
▪ Bone marrow (rare)
▪ Stool OB to r/o GI bleed
▪ HCG test r/o pregnancy
o Management
▪ Oral replacements 180 mg elemental iron (150-200)
▪ FeSO4 325 mg tid (65 mg elemental iron)
▪ Fe Fumarate 325 mg (106 mg elemental iron)
▪ Side effects
• GI: Metallic taste, n/v, diarrhea, constipation
• Check for tolerance
▪ Bioavailability affected by:
• Food- and calcium-containing foods
• pH – OJ
▪ Fe IV infusion: If intolerant to oral or severe, refer
▪ Identify the cause
• GI (+) guaiac
• GYN menorrhagia
o Patient Education
▪ Diet
▪ Fe replacement
o Follow up
▪ Repeat labs CBC ferritin; improvement expected in about 4 weeks
• Retic count expected to increase in 5 days
• Ferritin usually takes 4-6 months to replenish
▪ Continue supplement for 3 months once Hgb normalizes
▪ Monitor CBC periodically
▪ Refer depending on the underlying cause
▪ Refer to Gi for all men and post-menopausal women with IDA
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