CMN 572 UNIT 2 EXAM TEST BANK 100+ QUESTIONS WITH CORRECT DETAILED ANSWERS
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Course
CMN 572
Institution
CMN 572
CMN 572 UNIT 2 EXAM TEST BANK 100+ QUESTIONS WITH CORRECT DETAILED ANSWERS
Physiologic anemia of newborn - Answer-Physiologic Anemia:
Baby is born with Hgb F instead of Hgb A. Hgb A steadily increases during the first 6 mos of life. Hgb F causes RBCs to have a shortened life. It also
depresses ...
CMN 572 UNIT 2 EXAM TEST
BANK 100+ QUESTIONS WITH
CORRECT DETAILED ANSWERS
Physiologic anemia of newborn - Answer-Physiologic Anemia:
Baby is born with Hgb F instead of Hgb A. Hgb A steadily increases during the first 6
mos of life. Hgb F causes RBCs to have a shortened life. It also
depresses the production or erythropoietin (hormone released by kidney that stimulates
RBC production)
Around 2-3 months, most babies will have physiologic anemia because of the
suppression of erythropoietin. Iron supplements are not indicated, unless baby is
premature.
G6PD (Glucose‐6‐phosphate dehydrogenase deficiency) - Answer-G6PD is an enzyme
that helps RBCs function
Genetic x‐linked genetic condition so most common in males.
Any race but occurs in over 10% of black males and in large number of Kurdish Jews.
Certain oxidative drugs such as Bactrim or Macrodantin or antimalarial drugs, foods
such as fava beans or infections such as fifth disease can
cause an exacerbation by depressing G6PD activity and resulting in hemolysis of RBCs
Aplastic anemia - Answer-Low RBC count due to faulty bone marrow activity.
May be caused by chemotherapy
Patient has decreased values for all formed elements of the blood (RBCs, platelets,
and WBCs)
Refer
Sickle Cell Anemia - Answer-Hereditary - both parents must be carriers
o Autosomal recessive" transmission
If both parents have trait, the chance of child having disease is 25%
If both parents have disease, the chance of child having disease is 100%
Sickle Cell "Trait" occurs when only one parent carries gene
Most common in Blacks
Between 1 in 7‐12 Blacks is a carrier
Disease occurs in 1 of 350 Black babies
Those affected appear to have some resistance to malaria
Sickle cell screening and diagnosis - Answer-Screening with Sickledex or Sickle Cell
Prep.
o Screening shows positive even for those with trait because they have at least a few
sickled cells
,o Since 1988, all babies in Alabama are screened for hemoglobinopathies.
Diagnosis with Hgb electrophoresis - separates those with trait (carriers) from those
with disease.
Sickle cell anemia Pathology and Sickle Cell Crises - Answer-Under conditions of
decreased tissue oxygenation (may occur at high altitudes) and/or dehydration,
infection, trauma, or vasoconstriction from
smoking or alcohol, red blood cells become odd shaped (sickle shaped), fragile and
don't carry oxygen well, this creates a vicious cycle because
there is more sickling in response to the poor oxygen carrying ability of the now
deformed cells.
Deformed (sickle shaped) RBCs mean that they are fragile and are easily destroyed
(hemolysis). Destruction and loss of RBCs worsens tissue
oxygenation problems.
As cells sickle they become clogged in arterioles and create pain crisis or sickle cell
crisis - think of wire coat hangers getting tangled in a tight space. Clogging may cause
vessels to rupture resulting in bleeding into the tissues. This tends to happen most often
to children under the age of 7 yrs.
o These episodes are called pain crisis or sickle cell crisis
Some patients have few crises, some have many. There is no way to predict number of
crises when disease diagnosed. During a crisis tissues in vital organs are often injured
or die.
o The spleen normally filters bacteria from blood-especially important in children - when
it becomes clogged, it enlarges. This is called Splenic Sequestration or Splenic Crisis.
Splenectomy may be required which leaves child more susceptible to infection.
When bleeding occurs it is most common in joints (esp. fingers & toes because these
bones actually make RBCs up until the age of about 5
years‐the stasis in the vessels impairs blood flow to the bones) called hand‐foot
syndrome or dactylitis (see photo in Zetelli). May cause loss of digits (fingers/toes) or
may cause leg ulcers. Bone infarcts may occur and there may be bleeding into
abdomen.
In disease state, percent of abnormal hgb varies from day to day, depending on health
status.
Sickle cell anemia complications - Answer-"Acute chest syndrome" from lung vaso‐
occlusion
o Stroke (occluded vessel or bleeding in brain)
o Kidney damage (occluded vessels or bleeding in kidney)
o Retinal damage (occluded vessels or bleeding in eye)
o Cholelithiasis
o GI necrosis
o Osteomyelitis
o Joint infarction
o Necrosis of hip
o Stasis ulcers
o Cardiomegaly
, o Heart failure
o Hepatomegaly/Cirrhosis
o Splenomegaly and/or fibrosis shrinkage of spleen (from pooling
of RBCs)
o Pneumonia
o Meningitis
o Mortality due to infection - highest in first 5 yrs of life and first 6 mos of life is period of
greatest risk.
Sickle cell anemia management and teaching - Answer-Goal is to prevent sickling
Folic acid supplementation to form healthy new RBCs
Prophylactic penicillin given to children with sickle cell anemia to prevent infection
Keep patient WELL HYDRATED
o Daily need is 150% of normal daily maintenance fluids to prevent sickling.
o If patient gets sick (sick=begins sickling in response to a disease process) he will
need double maintenance fluids.
Teach to assess for splenomegaly; abd girth, splenic palpation and percussion. About
15% of infants and young children with sickle cell
will have a splenic sequestration crisis ‐ it can rapidly lead to death if prompt treatment
is not initiated .
ID card stating disease for parent to carry.
Plastic covers on bed; with high fluid intake bedwetting may occurs and potty training at
night should not be over emphasized.
Heat can be applied to painful areas; not ice which can make pain worse (cold causes
vasoconstriction).
Importance of daily penicillin if prescribed - do not run out of medication for even one
day
Watch for constipation if child is taking pain relievers
Sickle cell anemia immunizations and prophylactic medications - Answer-Stress
importance of Haemophilus immunization and all other vaccines
o penicillin begun about age 3 mos
o folic acid (one of the B complex) is needed for production of
erythrocytes (especially needed for pregnant women with sickle cell)
o pain at home: tx first with Tylenol, if no relief: Tylenol with codeine
-- don't be stingy with analgesics
Sickle cell reproductive issues - Answer-In females puberty may be delayed but after
puberty, there is usually no problem with conceiving
If OCPs are requested, use progestin only OCPs rather than combination. Estrogen
may promote stasis/congestion of blood.
During Pregnancy women with trait have more UTIs but usually have good outcomes,
while the women with actual disease are at risk for many complications including
infections, crises, and PIH.
Pregnancy actually aggravates and causes disease to become more active.
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