NU 335A - Exam 3 Study Guide.

NU 335A
Exam 3 Study Guide:
Heme, Endo, GI, GU, Neuromuscular,
and Musculoskeletal Disorders

Hematology:

Sickle Cell Crisis: cause, sx/sx, treatment, complications, nursing considerations
- cause: RBCs are destroyed- spleen enlarged from congestion of sickled cells; splenic
sinuses infarcted and gradually are replaced with scar tissue (fibrotic)
- signs and symptoms: pain in area of involvement
 extremities: sickle cell dactylitis
 abdomen: severe pain-sometimes mistaken for appendicitis
 cerebrum: stroke, visual disturbances
 chest: pneumonia-like symptoms, burn episodes of pulmonary disease (ACS)
 liver: obstructive jaudince, hepatic coma
 kidney-hematuria
 genitals: priapism (painful, extended) penile erection
- Nursing considerations:
 supportive, symptomatic, specific, and curative
 bed rest
 hydration
 electrolyte replacement (hypoxia results in metabolic acidosis)
 blood replacement (may need chelation-Why?)
 antibiotic therapy to treat any infection
 hydroxy urea
 hematopoietic stem cell transplantation is the only potential cure
 pain management


Hemophilia: cause, sx/sx, treatment, complications, nursing considerations
- types: hemophilia A (Classic) factor VII deficiency which is most prevalent; hemophilia B
(Christmas disease) factor IX deficiency
- causes: X-linked genetic disease; mother with hemophilia passes on trait to the son;
gene mutation in 1/3 of cases
- sx/sx: subcutaneous and intramuscular hemorrhages
 hemarthrosis: bleeding into joint cavities (mostly knees, elbows, ankles)
 bony changes and crippling deformities occur after repeated bleeding episodes over
several years

,  spontaneous hematuria
 bleeding into any cavity can be dangerous or deadly
 GI bleeding
 intracranial hemorrhage
 anemia
 epistaxis: not as frequent as other hemorrhage
- treatment: replacement of missing clotting factor; treatment needs to begin
immediately; family members are taught to do venipuncture at home to children over 2-
3 years of age; children 8-12 years old are taught to self-administer; never make a
hemophilia patient wait to be treated
 factor VIII concentrates
 DDVAP-synthetic vasopressin increases plasma factor VIII
 Corticosteroids for hematuria, acute hemarthrosis and chronic synovitis
 RICE: for hemarthrosis
- complications: hemorrhage; inability to stop the bleeding
- nursing considerations: never give IM injection except with pretreatment; never perform
invasive procedures without pretreatment of clotting factor; avoid arterial punctures;
decrease risk of injury; medical alert bracelet; genetic counseling; foster independence;
refer family to national hemophilia foundation and world federation of hemophilia
- nursing considerations in acute bleeding:
 apply pressure and administer factor- Hem A= Factor VIII; Hem B= factor IX
 immobilize
 elevate
 apply ice pack


Fe Deficiency Anemia: cause, sx/sx, treatments, who?, nursing education
- cause: inadequate supply caused by
- deficient dietary supply
 rapid growth rate
 excessive milk intake, exclusive breast feeding after 6 months, delayed addition of
solid foods
- inadequate iron stores at birth
 low birth weight, prematurity, multiple births
 mom severely anemic
 fetal blood loss
- iron inhibitors:
 phytates: (grains, nuts, legumes, & maize), phosphates (poultry, fish, nuts, beans, &
dairy), or Oxalates (spinach, bran flakes, beets, potato chips, French fries, nuts, & nut
butters)
 gastric alkalinity

, - malabsorption disorders
 lactose intolerance
 inflammatory bowel disease
- chronic diarrhea
- blood loss: acute or chronic hemorrhage
- excessive demands for iron required for growth
 prematurity
 adolescence
 pregnancy
- sx/sx: pallor, pica, fatigue, tachycardia, tachypnea, lethargy, irritability
- treatments:
- 3-6 mg of elemental iron per kilogram per day
 give in 2-3 divided doses b/w meals
 vitamin C containing food or juice aids absorption
 should see an increased hematocrit & RBC count in 1 month
- who?: ELBW and VLBW infants; children going through maturity or puberty
- nursing education: warn about: black, tarry stools; keep iron out of reach of children;
stains teeth; overdose can be fatal


Endocrinology:

Type 1 diabetes: who?, sx/sx, treatments, complications, education
- pancreatic beta cells destroyed; insulin deficiency; insulin is essential to push glucose
into cells to be metabolized. otherwise, the body uses available stores of protein and
fats; the body is actually starving even though there is plenty of glucose in the blood
stream
- who?: most often occurs in young children aged less than 20 years; peaks between 4-6
years of age and then at adolescence 10-14 years of age for new cases
- sx/sx: 3 P’spolyphagia, polyuria, polydipsia; weight loss, enuresis or nocturia,
shortened attention span, irritability, lowered frustration tolerance, dry skin, blurred
vision, poor wound healing, fatigue, flushed skin, HA, frequent infections, hyperglycemia
(elevated blood glucose levels, glucosuria), diabetic ketosis (ketones and glucose;
dehydration in some cases), diabetic ketoacidosis (dehydration; electrolyte imbalance;
acidosis; deep, rapid breathing kussmaul respirations)
- complications:
- diabetic ketoacidosis-life threatening
 severe lack of insulin- no glucose available for cellular metabolism
 body chooses alternate energy sources
 fats break down into fatty acids