NSG 320 Med Surge Exam 4 - Updated with anemias latest VERSION 2021/22

• A deficiency in: o Number of RBCS o Quantity of hemoglobin o Volume of packed RBCs (hematocrit) • RBC function: o Transport O2 from lungs to systemic tissues o Carry CO2 from tissues to lungs o Priority is OXYGENATION (FIRST – before fluids or transfusions) • Ratio of Hgb to Hct is 1:3 • Anemia is a manifestation of a pathologic process (underlying disorder) • Diagnosed by CBC, reticulocyte count, peripheral blood smear – ALWAYS AN INDICATION FOR FURTHER INVESTIGATION • Hemoglobin (Hgb) levels are used to determine severity of anemia o Mild states of anemia: Hgb 10-12 g/dL – May exist without symptoms o Moderate anemia: Hgb 6-12 g/dL – cardiopulmonary symptoms are increased o Severe anemia: Hgb less than 6 g/dL – clinical manifestations involving multiple body systems • Anemia is not normal – related to underlying cause • May be mistaken for normal aging • Decreased Erythrocyte Production: Erythropoietin (EPO) is a glycoprotein primarily produced in the kidneys o Elevated number of stem cells committed to RBC production o Shortens time to mature RBCs o Treat with Epogen o Life span of RBC is 120 days • Blood loss – major cause of iron deficiency in adults o Chronic blood loss most commonly through GI and GU systems • Goal: Treat underlying cause • Manifestations: • Integumentary Manifestations: o Pallor (decreased hemoglobin, decreased blood flow to skin) o Glossitis (inflammation of tongue) o Cheilitis (inflammation of lips) o Jaundice (elevated serum bilirubin) o Pruritus (elevated serum and skin bile salt concentrations • Cardiopulmonary Manifestations o Result from additional attempts by the heart and lungs to provide adequate oxygen to tissues o CO maintained by increasing heart rate and stroke volume o Murmurs may be present, MI, and CHF may develop • Diagnostic Studies • Iron Deficiency Anemia: o Lab findings (Hgb, Hct, MCV, MCH, MCHC, reticulocytes, serum iron, TIBC, bilirubin, platelets) o Stool occult blood test o Endoscopy o Colonoscopy o Bone marrow biopsy (if other tests are inconclusive) • Replace iron o Nutritional therapy o Oral iron supplements o Transfusion of packed RBCs for acute loss