NS 470Exam 2 Study Guide

NS 470
Exam 2 Study Guide


Exam blueprint:
Anemia-3 questions
Anemia exemplars-8 questions
Polycythemia-4 questions
Thrombocytopenia-5 questions
Thrombocytopenia exemplars-15 questions
Neutropenia and Myelodysplastic Syndrome -12 questions
Acute and Chronic Leukemia-9 questions
Lymphoma (Hodgkin’s and Non-Hodgkin’s)-7 questions
Multiple Myeloma-5 questions
Blood Component Therapy-5 questions
Client to see first-2 questions
Dosage Calculation-3 questions

 Heparin-calculating doses, following an algorithm

Heparin Weight Based Protocol (do not memorize it, is provided)
PTT values and adjustments as follows:
45 sec, give 80 units/kg IV bolus and increase drip by 4 units/kg/hour
46-55 sec, give 40 units/kg IV bolus and increase drip by 2 units/kg/hour
56-70 sec, increase drip by 1 unit/kg/hour
71-90 sec, no change
91-100 sec, decrease drip by 2 units/kg/hour >100 sec, hold heparin drip for one hour and then
restart drip at 3 units/k
Focus 3 Review Questions

What are normal CBC results? Reticulocyte count? Neutrophil count? What is pancytopenia?

 Hemoglobin:
o Female: 12-16
o Male: 13-17
 Hematocrit:
o Female: 45-47
o Male: 39-50
 RBCs: (3.8-5.7)
o Female: 3.8-5.1
o Male: 4.3-5.7

,  Reticulocyte Count:
o 0.5%-2.5%
 increased reticulocyte indicates anemia
 baby red blood cells which are sent out into the body as a response to
decreased oxygenation
 Will not be elevated in aplastic anemia because the bone marrow is NOT
working
 Normal Neutrophil Count:
o 2200-7700
 Pancytopenia:
o Decreased RBCs, WBCs, and platelets
 Symptoms:
 Poor TP—fatigue, dyspnea
 Bleeding—petechiae, epistaxis (nosebleed)
 Infection—septic shock, death

What are possible causes of anemia (Decreased RBC)?

 Renal disease or chronic inflammation
 Adverse effects of certain medication or OTC herbal supplements
 Ethnicity disparities
o African Americans are more likely to be anemic
 Blood loss/trauma
 Diet
 Chemo/drugs
 Prosthetic valve- hemolyzes RBCs when processing though
 Infectious disease or HIV
 Exposure to chemicals


What are assessment and lab findings in a client with anemia?

 Generalized tissue hypoxia
o Angina
o Fatigue
o Dyspnea
o Night cramps
o Dizziness/syncope
o Headache

 Compensatory—tachycardia, dyspnea, increased RR, systolic murmur, orthostatic
hypotension, syncope

 Lab findings from a CBC or a peripheral smear:
o Mild: hemoglobin = 10-12
o Moderate: 6-10
 Palpitations, dyspnea, “roaring” in ears
o Severe: <6
 Cardiopulmonary symptoms

, What is included in the general plan of care in a client with anemia, including client teaching?

 Assess pt knowledge
 Fall risk!
 Help with ADLs
 Lifestyle:
o Diet
o Smoking cessation
o No alcohol
o Occupational safety
 Medications
 Not normal for an older patient to be anemic due to their age

What are adverse effects of erythropoietin and monitoring outcomes?

 Cardiac arrest
 HTN
 HF
 MI/stroke—monitor EKG

What is happening in aplastic anemia (understand the etiology and pathophysiology so could explain to a
client)?

 Decreased production of erythrocytes (RBCs) from an autoimmune response
o Can be idiopathic or acquired
o Bone marrow failure, no cells are being produced
o Pancytopenic: all blood counts are low, because the bone marrow has failed
o Bone marrow biopsy done to make a definitive diagnosis

What is included in the plan of care (nursing and collaborative, pharmacological and
nonpharmacological) for the client with aplastic anemia?

 Prevent infections
 Prevent hemorrhages
 Hematopoietic stem cell transplant
o 1st treatment for under 55 y/o
 Immunosuppressive therapy
o ATG (Anti-Thyo Globulin)
o Cyclosporine
o Cyclophosphamide – chemo drug, hemorrhagic cystitis
o Corticosteroids
o Alemtuzumab
 Attaches and kills WBCs; believed to be responsible for destruction of cells in
the bone marrow
o Eltromopaq
 Receptor agonist or bone marrow stimulant
 For those not responding to other treatments
o O2
o Blood transfusion