NURS 580 Cumulative final Exam Questions
with 100% Verified Correct Answers
Anemia
Males Hgb <13, Females <12
- Congenital: born with
- Acquired: from diet, environmental factors
- Diminished production: Reticulocytopenia
- Accelerated loss: hemorrhage, destruction, Reticulocytosis
RBC components
Hct: 1 to 3 ratio of plasma to RBCs (ex: Hgb 10 = Hct 30)
- Mean Corpuscular Volume (MCV): size of RBCs (-cytic)
Normal = 80-100
- Mean Corpuscular Hemoglobin (MCH): weight of RBCs (-chromic)
Normal = 27-89
MCV anemia
Microcytic: <80: iron deficiency anemia, thalassemia
Normocytic: 80-100: anemia of chronic disease, renal failure, sickle cell, blood loss,
hemolytic
Macrocytic: 100+: B12 or folate deficiency, ETOH, liver failure, drugs
Labs needed to diagnose anemia
,Microcytic (MCV <80): most common is iron deficiency anemia
- need serum iron studies: iron, ferritin, TIBC
Normocytic: Need reticulocyte count (how many new cells are being produced)
- <2% reticulocytes: hypoproliferative, body not producing enough RBCs - suppressed by
diseases like leukemia, bone marrow suppression
- 2+% reticulocytes: hyperproliferative, body trying to compensate for blood loss,
hemorrhage
Macrocytic (MCV 100+): Need peripheral blood smear, would see megalocytes and
segmented neutrophils
Iron deficiency anemia
MICROcytic, #1 cause of iron deficiency anemia is blood loss (chronic GIB, menses)
- inadequate iron intake, impaired absorption of iron
- autoimmune diseases
Dx: Low MCV, low MCH, low iron, low ferritin (<12), high TIBC
Ferritin is most reliable indicator
Iron deficiency anemia S/S and Tx
S/S: slow onset, PICA cravings, dyspnea, HA, weakness, tachycardia, pallor
Tx: Oral ferrous sulfate 300-325mg 1-2hrs after meals
- do not take w/antacids, calcium, food
- Vit C increases iron absorption
,Thalassemia
MICROcytic anemia, decreased Hgb synthesis
- S/S: asymptomatic unless severe, then SOB, fatigue, CP
- Dx: Low MCV, Low MCH, Normal TIBC, normal iron, normal ferritin
- Tx: No tx unless severe, then PRBCs. Iron contraindicated bc can cause overload
Folic acid deficiency
MACROcytic
Causes: prolonged dietary deficiency, malabsorption, esp common in alcoholics
- S/S: fatigue, pallor, HA, NO NEURO S/S
- Dx: MCV 100+, normal MCH, folate low
- Tx: folic acid 1mg/day
Pernicious anemia (B12 deficiency)
MACROcytic
Causes: intrinsic, autoimmune, malabsorption (gastric bypass, resection)
- S/S: NEURO: Parasthesias, + Romberg, + Babinski, dizziness.
Can be reversible if tx w/in 6 mon of dx
- Dx: MCV 100+, normal MCH, low B12,
- Tx: B12 100mcg IM daily x 1wk. PO B12 may be destroyed in gastric secretions
Anemia of Chronic disease
, NORMOcytic, low iron and TIBC, high ferritin
Causes: inflammation, infection, renal failure, malignancy, 2nd most common type of anemia
3 types:
1. Anemia of inflammation: rheumatologic, arthritis, lupus, IBD, Crohn's
2. Anemia of organ failure: renal, liver, endocrine
3. Anemia of the elderly: 20% of people 85+, decreased RBC production
Tx: tx underlying disease
Sickle cell disease
Autosomal recessive trait. S/S: Cellular hypoxia/ischemia, pain, CVA, VTE, pain, DOE,
fever, ^HR, AMS
Precipitated by stressors, infection, dehydration
Complications: CVA, retinopathy, pulm HTN, aseptic necrosis, ACS, meningitis, priapism
Dx: Retic count high, LFTs/Cr may be high. CXR to r/o ACS
Sickle cell treatment
- IVF, O2, pain control, Hydroxyurea
- PRBCs, broad spectrum abx prophylactically
Hydroxyurea: chemo agent, will reduce # of crisis/yr, may be hepatotoxic so monitor LFTs
prior to starting. Need heme c/s
Aplastic Anemia
with 100% Verified Correct Answers
Anemia
Males Hgb <13, Females <12
- Congenital: born with
- Acquired: from diet, environmental factors
- Diminished production: Reticulocytopenia
- Accelerated loss: hemorrhage, destruction, Reticulocytosis
RBC components
Hct: 1 to 3 ratio of plasma to RBCs (ex: Hgb 10 = Hct 30)
- Mean Corpuscular Volume (MCV): size of RBCs (-cytic)
Normal = 80-100
- Mean Corpuscular Hemoglobin (MCH): weight of RBCs (-chromic)
Normal = 27-89
MCV anemia
Microcytic: <80: iron deficiency anemia, thalassemia
Normocytic: 80-100: anemia of chronic disease, renal failure, sickle cell, blood loss,
hemolytic
Macrocytic: 100+: B12 or folate deficiency, ETOH, liver failure, drugs
Labs needed to diagnose anemia
,Microcytic (MCV <80): most common is iron deficiency anemia
- need serum iron studies: iron, ferritin, TIBC
Normocytic: Need reticulocyte count (how many new cells are being produced)
- <2% reticulocytes: hypoproliferative, body not producing enough RBCs - suppressed by
diseases like leukemia, bone marrow suppression
- 2+% reticulocytes: hyperproliferative, body trying to compensate for blood loss,
hemorrhage
Macrocytic (MCV 100+): Need peripheral blood smear, would see megalocytes and
segmented neutrophils
Iron deficiency anemia
MICROcytic, #1 cause of iron deficiency anemia is blood loss (chronic GIB, menses)
- inadequate iron intake, impaired absorption of iron
- autoimmune diseases
Dx: Low MCV, low MCH, low iron, low ferritin (<12), high TIBC
Ferritin is most reliable indicator
Iron deficiency anemia S/S and Tx
S/S: slow onset, PICA cravings, dyspnea, HA, weakness, tachycardia, pallor
Tx: Oral ferrous sulfate 300-325mg 1-2hrs after meals
- do not take w/antacids, calcium, food
- Vit C increases iron absorption
,Thalassemia
MICROcytic anemia, decreased Hgb synthesis
- S/S: asymptomatic unless severe, then SOB, fatigue, CP
- Dx: Low MCV, Low MCH, Normal TIBC, normal iron, normal ferritin
- Tx: No tx unless severe, then PRBCs. Iron contraindicated bc can cause overload
Folic acid deficiency
MACROcytic
Causes: prolonged dietary deficiency, malabsorption, esp common in alcoholics
- S/S: fatigue, pallor, HA, NO NEURO S/S
- Dx: MCV 100+, normal MCH, folate low
- Tx: folic acid 1mg/day
Pernicious anemia (B12 deficiency)
MACROcytic
Causes: intrinsic, autoimmune, malabsorption (gastric bypass, resection)
- S/S: NEURO: Parasthesias, + Romberg, + Babinski, dizziness.
Can be reversible if tx w/in 6 mon of dx
- Dx: MCV 100+, normal MCH, low B12,
- Tx: B12 100mcg IM daily x 1wk. PO B12 may be destroyed in gastric secretions
Anemia of Chronic disease
, NORMOcytic, low iron and TIBC, high ferritin
Causes: inflammation, infection, renal failure, malignancy, 2nd most common type of anemia
3 types:
1. Anemia of inflammation: rheumatologic, arthritis, lupus, IBD, Crohn's
2. Anemia of organ failure: renal, liver, endocrine
3. Anemia of the elderly: 20% of people 85+, decreased RBC production
Tx: tx underlying disease
Sickle cell disease
Autosomal recessive trait. S/S: Cellular hypoxia/ischemia, pain, CVA, VTE, pain, DOE,
fever, ^HR, AMS
Precipitated by stressors, infection, dehydration
Complications: CVA, retinopathy, pulm HTN, aseptic necrosis, ACS, meningitis, priapism
Dx: Retic count high, LFTs/Cr may be high. CXR to r/o ACS
Sickle cell treatment
- IVF, O2, pain control, Hydroxyurea
- PRBCs, broad spectrum abx prophylactically
Hydroxyurea: chemo agent, will reduce # of crisis/yr, may be hepatotoxic so monitor LFTs
prior to starting. Need heme c/s
Aplastic Anemia
