CHA final exam Questions and Answers

CHA final exam Questions and Answers Sickle cell anemia crisis exacerbation Hypoxia, anesthesia, infections, cold temperature, acidosis, strenuous exercise, increased viscosity Sickle cell anemia s/s pain, leg ulcers, joint problems, hematuria, gray pallor, fatigue, dyspnea, jaundice, infections, respiratory, HTN, acidosis, DKA, (lungs, bones, liver, heart, kidney, brain,retina) Sickle cell anemia Hemolytic, very painful, RBC lasts 10-20 days, no cure, genetic, african americans, asians, hispanics. Trait- no s/s Sickle cell interventions for crisis Head to toe assessment, then focus on whats causing pain/signs., opioids (morphine IV) IV fluids, PRBCs, labs FIRST INTERVENTION: 02 Sickle cell treatment long term NSAIDS, ASA (antiplatelet) opioids, stem cell transplant, warm, no constriction, hydration, Arginine- amino acid, nitric acid (vasodilator) Hydrea- fetal F hemoglobin Immune Hemolytic anemia causes Medication, lymphoma, CVD, CLL, autoimmune, leukemia, infections, Idiopathic* produces antibodies against RBCs to destroy them warm body vs. cold body Hemolytic anemias Immune hemolytic, sickle cell, thalassemia, glucose 6 dehydronase, Hypoproliferative anemias Iron deficiency, Vit B12, Folic acid, aplastic Immune hemolytic anemia s/s Common anemia signs, finger clubbing, raynaud, splenomegaly, lymphatomapthy, jaundice, hepatomgaly Immune hemolytic anemia treatment steroids, immunosuppressant (CYTOXAN) transfusions, splenectomy, plasma exchange therapy (used when not responding to other drugs), immunoglobins Iron deficiency anemia causes malabsorption (IBS, celiacs, gastrectomy, gastric bypass) blood loss (menstruation, GI bleeding) inadequate intake (diet)pregnancy, growth spurts, alcoholism Iron deficiency anemia s/s common anemia sign, brittle nails, smooth sore tongue, angular cheiolsis (chapped corners of lips) PICA Iron deficiency anemia treatment IV iron (FERRIC GLUCONATE) SE: DIARRHEA packed RBC, work up for source, diet (organ meats, vegetables, molasses, raisins) VIT C on empty stomach FERROUS SULFATE. SE: constipation (hard stool) Vit B12 Deficiency Anemia/ PERNICIOUS causes failure to absorb (intrinsic factor deficiency PERNICIOUS anemia) gastric bypass, small bowel resection, PPI, metformin, Vit B12 Deficency s/s mild- few symptoms at first. left untreated = HEART FAILURE gastric caner, anemia s/s, smooth sore tongue, beefy red tongue, paresthesias in feet legs and hands, confusion, weak, poor gait, NEURO symptoms NERVE Vit b12 deficiency treatment increase foods of b12 (soy salmon crab organ beans nuts vegetables, fruit, dairy, eggs,) vitamin supplements injections/sublingual Folic acid deficiency causes poor nutrition, pregnancy, malabsorption (chrons, celiacs) alcohol, anticonvulsants, oral contraceptives NEED B12 AND FOLIC ACID folic acid deficiency s/s similar to B12 but WITHOUT neuro. cells are macrocytic folic acid deficiency treatment diet with floats (green vegetables, carrots, celery, corn, beans, nuts, livers) lozenge or IM given with B12 and B6 Aplastic anemia causes anticonvulsants, sulfas, antibiotics, pregnancy, radiation, hepatitis or vial illness, chemotherapy, benzenes (paint) oncology patients Attack BONE MARROW=deficiency in RBC, WBC AND PLATELETS aplastic anemia s/s anemia features, pancytopenia , infections, bruising, hemorrhage, splenomegaly, retinal hemorrhage, lymphadenopathy aplastic anemia treatment control infections, labs, no raw foods, washing hands, skin and oral care, protective isolation, energy saving techniques, identify source, splenectomy, immunosuppresents, PRBC, bone marrow transplant- potential cure Thalassemia causes genetic, diagnoses young alpha- mild form beta- severe Hgb rigitidy thalassemia s/s beta- jaundice of skin and eyes, facial bone deformities, slow growth, abdominal selling, dark urine, brittle bones, enlarged liver, spleen, heart, dysfunctional pancreas, common features of anemia asyymptomatic when alpha thalassemia treatment multiple transfusions (CAN LEAD TO IRON OVERLOAD AND THEN HEART FAILURE) CHELATION THERAPY- removes excess iron via IV drugs bone marrow transplant- possible cure PRBC, splenectomy. (similar to sickle) Glucose-6-phosphate dehydrogenase deficiency causes genetic, inherited as X linked blacks, asians, jewish RBCs break easier especially exposed to (ASA, aspirin, sulfa, thiazide diuretics, furosemide, toxins) Glucose-6-phosphate dehydrogenase deficiency s/s asymptomatic until exposed to drugs or severe infection then common features of anemia and jaundice Glucose-6-phosphate dehydrogenase deficiency treatment identify and remove drug/toxin MANNITOL-hydrate during hemolysis to avoid cellular debris in KIDNEY tubules leading to NECROSIS TRANSFUSE- when anemia is present and kidney function is normal. thrombocytopenic purpura immune ITP causes IDIOPATHIC secondary: viral infections (measles, mumps, respiratory infections, hepatitis, HIV) pregnancy, drugs (quinine, sulfa) autoimmune (lupus, i) antiplatlet antibody ITP s/s bleeding all over, epitaxis, hematuria, petechia, non-blanchable lesions, fatigue, could be asymptomatic initially ITP treatment immunosuppresent, steroids, platelet transfusion, splenectomy, immunoglobin transfusion, avoid drug trigger, bleeding precautions (avoid constipation, no vigorous flossing, soft toothbrushes, electric razors, no contact sports, no aspirin or NSAIDS) Hemophilia causes genetic X linked A- lacks factor 8 (most common) B- lacks factor 9 for clotting PROLONGED PTT normal bleeding time and PT hemophilia s/s LONG PTT hematomas, bleeding everywhere, fever or pain, joint destruction, poor healing, decreased sensation and weakness atrophy, potential for POST OP FATAL BLEEDING common features of anemia hemophilia treatment Desmopressin, FFP, PRBC, bleeding precautions, first aid, splinting joints, genetic testing Sickle cell and JAUNDICE hemolytic anemia breaks down RBC VERY QUICKLY, when broken down release bilirubin DECREASED RBC in aplastic anemia Normally RBCs and INCREASED in blood loss, but with APLASTIC ANEMIA, bone marrow is damaged and can't produce RBCs can't respond Common features of anemia Pale, cool, cold intolerance, tacky, orthostatic hypotension, dyspnea on exertion, decreased 02 sat levels, fatigue, dizzy, weak, headache Blood Plasma and cells, 4-5 L Plasma 55% extracellular fluid, 90% water then proteins, albumin, globulin, fibrin cells 45% produced by bone marrow all cells begin as stem cells then become myeloid or lymphoid lymphoid- lymphocytes myeloid- RBC, WBC, platelet erythrocytes RBCs. bi-concave disc. last 120 days. bind/release hydrogen. 4.2-6.2 million need iron, b12, b6, folic acid and minerals destroyed by MACROPHAGES spleen/liver reticulocyte- baby rbc liver=clotting heme iron/oxygen globin c02 Leukocytes WBCs Granulocytes neutrophils, eosinophils, basophils Agranulocytes lymphocytes(b and t) and monocytes neutrophils most abundant, (immature=band) Biggest, digest by phagocytosis Basophils produces histamine/heparin Eosinophils allergic reactions and parasites Monocytes turns into MACROPHAGES, debris fungi and parasites lymphocyte T rejects foreign tissue and tumors lymphocyte b makes antibodies Thrombocytes Platelets lasts 7-10 days 150,000-450,00 made in liver response to platelet loss platelets- smallest, 20 percent stored in spleen Assessment of the older adults referring to hematology decreased blood volume, decreased WBC, RBC, loss of body hair, skin dryness, skin pigmentation health history for hematology bleeding? family, drugs, NSAIDS, antibiotics, ASA, radiation, chemotherapy, alcohol. diet of increased fat and low protein? Reticulocyte test tests bone marrow function, increase is bad if they don't have anemia Coombs test antibiodies to RBC (autoimmune) Hemoglobin test hemoglobin S= sickle cells bleeding time 1-9 min normal PT 11-13 seconds INR 0.7-1.8. on coumadin 2-3 PTT 60-70 seconds Hbg 12-18 o2 carrying capacity