NUR 211
EXAM 1 3
STUDY GUIDE
Health Care Concepts
Forsyth Technical Community College
This Document Description:
❖ This study guide for NUR 211 at Forsyth Technical
Community College focuses on Exam 1 content from the
Health Care Concepts course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
, NUR 211 – Exam 1 Study Guide
1. Exemplar: Anemia
Anemia is the reduction in the number of RBC’s, the amount of hemoglobin, or the hematocrit
(percentage of packed RBC’s per deciliter of blood). It is a clinical indicator, not a specific disease
because it occurs with many health problems. Anemia can result from dietary problems, genetic disorders,
bone marrow disease, or excessive bleeding. GI bleeding is the most common reason for anemia in adults.
Pathophysiology:
o Iron deficiency anemia is the most common anemia worldwide, especially among
women, older adults, and people with poor diets. It can result from blood loss, poor GI
absorption, and an inadequate diet. The problem is a decreased supply for the developing
RBC. With chronic iron deficiency, RBC’s are small (microcytic) and the patient has mild
symptoms: fatigue, reduced exercise intolerance, pallor, weakness, fissures at the corners
of the mouth (cheilosis), spoon shaped nail beds, odd cravings – pica or chewing ice,
SOB. Serum ferritin values are less than 10 ng/mL.
Management: increase PO intake of iron food sources (red meat, organ meat, egg
yolks, kidney beans, leafy green vegetables, and raisins). If Fe losses are mild,
PO supplements are started until the Hgb levels return to WNL. If supplements
cause GI upset, take with a meal. If Fe deficiency is severe, iron solutions can be
given parentally.
Iron Supplement prototype - Ferrous Sulfate
Adverse Effects: nausea, heartburn, constipation, dark stools,
Cardiovascular collapse, aggravation of peptic ulcers or
ulcerative colitis, hepatic necrosis, anaphylaxis (iron dextran)
Oral, intramuscular, or intravenous administration
PO – separate administration from antacids and tetracyclines
because it can decrease absorption of Fe. Need to be sure there is
a 2-hour window between administrations
Vitamin C increases absorption
Caffeine and dairy can decrease absorption of iron
Assess for allergies using a test dose
May cause gastrointestinal disturbance
May turn stools dark green or black color
Should be given 1 hour before meal, but taking with food
reduces GI distress - but reduces absorption
Liquid form – dilute with water or juice and rinse mouth because
of teeth staining
Iron deficiencies common in young children: also monitor for
overdose
Pregnant women and those with heavy menstrual flow have
increased demand
Client teaching: Take iron with food, use straw to prevent
staining teeth, report signs of bleeding, keep out of reach of
children
Use z-track method when giving IM
Monitor bowel patterns
Increase water and fiber in diet
Patient typically takes for 1-2 months and you hope to see a 2-
point increase within the first month
, Iron dextran (Dexferrum) – iron for IV formulation. Test dose is
typically given before giving whole dose to monitor for
anaphylaxis reaction. Be sure you have emergency equipment on
hand.
Ferumoxytol (Feraheme) – has a black box warning label for
anaphylactic reactions occurring in the first 5 minutes of infusion
o Vitamin B12 deficiency anemia: results in failure to activate enzymes that move folic acid
into precursor RBCs cells so cell division and growth into functional RBCs can occur.
Cells need folic acid for DNA production. These precursor cells then undergo improper
DNA synthesis and increase in size – this type of anemia is called megaloblastic or
macrocytic anemia because of the large size in abnormal cells. Causes: vegan diets, diets
lacking dairy products, small bowel resection, chronic diarrhea, diverticula, tapeworm, or
overgrowth of intestinal bacteria, pernicious anemia (protein in the stomach called the
intrinsic factor helps the body absorb B12 and some clients have underlying issues that
impact the body’s ability to absorb B12 and they are labeled with pernicious anemia), or
malabsorption syndromes. S&S: pallor, jaundice, glossitis (smooth beefy tongue),
fatigue, weight loss, paresthesia’s (abnormal sensations) in the hands and feet. B12 is
responsible for protecting the nerves, so lack of B12 can cause damage to myelin sheath
that surrounds and protect the nerves – so patients may have neurological symptoms (ex.
difficulty walking, memory impairment, etc.)
Management: increase intake of PO B12 sources (animal proteins, fish, eggs,
nuts, dairy products, dried beans, citrus fruit, and leafy green vegetables).
Supplements may be prescribed if the anemia is severe. Patients with pernicious
anemia are given B12 injections weekly at first and then monthly for the rest of
their lives – can be painful and monitor blood counts q3-6 months of therapy.
Once levels are adequate – PO or nasal can be used to maintain levels
Vitamin B12 prototype - cyanocobalamin: replaces Vitamin B12
Adverse reactions: diarrhea, hypokalemia (muscle weakness,
irregular cardiac rhythms), rash, anaphylaxis
Can be given intranasal, PO, IM, SQ
Dairy is a great source of B12
Obtain baseline B12 level, Hgb, Hct, RBC
May need K supplement if levels drop too low
Give 1 hour before or after if given intranasal because if patients
are eating something hot or spicy it can alter absorption
o Folic acid deficiency anemia: Folic acid is one of the types B vitamins. Decreased levels
of folic acid lead to the decreased production of RBCs because folic acid is needed for
DNA production. May have symptoms similar to B12 anemia. However, nervous system
function remains normal because folic acid deficiency does not affect nerve function and
dose not result in paresthesia’s. Disease develops slowly. Causes: poor nutrition (diet
lacking green vegetables, liver, yeast, citrus fruits, dried beans, and nuts), alcoholics,
malabsorption (ex. Chron’s), and drugs (anticonvulsants and oral contraceptives). S&S:
pallor, fatigue, cheilosis, heart palpitations, diarrhea
Management: best managed by identifying adults at risk and preventing the
deficiency. High risk patients include: older, debilitated patients with alcoholism,
patients at risk for malnutrition, and those at increased folic acid requirements.
Diet rich in folic acid and B12 prevents deficiency. Increase dietary intake of
folic acid. Managed with scheduled folic acid replacement therapy.
Folic Acid: prototype - Vitamin B9 or Folate
Action: needed for erythropoiesis; increases RBC, WBC, platelet
formation in megaloblastic anemias
, Adverse Effects: bronchospasm, rash, pruritis, erythema, malaise.
May turn urine intensely yellow
Monitor potassium levels
Assess for itching, rash, flushing
Stress importance of diet, rest, and reporting shortness of breath
or edema
Assess for causes of anemia. Not an effective treatment for iron-
deficiency anemia. Monitor respiratory and cardiac status closely
Obtain baseline folic acid level and known baseline Hgb, Hct,
and RBC
Monitor patient closely if taking phenytoin. Folic acid can alter
phenytoin levels
o Aplastic anemia: Bone marrow may fail to produce RBC’s and this is the case with
aplastic anemia. There is a decreased number of circulating RBCs. Deficiency of
circulating RBCs because of impaired cellular regulation of the bone marrow, which then
fails to produce these cells. It is caused by an injury to the immature precursor cell for
RBCs. Can occur alone, but usually occurs with leukopenia (reduction in WBCs), and
thrombocytopenia (reduction in PLT’s). Pancytopenia: decreased WBC, RBC, and PLT’s
at the same time. Onset may be slow or rapid. Most common type of the disease results
from long-term exposure to toxic agents, drugs, and ionizing radiation, or infection; but
often the cause is unknown. May follow a viral infection. S&S: symptoms of severe
anemia typically, CBC shows microcytotic anemia, leukopenia, and thrombocytopenia,
bleed easily, HA, tachycardia, SOB, pallor, petechiae, ecchymosis, weakness.
Management: depends upon cause of anemia. If drug induced, management may
include blood transfusions and discontinuation of offending drug. This therapy is
discontinued as soon as the bone marrow begins to produce RBCs if the problem
is transient. Immunosuppressive agents help’s patients who have autoimmune
problems.
Prednisone, antithymocyte globulin, and cyclosporine A have shown to
help with remission
Daclizumab has improved both blood counts and transfusion
requirements
Splenectomy may be needed for patients with an enlarged spleen that is
either destroyed by normal RBCs or suppressing their development
Hematopoietic stem cell transplantation is the most successful treatment
method but is quite expensive
o Glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia: caused by a genetic
problem in which there is a deficiency of the enzyme G6PD. Inherited with x-linked
recessive disorders, with more severe expression in males and mild partial expression in
females. Affects 10% of African Americans and is more common in Middle East and
Asian adults. Patient typically doesn’t exhibit symptoms until exposed to triggering agent
or severe infection. During the acute phase the patient may develop anemia and jaundice.
Management: prevention is the most important therapeutic measure. Hydration is
important during an episode to prevent debris and Hgb from collecting in the
kidney tubules, which can lead to kidney damage.
Mannitol (osmotic diuretic) can be given to help prevent kidney
complications
Transfusions are needed when anemia is present and kidney function is
normal
o Immunohemolytic anemia (autoimmune hemolytic anemia): caused by abnormal
immunity that results in the excessive destruction of RBC membranes (lysis) followed by
EXAM 1 3
STUDY GUIDE
Health Care Concepts
Forsyth Technical Community College
This Document Description:
❖ This study guide for NUR 211 at Forsyth Technical
Community College focuses on Exam 1 content from the
Health Care Concepts course.
❖ It includes essential topics.
❖ The material is clearly organized to help students understand complex
systems and prepare effectively for exam questions.
, NUR 211 – Exam 1 Study Guide
1. Exemplar: Anemia
Anemia is the reduction in the number of RBC’s, the amount of hemoglobin, or the hematocrit
(percentage of packed RBC’s per deciliter of blood). It is a clinical indicator, not a specific disease
because it occurs with many health problems. Anemia can result from dietary problems, genetic disorders,
bone marrow disease, or excessive bleeding. GI bleeding is the most common reason for anemia in adults.
Pathophysiology:
o Iron deficiency anemia is the most common anemia worldwide, especially among
women, older adults, and people with poor diets. It can result from blood loss, poor GI
absorption, and an inadequate diet. The problem is a decreased supply for the developing
RBC. With chronic iron deficiency, RBC’s are small (microcytic) and the patient has mild
symptoms: fatigue, reduced exercise intolerance, pallor, weakness, fissures at the corners
of the mouth (cheilosis), spoon shaped nail beds, odd cravings – pica or chewing ice,
SOB. Serum ferritin values are less than 10 ng/mL.
Management: increase PO intake of iron food sources (red meat, organ meat, egg
yolks, kidney beans, leafy green vegetables, and raisins). If Fe losses are mild,
PO supplements are started until the Hgb levels return to WNL. If supplements
cause GI upset, take with a meal. If Fe deficiency is severe, iron solutions can be
given parentally.
Iron Supplement prototype - Ferrous Sulfate
Adverse Effects: nausea, heartburn, constipation, dark stools,
Cardiovascular collapse, aggravation of peptic ulcers or
ulcerative colitis, hepatic necrosis, anaphylaxis (iron dextran)
Oral, intramuscular, or intravenous administration
PO – separate administration from antacids and tetracyclines
because it can decrease absorption of Fe. Need to be sure there is
a 2-hour window between administrations
Vitamin C increases absorption
Caffeine and dairy can decrease absorption of iron
Assess for allergies using a test dose
May cause gastrointestinal disturbance
May turn stools dark green or black color
Should be given 1 hour before meal, but taking with food
reduces GI distress - but reduces absorption
Liquid form – dilute with water or juice and rinse mouth because
of teeth staining
Iron deficiencies common in young children: also monitor for
overdose
Pregnant women and those with heavy menstrual flow have
increased demand
Client teaching: Take iron with food, use straw to prevent
staining teeth, report signs of bleeding, keep out of reach of
children
Use z-track method when giving IM
Monitor bowel patterns
Increase water and fiber in diet
Patient typically takes for 1-2 months and you hope to see a 2-
point increase within the first month
, Iron dextran (Dexferrum) – iron for IV formulation. Test dose is
typically given before giving whole dose to monitor for
anaphylaxis reaction. Be sure you have emergency equipment on
hand.
Ferumoxytol (Feraheme) – has a black box warning label for
anaphylactic reactions occurring in the first 5 minutes of infusion
o Vitamin B12 deficiency anemia: results in failure to activate enzymes that move folic acid
into precursor RBCs cells so cell division and growth into functional RBCs can occur.
Cells need folic acid for DNA production. These precursor cells then undergo improper
DNA synthesis and increase in size – this type of anemia is called megaloblastic or
macrocytic anemia because of the large size in abnormal cells. Causes: vegan diets, diets
lacking dairy products, small bowel resection, chronic diarrhea, diverticula, tapeworm, or
overgrowth of intestinal bacteria, pernicious anemia (protein in the stomach called the
intrinsic factor helps the body absorb B12 and some clients have underlying issues that
impact the body’s ability to absorb B12 and they are labeled with pernicious anemia), or
malabsorption syndromes. S&S: pallor, jaundice, glossitis (smooth beefy tongue),
fatigue, weight loss, paresthesia’s (abnormal sensations) in the hands and feet. B12 is
responsible for protecting the nerves, so lack of B12 can cause damage to myelin sheath
that surrounds and protect the nerves – so patients may have neurological symptoms (ex.
difficulty walking, memory impairment, etc.)
Management: increase intake of PO B12 sources (animal proteins, fish, eggs,
nuts, dairy products, dried beans, citrus fruit, and leafy green vegetables).
Supplements may be prescribed if the anemia is severe. Patients with pernicious
anemia are given B12 injections weekly at first and then monthly for the rest of
their lives – can be painful and monitor blood counts q3-6 months of therapy.
Once levels are adequate – PO or nasal can be used to maintain levels
Vitamin B12 prototype - cyanocobalamin: replaces Vitamin B12
Adverse reactions: diarrhea, hypokalemia (muscle weakness,
irregular cardiac rhythms), rash, anaphylaxis
Can be given intranasal, PO, IM, SQ
Dairy is a great source of B12
Obtain baseline B12 level, Hgb, Hct, RBC
May need K supplement if levels drop too low
Give 1 hour before or after if given intranasal because if patients
are eating something hot or spicy it can alter absorption
o Folic acid deficiency anemia: Folic acid is one of the types B vitamins. Decreased levels
of folic acid lead to the decreased production of RBCs because folic acid is needed for
DNA production. May have symptoms similar to B12 anemia. However, nervous system
function remains normal because folic acid deficiency does not affect nerve function and
dose not result in paresthesia’s. Disease develops slowly. Causes: poor nutrition (diet
lacking green vegetables, liver, yeast, citrus fruits, dried beans, and nuts), alcoholics,
malabsorption (ex. Chron’s), and drugs (anticonvulsants and oral contraceptives). S&S:
pallor, fatigue, cheilosis, heart palpitations, diarrhea
Management: best managed by identifying adults at risk and preventing the
deficiency. High risk patients include: older, debilitated patients with alcoholism,
patients at risk for malnutrition, and those at increased folic acid requirements.
Diet rich in folic acid and B12 prevents deficiency. Increase dietary intake of
folic acid. Managed with scheduled folic acid replacement therapy.
Folic Acid: prototype - Vitamin B9 or Folate
Action: needed for erythropoiesis; increases RBC, WBC, platelet
formation in megaloblastic anemias
, Adverse Effects: bronchospasm, rash, pruritis, erythema, malaise.
May turn urine intensely yellow
Monitor potassium levels
Assess for itching, rash, flushing
Stress importance of diet, rest, and reporting shortness of breath
or edema
Assess for causes of anemia. Not an effective treatment for iron-
deficiency anemia. Monitor respiratory and cardiac status closely
Obtain baseline folic acid level and known baseline Hgb, Hct,
and RBC
Monitor patient closely if taking phenytoin. Folic acid can alter
phenytoin levels
o Aplastic anemia: Bone marrow may fail to produce RBC’s and this is the case with
aplastic anemia. There is a decreased number of circulating RBCs. Deficiency of
circulating RBCs because of impaired cellular regulation of the bone marrow, which then
fails to produce these cells. It is caused by an injury to the immature precursor cell for
RBCs. Can occur alone, but usually occurs with leukopenia (reduction in WBCs), and
thrombocytopenia (reduction in PLT’s). Pancytopenia: decreased WBC, RBC, and PLT’s
at the same time. Onset may be slow or rapid. Most common type of the disease results
from long-term exposure to toxic agents, drugs, and ionizing radiation, or infection; but
often the cause is unknown. May follow a viral infection. S&S: symptoms of severe
anemia typically, CBC shows microcytotic anemia, leukopenia, and thrombocytopenia,
bleed easily, HA, tachycardia, SOB, pallor, petechiae, ecchymosis, weakness.
Management: depends upon cause of anemia. If drug induced, management may
include blood transfusions and discontinuation of offending drug. This therapy is
discontinued as soon as the bone marrow begins to produce RBCs if the problem
is transient. Immunosuppressive agents help’s patients who have autoimmune
problems.
Prednisone, antithymocyte globulin, and cyclosporine A have shown to
help with remission
Daclizumab has improved both blood counts and transfusion
requirements
Splenectomy may be needed for patients with an enlarged spleen that is
either destroyed by normal RBCs or suppressing their development
Hematopoietic stem cell transplantation is the most successful treatment
method but is quite expensive
o Glucose-6-phosphate dehydrogenase (G6PD) deficiency anemia: caused by a genetic
problem in which there is a deficiency of the enzyme G6PD. Inherited with x-linked
recessive disorders, with more severe expression in males and mild partial expression in
females. Affects 10% of African Americans and is more common in Middle East and
Asian adults. Patient typically doesn’t exhibit symptoms until exposed to triggering agent
or severe infection. During the acute phase the patient may develop anemia and jaundice.
Management: prevention is the most important therapeutic measure. Hydration is
important during an episode to prevent debris and Hgb from collecting in the
kidney tubules, which can lead to kidney damage.
Mannitol (osmotic diuretic) can be given to help prevent kidney
complications
Transfusions are needed when anemia is present and kidney function is
normal
o Immunohemolytic anemia (autoimmune hemolytic anemia): caused by abnormal
immunity that results in the excessive destruction of RBC membranes (lysis) followed by
