CM 4 Exam 5

Exam 5 Text Chapters: 13, 40, 66, 67, 68 ATI Chapters: 39-42, 56-61 What type of tubing do you use for blood transfusions and which intravenous fluids? The nurse chooses a Y-type blood administration set to initiate a blood transfusion. Why does the nurse use this type of tubing? a. It contains an in-line filter b. It is micro drip tubing c. It applies negative pressure d. It keeps the blood product at the appropriate temperature Y-tubing facilitates maintenance of IV access in case a patient will need more than 1 unit of blood and it contains an in-line filter to remove debris and/or microemboli. The nurse is administering a blood transfusion. Which action requires correction? a. Monitors the patient's vital signs at 5 minutes, 15 minutes, and every 30 minutes until 1 hour after transfusion. b. Leaves Y-tubing set to be used for possible second transfusion the next day. c. Administers the patient's PO pain medication as requested. d. Opens the common tubing clamp and initiates the transfusion at a rate of 2 mL/minute. The nurse is preparing equipment to administer a unit of blood to a patient. Which type of fluid would the nurse piggyback with the blood transfusion? A. 0.45% normal saline B. 0.9% normal saline C. Dextrose 5% and 0.45% normal saline D. Dextrose 5% and 0.9% normal saline Which food should you recommend to patients with iron deficiency anemia and which one(s) have the greatest amount of iron? What causes Fe deficiency anemia? A group of nursing students is discussing the diagnosis of iron deficiency anemia, and one of the students asks what foods would be good for this child to eat. Which foods are high in iron? Select all that apply. a) Milk b) Raisins c) Peanut butter d) Oatmeal e) Egg yolks f) Cheese Egg yolks, raisins, peanut butter and oatmeal are food sources high in iron. Milk and cheese are not food sources that are high in iron. A nurse is teaching a client who is at risk for iron-deficiency anemia about optimizing her dietary intake of iron. The nurse should explain that which of the following sources of iron is easiest for the body to absorb? A. Spinach B. Cantaloupe C. Chicken D. Lentils Food sources of iron fall into two categories – heme iron (from lean red meat, poultry, and fish) and nonheme iron (from fruit, vegetables, grains, and dried peas and beans). The body more easily absorbs heme iron A nurse is teaching a client who has a history of ulcerative colitis and a new diagnosis of anemia. Which of the following manifestations of colitis should the nurse identify as a contributing factor to the development of the anemia? A. Dietary iron restrictions B. Intestinal malabsorption syndrome C. Chronic blood loss D. Intestinal parasites A client with long-standing ulcerative colitis is most likely anemic due to chronic blood loss in small amounts that occurs over time, although the colitis may result in erosion of the intestine and hemorrhage. These clients often report bloody stools and are therefore at increased risk for developing anemia. A nurse is teaching a client who is postpartum and has been diagnosed with iron deficiency anemia. Which of the following dietary recommendations should the nurse include in the teaching plan? A. Yogurt and mozzarella B. Spinach and beef C. Milk and turkey slices D. Fish and cottage cheese Spinach and beef are high in iron and would be recommended for this client. Locations that can be used for a bone marrow aspiration The client diagnosed with chronic lymphocytic leukemia (CLL) is scheduled for a bone marrow aspiration and biopsy. The client says, "I am frightened. I have never had this test before, and I don't know what to expect." Which statements will the nurse include when responding to the client's concerns? (Select all that apply.) A. "We will move you to the operating room where the test is always performed." B. "The bone in the front of your chest will be used for the biopsy specimen." C. "A tight pressure dressing will be placed over the test site after the procedure." D. "You will not feel any discomfort as the local anesthetic is injected." E. "There is a risk of bleeding, so we will monitor the test site frequent Hemophilia A manifestations Know your lab values (CBC, CMP, serum osmolality) – you’ll need to know what is abnormal Red blood cells RBC: circulating cells that transport oxygen.  Expected range: Females 4.2- 5.4million/uL and Males 4.7- 6.1  Lower levels: anemia, hemorrhage, kidney disease  Higher levels: causes include polycythemia, severe dehydration Creatinine: waste product from the normal breakdown of muscles in the body.  Expected range: 0.6- 1.2 mg/dL  Increased levels: indicates the presence of kidney dysfunction  Creatine is a more accurate assessment of kidney function than BUN. Blood Urea Nitrogen (BUN): Nitrogen in the blood from the waste product urea, produced when protein is broken down in the body.  Expected range: 10-20 mg/dL  BUN>20 mg/dL: cause include kidney disease, dehydration, or conditions that decrease blood flow to the kidneys (CHF, MI, Shock). Glomerular Filtration Rate (GFR) used to assess kidney function. Measures how much blood passes through the glomeruli each min 1. Expected range: > 90 ml/min 2. CKD STAGES o Stage 1: GFR > 90 ml/min, minimal kidney damage o Stage 2: GFR 60-89 ml/min, mild kidney damage o Stage 3: GFR 30-59 ml/min, moderate kidney damage o Stage 4: 15-29 ml/min, severe kidney damage o Stage 5: GFR < 15 ml/min, kidney failure Urine Output:  Expected ranges: urine output per hour:> 30 ml  Urine output less than 30 can indicate shock, trauma, infection, notify provider Urine specific gravity: compares density to urine to the density of water  Expected range: 1.010-1.025  < 1.010, dilute urine, causes include kidney dysfunction, DI, excess fluid intake  > 1.025: concentrated urine, cause include dehydration ( diarrhea, emesis, sweating UTI) Urine Osmolatiy : Unrine concentration, amount disolved in urine  Expected range: 300-900 mOsm/kg  Decreased Levels: Dilute urine, causes include dI, excess fluid intake  Increased Levels: Concentrated urine, causes include dehdration (ex; diarrhea, emesis, sweating), SIADH, kidney dysfunction. Serum Osmolality: measures the amount of dissolved substance in the liquid part (plasma) of the blood.  Expected range: 275-295 mOsm/L  <275 mOsm/L: Dilute blood! Causes include SIADH, overhydration, hyponatremia.  >295 mOsm/L: concentrated Blood. Causes include, DI, dehydration, DKA, hypernatremia Hemoglobin (HgB) iron rich protein in RBCs that carry oxygen.  Expected range: Females 12-16 g/dL, Males 14-18 g/dL  Lower levels: causes induced anemia, hemorrhage, kidney disease  Higher levels: causes include COPD, severe dehydration Hematocrit (Hct) percentage of blood made up of RBCs. 3x hemoglobin.  Expected range: Females 37-47% and Males 42-52%  Lower levels: causes include anemia, hemorrhage, kidney disease  Higher levels: Causes include COPD, severe dehydration Activated partial thromboplastin time (aPTT) Clotting time-intrinsic system and common pathways in coagulation cascade.  Expected Range: 30-40 seconds  Therapeutic range on heparin therapy: 1.5-2.0 times baseline (45-80 sec).  Increased time: causes include heparin therapy, DIC, hepatic disease  Protamine is the antidote for heparin Prothrombin Time (PT) Clotting time, extrinsic and common pathways in coagulation cascade.  Expected range: 11-13 seconds  Therapeutic range on warfarin therapy: 1.5-2.0 times baseline (17-26 sec)  Increased time: causes include DIC, liver disease, Vitamin K deficiency, clotting factor deficiency.  Vitamin K is the antidote for warfarin. International Normalized Ratio (INR): used to determine effectiveness of warfarin therapy  Expected range: 0.8-1.1  Therapeutic range on warfarin therapy: 2-3  Elevated levels: causes include warfarin therapy, bleeding disorders, liver disease, sudden decrease in vitamin K intake.  Vitamin K is the antidote for warfarin