NURS6202 (Capella)Advanced
Pathophysiology Final Exam Guide
anemia *** A condition in which the blood is deficient in red blood cells, in hemoglobin, or in total
volume. (Hgb and HCT)
can be blood loss, destruction (hemolysis, sickle cell disease, some meds, blood mismatch, trauma) ,or
decreased production of RBCs (iron deficiency, kidney disease)
normocytic normochromic anemia *** Characterized by red cells that are relatively normal in size and
hemoglobin content but insufficient in number
- caused by acute blood loss, CKD, hemolysis, sickle cell
MCH is size (mean corpuscular hemoglobin) MCV is color (mean corpuscular volume)
microcytic hypochromic anemia *** anemia characterized by small, pale red blood cells that lack
adequate hemoglobin to carry oxygen; can be caused by deficiency of iron or vitamin B6
low MCH and MCV
macrocytic normochromic anemia *** - large cells (megaloblastic), normal color
- usually folic acid or vitamin B12 deficiency anemia, liver disease
- pernicious anemia
- MCH and MCV high
anemia manifestations *** weakness, fatigue, pallor, syncope, dyspnea, tachycardia and murmurs from
low blood viscosity, integumentary changes- pruritus pallor and jaundice
Anemia manifestations *** Mild: Hemoglobin 10-12 (tired, pale nails and MM)
Moderate/Severe: Hemoglobin BELOW 6g/dl is severe, 7-10 is moderate (more stuggish, chest pain,
eyes look pale)
between 12-16 is normal
,Anemia: Cardiopulmonary Manifestations *** Result from additional attempts by heart and lungs to
provide adequate O2 to the tissues
Cardiac output maintained by increasing the heart rate and stroke volume
low blood viscosity leads to murmur
Gerontologic Considerations *** more common, s/s not recognized bc similar to normal aging
decreased erythrocyte production *** iron deficiency (tired and pale, ischemia) megaloblastic (b12
deficiency, folic acid def.) - neuropathy, tingling around mouth/hands/face/LE's, early graying of the hair
w folic acid def.
iron deficiency *** decreased Hbg and Hct, MCV low, iron low
normal b12 and folate
treat underlying cause- lots of GI bleeds
iron replacement- good nutrition, blood transfusion of packed RBCs, meds
iron supplements- best absorbed before meals on empty stomach, liquid iron stains teeth so use straw
and dilute, take w vitamin c, can cause constipation, heartburn or diarrhea
parental iron- IV or IM- im may stain skin, indicated for malabsorption or oral intolerance, higher dose,
poor pt compliance w oral
Cobalamin (B12) deficiency *** -Found in strict vegetarians - gastric system missing protein needed for
absorption
-Pernicious anemia (weakness, sore tongue, apathy)- gastric mucosa not secreting intrinsic factor in gut
can be GI alterations like surgery and chronic disease, chronic alcoholics, h12 blockers and ppi long term
use bc decreased acid and causes issues w absorption
s/s: beefy red tongue, n/v, abd pain, weakness, parethesia, confusion, decreased senses, ataxia
- treatment: cobalamin parental or intranasal, lifelong if no gi absorption, neuromuscular may not
improve, b12 supplement may help a little bit but maybe not if absorption problems, b12 injections
,Folic acid deficiency *** Macrocytic, megaloblastic anemia; no neurologic Sx (as opposed to vitamin B12
deficiency). Most common vitamin deficiency in the USA. Seen in alcoholism and pregnancy.
commonly caused by dietary deficiency and malabsorption, drugs, increased requirement, alcohol
abuse, anorexia, hemodialysis loss
treat w folic acid supplement and diet rich in folic acid
megaloblastic anemia nursing management *** hx of pernicious anemia for early detection, ensure
safety w diminished sensations to heat and pain from neuro impairment, protect from
burns/falls/trauma, frequent medical screening for risk of dev gastric cancers
Sickle Cell Disease (SCD) *** a group of inherited, autosomal recessive disorders characterized by the
presence of an abnormal form of hemoglobin in the erythrocyte
Hbg S destruction, severe pain often undertreated and can be fatal bc it sickles and cuts off oxygen and
cause damage to joints and organs
goal is to prevent
a/s: asymptomatic except during sickling, pain, pallor, jaundice d/t blood cell destruction and liver
breaking them down and bilirubin spills in bloodstream bc liver can't keep up, complications when
organs affected by hypoxia and infection, make sure patient is oxygenated and given IV fluids and need
pain meds
Sickling episodes are triggered by *** low O2 in the blood
can lead to crisis, and necrosis and go into shock bc low fluid volume and oxygenation
sickle cell crisis *** condition in sickle cell anemia in which the sickled cells interfere with oxygen
transport, obstruct capillary blood flow, and cause fever and severe pain in the joints and abdomen
need pain treatment, oxygen, watch for respiratory failure, rest, dvt prophylaxis, f/e, transfusions
sickle cell management *** pain management - often tolerant to pain meds, requires continuous and
breakthrough analgesia
, preventative meds- folic acid and hydrea an anti sickling agent
hematopoietic stem cell transplant
prevent infection and get vaccinated, avoid high altitudes, stay hydrated, prompt med attention and
treat infections early, counseling and support groups, med alert bracelet
Thrombocytopenia *** low platelet count <150,000, abnormal hemostasis, prolonged or spontaneous
bleeding, primarily an acquired disorder
mucosal bleeding or cutaneous bleeding, petichae, prolonged bleeding w routine procedures when less
than 50,000
hemorrhage risk when less than 20,000
Immune Thrombocytopenic Purpura (ITP) *** Autoimmune platelet destruction is a common cause of
thrombocytopenia and should be supsected in patients with echymoses, petechiae, mucosal bleeding,
and no other obvious causes of thrombocytopenia (ex- medications, bone marrow failure) abnormal
destruction of platelets
avoid aspirin, need corticosteroids, splenectomy if not responding to treatments, platelet transfusion if
less than 10,000 or if actively bleeding or prophylactically for planned procedure
thrombocytopenia nursing management *** - treat bleeding and evaluate and avoid anything that
causes bleeding, like sq/im injections avoided, monitor labs-platelets/pt/aptt time/coag studies,hbg/hct
teach self care to reduce bleeding risk, prompt treatment for s/s of bleeding, awareness of cancer drugs
causing this, heparin, and otc meds
leukemia *** cancer of white blood cells, affects bone marrow, lymph, and spleen
acute: immature hematopoietic cells proliferate, abrupt onset
chronic: more mature form of WBCs, gradual onset
acute myelogenous (usually presents as bleeding or infection, hyperplasia of bone marrow and spleen,
80%, 1 in 4 survive), acute lymphocytic, chronic myelogenous, chronic lymphocytic (CLL complications
may develop w time, lymph nodes enlarge and cause pain and paralysis from pressure)
acutes in kids and chronics in elderly usually
Pathophysiology Final Exam Guide
anemia *** A condition in which the blood is deficient in red blood cells, in hemoglobin, or in total
volume. (Hgb and HCT)
can be blood loss, destruction (hemolysis, sickle cell disease, some meds, blood mismatch, trauma) ,or
decreased production of RBCs (iron deficiency, kidney disease)
normocytic normochromic anemia *** Characterized by red cells that are relatively normal in size and
hemoglobin content but insufficient in number
- caused by acute blood loss, CKD, hemolysis, sickle cell
MCH is size (mean corpuscular hemoglobin) MCV is color (mean corpuscular volume)
microcytic hypochromic anemia *** anemia characterized by small, pale red blood cells that lack
adequate hemoglobin to carry oxygen; can be caused by deficiency of iron or vitamin B6
low MCH and MCV
macrocytic normochromic anemia *** - large cells (megaloblastic), normal color
- usually folic acid or vitamin B12 deficiency anemia, liver disease
- pernicious anemia
- MCH and MCV high
anemia manifestations *** weakness, fatigue, pallor, syncope, dyspnea, tachycardia and murmurs from
low blood viscosity, integumentary changes- pruritus pallor and jaundice
Anemia manifestations *** Mild: Hemoglobin 10-12 (tired, pale nails and MM)
Moderate/Severe: Hemoglobin BELOW 6g/dl is severe, 7-10 is moderate (more stuggish, chest pain,
eyes look pale)
between 12-16 is normal
,Anemia: Cardiopulmonary Manifestations *** Result from additional attempts by heart and lungs to
provide adequate O2 to the tissues
Cardiac output maintained by increasing the heart rate and stroke volume
low blood viscosity leads to murmur
Gerontologic Considerations *** more common, s/s not recognized bc similar to normal aging
decreased erythrocyte production *** iron deficiency (tired and pale, ischemia) megaloblastic (b12
deficiency, folic acid def.) - neuropathy, tingling around mouth/hands/face/LE's, early graying of the hair
w folic acid def.
iron deficiency *** decreased Hbg and Hct, MCV low, iron low
normal b12 and folate
treat underlying cause- lots of GI bleeds
iron replacement- good nutrition, blood transfusion of packed RBCs, meds
iron supplements- best absorbed before meals on empty stomach, liquid iron stains teeth so use straw
and dilute, take w vitamin c, can cause constipation, heartburn or diarrhea
parental iron- IV or IM- im may stain skin, indicated for malabsorption or oral intolerance, higher dose,
poor pt compliance w oral
Cobalamin (B12) deficiency *** -Found in strict vegetarians - gastric system missing protein needed for
absorption
-Pernicious anemia (weakness, sore tongue, apathy)- gastric mucosa not secreting intrinsic factor in gut
can be GI alterations like surgery and chronic disease, chronic alcoholics, h12 blockers and ppi long term
use bc decreased acid and causes issues w absorption
s/s: beefy red tongue, n/v, abd pain, weakness, parethesia, confusion, decreased senses, ataxia
- treatment: cobalamin parental or intranasal, lifelong if no gi absorption, neuromuscular may not
improve, b12 supplement may help a little bit but maybe not if absorption problems, b12 injections
,Folic acid deficiency *** Macrocytic, megaloblastic anemia; no neurologic Sx (as opposed to vitamin B12
deficiency). Most common vitamin deficiency in the USA. Seen in alcoholism and pregnancy.
commonly caused by dietary deficiency and malabsorption, drugs, increased requirement, alcohol
abuse, anorexia, hemodialysis loss
treat w folic acid supplement and diet rich in folic acid
megaloblastic anemia nursing management *** hx of pernicious anemia for early detection, ensure
safety w diminished sensations to heat and pain from neuro impairment, protect from
burns/falls/trauma, frequent medical screening for risk of dev gastric cancers
Sickle Cell Disease (SCD) *** a group of inherited, autosomal recessive disorders characterized by the
presence of an abnormal form of hemoglobin in the erythrocyte
Hbg S destruction, severe pain often undertreated and can be fatal bc it sickles and cuts off oxygen and
cause damage to joints and organs
goal is to prevent
a/s: asymptomatic except during sickling, pain, pallor, jaundice d/t blood cell destruction and liver
breaking them down and bilirubin spills in bloodstream bc liver can't keep up, complications when
organs affected by hypoxia and infection, make sure patient is oxygenated and given IV fluids and need
pain meds
Sickling episodes are triggered by *** low O2 in the blood
can lead to crisis, and necrosis and go into shock bc low fluid volume and oxygenation
sickle cell crisis *** condition in sickle cell anemia in which the sickled cells interfere with oxygen
transport, obstruct capillary blood flow, and cause fever and severe pain in the joints and abdomen
need pain treatment, oxygen, watch for respiratory failure, rest, dvt prophylaxis, f/e, transfusions
sickle cell management *** pain management - often tolerant to pain meds, requires continuous and
breakthrough analgesia
, preventative meds- folic acid and hydrea an anti sickling agent
hematopoietic stem cell transplant
prevent infection and get vaccinated, avoid high altitudes, stay hydrated, prompt med attention and
treat infections early, counseling and support groups, med alert bracelet
Thrombocytopenia *** low platelet count <150,000, abnormal hemostasis, prolonged or spontaneous
bleeding, primarily an acquired disorder
mucosal bleeding or cutaneous bleeding, petichae, prolonged bleeding w routine procedures when less
than 50,000
hemorrhage risk when less than 20,000
Immune Thrombocytopenic Purpura (ITP) *** Autoimmune platelet destruction is a common cause of
thrombocytopenia and should be supsected in patients with echymoses, petechiae, mucosal bleeding,
and no other obvious causes of thrombocytopenia (ex- medications, bone marrow failure) abnormal
destruction of platelets
avoid aspirin, need corticosteroids, splenectomy if not responding to treatments, platelet transfusion if
less than 10,000 or if actively bleeding or prophylactically for planned procedure
thrombocytopenia nursing management *** - treat bleeding and evaluate and avoid anything that
causes bleeding, like sq/im injections avoided, monitor labs-platelets/pt/aptt time/coag studies,hbg/hct
teach self care to reduce bleeding risk, prompt treatment for s/s of bleeding, awareness of cancer drugs
causing this, heparin, and otc meds
leukemia *** cancer of white blood cells, affects bone marrow, lymph, and spleen
acute: immature hematopoietic cells proliferate, abrupt onset
chronic: more mature form of WBCs, gradual onset
acute myelogenous (usually presents as bleeding or infection, hyperplasia of bone marrow and spleen,
80%, 1 in 4 survive), acute lymphocytic, chronic myelogenous, chronic lymphocytic (CLL complications
may develop w time, lymph nodes enlarge and cause pain and paralysis from pressure)
acutes in kids and chronics in elderly usually
