AH1 EXAM #2 Study Guide
Hematologic Disorders:
1. Anemias (Hgb is typically less than 6)
a. Iron Deficiency (See Hinkle pg. 930-931)
i. Oral Supplements
ii. Signs/symptoms:
1. Smooth, sore, red tongue (specific to iron deficiency type)
2. Pallor
3. Fatigue
4. Irritability
5. Numbness/tingling in extremities
6. Dyspnea on exertion
7. Sensitivity to cold
8. SOB esp. on exertion
9. Tachycardia
10. Dizziness or syncope
b. Pernicious (B12)
i. Foods that are high in Vitamin B12
1. Animal liver/kidneys
2. Clams
3. Sardines
4. Beef
5. Fortified cereal
6. Tuna
7. Fortified nutritional yeast
8. Trout
c. Sickle Cell Hinkle pg. 935-941
i. Signs and symptoms
1. Hgb 5-11 g/dL
2. Jaundice
3. Tachycardia
4. Murmurs
5. Cardiomegaly
6. Dysrhythmias and heart failure (adults)
ii. Nursing Interventions & management
1. Hydration
2. Oxygenation
3. Pain relief
4. Promote bed rest to reduce oxygen
5. Administer blood products (packed RBC)
iii. Crisis Prevention Education
1. Avoid sitations that precipitate a sickle cell crisis
2. Keep warm and hydrate
iv. Priority Actions (Remember ABCs!)
d. Folic Acid
i. Water soluble, B-complex vitamin necessary for the production of new RBC.
2. Lab values
a. Prothrombin (PT):
i. PT 11-12.5 (or 10-14?) seconds normal
, ii. PT is 1-2.5 times more when on coumadin
b. INR
i. INR 0.8-1.0 normal
ii. INR 2.0-3.5 on coumadin
c. Platelets
i. 150,000 to 400,000
d. H&H
i. Hgb: Females: 12-16 g/dL, Males: 14-18 g/dL
ii. Hct: Females: 37-47%, Males: 42-52%
e. RBC
i. Females: 4.2-5.4 million/uL, Males: 4.7-6.1 million/uL
3. Blood Transfusions/Products
a. Infusion care of the patient
i. Explain procedure to patient
ii. Asses VS and TEMPERATURE prior to transfusion
iii. REMAIN WITH PATIENT during initial 15-30 minutes of transfusion (most severe
reactions occur during this time frame)
iv. Assess lab values: Hbg <6, platelets <20,000
v. Obtain consent and blood sample for compatibility (type and cross-match)
vi. TWO RN’S MUST identify correct blood product and patient by looking at the hospital
ID number (noted on blood product) and patient ID number on wristband
vii. Initiate large-bore IV access: 18G (green) or 20G (pink)
viii. RN completing the blood product verification MUST be one of the nurses who
administers the blood
ix. Prime blood tubing with 0.9% NS only (Y-tubing with a filter is used)
x. Never add medications to blood products
xi. Begin transfusion and use a blood warmer if indicated. Initiate the transfusion within 30
MINUTES of obtaining the blood product to reduce risk of bacterial growth
b. Interventions
i. Acute hemolytic
1. Onset: Immediate or can manifest during subsequent transfusion
2. Results from blood products that are incompatible with the patient’s blood type or Rh
factor
3. Can be mild or life-threatening DIC or circulatory collapse
4. FINDINGS= chills, fever, low back pain, tachycardia, flushing, hypotension, chest
tightness/pain, tachypnea, nausea, anxiety, hemoglobinuria, sense of impending doom
5. ACTIONS: stop transfusion, remove blood tubing from IV, initiate 0.9% NS with new
tubing, monitor VS, send blood bag with blood tubing to lab for testing
ii. Febrile
1. Onset: 2 hr post starting transfusion
2. Results from anti-WBC antibodies which occur when patient has had multiple
blood transfusions
3. FINDINGS: chills, increase of 1 degree F (0.5 C) from initial temp., flushing,
hypotension, and tachycardia
4. ACTIONS: use WBC filter for administration to prevent reaction from occurring,
stop transfusion and administer antipyretics, initiate infusion of 0.9% NS with new
tubing
iii. Allergic
Hematologic Disorders:
1. Anemias (Hgb is typically less than 6)
a. Iron Deficiency (See Hinkle pg. 930-931)
i. Oral Supplements
ii. Signs/symptoms:
1. Smooth, sore, red tongue (specific to iron deficiency type)
2. Pallor
3. Fatigue
4. Irritability
5. Numbness/tingling in extremities
6. Dyspnea on exertion
7. Sensitivity to cold
8. SOB esp. on exertion
9. Tachycardia
10. Dizziness or syncope
b. Pernicious (B12)
i. Foods that are high in Vitamin B12
1. Animal liver/kidneys
2. Clams
3. Sardines
4. Beef
5. Fortified cereal
6. Tuna
7. Fortified nutritional yeast
8. Trout
c. Sickle Cell Hinkle pg. 935-941
i. Signs and symptoms
1. Hgb 5-11 g/dL
2. Jaundice
3. Tachycardia
4. Murmurs
5. Cardiomegaly
6. Dysrhythmias and heart failure (adults)
ii. Nursing Interventions & management
1. Hydration
2. Oxygenation
3. Pain relief
4. Promote bed rest to reduce oxygen
5. Administer blood products (packed RBC)
iii. Crisis Prevention Education
1. Avoid sitations that precipitate a sickle cell crisis
2. Keep warm and hydrate
iv. Priority Actions (Remember ABCs!)
d. Folic Acid
i. Water soluble, B-complex vitamin necessary for the production of new RBC.
2. Lab values
a. Prothrombin (PT):
i. PT 11-12.5 (or 10-14?) seconds normal
, ii. PT is 1-2.5 times more when on coumadin
b. INR
i. INR 0.8-1.0 normal
ii. INR 2.0-3.5 on coumadin
c. Platelets
i. 150,000 to 400,000
d. H&H
i. Hgb: Females: 12-16 g/dL, Males: 14-18 g/dL
ii. Hct: Females: 37-47%, Males: 42-52%
e. RBC
i. Females: 4.2-5.4 million/uL, Males: 4.7-6.1 million/uL
3. Blood Transfusions/Products
a. Infusion care of the patient
i. Explain procedure to patient
ii. Asses VS and TEMPERATURE prior to transfusion
iii. REMAIN WITH PATIENT during initial 15-30 minutes of transfusion (most severe
reactions occur during this time frame)
iv. Assess lab values: Hbg <6, platelets <20,000
v. Obtain consent and blood sample for compatibility (type and cross-match)
vi. TWO RN’S MUST identify correct blood product and patient by looking at the hospital
ID number (noted on blood product) and patient ID number on wristband
vii. Initiate large-bore IV access: 18G (green) or 20G (pink)
viii. RN completing the blood product verification MUST be one of the nurses who
administers the blood
ix. Prime blood tubing with 0.9% NS only (Y-tubing with a filter is used)
x. Never add medications to blood products
xi. Begin transfusion and use a blood warmer if indicated. Initiate the transfusion within 30
MINUTES of obtaining the blood product to reduce risk of bacterial growth
b. Interventions
i. Acute hemolytic
1. Onset: Immediate or can manifest during subsequent transfusion
2. Results from blood products that are incompatible with the patient’s blood type or Rh
factor
3. Can be mild or life-threatening DIC or circulatory collapse
4. FINDINGS= chills, fever, low back pain, tachycardia, flushing, hypotension, chest
tightness/pain, tachypnea, nausea, anxiety, hemoglobinuria, sense of impending doom
5. ACTIONS: stop transfusion, remove blood tubing from IV, initiate 0.9% NS with new
tubing, monitor VS, send blood bag with blood tubing to lab for testing
ii. Febrile
1. Onset: 2 hr post starting transfusion
2. Results from anti-WBC antibodies which occur when patient has had multiple
blood transfusions
3. FINDINGS: chills, increase of 1 degree F (0.5 C) from initial temp., flushing,
hypotension, and tachycardia
4. ACTIONS: use WBC filter for administration to prevent reaction from occurring,
stop transfusion and administer antipyretics, initiate infusion of 0.9% NS with new
tubing
iii. Allergic
