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EXAM 3 - MED SURG
ANEMIA, PAD, PVD
| Question | Answer |
|---|---|
| Iron Deficiency Anemia Definition | Typically results from an inadequate intake of iron, such as vegetarian diets. But the main cause is from blood loss due to ulcers, gastritis, or GI tumors. Also from Menorrhagia (excessive menstrual bleeding) |
| Clinical Manifestations of Iron Deficiency Anemia | Smooth, red tongue, brittle and ridged nails, and angular cheilosis |
| Nursing Management for Patients with Iron Deficiency Anemia | If blood loss is ruled out the treatments would include oral supplements such as ferrous sulfate, ferrous gluconate, and ferrous fumarate. Also may be avoided by eating foods high in iron such as organ meats, beans, leafy green veggies, raisins, and molasses. Encourage a healthy diet, and adherence to the regimen. Possible nutritional counseling |
| Treatments & Goals of Iron Deficiency Anemia | Treat can include OTC meds, Oral prescriptions for Ferrous Sulfate, Erythropoietin (EPO) injections, iron infusion therapy, and in severe cases blood transfusions. Lab tests and absence of symptoms can determine the effectiveness of treatment. |
| Patient Education for Iron Deficiency Anemia | Inform that meds should be taken on an empty stomach, preferably with orange juice (or other vitamin C products) as they aid in the absorption. Eat foods high in fiber to minimize constipation. Stool may become darker in color. Use straws for liquid forms of med to prevent staining of teeth. |
| Pernicious Anemia Definition | Absence of intrinsic factor that is normally secreted by cells within the gastric mucosa that binds with dietary Vitamin B12 and travels with it to the ileum where the vitamin is absorbed. The lack of this factor leads to inadequately absorbed Vitamin B12, and erythrocyte production is eventually diminished |
| Risk Factors for Pernicious Anemia | tends to run in families |
| Clinical Manifestations of Pernicious Anemia | Smooth, sore, red tongue. Mild Diarrhea. Extremely pale, especially in mucous membranes. May be confused, experience paresthesia in extremities. Balance difficulties from damage to spinal cord, and loss of position sense (proprioception) |
| Assessment of Pernicious Anemia | Inspection of the skin, mucous membranes, and tongue. Mild jaundice may be present and best seen in sclera without using fluorescent lights. Vitiligo (patchy loss of skin pigmentation) and premature graying of the hair are often present. Careful neurological assessments are important, including tests of position, vibration sense, and cognitive function. |
| Nursing Management of Pernicious Anemia | Monitoring ambulation and patient's gait and stability. Ensure the proper use of assistive devices (if needed). Assist with ADLs, and most importantly ensuring safety when position sense, coordination, and gait are effected. Physical and occupational therapy referrals may be needed. |
| Client Teaching of Pernicious Anemia | The need for monthly vitamin B12 injections or daily oral vitamin B12 even in the absence of symptoms. The gastric atrophy associated with pernicious anemia increases the risk for gastric carcinoma, so the patient needs to understand that ongoing medical follow-up and screening are important. Educate on mouth and tongue soreness that may limit nutritional intake so the nurse should advise the patient eats small amounts of bland, soft foods, frequently. |
| Risk Factors for Thalassemia | Associated with defective synthesis of hemoglobin. The production of one or more globulin chains within the hemoglobin molecule is reduced. |
| Assessment & Clinical Manifestations of Thalassemia | Can be asymptomatic until exposed to med or substance. Then symptoms include pallor, jaundice, and hemoglobinuria (hemoglobin in urine) |
| Nursing Management & Patient Education for Thalassemia | Education on the disease, and list of meds and substances to avoid. Instruct to wear a medical alert bracelet, and that genetic counseling may be indicated. |
| Thalassemia Definition | A group of hereditary anemias that are characterized by hypochromia (abnormal decrease in the hemoglobin content of erythrocytes), extreme mycrocytosis (smaller crythrocytes), hemolysis, and variable degrees of anemia. Consists of two type Alpha & Beta |
| Alpha-Thalassemia | Milder, often without symptoms. Erythrocytes are extremely microcytic, but the anemia, if present, is mild. Very effective in protecting against severe malaria, however it is not well understood |
| Beta-Thalassemia | Varies depending on the extent to which the hemoglobin chains are affected |
| Signs & Symptoms of Transfusion Reactions | Fever, chills, respiratory distress, low back pain, nausea, pain at IV site, or anything "unusual" |
| Assessment for Blood Transfusion Risk | Gather previous transfusion history, and reactions to the transfusions. |
| Fluid Overload Assessment and Signs & Symptoms | Crackles in lungs, altered electrolyte levels, anxiety, BP changes, mental status changes, and changes in respiratory patterns. Edema, increased venous pressure, jugular vein distention, SOB, and tachycardia. Important to monitor weight, intake and output, vital signs, edema, and JVD, serum electrolytes, and lung status |
| Thrombocytopenia Definition | Low platelet level that can result from decreased production of platelets within bone marrow, increased destruction of platelets, or increased consumption of platelets |
| Expected Assessment & and Lab Values in Thrombocytopenia | Chronically Low platelet count, excessive bruising, bleeding, and petechiae are seen in platelets below 20,000 |
| Thrombocytopenic Purpura (ITP) Definition | Disease that affects people of all ages, but it more common among children and young women. It is a platelet count less than 100 x 10 ^9 / L with an inexplicable absence of a cause from thrombocytopenia. It is the destruction of normal platelets by an unknown stimulus |
| Thrombocytopenic Purpura (ITP) Secondary Causes | Isolation, autoimmune diseases, viral infections, and various drugs, HIV, Hepatitis C |
| Thrombocytopenic Purpura (ITP) Discharge Instructions, Patient Education & Self-Care | Signs and symptoms of exacerbation of the disease (petechiae, ecchymoses), frequency of monitoring platelet count. Avoid all agents interfering with platelet function, including herbal and OTC. Avoid constipation, the Valsalva maneuver, and vigorous flossing of the teeth. Electric razors should be used for shaving, soft-bristled toothbrushes |
| Hemophilia Definition | A condition in which the ability of the blood to clot is severly reduced, causing the patient to bleed severely even with slight injuries. It is typically caused by a hereditary coagulation factor (factor VIII) |
| Von Willebrand Definitions | A hereditary life-long bleeding disorder, that a person is usually born with. The patient will have low levels of VWF, which is a protein that helps the blood clot, or the protein doesn't form as it should. |
| Hemophilia Treatments & Expected Medications | Clotting promoters, helps form clots to reduce bleeding such as Tranexamic Acid, Desmopressin |
| Von Willebrand Treatments & Expected Medications | Desmopressin (DDVAP), Synthetic hormone that controls bleeding by stimulating the body to release more clotting factors |
| Expected Assessment Findings in Peripheral Artery Disease (PAD) | Lesions confined to the arterial system, hallmark symptom is intermittent claudication from reduced arterial flow. Sensation of coldness or numbness in extremities. Extremity is cool and pale when elevated, or ruddy and cyanotic when placed in a dependent position. Skin (shiny, atrophic, and dry, with sparse hair)& Nail changes (thickened) ulcerations, gangrene, and muscle atrophy are possible. Bruits may be heard, peripheral pulses may be diminished or absent, |
| Peripheral Artery Disease (PAD) Long-Term Management | Smoking Cessation, balanced diet high in fiber, low in cholesterol, fat, and sodium. Exercise, and managing other health conditions such as hypertension, diabetes, or high cholesterol. Keep stress levels low |
| Peripheral Vascular Disease (PVD) Definition | Impediment of blood flow within the peripheral vascular system due to vessel damage. It mainly affects the blood flow to the lower extremities |
| Peripheral Vascular Disease (PVD) Lifestyle Modifications | Quit smoking, stress management, regular exercise, avoid restrictive clothing |
| Non-pharmacological Interventions for Peripheral Vascular Disease (PVD) | Promoting blood return by elevating the lower extremities above heart level throughout the day (returns blood to heart), avoiding standing for long periods of time. Wear elastic compression stockings on effected extremity routinely, ensuring they are clean and dry to prevent infection |
| Client Education/Post-Surgical Education in Peripheral Vascular Disease (PVD) | Avoid crossing legs, or prolonged dependency on extremity to prevent thrombosis. Edema is normal post-op, elevate while in bed to reduce. Graduated compressed stockings may be prescribe but care must be taken to avoid compressing distal vessel bypass grafts. Severe edema of an extremity, pain, and decreased sensation of toes or fingers can be an indication of compartment syndrome |
| Long-Term Management of Peripheral Vascular Disease (PVD) | Preventing stasis of blood through compression stocking, wound care, preventing infection, monitoring for clots, and helping treat clots. Blood thinners such as heparin and warfarin. |
| Post-Surgical Intervention Priority in PVD | Maintain circulation. Monitor pulse, doppler, color, temp, capillary refill, and sensory & motor function. All monitored initially every 15 minutes until stable. Monitor urine output, central venous pressure, mental status, pulse, and volume to monitor for fluid imbalances. Monitor for hemorrhage and hematomas |
| Peripheral Artery Disease (PAD) Pharmacological Interventions | Pentoxifylline (Trental), Cilostazol (Pletal), Aspirin, Clopidogrel (Plavix), Statins |
| Pentoxifylline (Trental) | increases erythrocyte flexibility, lowers blood fibrinogen concentration, and inhibits neutrophil adhesion and activation |
| Cilostazol (Pletal) | A phosphodiesterase III Inhibitor, Direct Vasodilator that inhibits platelet aggregation, plays a role in decreasing intimal hyperplasia after angioplasty and stenting. Improvement in maximal walking distance and pain free walking reported within 4-6 weeks |
| Aspirin, Clopidogrel (Plavix) | Antiplatelets which prevents the formation of thromboembolism |
| Statins | Improve endothelial function in patients with PAD, improve symptoms of intermittent claudication and increase walking distance. Benefit vascular inflammation, plaque stabilization, endothelial dysfunction, and thrombosis |
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