NURSING 6202 - Exam 2 Study Guide.

Anemia Is a deficiency in the number of erythrocytes (RBCs) and the quantity or quality of
hemoglobin and/or volume of packed RBCs (hematocrit)
Causes: blood loss, impaired production of RBCs or increased destruction of RBCs
 Deficient intake of iron
 CKD
 Aplastic anemia
 Medications (chemotherapy)
 Defective DNA synthesis (B-12 deficiency and folate deficiency)
 Hemolysis (sickle cell disease)
 Trauma

Iron-deficiency Causes: lack of iron intake, malabsorption, blood loss or hemolysis
Hgb: low Symptoms: pallor, glossitis (inflammation of the tongue), cheilitis (inflammation of the
Hct: Low lips), headache, paresthesias, fatigue, shortness of breath
MCV: normal, low Diagnostics: Hgb/Hct (CBC), reticulocyte count, stool examination for occult blood
Management: oral supplement (Ferrous sulfate) take with vitamin C (like orange
juice) to enhance absorption of iron. Blood transfusion for hemoglobin less than 8.
 can cause gastric side effects heart burn, constipation, diarrhea,
 have patient stay up right for 30 minutes after taking oral form
 stools may become black or green
 may need to start taking stool softeners
 liquid iron may stain patient’s teethingest through a straw

Macrocytic anemia Vitamin B12 deficiency: caused by impaired DNA synthesis
(large RBC’s) Causes: Pernicious anemia (missing intrinsic factor), poor absorption, lack of intake
(vegans). The gastric mucosa is not secreting IF
Hgb: low  alcoholics, gastritis, medications, GI surgery (gastrectomy), old age
Hct: low lab values: hemoglobin would be low, hematocrit would be low, MCV would be high
MCV: high Manifestations: weakness, paresthesia of hand and feet, fatigue, pallor, stomatitis,
cheilosis, glossitis
Diagnostics: reticulocyte count, CBC (hemoglobin and hematocrit), serum vitamin B
12
Folic acid deficiency: caused by impaired DNA synthesis
Causes: lack of intake/malnutrition, malabsorption, alcoholism
Manifestations: same as vitamin B 12 without neurological symptoms
Diagnostics: reticulocyte count, CBC, serum folate
Treatment: supplementation, Vitamin B-12 may have to be given as an injection


Microcytic anemia Small RBCs with low hemoglobin
(small RBCs) Causes: nutritional deficiency, blood loss (chronic)
Manifestations: general S/S of anemia, brittle nails, pale nails, Concave nails
Hgb: low (koilonychias), glossitis, cheilosis, palpitations, may develop Pica (craving clay or ice)
Hct: low Diagnostics: CBC, reticulocyte count, ferritin
MCV: normal, low  low MVC, MCHC, low hemoglobin and low hematocrit
Treatment: replace iron, treat cause of bleeding


Normocytic- cause: insufficient # of RBCs from acute blood loss, impaired production (old age)
normochromic  infection
anemia  CKD
Hgb: low  HF
Hct: low  Obesity
MCV: normal  RA/SLE
Manifestations: pallor, fatigue, weakness, dizziness
Treatment: injection of erythropoietin, blood transfusion

,Thrombocytopenia Is a disease characterized by decreased platelets
Causes: can be inherited, most are acquired
Immune thrombocytopenia: acquired immune disorder in which the
thrombocytopenia results from antiplatelet antibodies, impaired platelet production,
and T-cell–mediated destruction of platelets
 worsened by SLE, HIV or H. Pylori
Management: Corticosteroids, IV immunoglobulin, splenectomy,
immunosuppressives (cyclosporin), platelet transfusions
Thrombotic thrombocytopenia purpura: The disease is associated with enhanced
aggregation of platelets, which form microthrombi that deposit in arterioles and
capillaries
Causes: lack of ADAMTS13 enzyme (a type of blood protein). The ADAMTS13 gene
controls the enzyme, which is involved in blood clotting. Not having enough enzyme
activity causes overactive blood clotting
Management: plasmapheresis, corticosteroids, Rituxan, splenectomy,
immunosuppression therapy
Heparin induced thrombocytopenia: development of thrombocytopenia occurs 5 to
10 days after the onset of heparin therapy
Manifestations: bleeding, mucosal bleeding, petechiae purpura, ecchymosis,
weakness, fainting, dizziness, tachycardia, hypotension, abdominal pain
Management: thrombin inhibitor, thrombolytic agents, Warfarin, plasmapheresis

Notify your HCP of any symptoms of bleeding. These include:
 Black, tarry, or bloody bowel movements
 Black or bloody vomit, sputum, or urine
 Bleeding from the mouth or anywhere in the body
 Bruising or small red or purple spots on the skin
 Difficulty talking, sudden weakness of an arm or leg, confusion
 Headache or changes in how well you can see
Nursing interventions:
 Avoid risky behaviors or sports
 Do not blow nose forcefully
 Drink plenty of fluids to avoid constipation
 Shave with an electric razor
 Do not get IM injections
 Do not get tattoos
 Use a soft bristle toothbrush
 Do not take ASA or NSAIDs

Hemolytic anemia a disorder in which red blood cells are destroyed faster than they can be made
Causes: congenital
 Sickle cell disease
 Thalassemia: lack of globin
Acquired causes:
 Autoimmune
 Drug reaction
 Mechanical (prosthetic heart valve)
 Infections
Manifestations: jaundice, increased reticulocyte, paleness, dark-colored urine,
weakness, dizziness, confusion
Treatment: remove cause, fluid, folate, immunosuppression, blood transfusion, stem
cell transplant

Aplastic Anemia Disease in which a patient has peripheral blood pancytopenia (decrease of all cell
types RBCs, WBCs, and platelets)

, Causes: autoimmune disorder, inherited stem cell defect, toxic injury to bone marrow,
radiation
Manifestations: fatigue, dyspnea, thrombocytopenia (increased bleeding, petechiae,
nose bleeds), easy bruising, increased risk of infection (neutropenic precautions)
Diagnostics: bone marrow aspiration
Treatment: blood transfusions or stem cell transplant

Sickle cell disease is a group of inherited, autosomal recessive disorders characterized by an abnormal
form of hemoglobin in the RBC
RBCs become rigid, elongated and sticky, RBC death is sooner than normal
Sickling episodes are triggered by:
 High altitudes
 Infection
 Dehydration
 Increased temperature
 Low body temperature
 Surgery
 Blood loss
 Hypoxia
 Emotional or physical stress
Sickle cell crisis: severe, painful, acute exacerbation of RBC sickling causing a
vaso-oclusive crisis. Leads to impaired blood flowhypoxiatissue ischemia
Manifestations: pain, pallor, jaundice, gallstones
Complications: infection, repeated scarring of spleen, pneumonia, acute chest
syndrome MI, cor pulmonale, vision changes, pulmomary embolism, chronic leg
ulcers, osteoporosis
Diagnostics: hemoglobin electrophoresis
Nursing management:
 O2 therapy
 DVT prophylaxis
 Fluids
 Pain medication (morphine, opioids)
 Antibiotics for infection
 Transfusion therapy

Leukemia is the general term used to describe a group of cancers affecting the blood and blood-
forming tissues of the bone marrow, lymph system, and spleen
Acute leukemia is characterized by the clonal proliferation of immature hematopoietic
cells.
 The leukemia develops after malignant transformation of a single type of
immature hematopoietic cell, followed by cellular replication and expansion of
that malignant clone
Chronic leukemias involve more mature forms of the WBC.
 The disease onset is more gradual
Acute myelogenous leukemia (AML): is characterized by uncontrolled proliferation
of myeloblasts (immature WBC), the precursors of granulocytes
 There is hyperplasia of the bone marrow
Manifestations: fatigue, weakness, headache, mouth sores, anemia, bleeding, fever,
infection, mild hepatosplenomegaly, sternal tenderness, gingival hyperplasia
Diagnostics: Low RBC count, Hgb, Hct, platelet count. Low to high WBC count with
myeloblasts. High LDH. Hypercellular bone marrow with myeloblasts
Treatment: chemotherapy, stem cell transplant
Acute lymphocytic leukemia (ALL): immature small lymphocytes proliferate in the
bone marrow (WBCs)
Manifestations: bleeding or fever, progressive weakness, fatigue, bone or joint pain,
pallor, generalized lymphadenopathy, weight loss, ICP