NURS 571 Midterm exam with solutions

NURS 571 Midterm exam with solutions

Anemia |- |correct |answer |-Males |Hgb |<13, |Females |<12
- |Congenital: |born |with
- |Acquired: |from |diet, |environmental |factors
- |Diminished |production: |Reticulocytopenia
- |Accelerated |loss: |hemorrhage, |destruction, |Reticulocytosis


RBC |components |- |correct |answer |-Hct: |1 |to |3 |ratio |of |plasma |to |RBCs |(ex: |Hgb |10 |= |Hct |30)
- |Mean |Corpuscular |Volume |(MCV): |size |of |RBCs |(-cytic)
Normal |= |80-100
- |Mean |Corpuscular |Hemoglobin |(MCH): |weight |of |RBCs |(-chromic)
Normal |= |27-89


MCV |anemia |- |correct |answer |-Microcytic: |<80: |iron |deficiency |anemia, |thalassemia


Normocytic: |80-100: |anemia |of |chronic |disease, |renal |failure, |sickle |cell, |blood |loss,
|hemolytic




Macrocytic: |100+: |B12 |or |folate |deficiency, |ETOH, |liver |failure, |drugs


Labs |needed |to |diagnose |anemia |- |correct |answer |-Microcytic |(MCV |<80): |most |common |is
|iron |deficiency |anemia



- |need |serum |iron |studies: |iron, |ferritin, |TIBC


Normocytic: |Need |reticulocyte |count |(how |many |new |cells |are |being |produced)

,- |<2% |reticulocytes: |hypoproliferative, |body |not |producing |enough |RBCs |- |suppressed |by
|diseases |like |leukemia, |bone |marrow |suppression



- |2+% |reticulocytes: |hyperproliferative, |body |trying |to |compensate |for |blood |loss,
|hemorrhage




Macrocytic |(MCV |100+): |Need |peripheral |blood |smear, |would |see |megalocytes |and
|segmented |neutrophils




Iron |deficiency |anemia |- |correct |answer |-MICROcytic, |#1 |cause |of |iron |deficiency |anemia |is
|blood |loss |(chronic |GIB, |menses)



- |inadequate |iron |intake, |impaired |absorption |of |iron
- |autoimmune |diseases


Dx: |Low |MCV, |low |MCH, |low |iron, |low |ferritin |(<12), |high |TIBC
*Ferritin |is |most |reliable |indicator*


Iron |deficiency |anemia |S/S |and |Tx |- |correct |answer |-S/S: |slow |onset, |PICA |cravings,
|dyspnea, |HA, |weakness, |tachycardia, |pallor




Tx: |Oral |ferrous |sulfate |300-325mg |1-2hrs |after |meals
- |do |not |take |w/antacids, |calcium, |food
- |Vit |C |increases |iron |absorption


Thalassemia |- |correct |answer |-MICROcytic |anemia, |decreased |Hgb |synthesis


- |S/S: |asymptomatic |unless |severe, |then |SOB, |fatigue, |CP
- |Dx: |Low |MCV, |Low |MCH, |Normal |TIBC, |normal |iron, |normal |ferritin
- |Tx: |No |tx |unless |severe, |then |PRBCs. |Iron |contraindicated |bc |can |cause |overload

, Folic |acid |deficiency |- |correct |answer |-MACROcytic
Causes: |prolonged |dietary |deficiency, |malabsorption, |esp |common |in |alcoholics


- |S/S: |fatigue, |pallor, |HA, |NO |NEURO |S/S
- |Dx: |MCV |100+, |normal |MCH, |folate |low
- |Tx: |folic |acid |1mg/day


Pernicious |anemia |(B12 |deficiency) |- |correct |answer |-MACROcytic
Causes: |intrinsic, |autoimmune, |malabsorption |(gastric |bypass, |resection)


- |S/S: |NEURO: |Parasthesias, |+ |Romberg, |+ |Babinski, |dizziness.
Can |be |reversible |if |tx |w/in |6 |mon |of |dx
- |Dx: |MCV |100+, |normal |MCH, |low |B12,
- |Tx: |B12 |100mcg |IM |daily |x |1wk. |PO |B12 |may |be |destroyed |in |gastric |secretions


Anemia |of |Chronic |disease |- |correct |answer |-NORMOcytic, |low |iron |and |TIBC, |high |ferritin
Causes: |inflammation, |infection, |renal |failure, |malignancy, |2nd |most |common |type |of
|anemia




3 |types:
1. |Anemia |of |inflammation: |rheumatologic, |arthritis, |lupus, |IBD, |Crohn's
2. |Anemia |of |organ |failure: |renal, |liver, |endocrine
3. |Anemia |of |the |elderly: |20% |of |people |85+, |decreased |RBC |production


Tx: |tx |underlying |disease


Sickle |cell |disease |- |correct |answer |-Autosomal |recessive |trait. |S/S: |Cellular
|hypoxia/ischemia, |pain, |CVA, |VTE, |pain, |DOE, |fever, |^HR, |AMS