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why would a pt. w/ peptic ulcer have lower values on a CBC (complete blood count)?
peptic ulcer cause internal bleeding leading to a low blood count
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what labs should be done prior to surgery & why?
PT, PTT, INR, CBC to check for clotting/infections
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what happens to the blood when it has a high viscosity?
- becomes too thick & forms a clot
- *needs more fluid
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what are the ABC's of life?
airway, breathing, circulation & safety
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what lab should be monitored for a pt. w/ non-hodgkin's lymphoma [a group of malignant diseases originating in lymph nodes & other lymphoid tissues]?
- WBC's (normal values: 5,000-10,000)
- *CBC detects anemia
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which diagnostic test is done to confirm pernicious anemia [caused by a deficiency of gastric acid & intrinsic factor (a substance produced by the parietal cells of the stomach)--intrinsic factor is required for the absorption of vitamin b12; w/o b12 the body inhibits folic acid, a substance needed for RBC's to multiply properly; this leads the production of large RBC's (macrocytic, megaloblastic, increased MCV)]?
- schilling test [measures the absorption of radioactive vitamin b12 as it is excreted in the urine]; gastric analysis & megaloblastic anemia profile.
- *schilling test: 24 hr urine collection that requires a radiopaque dye
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which lab test is done to check for a possible iron deficiency anemia [can be caused by blood loss, poor GI absorption of iron & an inadequate diet & is common in women (menses), older adults, & people w/ poor diets]?
diagnostics include peripheral blood counts w/ low RBC's, H&H levels, low serum iron & low serum ferritin
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s/s of iron deficiency anemia?
monitor for weakness, fatigue, pallor, glossitis [sore red tongue], SOB, spoon-shaped nails, pica & pagophagia [eating strange things]
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in what position is the pt. put in for a bone marrow biopsy [solid tissue & cells are obtained by coring out an area of bone marrow w/ a large bore needle]?
prone to access the posterior iliac crest
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what nursing interventions are done following a bone marrow biopsy?
VS, apply pressure dressing, monitor for bleeding & infection, medicate for pain
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s/s of phlebitis [irritation of a vein by chemical, bacterial/mechanical irritation]?
monitor for redness, pain/burning, discomfort, warmth, edema, vein induration (hard), red streaks, slowing infusion rate, elevated temp., infection
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what nursing interventions are done for phlebitis?
- do not use arm w/ IV for BP/phlebotomy
- do not use hand veins in older adults who have lost SQ tissue
- do not use hand veins for vesicant med.
- use a hand board for sites affected by the motion of a joint
- apply direct pressure w/ gauze sponge when removing; cool compresses; elevation is optional; do not start new IV in same extremity
- *stop infusion immediately, remove catheter, apply warm moist compresses
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what causes an IV infiltration [fluid leaking into the surrounding SQ tissue]?
catheter displacement from an inadequately taped catheter
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why do you check glucose levels before doing anything to a pt. who is on a TPN [total parenteral nutrition: hypertonic IV solution that provides complete nutrition to a client to prevent/correct nutritional deficiencies]?
TPN can cause hyperglycemia b/c the solution is going straight to the blood stream instead of being metabolized
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what can cause abd pain for a pt. who just had a splenectomy?
internal bleeding (check abd girth)
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pt. teaching prior to a splenectomy?
how to splint, cough & deep breathe
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what is the most common cause of iron deficiency anemia?
blood loss, poor GI absorption of iron, & an inadequate diet & is common in women (menses), older adults, & people w/ poor diets
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s/s of pernicious anemia?
monitor for pallor, jaundice, glossitis (smooth sore, beefy-red tongue), fatigue, wt. loss, paresthesias (numbness & tingling)
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is cooley's anemia (beta-thalassemia) inherited?
- yes, a group of hereditary hemolytic (break down the RBC's) anemias characterized by a defect in the synthesis of a protein needed for production of hgb & RBC's
- *most common in people of mediterranean ancestry (italian & greek)
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what complications does sickle cell anemia [a congenital hemolytic (breaks down RBC's) anemia that occurs primarily in blacks; results from a defective hgb molecule (hgb s) that causes the RBC to become sickle shaped] present?
cells clump together, clogging capillaries & impair circulation resulting in chronic ill health (fatigue, dyspnea on exertion, swollen joints), periodic crisis, long-term complications (infarcts, ulcers); & early death
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pt. teaching to prevent sickle cell anemia crisis?
drink lots of fluids, avoid: infection, overexertion, stress, cold weather, ingestion of alcohol, smoking
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besides O2, what else is of priority care w/ a sickle cell anemia crisis?
analgesics (opioids) for severe pain
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why is pushing fluids important w/ a sickle cell anemia crisis?
to move the cells around & carry O2 (promotes perfusion)
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what is the most common blood type?
O (universal donor)
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what is the rarest blood type?
AB (universal recipient)
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normal H&H levels for men & women?
- men: hgb (14-18); hct (42-52)
- women: hgb (12-16); hct (37-47)
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how long does a blood transfusion take?
2-4 hrs
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why is an IV tube primed w/ saline prior to infusion?
lubricates to prevent solution from sticking
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what is the 1st thing you do if a pt. has a reaction to the transfusion?
stop transfusion
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what is polycythemia vera?
- chronic disorder characterized by increased RBC mass, erythrocytosis, leukocytosis, thrombocytosis, increased hgb level & low/normal plasma volume
- *aka primary polycythemia, erythemia/polycythemia rubra vera
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how does pushing fluids help polycythemia vera?
prevents clots
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why does polycythemia vera cause angina?
diminished blood flow & thrombocytosis leads to intravascular thrombosis
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tx for polycythemia?
push fluids & administer nitroglycerin to dilate blood vessels
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therapeutic phlebotomy for polycythemia vera?
removal of blood from the vein to reduce the RBC mass (500 mL of blood removed every other day until the hct is normal)
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why would a pt. w/ leukemia be more prone to bruises?
lack of platelets, WBC's & RBC's
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why is handwashing a precaution for a pt. w/ neutropenia?
handwashing lowers the risk of the pt. getting an infection due to their suppressed immune system
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s/s of infection?
- aches & pains
- chills
- cloudy urine
- fever
- glassy/red eyes
- increased WBC's
- redness
- swelling
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s/s of low platelet count?
- bleeding, bruising
- ecchymosis
- petechiae
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what is hemophilia?
hereditary bleeding disorder that results from a deficiency of specific clotting factors
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pathophysiology of hemophilia?
hemophilia is an x-linked recessive genetic disease causing abnormal bleeding b/c of specific clotting factor VIII & IX leading to excessive bleeding when clotthing factors are reduced by more than 75%
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why can't a pt. w/ hemophilia not take aspirin?
they will bleed to death
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what do you do when a hemophiliac child falls & later c/o abd pain?
bring child to hospital (might have internal bleeding)
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why would a pt. w/ a disseminated intravascular coagulation (DIC) recieve heparin?
low-molecular wt. heparin is given in the early stages to prevent micro-clotting
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which labs are monitored for a pt. w/ a disseminated intravascular coagulation?
- (decreased) serum platelet count
- (decreased) serum fibrinogen level
- PT, PTT & INR
- (decreased) clotting factors V & VIII
- (positive) D-dimer test
- peripheral blood smear shows schistocytes
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which (factors) components aid in clotting?
clotting factors VIII & IX; calcium
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what do you tell a mother w/ a hemophiliac son concerned about her 2 daughters having the same prob.?
they may be carriers, but will not have it
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a pt. w/ acute lymphocytic leukemia would be placed in what type of isolation?
reverse isolation
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how long does blood last when unrefridgerated?
4 hrs
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normal ranges of the following:
RBC?
WBC?
platelet count?
H&H for men & women?
total iron-binding capacity (TIBC)?
bleeding time?
prothrombin time (PT)?
partial thromboplastin time (PTT)?
international normalized ration (INR)?
- RBC = 4-6 million/mm
- WBC = 5,000-10,000/mm
- platelet count = 150,000-400,000/mm
- H&H for men = hgb (14-18 g/dL); hct (42%-52% [3 times the hgb])
- H&H for women = hgb (12-16 g/dL); hct (37%-47%)
- TIBC = 250-460 mcg/dL
- bleeding time = 1-9 min.
- PT = 11-13 sec.
- PTT = 1.5-2.0 (times normal values)
- INR = 0.7-1.8
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