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anemia is a disease. t or f
false
anemia is a clinical manifestation of a disease
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what can cause anemia
- impaired function
- decreased production
- increased destruction
- dietary probs
- genetics
- excess bleeding
- bone marrow disease
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how will anemia manifest in the integumentary system?
pallor, concave brittle nails, etc
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anemia:
manifestations in cardiovascular?
increase HR
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anemia:
manifestations respiratory?
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anemia:
manifestations neurological
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#1 NDx for sickle cell anemia
PAIN
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early dx for sickle cell is critical. what supports this?
all states mandate newborn screening
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is there a cure for sickle cell?
no cure
*bone marrow transplants
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what's the main goal for sickle cell?
- manage pain
- relieve sx
- prevent/treat complications
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what is the hemoglobin that is abnormal w/ sickle cell anemia
hbg S
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what does hgb S do to blood cells?
cells sickle when under stress, causing them to tangle --> vaso-occlusion = pain
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sickle cell:
patho of a vaso-occlusive crisis?
decrease in o2 --> rbcs sickle --> occludes --> compromises cirulation --> pain --> edema --> tissue ischemia --> infarction
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sickle cell anemia:
what can cause a vaso-occlusive crisis?
- cold
- dehydration
- late pregnancy
- physical exertion
- mental/emotional stress
- unknown
- decreased o2
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top 2 NDx for sickle cell anemia?
- pain
- risk for infection (splenomegaly)
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sickle cell:
what can cause ACUTE CHEST SYNDROME?
fat emboli
fat embolism (stroke in long bone d/t sticky sickle cell) --> decrease perfusion --> fat emboli to let loose--> severe occlusive crisis / PE
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sickle cell:
s/s of acute chest syndrome
- increase T
- CP
- cough
- wheezing
- tachypnea
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dc teaching for sickle cell:
- rcv year flu vaccine
- abd pain - splenomegaly
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sickle cell:
acute chest syndrome caused by......
- infection
- atelectasis (IS, cough, deep breathe)
- fat embolism
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sickle cell:
treatment for severe pain?
- morphine - vessel dilation
- hydration - d5w
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sickle cell crisis tx
- HYDRATE!
- pain management
- keep warm
- o2
****TEDS, BP cuff, bed position can impede blood flow
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what increases the viscosity of blood in sickle cell anemia?
clumping of cells together
*the clumping also causes occlusion
*organs may be occluded (spleen, liver)
*when the spleen is ischemic = decreased immunity
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what causes pain in sickle cell anemia?
ischemia!
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this is a complication of vaso-occlusive crisis w/c can lead to resp failure and death
ACUTE CHEST SYNDROME
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sickle cell:
acute chest syndrome diagnosis?
- chest xray may initially be normal but may have new pulmonary infiltrate
- hgb - 7.5-8
- wbc - 20,000/mm3
- spo3 - <93%
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What kind of anemai would you have to evaluate for bleeding, esp GI bleeding?
iron deficiency anemia
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what can cause iron deficiency anemia?
- blood loss
- decrease GI absorption
- inadequate diet
*iron stores depleted first, followed by hemoglobin stores, RBCs (microcytic)
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how is iron deficiency anemia managed?
- increase dietary intake
- oral suppls
- parenteral meds
*meats, beans, green leafies
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iron deficiency anemia:
s/s:
- easy fatigue
- pallor
- palpitation
- dyspnea
- hair loss
- malaise
- muscle weakness
- altered oral mucosa
- irritability
- mental status change
- tingling of extremities
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the difference between chronic and acute anemia
chronic - adjusts to low o2 levels and the individual may not feel different unless the anemia becomes severe
acute - pt may experience significat sx relatively quickly
*some pts with anemia have no sx
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vitamin b12 deficiency aka
pernicious anemia
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manifestation of pernicious anemia (B12)
- jaundice
- pallor
- NEUROFUNCTION - numbness, tingling (paresthesia), difficulty with gait, memory
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pernicious anemia is an issue with what?
absorption
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cause of pernicious anemia
inhibits folic acid transport, reduces DNA synthesis
*dietary
*failure to absorb b12 d/t deficient intrinsic factor in gut => decrease absorption
*result - precursor cells increase in size = macrocytic anemia
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what test is done for pernicious anemia (b12)
shilling test - take b12
* if they pee it out - b12 can be absorbed
*if they don't pee it out - b12 cannot be absorbed = pernicious anemia
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the difference between folic acid anemia and other anemias?
folic acid anemia has no nervous function involvement
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what causes folic acid anemia
poor nutrition
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what foods are rich in folic acid
grains, dairy, lentils, citrus, green leafies
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who's at risk for folic acid anemia
chronic alcoholic
etoh causes malabsorption
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deficiency in circulation RBC
failure of bone marrow to produce d/t injury to precursor cells for RBC
aplastic anemia
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what can cause destruction of RBC (aplastic anemia)
LT meds
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aplastic anemia can cause decrease in w/c type of cells?
ALL TYPES!
- leukopenia - wbc
- thrombocytopenia - platelets
- pancytopenia - all cells
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what is the most common type of aplastic anemia?
acquired aplastic anemia
*caused by LT exposure to drugs/toxins
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leukemia is present with what complaints?
pneumonia, anorexia, fatigue
*dx with leukemia when the CBC report is examined
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sx of leukemia (r/t to anemia)
- anemia
- frequent infections (decrease in mature wbcs)
- bruise easy
- bleed easy
- abd pain (splenomegaly)
- bone pain
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causes of leukemia
unknown
*environmental, genetic
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NDx for leukemia
- risk for injury
- risk for infection
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autoimmune thrombocytopenic purpura aka
ITP - idiopathic thrombocytophenic purpura
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cause of ATP (ITP)
platelets are attacked by our antibodies --> decreases platelets --> decreases clotting --> increases risk for bleeding
(destruction exceeds production)
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manifestations of ITP
bleeding, intracranial bleed, ecchymosis, petechiae
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treatments of ITP
- IVig
- plasmapheresis
- splenectomy
- platelet transfusion
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how does HIV attack the immune system
hi jacks the cell - take over cell function and replicates
destroys T cells and CD4 cells
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what is the CD4
immun cell
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what is the dx for aids in relation to CD4 cells and infections?
AIDS if:
- CD4 <200 or
- opportunistic infections (thrush)
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whats the normal range of CD4
800-1000
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where is HIV or AIDS found (bodily fluids)
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how can HIV/AIDS be transmitted
- sex
- sharing needles
- expousre to fetus or infant
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how is HIV/AIDS dx
- lymphocyte count
- antibody test
- ELISA
- WESTERN BLOT
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ELISA and WESTERN BLOT: how are they done
- ELISA done first - serum test
- WESTERN done to confirm
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what does the western blot look for? antibodies or the virus?
antibodies
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patient education (HIV/AIDS) re: meds
- lifelong meds
- expensive
- se: nvd, fatigue, anorexia
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NDX for HIV/AIDS
- risk for infection
- decreased self esteem
- isolation
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