Anemia
What is the difference between Vit B12 deficiency and Pernicious anemia?
Vit B12 deficiency is caused from poor B12 dietary intake or poor absorption from the GI tract
Pernicious anemia is an autoimmune disorder caused from inadequate Vit B12 absorption due to lack of intrinsic factors (body cant absorb it).
Who is at risk for a DVT?
1. Stasis of blood flow: immobility (bed rest/palne rides), recent surgery, pregnancy, paralysis, obesity)
2. Vessel wall injury: caused from trauma (fractures/contusions), CVC (PICC, central lines, pacemaker wires), IV medications, cancer therapy (chemo/hormonal/radiation)
3. Altered coagulation: caused by oral contraception or hormone replacement, cancer, smoking (thickens blood), late pregnancy
A client with what cardiac medical history is at risk for a PE?
Atrial fibrillation
- blood stagnates in the fibrillating atrium of the heart and forms clots and travels through the pulmonary artery from the right atrium and gets into the lung (PE)
In GENERAL, when does a patient receive a blood transfusion (packed RBC)?
When their Hgb is below 7 (abnomally low)
What are included in nursing considerations for Iron supplementation medications
- liquid iron can stain teeth, so have to use a straw
- best absorbed with Vit C
- should take on an empty stomach for best absorption
- high fiber diet due to constipation risk
- will have darker stool
What are risk factors for anemia?
Acute/chronic blood loss (Trauma/GI ulcers/tumors/postsurgical blood loss), NSAID usage, blood thinner complications, CKD)
Rapid metabolic activity (pregnancy, adolescents, infections)
Increased hemolysis (defective anemia: sickle cell), blood transfusion reactions
Inadequate dietary intake (iron def, vit B12 def, folic acid def, chronic alcohol use)
Increased age
Bone marrow suppression (Radiation/aplastic anemia)
What are S/S of a DVT
- Edema (larger calf circumference)
- unilateral swelling
- redness
- increased skin temperature
- tenderness/pain in the area
- low grade fever
- can also be ASYMPTOMATIC (sometimes incidental finding when a PE is diagnosed)
What are the S/S of a PE?
SOB
Anxiousness
Pleuritic chest pain
Cough
Hemoptysis
Decreased SpO2
Syncope
SEVERE: hypotension, distended neck, pulmonary crackles, petechial rash
For all blood transfusion reactions, what are the nurses immediate actions?
STOP the transfusion
Obtain vital signs
Notify the provider
What is the standard pharmacological treatment for Pernicious anemia
Vit B12 (cyancobalamin) IM injections weekly then monthly
What are specific symptoms associated with Vit B12 deficiency anemia?
NEUROLOGICAL
- paresthesia, poor coordination, confusion
Other
- sore, bright red tongue
What is contraindicated for a client with a DVT and WHY?
- SCD's
- ICE (causes constriction)
- massaging the extremity
- compression sleeves/socks
- can cause part of the clot to dislodge and travel to the lung (PE)
What diagnostic testing diagnoses a PE?
- What is the MOST definitive test?
- CTA (CT angio) is the most definitive test to diagnose a PE (requires contrast)
- other tests: VQ scan, chest x-ray (r/o other causes of S/S), arterial blood gases (ABG's)
Before starting the blood transfusion process on a client, what does the nurse need to verify first?
Blood consent is signed
What nursing education is included for a client taking warfarin (coumadin)?
- S/S of bleeding
- educating on AVOIDING foods high in Vit K (antidote), can reverse blood thinning effects of the medication
- educating on having their blood work (INR and PT) assessed on a regular basis to maintain therapeutic levels
What lab values should the nurse assess related to anemia?
Hematocrit (Hct)
RBC
Iron panel (Serum iron/serum ferritin)
KNOW Normal values and what values for each lab would be concerning to the nurse and what would require immediate intervention
What are nursing interventions for a DVT?
Apply moist heat
- elevate the entire extremity on pillows
-administer mild analgesics
- follow policy on ambulation: bedrest for a period of time until cleared
What lab value is most helpful in diagnosing a PE?
D-dimer
- 95% of people with a PE have an elevated D-dimer (above 0.4)
- if it is negative: a PE is excluded
Which client population cannot receive blood transfusions?
Jehovah's witness
- can receive epoetin alfa (to stimulate RBC production to help increase Hgb)
Which lab values does the nurse need to assess for a client on a heparin IV drip and WHY?
- to determine if the levels are therapeutic, that the blood is thinned adequately to decrease risk of another clot
Which population is most at risk for iron deficiency anemia and WHY?
Vegans (not enough protein through dietary sources)
- consume other foods high in Iron (legumes)
What is the most common diagnostic test to diagnose a DVT?
Venous dopplers
- ultrasound that assesses sound waves in an extremity
- NO SOUND: compromised blood flow (veins are thrombosed: CLOTTED)
What are the priority interventions for a client with a PE?
Elevate the HOB to high-fowlers
Administer Oxygen to relieve hypoxemia
Ensure IV access (for IV heparin drip)
Notify the healthcare provider
Administer analgesics
Help the client relax (due to anxiousness and breathing difficulty)
A complete blood transfusion needs to be administered within what time frame and WHY?
4 hours
- to decrease bacterial buildup in the blood
What are nursing considerations for clients taking an anticoagulant?
- assess for S/S of bleeding
- use electric razor- not taking NSAIDs
- soft bristle toothbrush (to prevent gums from bleeding)