MED SURGE

anemias

100

what are the values for red blood cells, hemoglobin, hematocrit  

Values: 

Rbc: <5 

Hemoglobin: 15

Hct: 45

200

Different anemia classifications? who is at risk for B12 deficiency?  

hypo proliferative- iron, folate, B12 

bleeding- acute blood loss 

hemolytic- sickle cell

• Kids
• Pregnancy (bigger demand for B12 for the baby can cause deficiency in the mom)
• Gastric bypass (small pouch that bypasses the stomach which makes the amount of nutrients that pass the stomach significantly less)
• Vegan
• Older adults
• Infection
• Malabsorption syndrome (prevents absorption of nutrients in small intestine)

300

treatment and complications for sickle cell 

Treatment: fluids, pain, oxygen. 2mg every 2 hours of morphine

Complications: ACS and Pulmonary HTN

• ACS is represented by cough, fever, and infiltrates in chest Xray.

400

general complications for anemia and nursing goals 

General complications for anemia 

• HF: heart is not able to perfuse good due to low oxygen
• Parathesia
• Delirium

Nursing goals/ treatment: 

• Decrease fatigue
• Adequate nutrition (check albumin levels)
• Reduce exertion (maintain physical activity/ still be active but allow for periods of rest)
• Cluster care and allow periods of rest
• Teach the family to reduce fall risk and about it nutrition

500

CM for iron deficiency 

smooth sore tounge, rigid nails, angular cheilosis

bleeding disorders

100

severe case of thrombocytopenia? who has to be screened for this? 

Thrombocytopenia <150k 

Severe case <50k (give platelet infusion) 

*hep B and C patients need to be screened for thrombocytopenia  

200

Bleeding precautions 

Bleeding precaution: RANDI

• Razor (electric)
• Aspirin (NO)
• Needle (small gauge)
• Decrease needle sticks
• Injury (protection from)

300

different types of platelet count and what they mean? management for thrombocytopenia? 

<50k= possible bleeding

<20k= petechia, nasal/ gingival bleeding, excessive period bleeding/ after surgery

<5k= spontaneous bleeding, CNS bleeding, GI bleeding

Management: 

• education
• soft bristle toothbrush
• no contact sports
• RANDI

 

400

what is ITP 

Immune thrombocytopenic purpura ITP

• autoimmune disorder that destructs normal platelets due to an unknown cause

500

acquired coagulation disorders 

Liver disease

• Low coagulation factors produced
• Prolonged pt
• Risk for bleeding

Vitamin K deficiency

• Common in malnourished pt’s
• Monitor INR (normal is 1.5:2, anything above this is too coagulated)
• Vitamin K is the antidote to warfarin use

Anticoagulation therapy complications

• Most common in those taking warfarin
• INR monitoring
• Vitamin K for warfarin toxicity
• Transfuse with fresh frozen plasma

Blood transfusions

100

requirements to donate blood 

• Weigh at least 50kg (110 lbs)
• If 17 or less, you need parental consent
• Oral temp no more than 37.5 (99.6)
• SBP 80-180 and DBP 50-100
• Hemoglobin levels at least 12.5

200

types of donations 

Directed donation

• Goes directly to someone you choose

Standard donation

• Donors are in semirecumbent position, after blood drawn is done, the arm is held straight up with pressure applied for 2-3 minutes. They remain another 15 minutes after and are given food and fluids
• Standard precautions used
• 450ml drawn in less than 15 minutes
• Avoid: smoking for 1 hour, alcohol for 3, increase fluid intake for 2 days, eat healthy for 2 weeks

Autologous

• Patients own blood is collected for future transfusions
• Used for many elective surgeries
• Collected 4-6 weeks before surgery. Typically, 1 unit each week. 72 hours before surgery the blood is not collected anymore
• Iron supplements are prescribed

Intraoperative blood salvage

• Blood is washed (with NS), filtered and returned to patient with an IV
• Those who cannot donate blood before surgery
• Used for vascular, orthopedic, or thoracic surgeries

Hemodilution

• Remove 1 or 2 units of the patients own blood to reduce blood loss during surgery
• Not for patients who have had MI’s

300

complications of transfusions 

• Febrile hemolytic reaction: fever with 1 degree elevation. Typically begins 2 hours after transfusion has begun
• Acute hemolytic reaction: most dangerous and life-threatening reaction. Occurs when the pt is not compatible with the blood (type 2 hypersensitivity). Can occur with as little as 10ml of blood

Delayed Hemolytic Reaction

Delayed hemolytic reactions usually occur within 14 days after transfusion, when the level of antibody has been increased to the extent that a reaction can occur

• Allergic reaction
• TACO (transfusion associated circulatory overload) vs TRALI (transfusion related acute lung injury):

TACO- too much blood infused too quickly (hypervolemia occurs)

• For patients who are at risk for, or already in, circulatory overload, diuretics are given prior to the transfusion or between units of PRBCs. Rates of transfusion may need to decrease to less than 100 to 120 mL/hr.  
• Restrict fluids

TRALI- occurs within 6 hours of the transfusion

• Idiosyncratic reaction
• Give fluids

400

steps for adverse reactions 

• STOP transfusion

Maintain IV line with NS with new tubing at a slow rate

• Assess the patient
• Call HCP
• Call blood bank
• Send blood back