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*N126-U4-Anemias-2*
Dobrisky-Folic Acid Deficiency, Fe Deficiency
| Question | Answer |
|---|---|
| what one lab value is increased in folic acid deficiency? | MCV |
| what three lab values are always low in pernicious, folic acid and Fe deficiency anemias? | Hb, Hct & RBCs |
| what type of murmor is associated with pernicious anemia? | systolic murmur |
| folic acid is stored in the body as | different compounds known as folates |
| dietary deficincies are more common in vit b12 or folic acid? | folic acid |
| why are deficincies more common in folic acid? | stores are much smaller in folic acid |
| what part of the body is the most instrumental in aiding in the absorption of folic acid? | mucosa of the duodenum and upper part of the jejunum |
| when inadequacies of folic acid occur in the body what type of anemia occurs? | megaloblastic anemia |
| what changes take place in the RBCs of a pt with megaloblastic anemia? | they are large, abnormal sized, fragile and don't contain sufficient amounts of hemoglobin |
| the oxygen carrying capacity of RBCs is affected how in anemia? | decreased |
| what are some of the causes of folic acid deficiency? | not enuf raw vegies and fruit, pregnancy, anorexia, CRF, alcoholism, heart valve patients, hemodialysis, faulty absorption and age. |
| why is age a risk factor for folic acid deficiency? | elderly do not eat adequate amounts of uncooked fruits & vegies because of dental problems, lack of resources for frequent shopping and cost of fresh foods. |
| alcohol intake does what to the need for folic acid in the body? | increases |
| the assessment of a patient with folic acid deficiency would show the same s/s as pernicious anemia except what? | no neuro s/s |
| anticonvulsants and oral contraceptives inhibit absorption of what? | folic acid |
| inhibition of the absorption of folic acid can lead to what type of anmeia? | folic acid deficiency |
| a heart valve replacement patient may be at risk for what type of anemia? | folic acid deficiency |
| why are uremia and hemodialysis patients at risk for folic acid deficiency? | folic acid is lost during dialysis |
| a patient taking methotrexate, or phobarbital or diphenylhydantoin could be at risk for what type of anemai? | folic acid deficiency |
| MCV is elevated in what types of anemias? | folic acid deficiency and pernicious anemia |
| reticulocytes are decreased in what anemias? | pernicious and fe deficiency |
| milk and eggs are recommended for replacement therapy in what type of anemia? | pernicious |
| liver, green leafy vegies, kidney and asparagus are recommended in the diets of patients with what type of anemia? | folic acid deficiency |
| how is folate affected by cooking? | 90% is destroyed |
| folic acid replacement therapy routes can be | orally or injections |
| if the patient has been NPO for prolonged periods what is the best route for folic acid replacement therapy? | injection |
| folic acid replacements may be given orally how often? | 2-3 times per day |
| in malabsorption states a pt may receive up to how much folic acid replacement? | 5mg |
| when malabsorption or disease of the small bowel is present what type of replacement therapy is used? | injection |
| if a patient complains of weight loss, tinnitus, painful tongue and numbness and tingling in the arms and legs what type of anemia should be suspected? | pernicious |
| if a patient presents with a red, beefy tongue and dyspepsia but no neuro signs what type of anemia should be suspected? | folic acid deficiency |
| what is the major difference in the presentation of patients with folic acid deficiency and pernicious anemia? | pernicious anemia patients show neurological s/s |
| what are some of the neuro s/s of pernicious anemia pts? | confusion, loss of balance, numbness |
| what is the normal serum folate level? | 7-20 |
| what serum folate level suggests folic acid deficiency? | <4 |
| milk is a poor source for this patient but kidney and asparagus are good sources, which type of anemia does this patient have? | folic acid deficiency |
| raw or cooked vegies are good for patients with folic acid deficiency? | raw |
| permanent replacement of folic acid may be needed in patients with what conditions? | small bowel disease, malabsorption or continued alcoholism |
| what serum level helps distinguis between pernicious and folic acid deficieny anemias? | vitamin b12 levels are normal in folic acid deficiency |
| schilling test looks for | low b12 in the urine |
| gastric analysis looks for | absence of HCl |
| antihistamines can cause | pernicious anemia |
| anticonvulsants can cause | folic acid deficiency |
| What is the most common type of anemia? | iron deficiency anemia |
| what is the difference in RBCs between the three types of anemias? | iron deficiency anemia will show smaller & pale RBCs |
| iron is an essential part of the | hemoglobin molecule |
| iron deficiency causes | a decreased production of rbcs |
| average adult body contains how much iron? | 4gm |
| where is the majority of iron found in the body? | in hemoglobin |
| the rest is in | liver and bone marrow and some is in tissues and enzyme systems |
| the average daily loss of iron is | 1.5mg |
| how is this loss of iron replaced? | dietary sources |
| most iron absorption takes place in the | duodenum |
| the development of iron deficiency anemia is usually secondary to what? | blood loss |
| parasulfate should be given how? | with meals |
| a woman on her period that has had gastric bypass is at risk for what type of anemia? | iron deficiency |
| diseases of the upper small bowel can cause a deficiency in what? | iron |
| what is the main complaint of a pt with iron deficiency? | tired |
| most artificial heart valve replacements cause what? | mechanical trauma to RBCs, leading to anemia |
| what type of valve does not cause a problem with RBCs? | porcine (pig) valves |
| chronic renal failure and dialysis are risk factors for what types of anemia? | iron deficiency and folic acid deficiency |
| what type of iron replacement therapy is new and recommended for bypass patients? | IV |
| early stage iron deficiency anemia is normally | asymptomatic |
| s/s in the chronic stage iron deficiency anemia | fatigue, SOB, palpitations |
| fatigue, SOB, palpitations, blurred vision, h/a, depression, anorexia, sensitivity and pruritis are all s/s of late stage... | iron deficiency anemia |
| if a patient presents with glossitis, dry skin, dry hair and brittle nails, inflamed and cracked lips what type of anemia would be suspected? | iron deficiency anemia |
| in which types of anemia is CHF a late stage s/s? | all |
| thin and spoon-shaped fingernails are a s/s of what type of anemia? | iron deficiency |
| what three labs are increased in the CBC of a pt with iron deficiency? | TIBC, Sed rate and platelets |
| for what type of anemia would you assess for blood in stool and emesis | iron deficiency |
| what type of testing would be done to assess for bleeding causing iron deficiency anemia? | CBC, endoscopy, xrays, occult blood, bone marrow biopsy |
| when would a bone marrow biopsy be done? | if a patient suspected of having iron def anemia had all other tests that were negative |
| liver, meat, egg yolk, cereals, dark green vegies, legumes and nuts should be included in the patient with what type of anemia? | iron deficient anemia |
| what vitamin supplement would aid in the absorption of iron? | vitamin c |
| what type of vitamin supplement interferes with products that would combine with iron and inhibit it's absorption? | calcium |
| what vitamin replacements are sugested for the patient with iron def anemia? | iron, vitamin c and calcium |
| what affect do tea and coffee have on iron absorption? | inhibits absorption |
| decreased gastric acid secretion can be a factor in what anemia? | pernicious anemia and iron deficiency anemia |
| iron supplements should be continued for 2-3 months after what serum value returns to normal? | Hb |
| an infants iron requirements during the first year are | 1.5mg/kgm |
| 10mg/day is a normal iron requirement for what gender? | male |
| a pregnant woman's iron requirement is between | 30-60mg/day |
| a female's iron requirement is | 18mg/day |
| enteric coated ferrous sulfate should be administered how and how often? | 300mg 3-4 times daily with food |
| a nursing ongoing assessment of a patient on ferrous sulfate should include looking for | nausea, heartburn, upper abdominal pain, constipation or diarhhea. |
| a normal reaction to ingestion of ferrous sulfate is | black stools |
| ferrous sulfate is given | orally |
| iron-dextran or Imferon is given | IM or IV |
| iron stores are built up more rapidly in which type of preparation? | IM or IV |
| when giving Iron-dextran or Imferon IM what type of method should be used? | z track |
| what should be monitored for following IV or IM injection of iron? | anaphylactic reaction |
| how should iron dextram be prepared? | undiluted, alone and at a rate of no more than 1ml/min. |
| what should an IV line used for iron dextram push be flushed with? | NS |
| can you mix IV dextram with any other medications? | NO |
| what would indicate the need for a blood transfusion in a patient with iron deficient anemia? | only after all other treatments had been tried and unsuccessful |
| what type of blood is given for replacement in chronic anemia? | packed RBCs |
| early detection of iron deficient anemia can be made by what simple test? | occult blood |
| what diagnostic tests are used to detect iron deficiency anemia? | endoscopy, colonoscopy, radiography and occult blood testing |
| what is the best dietary source of iron for anemia patients | organ meats, especially liver |
| other sources of dietary iron are | meats, seafood, egg yolk, whole grains, legumes, green leefy vegies and nuts |
| iron is best absorbed on an empty stomach, why do we give it with food? | to avoid GI side effects |
| should iron replacements be given before, during or after meals for patients that experience GI side effects? | after |
| what is the most important nursing diagnosis for a patient with any type of anemia? | risk for injury due to wekaness, fatigue |
Created by:
Lori Dobrisky
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