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Nurs 332 Test #1

Fluid and Electrolyte, Hematology

What is the major extracellular cation? Sodium
What is the normal range for sodium in the body? 135-145 mEq/L
What 2 functions does sodium perform in the body? -Determines plasma osmolality and regulates water balance. -Promotes neuromuscular response (ex: sodium/potassium pump).
What organ primarily regulates sodium levels? Kidneys
What is a condition usually associated with hypervolemia sometimes referred to as water intoxication? Hyponatremia
What happens to cells during hyponatremia? What s/s occur? Swelling/edema of cells. S/s: nausea and vomiting, headache, confusion, muscle weakness or cramping, decrease LOC, etc.
What are s/s of hypernatremia? Lethargy, weakness, irritability, neuromuscular excitability, decrease LOC, seizures, etc.
What is the cause of hypernatremia? Usually caused by too little water in the body rather than too much sodium: a more precise term for dehydration.
What is the normal range for potassium? 3.5 - 5.0 mEq/L
What is the major intracellular cation? Potassium
What is potassium responsible for? Maintaining action potentials in muscles, neurons, ect. Controls cardiac rate, rhythm, skeletal muscle contraction and function of smooth muscles.
What can eating a lot of black licorice do to your electrolyte levels? Can cause excess K+ wasting.
What does Addison's disease do to k+ levels? decreased aldosterone leads to NA depletion and K+ retention.
What are s/s of hyperkalemia? Malaise, palpitations and muscle weakness.
What are some ways to reduce K+ levels? Short-term: insulin injection. Diuretic and kayexalate.
What are normal ranges for calcium levels? 8.6 - 10.2
What are some s/s of hypocalcemia? Positive Chvostek's sign and Trousseau sign of latent tetany. Can be recalled by the mnemonic "CATS go numb"- Convulsions, Arrythmias, Tetany and numbness/parasthesias in hands, feet, around mouth and lips
What are some s/s of hypercalcemia? Nausea and vomiting, loss of appetite, excessive thirst, frequent urination and constipation, abdominal pain, muscle weakness, muscle and joint aches, confusion and fatigue.
What is a common cause of hypomagnesium? NG Suction
What types of people does hypophosphatemia occur in? Alcoholics and elderly people with poor dietary habits.
What condition usually exists for hyperphosphatemia to develop? Generally poor kidney function.
What fluids are isotonic? Normal plasma, NS, and Lactated Ringers.
What does a blood cell do in a hypotonic solution? Pulls water into the blood cell forming a blood donut.
What does a blood cell do in a hypertonic solution? Pulls water out of cell into a shriveled up little blood raisin.
Which groups of people are most at risk of dehydration? Elderly and infants. Also people who are sick or exercise in the heat.
If someone is dehydrated what might their hematocrit look like? Normal to high.
Risk factors for fluid overload (excess fluid volume) are? Having CHF, renal failure, taking corticosteriods, and high levels of aldosterone.
What are some s/s of fluid overload? peripheral edema, extra heart sounds, crackles in the lungs, 3rd spacing, weight gain, jvd, clear urine.
What are the normal values for acid-base balances in the body? pH, PaCo2, HCO3, PaO2, and SaO2? pH 7.35 - 7.45 PaCo2 35 - 45 HCO3 22 - 26 PaO2 80 - 100 SaO2 95 - 100%
What events can cause anemia? Too few or poor quality of RBCs, blood loss, RBC production or destruction problems.
What is a normal hematocrit percent? Male: 40 - 50 % Female: 38 - 47 %
What is a normal hemoglobin amount? Male: 13.5 - 18 Female: 12 - 16 g/dl
What is a normal platelet count? WBC count? Platelet: 150,000 - 400,000 WBC: 4,000 - 11,000
During a blood transfusion, what happens to hematocrit and hemoglobin levels? They should both increase.
What hemoglobin lab results would be seen for mild, moderate and severe anemia? mild: 10 - 14 moderate: 6 - 10 severe: <6
What 6 ingredients are necessary for erythropoiesis? Cobalamin (Vit B12), Folic Acid, Iron, Vit B6, Amino Acids, and Vit C.
What is the most common anemia? Iron deficiency anemia
What is a major cause of iron deficiency? Blood loss
Where is iron absorbed? duodenum
What tx should be given to treat iron deficiency anemia? Fix the bleeding, give iron or packed RBCs.
What considerations must be made when taking iron supplements? Take before meals or with vitamin C, stains teeth so use straw, with injection use Z-track and don't massage skin. Causes constipation, dark stools and diarrhea.
What is Thalassemia? An autosomal recessive disease that causes insufficient production of normal Hb. Ethnic groups in Mediterranean sea and equitorial regions.
What do people with Thalassemia often die from? Iron overdoses-- have short life spans since no drug or diet treatments are available. Book says hematopoietic stem cell transplant is a risky cure.
What causes Megaloblastic anemias? A Cobalamin Deficiency
What are the 2 megaloblatic anemia types? Pernicious anemia (most common) and folic acid deficiency.
What is the difference in symptoms with pernicious anemia and folic acid defeciency? Symptoms or hypoxia, anorexia, N & V, and weakness are all s/s of both; neuro problems like paresthesia (numbness and tingeling) in only pernicious.
What types of people suffer from folic acid deficiency? Those with poor nutrition, malabsorbtion syndromes, certain drugs, alcoholics, and dialysis pts.
What precautions does someone with sickle cell anemia need to take? Stay hydrated, don't travel to high altitudes. Condition exacerbated by low O2 levels. Avoid respiratory tract infections.
What is aplastic anemia? A decrease in all blood cell types. It is congenital. These pts have poor outcomes.
What s/s may someone have with hemolytic anemia? Severe pain (back, chest, extremities, and abdomen) and pallor.
What is Thrombocytopenia? Platelets below 150,000 (can be drug induced)
What 3 types of Thrombocytopenia are there? Immune Thrombocytopenia Purpra (ITP), Heparin-Induced thrombocytopenia (HIT), and Thrombosis syndrome (HITTS)
What is the most common type of Thrombocytopenia? Immune Thrombocytopenia Purpra (ITP
What is Thrombocytopenia? Platelets below 150,000 (can be drug induced)
What 3 types of Thrombocytopenia are there? Immune Thrombocytopenia Purpra (ITP), Heparin-Induced thrombocytopenia (HIT), and Thrombosis syndrome (HITTS)
What is the most common type of Thrombocytopenia? Immune Thrombocytopenia Purpra (ITP)
What is a s/s of thrombocytopenia? Bleeding (watch IV site, surgery site, and mouth)
What is polycythemia? Proliferation of RBCs, WBCs, and Platelets
What are the two types of polycythemia? Secondary Polycythemia: high altitudes Primary or Polycythemia vera: chromosomal mutation
Treatments for polycythemia include? Phlebotomy, mediation, and being well hydrated.
When might a pt with thromobocytopenia be given a transfusion? Platelet count below 10,000
What tx would a pt with ITP (Immune Thrombocytopenia Purpra) receive? Corticosteriods and splenectomy
What tx would a patient with heparin-induced thrombocytopenia receive? stop heparin (forever), tx with thrombin inhibitors (Refludan, Arixtra), coumadin can be restarted.
List the 3 types of hemophilia? Type A (factor VIII), Type B (factor IX), and Von Willebrand's (deficit in factor 8 protein)
What s/s will hemophiliacs have? slow bleed, delayed bleeds, uncontrollable hemorrhage, GI, Trauma, Ecchymoses, Neuro, and Hemathrosis. Painful!
Tx for a hemophiliac's bleeding joint? Apply pressure, don't move joints till after bleeding stops, administer missing factor.
What is Disseminated Intravascular Coagulation (DIC)? A secondary condition which leads to uncontrolled bleeding due to using too much clotting factors and platelets and then running out of them.
S/s of Disseminated Inrtavascular Coagulation? Bleeding, petechiae, purpura, oozing blood
What is Neutropenia? Neutrophil count of less than 1000 to 1500.
What is Leukopenia? Decrease of total WBCs
Treatment for Neutropenia? Neupogen
Nursing management of neutropenia? Determine cause, id offending organism, antibiotics, administer hematopoietic growth, protective environment
What needs to be done to administer blood? Consent, 2nd nurse check, blood tubing for 2 units or 4 hrs, start infusion w/in 30 mins of receiving blood, infuse over 4 hrs, start slow...increase after 15 min
What 3 symptoms occur most frequently with Iron-deficient anemia? Pallor (most common), glossitis (inflammation of tongue), cheilitis (inflammation of lips).
What less common symptoms occur with iron-deficient anemia? headache, paresthesias, and a burning sensation in tongue.
Iron defiecendy affects the ______ part of Hb and Thalassemia affects the ______ part of Hb heme, globin
What is the difference between thalassemia minor and thalassemia major? minor: person has one thalassemic gene and one normal gene. Major: homozygous person (2 bad genes) causes sever form of disease.
Symptoms of thalassemia major: Pale, physical and mental retardation, symptoms by 2 yrs old, splenomegaly, hepatomegaly, jaundice.
What is the treatment for thalassemia minor? None, body adapts to reduced hemoglobin.
What is the most common cause of a Cobalamin deficiency? Pernicious anemia: gastric mucosa is not secreting IF due to antibodies directed against parietal cells or IF
Why are macrocytic RBCs easy to destroy? THey have a fragile cell membrane due to impaired DNA synthesis.
Symptoms of anemia from cobalamin defiency (megoblastic anemia)? Sore, red, beefy, shiny tongue; anorexia, nausea and vomiting; abdominal pain, and neuromuscular issues.
What does a Schilling test evaluate? parietal cell function (tests how much radioactive cobalamin is excreted)
Why must a nurse monitor heat therapy closely in a pt with pernicious anemia? Pt has diminished sensations to heat and pain resulting from neurologic impairment.
What leads to anemia of chronic disease? chronic inflammatory, autoimmune, infectious, or malignant diseases. Primarily immune driven.
What is a major focus of treatment in hemolytic anemia? To maintain renal function; increased Hb molecules can obstruct the renal tubules.
Which electrolyte imbalance causes U waves? hypokalemia
Which electrolyte imbalance causes peaked T waves or prolonged P-R intervals or a flat P? hyperkalemia
Created by: ewooda05