Fluid and Electrolyte, Hematology
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| What is the major extracellular cation? | Sodium
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| What is the normal range for sodium in the body? | 135-145 mEq/L
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| What 2 functions does sodium perform in the body? | -Determines plasma osmolality and regulates water balance.
-Promotes neuromuscular response (ex: sodium/potassium pump).
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| What organ primarily regulates sodium levels? | Kidneys
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| What is a condition usually associated with hypervolemia sometimes referred to as water intoxication? | Hyponatremia
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| 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.
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| What are s/s of hypernatremia? | Lethargy, weakness, irritability, neuromuscular excitability, decrease LOC, seizures, etc.
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| 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.
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| What is the normal range for potassium? | 3.5 - 5.0 mEq/L
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| What is the major intracellular cation? | Potassium
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| What is potassium responsible for? | Maintaining action potentials in muscles, neurons, ect. Controls cardiac rate, rhythm, skeletal muscle contraction and function of smooth muscles.
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| What can eating a lot of black licorice do to your electrolyte levels? | Can cause excess K+ wasting.
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| What does Addison's disease do to k+ levels? | decreased aldosterone leads to NA depletion and K+ retention.
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| What are s/s of hyperkalemia? | Malaise, palpitations and muscle weakness.
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| What are some ways to reduce K+ levels? | Short-term: insulin injection. Diuretic and kayexalate.
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| What are normal ranges for calcium levels? | 8.6 - 10.2
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| 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
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| 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.
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| What is a common cause of hypomagnesium? | NG Suction
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| What types of people does hypophosphatemia occur in? | Alcoholics and elderly people with poor dietary habits.
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| What condition usually exists for hyperphosphatemia to develop? | Generally poor kidney function.
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| What fluids are isotonic? | Normal plasma, NS, and Lactated Ringers.
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| What does a blood cell do in a hypotonic solution? | Pulls water into the blood cell forming a blood donut.
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| What does a blood cell do in a hypertonic solution? | Pulls water out of cell into a shriveled up little blood raisin.
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| Which groups of people are most at risk of dehydration? | Elderly and infants. Also people who are sick or exercise in the heat.
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| If someone is dehydrated what might their hematocrit look like? | Normal to high.
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| Risk factors for fluid overload (excess fluid volume) are? | Having CHF, renal failure, taking corticosteriods, and high levels of aldosterone.
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| What are some s/s of fluid overload? | peripheral edema, extra heart sounds, crackles in the lungs, 3rd spacing, weight gain, jvd, clear urine.
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| 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%
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| What events can cause anemia? | Too few or poor quality of RBCs, blood loss, RBC production or destruction problems.
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| What is a normal hematocrit percent? | Male: 40 - 50 %
Female: 38 - 47 %
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| What is a normal hemoglobin amount? | Male: 13.5 - 18
Female: 12 - 16 g/dl
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| What is a normal platelet count? WBC count? | Platelet: 150,000 - 400,000
WBC: 4,000 - 11,000
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| During a blood transfusion, what happens to hematocrit and hemoglobin levels? | They should both increase.
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| What hemoglobin lab results would be seen for mild, moderate and severe anemia? | mild: 10 - 14
moderate: 6 - 10
severe: <6
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| What 6 ingredients are necessary for erythropoiesis? | Cobalamin (Vit B12), Folic Acid, Iron, Vit B6, Amino Acids, and Vit C.
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| What is the most common anemia? | Iron deficiency anemia
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| What is a major cause of iron deficiency? | Blood loss
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| Where is iron absorbed? | duodenum
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| What tx should be given to treat iron deficiency anemia? | Fix the bleeding, give iron or packed RBCs.
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| 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.
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| What is Thalassemia? | An autosomal recessive disease that causes insufficient production of normal Hb. Ethnic groups in Mediterranean sea and equitorial regions.
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| 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.
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| What causes Megaloblastic anemias? | A Cobalamin Deficiency
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| What are the 2 megaloblatic anemia types? | Pernicious anemia (most common) and folic acid deficiency.
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| 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.
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| What types of people suffer from folic acid deficiency? | Those with poor nutrition, malabsorbtion syndromes, certain drugs, alcoholics, and dialysis pts.
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| 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.
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| What is aplastic anemia? | A decrease in all blood cell types. It is congenital. These pts have poor outcomes.
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| What s/s may someone have with hemolytic anemia? | Severe pain (back, chest, extremities, and abdomen) and pallor.
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| What is Thrombocytopenia? | Platelets below 150,000 (can be drug induced)
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| What 3 types of Thrombocytopenia are there? | Immune Thrombocytopenia Purpra (ITP), Heparin-Induced thrombocytopenia (HIT), and Thrombosis syndrome (HITTS)
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| What is the most common type of Thrombocytopenia? | Immune Thrombocytopenia Purpra (ITP
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| What is Thrombocytopenia? | Platelets below 150,000 (can be drug induced)
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| What 3 types of Thrombocytopenia are there? | Immune Thrombocytopenia Purpra (ITP), Heparin-Induced thrombocytopenia (HIT), and Thrombosis syndrome (HITTS)
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| What is the most common type of Thrombocytopenia? | Immune Thrombocytopenia Purpra (ITP)
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| What is a s/s of thrombocytopenia? | Bleeding (watch IV site, surgery site, and mouth)
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| What is polycythemia? | Proliferation of RBCs, WBCs, and Platelets
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| What are the two types of polycythemia? | Secondary Polycythemia: high altitudes
Primary or Polycythemia vera: chromosomal mutation
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| Treatments for polycythemia include? | Phlebotomy, mediation, and being well hydrated.
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| When might a pt with thromobocytopenia be given a transfusion? | Platelet count below 10,000
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| What tx would a pt with ITP (Immune Thrombocytopenia Purpra) receive? | Corticosteriods and splenectomy
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| What tx would a patient with heparin-induced thrombocytopenia receive? | stop heparin (forever), tx with thrombin inhibitors (Refludan, Arixtra), coumadin can be restarted.
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| List the 3 types of hemophilia? | Type A (factor VIII), Type B (factor IX), and Von Willebrand's (deficit in factor 8 protein)
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| What s/s will hemophiliacs have? | slow bleed, delayed bleeds, uncontrollable hemorrhage, GI, Trauma, Ecchymoses, Neuro, and Hemathrosis. Painful!
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| Tx for a hemophiliac's bleeding joint? | Apply pressure, don't move joints till after bleeding stops, administer missing factor.
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| 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.
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| S/s of Disseminated Inrtavascular Coagulation? | Bleeding, petechiae, purpura, oozing blood
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| What is Neutropenia? | Neutrophil count of less than 1000 to 1500.
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| What is Leukopenia? | Decrease of total WBCs
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| Treatment for Neutropenia? | Neupogen
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| Nursing management of neutropenia? | Determine cause, id offending organism, antibiotics, administer hematopoietic growth, protective environment
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| 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
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| What 3 symptoms occur most frequently with Iron-deficient anemia? | Pallor (most common), glossitis (inflammation of tongue), cheilitis (inflammation of lips).
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| What less common symptoms occur with iron-deficient anemia? | headache, paresthesias, and a burning sensation in tongue.
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| Iron defiecendy affects the ______ part of Hb and Thalassemia affects the ______ part of Hb | heme, globin
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| 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.
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| Symptoms of thalassemia major: | Pale, physical and mental retardation, symptoms by 2 yrs old, splenomegaly, hepatomegaly, jaundice.
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| What is the treatment for thalassemia minor? | None, body adapts to reduced hemoglobin.
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| 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
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| Why are macrocytic RBCs easy to destroy? | THey have a fragile cell membrane due to impaired DNA synthesis.
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| Symptoms of anemia from cobalamin defiency (megoblastic anemia)? | Sore, red, beefy, shiny tongue; anorexia, nausea and vomiting; abdominal pain, and neuromuscular issues.
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| What does a Schilling test evaluate? | parietal cell function (tests how much radioactive cobalamin is excreted)
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| 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.
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| What leads to anemia of chronic disease? | chronic inflammatory, autoimmune, infectious, or malignant diseases. Primarily immune driven.
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| What is a major focus of treatment in hemolytic anemia? | To maintain renal function; increased Hb molecules can obstruct the renal tubules.
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| Which electrolyte imbalance causes U waves? | hypokalemia
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| Which electrolyte imbalance causes peaked T waves or prolonged P-R intervals or a flat P? | hyperkalemia
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