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Exam 4: PNR 206/ PNR206 (Latest 2024/ 2025 Updates
STUDY BUNDLE WITH COMPLETE SOLUTIONS) Medical-
Surgical Nursing II | Questions and Verified Answers|
100% Correct| Grade A- Fortis
Blood - ANSWERA connective tissue consisting of plasma (the liquid component) and formed elements (cells and cell fragments). Blood Vessels - ANSWERIncludes arteries, veins, and capillaries, which transport blood throughout the body Bone Marrow - ANSWERThe primary site for hematopoiesis (blood cell production). It is located in the medullary cavities of bones. Spleen: - ANSWERFilters blood, removes old or damaged blood cells, and plays a role in immune response. Liver - ANSWERProduces clotting factors and helps in the breakdown of old red blood cells. Lymphatic System: - ANSWERIncludes lymph nodes and lymphatic vessels that play a role in immune response and fluid balance. Hematopoiesis - ANSWERThe process of blood cell production, including red blood cells (erythrocytes), white blood cells (leukocytes), and platelets (thrombocytes). It occurs primarily in the bone marrow. Red Blood Cells (RBCs) - ANSWERCarry oxygen from the lungs to tissues and carbon dioxide from tissues to the lungs. They contain hemoglobin. White Blood Cells (WBCs) - ANSWERPart of the immune system; they protect the body against infection and foreign substances. Platelets - ANSWERPlay a crucial role in blood clotting and wound repair. Assessment of Patients with Hematologic Disorders - ANSWER1. Patient History: Symptoms: Assess for fatigue, pallor, bleeding tendencies, bruising, pain, or swelling. Medical History: Include past illnesses, surgeries, or conditions affecting blood cell production. Family History: Inquire about hereditary blood disorders or conditions.
- Physical Examination: Skin and Mucous Membranes: Check for pallor, jaundice, or petechiae (small red or purple spots). Lymph Nodes: Palpate for swelling or tenderness, indicating possible lymphoma or infection.
Spleen and Liver: Assess for enlargement (hepatosplenomegaly). Joints: Examine for swelling or pain related to bleeding disorders. Diagnostic Procedures for Hematologic Disorders - ANSWERComplete Blood Count (CBC): Purpose: Measures levels of red blood cells, white blood cells, platelets, hemoglobin, and hematocrit. Components: Hemoglobin (Hb): Measures the oxygen-carrying capacity of the blood. Hematocrit (Hct): Indicates the proportion of blood volume occupied by red blood cells. White Blood Cell Count (WBC): Assesses immune function and infection. Platelet Count: Evaluates blood clotting ability.
- Peripheral Smear: Purpose: Examines blood cells under a microscope to identify abnormalities in cell shape, size, and number. Components: Red Blood Cells (RBCs): Look for signs of anemia or other disorders. White Blood Cells (WBCs): Check for abnormal cell types or counts. Platelets: Assess for any abnormalities in platelet number or appearance.
- Bone Marrow Aspiration and Biopsy: Purpose: Evaluates bone marrow function and assesses for conditions like leukemia or aplastic anemia. Procedure: A needle is inserted into the bone (usually the hip) to extract a sample of bone marrow for examination. Anemia - ANSWERAnemia Anemia is '' Decrease in number of red blood cells (RBCs) or less than the normal quantity of Hemoglobin in the blood. WHO Grading of Anemia - ANSWER❖ Grade 1 (Mild Anemia): 10 g/dl ❖ Grade 2 (Moderate Anemia): 7-10 g/dl ❖ Grade 3 (Severe Anemia): below 7 g/dl Classification of anemia - ANSWERClassification ❑ On The Basis of Cause A. Hypo proliferative (Resulting From Defective RBC Production) B. Haemorrhagic (Resulting from RBC Loss) C. Haemolytic Anaemia (Resulting From RBC Destruction) ❑ On the Basis of Morphology A. Microcytic Anemia (Cells are smaller than normal under 80 fl) B. Macrocytic Anaemia (cells are larger than normal over 100 fl) C. Normocytic Anaemia (Cells are normal size 80-100 fl) 1.Microcytic Anaemia - ANSWERIt Occurs in Iron Deficiency Anemia and Ineffective RBC Production a result of Hemoglobin synthesis failure/insufficiency.
causes continue.....anemia - ANSWERimpaired rbc production ( deficiency of nutrition e.g., iron, vitamin B12 , vitamin B6, decreased erythropoietin production increased destruction of RBC z9 hemolytic ( abnormal hemoglobin synthesis ( thalassemia ) enzymatic defect ( glucose- 6 phosphate deficiency infection ( malaria) antibody reaction ( RH or ABO iso immunizations poisoning ( lead poisoning ) burns splenomegaly idiopathic hereditary spherocytosis •Due to Increased Blood Loss(Haemorrhagic) -Acute (Trauma,Epistaxis,Scurvy,Hemophilia etc.) -Chronic(Chronic Dysentry,Bleeding Piles,Haemorrhage etc.) •Decreased RBC Production(Bone Marrow Depression)
- Hypoplasia ,Chronic Illness (Leukaemia & Nephritis)
- TB , Neoplastic Disease , Liver Disease
- Hypothyrodism PATHOPHYSIOLOGY OF ANEMIA ( DDHS) - ANSWERdecrease in RBCs, HB, or HCT diminished o2 carrying capacity hypoxia and hypoxia induced effects on organ function signs and symptoms of anemia ''Anemia occurs when there is a decrease in red blood cells (RBCs), hemoglobin (Hb), or hematocrit (Hct), leading to a reduced oxygen-carrying capacity in the blood. This diminished oxygen supply causes tissue hypoxia, which can impair the function of various organs. A reduction in RBCs, hemoglobin, or hematocrit can result from factors such as blood loss, destruction of RBCs (hemolysis), or decreased production in the bone marrow. As oxygen delivery to tissues declines, symptoms like fatigue, weakness, dizziness, and shortness of breath arise. Organs struggle to function properly without sufficient oxygen, contributing to further symptoms like pallor, increased heart rate, and difficulty breathing ''. INVESTIGATIONS - ANSWERCBC ( Hb, hematocrit, rbc, mcv) stool hemoglobin test peripheral blood smear iron levels ferritin folate vitamin B bilirubin lead level hemoglobin reticulocyte count
LFT ( liver function test ) RFT ( renal function test ) bone marrow biopsy SIGN AND SYMTPOMS of anemia - ANSWER➢Brittle nails ➢Koilonychia (spoon shaped nails) ➢Atrophy of the papillae of the tongue ➢Angular Stomatitis ➢Brittle hair ➢Dysphagia and Glossitis ➢Plummer Vinson Syndrome /Kelly Patterson Syndrome ( Dysphagia with Iron Deficiency Anemia) Iron deficiency anemia - ANSWER➢Anemia associated with either Inadequate Absorption or Excessive Loss of Iron/Blood. ➢It is Chronic Microcytic Anemia. ➢The most common Cause of Anemia in Children is Iron Deficiency Anemia. ➢It's most common cause by Microcytic Hypochromic Anemia. (microcytic- small RBCs hypochromic- decreased red colour ) Causes ➢Insufficient Iron Supply at Birth ➢Impaired Iron Absorption ➢Blood Loss ➢Insufficient Iron Intake in Diet ➢Periods of Rapid Growth Sign & Symptoms ➢Decreases Serum Iron Level ➢Decreased Hb Level (6 to 9mg/dl) ➢Cold Hands and Feet ➢Shortness of breath ➢Fatigue ➢Sore Tongue ➢ Brittle Nails ➢Irritability ➢Pale Skin Color ➢Dizziness Nursing Management ▪Oral Iron Supplements A. Ferrous Sulphate-6 mg/kg/24 hours B. Folic Acid - 0.4 mg/Day C. Vitamin B12 - 30-100 mg IM/SC(5 to 10 Days) ▪Parent Education A. The Side effects of Iron Therapy B. The Importance of Dietary Intake of Iron
❖ Folic Acid Supplements orally Or through a Vein on a Short Termbasis until The Anemia has been Corrected. ❖ Dietary Treatment ❖ Intake of Green Leafy Vegetables and Fruits. ❖ Replacement Therapy in Case of Poor Absorption by the Intestine 3.Aplastic Anemia - ANSWERo Aplastic Anemia is Rare and Serious Blood Disorder in which Bone Marrow Stops making Enough New Blood Cells. This is Because The Bone Marrow's Stem Cells are Damaged. o The Disorder tends to get Worse over Time, Unless it's cause is Found and Treated. Resulting Pancytopenia ( Insufficient Numbers of RBCs,WBCs and Platelets) causes, sign and symptoms and nursing management of aplastic anemia - ANSWERCauses ➢ Exposure to Toxic Substances such as Arsenic, Benzene ➢Cancer Therapy ➢Use of Certain Drugs ➢Autoimmune disorder such as Rheumatoid Arthritis ➢Viral Infection such as Hepatitis, HIV etc. ➢Damage to the Stem Cells in Bone Marrow that are Responsible for Blood Cell Production. ➢Weekend Bone Marrow (Hypoparathyroidism) Sign & Symptoms •Pancytopenia
- Fatigue and Restlessness •SOB •Hypoxemia
- Irregular Heartbeat •Heart Murmur •Pale Skin , Gums and Nail beds •Fever and Frequent Infection due to Leukocytopenia
- Increases Bleeding Tendency and Pinpoint Red Bleeding spots on the Skin due to Thrombocytopenia •Oral Thrush Nursing Management ▪Blood Transfusion ▪BMT OR Stem cells Transplantation ▪Medicines : ➢Erythropoietin to Stimulates The Bone Marrow ➢ Antibiotic & Anti Viral Medicines to Prevent & Treat Infection ▪Avoid Exercise ▪Avoid Contact Sports ▪Avoid Infections Hemolytic Anemia - ANSWERThe Rupture OR Destruction of Red Blood Cells is called Hemolysis.
▪Hemolytic Anemias is a Condition in Which RBCs are Destroyed ad Removed from the Blood stream before their Normal Life Spam. It can be: I. Inherited ( Parents passed the Gene for the condition on the Baby ) e.g.-Sickle Cell Anemia & Thalassemia II. Acquired ( Baby are not Born with this condition , But Develop it due to another Disease , Condition or Factor ) Sickle cell anemia - ANSWERSickle Cell Anemia is Serious Inherited Disease RBC that assume an abnormal, rigid, sickle shape. ▪ Sickling decreases the cells' flexibility and results in a risk of various complications. ▪The sickling occurs because of a mutation in the hemoglobin gene ▪Sickle cells contain abnormal hemoglobin called sickle hemoglobin or hemoglobin S. Sickle hemoglobin causes the cells to develop a sickle, or crescent, shape. ▪Sickle cells are stiff and sticky. They tend to block blood flow in the blood vessels of the limbs and organs. Blocked blood flow can cause pain and organ damage. It can also raise the risk for infection. Signs and symptoms, medication and management of sickle cell anemia - ANSWERSign & Symptoms The most common symptom of anemia is fatigue. Other signs and symptoms of anemia include: ➢ Shortness of breath ➢Dizziness ➢Headaches ➢ Coldness in the hands and feet ➢ Paler than normal skin or mucous membranes ➢Jaundice Medications ▪Iron ▪Vitamin supplements ▪Erythropoietin injection Nursing Management o The goal of treatment is to manage and control symptoms, and to limit the number of crises. People with sickle cell disease need ongoing treatment, even when not having a crisis
Red blood cell (RBC) tests: - ANSWER▪ Red blood cell (RBC) count is a count of the actual number of red blood cells in your blood sample. ▪ Hemoglobin measures the total amount of the oxygen-carrying protein in the blood, which generally reflects the number of red blood cells in the blood. ▪ Hematocrit measures the percentage of your total blood volume that consists of red blood cells. MCV - ANSWERMean corpuscular volume (MCV) is a measurement of the average size of your red blood cells Mean corpuscular hemoglobin (MCH) - ANSWERis a calculated measurement of the average amount of hemoglobin inside your red blood cells. Peripheral Smear - ANSWERA blood film—or peripheral blood smear—is a thin layer of blood smeared on a glass microscope slide and then stained in such a way as to allow the various blood cells to be examined microscopically. it evaluates RBCs, WBC & Platelets Mean corpuscular hemoglobin concentration (MCHC) - ANSWERa calculated measurement of the average concentration of hemoglobin inside your red blood cells. Red cell distribution width (RDW) - ANSWERis a measurement of the variation in the size of your red blood cells. reticulocyte count - ANSWERwhich is a measurement of the absolute count or percentage of newly released young red blood cells in your blood sample. The three types of cells evaluated by the CBC include: - ANSWERRed Blood Cells White Blood Cells Platelets A CBC is typically performed using an automated instrument that measures various parameters, including cell counts and the physical features of some of the cells. A standard CBC includes: Red blood cell (RBC) tests White blood cell (WBC) tests Platelet tests Bone marrow aspiration and biopsy - ANSWERA bone marrow aspiration and biopsy removes a small amount of bone and a small amount of fluid and cells from inside the bone (bone marrow).
It is often done to find the reason for many blood disorders and may be used to find out if cancer or infection has spread to the bone marrow Red blood cell indices provide information on the physical features of the RBCs: - ANSWERMean corpuscular volume (MCV) is a measurement of the average size of your red blood cells
. Mean corpuscular hemoglobin (MCH) is a calculated measurement of the average amount of hemoglobin inside your red blood cells. Mean corpuscular hemoglobin concentration (MCHC) is a calculated measurement of the average concentration of hemoglobin inside your red blood cells. Red cell distribution width (RDW) is a measurement of the variation in the size of your red blood cells. The CBC may also include reticulocyte count, which is a measurement of the absolute count or percentage of newly released young red blood cells in your blood sample. White blood cell (WBC) tests: - ANSWERWhite blood cell (WBC) count is a count of the total number of white blood cells in your blood sample. White blood cell differential may be included as part of the CBC or may be done in follow up if the WBC count is high or low. The WBC differential identifies and counts the number of the five types of white blood cells present (neutrophils, lymphocytes, monocytes, eosinophils, and basophils). The individual count can be reported as an absolute count and/or as a percentage of total. Platelet tests: - ANSWERThe platelet count is the number of platelets in the blood sample. Mean platelet volume (MPV) may be reported with a CBC. It is a measurement of the average size of platelets. Platelet distribution width (PDW) may also be reported with a CBC. It reflects how uniform platelets are in size ASSESSMENT OF ANEMIA - ANSWERCurrent and past medical history Medication Surgical history Previous hematological history Anemia Bleeding disorders Disorders, injuries and transplant history involving liver, kidney and spleen History of illicit use of IV drug use and other lifestyle habits Brief overview of the anatomy and physiology of the hematologic system - ANSWER•Blood is a type of connective tissue. It is the only fluid tissue in the body and is full of fibrous proteins. •It is comprised of formed elements, which are blood cells, suspended in a fluid called plasma. •When we centrifuge blood, it will separate into its components • Densest section- erythrocytes( red blood cells) • Least dense section- yellowish plasma •They are separated by buffy coat, White layer containing Platelets as well as leukocytes( white blood FUNCTIONS OF BLOOD - ANSWERAs a whole body is responsible for distributing various substances around the body, most notably:
Hemostasis - ANSWERis the physiological process that stops bleeding at the site of an injury while maintaining blood flow elsewhere in the circulation. OR the process that body stops bleeding through vascular spasm, platelet plug formation, then coagulation/ blood clotting Erythropoiesis - ANSWERErythropoiesis is the development of mature red blood cells from erythropoietic stem cells HEMOPHILIA - ANSWER• Hemophilia is a inherited X linked recessive and lifelong blood disorder where an essential blood clotting factor is either party or completely missing
- Hemophilia can be acquired, very rare.
- It occurs in all racial groups and affects about 1 in 10,000 of the male population TYPES OF HEMOPHILIA - ANSWERHAEMOPHILIA A, b and c HAEMOPHILIA A - ANSWER- most common type of hemophilia ( severe ) also known as factor VIII ( 8 ) Anti-Hemophilic Factor deficiency or classic hemophilia
- Hemophilia A is the most common form of hereditary clotting factor deficiencies.
- The prevalence: 30-100/million population.
- Inheritance is X linked
- 30% may results from spontaneous mutation.
- The defect is an absence or low level of plasma factor VIII. COAGULATION FACTORS - ANSWERFactor I (1) - Fibrinogen Factor II (2) - Prothrombin Factor III (3) - Tissue factor (Tissue Thromboplastin) Factor IV (4) - Calcium Factor V (5) - Labile factor (Proaccelerin) Factor VII (7) - Serum Prothrombin Conversion Accelerator (SPCA) Factor VIII (8) - Anti-Hemophilic Factor Factor IX (9) - Partial Thromboplastin Component (PTC); Christmas Factor Factor X (10) - Stuart-Prower Factor Factor XI (11) - Plasma Thromboplastin Antecedent (PTA) Factor XII (12) - Hagemann factor Factor XIII (13) - Fibrin stabilizing Factor spontaneous mutation - ANSWERin 30% cases of hemophilia there is no known family history
hemophilia is probably the result of spontaneous genetic mutation in these families GENERAL SYMPTOMS of hemophilia - ANSWER-bleeding into muscles/joints causes pain and swelling -frequent nose bleeds and abnormal bleeding after injury and surgery -blood found in urine and easy bruising SIGN & SYMPTOM of hemophilia - ANSWER-external bleeding
- Bleeding in the mouth from a cut or bite or from cutting or losing a tooth.
- Nosebleeds for no obvious reason.
- Heavy bleeding from a minor cut.
- Bleeding from a cut that resumes after stopping for a short time. -internal bleeding
- Blood in the urine (from bleeding in the kidneys or bladder).
- Blood in the stool (from bleeding in the intestines or stomach -bleeding in joints
- Bleeding in the knees, elbows, or other joints is another common form of internal bleeding in people who have hemophilia.
- The bleeding causes tightness in the joint with no real pain or any visible signs of bleeding. The joint then becomes swollen, hot to touch, and painful to bend. -bleeding in brain
- Long-lasting, painful headaches or neck pain or stiffness.
- Sudden weakness or clumsiness of the arms or legs or walking problems.
- Double vision
- Convulsions or seizures common sites for bleeding for hemophilic patients - ANSWER-soft tissue bleeds and bruising no functional impairment tenderness but no severe pain no factor needed thigh, calf bleeds pain with/without swelling impaired mobility routine factor dose if compartment syndrome is suspected neck swelling-EMERGENCY potential airwayt compromise
- Anti FVIII : should be tested
- DNA analysis:
- Antenatal diagnosis and carrier detection LABORATORY FINDINGS OF HEMOPHILIA B - ANSWER• APTT: Prolonged: corrected with Aged plasma.
- PT & BT: Normal
- TT and Fibrinogen: Normal
- PLT count : Normal
- F IX activity: decreased
- Anti FIX : should be tested
- DNA analysis: ➢ Antenatal diagnosis and carrier detection TREATMENT OF HEMOPHILIA B - ANSWER• F IX concentrate
- Infusions do not have to be given as frequently as F VIII. •Recombinant F IX is now available. HAEMOPHILIA B - ANSWER• First described in 1947 by pavlovsky.
- Hemophilia B, also called factor IX (FIX) deficiency or Christmas disease ( Factor IX (9) - Partial Thromboplastin Component (PTC); Christmas Factor)
- It is a genetic disorder caused by missing or defective factor IX, a clotting protein.
- Inheritance and clinical features are identical to Haemophilia A.
- Only can be distinguished by specific coagulation factor assays.
- Incidence 1/5th that of Haemophilia A.
- F IX gene is close to that of F VIII.
- Carrier detection and antenatal diagnosis are similar to those of A.
HAEMOPHILIA C INHIBITORS - ANSWER• 30% of people with haemophilia( more commonly A) develop an antibody to the clotting factor they are receiving for treatment. These antibodies are known as inhibitors.
- These patients are treated with high does of FVIIa for bleeds or surgery. This overrides defect in FVIII or FIX deficiency.
- Longterm management involves attempting to eradicate inhibitors by administering high dose FVIII (or FIX) in a process called immune tolerance ACQUIRED HEMOPHILIA - ANSWER• It is rare and not due to genetics.
- It develops due to an illness wherein the body makes autoantibodies that inhibit clotting factors from working normally.
- Some cases are attributed to pregnancy, cancer, drug reactions, or immunological problems. HAEMOPHILIA C - ANSWER• Described in 1953.
- mild form of hemophilia
- Due to F XI deficiency. (Factor XI (11) - Plasma Thromboplastin Antecedent (PTA)
- Mild disease without bleeding in the joints and Prolonged bleeding from injuries.
- Frequent or heavy nosebleeds, Traces of blood in the urine, Heavy menstrual bleeding in females.
- Inheritance: autosomal recessive the gene for factor XI is located on chromosome
- Usually causes excess bleeding after trauma such as surgery.
- Treated by F XI concentrate. Hemophilia general idea - ANSWERdefinition- autoimmune inherited ( genetic ) X linked recessive disorder ( 13 clotting factors in body ) hemophilia A factor VIII 8 APTT: prolonged corrected by absorbed plasma PT & BT: normal TT & fibrinogen: Normal PLT count: normal F VIII activity : decreased Anti F VIII should be: should be tested
chronic renal failure- significant decrease in renal function long period- irreversible GENE THERAPY - ANSWER• Researchers are trying to develop ways to correct the defective gene's that cause hemophilia
- Such as gene therapy hasn't yet developed to the point that its an accepted treatment
- Researchers continue to test gene therapies for hemophilia in clinical trails Acute renal failure - ANSWER▪ ARF is a 50% or greater increase in serum creatinine above baseline (normal creatinine is less than 1.0 mg/dL) ▪ characterized by azotemia (azotemia is when there's too much nitrogen and waste products in your blood. These waste products develop when your body breaks down protein in foods and drinks you ingest ). that progresses over several hours or days, with or without oliguria ▪ Urine volume may be normal, or changes may occur. ▪ Oliguria (less than 400 mL/day), ▪ Nonoliguria (greater than 800 mL/day), or ▪ Anuria (less than 100 mL/day)- lack of urine RENAL FAILURE DEFINITION - ANSWER▪ Kidneys cannot remove the body's metabolic wastes or perform their regulatory functions. ▪ Nitrogenous wastes accumulate in the blood as a result of impaired renal excretion, affecting endocrine and metabolic functions , fluid, electrolyte, and acid-base disturbances. Causes of Acute Renal Failure - ANSWER1. prerenal- hypoperfusion of the kidney
- intrarenal- actual damage to the kidney tissue
- postrenal;- obstruction to urine flow TYPES OF ACUTE RENAL FAILURE - ANSWER1. Prerenal, (caused by transient renal hypoperfusion due to hypotension, decreased cardiac output, decreased effective arterial blood volume
- Postrenal (obstruction to urine flow). due to obstruction of the urinary tract.
- intrinsic -acute glomerulonephritis ( involves inflammation and damage to the glomerular membrane
- an allergic reaction may be caused by a variety of drugs -acute tubular necrosis- accounts for more than 50% of cases of acute renal failure, causes - nephrotoxic agents, prolonged renal hypoperfusion Lab value-changes in acute renal failure - ANSWER-Creatinine (0.6-1.2 mg/dl
- Help determine Kidney function. Increase-
- Decreased kidney function -Creatinine clearance
- F- 85-125 ml/min.
- Male- 95-140ml/min -GFR (>90ml/min)
- Decrease- less output, more H
- HTN, edema, Azotemia, acidosis
- Increased K+, Phosphates, calcium BUN-Elevated 6-20mg/dl (blood urea nitrogen (BUN) test measures how much urea nitrogen is in your blood) PHASES OF ACUTE RENAL FUCNTION - ANSWER1. initiation- kidneys injury signs
- oliguria- decreased OP, waste increases, neurologic changes, itching, K+ increase, fluid retention, acidosis, respiratory changes
- Diuresis period- reversal of S & S, hypovolemia, hypotension, dehydration
- recovery phase- GFR- normal, waste in blood- normalize PATHOPHYSIOLOGY OF ARF - ANSWER▪ Presence of specific underlying problem reduce blood flow to the kidney and impair kidney function: ❖ Hypovolemia- Reduced blood volume (e.g., dehydration or blood loss) decreases blood flow to the kidneys, leading to ischemia and impaired kidney function. ❖ Hypotension- Low blood pressure (due to shock or sepsis) reduces perfusion to the kidneys, lowering the glomerular filtration rate (GFR) and causing toxin buildup. ❖ Reduced cardiac output & cardiac failure-Poor heart function reduces blood flow to the kidneys, causing prerenal azotemia and possible kidney damage (acute tubular necrosis). if these issues are not corrected promptly, the prolonged reduction in kidney perfusion
