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NURS 316 B Exam 3 Latest 2025 SPRING SUMMER
SEMESTER California State University
Tx for Megaloblastic Anemia Folic Acid (Leucovorin): PO, IV, IM or SC Vit B12 (Cyanocobalmine): IM qMonthly or Nasal Tx for iron deficiency anemia Ferrous drugs: IM in z-track pattern Contra: Hemolytic anemia, GI issues (hx ulcers, colitis, enteritis), Hemochromatin ( ++ Iron) Drug-drug: Antiinfectives, levodopa, antacids (all dec absorb), Chloramphenicol (iron tox.) Pt teaching re: Ferrous drugs Takes 2-3 weeks to see improvement and 6-10M to stabilize levels Dark stools, potential for tissue staining @ injection site Drug-food interactions w. eggs, dairy, tea, coffee Maintain 2hr window from antacid and ferrous consumption folic acid (Leucovorin) indications (3) Pregnancy Megaloblastic anemia
w. methotrexate to save cells in CA. Sickle Cell Anemia tx Hydroxurea PO: inc fetal hgb production Contra: breastfeeding, leukopenia, hepatic/renal dysfunction. Adverse: Bone marrow suppression, rash, stomatitis Drug-Drug: Uricosuric agents ( inc uric acid levels) Ertyhropoietin Stimulation Agents (Alfa's) Action: Stimulate RBC prod. Ind: Anemia r/t renal failure, AID's therapy, chemo Contra: allergy to albumin* Normal renal function/ erythropoietin levels, HTN. Indication for Epoetin Alfa (Procrit, Epogen)? Renal failure secondary to AIDS Indication for Darbopoetin Alfa (Aranesp) or Methyl Polyethylene Glycol (Mircera)? Chronic renal failure Pt teaching re: Erythropoietin stimulating agents (Alfa's) Risk of antibody production
Ind: Thrombus (MI, PE) Given IV Contra: Recent sx/trauma/delivery, GI bleed >2M Adverse: Hypotension, bleeding, arrhythmia Drug-Drug: Anticoags, anti platelets ( Incr bleeding) Low-Molecular Weight Heparin (-parin's) Blocks Factor Xa and 1ia (stops thrombus formation), also blocks angiogenesis in CA cells Ind: Clot prevention post-op 7-14D w. dec. adverse effects Drug-Drug: Nitroglycerin Tx for heparin allergy (Heparin- induced thrombocytopenia) Lepirudin Tx for heparin OD Protamine Sulfate Vitamin K Given for prothrombin deficiency Given post birth to prevent hemorrhage
Tx for warfarin bleeding Prothrombin Complex Hemorrhagic Agent: Pentoxyfylline Action: Dec platelet aggregation and fibrinogen core Ind: Intermittent Claudication Monitor pt CV status Systemic Hemostatic Agent (Aminocaproic Acid) : stop bleeding Action: Inhibits plasminogen activation Contra: Acute DIC, heart disease, renal/hep dysfunction Adverse: Dec cerebral BF = hallucinations, headache., muscle pain, renal dysfunction Drug/Drug: Heparin, oral contraceptives Topical Hemostatic (Gelatin:Gelfoam , Fibrin: Ericel, Collagen: Avitene, thrombin) Ind: slow bleeding wounds/ulcers Adverse: Infection from gelatin/collagen sponge. Antihemophilic Agents (Control bleeding via IV) Action: Replaces clotting factors VIII, Ix, and VIIa Ind: hemaphillia, liver disease, hemorrhage, bone marrow disorders Adverse: Flu-like, reaction at IV site
Drug/Drug: Anticoags, Vorapaxar/ CYP3A inhibitors Foods that increase bleeding (A,CCC,GGGGG,P,T) Angelica, Chamomile, Cats Claw, Chondrotin, Garlic, Ginger, Gingko, Ginseng, Green tea, Psyllium, Turmeric Peds Anticoagulant rules Warfarin for pre-op Heparin based on weight/age All - ase drugs, anti platelets, thrombolytics are contraindicated Geriatric anticoagulants rules Start at lowest dose and gradually increase Routine liver/kidney function tests What is a thrombolytic disorder? Thrombi formation = dec. blood flow Ex. CAD What are 3 hemorrhagic disorders bone marrow = dec. platelet formation
Hemophilia = no clotting factor Liver disease = no protein or clotting factor Multiple Myeloma Pt develops bone lesions in skull and long bones + hypercalcemia r/t pathologic fractures (B-cells perform plasma cell dyscrasia due to deletion/translocation on chromosome --> decreased cell immunity --> nuclear factor xB ligand activates --> osteoclasts proliferate ---> bone lesions form in skull and long bones + pathologic fractures create hypercalcemia) Risk Factors for Multiple Myeloma Age: 60+ Exposure to Agent Orange (From Vietnam War) Pesticide/hebicide exposure Hx autoimmune/ chronic immune stimulation Dx for Multiple Myeloma Hypercalcemia + Anemia + low albumin Tx for Multiple Myeloma Chemo: Doxorubicin, Vincristine Monoclonal antibodies (immune boosters): - mab's, Prolia Proteasome Inhibitors (eat proteins in myeloma cells): - mibs Stem cell transplant
What is the purpose of immunophenotyping? Determines leukemia lineage What is the purpose of Cytogenic Studies? Determines prognosis by looking at chromosomal abnormalities tx for leukemia chemo Induction therapy: elicits remission Intensification: maintains remission bone marrow/ stem cell transplant (last resort) Criteria for Remission < 5% blasts in marrow Normal peripheral blood count No cytogenic abnormalities Back to pre-illness PPS Age is biggest factor Complications of Acute Leukemia
Leukostasis (Inc blood viscosity): Dyspnea, headaches Hyperuricemia ( Inc nucleotides): tx w. prophylactic rasburicase Nosebleeds, ecchymosis, inc infections. What are the two classes of Leukemia? Lymphocytic: In spleen, lymph nodes, NCS Myelocytic: Interfere w. all blood cell maturation from granulocytes and monocytes Acute vs Chronic leukemia (location of malignancy) Acute: In progenitor cells and sudden onset Chronic: In mature myeloid and lymphoid cells Chronic Lymphocytic Leukemia (CLL) Origin, S&S, Dx, Tx. Most common leukemia ( in adults) mainly 67-72yrs Action: Malignancy in b-cells S&S: Asymptomatic at first..once disease spreads: thrombocytopenia, lymphadenopathy, splenomegaly, inc strep and pneumonia infection Dx: Isolated lymphocytosis + WBC > 20k/uL Tx: low risk = no tx Intermediate: corticosteroid for complications Aggressive: chemo or stem cell transplant
S&S: During prodromal period: flu-like + pharyngitis, lymphadenopathy w. petechiae @ groin and axillary nodes Dx: Inc IgM and IgG levels, mono spot for heterophilic antibodies Tx: Symtom control Hodgkin's lymphoma: Origin, S&S (stages), Dx, Tx. Presence of Reed-Sternberg cell (Large mononuclear tumour from b-cell) **** Originates in a node/node chain**** S&S: Stage A: Asymptomatic Stage B: Night sweats, weight loss Stage Advanced: Fatigue + anemia Dx: Lymph node biopsy for RS cell, CT abd + chest (check lymph node involvement, bipedal lymphangiogram (check tiny lymph nodes), bone marrow biopsy (for malignancy) Tx: Radiation and chemo combo Non-Hodgkin's Lymphoma: Origin, S&S, Categories, Tx No Reed-Sternberg cell** Starts in B, T or NK cells, then spreads into nodes*** S&S: Indolent stage: Mesentery/pelvic lymph node swelling Aggressive: Weight loss, night sweats, fatigue Categories: Low grade (B cells) Intermediate ( B + T cels) High Grade ( B, T, Burkett and non-burkitt cells) Tx: Radiation + Monoclonal antibodies (-mab's)
Hodgkin's vs Non-Hodgkin's lymphoma (Origin, s&s and tx differences) Hodgkins: RS cells, originates in node, anemia, chemo in tx Non-hodgkins: No RS cells, originates in B, T or NK cells, lymph swelling in pelvis, monoclonal antibodies in tx What causes Neoplastic Disorders? Chromosomal abbreviations from B-T cell genes myeloid stem cells produce Monoblasts or Myeloblasts Myeloblasts develop into neutrophils, eosinophils, basophils (Granular leukocytes) monoblasts develop into monocytes Monocytes develop into macrophages/dendritic cells
Myeloid tissue: location and function Location: Bone marrow Function: Blood cell production/ immature growth Lymphoid tissue: Location and function Location: Thymus, spleen, lymph nodes and vessels Function: Cell differentiation: B-lymphocytes in lymph follicles, T- lymphocytes in thymus..then t-cells move into paracortex of lymph nodes. Leukopenia: Definition and level Low WBC count: < 5000 cells/uL Neutropenia: Definition, level, cause and S&S Low neutrophil count <1000/uL Causes: Leukopenia, bone neoplasms, drugs, felty syndrome S&S: mimics bacterial infection ( fever, chills, fatigue) Hyperbilirubemia (cause, who's most at risk, onset age, tx) Jaundice r/t inc RBC breakdown at 5-7D old At Risk: asian descent, prematurity, and diabetics Tx: Phototherapy (converts uncongugated bili into congugated so it can be excreted), monitor baby temp and hydration
Kernicterus (bilirubin encephalopathy) Action/cause, S&S Brain damage to basal ganglia from untreated hyperbilirubinemia (levels 25>) S&S: lethargy, tonic motions such as backward arching of the neck and trunk, hypotonia Hemolytic Disease (Newborns) Action, cause, tx Agglutination + hemolysis ---> enlarged liver + spleen --> Hydrops Fetalis (Edema) + inc bilirubin. Cause: Rh- mom and Rh+ baby, usually @ 2nd pregnancy Tx: Rh immunoglobin @ 28wks + @ delivery Exchange transfusion: Replaces baby blood w. Rh- and removes bilirubin and hemolyzed RBC's. How does erythropoiesis change at middle age? Hbg and progenitor cells dec. RBC prod changes to axial skeleton Inflamm cytokines inc Dec sensitivity to erythropoietin (therefore dec response to hypoxia) How does erythropoiesis change in newborns? Hbg highest at birth, dec at 6 weeks --> pallor and dec weight gain Hbg life span: short ~ 50-70D Hbf changes to HBa --> inc O2 in tissues r/t dec affinity
Cells "sickle" when deoxygenated, return to normal in lungs S&S: chronic hemolytic anemia, pain, organ failure Tx: Hydroxyurea PO, pain control Pediatric Sickle Cell Disease (B-Thalassemia) Cause, S&S, Tx Cause: Excess alpha chain form heinz body which impairs DNA synthesis and damages RBC membrane Shows at 6-9M S&S: osteoporosis, enlarge maxilla and frontal bone, spleen and hepatomegaly Tx: Blood transfusions (Maintain Hbg, iron chelation therapy) Stem Cell transplant (Cure for youngsters) Aplastic Anemia (Presentation, cause, S&S, Dx, Tx) Low RBC, WBC, platelets (Pancytopenia) Cause: Chemicals, infection (Hep, virus), Radiation, chemo, benzene/aklylating agent exposure S&S: Gradual fatigue, petechiae, ecchymosis, nosebleeds, inc illness Dx: Pancytopenia + hx virus or immunosuppressant use Tx: Stem Cell Transplant Cause of Chronic Disease Anemia and explanation Most often: Chronic renal failure Also, chronic infections, inflammation, cancer Damage = dec erythropoietin...dec differentiation = dec RBC count
2 types of Chronic Disease Anemia G6PD: Hereditary. dec glucose- 6 - phosphate dehydrogenase causes damage in hemoglobin leading to RBC lysis A-Thalassemia: Hereditary. Common in Asian descent Dec Hbg synthesis r/t gene deletion leads to chronic moderate hemolytic anemia Pt's require blood transfusions when sick Methotrexate use can cause which type of anemia? Folic Acid Deficiency Megaloblastic Anemia (Cobalamin) Cause, S&S, Dx, Tx Cause: Diet (No dairy, meat, fish) or gastritis S&S: Parenthesis in fingers/toes, no sense of position, inc MCV Dx: Presence of parietal cells and instrinsic factor antibodies Tx: Vit B12 for life Pernicious Anemia (Cause) Cause: Secondary to b12 - lack of intrinsic factor from dec. b12 absorption in stomach (from gastritis)
