Medsurg Nurs 324 Final Exam bone marrow aspiration and biopsy ANS Invasive procedure cells fluids suctioned from the bone marrow w large bore needle Diagnostic Blood disorder anemia or thrombocytopenia Diseases or infections of the bone marrow leukemia or infection Staging lymphoma or other cancers Procedure and nursing interventions Iliac crest site most common or sternum Local anesthetic agent and sedation benzo Sterile technique position side lying or prone Nursing priorities after procedure Pressure to site with bleeding complications Ice to site for pain minimize bleeding and bruising Infection risks Pain management Anemia manifestations ANS pallor cold skin brittle nails rapid HR ortho HTN SOB fatigue numbness tingling types of anemia ANS iron deficiency vit B12 folic acid sickle cell disease Iron deficiency anemia ANS cause Gi ulcers alc diet malab interventions Increasing oral intake of iron from food sources Red meat egg yokes kidney beans green leafy vegtables folate vit B12 def anemia ANS cause diet pernicious anemia specific symptom red sore smooth tongue and paresthesia in hands feet interventions Increase foods in vitamin B12 Animal protein fish eggs nuts dairy green leafy vegtables folate complication of anemia ANS Heart failure Increased oxygen demand on the heart Low HCT decreases oxygen carrying to tissue organs making heart work harder and faster to compensate hypovolemia types of thrombocytopenia purpura ANS ATP thrombocytopenia purpura TTP heparin induced thrombocytopenia HIT Thrombocytopenia purpura TTP ANS Autoimmune reaction small blood vessels trigger abnormal platelet clumping Complications ischemic tissues kidney failure MI stroke fatal Heparin induced thrombocytopenia HIT ANS Immune mediated clotting disorder after Heparin Tx Drug reaction any type of heparin High risk treated with unfractionated heparin 1 Symptoms red painful warm swelling of the lower extremities thrombocytopenia purpura interventions ANS High risk for poor clotting and excessive bleeding Platelet transfusions 10K Monitor trends subtle cues VS assessments Safety to avoid injury Drug therapy Anticoagulants direct thrombin inhibitor HIT DIC Corticosteroids and immunosuppressants Antiplatelets Aspirin for TTP Surgical management Splenectomy drug therapy ineffective sickle cell disease interventions ANS 1 manage pain w opioid analgesics prevent sepsis and MODS hydration oxygen HOB less than or equal to 30 extremities extended sickle cell anemia labs ANS low Hct high reticulocyte and bilirubin sickle cell crisis symptoms ANS pain throbbing sharp stabbing sickle cell crisis triggers ANS high altitudes cold weather heavy physical labor sickle cell crisis prevention ANS hydration 3 4 L day avoid alc smoking avoid strenuous exercise do low impact leukemia interventions ANS 1 infection protection prevention PPE neutropenic precautions High risk with chemotherapy or bone marrow transplant Private room screen visitors Prevention of bacteria virus no live plants flowers Encourage personal hygiene encourage rest nutrition fluids sleep lymphoma nursing interventions ANS Infection risk anemia NV skin issues radiation infertility Close monitoring of infusion related reactions Blood components that are typed AND crossmatched ANS PRBC PRBC with washing FFP blood components that are typed but NOT crossmatched ANS platelets albumin PRBC transfusions ANS Infuse 2 4 hours Adults who have Rh positive blood can receive an RBC transfusion from a Rh negative donor but Rh negative adults must not receive Rh positive blood transfusion therapy nursing interventions ANS Pre initial therapy Informed consent Lab order IV access 18G or bigger CVAD Safety checks verify with RN Assess full VS temp Assess history of blood transfusions or reactions Drug therapy Verify and double check by two RN s Prime 0 9 NS prior to blood product blood tubing Infuse slow MD order or hospital policy stay with patient 15 30 minutes VS temp Severe reactions typically within first 15 minutes 50ml of blood Post therapy VS discontinue infusion dispose to agency blood bank policy document febrile transfusion reaction ANS acute occurs 2 hr chills tachycardia fever increased by 1 C or 2 F acute hemolytic transfusion reaction ANS Blood or Rh incompatibility Mild to severe reaction Fever chills tachycardia chest pain mild DIC and circulatory collapse severe transfusion reactions nursing interventions ANS stop infusion for all reactions Rapid response team ABC s are 1 priority Remove blood tubing flush with NS Close monitoring with subtle changes Return all components to laboratory hospital policy neurovascular assessment ANS CMS circulation movement sensation palpate pulses is C phosphorus ANS 3 0 4 5 ALP ANS 30 120 LDH ANS 100 190 AST ANS 0 35 ALD ANS 3 8 2 arthroscopy follow up care ANS Priority is neurovascular status every hour Monitor and document distal pulses warmth color cap refill pain movement and sensation of affected extremity Encourage patient to preform pre taught exercises Mild analgesic Acetaminophen APAP Ice Elevation Monitor for complications Swelling increased joint pain attributable to mechanical injury Thrombophlebitis Infection causes of secondary osteoporosis ANS DM hyperthyroidism hyperparathyroidism RA immobilization bone cancer cirrhosis HIV corticosteroids antiepileptic drugs barbiturates ethanol high thyroid hormone cytotoxic agents immunosuppressants loop diuretics aluminum based antacids osteoporosis labs ANS calcium Total 25 hydroxyvitamin D D2 plus D3 25 and 80 ng mL osteocalcin BSAP osteoporis imaging ANS DXA T score 1 or 1 equal to the norm for health young adult 1 to 2 5 low bone mass osteopenia 2 5 or lower osteoporosis osteoporosis nutrition calcium ANS Dairy beans leafy greens 4 5 foods 1200 mg over 50 and 1000 less than 50 of calcium per day and space it out throughout the day osteoporosis nutrition Vit D ANS Vitamin D is from the sunshine or fatty fish like salmon and sardines fortified dairy eggs and some foods Vitamin D per day or less than 70 you want 600IU older than 70 you want greater than 800IU osteoporsis nursing interventions ANS avoid jarring exercises Drug therapy relate back to T score Indicated when T score for hip or lumbar spine is 2 5 with no other risk factors Or when T score is below 1 5 with risk factors or previous fracture Or age 50 who had a hip or vertebral fracture Calcium and vitamin D3 if dietary intake is inadequate Oral bisphosphonates Alendronate or risedronate Osteomyelitis