Lippincott Certification Review Medical-Surgical Nursing

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Hemophilia

Box 8-1: Types of Anemia (continued)

Description and Etiology

Signs and Symptoms

Medical Management

Nursing Interventions

Megaloblastic anemia Anemia characterized by a predominance of megaloblast RBCs and a relative lack of normal RBC; includes pernicious, vitamin B 12 deficiency, and folic acid deficiency anemias • Gastric surgery, particularly of the terminal ileum where vitamin B 12 is absorbed; strict vegetarian diets; and prolonged exposure to nitrous oxide • Aging and long-term gastritis (pernicious anemia) • Alcoholic malnutrition and malabsorption (folic acid deficiency anemia)

• Provide care for oral mucous membranes to help relieve glossitis. • Teach the patient how to increase dietary intake of folic acid and vitamin B 12 . • Refer the patient with anemia related to alcohol • If the patient has a vitamin B 12 deficiency, teach them about long-term treatment with an oral or parenteral vitamin B 12 supplement. Treatment typically calls for IM administration of cyanocobalamin (B 12 ). misuse to an alcohol treatment program.

• Fatigue, loss of coordination, neuropathy, and paresthesia of the extremities • Gastritis, glossitis (red, beefy tongue), and malabsorption with anorexia and weight loss • Decreased RBC, platelet counts, and vitamin levels.

• Monthly administration of parenteral vitamin B 12 typically is required for pernicious and vitamin B 12 deficiency anemias. • An oral folic acid supplement and dietary improvement typically are required for a patient with folic acid deficiency, which commonly results from nutritional deficits.

From Braunstein, E. M. (2022). Overview of anemia. Merck Manual Professional Version. https://www.merckmanuals.com/home/ blood-disorders/anemia/overview-of-anemia

Hemophilia

●● Description ●● Hemophilia is a hereditary bleeding disorder that results from the lack of specific clotting factors. ●● Hemophilia A, called “classic hemophilia,” results from deficiency of factor VIII and is the most prevalent type of hemophilia, representing about 80% to 85% of cases. ●● Hemophilia B, sometimes called “Christmas disease,” results from deficiency of factor IX and is seen in around 15% of cases. ●● Hemophilia A and B are X-linked recessive traits; female carriers have a 50% chance of transmitting the gene to each child; sons who receive the gene have the disease, whereas daughters who receive the gene are carriers; patients with the disease are usually identified in childhood. ●● Hemophilia produces bleeding, though the degree of bleeding varies depending on the degree of clotting factor deficiency. ●● Mild hemophilia usually causes bleeding only during major surgery or trauma. ●● Moderate hemophilia occasionally causes spontaneous bleeding in addition to bleeding during surgery and from trauma. ●● Severe hemophilia causes spontaneous bleeding; bleeding from minor trauma may be severe. ●● Signs and symptoms ●● Signs of hemophilia include excessive bleeding from wound and puncture sites, hematomas, ecchymosis, spontaneous bleeding (epistaxis), and GI bleeding. ●● Bleeding into joints (hemarthrosis) is a common occurrence; this can lead to joint inflammation, pain, and stiffness. ●● A change in level of consciousness can signal intracranial bleeding. ●● Diagnosis and treatment ●● If a family history of hemophilia is present, chorionic villous sampling or amniocentesis may be completed for diagnosis before birth.

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