Vision: A PREMIER UNIVERSITY delivering

“Excellent nursing education that

world-class education that promotes
provides graduates with self-
sustainable development amidst climate
change.
Benguet State University direction, competence and
compassion.”
Mission: To provide quality education to COLLEGE OF NURSING
enhance food security, sustainable La Trinidad, Benguet “The College of Nursing is committed
communities, industry innovation, climate to provide a strong academic and
resilience, gender equality, institutional
www.bsu.edu.ph/ 422- 2127 professional foundation for the
development and partnerships. practice of nursing.”

NCM 112
Care of clients with problems in Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory
and immunologic response, Cellular Aberrations, Acute and Chronic.

WORKSHEET 4

PART 1: SHORT ANSWER

Read each statement carefully. Write your response in the space provided.
5-6
1. The volume of blood in humans is about _____________ L.

bone marrow
2. Blood cell formation (hematopoiesis) occurs in the ______________________________.

pelvis
3. Red bone marrow activity is confined in adults to the _______________________,
ribs
____________________, vertebrae
_______________________, sternum
and _______________________.

4. The principal function of the erythrocyte, which is composed primarily of

hemoglobin
________________________, transport oxygen between the lungs and tissues.
is to: ___________________________________________________.

15
5. Each 100 mL of blood should normally contain ________ g of hemoglobin.

2mg
6. Women of childbearing years need an additional _____________________ daily of iron to
replace that loss during menstruation.

C
7. The nurse advises a patient who is iron deficient to take extra vitamin ________________, which
is known for increasing iron absorption.

8. The major function of leukocytes is to:

Protect the body against infection and tissue injury
_________________________________________________________; the major function of neutrophils is:
Phagocytosis
__________________________________________________________.

albumin
9. Plasma proteins consist primarily of:_____________________________ and
globulins
__________________________.

10. The two most common areas used for bone marrow aspirations in an adult are:
iliac crest
________________ sternum
and ________________.

42
11. The average life expectancy for someone with sickle cell anemia is ________ years.

12. Distinguish between primary and secondary polycythemia.

Primary polycythemia is a disorder in which myeloid stem cells seems to have escaped normal control mechanisms while secondary
_____________________________________________________________________________________________
polycythemia is the overproduction of red blood cells.
____________.

excessive production of erythropoietin

13. Secondary polycythemia is caused by: ___________________________________, which may be
reducted amount of oxygen
in response to ____________________________________________.

14. The thalassemias (hereditary anemias) are characterized by: _________________________,hypochromia (abnormal decrase in the hemoglobin content of RBCs)

extreme microcytosis (smaller-than-normal RBCs) Destruction of blood elements (hemolysis) variable degrees of anemia
______________________________, ____________________________, and ____________________________.
Vision: A PREMIER UNIVERSITY delivering
“Excellent nursing education that
world-class education that promotes
provides graduates with self-
sustainable development amidst climate
change.
Benguet State University direction, competence and
compassion.”
Mission: To provide quality education to COLLEGE OF NURSING
enhance food security, sustainable La Trinidad, Benguet “The College of Nursing is committed
communities, industry innovation, climate to provide a strong academic and
resilience, gender equality, institutional
www.bsu.edu.ph/ 422- 2127 professional foundation for the
development and partnerships. practice of nursing.”

PART 2: MATCHING TYPE

INSTRUCTIONS: Match each of the anemic states with both the etiologic and morphologic
classifications (answers may be used more than once). 1
Type or Cause of Anemia Etiology (cause) Morphology (form)
1. Malaria Increased RBC production Normocytic, normochromic
2. Thalassemia Decreased RBC production Microcytic, hypochromic
3. Acute trauma Blood loss Normocytic, normochromic
4. Aplastic anemia Decreased RBC production Normocytic, normochromic
5. Pernicious anemia Decreased RBC production Macrocytic, normochromic
6. Sickle cell anemia Increased RBC production Normocytic, normochromic
7. Anemia of gastritis Blood loss Normocytic, normochromic
8. Anemia of leukemia Decreased RBC production Normocytic, normochromic
9. Iron-deficiency anemia Decreased RBC production Microcytic, hypochromic
10. Anemia of renal failure Decreased RBC production Normocytic, normochromic
11. Glucose-6-phosphate dehydrogenase
(G6PD) Increased RBC production Normocytic, normochromic
12. Anemia associated with prosthetic heart
valve Increased RBC production Normocytic, normochromic

Etiologic
1. Decreased RBC Production
2. Blood loss
3. Increased RBC production

Morphologic
4. Normocytic, normochromic
5. Macrocytic, normochromic
6. Microcytic, hypochromic

PART 3: ARRANGEMENT

Number from 1 to 8 (1 being the first event and 8 being the last event) in sequence the events
that occur in disseminated intravascular coagulation (DIC).
5
_____a. Activation of fibrinolytic system
8
_____b. Uncompensated hemorrhage
3
_____c. Widespread fibrin and platelet deposition in capillaries and arterioles
6
_____d. Release of fibrin-split products
2
_____e. Fibrinogen converted to fibrin
7
_____f. Inhibition of normal blood clotting
1
_____g. Production of intravascular thrombin
4
_____h. Depletion of platelets and coagulation factors
Vision: A PREMIER UNIVERSITY delivering
“Excellent nursing education that
world-class education that promotes
provides graduates with self-
sustainable development amidst climate
change.
Benguet State University direction, competence and
compassion.”
Mission: To provide quality education to COLLEGE OF NURSING
enhance food security, sustainable La Trinidad, Benguet “The College of Nursing is committed
communities, industry innovation, climate to provide a strong academic and
resilience, gender equality, institutional
www.bsu.edu.ph/ 422- 2127 professional foundation for the
development and partnerships. practice of nursing.”

PART 4: NURSING INTERVENTIONS IN BLOOD TRANSFUSION

Priority Decision: The nurse is preparing to administer a blood transfusion. Number the actions in
order of priority

(1 is first priority action; 10 is last priority action).

1
_______a. Verify the order for the transfusion.
3
_______b. Ensure that the patient has a patent 18-gauge IV.
4
_______c. Prime the transfusion tubing and filter with normal saline.
2
_______d. Verify that the physician has discussed risks, benefits, and alternatives with the patient.
5
_______e. Obtain the blood product from the blood bank.
6
_______f. Ask another licensed person (nurse or MD) to assist in verifying the product identification
and the patient identification.
10
_______g. Document outcomes in the patient record. Document vital signs, names of personnel,
and starting and ending times.
9
_______h. Adjust the infusion rate and continue to monitor the patient every 30 minutes for up to
an hour after the product is infused.
8
_______i. Infuse the first 50 mL over 15 minutes, staying with the patient.
7
_______j. Obtain the patient’s vital signs before starting the transfusion.

PART 5: EXPLAIN THE FOLLOWING LABORATORY FINDINGS IN ANEMIA 8

FINDING EXPLANATION
Reticulocyte counts are increased in chronic The hypoxia resulting from loss of RBCs in
blood loss but decreased in cobalamin chronic blood loss stimulates the kidney to
(vitamin B12) deficiency. release erythropoietin, stimulating production of
RBCs and reticulocytes. However, in pernicious
anemia, normal reticulocytes are not
produced because of the lack of cobalamin.

Bilirubin levels are increased in sickle cell Sickle cell anemia is a hemolytic anemia
anemia but are normal in acute blood loss. involving an accelerated RBC breakdown,
leading to increased serum bilirubin levels,
whereas acute blood loss results in loss of
the RBC and the bile pigments from the
body.

Mean corpuscular volume (MCV) is increased The MCV is a determination of the relative size
in folic acid deficiency but decreased in iron- of an RBC and macrocytic anemias, such as
deficiency anemia. folic acid deficiency and cobalamin deficiency,
are characterized by the production of large,
immature RBCs that would reflect an
increased MCV. In iron-deficiency anemia, the
MCV is low because of the lack
of Hgb in the cells.
Vision: A PREMIER UNIVERSITY delivering
“Excellent nursing education that
world-class education that promotes
provides graduates with self-
sustainable development amidst climate
change.
Benguet State University direction, competence and
compassion.”
Mission: To provide quality education to COLLEGE OF NURSING
enhance food security, sustainable La Trinidad, Benguet “The College of Nursing is committed
communities, industry innovation, climate to provide a strong academic and
resilience, gender equality, institutional
www.bsu.edu.ph/ 422- 2127 professional foundation for the
development and partnerships. practice of nursing.”

PART 6: CASE STUDY: Blood Transfusion

Jerry is to receive one unit of packed red cells because he has a hemoglobin level of 8 g/dL and
a diagnosis of gastrointestinal bleeding.

1. Before initiating the transfusion, the nurse needs to check:

a. for the abnormal presence of gas bubbles and cloudiness in the blood bag.
b. that the blood has been typed and crossmatched.
c. that the recipient’s blood numbers match the donor’s blood numbers.
d. all of the above.

2. Administration technique should include all of the following except:

a. adding 50 to 100 mL of 0.9% NaCl to the packed cells to dilute the solution and
speed up delivery of the transfusion.
b. administering the unit in combination with dextrose in water if the patient needs
additional carbohydrates.
c. administering the unit of blood over 1 to 2 hours.
d. squeezing the bag of blood every 20 to 30 minutes during administration to mix
the cell.

3. The nurse is aware that a transfusion reaction, if it occurs, will probably occur:
a. 1 to 2 minutes after the infusion begins.
b. during the first 15 to 30 minutes of the transfusion.
c. after half the solution has been infused.
d. several hours after the infusion, when the body has assimilated the new blood
components into the general circulation.

4. If a transfusion reaction occurs, the nurse should:

a. call the physician and wait for directions based on the specific type of reaction.
b. stop the transfusion immediately and keep the vein patent with a saline or
dextrose solution.
c. slow the infusion rate and observe for an increase in the severity of the reaction.
d. slow the infusion and request a venipuncture for retyping to start a second
transfusion.

Prepared by:

DOMINADOR B. ABAD JR.

Course Facilitator