CMN 571 Unit 2: HTN, Anemia,
Menopause, Osteoporosis
risks associated with HTN - ANS increased risk of stroke and heart failure
*unsymptomatic, systolic better indicator
*home monitoring greater indicator>clinic measures
high risk populations for HTN - ANS family history, blacks, physical inactivity, excess sodium, alcohol,
calories, high-normal readings, deficient in potassium intake
primary prevention of HTN - ANS decrease sodium, alcohol, calorie intake
regular exercise, potassium supplementation (loss of NA via urine)
chemoprevention for hypertension - ANS low-dose aspirin (81-325mg) for patient whose 10 year CVD
risk >10%
symptoms of a sports physical to initiate CVD screening: - ANS chest pain or discomfort with exercise
syncope
heart mumur
history HTN
SOB with exertion
FH: death/disability before 50 from CVD
physical signs of primary hematological disorders - ANS lymphadenopathy, hepatosplenomegaly, bone
tenderness (esp. sternum or anterior tibia)
,iron deficiency anemia causes & values - ANS reduction in RBCs caused by inadequate iron intake
main cause: bleeding
present if: serum ferritin <12ng/ml or <30ng/ml if anemic
Causes of iron deficiency - ANS deficient iron in diet
decreased absorption-H. pylori/autoimmune gastritis, celiac
increased requirements-pregnancy/lactation
blood loss (chronic)-GI, menstrual, blood donation, surgery
diseases of decreased RBC production - ANS iron deficiency, thalassemia (faulty hemoglobin synthesis),
hematopoetic stem cell lesion (leukemia, lymphoma, bone marrow infiltration)
diseases of increased RBC destruction (RBC loss) - ANS acute blood loss, hemolysis, infection
symptoms of iron deficiency anemia - ANS fatigue, tachycardia, palpitations, dyspnea on exertion,
paleness
severe (skin & mucous changes): smooth tongue, brittle nails, pica
treatment for iron deficiency anemia: - ANS PO: ferrous sulfate 325mg daily on empty stomach
(improves absorption)
Side effects: nausea & constipation
halfway to normal in 3 weeks-full return to baseline 2 months
continue taking 3-6 mo to replenish stores
Vitamin B12 deficiency causes: - ANS dietary deficiencty-vegans
decreased absorption intrinsic factor: pernicious anemia (autoimmue) or gastrectomy
, H. pylori, pancreatic insufficiency, Chrons
Vitamin B12 deficiency symptoms - ANS anemia symptoms+ peripheral paresthesias, difficulty balance,
proprioception, cerebral function
lab findings associated with vitamin B12 deficiency - ANS macrocytic anemia (lg RBCs)
megaloblastic blood smear (hypersegmented neutrophils=multiple nuclei in cells & macro-
ovalocytes=enlarged, oval-shaped erythrocytes)
low serum Vitamin B12 level
Treatment of Vitamin B12 Deficiency - ANS IM/SubQ B12 initial injections daily for week 1, monthly for
following month & continue monthly for life
-may switch to PO Methylcobalamin once deficiency of correction occured
-often co current folic acid low=Rx replacement first few months
Timeline: immediate improvement, levels stabilize in 2 months, neuro symptoms reversible if treatment
sought <6 months of symptoms
Folic acid deficiency causes - ANS dietary deficiency
decreased absorption
increased requirement (pregnancy, chronic hemolytic anemia)
excess loss from hemodialysis
Folic acid deficiency symptoms - ANS similar to anemia/vitmain B12 deficiency but without assoc neuro
symptoms
