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MedSurg- Hematolog

Units V-A, V-B

What are the 3 functions of the Hematologic system? 1.Transportation 2.Coagulation/Clotting 3.Immune Response
What are the four things that are transported in the hematological system? 1. Oxygen to cells 2. CO2 from cells 3. Hormones, electrolytes, and nutrients to cells. 4. Waste products to the liver and kidneys
What component of the hematological system carries hemoglobin? What is the importance of hemoglobin? 1. Erythrocytes 2. Hgb transports oxygen to the body tissues
What is a hormone that stimulates erythrocyte production? Where is the hormone found? Where does production occur? What is this production called? 1. Erythropoetin 2. Kidney 3. Bone Marrow 4. Erythropoiesis
Where are erythrocytes eliminated? Liver and Spleen
How many grams of Hgb does 100mL of whole blood contain? 14-15g
Leukocytes function by __________ to rid the body of what 3 things? 1. Phagocytosis 2. Foreign Particles 3. Mutations in Cell Division 4. Bacteria in the immune response
What is a normal WBC? 5,000-10,000/mml
What are the two types of WBCs? 1. Granulocytes 2. Nongranularcytes
What are the three types of granulocytes and their normal percentages of total WBC? 1.Neutrophil 60-70% 2.Eosinophils 1-3% 3.Basophils 1%
What are the two types of nongranular leukocytes and what are their normal percentages of total WBC? 1.Monocytes 3-8% 2.Lymphocytes 20-30%
What is the primary function of platelets? Aid the body in clot formation.
Thrombocytes are derived from what? These are found where? 1. Megakarocytes 2. Bone Marrow
What is the normal platelet count range? 150,000/mm3-450,000mm3
Platelet lifespan? 8-12 Days
What happens if the platelet count is too low? Clotting cannot occur
Where are platelets stored and how are they destroyed? Stored in the spleen Destroyed by phagocytosis
What percentage of the blood is made up of plasma? 55%
What are the three components that make up plasma? 1. Water (92%) 2. Protein (7%) 3. Inorganic Salts (1%)
What are the four types of protein found in plasma? 1. Hormones 2. Albumin 3. Fibrinogen 4. Globulins
What are also four components that make up the hematologic system? 1. Spleen 2. Lymphatics 3. Liver Clotting Mechanisms 4. Anticoagulants
What is the shape and location of the spleen? Is it vascular? 1. Bean-shaped 2. LUQ of the Abdomenm, behind stomach 3. Yes!
What are four functions of the spleen? 1. Hematopoietic function 2. Filter Function 3. Immune function 4. Platelet Storage
What does the spleen do during fetal development? Produces RBCs
What are the two filter functions of the spleen? 1. Remove defective cells from circulation 2. Breaks down RBC (recycles iron to bone marrow)
What is the immune function of the spleen? Contains a supply of lymphocytes and monocytes.
What is the function of Lymphatics? Carries lymph fluid via ducts and lymph nodes.
Lymphatic capillaries join to form what? Lymphatic Ducts
Lymphatic ducts carry lymph to what two places? 1. Right lymphatic duct 2. Thoracic duct
Where do lymphatic capillaries drain? Into the subclavian vein
What are the shape of lymph nodes and what do they filter? 1. Small rounded bean-shaped 2. bacteria and foreign particles
Where are lymph nodes distributed? 1. All over the body 2. Deep and Superficial
Where is the liver located? RUQ and epigastric region of the abdominen
Where does the liver receive blood from? The spleen and portal circulation.
What are the five functions of the liver? (Hint: BK DIP) B-bile production from erythrocyte destruction K- Kupffer cells carry out phagocytosis D-Detoxification of Drugs I-Iron and VitB12 storage P-Production of procoagulants
What is the purpose of clotting mechanism? To decrease blood loss when the body sustains injury
What are the 2 vascular responses in clotting? 1. Immediate vasoconstriction 2. Vascular spasm lasting 30 minutes (allow time for platelet response)
What is the platelet response in clotting? 1. Aggregation/clumping 2. activated by exposure to interstitial collagen
How is the platelet response activated? exposure to interstitial collagen
What role does plasma protein have in the clotting mechanism? It circulates in inactive form to initiate clotting.
What does Thrombin do and why is its action important? 1. Converts fibrinogen--> fibrin 2. Fibrin is essential in the formation of a blood clot
What is anticoagulation a counter mechanism to? What does it do? 1. Blood clotting 2. Maintains blood in its liquid state
What do antithrobins antagonize and what is the result? 1. Thrombin 2. Blood is maintained in its liquid state
When does fibrinolysis occur? When plasminogen is activated to plasmin (often initiated by thrombin)
What should a health history of the hematologic system include? (Hint: FIME-BARN) F-Family Hx of Hemat. problem I-I/O (Dietary) M-Mestrual Hx E-Elimination: Any blood? B-Beliefs about blood/bl products A-Abuse of subtance/chem exposure R-Resp Hx: SOB, exertion, Cough N-Neurological Hx: light headed, tingling, numbness, headach
What surgical complications should the Nurse know about when Assessing the hematologic system? 1.Blood (Clots, bleeding, Reaction to transfusion) 2. Spleen (injury/surgery)
What does a physical assessment of the hematologic system include? (Hint: PAPI) P- Palpation (Skin, lymph nodes, abdomen (spleen and liver) A-Auscultation (bruits, lung, heart sounds, rate and rhythym) P- Percussion (lungs, abdomen-spleen/liver) I- Inspection of body (color, rashes, bruising, ulcerations, cracking at corners of mo
What are five diagnostic tests that can be pulled when Assessing the hematologic system? (Hint: BB-L-RR) B-Blood test B-Bone Marrow Biopsy/Aspiration L-Lymph Node Biopsy R-Radiologic Test (Xray, CT, MRI, lymphangiogram) R-Radioisotope Scan (Isotope injected to assess structure of liver, spleen, bone, lymph node)
Describe Anemia. (Note: 3 answers) A reduction below normal in: 1. Number of Erythrocytes 2. Quantity of Hemoglobin 3. Volume of Erythrocytes (Hct)
Normal range of RBC for men and women? Men: 4.5-5.3 million Women: 4.1-5.1 million
Hct WNL for men/women? Men: 37-49% Women: 36-46%
Hbg WNL for men/women? Men: 13-18 grams Women: 12-16 grams
Erythropoiesis begins in the bone marrow of what four body parts? 1. vertebrae 2. sternum 3. ribs 4. pelvis
Where is Erythropoiesis completed? blood or spleen
What are cells called when they enter circulation from the bone and how long does it take for them to fully mature? 1. Reticulocytes 2. 48 hours
How long does it take for a stem cell to develop into an RBC? 3-5 days
What stimulates RBC production? Hypoxia Kidney releases erythropoietin in response to hypoxia.
What are the proper requirements for proper development of RBCs? 1. Iron (for Hgb synthesis) 2. Proteins, Vitamins (B12/Folate/C) and Minerals
Lifespan of RBC? 120 Days
Old or damages RBCs are lysed by phagocytosis in what four body parts? (Hint: BLLS) What is this process called? Bone Marrow Lymph nodes Liver Spleen Process is called HEMOLYSIS.
Phagocytes save and reuse _________ and ______ from the _______ units of lysed RBCS. 1 Amino Acid 2. Iron 3. Heme
Most of the heme unit is converted to what? Which is then removed from the blood by the liver and excreted in what? 1. bilirubin 2. bile
What are three causes of anemia? (Hint: DIA) 1. Decreased eythrocyte production 2. Increased erythrocyt destruction 3. Acute/Chronic Blood Loss
What are three causes of decreased erythrocyte production? (Hint: BAA) B-Bone marrow failure A-Altered Hgb synthesis A-Altered DNA synthesis
What are three things that cause altered hemoglobin synthesis? (Hint: TIC) T-Thalassemias (inherited disorders of Hgb synthesis) I-Iron deficiency C-Chronic Inflammation
What can alter DNA synthesis? Vitamin B12 or Folic Acid malabsorption or deficiency.
What are five types of marrow failure that cause decreased erythrocyte production? (Hint: MARCIF) M-Myeloproliferative leukimia (excess WBC production) A-Aplastic anemia (stem cell disfunction) R-Red aplasia C-Cancer metastasis, lymphoma I-Inection/Inflammation (Chronic) F-Fatigue (Physical/Emotional)
What are four causes of increased hemolysis (RBC destruction)? Hint: I-SO-DIME I-Infection S-Splenomegaly (spleen enlargement) O-Oxidation of Cell/Glycolysis affected by PK deficiency D-Defective hemoglobin (sickle cell/trait) I-Immune mechanism/disorder M-membrane disorders (of the cell) E- Erythrocyte Trauma (X:CardioPul
What are four general types of anemia? (Hint: BAHN) B-Blood Loss Anemia A-Aplastic Anemia H-Hemolytic Anemia N-Nutritional Anemia
During acute blood loss what happends to cardiac output? Circulating blood volume decreases which decreaes cardiac output
What are two compensations the body will attempt during acute blood loss? 1. Heart/Circulatory System compensation 2. Fluid volume shifts from ITF to vascular system These are in attempt to keep BP elevated
What are three types of Nutritional Anemia? (Hint: FIV) 1. Folic Acid Deficiency Anemia 2. Iron Deficiency Anemia 3. Vitamin B12 Deficiency Anemia
What is the most common type of anemia? Iron deficiency anemia
Malabsorption of Vitamin B12 is secondary to what four factors? (Hint: GIRL) G-Gastritis (common) I-Intrinsic factor lack (secreted in stomach/affected by caffeine and alchohol consumption) R-Resection of stomach/Ileum L-Loss of pancreatic secretions
Folic Acid Deficiency Anemia is due to what and usually seen in what three types of patients? (Hint: DOA) 1. Inadequate intake 2. Drug addicts 3. Older Adults 4. Alcoholics
What are four types of hemolytic anemia? (Hint: TAGS) T-Thalassemia A-Acquired Hemolytic Anemia G-Glucose 6 Dehydrogenase (G6PD) Anemia S
What is sickle cell anemia? Hereditary chronic anemia Causes synthesis of abnormal Hgb (causing sickling of RBCs)
What is Thalassemia? 1.Inherited disorder 2.Causes deficient prodcution of Hgb 3.Causes of fragile RBCs
What is acquired hemolytic anemia? 1. Hemolysis occurs due to factors OUTSIDE of the RBC 2. Mechanical Trauma
Acquired hemolytic Anemia is caused by mechanical trauma. What are 11 possible causes of this trauma? (Hint: SHRIP-DIVA-CT) S-Severe Burns H-Hemodialysis R-Radiation I-Infection (Bacterial or Protozoa) P-Prosthetic Heart Valve D-Drugs I-Immune mediated response (transfucion rx) V-Venom A-Autoimmune C-Chemical Agents T-Toxins
What are four characteristics of Aplastic Anemia?(Hint: BLER) B-Bone marrow fails to produce 3 types of blood cells L-Leads to panocytopenia E-Exposure to certain chemicals/toxins/infections can cause it R-Rare and is unknown in 50%
What is serum Ferritin? An iron storage protein produced by liver, spleen and bone marrow. Is depleted with depleted iron stores.
What does a Schilling test measure? When is it done and Why? 1. Vitamin B12 2. Before/after administration of intrinsic factor 3. To ID cause of VitB12 deficiency
A Bone marrow exam is used to diagnose which type of anemia? aplastic anemia
What are five medications used to treat Anemia? (Hint:SPIFE) S-Supplemental Iron (PO or IV) P-Parenteral Vitamin B12 I-Immunosuppressive therapy F-Folic Acid (for patients who are deficient, pregnant, childbearing age) E- Erythropoietin (Give c iron bc stimulus effect)
Patients with Anemia should eat diets that are high in what three vitamins? 1. Iron 2. Vitamin B12 3. Folic Acid
When is a blood transfusion necessary 1. severe blood loss 2. severe anemia (regardless of cause)
What are four Nursing Dx? (Hint: AISI) A- Activity Intolerance I-Impaired oral mucous membrances S-Self Care deficit I-Imbalanced nutrition less than body requirements
Interventions for an anemic patient you've diagnosed with Activity Intolerance? (A-MESI) A-Alternate activity and rest M-Monitor vital signs a/p activity schedule E-Establish priority for task/activity S- Sleep (8-10 hours) I-ID ways to conserve energy
Interventions for an anemic patient you've diagnosed with impaired oral mucous membrane. (PUMIC) P-Provide frequent oral hygiene U-Use lip protectant M-Mouthwash of saline, saltwater or 1/2 strength H2O2 q2-4h I-Instruct to avoid spicy/acidic food C-Condition of lips/tongue monitored daily
Interventions for an anemic patient you've diagnosed with self care deficit. (AR) A-Assist with ADLS R-Rest period importance discussed prior to activities that expend energy
Interventions for an anemic patient you've diagnosed with "Imbalanced nutrition less than body requirements." (FANN) F-Food high in needed supplements (educate) A-All ordered nutritional supps qd (encourage) N- Need for additional food source (educate) N- Nutritional strategies to address deficiencies
What are four physical assessment techniques that focus on the hematologic system? 1. skin color/temp 2. cap refill 3. respiratory rate/pattern 4. heart rate
What four factors does the manifestation of anemia depend on? 1. anemia severity 2. how quickly it developed 3. age 4. general health status
When do successful compensatory mechanisms result in less symptoms? When anemia develops gradually
Pallor of what occurs, and why? 1. skin, mucous membrances, conjunctiva, nail beds 2. it is the result of blood redistribution to vital organs and lack of hemoglobin
What increases as tissue oxygenation decreases? And why? 1. respiratory and heart rate 2. to increase cardiac output and tissue perfusion
What does tissue hpoxia cause? DAFN D - Dyspnea on exertion A - Angina F - Fatique N - Night cramps
What can an increase in erythropoietin activity lead to? It stimulates RBC production in the bone marrow and may lead to bone pain.
What are the two initial manifestations of rapid blood loss? tachycardia and tachypnea
What can cerebral hypoxia lead to? Headache Dizziness Dim vision
When can heart failure develop? In severe anemia.
What are signs of circulatory shock? hypotension, tachycardia, decreased LOC, and oliguria (production of abnorm small amt. of urine).
What can be a result of lowered blood viscosity? systolic heart murmur
In addition to the general manifestations of Anemia, what are manifestations specific to iron deficiency anemia? 1. brittle spoon-shaped nails 2. cheilosis (cracks at corner of mouth) 3. smooth, sore tongue 4. pica (unusual cravings)
What is pernicious anemia? Failure to absorb Vitamin B12
How do symptoms of VitB12 deficiency anemia develop? Gradually as bodily stores of the vitamin are depleted
In addition to the general manifestations of Anemia, what are manifestations specific to Vitamin B12 deficiency anemia? (PPSD) P-Paresthesias (altered sensation-numbness/tingling P-Proprioception (sense of one's position in space) S- Smooth, sore, beefy red tongue D- Diarrhea
In addition to the general manifestations of Anemia, what are manifestations specific to folic acid deficiency anemia? PSH-GCD P-Progressive weakness/fatigue S-SOB H-heart palpitations Same as Vitamin B12: G-Glossitis (inflammation of tongue) C-Cheilosis (cracked mouth) D-Diarrhea
Extensive sickling can precipitate a crisis due to what three things? (SIC) S-Sequestration of large amounts of blood in liver or spleen I-Impaired erythropoiesis C-Circulation occlusion
What two kinds of crisis occur when sickling develops in the microcirculation? 1. Vasoocclusive 2. Thrombotic
What does obstruction of blood flow due to sickling cells cause? Which does what? 1. Vasospasm 2. halts all blood flow in vessel
What does infarction of small vessels in the extremities cause? Painful swelling of the hands and feet
Cerebral vessel occlusion may lead to what? Stroke
Which organs' structure and function can be affected by repeated infarcts associated with sickling? every organ system
Thalassemia minor is usually asymptomatic. What symptoms can occur if any? SBBM S-Splenomegaly B-Bronze skin coloring B-Bone marrow hyperplasia M-Mild to moderate anemia
What can Thalassemia Major cause?SHL S-Severe anemia H-heart failure L-Liver and spleen enlargement from increased RBC destruction
What may happen as a result of increased hematopoiesis? fractures of long bones, ribs, vertebrae (due to bone marrow expansion and thinning)
Aplastic anemia eventually leads to what two things? tachycardia and heart failure
Platelet deficiency leads to what bleeding problems? BENI B - Bleeding gums E - Excessive bruising N - Nose bleeds
What is the priority of care when treating anemia? ensuring adequate tissue oxygenation
Where are most anemic patients treated? At home and in a community setting.
Created by: kluiz777@aol.com