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MedSurg- Hematolog
Units V-A, V-B
| Question | Answer |
|---|---|
| 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. |
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