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Hematology

Hematologic System

QuestionAnswer
May become tissue macrophages Monocyte
30% of volume stored in spleen Platelet
Primarily responsible for immune response Lymphocyte
4% to 8% of white blood cell count (WBC) Monocyte
Production stimulated by hypoxia Erythrocyte
0% to 2% of WBCs Basophil
Immature cell is a band Neutrophil
Increased in individuals with allergies Eosinophil
Responds first at injury site Neutrophil
20% to 40% of WBC Lymphocyte
Releases granules that increase allergic and inflammatory responses Basophil
Arises from megakaryocyte Platelet
50% to 70% of WBCs Neutrophils
Increases indicate an increased rate of erythropoiesis Reticulocyte
Make up 2% to 4% of WBCs Eosinophil
Also known as "segs" Neutrophils
Granulocytic leukocytes include Neutrphils, basophils and eosinophils
REd blood cell production is stimulated by the release of the growth factor______________ ERYTHROPOIETIN from the kidney
Nutrients essential for red blood cell production include Iron, Vitamin B12, folic acid
Obstruction of the lymph flow results in accumulation of lymph fluid known as lymphedema
Organs of the hematologic system that have filtering functions include the liver spleen, lymph notes
Iron is stored in the body in the form of ferritin, hemosiderin
Thrombin converts fibrinogen to fibrin Plasma clotting factors
Platelets interact wtih collagen Platelet plug formation
Release of adrenosine diphosphate Platelet plug formation
Thrombin catalyzes conversion of plasminogen to plasmin Lysis of clot
Release of PF3, serotonin and epinephrine Platelet plug formation
Fibrin split products formed with action of plasmin Lysis of clot
Action of Protein C and Protein S Lysis of clot
Vasoconstriction and spasm Vascular response
Prothrombin converted to thrombin Plasma clotting factors
Damaged vascular surface Vascular response
Serum calcium activity as factor IV Plasma clotting factors
Platelet agglutination Platelet plug formation
An appropriate nursing action for a patient's laboratory test results which indicate increased fibrin split products (FSP) is bleeding
Reason: During fibrinolysis by plasmin, the fibrin clot is split into smaller molecules known as FSPs) or FDPs. Increased FSP impair platelet aggregation, reduce prothrombin, and prevent fibrin stabilization and lead to bleeding
FSP = Fibrin Split Products
FDP = Fibrin degradation Products
PTT = Partial Thromboplastin Time
Blood test results of an 83-year old would be of major concern if the results were: PTT of 60 seconds
Rationale: In aging, the PTT is normally decr, so an abnormally high PTT of 60 secs is an indication that bleeding could readily occur. Plt are unaffected by aging, & 150k is a normal count. Serum FE levels are decr & the ESR is significantly incr with aging.
A patient with a bone marrow disorder with an overproduction of myeloblasts. The nurse would expect the results of a CBC to include increased basophils, neutrophils, eosinophils
Rationale: The myeloblast is a committed hematopoietic cell found in the bone marrow from which granulocytes develop. A disorder in which myeloblasts are overproduced would result in increased basophils, neutrophils, eosinophils
During the nursing assessment of a patient with anemia, the nurse asks the patient about a history of stomach surgery
Rationale: The parietal cells of the stomach secrete intrinsic factor, a substance necessary for the absorption of cobalamin (Vit B12), & if all or part of the stomach is removed, the lack of intrinsic factor can lead to impaired red cell prodtn & pernicious anemia.
Rationale continued: Recurring infections indicate decreased WBCs and immune response, and corticosteroid therapy may cause a neutrophilia and lymphopenia. Oral contraceptive use is strongly associated wtih changes in blood coagulation.
Specific findings identified by the nurse during assessment of the patient's functional health patterns that indicates risk factors for hematologic problems or a patient response to actual hematologic problems are:
Health perception-health management Family history of hematologic disorders; alcohol and cigarette use
Nutritional Metabolic deficiencies of iron, Vit B12, and folic acid; GI bleeding; petechiae or bruising of the skin fever, lymph node swelling
Elimination frankly bloody or dark, tarry stools; dark or bloody urine
Activity-exercise fatigue and weakness, change in ability to perform normal activities of daily living
Sleep-rest fatigue unrelieved by sleep
Cognitive-perceptual pain, especially in joints, bones, paresthesias, numbness, tingling, changes in hearing, vision, taste, mental status
Self-perception-self-concept altered self-perception because of lymph node enlargement, skin changes
Role-relationship home or work exposure to radiation or chemicals; military history
Sexuality-reproductive menstrual history and characteristics of bleeding intrapartum or postpartum bleeding problems impotence
Coping-stress tolerance lack of support to meet daily needs; methods of coping with stress
Value-belief Value conflicts with treatment, especially blood products or bone marrow transplants
Using light pressure with index and middle fingers, the nurse cannot palpate any of the patient's superficial lymph nodes. The nurse records this finding as normal
Rationale: superficial lymph nodes are usually not palpable. It may be normal to find small (< 1.0 cm) mobile, firm, nontender nodes. Deep lymph nodes are detected radiographically.
During physical assessment of a patient with thrombocytopenia, the nurse would expect to find petechia and purpura
Rationale: Petechiae are small, flat, red or reddish brown pinpoint microhemorrhages that occur on the skin when platelet levels are low; when they are numerous, they group, causing reddish bruises known as purpura. Jaundice occurs when anemias are of a hemolytic
Rationale continued: ... origin, resulting in accumulation of bile pigments from RBCs. Enlarged, tender lymph nodes are associated with infection, and sternal tenderness is associated with leukemias
A patient with a hematologic disorder has a smooth, shiny red tongue. The nurse would expect the patient's laboratory results to include Hb: 9.6 g/dL (96 g/L)
Rationale: A smooth, shiny, reddened tongue is an indication of iron-deficiency anemia or pernicous anemia that would be reflected by a decr hgb level. Incr WBC could be indicative of an infection; the decr neutrophils, or a neutropenia; & incr RBC, or polycythemia.
A ptient is being treated with chemotherapeutic agents. The nurse revises teh patient's care polan based on the CBC results of Platelets: 50,000/ul
Rationale: Plt ct < 150k/ul is considered thrombocytopenia & could place the pt at risk for bleeding, necessitating consideration in nursing care. CHemo may cause bone marrow suppression & a depletion of all blood cells. Other factors are all w/in normal range.
Identify the type of condition indicated by the following laboratory study results
Serum Iron: 40 mcg/dL (7 umol/L) iron deficiency anemia
ESR: 30 mm/hr inflammatory conditions of any kind
Increased band neutrophils infection
Activated partial thromboplastin time: 60 secs heparin therapy
Indirect bilirubin: 2.0 mg/dl (34 umol/L) hemolysis of RBCs
Urine Bence-Jones protein multiple myeloma
If a patient with blood type O Rh+ is given AB Rh- blood, the nurse would expect The anti-A and Anti-B antibodies in the patient's blood to hemolyze the donor blood
Rationale: A pateint with O Rh+ blood has no A or B antigens on the red cell but does have anti-A or anti-B antibodies in the blood & has an Rh antigen. AB Rh- blood has both A & B antaigens on red cell but no Rh antigen & no Anti-A or Anti-B antibodies If the AB Rh-
A patient is undergoing a contrast CT of the spleen. Before this test, it is important for the nurse to ask the patient about
To prepare the patient for a bone marrow aspiration from the most common site for adults, the nurse positions the patient
When teacing a patient about a bone marrow examination, the nurse explains that
A lymph node biopsy is most often performed to diagnose
Hematology The study of blood and blood-forming tissues. This includes bone marrow, blood, spleen and lymph system. Evaluate the patients ability to transport Oxygen and Carbon dioxide, coagulate blood and combat infections
Hematopoiesis (Blood cell production) Occurs within the bone marrow.
Bone Marrow the soft material that fills the central core of bones.
All three types of blood cells (RBC, WBC and platelets) develop from a common hematopoietic stem cell within the bone marrow.
Hematopoietic stem cell nondifferentiated immature blood cell found in the bone marrow;
Three types of Blood Cells As the cells mature and differentiate, several different types of blood cells are formed
Blood: A type of connective tissue that performs three major functions Transportation, regulation, and protection.
Blood is responsible for transportation of oxygen, nutrients, hormones, and waste products around the body. Blood also plays a role in the regulation of fluid, electrolyte, and acid-base balance.
Blood's role protective in its ability to clot and combat infections.
Two major components to blood: Plasma and blood cells
Plasma is 55% of blood; composed primarily of water It contains proteins, electrolytes, gases, nutrients and waste
Serum Plasma minus its clotting factors
Plasma Protein Albumin, Globulin, Clotting factors, mostly fibrinogen
Blood Cells are 45% of the blood Is comosed of formed elements or blood cells
Three types of blood cells Erythrocytes (RBCs), leukocytes (WBCs), and thrombocytes (Platelets).
Primary function of erythrocytes is Oxygen transportation,
Leukocytes are involved in protection of the body from infection.
Platelets function promote blood coagulation
Erythrocytes (RBC) the primary functions of RBCs include transport of gases (both O2 and CO2) and assistance in maintaining acid-base balance.
Composition of Erythrocyte it is a flexible cell with a unique biconcave shape
Hemoglobin A complex protein-iron compound composed of heme (an iron compound) and globin ( a simple protein). functions to bind with O2 & CO2.
Erythropoiesis (the process of RBC production) stimulated by hypoxia and controlled by erythropoietin, a glycoprotein growth facdtor sythesized and released by the kidney.
Erythropoietin stimulates the bone marrow to increase erythrocyte production
Erythropoietin production normally the bone marrow releases 3x10 to the 9th RBCs/kg of body wt/day. Erythropoiesis is also influenced by the availability of nutrients.
Essential nutrients necssaray for erythropoiesis are protein, iron, folate (folic acid), cobalamin (vit b12), riboflavin (vit b2) and pyridoxine (vit b6) Erythrocyte production is also affected by endocrine hormones, such as thyroxine, corticosteroids, & testosterone.
Example of microcytic anemia hypothyroidism can be the cause of microcytic anemia
Reticulocyte an immature erythrocyte. It measures the rate at which new RBCs appear in the circulation. They can develop into mature RBCs w/in 48hrs of release into circulation. assessing # of retic is a useful means of eval the rate & adequacy of erythrocyte prodctn
Hemolysis (destruction of RBCs) by monocytes and macrophages removes abnormal, defective, damaged and old RBCs from circulatiaon. This usually occurs in teh bone marrow, liver & spleen.
Hemolysis of RBCs results in increased bilirubin to be processed by the body. When hemolysis occurs via normal mechanism, the liver is able to conjugate ane excrete all bili that is released
Normal lifespan of erythrocyte 120 days
Leukocytes (WBC) appear white when separated from blood. they originate from stem cells within the bone marrow
Five different tyepes of leukocytes, each with a different function Granulocytes, Agranulocytes, neutrophil, monocytes,
Granulocytes: neutrophils, basophils and eosinophils
Leukocytes without granules within the cytoplasm are called agranulocytes and include lymphocytes and monocytes.
Lymphocytes and monocytes are also referred to as mononuclear cells because they have only one discrete nucleus.
Leukocytes have a widely variable life span.
Granulocytes may only live for hours, yet some T-lymphocytes may live for years.
Primary function of the granulocytes phagocytosis which is a process by which WBCs ingest or engulf any unwanted organism and tehn digest and kill it.
Neutrophil the most common type of granulocyte - 50 to 70% of all WBCs.
Neutrophils primary phagocytic cells involved in acute inflammatory responses
Mature neutrophil called segmented neutrophil or seg or polysemented neutrophil because the nucleus is segmented into two to five loves connected by strands.
A Band Immature neutrophil. Also capable of phagocytosis, but the mature neutrophil is much more effective
Eosinophils account for only 2 to 4% of all WBCs. they have a similar but reduced ability for phagocytosis. One of their primary functions is to engulf antigen-antibody complexes formed during an allegic response.
Which cells are able to defend against parasitic infections Eosinophils
Basophils make up less than 2% of all leukocytes They have a limited role in phagocytosis. They have cytoplasmic granules that contain heparin, serotonin, and histamine.
The response seen in allergic and inflammatory reactions is when a basophil is stimulated by an antigen or by tissue injury.
Examples of Nticoagulants are Protein C and Protein S, Antithrombins and fibrinolysis. Endogenous heparin is an example of an anticoagulant.
Fibrinolysis A process resulting in the dissolution of the fibrin clot.
Spleen Located in the upper left quadrant of the abdomen.
Functions of the Spleen Hematopoietic, filtration, immunologic and storage.
Hematopoietic function manifested by the spleen's ability to produce RBCs during fetal development.
Filtration Function demonstrated by teh spleen's ability to remove old and defective RBCs from the circulation by the mononuclear phagocyte system It also involves the reuse of iron.
The spleen also plays a role in filtering circulating bacteria, especially encapsulated organisms such as gram-positive cocci.
The spleen as storage About 30% of the platelet mass is stored in the spleen.
The Lymph System consists of lymph fluid, lymphatic capillaries, ducts, & lymph nodes.
The Lymph System It carries fluid from the interstitial spaces to the blood. It is by means of the lymph that proteins & fat from the GI tract & certain hormones are able to return to the circulatory system. It also returns excess interstitial fluid to the blood.
Returning excess interstitial fluid to the blood is important in preventing the development of edema.
Primary function of lymph nodes filtration of pathogens and foreign particles that are carried by lymph to the nodes.
Created by: howardccnurs
 

 



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