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Blood 1329

hematopoiesis manufacture and development of blood cells
functions of blood carries O2 to cells; returns CO2 to lungs to be eliminated; transports food to nourish cells; carries away waste products of cell metabolism; regulates body demp; provides clotting factors
blood cells suspended in plasma
acute blood loss that has serious effects on the body loss of 1,000 mL or more
amount of circulating blood volume in adults 5-7 liters
characteristics of blood: slightly sticky, characteristic odor, faint salty taste, bright red in the arteries (carrying O2), dark red in veins (carrying CO2)
Structure of blood - 3 groups of formed elements erythrocytes (RBCs), leukocytes (WBCs), thrombocytes (platelets)
RBCs formed in the red bone marrow, produced in liver and spleen before birth erythrocytes
continuous production of RBCs erythropoiesis
Essential for formation of RBCs folic acid and Vitamin B12 (Nutrition Notes 30-1)
RBC's Men have more than women; newborns have the most
normal range of RBCs 3.6 - 5.4 million/mm
Main ingredient of RBCs hemoglobin
Amount of hgb in the RBC depends on: adequate iron storage
Iron is essential for: hgb synthesis
Iron is important for the O2 carrying ability of the: hgb molecule
low iron levels anemia
normal range of adult hgb 12-17.4
hemorrhage causes a decrease in: amount of circulating fluid; number of RBCs; amount of Hgb; iron levels
hemorrhage results in: low hemoglobin; tachycardia; tachypnea; anemia (chronic blood loss); fatigue; chills; change in Hct level
hematocrit (Hct) measures percentage of RBCs in the total blood volume
Hematocrit will decrease with: anemia
During dehydration, Hct will increase while Hgb: decreases
When RBCs are destroyed, iron is returned to red bone marrow and: reused
bilirubin waste product of destroyed RBCs (made when RBCs die, goes to liver to be processed)
leukocytes white blood cells; arise from ctem cells in bone marrow
normal range of leukocytes 5,000 - 10,000 mm3
leukocytosis increased number of WBCs
leukopenia decreased number of WBCs
for leukopenia, monitor closely for: infection, use strict handwashing, protective isolation
functions of leukocytes protect body from infection; repair damaged tissue; lab levels aid in diagnosis
When RBCs are destoryed, iron is returned to the red bone marrow and: reused
waste product of destroyed RBCs bilirubin
also known as WBCs (white blood cells); arise from stem cells in bone marrow leukocytes
normal range of leukocytes 5,000 - 10,000
increased number of WBCs leukocytosis
decreased number of WBCs leukopenia
with leukopenia, monitor closely for: infection, use strict handwashing, protective isolation
functions of leukocytes: protect body from infection; repair damaged tissue; lab levels aid in diagnosis
classifications of leukocytes granulocytes and agranulocytes
agranulocyte classifications: lymphocytes (aid with development of immunity) monocytes (phagocytic cells involved with inflammatory process)
thrombocytes platelets (PTLs)
thromobcytes are the smallest cell in the body and are essential for: blood coagulation
thrombocytes are formed in the: red bone marrow
Normal range of thrombocytes: 150,000 - 350,000
thrombocytes play an important role in: hemostasis (maintaining blood levels)
When hemostasis is achieved: hemorrhage is prevented
serious bleeding occurs due to decrease in number of platelets thrombocytopenia
blood clots form too easily due to abnormally high number of platelets thrombocytosis
functions of thrombocytes controls bleeding (injury occurs; platelets gather at the site of injury; "stick" together using Factor III which is necessary for coagulation and formation of fibrin; forms a plug or clot; eventually pulls plug tight, bringing margins together
If platelet count is low (<150,000) use small needles for injections (avoid injections if possible); apply prolonged pressure to injuries and sticks; encourage pt to use toothette instead of toothbrush; take oral, not rectal temp; use electric razor; gentle handling pt; safety is priority
liquid part of blood; contains no cells plasma
characteristics of plasma 90% water and 10% proteins; clear, straw colored fluid with dissolved substances; can be separated from teh formed elements of blood; administered for several bleeding disorders because it contains clotting proteins
plasma proteins; may be given in plasma or as individual blood components gamma globulin, serum albumin, fibrinogen, cryoprecipitate
gamma globulin helps with immunity; used in the prevention or modification of infectious disease; given to pts with low immunity
serum albumin osmotic pressure; shifts fluid back into vascular compartment; administered to maintain osmotic pressure of the plasma; may also be given to treat hypovolemic shock in burn patients and liver disease; most abundant plasma protein
fibrinogen essential clotting factor; converted into fibrin; uses calcium ions to help pull platelets together to form a clot
deficiency of fibrinogen may occur due to a congenital disorder or an acquired condition such as: massive hemorrhage, prolonged active bleeding, hematologic diseases
cryoprecipitate restores clotting factors to normal ranges; contains Factor VIII and Factor IX
A deficiency if Factor VIII or Factor IX can result in: severe bleeding
PRBCs packed red blood cells (red blood cells without the plasma)
When blood volume is WNL (within normal limits) but RBCs and Hgb are decreased, patient will be given: PRBCs
Giving PRBCs without plasma containing WBCs and antibodies: reduces the risk of an allergic reaction occurring during transfusion
lymphatic system consists of: thumus gland, spleen, liver (also adenoids and tonsils)
functions in utero and briefly after birth; develops T lymphocytes to assist with immune response (when older) thymus gland
stores about 500 mLs of blood that can be released in emergencies; destroys worn out RBCs (after 120 days); removes bacteria by phagocytosis spleen
regulates blood glucose levels; regulates blood levels of amino acids based on tissue needs for protein synthesis; forms lipoproteins for the transport of lipids in the blood to other tissues liver
synthesizes albumin, clotting factors, and globulins; phagocytizes old RBCs, forming bilirubin; stores minerals, synthesizes enzymes, and activates Vit D liver
stimulates liver cells to increase the synthesis of Prothrombin (for clotting) Vitamin K
waste product of RBCs bilirubin
form activated lymphocytes and monocytes; return tissue fluid to maintain blood volume; protect the body against pathogens and foreign material lymph nodes
If the patient is admitted with suspected bleeding problems, assess for: bleeding from a recent injury; c/o fatigue, unexplained blood loss, rectal bleeding, nose bleeds, bleeding gums, or vomiting of blood; dizziness or syncope
General assessment with suspected bleeding problems: 1 of 3 bruising or c/o chills; discomfort in axilla, groin, or neck (lymph node sites); difficulty swallowing with throat tenderness (possible lymph involvement (look at tonsils); surgical history involving lymph nodes, the spleen, or cancer treatments
General assessment with suspected bleeding problems: 2 of 3 frequent infections; record drug history; what meds are they taking; how often; when was last dose; prescribed, OTC, street drugs; dietary history (poor diet may cause production problems with RBCs and Hgb; chronic issues; traveling (parasites, germs)
General assessment with suspected bleeding problems: 3 of 3 assess physical appearance; skin color (pale); temperature (cold); lesions; monitor pulse rate and heart rhythm (weak, thready); palpate lymph nodes for tenderness or swelling; check extremities for similar size
obstruction of lymph circulation may cause: unilateral enlargement
CBC (complete blood count) most common type of blood test; checks the RBCs, WBCs, Hgb, Hct, platelets and more; assists in diagnosing patient conditions (anemia, etc)
an increase in WBCs may indicate: infection
a decrease in RBCs suggests: anemia or bone marrow suppression
Hemoglobin (Hgb) measures the total amount Hgb (oxygen carrying pigment of the RBCs) in peripheral blood; altered levels will be seen in sickle cell anemia, pernicious anemia, etc
Hematocrit (Hct) tells the percentage of RBCs in the total blood volume; a decrease will be seen in anemia, hemorrhage, extracellular fluid excess; may be increased in dehydration; more fluid = more Hct
Coagulation test measures the ability of the blood to clot;
coagulation test that measures amount of time it takes platelets to form clot and seal walls of an injured blood vessel; can detect vascular abnormalities, platelet abnormalities and deficiencies bleeding time
coagulation test that measures the time it takes the blood to clot; frequently ordered for patients receiving Coumadin; the lower the time, the faster clots form PT (Prothrombin Time)
coagulation test that also checks the clotting time of blood; frequently ordered for pts receiving Heparin; the higher the level, the higher the risk for prolonged bleeding; the lower the level, the higher the risk for clot formation PTT (Partial Thromboplastin Time)
measures the O2 and Co2 content of the blood; determines the functional ability of the lungs to maintain adequate gas levels in the blood; holds pressure to site for at least five minutes after drawn (usually done by Respiratory Therapist) ABG (Arterial Blood Gas)
WBCs are counted and reported as percentages of the total examined or absolute (actual number) WBC Differential
patient's blood evaluated to determine blood type and ensure compatibility between donor and recipient blood T & C (Type and Crossmatch)
Blood types: A, B, AB, O
considered the universal donor O negative
universal recipient AB
24 hour urine test; identifies deficiencies of intrinsic factor in the gastric mucosa (needed for the absorption of Vit B12); used to diagnose pernicious anemia Schilling Test
Gerontologic Considerations page 427
3 areas bone marrow biopsy and aspiration sternum, iliac crest (posterior hip), tibia; majority - iliac crest
To perform bone marrow biopsy: consent form signed; provide pain relief and emotional support; pressure dressing should be applied 5 minutes post-test; puncture site observed for bleeding and signs of infection; helps diagnose anemia, decreased WBCs, acute leukemia, decreased platelets
Blood tests: make sure all test specimens are preserved correctly (sterile technique, collected in proper tube or cup, refrigerated if necessary); labeled properly with time, date, patient's info, initials of person who obtained specimen.
If samples are not properly cared for: a false reading or delay in diagnosis could occur
Anemia is a condition (not a disease) in which: low RBC count which results in a low Hgb count; leads to decreased oxygen in the tissues
s/s of anemia: pallor; activity intolerance; orthostatic hypotension; skin and mouth ulcers; jaundiced eyes; HA; tinnitus; dizziness; difficylty concentrating; difficulty swallowing; tachycardia; cold/clammy skin; tachypnea
Results from blood loss and can be acute or chronic hypovolemic/hemorrhagic anemia
hypovolemic/hemorrhagic anemia can be caused by: traumatic injury; vomiting blood; hemorrhage at childbirth; bleeding ulcers; bleeding hemorrhoids; heavy periods; coagulation disorders
s/s of hypovolemic/hemorrhagic anemia fatigue; weakness; thirst; tachycardia; pallor; hypotension; tachypnea; decreased temperature; clammy skin; confusion; syncope
treatment and interventions for hypovolemic/hemorrhagic anemia first priority: control bleeding; place in supine position or modified Trendelenburg; warming blankets; frequent VS; monitor I&Os; safety is high priority
Mild hypovolemic/hemorrhagic anemia can be treated with: iron therapy - IM (Imferon); Z-track method in gluteus medius; oral - take with OJ to help with absorption; take 1 hour before or 2 hrs after meals; if GI upset, take with meals; avoid taking with milk products; use straw to prevent teeth staining
when taking iron supplement, warn pt that: stools may be dark green or black and tarry
Severe cases may need to be treated with: blood transfusion
also know as hypochromic anemia (most common type of anemia); occurs gradually and usually unnoticed until symptoms cause significant discomfort iron deficiency anemia
iron deficiency anemia is caused by: insufficient dietary intake (usually lack of eating red meat); malabsorption problem
s/s or iron deficiency anemia fatigue, weakness, pallor, dyspnea, palpitations, decreased appetite, brittle poorly shaped nails, sore tongue, difficulty swallowing
treatment and interventions of iron deficiency anemia diagnosed by Hgb level or bone marrow biopsy; encourage diet high in iron (eggs, organ meats, kidney beans, dried raisins, apricots, yellow vegs, turnips, dark green leafy vegs, whole wheat bread; oral iron meds (liquid or tabs); IM iron injection
iron deficiency anemia has a good prognosis if: treated early
oral iron meds: Feosol, Fergon, Ircon
IM iron injection Imferon given IM via Z-track technique
Created by: akgalyean