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Blood 1329
| Question | Answer |
|---|---|
| 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
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