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blood & lymph (14)

functions, sabs, dx, disrorders, patho

Disseminated Intravascular Coagulation
bleeding into a joint space Disseminated Intravascular Coagulation
Hemophilia A hereditary coagulation disorder; caused by lack of antihemophilic factor VIII, which is needed to convert prothrombin into thrombin through thromboplastin component
Heterozygous having two different genes
Homozygous having two identical genes inherited from each parent for a given hereditary characteristic
Leukemia malignant disorder of the hematopoietic system in which an excess of leukocytes accumulates in the bone marrow and lymph nodes
Lymphangitis inflammation of one or more lymphatic vessels or channels that usually results from an acute streptococcal or staphylococcal infection in an extremity
Lymphedema primary or secondary disorder characterized by the accumulation of lymph fluid in soft tissue, resulting in edema
Multiple Myeloma malignant neoplastic immunodeficiency disease of the bone marrow
Myeloproliferative excessive bone marrow production
Pancytopenic deficient condition of all three major blood elements (red cells, white cells and platelets) results from bone marrow being reduced or absent
Pernicious capable of causing great injury or destruction; deadly fatal ion; deadly fatal
Reed-Sternberg cell Atypical histiocytes; large abnormal, multinucleated cells in the lymphatic system, found in Hodgkin’s disease.
Thrombocytopenia An abnormal hematologic condition in which the number of platelets is reduced to fewer than 100,000/mm3
Anemia A disorder characterized by RBC and hemoglobin and hematocrit levels below normal range is known as?
Plasma 55% Contains 90% water 10% proteins
Blood - Normal Function (3) Transports oxygen and nutrients to cells and waste products away from cells Regulates the acid-base balanceProtects the body against infection and prevents blood loss
Erythrocytes (RBC)Proper production healthy bone marrow adequate vitamins (B12 & B6) and minerals in the body stimulated by a feedback mechanism noting decreased oxygenation Hematocrit – volume of RBC
Erythrocytes (RBC) Normal level 14 to 18 g/dL men 12 to 16 g/dL women
Leukocytes (WBC)Conduct body defense from foreign invaders Produced in the bone marrow Normal Normal 5000 – 10,000 per mm3 Two broad categories: granulocytes agranulocytes Differential WBC count Examine different WBC’s
Granulocytes - phagocytes - cells that surround and "eat" invaders , what is a neurtophil? Neutrophils - make up 70% of WBC Initial responder to any invasion Ingest bacteria & dispose dead tissue 6 day supply in body “seg” mature ~ “band” immature
what is a basophil and Eosinophil? Basophils - key in the inflammatory response Eosinophils - key in allergic responses
Leukocytes (WBC) are agranulocytes, what are monocytes? Monocytes - circulate in blood and work similarly to neutrophils Engulf foreign antigen Macrophages – (mature monocytes) live in tissue (i.e., alveolar macrophages in the lung and Kupffer cells in the liver)
what are lymphocytes? Lymphocytes – directly kill invaders and produce antibodies T cells B cells
Platelets, Thrombocytes Produced in the red bone marrow Assist in clotting formation Normal 150,000 – 400,000 per mm3 Hemostasis (stop to prevent hemorrhage) Vessel spasm Platelet plug formation Clot formation
Blood Types, ABO system ABO system of typing Type A Type B Type AB – universal recipient Type O – universal donor
Determined by presence/absence of specific antigens outer surface of RBC Rh Factor Positive – on outer surface Negative – missing Wrong Rh – antibodies develop
Lymphatic System Subdivision of cardiovascular system Consists of lymphatic vessels, lymph fluid and lymph tissue
Lymphatic System - Functions Maintain fluid balance Produce (mature) lymphocytes WBC produced in the bone marrow but matured in lymph tissue Absorption and transportation of lipids from the intestine to the stream
Lymph fluid Excess fluid & protein - remain in tissues not transported by blood Without lymph drainage, volume overload in tissues Lymph fluid transported back to blood stream through the lymphatic vessels
Lymphatic vessels Vessels connect lymph nodes and collect lymph fluid Connected to the circulatory system for return lymph fluid to blood
Lymph tissue Lymph nodes Tonsils Spleen Thymus
Lymph Nodes – functions Filter impurities from the lymph Produce lymphocytes (WBCs) 500 – 600 in body
Tonsils – functions Protect the body against invasion Produce lymphocytes and antibodies Trap bacteria and may become enlarged
Spleen – location Located in left upper quadrant, just below the diaphragm Highly vascular
Spleen – Functions Reservoir for blood. Stores approximately 500ml Matures lymphocytes, monocytes and plasma cells (B cells) Destroys worn out RBCs Removes bacteria by phagocytosis (macrophages) Produce RBCs before birth
Thymus Located between the lungs in the mediastinum Functions in utero and for several months after birth to develop the immune system Matures T cells Atrophies at puberty
What WBC is the initial responder to any invasion? Neutrophils
Lab and Diagnostic Tests Complete Blood Count (CBC) Red Cell Indices Differential Count Peripheral Smear Schilling Test & Anemia Profile Gastric Analysis Lymphangiography Bone Marrow Aspiration or Biopsy
Complete Blood Count (CBC) Detects disorders & provides data for the diagnosis and evaluation Includes RBC & WBC count hematocrit and hemoglobin level erythrocyte (RBC) indices differential white cell count Examine peripheral blood cells
Red Cell Indices Measure size and hemoglobin content of erythrocytes. Mean corpuscular volume (MCV) size Mean corpuscular hemoglobin (MCH) weight Mean corpuscular hemoglobin concentration (MCHC) Percentage of hemoglobin
Mean Corpuscular Volume (MCV) The average volume or size of a single RBC
Differential Count Actual cell count of leukocytes Identifies the number and percentage of individual types: Neutrophils, basophils, eosinophils Monocytes, macrophages Provides the physician with diagnostic information
Peripheral Smear Often accompany differential WBC count Permits examination of the size, shape, and structure of individual RBCs, WBCs and platelets Most informative of all hematologic tests
Schilling Test and Megaloblastic Anemia Profile Schilling Test and Megaloblastic Anemia Profile
Schilling Test and Megaloblastic Anemia Profile Absorption in the stomach is dependent on intrinsic factor produced by gastric mucosa Patients with large resections of stomach may not produce adequate intrinsic factor to prevent pernicious anemia
Schilling Test and Megaloblastic Anemia Profile Measures excretion of Vitamin B12 after parenteral administration Normal findings are excretion of 8% to 40% of radioactive vitamin B12 within 24 hours
Gastric Analysis Evaluates presence of intrinsic factor In pernicious anemia: gastric secretions minimal pH remains elevated after histamine injection Proper function of parietal cell cause increase in ph with histamine
Lymphangiography A radiological examination used to detect metastatic involvement of the lymph nodes Contrast medium is injected into a lymphatic vessel of the foot or hand, followed by radiological visualization of the lymphatic system
Bone Marrow Aspiration or Biopsy Bone marrow aspiration or biopsy is specific for establishing the diagnosis and for treatment response. Iliac crest most commonly used, although the sternum can also be used
Bone Marrow Aspiration or Biopsy Bone marrow Soft & semi-fluid aspirated through a needle Most commonly performed: Marked anemia Neutropenia Acute leukemia Thrombocytopenia
What is the most common site for bone marrow aspiration or biopsy? Iliac Crest
Nursing Interventions and Patient Teaching Before any diagnostic testing: Determine patient knowledge of procedure Reviews the test procedure Teaches/assesses understanding Patient’s participation before and during procedure Discomfort that might be experienced
Nursing Interventions and Patient Teaching Before any diagnostic testing: Inspects specimen for correct labeling and immediately forwards to the lab When tests involve a puncture: Assess for excessive bleeding Apply pressure Apply pressure dressing to the site as needed
Nursing Interventions and Patient Teaching Before any diagnostic testing: Monitors vital signs during recover Notifies physician regarding adverse responses Analyzes and reports test results promptly
Lymph Node Biopsy Teach/assess understanding of procedure: Conscious sedation Witness consent from
Lymphangiography Teach/assess understanding of procedure: Conscious sedation Procedure in Radiology/ Special procedures Witness consent from Renal function (contrast) Allergies iodine
Ultrasonography, CT, MRI Teach/assess understanding of procedure: conscious sedation (may) Performed to visualize size, structure and flow through the spleen or lymph nodes No special preparation is required
Bone scan Teach/assess understanding of procedure: Performed to identify bone metastasis Radioactive isotope injected into vein and body Scans performed in Nuclear Medicine No special preparation required
Bone Marrow Aspiration Teach/assess understanding of the plan: Approximate time for the bone marrow aspiration Allow patient time for questions & verbalize fears/concerns Witness consent form
Bone Marrow Aspiration Verify history of allergies (patient & records) local anesthetics latex Obtain a sterile bone marrow aspiration tray Add local anesthetic (type & strength)
Identify appropriate site proper position the client Suggest distraction techniques avoid focusing on the pressure discomfort associated with puncturing the bone Bone Marrow Aspiration
Bone Marrow Aspiration Label the specimen and ensure delivery to laboratory Maintain standard precautions Limit activity for approximately 30 min after procedure
Bone Marrow Aspiration Monitor puncture site Bleeding Unusual pain at site Infection Report finding
What must be checked before performing lymphangiography? Renal function Allergies
The Nursing Process Anxiety, related to diagnosis (actual/potential) or diagnostic test Patient verbalizes understanding of need for procedure and has a manageable anxiety level
Anxiety Nursing Interventions Provide privacy, reassurance and information to all patients Allow patient to verbalize fears/concerns regarding procedure and prognosis Provide additional education, as needed
The Nursing Process Knowledge deficit related to test, patient preparation and recovery Patient verbalizes understanding of procedure, preparation and expected recovery
Knowledge deficit Nursing Interventions Provide patient education regarding specimen collection Explain procedures and provide written instructions to the patient for procedure preparation
Name a nursing diagnosis appropriate for the patient with a disorder of the blood or lymphatic system. Anxiety or Knowledge deficit
Summary A: Define key terms related to the blood and lymphatic system. B: Review the normal function of the blood and lymphatic systems. C: Identify laboratory and diagnostic tests used in the diagnosis of blood and lymphatic disorders
Created by: redhawk101