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Ch. 33

Hematology

QuestionAnswer
What is included in the hematological system blood, bone marrow, Reticuloendothelial system (spleen, lymph system)
What are three fx of blood Transportation- O2, nutrients, hormones, wastes Regulation- F&E balance, acid/base bal, body temp Protection- combats pathogens, hemostasis of blood coagulation
What are three primary cell types of blood erythrocytes, leukocytes, thrombocytes
what is hematopoiesis formation of blood cells, done in the bone marrow. Makes up 5-6L of volume in body
What is plasma % and what makes it up 55% of blood volume, consists of albumin, blobulin, fibrinogen, adn other clotting factors plus serum (no clotting factors)
Where is blood cell formation done in the body of adults? Where is it typically aspirated from pelvis, ribs, vertebrae, sternum iliac crest, sternum for study or transplant, consent form
What are stem cells In bone marrow and undifferentiated that can produce RBC, WBC, platelets.
What do RBCs do bi-concave(lg surface area helps in )2 absorption/release) with hemoglobin contains iron. No nuclei in mature RBCs.
what are reticulocytes immature RBCs that get released with some disease states or extreme demand for RBCs. Have nucleus.
How do RBCs transport oxygen the hemoglobin contains iron, heme, which binds to O2 and is carried to lungs as oxyhemoglobin.
what is erythropoiesis process of formation of RBCs. Requires iron, B12(need intrinsic factor in stomach), folic acid, B6, protein, takes 5 days. If spleen takes over, reticulocytes(immature RBC) released,
what is erythropoietin hormone made by kidney to help myeloid cell into erythroblast
what is erythrocyte sedimentation rate measures the rate of settling RBCs, high is inflammation called the "sed rate"
what is life span of RBC 105-120 days(4mos)
Stem cells differentiate into two types myeloid- RBC, WBC, platelets lymphoid- T or B lymphocytes
What are megoblasts abnormally lg RBCs produced when not enough B12 or folic acid and results in megaloblastic anemia, becuase get stuck and block other RBCs
What are two categories of WBCs granulocytes lymphocytes
what is normal count of WBC 4,000-11,000
What are the three granulocytes eosinophils-prasitic inf 2-4% basophils- allergic, histamine <2% neutrophils-kill bacteria 50-70% band cell(immature neutrophil and lead to "left shift" and release of many in response to infection
What are the two types of agranulocytes monocytes- 4-8%, on site, non circulating, lgst WBC, macrophages (in spleen,liver,peritoneum, alveoli) lymphocytes- B-cells(marrow),T-cells(thymus)
What are three different macrophages residents to protect body Kupffer cells - liver Osteoclasts- go to bone Alveolar macrophages - sit in lung
Fx of macrophages defend, remove old/damaged cells, stimulate inflammatory process, present antigen to immune system
what is cellular immunity T cells kill foreign cells directly
what is humoral immunity plasma cells produce antibodies called immunoglobulins that destroy
How is platelet production regulated by thrombopoietin which stimulates produciton of megakaryocytes from myeloid stem cells. Lifespan of 7-10 days
what is fx of spleen hematopoietic- fetal and adult PRN filtration- RBCs, iron, hgb immunologic- b,t-cell, IgM storage - RBC, platelets
what is fx of lymph sustem return protein/fat from GI to blood, 60% interstitial fluid to blood
what is a lymp system adjunct organ liver - filters, produces pro-coagulants, stores excess iron, excretes bilirubin to common duct
what is hemostasis and what are two responses preventing blood loss: primary-vascular, platelets form plug secondary- intrinsic/extrinsic pathway clotting with fibrin
Once fibrin clot is formed and injured vessel is repaired what happens? fibrinolytic(lyse fibrin clot) system, plasminogen(protein to dissolve clots) to lyse fibrin(basis of blood clot).
What does hematocrit measure % of blood volume consisting of RBCs
What are hematemesis, melena, polycythemia, hemarthrosis, petechiae/pupur hematemesis: bloody vomit melena: blood in stool polycythemia:overproduction RBCs Hemarthrosis: blood in joints petechiae/purpura: red/purple hemorrhages
what is normal count for platelets? 150,000-400,000 Thrombocytopenia: <100,000 Thrombocytosis: excessive platelets
What is normal prothrombin time? INR? Prothrombin: 11-12.5sec INR: 0.8-1.1 or <2.0 (want 2-3 for those on anticoagulation)
what is activated partial thromboplastin time (aPTT) 30-45sec
What is D-dimer fragment fibrin indicating clotting activity
What is anemia Condition that is deficiency of # of RBCs, hemoglobin, or hematocrit. Most common hemotologic condition in elderly
Anemia is defect is these three things loss of RBCs, decr production of RBCs, incr destruction of RBCs, blood loss, deficient iron, B12, folate, hemolytic
What look for in CBC for anemia Hgb, Hct, reticulocyte county, MCV, RDW
what do you give for active hemorrhage? For anemia? whole blood b/c of volume adn clotting factors pRBCs
what are morphology of RBCs in anemia normocytic, normochronmic: normal size, color macrocytic, normochromic: lg size, normal color microcytic, hypochromic: sm size, pale color macrocytic, hypochromic: lg size, pale color
s/s of anemia sudden = more devastating weakness, fatique, malaise, pallor, tachy, dizzy, dyspnea, exertional dyspnea
tx for s/s conserve energy....drink meals. Iron rich foods: organ meats, beans, green leafy vegs, molasses, raisins
What is sever anemia hct <6
what are complications of severe anemia heart failure, angina, paresthesias, delirium(no O2 to brain). Inf,inflammatory conditions can cause low iron
what are some findings wtih anemia brittle hair/nails, not jaundice, smooth, pale, sore tongue, burning stomatitis
Where si iron normally absorbed duodenum/upper jejunum, only 5-10% is absorbed, 1/3 is stored/recycled, .5-1mg absorbed from sm int.
what are nsg interventions teach dietary sources and Vit C helps absorption, monitor bleeding, give rest, O2 therapy, give liquid iron, but use straw to get over teeth
What are patterns of anemia of ESRD(end stage renal disease) Creatinine >3/100ml, hemodialysis removes folic acid and breaks RBCs, no kidney erythropoietin
The tongue looks different wtih iron dificiency anemia and megaloblastic anemia iron: smooth/red megaloblastic: beefy red/sore
what is aplastic anemia decr bone marrow, lead to panyctopenia, 75% fatal
what is the cause of aplastic anemia congenital, chemical toxins, meds, radiation
Tx for pancytopenia transfusions, immunosuppressive therapy, bone marrow transplant, stem cell transplant
nsg mgmt for aplastic anemia assess for bleeding or inf, reverse isolation, immunosuppressive reactions, manage meds
S/S for aplatic anemia hemorrhage (GI), lg spleen, pupura in extremeties,
What is megaloblastic anemias missing folic acid and B12 and iron, lg shape
s/s of folic acid deficiency differs from B12 deficiency no neurologic s/s vs neurologic s/s
what is pernicious anemia can't absorb B12 b/c lack intrinsic factor in GI, red beefy tongue, painful
What test is used to test for Pernicious anemia Schillings Test(oral radiation to track B12 if absorbed- if radiation in urine, then B12 absorbed
what are some hemolytic anemias break down of heme to bilirubin, decr life of RBCs, Sickle Cell, Thalassemia
who is affect most with sickle cell anemia black children, low O2 bc sickle shape blocks vessels. Very painful, hemoarthrosis(blood in joints)
How long do sickle RBCs live 20 days vs normal 120, jaundice in scelera
what are three sickle cell crises painful sickle crisis: hypoxia/necrosis aplastic crisis: infection with human parvovirus Sequestration crisis: organs pool the sickled cells (spleen/liver/lungs)
What are some complications of sickle cell Hand Foot syndrome: swelling bn 6mos adn 2yr Jaundice: can lead to gallstones Leg Ulcers, stroke, retinal damage, kidney failure, splenectomy, pneumonia, pulmonary HTN(most cause of deathm screen wtih Doplar)
What are nsg tx for sickle cell conserve energy, O2, fluids, transfusion leads to chelation, Prbcs, hydroxurea(chemo)
What is Thalassemia Low hgb so low O2
what is polycythemia Vera and what are two types excess RBCs, primary, secondary
what is primary polycythemia Male 65yr, incr Hct/WBC/blood vol, fluids, ruddy complexion, lg spleen/liver, pruritus, thrombosis Tx: movement, blood letting
What is neutropenia lack of neutrophils so decr produciton, incr destruction, risk for infection
What are nsg interventions for pt with infections avoid fresh flowers, plants, litter boxes, bird cages, fresh salads, unpeeled fruit/veg, crowds
What is most common childhood disease that causes death Leukemia,neoplastic proliferation of WBCs, acute/chronic, lymphoid, myeloid
what are 4 types of leukemia and which affects children and adults more ALL(acute lymphocytic)- child(boys) AML(acute myeloid) all ages, peak 60, induction therapy(aggressive chemo) CML(chronic myeloid) CLL(chronic lymphocytic) adult50-60, most common, gleevec tx Complictions: tumor lysis syndrome
Lymphoid affects what cells myeloid affects what cells T&B cells monocytes, granulocytes, erythrocytes, platelets
What are lymphomas and what are two clssifications cancer of lymphoid cells, start in nodes Hodgkins - nodular, 20s/50s, painless, pruritus after alcohol, Ree-Sternberg cells Non-Hodgkins - diffuse, all ages, B/T cell origin
What is multiple myeloma malignancy of plasma cells(B lymphocytes) in bone marrow, Men after 40, bone destruction, so bone pain. **back pain and elevated protein
nsg interventions for Myeloma ambulation, bone pain, prevent fractures, fluids for hyperca
Bleeding disorders Thrombocytopenia, Idiopathic Thrombocytopenia Purpura, DIC, Hemophilia, Von Willebrand's Disease
What is normal platelet count and counts for various bleeding normal: 150,000-400,000 no bleeding: 50,000 petechiae, nose/gingival: 20,000 GI/CNS bleed: 5,000
What are signs of ITP, idiopathic thrombocytopenia purpura bruising, petechiae, heavy menses, children/women, <20,000 count TX: IVIG, immunosuppressive meds, splenectomy, HLS transfusions
What is hemophelia what is Von Willebrand's disease inherited, X-linked, loss of factor VII or IX taxi for VII factor
What is first tx for DIC treat underlying cause, then heparin, then platelets/pRBCs
How are transfusions given IV
What is left shift incr of immature neutrophils, band cells from the bone marrow.
what is myelopoiesis mature neutrophils formed from myeloid blast cells, depends on cytokines
where is albumin produced liver, helps with fluid balance
What three factors can help tell if anemia is from destruction or inadequate production 1. marrows ability to decr RBC AEB incr reticulocyte count 2. amt of immature RBC in marrow 3. end products presence/absence, bilirubin level
Created by: palmerag