Units V-A, V-B
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| What are the 3 functions of the Hematologic system? | 1.Transportation
2.Coagulation/Clotting
3.Immune Response
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| What are the four things that are transported in the hematological system? | 1. Oxygen to cells
2. CO2 from cells
3. Hormones, electrolytes, and nutrients to cells.
4. Waste products to the liver and kidneys
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| What component of the hematological system carries hemoglobin? What is the importance of hemoglobin? | 1. Erythrocytes
2. Hgb transports oxygen to the body tissues
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| What is a hormone that stimulates erythrocyte production? Where is the hormone found? Where does production occur? What is this production called? | 1. Erythropoetin
2. Kidney
3. Bone Marrow
4. Erythropoiesis
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| Where are erythrocytes eliminated? | Liver and Spleen
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| How many grams of Hgb does 100mL of whole blood contain? | 14-15g
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| Leukocytes function by __________ to rid the body of what 3 things? | 1. Phagocytosis
2. Foreign Particles
3. Mutations in Cell Division
4. Bacteria in the immune response
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| What is a normal WBC? | 5,000-10,000/mml
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| What are the two types of WBCs? | 1. Granulocytes
2. Nongranularcytes
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| What are the three types of granulocytes and their normal percentages of total WBC? | 1.Neutrophil 60-70%
2.Eosinophils 1-3%
3.Basophils 1%
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| What are the two types of nongranular leukocytes and what are their normal percentages of total WBC? | 1.Monocytes 3-8%
2.Lymphocytes 20-30%
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| What is the primary function of platelets? | Aid the body in clot formation.
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| Thrombocytes are derived from what? These are found where? | 1. Megakarocytes
2. Bone Marrow
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| What is the normal platelet count range? | 150,000/mm3-450,000mm3
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| Platelet lifespan? | 8-12 Days
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| What happens if the platelet count is too low? | Clotting cannot occur
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| Where are platelets stored and how are they destroyed? | Stored in the spleen
Destroyed by phagocytosis
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| What percentage of the blood is made up of plasma? | 55%
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| What are the three components that make up plasma? | 1. Water (92%)
2. Protein (7%)
3. Inorganic Salts (1%)
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| What are the four types of protein found in plasma? | 1. Hormones
2. Albumin
3. Fibrinogen
4. Globulins
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| What are also four components that make up the hematologic system? | 1. Spleen
2. Lymphatics
3. Liver Clotting Mechanisms
4. Anticoagulants
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| What is the shape and location of the spleen? Is it vascular? | 1. Bean-shaped
2. LUQ of the Abdomenm, behind stomach
3. Yes!
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| What are four functions of the spleen? | 1. Hematopoietic function
2. Filter Function
3. Immune function
4. Platelet Storage
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| What does the spleen do during fetal development? | Produces RBCs
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| What are the two filter functions of the spleen? | 1. Remove defective cells from circulation
2. Breaks down RBC (recycles iron to bone marrow)
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| What is the immune function of the spleen? | Contains a supply of lymphocytes and monocytes.
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| What is the function of Lymphatics? | Carries lymph fluid via ducts and lymph nodes.
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| Lymphatic capillaries join to form what? | Lymphatic Ducts
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| Lymphatic ducts carry lymph to what two places? | 1. Right lymphatic duct
2. Thoracic duct
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| Where do lymphatic capillaries drain? | Into the subclavian vein
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| What are the shape of lymph nodes and what do they filter? | 1. Small rounded bean-shaped
2. bacteria and foreign particles
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| Where are lymph nodes distributed? | 1. All over the body
2. Deep and Superficial
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| Where is the liver located? | RUQ and epigastric region of the abdominen
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| Where does the liver receive blood from? | The spleen and portal circulation.
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| What are the five functions of the liver? (Hint: BK DIP) | B-bile production from erythrocyte destruction
K- Kupffer cells carry out phagocytosis
D-Detoxification of Drugs
I-Iron and VitB12 storage
P-Production of procoagulants
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| What is the purpose of clotting mechanism? | To decrease blood loss when the body sustains injury
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| What are the 2 vascular responses in clotting? | 1. Immediate vasoconstriction
2. Vascular spasm lasting 30 minutes (allow time for platelet response)
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| What is the platelet response in clotting? | 1. Aggregation/clumping
2. activated by exposure to interstitial collagen
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| How is the platelet response activated? | exposure to interstitial collagen
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| What role does plasma protein have in the clotting mechanism? | It circulates in inactive form to initiate clotting.
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| What does Thrombin do and why is its action important? | 1. Converts fibrinogen--> fibrin
2. Fibrin is essential in the formation of a blood clot
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| What is anticoagulation a counter mechanism to? What does it do? | 1. Blood clotting
2. Maintains blood in its liquid state
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| What do antithrobins antagonize and what is the result? | 1. Thrombin
2. Blood is maintained in its liquid state
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| When does fibrinolysis occur? | When plasminogen is activated to plasmin (often initiated by thrombin)
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| What should a health history of the hematologic system include? (Hint: FIME-BARN) | F-Family Hx of Hemat. problem
I-I/O (Dietary)
M-Mestrual Hx
E-Elimination: Any blood?
B-Beliefs about blood/bl products
A-Abuse of subtance/chem exposure
R-Resp Hx: SOB, exertion, Cough
N-Neurological Hx: light headed, tingling, numbness, headach
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| What surgical complications should the Nurse know about when Assessing the hematologic system? | 1.Blood (Clots, bleeding, Reaction to transfusion)
2. Spleen (injury/surgery)
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| What does a physical assessment of the hematologic system include? (Hint: PAPI) | P- Palpation (Skin, lymph nodes, abdomen (spleen and liver)
A-Auscultation (bruits, lung, heart sounds, rate and rhythym)
P- Percussion (lungs, abdomen-spleen/liver)
I- Inspection of body (color, rashes, bruising, ulcerations, cracking at corners of mo
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| What are five diagnostic tests that can be pulled when Assessing the hematologic system? (Hint: BB-L-RR) | B-Blood test
B-Bone Marrow Biopsy/Aspiration
L-Lymph Node Biopsy
R-Radiologic Test (Xray, CT, MRI, lymphangiogram)
R-Radioisotope Scan (Isotope injected to assess structure of liver, spleen, bone, lymph node)
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| Describe Anemia. (Note: 3 answers) | A reduction below normal in:
1. Number of Erythrocytes
2. Quantity of Hemoglobin
3. Volume of Erythrocytes (Hct)
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| Normal range of RBC for men and women? | Men: 4.5-5.3 million
Women: 4.1-5.1 million
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| Hct WNL for men/women? | Men: 37-49%
Women: 36-46%
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| Hbg WNL for men/women? | Men: 13-18 grams
Women: 12-16 grams
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| Erythropoiesis begins in the bone marrow of what four body parts? | 1. vertebrae
2. sternum
3. ribs
4. pelvis
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| Where is Erythropoiesis completed? | blood or spleen
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| What are cells called when they enter circulation from the bone and how long does it take for them to fully mature? | 1. Reticulocytes
2. 48 hours
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| How long does it take for a stem cell to develop into an RBC? | 3-5 days
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| What stimulates RBC production? | Hypoxia
Kidney releases erythropoietin in response to hypoxia.
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| What are the proper requirements for proper development of RBCs? | 1. Iron (for Hgb synthesis)
2. Proteins, Vitamins (B12/Folate/C) and Minerals
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| Lifespan of RBC? | 120 Days
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| Old or damages RBCs are lysed by phagocytosis in what four body parts? (Hint: BLLS) What is this process called? | Bone Marrow
Lymph nodes
Liver
Spleen
Process is called HEMOLYSIS.
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| Phagocytes save and reuse _________ and ______ from the _______ units of lysed RBCS. | 1 Amino Acid
2. Iron
3. Heme
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| Most of the heme unit is converted to what? Which is then removed from the blood by the liver and excreted in what? | 1. bilirubin
2. bile
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| What are three causes of anemia? (Hint: DIA) | 1. Decreased eythrocyte production
2. Increased erythrocyt destruction
3. Acute/Chronic Blood Loss
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| What are three causes of decreased erythrocyte production? (Hint: BAA) | B-Bone marrow failure
A-Altered Hgb synthesis
A-Altered DNA synthesis
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| What are three things that cause altered hemoglobin synthesis? (Hint: TIC) | T-Thalassemias (inherited disorders of Hgb synthesis)
I-Iron deficiency
C-Chronic Inflammation
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| What can alter DNA synthesis? | Vitamin B12 or Folic Acid malabsorption or deficiency.
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| What are five types of marrow failure that cause decreased erythrocyte production? (Hint: MARCIF) | M-Myeloproliferative leukimia (excess WBC production)
A-Aplastic anemia (stem cell disfunction)
R-Red aplasia
C-Cancer metastasis, lymphoma
I-Inection/Inflammation (Chronic)
F-Fatigue (Physical/Emotional)
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| What are four causes of increased hemolysis (RBC destruction)? Hint: I-SO-DIME | I-Infection
S-Splenomegaly (spleen enlargement)
O-Oxidation of Cell/Glycolysis affected by PK deficiency
D-Defective hemoglobin (sickle cell/trait)
I-Immune mechanism/disorder
M-membrane disorders (of the cell)
E- Erythrocyte Trauma (X:CardioPul
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| What are four general types of anemia? (Hint: BAHN) | B-Blood Loss Anemia
A-Aplastic Anemia
H-Hemolytic Anemia
N-Nutritional Anemia
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| During acute blood loss what happends to cardiac output? | Circulating blood volume decreases which decreaes cardiac output
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| What are two compensations the body will attempt during acute blood loss? | 1. Heart/Circulatory System compensation
2. Fluid volume shifts from ITF to vascular system
These are in attempt to keep BP elevated
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| What are three types of Nutritional Anemia? (Hint: FIV) | 1. Folic Acid Deficiency Anemia
2. Iron Deficiency Anemia
3. Vitamin B12 Deficiency Anemia
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| What is the most common type of anemia? | Iron deficiency anemia
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| Malabsorption of Vitamin B12 is secondary to what four factors? (Hint: GIRL) | G-Gastritis (common)
I-Intrinsic factor lack (secreted in stomach/affected by caffeine and alchohol consumption)
R-Resection of stomach/Ileum
L-Loss of pancreatic secretions
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| Folic Acid Deficiency Anemia is due to what and usually seen in what three types of patients? (Hint: DOA) | 1. Inadequate intake
2. Drug addicts
3. Older Adults
4. Alcoholics
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| What are four types of hemolytic anemia? (Hint: TAGS) | T-Thalassemia
A-Acquired Hemolytic Anemia
G-Glucose 6 Dehydrogenase (G6PD) Anemia
S
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| What is sickle cell anemia? | Hereditary chronic anemia
Causes synthesis of abnormal Hgb (causing sickling of RBCs)
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| What is Thalassemia? | 1.Inherited disorder
2.Causes deficient prodcution of Hgb
3.Causes of fragile RBCs
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| What is acquired hemolytic anemia? | 1. Hemolysis occurs due to factors OUTSIDE of the RBC
2. Mechanical Trauma
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| Acquired hemolytic Anemia is caused by mechanical trauma. What are 11 possible causes of this trauma? (Hint: SHRIP-DIVA-CT) | S-Severe Burns
H-Hemodialysis
R-Radiation
I-Infection (Bacterial or Protozoa)
P-Prosthetic Heart Valve
D-Drugs
I-Immune mediated response (transfucion rx)
V-Venom
A-Autoimmune
C-Chemical Agents
T-Toxins
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| What are four characteristics of Aplastic Anemia?(Hint: BLER) | B-Bone marrow fails to produce 3 types of blood cells
L-Leads to panocytopenia
E-Exposure to certain chemicals/toxins/infections can cause it
R-Rare and is unknown in 50%
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| What is serum Ferritin? | An iron storage protein produced by liver, spleen and bone marrow.
Is depleted with depleted iron stores.
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| What does a Schilling test measure? When is it done and Why? | 1. Vitamin B12
2. Before/after administration of intrinsic factor
3. To ID cause of VitB12 deficiency
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| A Bone marrow exam is used to diagnose which type of anemia? | aplastic anemia
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| What are five medications used to treat Anemia? (Hint:SPIFE) | S-Supplemental Iron (PO or IV)
P-Parenteral Vitamin B12
I-Immunosuppressive therapy
F-Folic Acid (for patients who are deficient, pregnant, childbearing age)
E- Erythropoietin (Give c iron bc stimulus effect)
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| Patients with Anemia should eat diets that are high in what three vitamins? | 1. Iron
2. Vitamin B12
3. Folic Acid
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| When is a blood transfusion necessary | 1. severe blood loss
2. severe anemia (regardless of cause)
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| What are four Nursing Dx? (Hint: AISI) | A- Activity Intolerance
I-Impaired oral mucous membrances
S-Self Care deficit
I-Imbalanced nutrition less than body requirements
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| Interventions for an anemic patient you've diagnosed with Activity Intolerance? (A-MESI) | A-Alternate activity and rest
M-Monitor vital signs a/p activity
schedule
E-Establish priority for task/activity
S- Sleep (8-10 hours)
I-ID ways to conserve energy
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| Interventions for an anemic patient you've diagnosed with impaired oral mucous membrane. (PUMIC) | P-Provide frequent oral hygiene
U-Use lip protectant
M-Mouthwash of saline, saltwater or 1/2 strength H2O2 q2-4h
I-Instruct to avoid spicy/acidic food
C-Condition of lips/tongue monitored daily
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| Interventions for an anemic patient you've diagnosed with self care deficit. (AR) | A-Assist with ADLS
R-Rest period importance discussed prior to activities that expend energy
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| Interventions for an anemic patient you've diagnosed with "Imbalanced nutrition less than body requirements." (FANN) | F-Food high in needed supplements (educate)
A-All ordered nutritional supps qd (encourage)
N- Need for additional food source (educate)
N- Nutritional strategies to address deficiencies
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| What are four physical assessment techniques that focus on the hematologic system? | 1. skin color/temp
2. cap refill
3. respiratory rate/pattern
4. heart rate
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| What four factors does the manifestation of anemia depend on? | 1. anemia severity
2. how quickly it developed
3. age
4. general health status
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| When do successful compensatory mechanisms result in less symptoms? | When anemia develops gradually
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| Pallor of what occurs, and why? | 1. skin, mucous membrances, conjunctiva, nail beds
2. it is the result of blood redistribution to vital organs and lack of hemoglobin
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| What increases as tissue oxygenation decreases? And why? | 1. respiratory and heart rate
2. to increase cardiac output and tissue perfusion
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| What does tissue hpoxia cause? DAFN | D - Dyspnea on exertion
A - Angina
F - Fatique
N - Night cramps
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| What can an increase in erythropoietin activity lead to? | It stimulates RBC production in the bone marrow and may lead to bone pain.
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| What are the two initial manifestations of rapid blood loss? | tachycardia and tachypnea
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| What can cerebral hypoxia lead to? | Headache
Dizziness
Dim vision
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| When can heart failure develop? | In severe anemia.
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| What are signs of circulatory shock? | hypotension, tachycardia, decreased LOC, and oliguria (production of abnorm small amt. of urine).
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| What can be a result of lowered blood viscosity? | systolic heart murmur
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| In addition to the general manifestations of Anemia, what are manifestations specific to iron deficiency anemia? | 1. brittle spoon-shaped nails
2. cheilosis (cracks at corner of mouth)
3. smooth, sore tongue
4. pica (unusual cravings)
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| What is pernicious anemia? | Failure to absorb Vitamin B12
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| How do symptoms of VitB12 deficiency anemia develop? | Gradually as bodily stores of the vitamin are depleted
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| In addition to the general manifestations of Anemia, what are manifestations specific to Vitamin B12 deficiency anemia? (PPSD) | P-Paresthesias (altered sensation-numbness/tingling
P-Proprioception (sense of one's position in space)
S- Smooth, sore, beefy red tongue
D- Diarrhea
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| In addition to the general manifestations of Anemia, what are manifestations specific to folic acid deficiency anemia? PSH-GCD | P-Progressive weakness/fatigue
S-SOB
H-heart palpitations
Same as Vitamin B12:
G-Glossitis (inflammation of tongue)
C-Cheilosis (cracked mouth)
D-Diarrhea
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| Extensive sickling can precipitate a crisis due to what three things? (SIC) | S-Sequestration of large amounts of blood in liver or spleen
I-Impaired erythropoiesis
C-Circulation occlusion
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| What two kinds of crisis occur when sickling develops in the microcirculation? | 1. Vasoocclusive
2. Thrombotic
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| What does obstruction of blood flow due to sickling cells cause? Which does what? | 1. Vasospasm
2. halts all blood flow in vessel
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| What does infarction of small vessels in the extremities cause? | Painful swelling of the hands and feet
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| Cerebral vessel occlusion may lead to what? | Stroke
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| Which organs' structure and function can be affected by repeated infarcts associated with sickling? | every organ system
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| Thalassemia minor is usually asymptomatic. What symptoms can occur if any? SBBM | S-Splenomegaly
B-Bronze skin coloring
B-Bone marrow hyperplasia
M-Mild to moderate anemia
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| What can Thalassemia Major cause?SHL | S-Severe anemia
H-heart failure
L-Liver and spleen enlargement from increased RBC destruction
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| What may happen as a result of increased hematopoiesis? | fractures of long bones, ribs, vertebrae (due to bone marrow expansion and thinning)
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| Aplastic anemia eventually leads to what two things? | tachycardia and heart failure
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| Platelet deficiency leads to what bleeding problems? BENI | B - Bleeding gums
E - Excessive bruising
N - Nose bleeds
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| What is the priority of care when treating anemia? | ensuring adequate tissue oxygenation
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| Where are most anemic patients treated? | At home and in a community setting.
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