Chapter 30, VNE Rusk
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| What is the function of blood? | carries O2 to cells, returns CO2 to the lungs to be eliminated, Transports food to nourish cells, carries away waste products of cell metabolism, regulates body temperature, provides clotting factors
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| What is heat carried by? | blood
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| Bone Marrow | soft tissue that fills spaces in the interior of the long bones and spongy bones. Manufactures blood cells
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| What type of bone marrow is there? | Red marrow and yellow marrow.
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| Red bone marrow | manufactures blood cells and hemoglobin
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| Yellow bone marrow | consists of fat cells and connective tissue; does not manufacture blood cells; can manufacture blood cells under intense stimulation.
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| What does blood consist of? | cells suspended in a fluid call plasma
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| Where are blood cells produced from? | stem cells in the bone marrow
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| Elements that are formed | Erythrocytes, leukocytes, platelets
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| What is significant about blood functions? | prevents serious loss of fluids in case of injury, prevents clot formation in blood vessels which would seriously interfere with oxygen supply to the cells.
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| Acute blood loss has serious effects on the body at what loss | 1000 mL or more
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| How much blood circulates in a human adult body? | 5-7 liters of circulating blood volume
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| What are the characteristics of blood? | slightly sticky, characteristic odor, faint salty taste, bright red in the arteries, dark red in the veins
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| veins | carry carbon dioxide
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| arteries | carry oxygen
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| Two parts of blood | liquid or plasma and solid or formed elements
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| Erythrocytes | red Blood cells, RBC, formed in red bone marrow, produced by the LIVER and SPLEEN before birth. Erythropoiesis is a continuous process.
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| Erythropoiesis | production of RBC (range 3.6-5.4 million/mm3)
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| People who live at higher atltitudes | have an increased number of RBC's.Women have fewer than men.
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| How long does RBC's circulate? | 120 days.
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| Discription of Erythocytes(RBC's) | flexible, anuclear, biconcave disks covered by thin membrane through which O2 and CO2 pass freely. flexibility allows them to change shapes as they travel the capillaries.
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| What is the major function of Erythocytes? | transport O2 and remove CO2 from the tissues.
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| Who has the most RBC's | Newborns
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| Main ingredient in Erythocytes? | Hemoglobin
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| What does low iron levels mean? | anemia
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| Hemoglobin adult normal range | 12 to 17.4
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| What does hemorrhage cause a decrease in? | amount of circulating fluid, number of RBC's, amount of Hgb, Iron levels.
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| As the erythrocytes pass through the lungs, what does hemoglobin pick up | oxygen and relases CO2
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| Oxygenated blood | bright red and carried by arteries, aterioles, and capillaries to body tissues.
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| Low Hemoglobin S/S | tachycardia, tachypnea, anemia, fatigue, chills, change in HCT level.
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| HCT level | measure the % of RBC's in the total blood volume
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| HCT level in anemia | HCT will decrease
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| HCT level in dehydration | will increase but HGB decreases
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| What happens to iron when RBC's are destroyed? | returned to red bone marrow and reused.
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| bilirubin | waste product of destroyed RBC's
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| Leukocytes | WBC, arise from stem cells in bone marrow, protects body from infection, repair damaged cells.
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| What is the lifespan of WBC (leukocytes) | 1-2 days
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| Normal range of WBC (leukocytes) | 5000-10,000
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| Leukocytosis | increased number
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| Leukopenia | decreased number
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| Classifications of WBC | granulocytes and agranulocytes
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| lymphocytes | aid with development of immunity
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| monocytes | phagocytic cells, involved with inflammatory process
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| platelets - Thrombocytes (PLT's) | smallest cell in body, essential for blood coagulation. formed in red bone marrow.
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| What is the lifespan of Platelets (throbocytes) | 7.5 days
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| normal range of platelets | 150,000 to 350,000
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| Where do platelets migrate when a blood vessel is injured? | injury site.
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| What is released that causes platelets to adhere and form a clot? | glycoprotein llb/lla
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| When hemostatsis is achieved | hemorrhage is prevented
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| thrombocytopenia | serious bleeding occurs due to decrease in number of platelets
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| thrombocytosis | blood clots form too easily due to abnormally high number of platelets.
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| Function of Thrombocytes? | Control bleeding
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| How does thrombocytes work to control bleeding | injury occurs, platelets gather at the injury site, stick together using factor #, form a plug or clot, eventually pull plug tight bringing damaged blood vessel margins together.
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| Factor III | necessary for coagulation and formation of birth.
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| What if platelet count if low? | use small needles for injections, apply prolonged pressure to sites, encourage patient to use a toothette instead of toothbrush, take oral not rectal temp, encourage electric and not straight razor, be gentle!
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| plasma | liquid part of blood, contains no cells, 90% water, 10% proteins
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| What does plasma transport? | proteins, clotting factors, vitamins, glucose, lipids, electrolytes, enzymes, hormones.
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| gamma globulin | used in prevention or modification of infectious disease; given to patients with low immunity.
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| serum albumin | administered to maintain osmotic pressure of the plasma; may also treat hypovolemic shock in burn patients and liver disease.
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| fibrinogen | plasma protein, essential clotting factor. converted into fibrin. uses calcium ions to help pull platelets together to form a clot.
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| Deficiency of fibrinogen may occur due to | congenital disorder or massive hemorrhage, prolonged active bleeding, or hematologic diseases.
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| cryoprecipitate | restores clotting factors to normal ranges; contains factor 8 VIII and IX
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| Packed red blood cells PRBC's | red blood cells without the plasma. given to reduce the risk of allergic reaction in transfusions.
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| Blood groups | A, B, AB, and O
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| How is blood type determined | heredity, identifying the protein or antigen on the red cell membrane, antibodies, immunoglobulins in plasma that inactivate any substance that is nonself.
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| RH Factor | specific protein on the RBC membrane,
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| RH factor with present protein | RH positive
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| RH factor without the presence of protein | RH negative
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| T&C | Type and crossmatch - blood evaluated to determine blood type and ensure compatibility between donor and recipient blood.
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| Blood transfusion | blood is transfused and donor blood must be both type and RH compatible with recipients blood.
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| RH positive blood | can receive RH positive and negative
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| RH negative blood | can never receive RH positive blood.
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| Lymphatic system | circulates interstitial fluid and carries it to the veins; filters and destroys pathogens and removes potentially harmful substances.
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| Lymphatic system includes | thymus gland, spleen, lymphatic vessels (lymph nodes and lymph)
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| Function of the thymus gland | functions in utero and briefly after birth. develops T lymphocytes to assist with immune system.
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| Function of the spleen | stores about 500mls of blood that can be released in emergencies; destroys warn out RBC's; removes bacteria by phagocytosis.
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| Function of the liver | 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; Vit K stimulates livers cells to increase the synthesis of Pro
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| Liver synthesizes | albumin, clotting factors, globulins
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| Additional functions of the liver | phagocytizes old RBC's forming bilirubin; stores mineral, synthesizes enzymes and activates Vit D.
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| Lymph nodes | form activated lymphocytes and monocytes; return tissue fluid to maintain blood volume; protect the body against pathogens and foreign material.
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| Lymphatic network | axilla, groin, neck, large vessels of thorax and abdomen.
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| Lymph fluid | flows through the lymphatic system by contraction of skeletal muscles.
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| What do macrophages do when the lymph passes through the nodes | attach and engulf foreign substances.
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| Physical Assessment for bleeding problems | drug history, meds taking now, how often, last dose, dietary history, skin color, temp, lesions, pulse rate and heart rhythm, palpate lymph nodes for tenderness and swelling, check extremities for similar size.
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| CBC | complete blood count; most common blood test; checks RBC's, WBC's, Hgb, Hct, platelets and more.
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| What does an increase in WBC indicate | infection
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| decrease in RBC's suggests | anemia or bone marrow suppression
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| Hgb | Hemoglobin; measures total amount of Hgb (oxygen carrying pigment of the RBC's) in the peripheral blood.
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| What can alter levels of Hgb | sickle cell anemia and pernicious anemia
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| Hct | Hematocrit; tells the percentage of RBC's in the total blood volume.
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| Alterations of Hct | decrease seen in anemia, hemorrhage, and extracellular fluid excess and an increase in dehydration
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| Coagulation test | measures the ability of blood to clot
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| bleeding time (type of coag test) | measures the amount of time it takes platelets to form a clot and seal the walls of an injured blood vessels.
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| PT | prothrombin time; measures the time it takes the blood to clot; frequently ordered for patients receiving Coumadin. lower the time, faster the clot.
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| PTT | partial Prothrombin time. checks clotting time of blood. Heparin patients, higher the level, higher risk for prolonged bleeding, lower the level, higher the risk for clot formation.
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| WBC differential | counted and reported as percentages of the totaled examined or absolute number.
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| Schilling Test | 24 hour urine test,
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| anemia | deficiency of erythrocytes and hemoglobin; reduction in amount of O2 carried to cells.
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| What causes anemia | blood loss, inadequate or abnormal erythocyte production; destruction of normally formed RBC's.
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| Types of anemia | Hypovolemic anemia, iron deficiency, pernicious, folic acid, sickle cell, hemolytic
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| hypovolemic anemia | blood loss, compromised cellular function; s/s pallor, tachycardia, hypotension, reduced urine, altered consciousness, fatigue, chills, CBC, Treatment - blood transfusion
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| Iron deficiency Anemia | insufficient iron for hemoglobin production
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| Assessment finding for iron deficiency anemia | Reduced energy, feel cold all the time, fatigue, dyspnea with minor physcial exertions, rapid heart rate.
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| causes of iron deficiency | heme cannot be recycled because of blood loss. dietary intake of iron is insufficient, absorption of iron from food is inadequate, need for iron exceeds reserves.
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| Medical management of iron deficiency | determine cause, correct it, nutritional intake of iron, oral supplements.
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| Oral Iron supplements | take on empty stomach, do not take with antacid, take with orange juice, dilute if liquid iron - drink with straw.
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