Blood 1329
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| hematopoiesis | manufacture and development of blood cells
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| 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
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| blood | cells suspended in plasma
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| acute blood loss that has serious effects on the body | loss of 1,000 mL or more
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| amount of circulating blood volume in adults | 5-7 liters
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| characteristics of blood: | slightly sticky, characteristic odor, faint salty taste, bright red in the arteries (carrying O2), dark red in veins (carrying CO2)
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| Structure of blood - 3 groups of formed elements | erythrocytes (RBCs), leukocytes (WBCs), thrombocytes (platelets)
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| RBCs formed in the red bone marrow, produced in liver and spleen before birth | erythrocytes
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| continuous production of RBCs | erythropoiesis
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| Essential for formation of RBCs | folic acid and Vitamin B12 (Nutrition Notes 30-1)
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| RBC's | Men have more than women; newborns have the most
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| normal range of RBCs | 3.6 - 5.4 million/mm
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| Main ingredient of RBCs | hemoglobin
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| Amount of hgb in the RBC depends on: | adequate iron storage
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| Iron is essential for: | hgb synthesis
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| Iron is important for the O2 carrying ability of the: | hgb molecule
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| low iron levels | anemia
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| normal range of adult hgb | 12-17.4
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| hemorrhage causes a decrease in: | amount of circulating fluid; number of RBCs; amount of Hgb; iron levels
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| hemorrhage results in: | low hemoglobin; tachycardia; tachypnea; anemia (chronic blood loss); fatigue; chills; change in Hct level
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| hematocrit (Hct) | measures percentage of RBCs in the total blood volume
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| Hematocrit will decrease with: | anemia
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| During dehydration, Hct will increase while Hgb: | decreases
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| When RBCs are destroyed, iron is returned to red bone marrow and: | reused
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| bilirubin | waste product of destroyed RBCs (made when RBCs die, goes to liver to be processed)
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| leukocytes | white blood cells; arise from ctem cells in bone marrow
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| normal range of leukocytes | 5,000 - 10,000 mm3
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| leukocytosis | increased number of WBCs
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| leukopenia | decreased number of WBCs
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| for leukopenia, monitor closely for: | infection, use strict handwashing, protective isolation
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| functions of leukocytes | protect body from infection; repair damaged tissue; lab levels aid in diagnosis
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| When RBCs are destoryed, iron is returned to the red bone marrow and: | reused
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| waste product of destroyed RBCs | bilirubin
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| also known as WBCs (white blood cells); arise from stem cells in bone marrow | leukocytes
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| normal range of leukocytes | 5,000 - 10,000
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| increased number of WBCs | leukocytosis
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| decreased number of WBCs | leukopenia
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| with leukopenia, monitor closely for: | infection, use strict handwashing, protective isolation
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| functions of leukocytes: | protect body from infection; repair damaged tissue; lab levels aid in diagnosis
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| classifications of leukocytes | granulocytes and agranulocytes
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| agranulocyte classifications: | lymphocytes (aid with development of immunity) monocytes (phagocytic cells involved with inflammatory process)
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| thrombocytes | platelets (PTLs)
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| thromobcytes are the smallest cell in the body and are essential for: | blood coagulation
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| thrombocytes are formed in the: | red bone marrow
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| Normal range of thrombocytes: | 150,000 - 350,000
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| thrombocytes play an important role in: | hemostasis (maintaining blood levels)
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| When hemostasis is achieved: | hemorrhage is prevented
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| serious bleeding occurs due to decrease in number of platelets | thrombocytopenia
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| blood clots form too easily due to abnormally high number of platelets | thrombocytosis
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| 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
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| 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
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| liquid part of blood; contains no cells | plasma
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| 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
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| plasma proteins; may be given in plasma or as individual blood components | gamma globulin, serum albumin, fibrinogen, cryoprecipitate
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| gamma globulin | helps with immunity; used in the prevention or modification of infectious disease; given to pts with low immunity
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| 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
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| fibrinogen | 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 a congenital disorder or an acquired condition such as: | massive hemorrhage, prolonged active bleeding, hematologic diseases
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| cryoprecipitate | restores clotting factors to normal ranges; contains Factor VIII and Factor IX
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| A deficiency if Factor VIII or Factor IX can result in: | severe bleeding
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| PRBCs | packed red blood cells (red blood cells without the plasma)
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| When blood volume is WNL (within normal limits) but RBCs and Hgb are decreased, patient will be given: | PRBCs
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| Giving PRBCs without plasma containing WBCs and antibodies: | reduces the risk of an allergic reaction occurring during transfusion
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| lymphatic system consists of: | thumus gland, spleen, liver (also adenoids and tonsils)
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| functions in utero and briefly after birth; develops T lymphocytes to assist with immune response (when older) | thymus gland
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| stores about 500 mLs of blood that can be released in emergencies; destroys worn out RBCs (after 120 days); removes bacteria by phagocytosis | spleen
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| 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
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| synthesizes albumin, clotting factors, and globulins; phagocytizes old RBCs, forming bilirubin; stores minerals, synthesizes enzymes, and activates Vit D | liver
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| stimulates liver cells to increase the synthesis of Prothrombin (for clotting) | Vitamin K
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| waste product of RBCs | bilirubin
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| form activated lymphocytes and monocytes; return tissue fluid to maintain blood volume; protect the body against pathogens and foreign material | lymph nodes
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| 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
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| 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
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| 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)
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| 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
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| obstruction of lymph circulation may cause: | unilateral enlargement
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| 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)
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| an increase in WBCs may indicate: | infection
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| a decrease in RBCs suggests: | anemia or bone marrow suppression
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| 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
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| 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
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| Coagulation test | measures the ability of the blood to clot;
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| 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
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| 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)
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| 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)
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| 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)
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| WBCs are counted and reported as percentages of the total examined or absolute (actual number) | WBC Differential
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| patient's blood evaluated to determine blood type and ensure compatibility between donor and recipient blood | T & C (Type and Crossmatch)
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| Blood types: | A, B, AB, O
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| considered the universal donor | O negative
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| universal recipient | AB
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| 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
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| Gerontologic Considerations | page 427
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| 3 areas bone marrow biopsy and aspiration | sternum, iliac crest (posterior hip), tibia; majority - iliac crest
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| 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
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| 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.
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| If samples are not properly cared for: | a false reading or delay in diagnosis could occur
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| 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
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| 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
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| Results from blood loss and can be acute or chronic | hypovolemic/hemorrhagic anemia
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| hypovolemic/hemorrhagic anemia can be caused by: | traumatic injury; vomiting blood; hemorrhage at childbirth; bleeding ulcers; bleeding hemorrhoids; heavy periods; coagulation disorders
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| s/s of hypovolemic/hemorrhagic anemia | fatigue; weakness; thirst; tachycardia; pallor; hypotension; tachypnea; decreased temperature; clammy skin; confusion; syncope
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| 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
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| 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
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| when taking iron supplement, warn pt that: | stools may be dark green or black and tarry
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| Severe cases may need to be treated with: | blood transfusion
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| also know as hypochromic anemia (most common type of anemia); occurs gradually and usually unnoticed until symptoms cause significant discomfort | iron deficiency anemia
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| iron deficiency anemia is caused by: | insufficient dietary intake (usually lack of eating red meat); malabsorption problem
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| s/s or iron deficiency anemia | fatigue, weakness, pallor, dyspnea, palpitations, decreased appetite, brittle poorly shaped nails, sore tongue, difficulty swallowing
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| 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
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| iron deficiency anemia has a good prognosis if: | treated early
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| oral iron meds: | Feosol, Fergon, Ircon
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| IM iron injection | Imferon given IM via Z-track technique
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