functions, sabs, dx, disrorders, patho
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| Disseminated Intravascular Coagulation |
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| bleeding into a joint space | Disseminated Intravascular Coagulation
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| Hemophilia A | hereditary coagulation disorder; caused by lack of antihemophilic factor VIII, which is needed to convert prothrombin into thrombin through thromboplastin component
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| Heterozygous | having two different genes
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| Homozygous | having two identical genes inherited from each parent for a given hereditary characteristic
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| Leukemia | malignant disorder of the hematopoietic system in which an excess of leukocytes accumulates in the bone marrow and lymph nodes
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| Lymphangitis | inflammation of one or more lymphatic vessels or channels that usually results from an acute streptococcal or staphylococcal infection in an extremity
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| Lymphedema | primary or secondary disorder characterized by the accumulation of lymph fluid in soft tissue, resulting in edema
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| Multiple Myeloma | malignant neoplastic immunodeficiency disease of the bone marrow
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| Myeloproliferative | excessive bone marrow production
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| Pancytopenic | deficient condition of all three major blood elements (red cells, white cells and platelets) results from bone marrow being reduced or absent
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| Pernicious | capable of causing great injury or destruction; deadly fatal ion; deadly fatal
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| Reed-Sternberg cell | Atypical histiocytes; large abnormal, multinucleated cells in the lymphatic system, found in Hodgkin’s disease.
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| Thrombocytopenia | An abnormal hematologic condition in which the number of platelets is reduced to fewer than 100,000/mm3
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| Anemia | A disorder characterized by RBC and hemoglobin and hematocrit levels below normal range is known as?
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| Plasma | 55% Contains 90% water 10% proteins
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| 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
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| 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
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| Erythrocytes (RBC) Normal level | 14 to 18 g/dL men 12 to 16 g/dL women
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| 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
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| 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
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| what is a basophil and Eosinophil? | Basophils - key in the inflammatory response Eosinophils - key in allergic responses
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| 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)
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| what are lymphocytes? | Lymphocytes – directly kill invaders and produce antibodies T cells B cells
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| 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
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| Blood Types, ABO system | ABO system of typing Type A Type B Type AB – universal recipient Type O – universal donor
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| Determined by presence/absence of specific antigens outer surface of RBC | Rh Factor Positive – on outer surface Negative – missing Wrong Rh – antibodies develop
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| Lymphatic System | Subdivision of cardiovascular system Consists of lymphatic vessels, lymph fluid and lymph tissue
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| 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
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| 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
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| Lymphatic vessels | Vessels connect lymph nodes and collect lymph fluid Connected to the circulatory system for return lymph fluid to blood
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| Lymph tissue | Lymph nodes Tonsils Spleen Thymus
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| Lymph Nodes – functions | Filter impurities from the lymph Produce lymphocytes (WBCs) 500 – 600 in body
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| Tonsils – functions | Protect the body against invasion Produce lymphocytes and antibodies Trap bacteria and may become enlarged
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| Spleen – location | Located in left upper quadrant, just below the diaphragm Highly vascular
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| 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
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| 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
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| What WBC is the initial responder to any invasion? | Neutrophils
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| 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
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| 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
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| 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
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| Mean Corpuscular Volume (MCV) | The average volume or size of a single RBC
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| 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
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| 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
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| Schilling Test and Megaloblastic Anemia Profile | Schilling Test and Megaloblastic Anemia Profile
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| 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
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| 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
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| 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
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| 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
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| 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
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| Bone Marrow Aspiration or Biopsy | Bone marrow Soft & semi-fluid aspirated through a needle Most commonly performed: Marked anemia Neutropenia Acute leukemia Thrombocytopenia
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| What is the most common site for bone marrow aspiration or biopsy? | Iliac Crest
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| 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
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| 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
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| 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
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| Lymph Node Biopsy | Teach/assess understanding of procedure: Conscious sedation Witness consent from
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| Lymphangiography | Teach/assess understanding of procedure: Conscious sedation Procedure in Radiology/ Special procedures Witness consent from Renal function (contrast) Allergies iodine
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| 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
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| 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
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| 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
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| Bone Marrow Aspiration | Verify history of allergies (patient & records) local anesthetics latex Obtain a sterile bone marrow aspiration tray Add local anesthetic (type & strength)
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| Identify appropriate site proper position the client Suggest distraction techniques avoid focusing on the pressure discomfort associated with puncturing the bone | Bone Marrow Aspiration
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| Bone Marrow Aspiration | Label the specimen and ensure delivery to laboratory Maintain standard precautions Limit activity for approximately 30 min after procedure
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| Bone Marrow Aspiration | Monitor puncture site Bleeding Unusual pain at site Infection Report finding
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| What must be checked before performing lymphangiography? | Renal function Allergies
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| 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
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| 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
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| The Nursing Process | Knowledge deficit related to test, patient preparation and recovery Patient verbalizes understanding of procedure, preparation and expected recovery
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| Knowledge deficit Nursing Interventions | Provide patient education regarding specimen collection Explain procedures and provide written instructions to the patient for procedure preparation
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| Name a nursing diagnosis appropriate for the patient with a disorder of the blood or lymphatic system. | Anxiety or Knowledge deficit
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| 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
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