Blood, lymph and immune (test 9)

Production of blood cells

Developed from stem cells located in the bone marrow through erythropoiesis

Kidney makes most of bodies erythropoietin stimulating factor that then

stimulates liver to release erythropoietin to then produce the RBC's.

Normal range of RBC's

4.2-6.2 million

Live for about 120 days

Normal Hemoglobin

12-18

Is sickle cell genetic? True or false?

True, inherited from both parents

Sickle cell patho

-composed of an abnormality of hemoglobin S that forms clumps in the red cells causing the "sickle shape".

Sickle shaped cells block BV, forming thrombi. The body destroys the cells, causing anemia

Treatment for sickle cell

No specific tx, but:

- taking folic acid and eating protein to help build red cells

- infection prevention including vaccines

Pt teaching for sickle cell

- Avoid high altitudes
- Avoid vigorous exercise
- Avoid iced liquids
- No alc
- Obtain tx for any infections quickly

- O2 in case of inadequate oxygenation during a sickle crisis
- Push fluids to help stop/slow clumping
- Warm blankets to vasodilate

Iron deficiency anemia s/s

- Thin, concave (spoon-shaped) nails with raised edges
- dizziness
- headache
- palor (too little RBC's)

Iron deficiency anemia patho

- not enough iron to produce adequate RBC

Disseminated Intravascular Coagulation (DIC)

DEATH IS COMING
- occurs with tissue damage (childbirth, trauma, sepsis)
- excessive clotting, depletes the body's clotting factors causing the pt to hemorrhage

S/S of disseminated intravascular coagulation

- bleeding at IV site, oral, vaginal, rectal bleeding.

tx of disseminated intravascular coagulation

Fresh frozen plasma and packed RBCs to restore blood volume and control clotting

Aplastic Anemia patho

Bone marrow suppression/failure
- can be caused by some meds such as chemo and antiarthritics.

EMERGENCY SITUATION

Aplastic Anemia symptoms

- anemia s/s
- ecchymosis
- peticia
- hemorrhage

Aplastic Anemia tx

- bone marrow transplant common in pts under 45
prevention of hemorrhage and infection are important

Pernicious anemia tx

Vitamin b12 injections.

When should iron supplements be taken?

1 hr before or 2 hours after a meal
- antacids may interfere.

polycythemia vera patho

too many RBCs
- causing blood to be too thick
- blood flow is slowed

Polycythemia vera s/s

- reddish face
- purple lips
- fatigue
- blood clots
Genetic mutation of JAK2V617F is + in 95% of cases

Treatment of polycythemia vera

Phlebotomy (removal of blood q 2-3 months)
Increased fluid intake
Aspirin

Leukemia patho

Too many immature or abnormal WBC's. Type of cancer

S/S and dx of leukemia

- usually no s/s but sometimes severe, persistent infections can occur as a result of abnormal WBC's.

-dx by CBC

Multiple Myeloma patho

calcium leaking out of bones
- leads to osteoporosis

-Type of cancer

Multiple myeloma s/s

similar to that of osteoporosis
- easily broken bones
- bone pain
- hypercalcemia

treated with chemo
- pain control

How is iron best absorbed?

With vitamin c

What is the most common cause of death from sickle cell anemia?

Acute chest syndrome (damage to lungs)

In pt's who are prone to excessive bleeding, what should the nurse do after giving an IM injection?

Hold pressure for 10 minutes

What is classified as thrombocytopenia

Platelet count

Hemophilia

Bleeding into the joints
- NO ASPRIN

Needle gauge for blood transfusions

18 or bigger
22 for older adults

Ab blood type

universal recipient

O blood type

Universal donor

Blood admin best practice

Y shaped IV line, one side with blood other side with 250 mL of NS.
- if reaction occurs shut off blood and run saline

How soon must blood be started after arriving on scene?

30 minutes

Can blood be left at room temp?

Not for more than 4 hours

How long does blood take to infuse?

1.5-4 hours

function of lymph vessels

drain lymph fluid into large veins

Lymph fluid

waste after plasma has delivered nutrients to the cells

Tonsils and adrenals function

Lymph tissue
- guards airway

Spleen function

filters blood:
- filtering out damaged rbc
- recycling hemoglobin

B lymphocytes

formed in the bone marrow and releases antibodies that fight bacterial infections

T lymphocytes

Formed in thymus (located behind breastbone)

Capillaries vs lymphatic system

Capillaries absorb about 80% of fluid

Inflammatory response

Reaction to tissue damage caused by injury or infection:

- histamine

Immune response

The body's defensive reaction to invasion by bacteria

Specific immunity

Invader is marked for later if it comes back (part of immune response)

Passive immunity

the short-term immunity that results from the introduction of antibodies from another person or animal.

- ex. ebola "vaccine" where bone marrow from survivors is injected into sick
- Infants who breastfeed have temporary immunity to lots of diseases

natural active immunity

When body makes own antibodies and T cells.

Example when you get a cold

artificial active immunity

vaccination:
exposure of a controlled dose of a weakened/dead virus to induce formation of antibodies

innate immunity

present at birth

cell-mediated immunity

type of immunity produced by T cells that attack infected or abnormal body cells

primary humoral immune response

Antibodies mark the cells to kill later

Fat soluble vitamins

ADEK

Conditions to postpone vaccine

- fever
- immune deficiency disease or immunosuppressive therapy
- blood transfusion 6-8 weeks before
- live vaccine before and during pregnancy

Influenza vaccine recommended for:

All persons 6 months and older

Anemia

a deficiency of red blood cells

Thrombocytopenia

low platelet count

Neutropenia

deficiency of white blood cells

Nursing management for fever

Increase nutrition to meet demands of increased metabolic rate

Steroids can cause immunosuppression (true or false)

True

Anorexia can cause lowered immune system (true or false)

True

C-reactice protein (CRP)

a protein whose level in the blood increases with inflammation

Normal below 8mcg/mL

Rules for patient on neutropenic precautions

- no fresh fruits or flowers
- No visitors with infectious diseases

immune deficiency

Body does not make enough antibodies

autoimmune disorder

Antigen in body cannot tell self from invader (body is attacking its own cells)

HIV

human immunodeficiency virus

HIV 1 most common in US

AIDS

Caused by HIV

Pre-exposure prophylaxis

- Truvada: approved for pt's of high risk (msm relationships)... works by suppressing HIV replication

- Emtricitabine: for patients of high risk

- Safer sexual practices

- Screening of blood products

HIV Patho

A retroviral virus that inserts its RNA into a healthy cell

Why no HIV/AIDS vaccine?

Constant mutation

HIV Transmission

HIV infected blood

S/S of HIV

Often no obvious symptoms... in the early stages flu like symptoms

Later in the disease evidence of the immune system failing

such as s/s of frequent infections
(thrush

swollen lymph nodes

Treatment of HIV/AIDS

No cure

Wasting syndrome

Losing more than 10% of weight longside at least 30 days of diarrhea or weakness accompanied by fever

Needle stick injury

Wash with soap and water

Treatment of autoimmune disorders

Replacement or support of lost body function

systemic lupus erythematosus (SLE)

Body creates antibodies that attack own cells

Appears after puberty

Symptoms of systemic lupus erythematosus (SLE)

- Butterfly rash under eyes

- Painful/swollen joints
- Loss of hair
- Light sensitivity
- Swollen glands
- Weakness

What can make systemic lupus erythematosus worse?

- Sun exposure
- Birth control pills
- Penicillins

Diagnosis of SLE

Must meet 4/11 criteria given by ruematologist

Symptom management of SLE

- Sunblock and clothing
- Gulcorticosterious to lower s/s
- NSAIDS to lower inflammation
- B-lymphocyte protein inhibitor
- Corticosteroids

Lymphoma

Cancer of lymphocytes (type of WBC)

Hodgkin's lymphoma

More curable! Rarer

S/S of Hodgkin's Lymphoma

- enlarged painless lymph nodes
- presence of R-S cells in tissue

Non-Hodgkin's Lymphoma

Less treatable. More common due to link with HIV

S/S of Non-Hodgkin's Lymphoma

Enlarged nodes that skip every other node... one is inflamed

firbomyalgia

Chronic systemic pain that is not caused by another disease or source

Unknown cause

s/s of fibromyalgia

Musculoskeletal pain

Hyperalgesia

increased pain sensation

Allodynia

Pain to non painful stimuli

Tx of fibromyalgia

No cure

Allergy

Considered systemic immune disorder

Common conditions include: anaphylaxis

Diagnosis of allergy

- Radioallergosorbent test (RAST)
- IgE to allergen test
- Scratch test (needle with allergen)
- Patch test (patch with allergen)

Treatment of anaphylaxis

1. Establish airway