PathoPharm: Hemo & Blood - Exam #2

What are the functions of the blood?

- transport O2 & nutrients to tissues

- remove waste products of cellular metabolism

- immune response

- maintenance of acid base balance

What are the functions of the bone marrow?

- creates billions of cells daily

- stores fat for energy

- stem cells

Bone marrow is aka...

"cell factory"

What are some diagnostic tests used to analyze the blood components?

- CBC

- RBCs (hgb & hct)

- reticulocyte count

- bleeding time

- PT & PTT (clotting times)

What medication does the PT test focus on? What about the PTT test?

- pt: warfarin

- ptt: heparin

What is anemia?

- low RBCs

- causes a reduction in O2 transport

- basic problem is hgb deficit

What is polycythemia?

high RBCs

What is leukocytosis?

high WBCs

What is neutropenia/leukopenia?

low WBCs

What is thrombocytopenia?

low platelets

What is thrombocytosis?

high platelets

What is pancytopenia?

- imbalance of ALL cells (low or high)

- indicates more serious underlying problem

What are reticulocytes?

immature RBCs which tell the level of function of the bone marrow

What is filgrastim?

bone marrow stimulant

What are the common brands of filgrastim?

neupogen

What is the action of filgrastim?

help body make WBCs after receiving cancer medications

true or false: filgrastim can also improve survival in people who have been exposed to radiation

true

What is oprelvekin?

- synthetic interleukin-11

- stimulates platelet production in bone marrow

What are the common brands of oprelvekin? What's the route?

- neumega

- subcutaneous injection

What is epoetin?

- man made erythropoietin (EPO)

- causes RBC production in bone marrow

What are the common brands of epoetin?

epogen

Who is most likely going to receive epogen?

people w/ chronic kidney failure whose kidneys are not working properly

What is iron deficiency anemia?

insufficient iron impairs hgb synthesis

true or false: iron deficiency anemia is very common

true

Who does iron deficiency anemia affect?

- all age groups

- more common in women of childbearing age

true or false: it is estimated that 1 in 5 women are affected by iron deficiency anemia

true (proportion increases in pregnant women)

Iron deficiency anemia is frequently a sign of an underlying _______.

problem

What are the causes of iron deficiency anemia?

- dietary intake of iron below minimum requirement

- chronic blood loss

- impaired duodenal absorption of iron

- severe liver disease

What is pernicious anemia?

vitamin B12 deficiency due to lack of intrinsic factor

What do the erythrocytes look like in pernicious anemia?

- large

- immature

- nucleated

- carry less hgb

- shorter life span

What is the key symptom of pernicious anemia?

beefy red tongue

What are food sources of B12?

- meat

- fish

- eggs

- dairy

- vegan: sunflower margarine

What are the supplementations for pernicious anemia? What should the nurse monitor?

- oral or parenteral

- potassium for secondary hypokalemia

What is aplastic anemia?

- impairment or failure of bone marrow

- may be temporary or permanent

Aplastic anemia is often idiopathic BUT some possible causes include...

- myelotoxins

- viruses

- genetic abnormalities

What mycotoxins can cause aplastic anemia?

- radiation

- industrial chemicals

- drugs

What viruses can cause aplastic anemia?

hepatitis C

What genetic abnormalities can cause aplastic anemia?

myelodysplastic syndrome

What is hemolytic anemia?

excessive destruction of RBCs

What are the causes of hemolytic anemia?

- genetic defects

- immune reactions

- changes in blood chemistry

- infections such as malaria

- toxins in the blood

- antigens-antibody reactions/incompatible blood transfusion

What is sickle cell anemia?

- affects shape of RBCs (crescent shaped)

- cells become rigid & sticky

- too large to pass through microcirculation

Sickle cell anemia creates obstructions leading to what?

multiple infarctions & areas of necrosis

Multiple infarctions of sickle cell anemia affect...

- brains

- bones

- organs

What else can result from sickle cell anemia?

- hyperbilirubinemia

- jaundice

- gallstones

What are the clinical signs of sickle cell anemia?

- do not appear until 12 months old

- pain & SOB

What is primary polycythemia-polycythemia vera?

- increased production of erythrocytes & other cells in bone marrow

- serum erythropoietin levels are low

- neoplastic disorder

What is secondary polycythemia-erythrocytosis?

- increase in RBCs in response to prolonged hypoxia

- increased erythropoietin secretion

- compensation mechanisms to provide increased O2 transport

What is hemophilia?

- bleeding disorder

- hemophilia A

- deficiency or abnormality of factor VIII (8)

What is von willebrand disease?

- bleeding disorder

- most common hereditary clotting disorder

What are the two stages of disseminated intravascular coagulation (DIC)?

- overactive clotting

- bleeding

What are the S & S of DIC?

- clotting

- chest pain

- swollen legs (DVT)

- bleeding

- petechiae

- purpura

What are the causes & risk factors for DIC?

- sepsis

- cancer

- liver disease

- severe injury/burns

- blood transfusion reaction

What is leukemia?

- group of neoplastic disorders involving WBCs

- uncontrolled WBC production in bone or lymph nodes

- infiltrate lymph nodes, spleen, liver, brain, & other organs

What is acute leukemia?

- high proportion of immature nonfunctional cells in bone marrow & peripheral circulation

- onset usually abrupt, marked signs of complications

Who is primarily affected by acute leukemias?

- children

- younger adults

What is chronic leukemia?

- high proportion of mature cells bit with reduced function

- insidious onset

- mild signs & better prognosis

- common in older adults

What is multiple myeloma?

- neoplastic disease that involves increased production of plasma cells in bone marrow

- high serum calcium (assess parathyroid)

Plasma proteins...

- majority produced in liver

- albumins, globulins, clotting factors

Which plasma proteins are NOT made in the liver? What are they made by?

- immunoglobulins

- plasma cells

What is the function of plasma proteins?

clotting, defense, transport, & regulation

What are the cellular components of blood?

RBCs, WBCs (leukocytes), platelets (thrombocytes), & plasma

What are RBCs actions?

O2 and CO2 transport

What are WBCs actions?

- defense against infection

- inflammation

- immune response

- removes dead/damaged cells

What is the action of plasma?

- clotting

- defense

- regulation

- transport

Who is the universal donor?

O-

Who is the universal recipient?

AB +

Nursing considerations for blood transfusions using the nursing process: Assessment

- verify baseline labs

- signed consent

- assess risk of FVE/allergies

- baseline vitals

- inspect IV site for patency & infection

What gauge needle (at least) should you use?

20 g

Nursing considerations for blood transfusions using the nursing process: Planning

- crossmatch/type

- start within 30 min of blood arrival

- prepare NS to prime tubing

- change tubing after every 2 uses

Nursing considerations for blood transfusions using the nursing process: Implementation

- admin blood products

- monitor reaction

- complete within 4 hours of removal from blood bank

Nursing considerations for blood transfusions using the nursing process: Evaluation

- document procedure, client response, & adverse reactions

- continue to monitor VS & infusion site

- evaluate for complications

What are complications of blood transfusions?

- acute hemolytic reaction

- febrile nonhemolytic reaction

- anaphylactic reaction

- mild allergic reactions

- circulatory overload (FVE)

What is an acute hemolytic reaction? S&S?

- host antibodies destroying donor RBCs

- Chills, fever, low back pain, tachycardia, tachypnea, hypotension

What is febrile nonhemolytic reaction? S&S?

- clients antibodies against the donors WBCs

- sudden chills, headache, flushing, anxiety, muscle pain, fever 1C more from baseline

What is an anaphylactic reaction? S&S?

- immune system reacts to allergens or antigens in the donors blood

- anxiety, rash, wheezing, shock, cardiac arrest

What are S&S of a mild allergic reaction?

flushing, itching, urticaria

What are S&S of circulatory overload (FVE)?

Cough, SOB, crackles, hypertension, tachycardia, & distended neck veins

What are the nursing actions of a blood transfusion complication?

- stop transfusion & notify provider immediately

- administer 0.9% NaCl through new tubing

- stay w/ client & monitor VS & UO

- notify blood bank & PCP

What are considerations for older adults getting a blood transfusion?

prevent overload of fluid

What is an autologous transfusion?

giving our own blood back to ourselves

What is step #1 of clotting?

- platelets initiate process

- after wall damage, plaque deposit, rupture

What is step #2 of clotting?

fibrin formation of mesh over platelets

What is step #3 of clotting?

RBCs are trapped in fibrin mesh

What is a thrombus?

a blood clot attached to a vessel wall

What conditions are associated with a thrombus?

- angina/MI

- ischemic stroke

- peripheral artery

What os a thromboembolism?

clot that dislodges & travels through blood stream

What conditions are associated with a thromboembolism?

- PE

- MI

- ischemic stroke

- tissue ischemia (loss of circulation to extremeties)