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What is the primary function of the hematologic system?
oxygenation and hemostasis (control of bleeding)
What is bone marrow?
spongy center of the bones where the red blood cells and platelets are made
How does the kidneys relate to hematology?
manufacture of hematopoietin which stimulates the production of RBCs in the bone marrow
What is the function of hematopoietin?
released by the kidneys in response to hypoxia
How does the liver relate to hematology?
manufactures the clotting factors
How does the spleen relate to hematology?
removes old red blood cells from circulation
How does blood relate to hematology?
transports oxygen from the lung to tissues and maintain hemeostasis
What do red blood cells do? (RBCs or erythrocytes)?
hemoglobin in the red blood cells makes the transport of oxygen and carbon dioxide possible
What do platelets (thrombocytes)?
activate the blood clotting system by going to a break in a blood vessel and forming a platelet plug
What do clotting factors do?
form a stable fibrin matrix over the wounded area, protecting the injured site while the healing process is completed
What does plasma do?
carries the red blood cells, platelets, and clotting factors through the circulatory system
How is oxygenation obtained?
RBCs transport o2 from the lungs to the tissues and carry carbon dioxide from the tissues back to the lungs for excretion
How is homeostasis obtained?
control of bleeding
What is the coagulation cascade?
the series of events that occur in the process of blood clotting
Why would a patient come to the hospital related to hematology?
easily bruises, bleeds for unusually long time, chronically fatigued
What kind of diseases run in the family related to hematology?
sickle cell disease, hemophilia
What would be seen on a skin assessment on a pt with low RBCs?
reddened, swollen areas, jaundice, dry, itchy skin and scalp, brittle fingernails and toenails, pale
What is petechiae?
small red or reddish purple pinpoint spots on the skin from broken blood capillaries
What is purpura?
small blood vessels leak under the skin
What is ecchymosis?
bruising
What would the nurse find in a head and neck assessment on a pt related to hematology?
jaundiced conjunctiva, assess for bleeding, cracking at the corners of the mouth from a vit B deficiency
What would a nurse find on a thorax assessment on a pt with low blood cells?
clear lungs, tachypenic, shortness of breath with strenuous activity
Why would an abdomen of a hematologic pt be full and tender?
the liver and spleen become enlarged with blood cell disorders
What is is RBC count test?
total number of RBCs found in a cubic millimeter of blood
What does a hemoglobin test show?
indicated the oxygen carrying capacity in the blood
What does a hematocrit test show?
percentage of red blood cells in whole blood
What do RBCs indices do? (MCV, MCH, RDW, MCRH)
helps determine the type of anemia
What does WBC count and differential?
increased: consistent with infections, inflammation, tissue necrosis, or leukemic neoplasia
decreased: reduced bone marrow activity
What is a prothrombin time, partial thromboplastin time activated , partial thromboplastin time?
measures how quickly blood clots
What test is used to monitor heparin therapy?
partial thromboplastin time
What is a bone marrow biopsy?
shows how well cells are being made in bone marrow
What is the most common area for a bone marrow biopsy?
posterior superior iliac spine
What are some nursing interventions for a pt at risk for injury from insufficient oxygenation related to anemia?
-administer oxygen-
-administer blood products
-administer erythropoietic growth factor to stimulate bone marrow production to produce RBCs
position change
extra blankets
What are some nursing interventions for a pt at risk for injury from bleeding?
-administer blood products
-avoid damage to rectal mucosa
-inflate BP cuff until pulse is heard to prevent petechiae
-instruct pt to use a soft bristled toothbrush and an electric razor
-avoid drugs that interfere with platelet function: aspirin and NSAIDS
What is the universal donor?
O negative
What are the universal recipients?
AB postive
What are some indications for a blood transfusion?
hemorrhage/ hypovolemic shock
-thrombocytopenia/ platelet dysfunction
-anemia
What should the nurse assess/ monitor in the administration of a RBC transfusion?
-past reactions
-monitor the first 5 to 10 minutes after starting the infusion
-vital signs, respiratory status
-rate of infusion
-IV access of at lease 18 or 20 gauge
Why is used to prime the IV tubing of an IV before a RN administers a blood transfusion?
NaCl
never add meds to…..
blood product
what does the nurse do if a pt is having a reaction to the blood?
stop the transfusion immediately
How should blood transfusions be confirmed?
Blood should be check in bedside by 2 licensed people
transfusions should be start…………. from leaving blood bank
30 minutes
infuse blood over …….. hrs to prevent bacterial growth
4
you may need a blood warmer to decrease potential ……..
hypothermia
what are the four main types of reactions to blood transfusions?
hemolytic, anaphylactic, febrile, circulatory overload
After about ……. days, the old red blood cells are filtered out of circulation by the liver and spleen?
120
a person with type O blood would have?
neither the A and the B antigen
What is polycythemia?
too many RBCs, WBCs, and platelets are produced
What is anemia?
not enough RBCs
What can cause anemia?
major blood loss over a short period of time, too few RBCs being made, or increased RBC destruction
How does the body compensate for the anemia?
increased HR, RR
redistribution the blood away from the skin, GI tract, and the kidneys to the brain and heart
increasing the production of eyrythropoitin?
What are the symptoms of ploythemia vera?
headache, dizziness, ringing in the ear (tinnitus), and blurred vision, reddish complexion, hypertension
What is the treatment for polythemia vera?
have one unit phlebotomixed to keep pt Hct normal
what is aplastic anemia?
results from complete failure of the bone marrow
What kind of labs do people with aplastic anemia look like?
low RBC, low WBC, low platelet, low numbers of blood making cells in their bone marrow
What are some signs and symptoms of aplastic anemia?
pallor, extreme fatigue, tachicardia shortness of breath hypotension, prolonged or spontaneous blooding and frequent infections that do not resolve
what is the treatment for a liver?
-transfusions to replace RBCs and platelets
What is a autoimmune hemolytic anemia?
antibodies that destroy RBC,s are active at body temperature
What are some caueses for you to have autoimmune hemolytic anemia?
What are the signs and symptoms
pallor, extreme fatigue, tachycardia, shortness of breath, and hypotension
What are some signs and symptoms of autoimmune hemolytic anemia
Whow is iron deficiency anemia?
caused by diet too lo =w in room, body not absorbing enough from GI tract, blood loss
What are some signs and symptoms
fatigue, weakness, headache, decreased, exercise tolerance, irritably, depression pallor
What is pernicious anemia- vitamin B12 anemia?
occurs when a pt doesn’t absorb vitamin B12 from the stomach
What are the symptoms of pernicious anemia vit b12 anemia
fatigue, pallor, weakness, sore tongue, and numbness of hands or feet
What is the treatment for pernicious anemia b12 anemia?
bvitamin B12 given IM or PO
What is sickle cell anemia?
disease in which the normally shaped disk shaped RBCs become sickles shaped
common in African American
What must a person have to develop sickle cell anemia?
both recessive genes
carriers do not experience any kind of signs or symptoms
What are some symptoms for sickle cell anemia?
persistently low RBC count, fatigue, jaundice
What does a low RBC cause over time?
cardiomegaly, enlarge heart
What is a sickened cell cirisis?
a sickle cell crisis occurs when the sickled cell crisis occurs when the sickled cell crisis occurs when the sickled cells become stick in larger blood vessels of the body, obstructing blood flow and causing severe pain
What are the signs and symptoms of sickle cell crisis anemia?
dehydration, infection, overexertion, and smoking], cold weather changes, excessive alcohol
Why do patients in a sickle cell crisis often have a fever?
either because infection precipitated the crisis or a part of the inflammatory response to tissue hypoxia
How long can a sickle cell anemia crisis last?
1-10 days
some experiences iris
there is no cure for……..
sickle cell anemia, Iv fluid
pt with sickle cell disease who regularly take hydroxyurea experience fewer crisis
hydoroxyurea does not work quickly enough to reduce the severity of the drama
What is a coagulation disorder?
result from a platelet abnormality or a clotting factor deficiency
ex) thrombocytopenia, dissemination intravascular coagulation, hemophilia
What is thrombocytopenia?
too few platelets circulating the blood
What is a major cause of thrombocytopenia?
chemotherapy or radiation thrombocytopenia can be expected 10-14 days after treatment and lasts until bone marrow is able to make more platelets
What are the symptoms of thrombocytopenia?
petechia, purpura, gingival bleeding, epistaxis, other unusual prolonged bleeding
What is disseminated intravascular coagulation
hypercoagulative state, blood clotting is abnormally increased
When does DIC occur?
overstimulation of the normal coagulation cascade results in
DIC is always ….. to another pathologic process?
secondary
What blood tests are done to test for DIC?
PT, PTT, fibrinogen degradation products FDP, D dimers
hemophilia xmas disease?
genetic disease in which the affected person lacks some of the blood clotting factors normally found in plasma
women rarely have this deisease
What are the symptoms of hemophilia?
uncontrollable bleeding that generally occurs into the joints, causing severe and swelling and pain
How is a diagnosis made for hemophllloa?
measuring factors PTT and prolonged factors 8 and 9
There is no ….. for hemophilia?
cure
treatment of hemophilia?
symtomatic, transfusions of FFP or cryoprecipitate or both
Pt with hemophilia A need factor ….. which is found in FFP and ………..?
f8 cryoprecipitate
pt with hemophilia B need factor ….. which is found in ……?
4, cryoprecipitate
A nurse’s inspecting a clients skin and notices multiple ecchymoses and petechiae. This should lead the nurse to suspect a deficiency of which blood component?
platelets
What is a neoplasm?
new and abnormal growth of tissue can be benign and malignant
Benign Harmless
not invasive or spreading, slow growth, usually not injuries unless on or around v/s
minor tissue damage
noncancerious
What is metastasi
mot common it’s, liver brain, bone, lungs
tumors cells found away from the original site of malignant cells
What are some factors for malignant transformation?
increasing age, diet, hormones, and chronic irritation
Carcinogens
substances that damage cell DNA causing normal cells to become malignant
Step one in malignant transformation
DNA exposed a carcinogen and irreversible changes occur
What is step 2 of malignant transformation?
promotion, sufficient exposure to an agent to encourage enhance of cell growth