Test 3 NOA

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