Blood, Lymphatic and Immune System & Speech and Language

Components of Blood

  • Blood is divided into 3 specific components:
    • Plasma (55% of whole blood)
    • Buffy coat: leukocytes and platelets (less than 1%)
    • Erythrocytes: (45%)

Plasma

  • 90% water
  • Contains over 100 different solutes including nutrients, gases, hormones, waste products, protein

Buffy Coat

  • Contains two different items:
    • Leukocytes (White Blood Cells)
    • Platelets (Thrombocytes)
  • Leukocytes (White Blood Cells)
    • Account for 1% of total blood volume
    • Help fight infection in the body
    • There are five types (neutrophils, eosinophils, basophils, lymphocytes and monocytes)
  • Platelets (Thrombocytes)
    • Are essential for the clotting process
    • They clump together at the damaged site (cut) and the platelets form a temporary plug that helps seal the break

Erythrocytes

  • Also know as Red Blood Cells (RBC)
  • Function is to pick up oxygen in the lungs and distribute it to the body cells
  • Their shape looks like miniature doughnuts
  • Blood formation is called hematopoiesis and occurs in the bone marrow

Hemostasis

  • Hemostasis means the stoppage of blood flow
  • When you cut yourself and you start to bleed, you put pressure on the cut to make the bleeding stop. You are creating hemostasis.
  • Involves three phases that occur in rapid sequence:
    • Vascular spasms
    • Platelet plug formation
    • Coagulation, or blood clotting

Vascular Spasms

  • Is the first response after a cut
  • The blood vessels constrict (become narrower) therefore, decreasing the amount of blood lost

Platelet Plug Formation

  • This plug made of platelets temporarily seals the break in the vessel (where the cut is)
  • The platelets become sticky, swell, and attract other platelets to the site
  • The clot is formed in a matter of a few minutes

Coagulation or Blood Clotting

  • A complicated process with many steps involving several proteins (fibrinogen, prothrombin, thromboplastin, calcium,)
  • Forming a blood clot.
Skip Process
  • Injured vessel walls and platelets release clotting factors
  • Clotting factors convert an inactive blood protein into pro-thrombin activator
  • Prothrombin activator converts prothrombin into thrombin
  • Thrombin converts fibrinogen into fibrin
  • Fibrin network traps RBCs and platelets
  • All of these have a role in the process gluing platelets together and intertwine to make a web that forms the structural basis of the clot

Lymphatic and Immune System

  • Several body systems help defend against hazards that we are exposed to everyday
  • The immune system which incorporates the lymphatic system are the main systems that protect our body from invasion, illness and protect us from disease

Parts of the Lymphatic System

  • Consists of:
    • Lymph
    • Lymphatic vessels
    • Lymph nodes
    • Other lymphoid organs
    • Spleen
    • Tonsils
    • Thymus

Roles

  • There are 4 main roles
    • Forms part of the immune system and helps to fight foreign bodies such as bacteria
    • Maintains the balance of fluid in the blood (versus in the tissues)
    • Helps in the absorption of fats and nutrients in the digestive system
    • Acts as a highway; transporting WBCs to/from the lymph nodes into the bones, and antigen- presenting cells to the lymph nodes

Lymph Nodes

  • 500-700 lymph nodes
  • Filter the lymph before it returns to the circulatory system.

Lymph

  • A clear, watery substance
  • Made up of protein molecules, salt, glucose, white blood cells, urea (a metabolic waste)
  • When this fluid enters the lymphatic system it is called lymph.
  • Slowly flows in from all around the body towards the chest
  • The filtered fluid, salts and proteins return to the bloodstream

Lymphatic Capillaries

  • Lymph leaves the tissues and enters through the lymphatic capillaries; they are only single-cell thickness
  • Located throughout the body in all tissues that have blood vessels.
  • Some open-ended lymph vessels act like drainpipes
  • These capillaries gradually join together to form a network of tubes deeper in the body
  • As the capillaries become larger and deeper they form lymphatic vessels
  • Found alongside the arteries or veins and connected to the lymph nodes where the lymph is filtered
  • Contain valves to prevent backward flow of lymph

Role of Lymphatic Vessels

  • Lymph moves through the vessels passively (from a high concentration to a low concentration), it is not pumped like blood
  • The vessels are compressed and contracted by surrounding muscles to move lymph

Lymphatic Vessels

  • Approx. 3 litres of lymph enters the bloodstream every 24 hours
  • When physical activity increases the transport/movement of lymph becomes more efficient and lymph flow is much more rapid

Lymph Nodes

  • Are located all over the body usually in clusters
  • Vary in size and shape- from a pinhead size to an almond.
  • Work as filters for harmful substances (foreign particles, dead blood cells and cancer cells)
  • Filter and store lymph
  • Produce lymphocytes (type of WBC) and ANTIBODIES (fight infection)

Lymphatic Draining

  • As lymphatic vessels leave the lymph nodes, they join to form larger vessels.
  • Eventually they drain into one of two lymphatic ducts.
  • Called Right and Thoracic Duct
Right Lymphatic Duct
  • Drains right side of head & neck, right arm
  • Empties into the right subclavian vein
Thoracic Duct or Left Lymphatic Duct
  • Much larger
  • Drains the rest of the body Both legs, abdomen, left arm and left side of head and chest
  • Empties into the left subclavian vein

Organs of the Lymphatic System

  • Tonsils Are masses of lymphatic tissues that filter fluid that surrounds cells
Three pairs of tonsils:
  1. Palatine tonsils: located on each side of the soft palate
  2. Lingual tonsils: located on the back of the tongue
  3. Pharyngeal tonsils: also called adenoids located in the nasopharynx (upper part of the throat)
Spleen
  • Soft, blood rich, largest lymphoid organ
  • Located on the left side, beneath the diaphragm
  • Function is to remove aged or defective red blood cells (filters)
  • Stores RBCs
  • Produces leukocytes (WBCs)
  • Produces ANTIBODIES
Thymus Gland
  • Develop from stem cells
  • Divided into 2 lobes
  • Infant – largest at birth because immune system is maturing (produces antibodies)
  • After 1 year it starts to shrink
  • Wastes away after puberty and its function is taken over by the lymph nodes
Peyer’s Patches
  • Isolated clusters of lymph nodules, similar to the tonsils and are found in the small intestine
  • Capture and destroy bacteria found in food
Bone Marrow
  • Is the soft tissue at the core of bones that produces Blood cells
  • Make up 4% of body weight
  • Produces both lymphocytes and RBC’s
  • Where B-Cells (B-lymphocytes) mature here
  • B-cells fight bacteria and viruses by making Y-shaped proteins called antibodies

Diseases and Abnormal Conditions

Hodgkin’s Disease
  • Is a chronic, malignant disease of the lymph nodes
  • Signs & Symptoms: painless swelling of the lymph nodes, fever, night sweats, weight loss, fatigue
  • Treatment: chemotherapy and radiation
Tonsillitis
  • Inflammation or infection of the tonsils
  • S & S: throat pain, dysphagia (difficulty swallowing), fever, white spots, swollen lymph nodes, chronic sickness
  • Treatment: surgical removal called, tonsillectomy and adenoidectomy (removal of lymph nodes at base of tongue)
Lymphatic Vessels Abnormalities
  • Anything that prevents the normal return of lymph (eg: tumors) results in severe localized edema.
  • As blood circulates through the capillaries, blood plasma leak into the spaces between the cells.
  • Approx. 85% of the fluid is redistributed back to the blood capillaries
  • The other 15% drains into the lymphatic capillaries that surround the blood capillaries… called lymph
Elephantiasis
  • Is a condition where a specific body area has enlarged; usually the limbs, external genitals
  • Is caused by a blockage of the lymphatic system, which results in a buildup of lymph fluid in the affected areas.
  • S & S: extensive swelling of an area of the body
  • Treatment: antiparasitic drugs to kill the microfilaria (small worms in blood) causing the blockage

Speech and Language

  • Speech and language disorders are an inability to speak, understand, read, or write.
  • Can occur at any age

Causes

  • Genetic problems
  • Brain Injury
    • Accident, infection, drug abuse, stroke,
  • Disease
  • Hearing Loss
  • Brain tumour
  • Problems with speech

Aphasia

  • Aphasia is the partial or total loss of speech and language skills caused by brain injury.
Common causes are:
  • Stroke (CVA) or cerebral vascular accident
  • Head injury
  • Brain infections
  • Cancer
  • Three types of aphasia
  • The patient/client with aphasia has many emotional needs.
Receptive Aphasia
  • Difficulty understanding language both spoken and written words
  • Difficulty understanding what is said or read
  • Cannot understand their own words
  • Speech is mixed up or “muddled”
  • Clients make up or use wrong words but are not aware of their mistakes.
Expressive Aphasia
  • Difficulty speaking and writing
  • Can understand spoken and written words, but their speech is jumbled or slurred and difficult to understand
  • Think one thing but say another
  • Cannot think of the right word or put the right sounds together to form words or sentences
  • May leave out connecting words
  • Very aware of their mistakes because they can understand what they are saying
  • Leads to frustration/depression
Expressive-Receptive Aphasia
  • Difficulty speaking and understanding language
  • Some clients can only say “yes”, “no”, and make sounds such as “da da”.
  • Some lose all speech and language skills.

Apraxia

  • The client with apraxia of speech cannot use the speech muscles to produce understandable speech.
  • The client understands speech and knows what to say.
  • The brain cannot coordinate the speech muscles to make the words – lip, jaw or tongue movements.
  • Apraxia is caused by damage to the motor speech area in the brain.
  • Difficult to understand – speech is usually slow
  • Inconsistent speech is common
  • Difficult to put words in the right order, or find words

Dysarthria

  • Dysarthria – difficulty speaking clearly
  • It is caused by weakness or paralysis in the muscles used for speech.
Common causes:
  • Cerebral palsy
  • Multiple sclerosis
  • Head injury
  • Tumour
  • Infection
  • Clients may have slurred speech and speak in flat, harsh, or nasal tones.
  • Problems forming words, spacing their words
  • Speech errors are usually consistent and predictable – you may become familiar with client’s speech.

Emotional Effects

  • Communication – important for functioning and for maintaining relationships with others
Difficulty in communication may lead to:
  • Avoiding social situations
  • Avoiding friends, family
  • Extreme stress
  • Loss of employment
  • Difficulties doing routine tasks – shopping, paying bills

Treatment of Speech Disorders

  • Some clients need speech therapist.
  • The goal is to improve the person’s ability to communicate.
  • The amount of improvement possible depends on many factors.
    • The cause, amount, and area of brain damage
    • The client’s age and health
    • The client’s willingness and ability to learn
A speech-language pathologist and other health team members help the person:
  • Improve affected language skills.
  • Use remaining abilities.
  • Restore language abilities to the extent possible.
  • Learn other methods of communicating.
  • Strengthen the muscles of speech.

Communication Aids

Communication boards
  • Boards with pictures or words that show functions or task
  • Related to activities of daily living
  • Client points to the things he or she needs
Mechanical and electronic devices
  • Client touches a picture and the message is then voiced, or printed on a screen.

Use of Computers

  • Electronic devices use a combination of screen reading, magnification systems and alternate input methods.
  • Can speak for the user
  • Type in the correct words
  • Identify symbols that represent the words
  • Speech synthesizer
  • Invaluable in improving the client’s quality of life

Communicating with Clients

  • Follow the care plan – incorporate DIPPS.
  • Use communication methods that are best for your client.
  • Be mindful of your facial expression – you can reflect your impatience or frustration.
  • Be alert for signs of client fatigue – drooping shoulder, irritability, lack of interest, decline in understanding.
  • Always try to include client in conversation.