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NUR 201 Week 3 > Assessment of Hematologic Function > Flashcards

Assessment of Hematologic Function Flashcards

1
Q

Hematologic System

  • Blood
  • Lymph nodes/nodules
  • Thymus
  • Accessory organs (liver, spleen)
  • Bone marrow
A
  • Lymph nodes are interconnected in our bodies by lymph vessels. Most are found in the thoracic and abdominal cavities, the neck, axilla, inguinal, and superficial areas
    > Look to see if there are changes to the lymph shape or size
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2
Q

Lymph nodes produce Ig and IgA (immunoglobulins)

Nodules are smaller than lymph nodes but equally important

A
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3
Q

?

Is an endocrine organ responsible for producing T cells

The accessory organs are the liver and spleen

A

Thymus

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4
Q

?

Is the primary producer of most clotting factors; is the storage site for most blood cells

A

Liver

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5
Q

?

This organ balances blood cell production and destruction; assists with immune function; iron metabolism; and restores platelets and blood cells

A

Spleen

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6
Q

?

Is the major site of blood cell and stem cell formation

Produces most of the cells of the blood (RBC’s, WBC’s, platelets) and is involved in the immune response

A

Bone marrow

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7
Q

Blood Function

  • Carry oxygen to cells
  • Assist with acid-base balance
  • Transport carbon dioxide back to the lungs
  • Coagulation
  • Defense against infection
A
  • Blood volume is higher in males (5-6L) opposed to females (4-5L) [can vary based on factors]
  • Blood is more viscous than water; made in the bone marrow, spleen, and liver
  • Affected by age, body composition, nutrition, hydration, medications
    > NSAIDs impair the hematologic system
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8
Q

Blood Composition

  • Plasma (55%)
    > Proteins (8%) [albumin, globulin, fibrinogen]
    > Water (90%)
    > Other solutes (2%) [nutrients, electrolytes, waste products, hormones, gases]
A
  • Buffy coat: WBC’s and platelets (<1%)
  • RBC’s (45%)
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9
Q

?

Is the component of plasma involved in blood clotting

A

Fibrinogen

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10
Q

?

Is the component of plasma that maintains osmotic pressure of the blood which prevents plasma from leaking into tissues

A

Albumin

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11
Q

?

Is the component of plasma that is involved in the transportation of substances and antibiotic function

A

Globulin

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12
Q

Erythrocytes (RBC’s)

  • Erythrocyte - mature RBC
  • Reticulocyte - immature RBC
  • Needs Vitamin B12 and folic acid for RBC maturation
A
  • Lifespan is 120 days
  • Normal: 4-6 million
  • Responsible for producing hemoglobin
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13
Q

Hemoglobin’s main function is to carry oxygen; carry iron to tissues, lungs, and other organs
> Needs iron in order to produce hemoglobin (Hgb)

A
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14
Q

?

Normal Hgb in females ?

A

12-16

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15
Q

?

Normal Hgb in males ?

A

13-18

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16
Q

?

Is a growth factor that stimulates RBC production in the bone marrow
> Is released by the kidneys and the bone marrow produces it

A

Erythropoietin

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17
Q

Leukocytes (WBC’s)

  • Function = inflammation/immunity
  • Most are formed in the bone marrow
  • What is a normal count?
  • What are the 2 categories?
A

5000 - 10,000 μL

Granulocytes, agranulocytes

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18
Q

What are the 3 types of granulocytes?

A
  • Neutrophils
  • Eosinophils
  • Basophils
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19
Q

?

Are responsible for allergic reactions/responses

A

Eosinophils

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20
Q

?

Are involved in the allergic response; release histamine and also heparin to correct tissue damage

A

Basophils

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21
Q

?

Are the primary responders to inflammation; comprise 55-70% of WBC’s

A

Neutrophils

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22
Q
  • Chemotherapy patients may need an ANC level done daily
    > What is their neutrophil count?
  • ANC determines the risk for bacterial infection; looks at immune status helps determine the need for reverse precautions
    > The higher the ANC, the higher the chance to being resistant to infection; a lower # indicates being more susceptible to infection
A

<1000 = risk for bacterial infection

<500 - high risk

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23
Q

What are the 2 types of agranulocytes?

A
  • Monocytes
  • Lymphocytes
24
Q

?

These cells destroy bacteria

A

Monocytes

25
Q

?

These cells enhance the immune response

A

Lymphocytes

26
Q

Leukopenia - a reduction in WBC’s

A

Someone with a very low ANC ⥰ Neupogen

27
Q

Rx’s that affect WBC’s

Might these lower or increase the WBC count?

  • Beta adrenergic agonists (i.e., albuterol)
  • Corticosteroids
  • Epinephrine
  • Granulocyte colony stimulating factor
  • Heparin
  • Lithium
A

may INCREASE

28
Q

Might these lower or increase the WBC count?

  • Antibiotics, anticonvulsants
  • Anti-thyroid, arsenicals
  • Captopril
  • Chemotherapy drugs, Chlorpromazine
  • Clozapine, diuretics
  • Histamine-2 blockers
  • Sulfonamides
  • Quinidine, terbinafine, ticlopidine
A

may LOWER

29
Q

Thrombocytes (Platelets)

  • Smallest cell
    ! Controls bleeding
    Normal count is ?

Lifespan of 1-2 weeks
! Thrombocytopenia is a deficiency in platelets

A

150,000 - 400,000 μL

30
Q

Thrombocytes (Platelets)

  • Formed in the bone marrow; stored in the spleen; and released as needed. Used to control bleeding
  • Stick to an injured vessel wall and form platelet plugs; helps to repair damage to small cells to control bleed

<50,000 μL = huge risk for bleeding

A

Bleeding & Coagulation Measurements

  • PT
  • INR
  • PTT or aPTT
  • Platelet agglutination/aggregation
31
Q

What is a normal PT?

A

10-13

32
Q

What is a normal INR?

A

0.8-1.2

33
Q

What is a normal PTT/aPTT?

A

20-36

34
Q
  • INR can be used with PT for those on warfarin
  • Therapeutic INR for coumadin is 2.0-3.0
  • PTT - looks at how long it takes the blood to clot and evaluates clotting factors II, V, VII, and IX
A
  • PTT usually drawn on patients receiving heparin therapy; ranges can differ based on patient complication (cardiac issue vs DVT)
35
Q

Which hematological measurement is looked at for warfarin?

A

PT/INR

36
Q

Which hematological measurement is looked at for heparin?

A

PTT

37
Q

Age-Related Changes to the Hematological System

> As the body ages, the # of cells are gradually reduced
Lean body mass decreases
Fat tissue increases until around 60
Bone mass and intracellular fluids also tend to decrease
Normal aging causes a decrease in total body water

A
  • Blood volume decreases with age; bone marrow activity production to make RBCs and WBCs may be decreased
  • Circulating Hgb and Hct levels may be lower, leading to fatigue in the older individual
  • Reduction in lymphocyte count leads to decreased ability to fight infection
38
Q

?

  • An insufficient supply of healthy RBCs
  • Common causes = nutritional, hereditary, bone marrow disease, or bleeding
A

Anemia

! Is a clinical sign; NOT a specific disease; can be referred to as a disease

These patients have an insufficient amount of RBCs; decreased Hgb, Hct

! Hgb (g/dL) will determine how severe the anemia is

39
Q

Mild anemia: 10-14 g/dL

Moderate: 6-10 g/dL

Severe: <6 g/dL

A
40
Q

Hematocrit - the % of RBCs

Normal % in males is __-__%; is slightly higher than females __-__%

! Hct is 3x the Hgb

A

Males: 42-52%

Females: 37-47%

41
Q

Clinical Manifestations of Anemia

  • Pallor, fatigue
  • Intolerance to cold, cold to touch
  • Nails brittle/ridged “spoon shaped”
  • Tachycardia
  • Weakness, palpitations
  • Orthostatic hypotension, headache
A

Types of Anemia

> Iron deficiency
Vitamin B12 deficiency
Folic acid deficiency
Aplastic

  • Iron deficiency anemia lacking iron as opposed to aplastic anemia where the bone marrow doesn’t make enough new blood cells
42
Q

Iron Deficiency Anemia

  • Most common
  • Causes - insufficient dietary intake, blood loss, impaired absorption
  • Common in women, menstruating women, childbearing or pregnant women, older adults, and people with poor dietary habits
  • Type tends to be chronic and dietary intake is a big factor
A
  • Another source is from blood loss (i.e., from the GI tract [coffee-ground emesis, black tarry stools] or menstruation)
    > Also, the patient with impaired intestinal absorption or someone who’s had gastric bypass surgery
  • Increase dietary intake - red meat, organ meat, egg yolks, leafy green vegetables
    > May need iron supplements [! Constipation = offset with fiber or increased water intake] or IM injections
43
Q

Vitamin B12 Deficiency

  • Lack of B12 in the diet
  • Poor absorption
  • Diagnosed: CBC, MMA (methylmalonic acid), or Schilling Test
  • Treatment = dietary, B12 injections, nasal inhalation
A
  • Increase intake through animal protein, meat, seafood, eggs, and dairy
  • Psychiatric and neurological dysfunction; glossitis and paresthesia
  • Someone who is unable to absorb vitamin B12 may be lacking the intrinsic factor needed to absorb B12; known as pernicious anemia (glossitis)
  • Identifying the cause and whether the patient is able to absorb it or not will help determine treatment
44
Q

Folic Acid Deficiency Causes (Water-Soluble B9)

  • Dietary
  • Malabsorption
  • Medications
  • Affects the elderly, chronic illness, chronic ETOH abuse
A
  • Occurs in those who don’t eat vegetables or go on extreme diets
  • Also, malabsorption due to Crohn’s or gastric bypass; chronic illness; chronic alcohol abuse
  • Rx’s - oral contraceptives, metformin, anticonvulsants, chemotherapeutic agents (methotrexate)
    ! Increase intake of fortified cereals, grains, green vegetables, yeast extracts, nuts, and folic acid supplements
45
Q

?

! Rare
- Deficiency in circulating RBCs
- Chronic exposure to toxic agents, congenital
- Accompanied by decreased leukocytes, platelets

A

Aplastic anemia

46
Q
  • Can cause heart arrythmias
  • Can be caused by chronic exposure to toxic agents like pesticides or insecticides, radiation, autoimmune disease, chemotherapy, and other medications. Can also be idiopathic
A
  • Treatment with blood transfusions or immunosuppressive therapy
47
Q

Anemia Management

  • Early identification of those at risk
  • Dietary modification
  • Supplements/rx’s
  • Blood transfusion
A

Transfusion Therapy

  • Verify prescription
  • Test donor’s and recipient’s blood for compatibility (type and screen/cross-match)
  • Examine blood bag for identification
  • Check expiration date
  • Inspect blood for discoloration, gas bubbles, or cloudiness
48
Q

Transfusion Responsibilities

  • Provide patient education
    > Obtain informed consent
  • Assess VS
    > May need to pre-medicate with Tylenol or Benadryl
  • Begin transfusion slowly and stay with the patient for the first 15-30 minutes
A
  • Ask patient to report unusual sensations such as chills, SOB, hives, or itching
  • Administer blood products per protocol
  • Assess for hyperkalemia
    ! Occurs due to cellular damage and release of potassium into the blood; can occur from units of blood that are too old or too cold [a blood warmer may be used]
49
Q

Transfusion Reactions

  • Febrile transfusion reaction
    > Chills, fever, tachycardia, HTN, tachypnea
  • Hemolytic transfusion reactions
    > When the blood type or blood antigens are incompatible
    > Fever, chills, headache, tachycardia, tachypnea, chest pain, HTN
A
  • Allergic transfusion reaction
    > Itching, bronchospasm, anaphylaxis
50
Q
  • Bacterial transfusion reaction
    > Can be caused by contaminated blood
    > Tachycardia, HTN, fever, chills, and in severe cases, shock
A
  • Circulatory overload
    > Happens when blood is infused too quickly
    > HTN, bounding pulse, distended neck veins, dyspnea, restlessness, confusion
51
Q

Autologous Blood Transfusion

  • Collection and infusion of patient’s own blood
  • Eliminates compatibility problems; reduces risk for transmission of bloodborne disease
A
  • Also a way to minimize transfusion reactions
  • Useful for a surgery; need to be infection-free; Hgb >11 g/dL; and by a provider’s prescription
52
Q

Sickle Cell Disease (Anemia)

  • Increased RBC destruction
  • Genetic disorder
  • Sickle-shaped RBCs
  • Painful
A
  • RBCs cannot effectively transport oxygen and deliver oxygen to tissues, organs, etc.
  • Those with the disease go into times of crisis
    > Crisis can be caused by hypoxia, dehydration, infection, pregnancy, high altitudes, stress, alcohol, and strenuous activities
53
Q
  • Pain is the first and most severe symptom
  • Blood is not getting to the tissue and there is poor oxygenation from the obstructed blood flow
  • We give these patients more oxygen, analgesics to help with the pain, rehydration, and blood transfusions
    > Typically need opiate rx’s to ease their pain
A
54
Q

?

  • A greater than normal RBC count
  • Temporary or permanent
  • Treatment = phlebotomy, hydration, anticoagulants
A

Polycythemia vera

55
Q

Hgb >18 g/dL
Hct >48-52 in men

Massive production of RBCs, WBCs, and platelets

! A dark, flushed appearance, intense itching, HTN, poor tissue oxygenation (the greater viscosity of blood slows down oxygen exchange to the tissues)
> Are at a high risk for clotting

A
  • 2-3x/week for phlebotomy isn’t unusual
  • Give radiation or Interferon

! Complications of this disorder are thrombosis, or blood clotting, and hemorrhage; bone marrow scarring; development of AML; HF from the heart being overtaxed; PE concern

  • May get hypoxic

NUR 201 Week 3 (3 decks)

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