Assessment Of Hematologic System Flashcards
Bone marrow
Responsible for blood formation
Produces RBC, erythrocytes, WBC, leukocyte, and platelets
Also involved in immune responses
WBC fxn.
Provide protection through inflammation and immunity
Red blood cells (erythrocytes) fxn.
Largest proportion of blood cells
Life span of 120 days
Help maintains acid-base balance
Maintain good perfusion with oxygen and for clotting
Process of hypoxia
When oxygen is low, kidneys release more erythropoietin which then increases RBC production in bone marrow
When oxygen is normal or high, erythropoietin levels fall, slowing RBC production
Platelets fxn.
Stick to an injured blood vessel walls and form platelet plugs to stop the bleeding
Keep small blood vessels intact by initiating repair after damage
Stored in the spleen
80% circulate 20% stored
Accessory organs of blood formation
Spleen- contain three tissues, they all help balance blood cell production with blood cell destruction and assist in immunity, destroys old or imperfect RBC, breaks down the Hgb released from the old cells, stores platelets, filters antigens
Anyone with splenectomy has reduced immune functions and increased risk for infection/sepsis
Liver- produced prothrombin and other blood clotting factors, vit K production, stores whole blood, blood cells, and extra iron
Hemostasis
Multi stepped process of controlled blood clotting
Starts the formation of a platelet plug and continues with steps that eventually cause formation of a fibrin clot
Platelet aggregation
Platelets clumps together
Not blood clots, last only few hours, start the hemostatic process
Blood clotting
Cascade triggered by platelet plug
End result is formation of a fibrin clot and local blood clotting (coagulation)
Thrombin/Platelet inhibitors
T- heparin & enoxaparin
P- aspirin & clopidogrel
These prevent clots from forming
Fibrinolytics
Alteplase & streptokinase
Use once a clot is formed
Patient history assessment
Age: Bone marrow fxn and immune activity decrease with age
Gender: women have lower blood cell count than men
Liver fxn
Presence of known immunologic or hematologic disorders
Current drug use
Diet
Socioeconomic status
History of gallstones, jaundice, anemia
Use of blood thinners and NSAIDs
Nutritional status assessment
Diet can Alter cell quantity and blood clotting
Iron, protein, mineral, or vitamin deficiency
Diets high in vit K- Green leafy vegetable: increase rate of blood clotting
Alcohol consumption
Finances
Family hx
Ask about hemophilia, frequent nosebleeds, PPH, excessive bleeding after tooth extractions, heavy bruising
Sickle cell disease or trait
Current health problem assessment
Lymph nodes swelling Excessive bruising Women estimate number of tampons used during menstrual cycle SOB on exertion Palpitations Frequent infections Fever Wt loss Fatigue: most common manifestation of anemia
Physical assessment
Nail beds for pallor Gums active bleeding Petechiae: pinpoint hemorrhagic lesions Absent hair on lower extremities Darker patients: see on roof of tongue, petechiae on palm of hands Pulse may be weak and thready Blood in urine rib tenderness Enlarged spleen:if inspect a hematologic problem do not palpate spleen, can rupture easily
Diagnostic assessment
Peripheral blood smear- info on size, shape, proportions of different blood cell types
CBC- RBC, WBC, Hct, Hgb
Reticulocyte count- determines bone maroon function, elevated RBCs are being produced and released before mature- polycythemia Vera
Platelets- low increases risk of bleeding, high indicates prolonged bleeding from trauma
Hgb electrophoresis- detects abnormal forms of Hgb
Coombs- blood typing, detects antibodies
Serum ferritin, transferritin, total iron- iron levels, abnormal iron deficiency anemia, increased liver disorder
Pat- how long it takes for blood to clot
Bone marrow aspiration
Evaluate the patients hematologic status Bone marrow fxn- Production of all blood cells and platelets Reduce anxiety Site is usually iliac crest or sternum 5-15 min Sterile technique Prevent excess bleeding Observe 24 hrs Mild Analgesic
Patient preparation on a bone marrow aspiration
Help reduce anxiety Explain procedure Typically iliac crest Place patient in prone, or side lying position Invasive and sterile procedure
Follow up care of a bone marrow aspiration
Priority: prevention of excessive bleeding
Cover site with dressing for 24 hours
Ice packs
Avoid contact sports for 48 hours
80 yo reports fatigue, SOB, HA. What is priority assessment
Can you tell me about your diet
Have u been feeling depressed
What medications do u take
History of CVD
A
Pt reports fatigue, malaise, bleeding gums, and chills. What is priority nursing intervention
Document findings
Notify health care provider
Obtain vital signs and give antipyretic
Review labs
D
Pt transitioning from IV heparin to oral warfarin. What lab indicates warfarin tx efficacy
Bleeding time of 5 min
PT of 18
INR 2.5
PTT 24.3
C
