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NURS 327 Medical Surgical Nursing > Assessment of Hematologic System > Flashcards

Assessment of Hematologic System Flashcards

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1
Q

What is hematology?

A

The study of blood and blood forming tissues. Includes the bone marrow, blood, spleen, and lymph system

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2
Q

A basic knowledge of hematology is useful in clinical settings to evaluate the patients ability to transport 02 and CO2, maintain ____________ volume, coagulate blood and combat ____________

A

intravascular volume; infections

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3
Q

The assessment of the hematologic system is based on ……

A

diagnostic studies, physical examination and the patients health history

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4
Q

What is hematopoiesis ?

A

Blood cell production that occurs within the bone marrow

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5
Q

Which type of marrow actively produces blood cells ?

A

Red bone marrow

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6
Q

Where is the red marrow primarily found ?

A

In the flat and irregular bones such as the ends of long bones, vertebrae, sacrum, sternum, ribs, flat cranial bones and scapulae

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7
Q

What are the three types of blood cells ?

A

WBC, RBC, platelets

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8
Q

When tissue hypoxia occurs, what happens , regarding the production of blood cells ?

A

Erythropoietin, a cytokine protein, is released by the liver and kidney and it circulates to the bone marrow and stimulates the production of RBC.

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9
Q

Albumin helps to regulate the ________ ____________ within the blood

A

oncotic pressure

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10
Q

Thrombocytes

A

another name for platelets

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11
Q

Blood is a type of ___________ tissue that performs 3 major functions: ______, ______ , ______.

A

connective; regulation; protection; transportation

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12
Q

primary function of erythrocytes

A

transport O2 and CO2 and maintain acid base balance

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13
Q

Hemoglobin that has oxygen bound to it is referred to as

A

oxyhemoglobin

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14
Q

hemoglobin is composed of what two compounds?

A

Heme (an iron compound) and globin (a simple protein)

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15
Q

The heme portion of hemoglobin binds to ……

A

oxygen

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16
Q

The globin portion of hemoglobin binds to

A

CO2

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17
Q

Erythropoiesis

A

the process of RBC production

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18
Q

What is erythropoiesis regulated by ?

A

cellular O2 requirements and general metabolic activity

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19
Q

Erythropoiesis is stimulated by _________ and controlled by _________________

A

hypoxia; erythropoietin

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20
Q

What glycoprotein growth factor stimulates the red bone marrow to produce RBC ?

A

Erythropoietin

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21
Q

About how many RBC are produced per second during erythropoiesis?

A

2.5 million

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22
Q

Erythropoiesis is influenced by the availability of certain ______________ and _______________

A

nutrients and hormones

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23
Q

What is a reticulocyte?

A

Immature red blood cell

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24
Q

A reticulocyte can develop into mature RBCs within how many hours upon release into the circulation ?

A

48 hours

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25
Q

Assessing the number of reticulocytes is a useful means of evaluating …….

A

the rate and adequacy of erythrocyte production

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26
Q

hemolysis

A

destruction of RBC by macrophages and monocytes `

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27
Q

Hemolysis normally occurs where?

A

In the bone marrow, spleen, and liver

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28
Q

bilirubin; how does it relate to hemolysis ?

A

one of the components of RBC; when hemolysis occurs, there is an increased amount of bilirubin to be processed by the body. When hemolysis occurs via normal mechanisms, the liver is able to conjugate and excrete all bilirubin that is released

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29
Q

Leukocytes have a widely available life span: granulocytes may only live for ________, yet some T lymphocytes may live for _______

A

hours; years

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30
Q

What is the primary function of granulocytes ?

A

Phagocytosis

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31
Q

What is the most common type of granulocyte?

A

Neutrophils - accounting for 50-70% of all WBC

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32
Q

Once neutrophils engulf the pathogen, they die in ___________________

A

1-2 days

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33
Q

a mature neutrophil is called what ?

A

A segmented neutrophil or “seg” or poly segmented neutrophil

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34
Q

Eosinophils account for only ______ % of all WBC

A

0-4%

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35
Q

Basophils accounts for less than ______________ % of all leukocytes

A

2%

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36
Q

Lymphocytes account for what percentage of WBC

A

20-40%

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37
Q

About 2/3 of total body iron is bound to ______ in erythrocytes (hemoglobin) and muscle cells (myoglobin).

The other 1/3 of iron is stored as …….

A

heme

The other 1/3 is stored as ferritin and hemosiderin (degraded form of ferritin) in the bone marrow, spleen, liver and macrophages

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38
Q

This is a carrier plasma protein for iron

A

Transferrin

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39
Q

The degree to which transferrin is saturated with iron is a reliable indicator of ………………….

A

the iron supply for developing RBC’s

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40
Q

Is iron usually recycled ?

A

Yes - only 3% is lost daily in urine, sweat, bile and epithelial cells in the GI tract.
Iron is recycled after macrophages in the liver and spleen phagocytize, or ingest and destroy old and damaged RBCs

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41
Q

There is normally very little iron loss except from ______ _____

A

blood loss

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42
Q

Hemostasis is a term that means

A

arrest of bleeding

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43
Q

Hemostasis stages

A 
vascular injury and subendothelial exposure 
Adhesion
Activation
Aggregation
Platelet Plug formation 
Clot retraction and Dissolution
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44
Q

Upon injury to a blood vessel, an immediate local vasoconstrictive response occurs. How does vasoconstriction reduce the leakage of blood from the vessel?

A

By restricting the vessel size and by pressing the endothelial surfaces together The latter reaction enhances vessel wall stickiness and maintains closure of the vessel even after vasoconstriction subsides

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45
Q

What triggers the platelet response and plasma clotting factors ?

A

Endothelial injury and the release of substances such as TXa2

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46
Q

TXA2

A

Thromboxane A2 - this is produced by platelets in response to endothelial injury and subendothelial exposure… causes vasoconstriction and promotes the degranulation of platelets

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47
Q

The loss of endothelial cells exposes adhesive glycoproteins such as

A

collagen and von Willebrand factor

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48
Q

The adhesion of platelets refers to

A

the platelets adhering to the exposed collagen and von Willebrand factors in the subendothelial tissue.

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49
Q

The formation of clumps is referred to as

A

aggregation

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50
Q

The adhesion process causes the platelets to undergo an _________ ______ which leads to changes in ……

A

activation process; platelet shape

51
Q

Once the platelet changes shape through the adhesion process, what happens to the platelets …..

A

They then have the ability to bind adhesive proteins , including fibrinogen and von Willebrand factor. The release of various platelet granules (including ADP) also recruits and activates other platelets, growth factors and clotting factors

52
Q

Platelet aggregation is stimulated by

A

TXA2 and ADP, which induce fibrinogen receptors on the platelet plug

53
Q

The formation of a visible fibrin clot on the platelet plug is the conclusion of a complex series of reactions involving different _______ _______

A

clotting factors

54
Q

Plasma proteins circulate in ________ forms until stimulated to initiate clotting through one of two pathways, _________ or ________

A

inactive; intrinsic; extrinsic

55
Q

How is the intrinsic pathway activated ?

A

By collagen exposure from endothelial injury when the blood vessel is damaged

56
Q

How is the extrinsic pathway initiated ?

A

When tissue factor is released extravascularly from injured tissues

57
Q

What does thrombin do ?

A

This enzyme converts fibrinogen into fibrin within the clotting cascade

58
Q

Platelet plug formation - the final blood clot in the coagulation process is a meshwork of

A

fibrin strands that stabilizes the platelet plug and traps other cells such as erythrocytes, phagocytes and microorganisms

59
Q

What helps to keep blood in its fluid state?

A

Anticoagulants of the body counter the mechanism to blood clotting

60
Q

Antithrombins help keep blood in a fluid state by

A

antagonizing thrombin, a powerful coagulant

61
Q

Endogenous heparin, antithrombin III, protein C, protein S are all examples of

A

anticoagulants

62
Q

Fibrinolysis is the

A

dissolution of a blood clot

63
Q

When is the fibrinolytic system initiated?

A

When plasminogen is activated into plasmin - Thrombin is one of the substances that can activate this conversion

64
Q

Plasmin attacks either fibrin or fibrinogen by splitting molecules into smaller elements known as

A

fibrin split products (FSPs) or FDP (fibrin degradation products)

65
Q

If fibrinolysis is excessive, the patient is predisposed to ……

A

bleeding

66
Q

Increased FSPs lead to …..

A

impaired platelet aggregation, reduced prothrombin, and an inability to stabilize fibrin

67
Q

FSP

A

fibrin split products - these result from clot dissolution

68
Q

The spleen is located where?

A

In the upper left quadrant of the abdomen

69
Q

4 major functions of the spleen

A

hematopoietic, filtration, immunologic and storage

70
Q

True or false ….. the spleen is able to produce RBC during fetal development

A

True

71
Q

How does the spleen function in filtration ?

A

The spleen has the ability to remove old and defective RBC from the circulation by the mononuclear phagocyte system

spleen is also able to breakdown hemoglobin released by hemolysis and return the iron component of the hemoglobin to the bone marrow for reuse

spleen also filters circulating bacteria

72
Q

Spleens immunologic function - it has a good supply of

A

lymphocytes, monocytes and stored immunoglobulins

73
Q

Storage function of spleen - it is a storage site for

A

RBC, platelets

74
Q

More than 300 ml of blood can be stored within the …….

A

spleen

75
Q

About 1/3 of platelets are stored in the ……

A

spleen

76
Q

The lymph system consists of

A

lymph nodes, lymph fluid, lymphatic capillaries, and ducts

77
Q

What does the lymph system do ?

A

Carries fluid from the interstitial spaces to the blood

78
Q

How does the lymph system help prevent edema ?

A

It returns excess interstitial fluid into the blood

79
Q

The formation of lymph fluid increases when ___________ ___________ increases, thereby forcing more fluid into the ________ ______________

A

interstitial fluid; lymph system

80
Q

lymphatic capillaries characteristics

A

thin walled, have irregular diameter, do not contain valves, somewhat larger than blood capillaries

81
Q

Lymph node shape

A

round, oval, or bean shaped

82
Q

Lymph node size

When would they be enlarged ?

A

vary in size according to their location

Enlarged during an infection

83
Q

How many lymph nodes are found throughout the body and where are they greatest in number ?

A

More than 200 lymph nodes are found throughout the body with the greatest in number being in the abdomen surrounding the GI tract

84
Q

Lymph nodes are situated both _______ and _______

A

superficially; deep

85
Q

Can the deep nodes be palpated ?

A

No; it requires radiologic examination

86
Q

Primary function of lymph nodes

A

Filtration of pathogens and foreign particles that are carried by lymph to the nodes

87
Q

Liver functions as a ____________

A

filter

88
Q

What structure produces all the procoagulants that are essential to hemostasis and blood coagulation ?

A

The liver

89
Q

Produced by the liver, this is a key regulator of iron balance…..

A

hepcidin - it inhibits the release of stored iron from enterocytes in the intestines and macrophages

90
Q

The liver stores iron that is in excess of

A

tissue needs

91
Q

Assessment of Hematologic system : past health history

A

previous problems with anemia, bleeding disorders,
and blood diseases such as leukemia

any kidney, liver, spleen disorders

problems with blood clotting

92
Q

Assessment of Hematologic system : medications

A

need complete medication history of prescription and OTC drugs

additional supplements, vitamins, herbal products

93
Q

Many drugs can interfere with ____________ function

A

hematologic

94
Q

Assessment of Hematologic system : surgery or other treatments

A

specific past surgical procedures such as splenectomy, tumor removal, prosthetic heart valve placement, surgical excision of the duodenum (where iron absorption occurs) partial or total gastrectomy, gastric bypass, and ileal resection

ask about wound healing after surgery and if any bleeding problems occurred

95
Q

Hematologic problems that have a strong genetic link

A

sickle cell anemia
hemophilia
thalassemia
hemochromatosis

96
Q

Should you ask about alcohol and cigarette use when assessing the hematologic system?

A

Yes, as these can disrupt the hematologic system

97
Q

Hematemesis

A

bright red, brown or black vomitus

manifestation of an underlying problem

peptic ulcer disease is a common cause

98
Q

Lymph nodes that are enlarged and tender are usually associated with an

A

acute infection

99
Q

Polycythemia

A

excessive amount of red blood cells

100
Q

Assessment of Hematologic system : Elimination pattern

A

any blood in urine or stool

any black, tarry stools

101
Q

Assessment of Hematologic system : activity- exercise pattern

A

ask about tiredness, any weakness of extremities, any change in ability to perform ADLs

102
Q

Hemarthrosis

A

blood in a joint

occurs in patient with bleeding disorders and can be painful

103
Q

Lymph nodes are not ordinarily ________ in adults

A

palpable

104
Q

if a lymph node is palpable it should be ……..

A

small, mobile, firm and nontender

105
Q

abnormal lymph node finding

A

tender, hard, fixed or enlarged

106
Q

tender nodes are usually a result of …..

A

inflammation

107
Q

hard or fixed nodes suggest

A

malignancy

108
Q

Skin assessment: Petechiae

A

small, purplish, red, pinpoint lesions

109
Q

ecchymoses

A

bruising

110
Q

Morphology

A

shape and appearance, as in RBCs

111
Q

pancytopenia

A

marked decrease in number of RBC, WBCs, and platelets

112
Q

blood group antigens (A and B) are found only on

A

RBC membranes

113
Q

Blood group A has what kind of antigens ?

A

A antigens

114
Q

Blood group B has what kind of antigens ?

A

B antigens

115
Q

blood group AB has what kind of antigens ?

A

both A and B antigens

116
Q

blood group O has what kind of antigens ?

A

neither A nor B antigens

117
Q

B antibodies are found in the serum of people with blood group

A

A

118
Q

Agglutinate

A

clump

119
Q

the Rh system is based on a third antigen, ____, which is also found on the ______ membrane

A

D; RBC

120
Q

Rh- positive people have the _____ antigen

A

D

121
Q

Rh negative people do not have the ______ antigen

A

D

122
Q

someone with blood type B would have what kind of antibodies

A

A antibodies

123
Q

AB+

A

Blood type AB, along with Rh positive

NURS 327 Medical Surgical Nursing (6 decks)

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