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NRSG 200: Med Surg 3 > [Exam 1] Chapter 32 - Assessment of HEmatologic Function and Treatment Modalities > Flashcards

[Exam 1] Chapter 32 - Assessment of HEmatologic Function and Treatment Modalities Flashcards

1
Q

Stucture and Function of Hematologic System - Blood: BLood consists of what three types?

A

Erythrocytes (RBCs)
Leukocytes (WBCs)
Thrombocytes (Platelets)

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2
Q

Stucture and Function of Hematologic System - Blood: What is Hematopoiesis?

A

The need for the body to replenish its supply of cells

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3
Q

Stucture and Function of Hematologic System - Blood: How much does the bone marrow product each day? Erythrocytes / Neutrophils / Platelets

A

Erythrocytes - 175 Billion

Neutrophils - 70 Billion

Platelets - 175 Billion

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4
Q

Stucture and Function of Hematologic System - Blood: How many L of blood does this make up?

A

5-6 L

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5
Q

Stucture and Function of Hematologic System - Blood: What is the Fibrinolytic Mechanism?

A

A mechanism that eventualy disolves clots (thrombi) formed within blood vessels

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6
Q

Stucture and Function of Hematologic System - Blood: What is the balance between clot (thrombus) and clot dissolution (fibrinolysis) called

A

Hemostasis

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7
Q

Stucture and Function of Hematologic System - Bone Marrow: Bone marrow is the site of what

A

hematopoiesis or blood cell formation

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8
Q

Stucture and Function of Hematologic System - Bone Marrow: Blood cell formation usually limited where?

A

Pelvis, ribs, vertebrae and sternum.

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9
Q

Stucture and Function of Hematologic System - Bone Marrow: What happens to marrow as people age?

A

Proportion of active marrow is replaced by fat

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10
Q

Stucture and Function of Hematologic System - Bone Marrow: What happens if disease causes marrow destruction, fibrosis, or scarring

A

Liver or spleen can resume production of blood cell, known as extramedullary hematopoiesis.

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11
Q

Stucture and Function of Hematologic System - Bone Marrow: Within the marrow are stem cells, which do what

A

have ability to self-replicate, ensuring continuous supply of stem cells throughout life cycle. Then begin process of differentiation (into myeloid or lymphoid stem cells)

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12
Q

Stucture and Function of Hematologic System - Bone Marrow: Lymphoid cells produce what

A

Either T or B Lymphocytes.

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13
Q

Stucture and Function of Hematologic System - Bone Marrow: Myeloid cells do what?

A

Differentiate into erythrocytes, leukocytes, and platelets.

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14
Q

Stucture and Function of Hematologic System - Bone Marrow: What is the stroma of the marrow??

A

Refers to all tissu within the marrow that is not directly involved in hematopoiesis. Produces colony-stimulating factors needed for hematopoiesis, with yellow marrow being the largest ocmponent

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15
Q

Stucture and Function of Hematologic System - Blood * Erythrocytes (RBCs): Mature erythrocytes consist primarily of what

A

hemoglobin, which contain iron .

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16
Q

Stucture and Function of Hematologic System - Blood * Erythrocytes (RBCs): What are reticulocytes?

A

Marrow sometimes releases slightly immature forms of erythocytes, occurs in response for increase demand like bleeding

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17
Q

Stucture and Function of Hematologic System - Blood * Erythrocytes (RBCs): What happens after oxygen is recieved at the tissue to the cells?

A

Hemoglobin combines with hydrogen produced by cellular metabolism and buffers excessive acid.

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18
Q

Stucture and Function of Hematologic System - Blood, Erythropoiesis: Erythroblasts arise form where

A

primitive myeloid stem cells in bone marrow. Is an immature nucleated cell that gradually loses its nucleus

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19
Q

Stucture and Function of Hematologic System - Blood, Erythropoiesis: What is Erythropoietin?

A

Differentiation of the primitive myeloid cel into an erythroblast, and is a hormone produced by the kidney.

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20
Q

Stucture and Function of Hematologic System - Blood, Erythropoiesis: What happens when kidneys detect low levels of oxygen

A

Erythropoietin increases , which stimulates the marrow to increase the production of erythrocytes.

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21
Q

Stucture and Function of Hematologic System - Blood, Erythropoiesis: Deficiency in what factors during erythropoiesis can result in decreased rbc production?

A

Iron, Vit B12, Folate, Protein and other factors

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22
Q

Stucture and Function of Hematologic System - Blood, Iron Stoarge/Metabolism: Iron is stored as what

A

ferritin, and released into plasma when required. Binds to transferrin and transported into membranes of normoblasts and then incorporated into hemoglobin

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23
Q

Stucture and Function of Hematologic System - Blood, Iron Stoarge/Metabolism: Iron concentration in blood is usually what?

A

50-150 ug / dL

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24
Q

Stucture and Function of Hematologic System - Blood, Iron Stoarge/Metabolism: What happens to production iwth iron deficiency?

A

Bone marrow iron stores are rapidly depleted, hemoglobin synthesis depressed, and erythrocytes produced by marrow small and low in hemoglobin.

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25
Q

Stucture and Function of Hematologic System - Blood, Vit B12/Folate Metabolism: Required for what?

A

Synthesis of DNA in RBCs.

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26
Q

Stucture and Function of Hematologic System - Blood, Vit B12/Folate Metabolism: Why is B12 needed?

A

Binds with IF produced in the sotmach.

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27
Q

Stucture and Function of Hematologic System - Blood, Vit B12/Folate Metabolism: Deficiency here characterized by what?

A

Production of abnormally large erythrocytes called megaloblasts. Usually stay trapped while still in bone marrow and rate of release decreased.

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28
Q

Stucture and Function of Hematologic System - RBC Destruction: Average lifespan?

A

120 days. Lose elasticity and become trapped in small blood vessels and spleen. Hemoglobin recycled as they are removed.

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29
Q

Stucture and Function of Hematologic System - Leukocytes: Divided into what two categories?

A

Granulocytes and Lymphocytes.

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30
Q

Stucture and Function of Hematologic System - Leukocytes: Normal Leukocyte count?

A

4000 to 11000 cells.

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31
Q

Stucture and Function of Hematologic System - Leukocytes: What do leukocytes do?

A

Protect the body against infection and tissue injury.

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32
Q

Stucture and Function of Hematologic System - Leukocytes - Granulocyes: What is this defined as?

A

The presence of granules in the cytoplasm of the cell. Divided into eosinophils, basophils, and neutrophils.

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33
Q

Stucture and Function of Hematologic System - Leukocytes - Granulocyes: How do these stain?

A

Eosinophil - Bright Red

Basophils - Deep Blue

Neutrophil - Pink to Violet Hue

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34
Q

Stucture and Function of Hematologic System - Leukocytes - Granulocyes: Where do fully mature neutrophils result from?

A

Gradual differentiation of myeloid stem cells, specifically myeloid blast cells

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35
Q

Stucture and Function of Hematologic System - Agranulocytes - Monocytes: What are these?

A

Leukocytes with a single-lobed nucleus and a granule free cytoplasm. Transform into marcopages and remove debris from the spleen and liver.

36
Q

Stucture and Function of Hematologic System - Agranulocytes - Lymphocytes: What do mature lymphocytes do?

A

Are the principal cells of the immune system, producing antibodies and idedntifying other cells and organisms as “foreign”. NK Cells mature and are activted from spleen / lymph nodes

37
Q

Function of Leukocytes: What do they do?

A

Protect the body from invasion by bacteria and other foreign entities.

38
Q

Function of Leukocytes: Major function of neutrophils?

A

Phagocytosis. Arrive within 1 hour of onset of inflammation and initiate phagocytosis, but are short-lived. Monocytes follow.

39
Q

Function of Leukocytes: Primary function of lymphocytes?

A

Attack foreign material.

40
Q

Function of Leukocytes: What do T Lymphocytes do?

A

Kill foreign cells directly or release lymhokines , substances that enhance activity of phagocytic cells. Responsible for dleayed reactions, tissue rejection, and destruction of tumor cells. Cellular Immunity

41
Q

Function of Leukocytes: What do B Lymphocytes do?

A

Capable of differentiating into plasma cells. Produce antibodies that destroy forieng material by several mechanisms. Humoral Immunity

42
Q

Function of Leukocytes: What is the function of Eosinophils and basophils

A

Hypersensitivity reactions. Eosinophils important in phagocytosis. Basophils produce and store hsitamine.

43
Q

Platelets (Thrombocytes): Production regulated b y what?

A

Thrombopoietin, which stiulates production and differentiation of megakaryocytes from myeloid stem cell

44
Q

Platelets (Thrombocytes): Play an essential role in doing what?

A

Controlling bleding.

45
Q

Platelets (Thrombocytes): What do they release at bleeding site?/

A

Stable clot composed of fibrin.

46
Q

Plasma and Plasma Proteins: What is this?

A

90% of blood. COnsists of plasma proteins, clotting factors, and small amounts of other susbtances like nutrients, enzymes, waste products, and gasees.

47
Q

Plasma and Plasma Proteins: If plasma is allowed to clot, remaining fluid is called

A

serum

48
Q

Plasma and Plasma Proteins: Plasma proteins consist of what

A

albumin and globulins.

49
Q

Plasma and Plasma Proteins: Important proteins in the alpha and beta fractions are what

A

transport globulins and the clotting factors that are made in the liver.

50
Q

Plasma and Plasma Proteins: Why is Albumin important?

A

For the maintenance of fluid balance within the vascular system. Presence in plasma creates an osmotic force that keeps fluid within the vascular space. Has capacity to bind to several substances that are transported in plasma.

51
Q

Plasma and Plasma Proteins: People with impaired hepatic function has low concentration of albumin, which causes

A

resultant decrease in pressure and the development of edema

52
Q

Reticuloendothelial System (RES): What is this?

A

Composed of special tissue macrophages.

53
Q

Reticuloendothelial System (RES): What is located within the red pulp of the spleen?

A

Tiny aggregates of white pup, consisting of B and T lymphocytes

54
Q

Hemostasis: What is this?

A

Process of preventing blood loss from intact vessels and of stopping bleeding from a severed vessels, which requires adequate number of functional platelets.

55
Q

Hemostasis: What is involved in arresting bleeding?/

A

Primary and secondary hemostasis

56
Q

Hemostasis: What happens in primary hemostasis?

A

Severed blood vessel constricts. Platelets aggregate at the site, and adhere to the vessel and to one another. Unstable plug formed.

57
Q

Hemostasis: What happens in secondary hemostasis?

A

This is the end formation of fibrin , which reinforces the platelet plug and anchors it to the injury site.

58
Q

Hemostasis: What does the extrinsic pathway do when tissue is injured?

A

Its acativated by the release of thromboplastin from the tissue. Prothrombin is converted to thrombin which in turn catalyzes the conversion of fibrinogen to fibrin.

59
Q

Hemostasis: When is the contact activation pathway activated?

A

When the collagen that lines blood vessels is exposed. Keeps being activated until fibrin is formed. This is slower, but important if a noninjured vessel wall comes into contact with lipoproteins or bacteria.

60
Q

Hemostasis: Fibrin clot is digested by what two systems

A

Plasma fibrinolytic system and cellular fibrinolytic system.

61
Q

Hemostasis: WHat is plasminogen?

A

The substance required ot lyse (break down) the fibrin.

62
Q

Hematologic Studies: Most common tests?

A

CBC and Peripheral blood smear.

63
Q

Hematologic Studies: What does CBC identify

A

total nnumber of blood cells (leukocytes, erythrocytes and platelets) as well as the hemoglobin, hematocrit, and RBC

64
Q

Hematologic Studies: The International Normalized Ratio (INR) and Activated Partial Thromboplastin Time (aPTT) are useful screening tools for what

A

evaluating the patient’s clotting ability and monitoring the therapeutic effectiveness of anticoagulant meds. Evalaute how quickly they clot.

65
Q

Bone Marrow Aspiration and Biopsy: Why is this important?

A

Give additional information to assess how a patients blood cells are being formed and to assess the quantity and quality of each type of cell produced. Also document utmor/infection.

66
Q

Bone Marrow Aspiration and Biopsy: Bone marrow usually aspirated form where?

A

The iliac crest and occasionally from the sternum.

67
Q

Bone Marrow Aspiration and Biopsy: Biopsies are performed where?

A

Biopsy samples are taken from the posterior iliac crest

68
Q

Bone Marrow Aspiration and Biopsy: Patient preparation for this includes what

A

explanation of procedure, which may be done at bedside.

69
Q

Bone Marrow Aspiration and Biopsy: What is done to skin ebfore procedure

A

skin cleansed using aseptic technique. Then small area anesthetized.

70
Q

Bone Marrow Aspiration and Biopsy: How will the body be prepared for a biopsy

A

Surgical blade used to make a 3-4 mm incision. Advanced into the marrow cavity.

71
Q

Bone Marrow Aspiration and Biopsy: What should patienet be doing throughout procedures?

A

Deep breathing exercises

72
Q

Bone Marrow Aspiration and Biopsy: Complications of this?

A

Bleeding and infection.

73
Q

Bone Marrow Aspiration and Biopsy: Risk of bleeding increased when?

A

If patient’s platelet count is low or if the patient has been taking a medication that alters platelet function.

74
Q

Splenectomy: An enlarged spleen may be the site of what

A

excessive destruction of blood cells. May also develop thrombocytopenia as a result of platelets being sequestered in the spleen.

75
Q

Splenectomy: Postop complications include

A

atelectasis, pneumonia, abdominal distention and abscess formaiton.

76
Q

Therapeutic Aphresis: What happens here?

A

BLood is taken away from the patient and passed through a centrifuge, where a specific component is separated form the blood and removed. remaining bood returned to patient.

77
Q

Therapeutic Aphresis: What is plateletphresis?

A

Remove platelets

78
Q

Therapeutic Aphresis: What is leukaphresis

A

remove wbcs

79
Q

Therapeutic Aphresis: What is erythrocytapheresis

A

removes rbcs

80
Q

Therapeutic Aphresis: what is plasmaphresis

A

removes plasma proteins

81
Q

Therapeutic Aphresis: what is stem cell harveest?

A

remove circulating stem cells

82
Q

HSCT: What is this?

A

Therapeutic modality that offers the possibility of cute for some patients with hematologic disorders like anemia, leukemia, and thalassemia.

83
Q

Therapeutic Phlebotomy: What is this

A

Removal of certain amount of blood under controlled conditions. Patients with elevated hematocrits or excessive iron can be managed by removing 1 unit of blood

84
Q

Blood Component Therapy: What is this?

A

The process of storing and separating all of the different components of the plasma.

85
Q

Special Precautions: What is Factor VIII concentrate?

A

Is a freeze-dried concentrate of pooled fractionated human plasma. USed in treating hemophilia A.

86
Q

Special Precautions: What is Factor IX concentrate used for?

A

To treat Factor IX (Hemophilia B).

87
Q

Special Precautions: What is albumin used for?

A

Stays within vessels. Used to expand the blood volume of patients in hypovolemic shock and rarely, to increase the concentration of circulating albumin

NRSG 200: Med Surg 3 (46 decks)

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