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Exam 7 > Hematologic and Lymph System > Flashcards

Hematologic and Lymph System Flashcards

1
Q

Hematopoietic System

A
  • Bone marrow, blood, and blood components
  • Transports O2, nutrients and cellular waste products
  • Transport of cells to protect the body
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2
Q

Hematopoietic System regulates:

A
  • Body temperature
  • pH
  • Fluid balance
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3
Q

Blood is produced in:

A
  • Red bone marrow (RBM) tissue in flat bones
  • Irregular bones
  • Epiphysis of long bones
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4
Q

Plasma contains:

A

90% water, 10% plasma

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5
Q

Plasma transports:

A 
Nutrients
Wastes 
Hormones 
Enzymes 
Electrolytes 
Gases
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6
Q

Plasma protects:

A

Clotting factors (liver) circulating until activated by clotting

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7
Q

Albumin (liver) helps maintain:

A

Blood volume and pressure

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8
Q

Globulins carry:

A

Fats

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9
Q

Gamma globulins are the:

A

antibodies produced by the lymphocytes

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10
Q

Reticulocytes:

A

Immature blood cells

1% of the RBCs in the human body

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11
Q

Where do reticulocytes develop and mature?

A

In the RBM

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12
Q

Reticulocytes circulate for how long before developing into a mature RBC?

A

1 day

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13
Q

When reticulocyte mature, they eject their:

A

nuclei, giving the biconcave look

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14
Q

What destroys old RBCs?

A

Liver and spleen

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15
Q

Life span of RBCs

A

120 days

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16
Q

RBCs carry O2 binded to the:

A

Iron in Hgb

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17
Q

Erythropoisesis occurs from:

A

stem cells in the RBM and is influenced by O2 levels

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18
Q

What determines the amount of O2 the blood can carry?

A

Amount of Hgb in the RBCs
Amount of iron in the Hgb
# of RBCs

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19
Q

Malaria and Sickle Cell Anemia destroys:

A

RBCs

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20
Q

Heme is converted to:

A

Bilirubin (blue pigment) and excreted in bowel

-Causes jaundice

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21
Q

Bilirubin

A
  • Orange-yellow pigment in the blood
  • Natural byproduct from the normal breakdown of RBCs

-Pigment portion of bile
When RBCs are destroyed, pigment is excreted and the liver combines it into bile

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22
Q

Bile

A

-Yellow-green fluid made by the liver, stored in gallbladder, passes through the common bile duct into the duodenum where it aids in digesting fat

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23
Q

Principle Components of Bile

A
  • Cholesterol
  • Bile salts
  • Pigment bilirubin (give bile its green color)
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24
Q

RBC Normal Lab Value

A

MEN: 4.7-6.1 million/mm3
WOMEN: 4.2-5.4 million/mm3

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25
Q

Hct Normal Lab Value

A

MEN: 42% - 50%
WOMEN: 40-48%

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26
Q

Hgb Normal Lab Value

A

MEN: 13-18 g/dL
WOMEN: 12-16 g/dL

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27
Q

Hemoglobin Test

A

Determines amount of hemoglobin in 100 dL of blood

A deciliter is 1/10th of a Liter

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28
Q

Hemoglobin

A

Protein in RBCs that carries O2

Also contains iron

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29
Q

Hemoglobin Test Measurements

A

MAN: 13-18 g/dL
WOMAN: 12-16 g/dL
CHILD: 11.12.5 g/dL

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30
Q

Hematocrit Test

A

Measures percentage or RATIO of RBCs per fluid volume of blood

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31
Q

Hematocrit Test Measurements

A

MAN: 42-50%
WOMAN: 40-48%
CHILD (3-12 years): 35-45%

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32
Q

Erythropoiesis

A

Process of RBC production

Depends on healthy bone marrow

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33
Q

Dietary requirements of erhythropoiesis

A 
Iron 
Copper
Vitamin B 12 
Folic Acid 
Riboflavin (Vitamin B2) 
Pyridoxine (Vitamin B6)
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34
Q

Erythropoietin is carried to the bone marrow where it initiates development of:

A

Mature RBCs

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35
Q

Leukocytes

A 
WBCs 
Indicate infection 
Contain a nuclei 
Colorless 
Involved in body defenses
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36
Q

2 types of Leukocytes

A

Granular or Granulocytes

Agranular or Nongranulocytes

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37
Q

Leukocytosis

A

WBCs elevated above normal

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38
Q

Leukopenia

A

WBCs lower than normal

“Peenie-Weenie”

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39
Q

Normal WBC Count

A

5,000 - 10,000/mm3

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40
Q

3 types of Granulocytes

A

Basophils
Eosinophils
Neutrophils

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41
Q

Granulocytes

A

Contain granules in their cytoplasm

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42
Q

Basophil

A

Release histamine (vasodilator)
Cytoplasm granules contains heparin, serotonin, and histamine
Released in an allergic response

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43
Q

Basophil Range

A

0.5-1%

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44
Q

Eosinophils

A

Plays role in allergic reaction and certain parasitic worms - EOs!!
Combat effects of histamine

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45
Q

Eosinophils Normal Value

A

1-4%

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46
Q

Neutrophils

A

Responsible for phagocytosis

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47
Q

Who is 1st to arrive at infection site?

A

Neutrophils

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48
Q

Mature neutrophils are called what and why?

A

Segmental neutrophils or SEGs because the nucleus is segmented into 2-5 lobes connected by strands

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49
Q

Lysozymes are released by what and kill what?

A

Neutrophils

Bacteria (stomach)

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50
Q

Lysozymes Normal Value

A

60-70%

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51
Q

Mature neutrophils life span

A

approx. 7 hours

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52
Q

What constantly works to produce neutrophils?

A

Bone marrow
Stores a 6 day supply

Overwhelming infection depletes the stores and immature “polys” are released

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53
Q

Polys are also called:

A

BANDs

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54
Q

When BAND count exceeds 8% of the total # of of polyps,

A

marrow has used up its reserve

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55
Q

Presence of excess bands in the peripheral blood is called:

A

A shift to the left

Indicates severe infection

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56
Q

If segmented neutrophils are elevated, but bands are not:

A

A new infection

If bands are also elevated, infection is worsening

More elevated the bands, worse the infection

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57
Q

Normal segmented neutrophils

A

60-70%

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58
Q

Bands should be

A

< 8%

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59
Q

2 types of Agranulocytes

A

M - Monocytes
L - Lymphocytes

Mary Lou is not gritty

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60
Q

Monocytes

A

Similar function to neutrophils
Circulate and move into tissue where they engulf and destroy foreign antigens and cell debris
Remove dead bacteria in recovery phase

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61
Q

2nd type of WBC to arrive at scene of injury

A

Monocytes

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62
Q

Monocyte range

A

2-6%

63
Q

Lymphocytes

A

Responsible for antibody formation (a protein)

Set up the antigen-antibody formation

64
Q

Lymphocytes Range

A

20-40%

65
Q

Two groups of Lymphocytes

A

B cells and T cells

66
Q

B cells

A

Bone cells
Hunt through blood for bacteria
Responsible for humoral immunity

67
Q

Where are B cells produced?

A

Bone marrow

68
Q

B cell produce:

A

Immunoglobulins

69
Q

T cells

A 
Thymus cells 
Hunt through tissues for viruses 
Hunt transplanted organs 
75% of total lymphocytes 
Responsible for cellular immunity
70
Q

Where are T cells formed?

A

In marrow and develop in the thymus

71
Q

T and B lymphocytes become activated, proliferate, and differentiate in the:

A

Lymph nodes, spleen, and lymphatic nodules

72
Q

Indications of viral infection:

A

Lower segmented neutrophils and BANDs

Elevated lymphocytes

73
Q

Normal WBC count all adds to 100%

A 
Neutrophils: 40-60% 
Lymphocytes: 20-40% 
Monocytes: 2-8% 
Eosinophils: 1-4% 
Basophils: 0.5-1% 
BAND (young neutrophil): 0-3%
74
Q

Platelets

A

Thrombocytes - smallest cells, circular cell fragments, no nuclei

75
Q

Where are platelets produced?

A

RBM

76
Q

Average life span of platelets

A

5-9 days

77
Q

Platelets assist in:

A

Clotting formation and hemostasis

  • Vascular spasms
  • Platelet plugs
  • Chemical clotting
78
Q

Normal Platelet Count

A

150,000 - 400,000/mm3

79
Q

Platelets activate:

A

Blood clotting system

80
Q

Megakaryocyte

A

Large bone marrow cell

Regarded as the source of blood platelets

81
Q

When a blood vessel is damaged:

A

Platelets release serotonin
Vasoconstriction
Clot adherence

82
Q

Platelet factors

A

Produced by platelets

Chemicals released when blood comes in contact with a rough surface, such as broken or damaged vessel lining

83
Q

You need Ca+ to clot!

A

Just a reminder : )

84
Q

Ionized Calcium

A

Freely flowing calcium in your blood not attached to proteins
Also called “free calcium”

85
Q

Normal Ionized Ca+ Range

A

4.5-5.5 mg/dL

86
Q

Normal Calcium Range

A

9-11 mg/dL

87
Q

Prothrombin converts to

A

Thrombin

88
Q

Fibrinogen converts to

A

Fibrin (clot)

89
Q

Normal Clot Lysis takes

A

7-10 days

90
Q

Antithrombin (liver) inactivated excess thrombin to:

A

prevent the clotting mechanism from becoming a viscous cycle

91
Q

Homeostasis

A

Control of bleeding and prevention of hemorrhage

92
Q

3 actions of homeostasis

A

Vessel spasm - reduces amount of bleeding

Platelets adhere - to injured blood vessel, forming an unstable platelet plug

Clot formation forms a scab (coagulation cascade)

93
Q

5 Lymphatic Tissues

A 
Lymph nodes
Lymph 
Tonsils 
Spleen 
Thymus
94
Q

Function of Lymphatic System

A

Maintain fluid balance
Produce lymphocytes
Absorb and transport lipids from the intestine to the bloodstream

95
Q

Lymph

A

Specialized fluid formed in tissue spaces

Transported by way of lymphatic vessels and re-enters circulatory system

96
Q

How many lymph nodes does the body have?

A

500-600

97
Q

Lymph Nodes (shape, where they’re found, what they house)

A

Small, bean-shaped
Found beneath epithelium
House lymphocytes and monocytes

98
Q

MALT

A

Mucosa-associated lymphatic tissue

99
Q

2 functions of lymph nodes

A

Defense

WBC Production

100
Q

Tonsils

A

Masses of lymphoid tissue
Protect body against invasion of foreign substances by producing lymphocytes and antibodies
Trap bacteria and may become enlarged
Atrophy after age 7

101
Q

How large is the spleen?

A

5-6” long x 2-3” wide

102
Q

Spleen contains:

A

Lymphatic nodules

103
Q

Spleen stores:

A

1 pint of blood that can be released in 60 seconds

104
Q

Functions of the spleen:

A
  • Reservoir of blood
  • Forms lymphocytes, monocytes, and plasma cells
  • Destroys RBCs
  • Stores up to 1/3 of the body’s platelets
105
Q

Thymus

A
  • Functions in utero and 1st few months after birth to develop immune system
  • Development of T Cells before they migrate to lymph nodes and spleen
  • Replaced at puberty with fat and connective tissue
106
Q

Peripheral Smear

A

Examines size, shape, and structure of RBCs and platelets

  • Helps differentiate types of anemias and blood dyscrasias
  • RBCs and WBCs can be examined
107
Q

Schilling Test

A

Diagnostic test for Pernicious Anemia
-Measures radioactive Vitamin B12 before and after injection of intrinsic factor by examining urine excretion in a 24 hr urine

108
Q

Megaloblastic Anemia Profile

A

Replaces Schilling test

Measures Vitamin B 12, methylmalonic acid and homocystine levels for diagnosis of Pernicious Anemia

109
Q

Tourniquet Test

A

Test of capillary fragility or thrombocytopenia

BP cuff applied for 5 minutes (1/2way between diastolic and systolic BP)

of petechiae within a circumscribed area is counted (0-+4 petechiae)

110
Q

Bone Marrow Aspiration

A

Evaluation of the cells, types, and maturation

Risks: Pain, penetration of the bone, infection leading to osteomyelitis

111
Q

Bleeding Time Test

A

Measures duration of bleeding after standardized skin incision
Used for pre-op screening

Normal: 2-9 minutes

112
Q

PT

A

Monitors effectiveness of Coumadin therapy

Detects coagulation disorders

113
Q

PT Values

A

Normal: 9-13 seconds
Therapy: 1.5-2.5 x normal

Critical: >20

114
Q

INR

A

Used to have uniform PT results in different countries

INR results are independent of the reagents or methods used

115
Q

INR Value

A

Therapeutic: 2-3

Critical: >5.5

116
Q

aPTT

A

Monitors effectiveness of heparin therapy

Detects coagulation disorders

117
Q

aPTT values

A

25-35 seconds

Critical: >70 seconds

118
Q

Sedimentation Rate (ESR)

A

Speed RBCs settle out in a tube of unclotted blood in one hour
Indicated inflammation
Increase in tissue destruction
Stable indicator of course of disease, especially inflammatory auto-immune disorders

119
Q

Sedimentation Rate (ESR) values

A

Men: 0-15 mm/h
Women: 0-20 mm/h

120
Q

D-Dimer

A 
Assess thrombin and plasmin activity 
Fibrin degradation fragment 
Confirmatory test for DIC 
High levels in: 
  -PE 
  -Sickle cell anemia 
  -Thrombosis of malignancy 
  -Screen for DVT
121
Q

D-Dimer Value

A

< 250-600 mcg/L

122
Q

Rh Factor

A

D antigen is present

  • Rh antibodies located on surface of RBC
    • Rh (+) antibodies present
    • Rh (-) antibodies not present
123
Q

9 Types of Blood Replacement Products

A
  • Packed RBCs
  • Clotting Factors
  • Fresh frozen plasma
  • Antibodies
  • White cells
  • Albumin
  • Cryoprecipitate
  • Platelets
  • Blood substitutes
124
Q

Packed RBCs

A

Restore blood’s O2 carrying capacity
-RBCs separated from plasma
Can be refrigerated up to 42 days
-Rare blood types can be frozen up to 10 years

125
Q

When would you want to use whole blood?

A

In Hypovolemia

126
Q

Clotting Factors

A
  • Found in plasma

- Proteins that work with platelets to help clot blood

127
Q

Fresh Frozen Plasma

A

Contain proteins and clotting factors
Is frozen soon as separated from the cells of the donor blood
Can be stored up to 1 year

128
Q

Antibodies

A

Disease fighting components of the blood
Provide temporary immunity
Antibodies are produced from treated plasma donations

129
Q

White Cells

A
  • Transfused in life-threatening infections to clients with greatly reduced WBCs or malfunctioning WBCs
  • Rare
130
Q

Albumin

A

-Plasma volume expander made from pooled human venous plasma

  • Hypovolemic shock
  • Burns
131
Q

Cryoprecipitate

A 
-From the plasma 
Contains: 
 -Fibrinogen (for clotting) 
 -Von Willebrand factor
 -Factor VIII and XIII 
 -Fibronectin
132
Q

Immune-Mediated Thrombocytopenia Purpura (IMTP)

A
  • Immune system mistakes platelets as invaders
  • Antibodies coat the platelets
  • Spleen phagocytes remove them 10x faster than normal
  • Platelets live for minutes or hours - not days
133
Q

Blood Substitutes

A
  • Contains chemicals or specially treated solutions of Hgb
  • Stored at room temperature
  • More research needed
  • Risky
134
Q

Autologus Transfusions

A
  • Pre-op donation collected 4-6 weeks before surgery
  • Iron supplements may be ordered
  • Prevention of infection
  • Used for people with rare blood types
135
Q

Contraindications for Autologus Transfusions

A
  • Acute infections
  • Chronic disease
  • Hgb <11 g/L
  • Cerebrovascular disease
  • CVD
136
Q

Symptoms of Allergic Reaction

A 
Hypersensitivity to antibodies
 -Urticaria 
 -Itching
 -Flushing 
 -Hypotension 
 -Dyspnea 
 -Decreased O2 sats 
Occurs immediately within 24 hours
137
Q

Nursing Considerations of Allergic Reactions

A 
Pre-medicate with antihistamines 
STOP the blood 
Restart NS 
Notify MD 
O2 
Steroids
138
Q

Acute Hemolytic Reaction Cause and Symptoms

A 
Incompatible blood 
Occurs within minutes to 24 hours 
-N/V
-Lower back pain 
-Hypotension 
-Tachycardia 
-Hematuria
139
Q

Nursing Considerations of Acute Hemolytic Reactions

A

STOP the blood
O2
Antihistamines
Airway management

140
Q

Febrile Reaction Symptoms

A 
Most common 
Antibodies to donor platelets or leukocytes 
Occurs in minutes to hours 
-Fever 
-Chills 
-Nausea 
-HA
-Flushing 
-Tachycardia
141
Q

Nursing Considerations of Febrile Reactions

A

STOP the blood
Supportive care
ASA
Seen in clients with multiple transfusions

142
Q

Cause and Symptoms of Bacterial Infections

A 
Contaminated blood 
Occurs within minutes to 24 hours 
Symptoms:
-Tachycardia 
-Hypotension 
-Fever
-Chills 
-Shock
143
Q

Nursing Considerations of Bacterial Infections

A 
STOP the blood 
Obtain blood culture 
Antibiotics 
IV Fluids 
Vasopressors 
Steroids
144
Q

Circulatory Overload Cause and Symptoms

A 
Large volume over short time 
Occurs within minutes to hours 
Symptoms:
-Dyspnea 
-Crackles
-Tachypnea
-Tachycardia
145
Q

Nursing Considerations of Circulatory Overload

A

Monitor high risk patients

  • Elderly
  • Heart disease
  • Slow or discontinue transfusion
146
Q

Transfusion-Related Acute Lung Injury TRALI Cause and Symptoms

A 
Presents like ARDS 
"Shock lung" 
Onset within 6 hours of transfusion 
Symptoms:
-Fever 
-Dyspnea
-Hypotension 
-Non-cardiogenic pulmonary edema
147
Q

TRALI Nursing Considerations

A

Notify MD
Probable transfer to ICU
Ventilator support

148
Q

Monitoring Blood Transfusions

A
  • Stay with pt for 15-30 minutes
  • Recheck VS Q15 minutes after start of infusion x institution’s policy
  • Take hourly per institution’s policy
  • If reaction suspected, STOP THE BLOOD
149
Q

Issues with Multiple Transfusions

A
  • Transmitting infectious diseases or bacterial infections
  • K+ disturbances
  • Ca+ disturbances from Citrate
  • Hypothermia carries risk of cardiac arrhythmia or cardiac arrest
  • Volume overload
150
Q

Hemostasis

A

Body process that arrests the flow of blood and prevents hemorrhage

151
Q

Homeostasis

A

Body’s internal environment is relatively stable

152
Q

Clotting Cascade (1-6)

A
  1. Injury occurs
  2. Bleeding or hemorrhage occurs
  3. Sticky platelets move to the site
  4. Clotting factors released from the blood vessels and the platelets
  5. Thromboplastin is released
  6. Interacts with protein and Ca+ to form prothrombin activator
153
Q

Clotting Cascade (7-11)

A
  1. Prothrombin activator reacts with Ca+ to convert prothrombin to thrombin
  2. Thrombin converts fibrinogen to fibrin
  3. Threads of fibrin form a net, traps RBCs and platelets
  4. Forms a clot - acts like a plug in a hole, draws the injured edges together
  5. Clot shrinks

Exam 7 (6 decks)

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