Hematologic System

Question 1

Hematologic Changes w/ Aging

Answer 1

• Dcrd blood volume
• Lower lvls of plasma proteins
  > could be r/t dcr in protein intake
• Bone marrow produces less blood cells
  > RBC & WBC counts dcr
  > Platelet counts don’t change w/ age
• Hemoglobin lvls in men & women fall after middle age
  > could be r/t dcr in iron intake

Question 2

Immune Responses in Aging

Answer 2

• Immune responses are changed:
  > WBC counts may be lower
  > WBC count doesn’t rise as high in response to infection in older adults
  > Antibody lvls & responses are lower & slower in older adults
  > Lymphocytes become less reactive to antigens

Question 3

Hematologic Assessment

Answer 3

• Pt hx
  > age
  > gender; females have lower RBCs
  > liver func
  > presence of known immunologic or hematologic disorders
  > drug use; some meds can cause bone marrow suppression, hemolysis, or disrupt platelet action or clotting factors
• Nutrition status
• Envirn’t exposure
• Family hx & genetic risk
  > many disorders are inherited; sickle cell, hemophilia

Question 4

Hematologic - Current Health Problems

part of assessment

Answer 4

• Lymph node swelling
• Excessive bruising or bleeding
• Common Symps w/ hematological disease:
  > SOB on exertion
  > palpitations
  > frequent infections
  > fevers
  > recent weight loss
  > headaches
  > paresthesia
• Most common mani of anemia is fatigue as result of dcrd oxygen delivery to cells

Question 5

Hematological Physical Assessment

skin

Answer 5

• Inspect skin & mucous membranes for pallor
• Assess nail beds for pallor or cyanosis
  > pallor of the gums, conjunctivae, and palmar creases indicates dcrd hgb lvls & poor tissue oxygenation
• Inspect for petechiae and ecchymoses

Question 6

Hematological Physical Assessment

head & neck

Answer 6

• Check for pallor or ulceration of the oral mucosa
• Inspect & palpate all lymph node areas

Question 7

Hematological Physical Assessment

resp

Answer 7

• Assess respirations and dyspnea at rest and on exertion
• Assess for fatigue
• Orthopnea

Question 8

Hematological Physical Assessment

cardio

Answer 8

• Assess pulses
• BP
• Abn heart sounds
• Irregular rhythms

Question 9

Hematological Physical Assessment

kidney & urinary

Answer 9

Assess urine for hematuria

Question 10

Hematological Physical Assessment

musculoskeletal

Answer 10

• Rib or sternal tenderness may occur with leukemia
• Assess range of joint motion, document any
  swelling or joint pain

Question 11

Hematological Physical Assessment

abdominal

Answer 11

• Evaluate spleen
  > Normal adult spleen is usually not palpable
  > Enlarged spleen may occur with many hematologic problems
• Stool specimen to check for occult blood testing

Question 12

Hematological Physical Assessment

CNS

Answer 12

Neurologic checks & checks of cognitive func

Question 13

Bone Marrow Aspiration & Biopsy

Answer 13

• Evaluates hematologic status
  > specifically for a possible prob in blood cell production or maturation
• Invasive procedure
• Aspiration
  > cells & fluids are suctioned from bone marrow
• Biopsy
  > solid tissue & cells are obtained by coring out an area of bone marrow w/ a large-bore needle
• Informed consent needed

Question 14

Bone Marrow Aspiration & Biopsy - Preparation

Answer 14

• Provide info & emotional support
• Explain procedure:
  > local anesthetic is used & may feel stining or burning sensation
  > mild trtanquilizer or a rapid-acting sedative could be used
  > expect a heavy sensation of pressure & pushing while needle is inserted
• Positioning
  > usually use the iliac crest
  > pt should be placed in prone or side-lying position

Question 15

Bone Marrow Aspirtation & Biopsy - Post Procedure

Answer 15

• Hold pressure briefly to site
• Cover site w/ a dressing after bleeding is controlled
• Give mild analgesic for discomfort
• Apply ice bag to needle site to limit bruising
• Observe site q2 for 24hrs for signs of bleeding, bruising, & infection
• Advise pt to avoid contact sports or any activity tht might result in trauma to site for 48hrs