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Med Surg 2 > hematological function > Flashcards

hematological function Flashcards

1
Q

hematology

A

Study of blood and blood forming tissues

Key components of hematologic system are:
- Blood
- Blood forming tissues
- Bone marrow
- Spleen: filters blood
- Lymph system: excretes copnents

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2
Q

What Does Blood Do?

A

Transportation
- Oxygen
- Nutrients
- Hormones
- Waste Products

Regulation
- Fluid, electrolyte
- Acid-Base balance

Protection
- Coagulation
- Fight Infections

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3
Q

erythropoiesis

A

= RBC production
- Stimulated by hypoxia
- Controlled by erythropoietin
+ Hormone synthesized in kidney

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4
Q

Hemolysis

A
  • = destruction of RBCs (back pain)
  • Releases bilirubin into blood stream
  • Normal lifespan of RBC = 120 days
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5
Q

Leukocytes/White Blood Cells

A

5 types
- Basophils
- Eosinophils
- Neutrophils
- Monocytes
- Lymphocytes

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6
Q

Diagnostic Procedures

A
  • Evaluate blood function by testing indicators such as erythrocytes (RBCs), leukocytes (WBCs), platelets, and coagulation times.
  • By testing the blood, diagnosis of a disease and efficacy of treatment can be determined.

Blood Work
- CBC
- Clotting Factors

Radiologic Studies
- CT/MRI of lymph tissues

Biopsies
- Bone Marrow examination
- Lymph node biopsies

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7
Q

wbc

A

Normal 4,000 -11,000 µ/ℓ
Associated with infection, inflammation, tissue injury or death

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8
Q

Leukopenia-

A

decrease WBC

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9
Q

Neutropenia

A

decrease neutrophil count

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10
Q

rbc

A

♂ 4.5 – 5.5 x 106/ℓ
♀ 4.0 – 5.0 x 106/ℓ

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11
Q

Hematocrit (Hct)

A

The hematocrit is the percent of whole blood that is composed of red blood cells. The hematocrit is a measure of both the number of red blood cells and the size of red blood cells.

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12
Q

platelet count

A

150,000-400,000
- thrombocytopenia- decrease platelet count
- spontaneous hemorrhage likely when count is below 20,000

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13
Q

pancytopenia

A

decrease in number of rbc, wbc, and platelets

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14
Q

Blood and Blood Product Transfusions

A
  • Clients can receive transfusions of whole blood or components of whole blood for replacement due to blood loss or blood disease.
  • Blood components include packed RBCs, fresh frozen plasma, albumin, clotting factors, cryoprecipitate, and platelets.
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15
Q

standard donation

A

Transfusion from compatible donor blood.

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16
Q

Autologous transfusions:

A

The client’s blood is collected in anticipation of future transfusions (elective surgery).
- up to 6w before surgery

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17
Q

Intraoperative blood salvage:

A

Blood loss during some surgeries (trauma-related, liver transplantation) is recycled through a device that filters blood into a transfusion bag for transfusion intraoperatively or postoperatively.

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18
Q

Excessive blood loss

A

packed RBCs

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19
Q

Anemia

A

packed RBCs

20
Q

Kidney failure

A

packed rbc

21
Q

Coagulation factor deficiencies such as hemophilia

A

fresh frozen plasma

22
Q

Thrombocytopenia/platelet dysfunction:

A

platelets

23
Q

Hemophilia A:

A

cryoprecipitate

24
Q

Burns, hypoproteinemia

A

albumin

25
Q

incompatobility to blood

A
  • Incompatibility is a major concern when administering blood or blood products.
  • Preventing incompatibility requires strict adherence to blood transfusion protocols.
  • Blood is typed based on the presence of antigens.
26
Q

RH factor

A
  • Another consideration is the Rh factor.
    Clients who are Rh-negative are born without the Rh antigen in their RBCs.
  • As a result, they do not develop antibodies unless sensitization occurs.
  • Once this occurs, any transfusion with Rh-positive blood will cause a reaction.
27
Q

nursing actions for blood transfusion

A
  • Explain the procedure to the client.
  • Assess vital signs and the client’s temperature prior to transfusion.
  • Remain with the client during the initial 15 to 30 min of the transfusion. Most severe reactions occur within this time frame.
  • Assess laboratory values (e.g., platelet count less than 20,000 and hemoglobin less than 6 g/dL).
  • Verify the prescription for a specific blood product.
  • Obtain blood samples for compatibility determination, such as type and cross-match.
  • Assess for a history of blood-transfusion reactions.
28
Q

giving transfusion

A
  • Initiate large-bore IV access. An 18- or 20-gauge needle is standard for administering blood products.
  • Obtain blood products from the blood bank. Inspect the blood for discoloration, excessive bubbles, or cloudiness.
  • Prior to transfusion, two RNs must identify the correct blood product and client by looking at the hospital identification number (noted on the blood product) and the number identified on the client’s identification band to make sure the numbers match.
  • The nurse completing the blood product verification must be one of the nurses who administers the blood product.
  • Prime the blood administration set with 0.9% sodium chloride only. Never add medications to blood products. Y-tubing with a filter is used to transfuse blood.
  • Begin the transfusion, and use a blood warmer if indicated. Initiate the transfusion within 30 min of obtaining the blood product to reduce the risk of bacterial growth.
29
Q

Intra Procedure/Transfusion

A
  • Remain with the client for the first 15 to 30 min of the infusion (reactions occur most often during the first 15 min) and monitor vital signs and rate of infusion per facility policy.
  • Usually every hour after the first set has been obtained after induction.
30
Q

complications

A

acute hemolytic transfusion
allergy
fever
bacteria
circulatory overload

31
Q

Acute Hemolytic Transfusion Reaction onset

A
  • Immediate or can manifest during subsequent transfusions. Results from a transfusion of blood products that are incompatible with the client’s blood type or Rh factor.
  • Can occur following the transfusion of as few as 10 mL of a blood product.
32
Q

Acute Hemolytic Transfusion Reaction s/s

A
  • Can be mild or life-threatening, resulting in disseminated intravascular coagulation (DIC) or circulatory collapse.
  • Findings include chills, fever, low-back pain, tachycardia, flushing, hypotension, chest tightening or pain, tachypnea, nausea, anxiety, hemoglobinuria, and an impending sense of doom.
33
Q

Acute Hemolytic Transfusion Reaction nursing actions

A
  • Stop the transfusion!! DO THIS FIRST
  • Remove the blood tubing from the IV access.
  • Avoid infusing further blood products into the circulatory system! The patient is more at risk now!
  • Initiate an infusion of 0.9% sodium chloride using new tubing.
  • Monitor vital signs and fluid status.
  • Send the blood bag and administration set to the lab for testing.
34
Q

fever onset

A

Commonly occurs within 2 hr of starting the transfusion

35
Q

fever results

A

from the development of anti-WBC antibodies. Can be seen when the client has received multiple transfusions.

36
Q

fever findings include

A
  • chills
  • increase of 1° F (0.5° C) or greater from the pre– transfusion temperature
  • Hypotension
  • tachycardia.
37
Q

fever nursing actions

A
  • Use WBC filter for administration to prevent the reaction from occurring.(before transfusion)
  • Stop the transfusion and administer antipyretics.
  • Initiate an infusion of 0.9% sodium chloride using new tubing.
38
Q

allergic onset

A

Onset: 24 hours after transfusion
Results from a sensitivity reaction to a component of the transfused blood products.

39
Q

allergy s/s

A
  • usually mild and include itching, urticaria, and flushing.
  • The client can develop an anaphylactic transfusion reaction resulting in bronchospasm, laryngeal edema, and shock.
40
Q

allergy mild reaction nursing action

A
  • Stop the transfusion.
  • Initiate an infusion of 0.9% sodium chloride using new tubing.
  • Administer an antihistamine, such as diphenhydramine.
  • If the provider prescribes to restart the transfusion, do so slowly.
41
Q

ANAPHYLACTIC REACTION NURSING ACTIONS

A
  • Stop the transfusion.
  • Administer epinephrine, oxygen, or CPR if indicated.
  • Remove the blood tubing from the client’s IV access.
  • Initiate an infusion of 0.9% sodium chloride using new tubing.
42
Q

bacterial onset

A
  • During or up to several hours after transfusion
    ● Results from a transfusion of contaminated blood products.
43
Q

s/s of bacterial

A

Wheezing/Dyspnea
Chest tightness
Cyanosis
Hypotension
Shock.

44
Q

bacterial nursing actions

A
  • Stop the transfusion.
  • Administer antibiotics and an IV infusion of 0.9% sodium chloride using new tubing.
  • Send a blood culture specimen to the lab for analysis.
45
Q

circulatory overload onset

A

ONSET: Can occur any time during the transfusion
Results from a transfusion rate that is too rapid for the client.

46
Q

circulatory s/s include

A

Crackles, dyspnea, cough
Anxiety
jugular vein distention
tachycardia
Manifestations can progress to pulmonary edema.

Med Surg 2 (35 decks)

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