Med Surg Hema Ch. 33 Flashcards
1
Q
The hematological system includes?
A
blood, blood cells, lymph, and organs involved with blood formation or blood storage
2
Q
Blood is a
A
specialized connective tissue that acts as a transport vehicle of materials between the external environment and the body’s cells
3
Q
Blood consists of
A
plasma (a clear yellow, protein-rich fluid); solutes (proteins, electrolytes, and organic elements); red blood cells (RBCs), white blood cells (WBCs); and platelets (which are fragments of cells).
4
Q
The hematological system is important in
A
helping the body by circulating oxygen, nutrients, hormones, and metabolic wastes; protecting against invasion of pathogens; maintaining blood coagulation; and regulating fluids, electrolytes, acids, bases, and body temperature
5
Q
Bone marrow is the primary site for
A
Blood formation and maturation (hematopoiesis)
6
Q
Bone marrow is
A
network of flexible connective tissue that produces stem cells
7
Q
Stem cells are
Fxn?
A
are immature, undifferentiated cells that have the ability to become any one of several types of blood cells.
**Can become whatever cell you need and can divide over and over again to produce new cells
8
Q
Lymphoid stem cells produce
A
either T or B lymphocytes, which are the main functional cells of the immune system
9
Q
Myeloid stem cells differentiate
A
into three cell types: RBCs (erythrocytes), WBCs (leukocytes), and platelets (thrombocytes)
10
Q
Which is the most abundant of the formed elements?
A
RBCs
aka = erythrocytes
11
Q
RBC’s characteristics
A
small, biconcave disk with no nucleus
12
Q
Are RBCs rigid or flexible?
A
Flexible- that it can move through small capillaries of the circulatory system
13
Q
Are RBCs thin or thick?
A
Very thin so that O2 and CO2 gases easily diffuse across
14
Q
RBCs fxn
A
- to pick up O2 from the lungs and transport it to systemic tissues
- to pick up CO2 from the tissues and deliver it in the lungs
15
Q
What affects RBCs ability to perform fxns?
A
Shifts in the:
- Amount
- Size
- Shape
- Composition
**Think about sickle cells
16
Q
Where are RBCs formed?
A
Bone marrow
17
Q
What is the lifespan on RBCs?
A
120 days
18
Q
RBC normal range
A
3.61 to 5.81 million/mm3
19
Q
Erythropoiesis
A
the selective maturation of stem cells into mature erythrocytes
20
Q
RBCs produce
A
Hemoglobin
21
Q
Hemoglobin is
A
-the oxygen carrying component of an RBC
**Needs iron
22
Q
Hemoglobin is composed of
A
Pigment (heme) that contains iron (Fe2+) and a protein (globin)
23
Q
Hgb molecule is made up of
A
4 globins with a heme molecule attached to each globin
24
Q
The heme molecule has what at the center?
How many O2 molecules can be carried?
A
iron at the its center which binds with O2
-This makes Hbg capable of transporting up to four molecules of O2; therefore, iron is a significant component of Hgb
25
Hematopoiesis
Making of blood cells
26
Why are erythrocytes critical for survival?
because a severe deficiency of erythrocytes in the case of major trauma or hemorrhage, can be fatal within a few minutes because of the lack of oxygen.
27
WBCs are called
leukocytes
28
WBCs fxn
Components of the body’s defense system against infection and disease
29
What is the least abundant formed element?
WBCs
| yet they are required for life to provide protection against infectious microorganisms and other pathogens.
30
Normal number of WBCs
4500-11,000 WBCs per cubic mm of blood
31
Where can RBCs and WBCs travel?
```
RBCs= stay in the vascular space (w/in blood vessels)
WBCs = travel anywhere
```
32
WBCs: Granulocytes
- Neutrophil
- Eosinophils
- Basophils
33
WBCs: Agranulocytes
- Lymphocytes
| - Monocytes
34
Neutrophil fxn:
phagocytosis (engulfing and digesting bacteria)
35
Pt teaching for decreased neutrophil:
Decreased neutrophil counts significantly increase the risk of infection because of a decreased immune response. Protect the patient by using and teaching proper hand hygiene, performing frequent oral care, and limiting visitors.
36
Eosinophil fxn
involved in hypersensitivity reactions, inactivating some of the inflammatory chemicals released during the inflammatory response.
Combat effects of histamine in allergic reactions
37
Basophil fxns
allows vessels to become more permeable to allow neutrophils to enter and do its job
*have heparin component
38
Lymphocytes fxns
Produce antibodies such as B and T cells
39
Monocytes fxn
Macrophages remove debris and phagocytize bacteria within the tissues
40
Platelets aka
| fxn:
thrombocytes
| -clotting
41
How does a clot form?
After a vascular injury occurs, platelets play an essential part in the control of bleeding.
Platelets collect at the damaged site and are activated to begin adhesion and formation of a temporary plug.
Their cytoplasmic granules release mediators to activate coagulation factors in the blood plasma and initiate the formation of a stable clot composed of fibrin (a fibrous protein).
42
What is blood made up of?
plasma (a clear yellow, protein-rich fluid), and the cells and cell fragments suspended in it are RBCs, WBCs, and platelets
43
What is plasma made up of?
complex mixture of water, proteins, nutrients, electrolytes, nitrogenous wastes, hormones, and gases.
44
Spleen fxn
serves as a large filter by removing aged erythrocytes
| and removal of abnormal WBCs and platelets
45
What is the primary fxn of erythrocytes?
Respiration
46
Hemostasis
Stopping of bleeding
47
How does a clot form?
(1) vasospasm, (2) formation of a platelet plug, (3) development of a fibrin clot, (4) clot retraction, and (5) fibrinolysis. Hemostasis is normal when it seals a blood vessel to prevent blood loss and hemorrhage.
48
Steps of hemostasis detailed
```
1 Vasospasm = Damage to a blood vessel causes it to spasm. This spasm, which lasts more than a minute, constricts the vessel and reduces blood flow.
2 Formation of the platelet plug = Platelets adhere to the damaged vessel wall and to one another, forming a platelet plug. Von Willebrand’s factor (an adhesive protein that is synthesized by the endothelium and megakaryocytes) is necessary for platelets to adhere to one another. The platelet plug is stabilized by fibrin, which binds the platelets and other blood cells.
3 Clot formation = Coagulation occurs as fibrin forms a meshwork that cements blood components together into an insoluble clot. The process involves two different clotting pathways. The intrinsic pathway is activated by vessel injury; the extrinsic pathway is activated by blood leaking out of the vessel into the tissues. The final outcome is fibrin clot formation. Each clotting factor is activated in sequence; activation of one clotting factor activates another in turn. A deficiency of one or more factors interrupts blood clotting.
4 Clot retraction = After approximately 30 minutes, platelets trapped within the clot begin to contract. This pulls the broken portions of the ruptured blood vessel closer together. At the same time, platelets release growth factors that stimulate cell division and tissue repair in the damaged vessel.
5 Clot dissolution A process called fibrinolysis removes the clot after tissue has been repaired. Fibrinolysis begins within a few days of clot formation and continues until the clot is dissolved.
```
49
A clot is
Platelet plug with fibrin
50
Intrinsic factors r/t clots
involves any bleeding inside cells/vessels
51
Extrinsic factors r/t clots
any bleeding outside of the body ex: tissue trauma
52
What is inflammation?
protective response that aims to eliminate the initial cause of cell injury, remove the damaged tissue, and generate new tissue
53
What happens when body stays in inflammatory stage for too long? and what do we add?
If body stays in inflammation stage too long the tissue dies/becomes damaged. Can not stay in state too long. IF things become inflamed we add ice.
54
What cells rush first to area during inflammatory response?
Neutrophils
55
Diets high in vitamin K may cause
Diets high in vitamin K
56
Questions to ask for a nutrition hx and why
Have you had any recent changes in energy level?
-b/c of low iron levels
Have you been experiencing any pain, burning, or tingling sensations? Any changes in skin color or temperature? Any swelling (edema)?
-want to ask b/c = specific to sickle cell patients. gives you idea how health RBCs are and are getting good amount of oxygenation
Have you experienced any bleeding or easy bruising, dizziness, fatigue, or changes in lymph nodes (swelling, pain or tenderness, warmth)?
57
Why is past medical hx important for hematological system?
- want to ask b/c = specific to sickle cell patients. gives you idea how health RBCs are and are getting good amount of oxygenation
- pregnancy- b/c of increased blood volume and they increase need of iron to provide blood to fetus
58
What meds do you ask about during medication hx?
Inquire about current medications, including anticoagulants, aspirin and other salicylates, herbs, nutritional supplements, and nutraceuticals.
59
Anticoagulants
“blood thinners” such as sodium warfarin (Coumadin), aspirin, or other NSAIDs
60
What can aspirin do to platelets?
Aspirin can irreversibly inhibit platelet aggregation by inactivation of a crucial cyclooxygenase (COX) enzyme. A 325-mg dose of the medication results in approximately 90% inhibition of COX in circulating platelets. This effect lasts for the life span of platelets (4–7 days)
61
What tests and labs should be done for pts on aspirin therapy?
During prolonged aspirin therapy, periodic assessments of Hct, Hgb level, prothrombin time (PT), International Normalized Ratio (INR), and renal function are recommended
62
Antidote for warfarin
Vitamin K
63
Hematological Assessment
```
Color of skin and mucous membranes
Skin temperature, capillary refill, edema
Palpate skin, lymph nodes
Inspect oral mucous membranes and skin
Inspect tongue
```
64
What is glossitis?
A red, swollen, smooth, shiny, and tender tongue (glossitis) may indicate iron deficiency anemia or pernicious anemia
65
Why do we assess respiratory rate and VS?
- Assess RR b/c will tell us if getting adequate oxygenation
| - VS b/c not getting oxygen = Tachycardia and tachypnea
66
Why do we do a urinary assessment?
To be sure there is no blood in urine
67
Why do we assess Musculoskeletal
To assess for weakness and RBCs are made in the long bones and pelvis
68
Why do we assess the abdomen?
b/c spleen filters so if spleen is not working it becomes enlarge and felt during palpation but too much pressure can cause it to rupture
69
Low H&H suggests
Anemia
70
CBC looks at?
Hemoglobin and hematocrit (for anemia)
Red blood cells
White blood cells (for infection and inflammation)
Platelets (for clotting)
71
Reticulocytes
Reticulocytes are non-nucleated, immature RBCs that remain in the peripheral blood for 24 to 48 hours while maturing
72
Hemoglobin electrophoresis
Washes blood and replaces blood with new blood
ex: when mom is Rh- and baby is Rh+ and some of babies blood mixes with moms blood
73
Coombs test
test detects the presence of immunoglobulins (antibodies) on the surface of RBCs that develop through sensitization to antigens (such as Rh factor)
74
Positive coombs test
test in the neonate indicates that maternal antibodies have crossed the placental barrier and coated the fetal RBCs, causing hemolytic disease of the neonate.
75
Serum Ferritin
A ferritin level provides information about the body’s ability to store iron for later use and is usually performed with iron testing and total iron-binding capacity (TIBC)
76
Low serum ferritin levels
iron deficiency, chronic GI bleeding, or heavy menstrual bleeding
77
High serum ferritin levels
alcoholic liver disease, hemochromatosis (excessive iron absorption), hemolytic anemia, Hodgkin’s lymphoma, or megaloblastic anemia
78
Prothrombin time (PT)
measures the time required for a fibrin clot to form
79
INR
to evaluate the effectiveness of oral anticoagulant therapy (warfarin sodium, Coumadin)
80
partial thromboplastin time (PTT)
is to screen for deficiencies of the clotting factors in the intrinsic pathways and to monitor response to thrombin inhibitor therapy (heparin)
81
The purpose of a bone marrow aspiration and biopsy
is to diagnose thrombocytopenia, leukemias, granulomas, anemias, and primary and metastatic tumors
82
RBCs
Women:
Men:
W: 3.61-5.11 million/mm3
M: 4.21-5.81 million/mm3
83
Hematocrit
Women:
Men:
W: 36-48%
M: 42-52%
84
Hemoglobin
Women:
Men:
W: 11.7-15.5 g/dL
M: 14-17.3 g/dL
85
WBCs
4.5-11.1 x 10^3/mm3
