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Bone marrow

red and yellow.

red marrow is where production of blood cells occurs, if need be yellow marrow can be activated to help in the production if the red marrow is not making enough

Blood is ___% solid (Cells) and ___% liquid (plasma)

90% water and 10% protiens. Protiens are albumin and globulin. Also contains fibrinogen and prothrombin.

(Serum is without fibrinogen)

erythrocytes

function?

normal range?

Hgb?

Hct?

Produced where?

live how long?

red blood cells ( carry oxygen)

Hgb carries O2 and CO2- also contains iron which gives it the red color. 12-17g/dL norm Hgb

 3.6-5.4 million/mm³ is norm RBC.

% of RBC compared to whole blood. Should be 36%-54%

RBC's are produced in red marrow-need vit B12 and IF for production

live 120 days.

leukocytes

function?

normal range?

excessive amt?

low amt?

granulocytes

agranulocytes

live how long?

white blood cells

fight infection

5-10,000/mm³

Leukocytosis > 10,000

Leukopenia < 5,000

granulocytes= neutrophils, eosinophils, basophils

agranulocytes= lymphocytes, monocytes

1-2 days

platelets

function?

normal?

produced where?

thrombocytopenia?

live how long?

thrombocytes

cell fragments used for clotting

150,000-450,000/mm³

made in red marrow

thrombocytopenia= decreased number of platelets

7.5 days.

lymph system

circulates interstitial fluid and carries it to__?

depends on what for movement?

where do right and lymphatic ducts empty into?

what do lymph nodes do?

function of spleen?

veins

depends on muscle action and valves for movement- returns tissue fluid to bloodstream

subclavian veins

filter and make lymphocytes (immune cell production)

stores blood and makes lymphocytes

when s/s began, severity and frequency

diet history

drug history

foreign travel

check skin, lymph nodes, tonsils, extremeties and pulse

observations?

most symptoms relate to 3 areas?

can affect any part of body

most symptoms relate to 3 areas***

1. lack of O2 to tissues (RBC)

2. susceptibility to infection (WBC)

3. Hemorrhage (Plts)

decreased O2 supply to brain-headache, dizzness, visual disturbances, syncope

skin color- pale, cyanotic, jaundice, ecchymosis, purpura, petechiae

respiratory-dsypnea

GI- N/V, indegestions, bloating

signs of infection-- fever, chills, pain, fatigue

paresthesias (numbness and tingling)

loss of blood

behavior changes

Bone marrow aspiration

what to check for?

sites used?

in infants?

How do you give back bone marrow?

checks number and type of cells

-sternum and iliac crest

tibia is used for infants

12 clotting factors, total time 9-12 minutes could bleed to death. Increased Hct= dehydration like symptoms

decreased Hct= too much fluid

clotting studies:

prothrombin

clotting studies:

INR

clotting studies:

PTT

clotting studies:

ESR (erythrocyte sedimentation rate)

0-20mm/hr. increased rate with inflammation.

how long it takes for RBC's to settle to bottom

could also do culture

Lymphogram- dye injected between either fingers or toes and watched movement by x-ray for maybe up to year.

determined by heredity

types A,B,O, AB

Rh factor- present or absent

O- is universal donor

AB+ is universal receiver.(needs to be Rh + tho)

plasma contains antibodies and will effect people who don't have the same antibodies

Blood Transfusion

compatibility?

type and crossmatch done to determine compatibilty

several steps to signing out blood and checking correct patient-RN needs to go to lab to get it

if blood is out of fridge for over an hr without being used it must be discarded.

More than one person needs to check before blood is hung.

watch for 15 minutes to see if there will be reaction if not can bump up rate.

if given under 1/2 hr unable to determine if there will be a reaction

Blood transfusions

Steps...

1. Check IV site

2. Set up equipment

3. check VS and lung sounds after first 15 minutes and every hour

4. check one hour after transfusion completed

5. Use transfusion record.

*Needs to be primed with NS and only NS. takes 2 hrs and no less than 1/2 hr and no more than 4 hrs.

Blood transfusions

adverse reactions....

what to do if reaction occurs..

most often due to minerals used for preservation, could be inaccurate typing

s/s- fever chills dyspnea tachycardia chest pain, hematuria, itching

STOP transfusion, call MD, collect UA, treat symptoms

personal hygeine- prevents infections

rest/poisitioning- decrease O2 need

O2 therapy, transfusions (prevents tissue hypoxia)

Fluids/diets- iron, protien, vitamins, sm frequent meals, increased fluids, I&O

Control pain/fever

teaching- coping mechanisms

Anemia

what is it?

3 causes?

sypmtoms related to what?

described how?

decreased number of RBC's or decreased Hgb. can involve all age groups

3 causes:

1. loss of RBC's

2. destruction of RBC's

3. interference with production of RBC's

symptoms similar or related to inability to carry oxygen-low Hgb

can be described by size, shape and color

from blood loss-can be acute or chronic

hemolytic anemia?

thalassemia?

chronic premature destruction of erythrocytes (arsenic or lead)

causes: poisoning, parasites, infections, hereditary, idiopathic

s/s = anemia

treatment- remove cause, corticosteriods, transfusions, splenectomy

thalassemia= hereditary hemolytic anemia

aplastic anemia

what is it?

causes?

S/S?

Treatment?

bone marrow has stopped adequately making blood cells

causes= cancer, chemicals, x-rays, chemo, meds

S/S= weakness, fatigue, SOB

Treatment= antibiotics, transfusions, remove cause, bone marrow transplant

iron deficiency anemia

what is it?

S/S?

Treatment?

Who gets it?

seen in those with increased need of iron, heme cannot be recycled, dietary insufficiency, decreased absorption

S/S= fatigue, anorexia, pallor

Treatment= supplemental iron and iron rich foods, improve diet, blood transfusion if severe

women who are menstruating, and any periods of rapid growth

Iron supplements

2 types?

how to take them? and with what?

causes what SIDE EFFECTS?

why would liquid be given with straw?

can be given in ___,__,and ___?

Complication? and symptoms?

ferrous sulfate, ferrous gluconate

take on empty stomach unless to causes gastric upset, take with vit C

cause dark stools, and constipation

liquid will turn mouth orange

injection IM, z-track, oral

Iron toxicity- abd cramps, nausea, diarrhea

intrinsic factor and hydrochloric acid absent from stomach

which are necessary for vit B12 absorption

Vit B12 is necessary for normal mature RBC

cause- Heredity, stomach cancer, gastrectomy

perniscious anemia S/S

and Diagnostic

smooth red sore tongue, and sore mouth, diarrhea, digestive disturbances, SOB, jaundice, personality changes, irritable, confused, depressed, degenerative changes or nervous system.

Diagnostics= H&P, gastric analysis, shilling test, bone marrow biopsy, labs

immature RBC's

related to decreased dietary intake

Sickle Cell disease

cause?

what is it?

S/S?

what it effected?

cure?

hereditary disease

RBC's sensitive to decrease in O2 and change shapes.

S/S= tissue pain, ischemia, swelling, fever

every body system is affected and damaged

no cure or fully effective treatment

**Common in African Americans

** Both parents need to at least carry the trait for it be passed on.

Thalassemia

what is it?

how do you get it?

S/S?

Treatment?

chronic destruction of premature RBC's-- most common inherited diseases of the blood **middle and far east, italian or greek descent, boys and girls equally

S/S= pale, listless, fussy poor appetite, bones, become thin and brittle, liver and spleen enlargement.

Treatment-- no cure and needs regular blood transfusions to stay alive.

Malaria/Erythrocytosis?

polycythemia?

Malaria is damage to RBC's from a parasite and is treated with Chloroquinine

Polycythemia Vera is an INCREASE in # of RBC's and WBC's and platelets that leads to increased blood vicosity and clot formation.

S/S- fatigue, headache, SOB, bleeding, read face, increase bleeding

Treatment= with phlebotomy, chemo or radiation (this forces into bone depression), increase fluids, increase physical activity, TEDS

Leukemia

what is it?

who gets it?

cause?

cancer of lymphatic system, bone marrow and spleen.

Marked increase of WBC's- immature and ineffective(leukocytosis), deacreased RBC's and plts.

most common cancer in children

cause is unknown

acute leukemia

what is it?

s/s?

diagnostics?

treatments?

increase in immature lymphocytes

s/s= occur suddenly, are severe and prognosis poor, in young (2-5years)

*pallor, weakness, fatigue, decreased platelets and RBC's, fever, lymph node enlargement=> symptoms progress most often but can develop spontaneous remission. survival rate lengthening with improved treatments.

*Diagnostics- labs, bone marrow biopsy

treatments- blood transfusion, chemo, antibiotics, treat symptoms, antiinflammatory agents, bone marrow transplant, stem cell transplant, antineoplastics

Chronic Leukemia

who does if affect?

S/S?

Treatment?

affect adults with gradual onset and lasts as long as 30 years

S/S= swollen lymph nodes, anemia, weakness

Treatment= radiation, chemo, transfusions, antibiotics and steriods. Bruising and weight loss

*Prevent fatigue, prevent bleeding, pain control, control fever, protect from infection, treat itching, emotional support, safety

blood and tissue matching

500-700 cc removed

recipient is treated with chemo and radiation before transplant

Marrow given IV

half of clients bone marrow is removed, washed ad purged of leukemic cells, then frozen and stored.

Client is irradiated and receives chemo to destroy cancerous cells

Cleaned marrow is returned to client via IV.

Stem cell transplant

types?

1. autologous-from one-self

2. syngeneic- from an identical twin

3. Allogeneic- from another

agranulocytosis

what is it?

cause?

s/s?

treatment?

recovery?

severe leukopenia- decrease in granulocytes (too many agranulocytes) and leads to risk of infection

caused usually from drug toxicity

s/s-high fever, chills, ulceration of mucous membrane. susceptible to infections.

treatment- remove cause

recovery okay if toxic substance removed

Multiple Myeloma

what is it?

cause

onset at age?

prognosis?

malignancy involving plasma cells (b-lymphocyte cells)

unkown

at age 40

poor but improving, average survival 3-5 years after diagnosis

idiopathic thrombocytopenia purpura

what is it?

S/S?

cause?

Treatment?

decreased in platelets due to decreased production or increased destruction by the spleen.

Hemorrhages into tissues - purpura, petechiae, ecchymosis, enlarged spleen, cerebral hemorrhage (brain bleeding due to decrease platelets)

Ideopathic-cause is unkown

Treat with spleenectomy, steroids, replace platelets, eliminate cause.

Hemophilia

what is it?

cause?

s/s?

treatment?

Diagnostic?

3 types?

dysfunction of clotting involving platelets, lack of calcium, vit K, Prothrombin or fibrinogen.

cause-- hereditary mothers to sons

S/S- bleeding, anemia ( joints stiff and pain)

Treatment- transfusions of fresh blood, frozen plasma, factor VIII or IX or XI concentrate.

Diagnostic: look for factors (Lee White test)

3 types;

type A- deficiency in factor 8

type B- (christmas) deficiency in factor 9

type C- vandwildibrans) deficiency in factor 11

lymphoma

what is it?

two types to know??

group of cancers that affect lymphatic system

1. hodgkins

2. non hodgkins

hodgkins disease

what is it?

cause?

S/S?

Diagnostics?

age groups?

chronic disease of lymph circulation

unknown cause mostly in men

S/S enlarged lymph, splenomegaly, weight loss, anorexia, fatigue, weakness, fever and chills, anemia, bleeding, pruritis, edema, jaundice, dypnea

Diagnostics- biopsy- reed-sternberg cells particular to hodgkins, lymphangiogram(dye into fingers and toes)

15-35 and 55-75 years old.

Hodgkins stages

stage 1

stage 2

stage 3

stage 4

stage 1-- single lymph node group

stage 2-- more than one on same side of diaphragm

stage 3-- both sides of diaphragm and/or spleen involvement

stage 4-- extranodal (everywhere in body)

treatment radiation-need to start early, chemo, surgery, steroids, antibiotics, transfusions to treat anemia, autologou bone marrow or peripheral stem cel transplant

no cure but can go into remission

Non hogdkins lymphoma

what is it?

cause?

s/s?

treatment?

group of 30 sub-classifications of malignant diseases originating in lymph glands or tissue

cause is uknown

s/s depend on nodes involved

treatment- radiation and or chemo

lymphedema

what is it?

cause?

common in __?

obstruction of lymph circulation- accumulation of lymph fluid

common after mastectomy

common in women

swelling with pitting and eventually ulcerations and infections

mononucleosis aka mono

"the kissing disease"

what is it?

how is it spread?

who does if effect?

cause herpes type virus

acute infectious disease involving lymph system and spleen

oral contact or droplet infection, incubation of 30-50 days, acute stage 7-20 days, convalescent stage 2-6 weeks.

mono

S/S

diagnostics

treatments

complications

prognosis

s/s= fever, sore throat, headache, fatigue, malaise, skin rash, enlarged lymph nodes, splenomegaly

diagnostics- lymphocytosis, monospot

treatment- supportive, rest

complications- ruptured spleen, pneumonia

prognosis good