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Term
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Function-transport oxygen/homeostasis Separated by centrifusion-it is composed of:–Plasma •uspended elements- –Electrolytes, antibodies –Formed cellular elements –RBC –WBC –Platelets
Peripheral blood smear–Look at components under the microscope •Manual differential" –Machine looks at components •Auto differential"
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Definition
Plasma (55%) Serum –Water (90-95%) •lear, straw-colored fluid –Suspended substances •lectrolytes •ntibodies •rotein, Carbs, Fat, & Albumin •ormones •itrogenous wastes •ases –O2 –CO2
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Definition
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–Leukocytes-WBC’s (1% of formed elements) •Defend body against disease •Can leave bloodstream-go to tissue •Elevated = leukocytosis •Decreased = leukopenia
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Leukocytes 5 Types of WBC's |
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Definition
Five types WBC’s Granulocytes ("Big BEN") Basophils –Eosinophil –Neutrophils
Non-Granulocytes –Lymphocytes –Monocytes
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Granulocytes –Short life span –Increased in acute infection –Made in bone marrow –Surround and destroy invaders •Basophils –Allergies •Eosinophils –Parasites •Neutrophils –Nonspecific (first to respond) –Bands-immature (elevated levels = left shift) –Segs-mature
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Leukocytes Non-Granulocytes |
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Definition
Non-Granulocytes –Lymphocytes-lymph tissue •B cells-antibodies (Navy) –Aka humoral immunity •T cells-cell specific (Army) –Aka cell-mediated immunity –Monocytes •Nonspecific •Spleen has increased concentration •Macrophages (Marine) –Fixed in tissues •Defensive force –Migrate to tissues and lie in wait until activated
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Small vessels, ducts and nodes Fluids flow from tissue spaces to circulatory system Lymph Nodes–Produce lymphocytes and filter cell debris Lymphadenitis–Inflammed nodes during severe infection |
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Definition
Terms: Sepsis –Lymph nodes unable to contain infection
Lymphoma –Primary malignant disease of the lymph nodes
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Lymphatic System Consists of: |
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Definition
Lymphatic System consists of: Spleen –Located upper left quad –Stores and releases blood –Helps mature leukocytes –Filters and removes old blood cells –Problems •raumarupture and severe blood loss •plenomegaly –Usually with systemic infections or hemolytic anemias
Thymus –Where T-cells mainly mature
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Platelets aka thrombocytes |
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Definition
Formed in Red marrow Adhere to each other during injury Release factors (VII, IX, etc) which initiate the clotting cascade Increase numbers= thrombocytosis Decreased numbers= thrombocytopenia risk of hemorrhage caused by use and destruction orproduction Normal life span=10 days Normal levels= 250,000-400,000
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Definition
#1 cause of initiation= Injury–Wall of injured vessel constrict and decreases blood flow –Platelets adhere to collagen fibers of the injured vessel forming a white thrombus or platelet plug –Serotonin is released from platelets –Serotonin initiates the clotting cascade –Bleeding will cease •cab will be produced
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Prothrombin + Prothrombin activator + Calcium = Thrombin Thrombin+ Fibrinogen + Calcium = Fibrin threads Entire process is dependent on an injury
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Reaction to blood is determined by the receiver’s antibodies AB is universal recipient (no antibodies) O is universal donor (no antigens)
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Blood Administration Blood Products |
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Definition
Blood Products –PRBC’s –Whole blood –Platelets –FFP –Albumin –Globulin
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Blood Administration Nursing considerations |
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Definition
Nursing considerations –Give upon receipt –Max infuse time is 4 hours –Check by two licensed people –NORMAL SALINE ONLY –Vitals –Monitor for reactions
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Blood Administration - Reactions Circulatory Overload |
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Definition
Circulatory overload –Dyspnea –Cough –Crackles –Frothy sputum –Common in elderly –Monitor rate
Febrile –Fever –Chills –HA –NV –Response to WBC’s
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Blood Administration - Reactions Allergic |
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Definition
Allergic–Mild-Hives –Severe-Anaphylaxis •ives, chills, dizziness, edema, wheezing, bronchospasm •eaction to plasma proteins
Hemolytic–Response to antigen –Hypotension –Dyspnea –Back pain –Chest tightness –Hematuria
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Blood Administration-Reaction Care |
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Definition
STOP TRANSFUSION!! -
Assess and intervene where necessaryCall the DR. Keep line open with NS Save bag and tubing Get urine specimen Document events Call lab or transfusion services
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Anemias Abnormally low number or altered characteristics of RBC’s |
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Definition
Abnormally low number or altered characteristics of RBC’s Bottom line –RBC’s carry O2 –RBC’s = O2 to tissues •Fatigue •Dizziness •Near syncope or syncope |
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Anemias 3 main ways to have decreased RBC’s |
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Definition
3 main ways to have decreased RBC’s –Blood Loss-hemorrhage or gradual –Deficiency in production •Bone marrow failure •Malnutrition –Excessive Destruction •Toxins •Tumor |
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Anemias Ways the body compensates |
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Definition
Ways the body compensates: –Increase HR and RR –Shunt blood away from non-vital organs –Increase production of erythropoietin |
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Anemia r/t blood loss Decreased circulatory volume |
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Definition
30Anemia r/t blood loss Decreased circulatory volume Decreased O2 delivery Manifests as: –Pale, cold, clammy –Confused –Thirsty –Hypotensive –Tachycardic –Oliguric –Hypovolemic shoc |
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Anemia r/t blood loss Diagnosis |
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Definition
Anemia r/t blood loss Diagnosis –CBC What is on a CBC? –See Diagnostic Blood Study Sheet |
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Blood loss anemia Can be caused by: |
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Definition
Blood loss anemia Can be caused by: –GI Bleed –Surgery –Trauma –Ineffective clotting –Menstruation |
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Anemia r/t Blood Loss Treatment Nursing |
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Definition
Treatment –Identify cause and stop bleeding –Transfusion –Fluids –O2 Nursing considerations –I & O –Monitor blood loss –Frequent vitals –Assessment |
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Definition
Bone marrow goes bad –60% mortality rate ALL components made in bone marrow are suppressed –RBC –WBC –platelets |
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Aplastic Anemia - Etiology |
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Definition
Medications –Chemotherapy agents –Chloramphenicol –Streptomycin –steroids Radiation Viral infection Inherited tendency |
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Aplastic Anemia Clinical manifestations |
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Definition
Aplastic Anemia Clinical manifestations –Ecchymosis-petechiae –Excessive bleeding •GI/GU/ gums? •Epistaxis –Frequent infections –Fatigue-weakness-dizziness –Dyspnea –Palpitations |
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Definition
Aplastic Anemia Diagnosis –CBC –Bone marrow Bx •Needle aspiration -look for bleeding Treatment –Reverse isolation –Transfusions –ATB and Steroids –Bone marrow transplant •Destroy existing marrow and replace with healthy |
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Aplastic Anemia Nursing –Avoid fatigue –Prevent infection/hemorrhage –Decrease trauma/injury –No needle sticks –Exposure to infections –Monitor for S/S of infection –Skin integrity and hygiene |
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Definition
Population risk Etiology –Decreased Fe intake –Malabsorption of Fe S/S –Fatigue –Weakness –Pallor –Dizziness –Dyspnea -Body unable to make adequate Hgb |
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Iron Deficiency Anemia Diagnosis Treatment |
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Definition
40Iron Deficiency Anemia Diagnosis –Serum blood test •Serum Fe level (available Fe) •Fe binding capacity-high •CBC •Ferritin Treatment –Fe supplements –Symptoms –R/O pernicious anemia |
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Iron Deficiency Anemia Iron supplement adverse reactions |
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Definition
Iron supplement adverse reactions –GI upset –Constipation –Stained teeth –IM by Z-track method –Black, tarry stools |
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Iron Deficiency Anemia Ferrous Sulfate -Teaching |
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Definition
Iron Deficiency Anemia Ferrous Sulfate -Teaching –Take PO Fe with food –Liquid with a straw –Dark stools –Take with Vit C –Increase fluids and fiber in diet |
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Iron Deficiency Anemia Fe rich foods Toxic Fe levels |
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Iron Deficiency Anemia Fe rich foods –Organ meats –Egg yolks –Fish & chicken –GREEN LEAFY –Dried fruit (raisin and prunes) –Dried beans Toxic Fe levels –Skin discoloration-Blue –N/V –Shock, seizures, hepatic injury |
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Folic Acid Deficiency Anemia Folic acid is required for DNA synthesis Etiology |
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Definition
Folic Acid Deficiency Anemia Folic acid is required for DNA synthesis Etiology –Poor diet –Malabsorption –Drugs-sulfa-steroids -estrogen –Infants (because mom didn’t have enough) –ETOH (malnutrition) big one –Pregnant adolescents (increased need) |
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Folic Acid Deficiency Anemia S/S |
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Definition
S/S –Glossitis –Diarrhea/ constipation –Pallor –Wt loss –Muscle pain –Insomnia –Increase risk of miscarriage |
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Folic Acid Deficiency Treatment |
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Definition
Folic Acid Deficiency Treatment –Folic acid replacement –Increase intake of folacin-rich foods –Fe foods + wheat germ yeast and milk –Needs Vit C to increase absorption –Modify drug choices |
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Pernicious Anemia Decreased HCL production leads to atrophy of mucosa in fundus of stomach –Decreased production of intrinsic factor Failure of the stomach to secrete adequate amounts of intrinsic factor for absorption of Vitamin B12 (cobalamin) –Causes of decreased HCL •Gastric or small bowel surgery •Autoimmune |
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Pernicious Anemia Vitamin B12 (Cobalamin) |
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Pernicious Anemia Vitamin B12 (Cobalamin) –A MUST for Fe to absorbed by the body –Also required for nerve myelination –Therefore---- •B12 deficiencies cause severeirreversiblenerve damage •Anemia |
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Pernicious Anemia S/S-Anemia Neuro S/S |
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Pernicious Anemia S/S-Anemia –Weakness –Dyspnea –Fatigue –Hypoxia –Jaundice –Glossitis –Deterioration of teeth and gums Neuro S/S –Behavior changes –Paresthesia –Ataxia (defective muscular coordination) –Poor memory |
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Pernicious Anemia Diagnosis |
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Definition
Pernicious Anemia Diagnosis –Schilling Test –CBC •Macrocytic RBC •Decrease H & H •Decrease Retic count –Low Serum B12 level |
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Pernicious Anemia Treatment Nursing Care |
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Definition
Pernicious Anemia Treatment –Vitamin B12 injections for LIFE –Fe and Folic acid replacement Nursing Care –Frequent VS –Diet teaching –Special mouth care –Prevent fatigue |
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Hemolytic Anemia Destruction of RBC’s Etiology |
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Hemolytic Anemia Destruction of RBC’s –Hemo= blood, Lysis= destroy/separate Etiology –Congenital •Thalassemia •Sickle Cell –Acquired •Wrong blood type transfused •Snake bite •Drugs •Chemotherapy/Cancer •Sometimes unknown |
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Hemolytic Anemia S/S –Jaundice –Hematuria –Splenomegaly –Back Pain –All other anemia S/S |
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Hemolytic Anemia Diagnosis |
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Definition
Hemolytic Anemia Diagnosis –Direct Coombs Test •Checks to see if antibodies present-caused by trauma (birth) or drugs –Indirect •Blood typing-antibody/ antigens on surface of RBC –CBC •Retic count |
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Hemolytic Anemia Treatment |
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Definition
Hemolytic Anemia Treatment –Blood and blood product replacement –Genetic counseling –Splenectomy –Steroids •Suppress antibodies –Maintain renal function |
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Hemolytic Anemia -Congenital Thalassemia Treatment |
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Hemolytic Anemia -Congenital Thalassemia –Increases incidence in Eastern, Asian and African cultures –Autosomal recessive disorder –Major or minor –Can be fatal Treatment –Transfusions |
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Hemolytic Anemia-Congenital Sickle Cell Anemia |
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Hemolytic Anemia-Congenital Sickle Cell Anemia –Increased incidence in African Americans and those of Mediterranean countries –Hereditary hemolytic anemia •Autosomal recessive trait –Defective Hgb will form crescent shape –RBC’s "sickle" under certain circumstances |
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Hemolytic Anemia-Congenital Sickle Cell (cont’d) S/S |
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Definition
Sickle Cell (cont’d) –These sickled cells get caught in capillaries which obstruct blood flow causing ischemia and infarction –Sickled cells are rapidly destroyed
S/S –Anemia –Fatigue, pallor, activity intolerance –Fever, jaundice –Joint and abdominal pain –Enlarged liver and spleen
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Hemolytic Anemia-Congenital Sickle Crisis Diagnosis–Treatment |
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Sickle Crisis– Episodic event with increased symptoms Diagnosis– Decreased RBC– Hgb electrophoresis Treatment– Hydration– Pain medication– Blood transfusions– Genetic counseling– Treat symptoms |
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Hemolytic Anemia - Congenital Teach |
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Definition
Teach –Avoid high altitudes or other events which will precipitate hypoxia –Avoid dehydration –Avoid strenuous exercise –Avoid illness
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Definition
Hereditary –Sex linked (X chromosome) –Female is carrier –Male usually manifests the disease –Deficiency of Factor VIII •Converts prothrombin to thrombin –Prolonged coagulation time
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Hemophilia A S/S–Abnormal bleeding– Edema in joints r/t bleeding– Pain with movement– Crippling deformities– Major injury can be fatal– Hemorrhage internal and externally |
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Hemophilia Treatment Transfusions Teaching |
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Transfusions –PRBC’s –FFP-clotting factors •Contains Factor VIII-
Teaching –Avoid injury -DUH! –Medic alert •No ASA, Ibuprofen –Safety •Knee and elbow pads •Avoid being overprotective •Bleeding first aid
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Von Willebrand’s Disease Less serious form of Hemophilia A Congenital bleeding disorder –deficiency of factor VIII
Autosomal dominant trait Manifests at an early age, usually as epistaxis or easy bruising Symptoms typically decrease in severity with age
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Von Willebrand's Disease Diagnosis Treatment |
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Diagnosis –Symptoms –Prolonged bleeding time –Factor VIII deficiency
Treatment –Administration of factor VIII 24 hours prior to surgical procedures or during attacks of bleeding
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Von Willebrand’s Disease Nursing Care |
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Polycythemia Vera Excessive production of RBC’s Concentration of Hgb increases Blood flow sluggish Etiology
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Polycythemia Vera S/S –Red face –Purple lips –Dizziness –Fatigue –Pain in extremities –Weakness–HA |
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Polycythemia Vera Diagnosis Treatment |
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Definition
Polycythemia Vera Diagnosis Treatment –Phlebotomy Drain Drain 500-800 cc blood –Suppress RBC production –Increase fluid intake Prevent clots
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Thrombocytopenia Decrease in number of platelets Less than 100,000 Etiology –Not enough being made or being destroyed –Idiopathic Thrombocytopenia Purpura Platelets destroyed –Drugs Chemotherapy Etoh or illegal drugs NSAIDS,ASA Quinidine Sulfa bases Oral hypoglycemics –Leukemia Platelet production decreased
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Thrombocytopenia S/S Diagnosis |
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Definition
S/S –Pupura Large red/purple spots under the skin –Ecchymosis –Petechiae Smaller, fine red/purple spots under the skin –Prolonged, heavy menses –epitaxsis
Diagnosis –CBC –Bone Marrow aspiration
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Thrombocytopenia Treatment Nursing |
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Definition
Treatment –Platelet replacement –Splenectomy –IVIG –Remove causative agent
Nursing
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Term
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Definition
Rampant proliferation of leukocytes Immature, ineffective disease fighters Two types: myelogenous (myeloid line) & lymphocytic (lymphoid line) Etiology –Genetic-Down’s syndrome –Viral –Radiation –Chemo –Insecticides –Fertilizers –Cleaning agents
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Definition
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Leukemia Lymphloid Line –CLL-Chronic lymphocytic leukemia |
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Lymphloid Line –ALL-Acute lymphocytic leukemia •Children •5yrs+ remission possible •Most curable –CLL-Chronic lymphocytic leukemia •Adult •Nearly asymptomatic •Prognosis can go either way
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Leukemia - Manifestations |
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Definition
Leukemia-Manifestations Low grade fever and night sweats Enlarged lymph node, spleen Bone pain Malaise Low RBC’s Low platelets Frequent infections
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Diagnosis –WBC high or low •Blasts presents –CXR –Bone Marrow Aspiration –Lymph node bx
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Treatment –To induce remission or achieve palliation –Chemo •Induction-destroys diseased marrow/immature WBC’s •Maintenance –Radiation –ATB•Preventative –Bone marrow transplant –Blood Transfusions |
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Nursing Care –Infection is the #1 killer –Prevent injury •Bleeding is a common side effect of therapy –Comfort –Encourage self-care –Coping •Hair loss and grief –Assess for and treat complications •N/V, stomatitis •Neutropenic fever
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S/S –Painless enlarged lymph nodes-can be anywhere –Low grade fever –Night sweats –Weight loss –Anemia –Frequent infections |
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Hodgkin's Lymphoma Diagnosis Treatment |
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Definition
Diagnosis –Lymph node/ bone marrow biopsy –Reed-Sternberg cells in lymph node biopsy Treatment –Radiation –Chemo –Steroids |
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Lymphoma Hodgkin's and Non-Hodgkin's |
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Definition
Nursing Care –Treat complications of radiation and chemotherapy –Avoid infection –Can be very hopeful depending on stage |
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Definition
Similar signs and symptoms to Hodgkin’s Same Treatment as with Hodgkin’s Absence of Reed-Sternberg cells Less Hopeful |
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Definition
Plasma cells proliferate in the bone marrow causing excruciating pain Bone tumors Myeloma infiltrates the liver, spleen, and kidneys |
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Multiple Myeloma Diagnosis |
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Definition
Diagnosis –Skeletal X-rays –Bence Jones Protein in urine |
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Definition
Treatment –Chemo –Radiation –Steroids –ATB –Blood Transfusions –Braces |
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Definition
Complications –Pathologic fractures –Anemia –PAIN!!! (lots) –Infection –Renal failure r/t increased Ca levels from bone demineralization |
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Nursing Care –Pain –Safety –I & O –Prevent infection |
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Decreased drainage of the lymph system Congenital –Pitting edema to lower extremities Acquired –Following tumor removal (mastectomy) –Parasites in tropical countries –Overwhelming infection |
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Lymphedema Treatment Nursing Care |
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Definition
Treatment –Elevate extremities –Exercise to promote circulation –Elastic gloves or stocking to promote venous return –Eliminate cause Nursing Care –No BP’s, IV’s, IM’s –Monitor for cellulitis |
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