Chapter 7: Hematologic and Lymphatic Disorders
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Chapter 7: Hematologic and Lymphatic Disorders - Leaderboard
Chapter 7: Hematologic and Lymphatic Disorders - Details
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| What is hypovolemic shock? | Secondary anemia which occurs when deficiencies in RBCs and other components are caused by abnormally low circulating blood volume. Blood loss of 1L or more will have severe consequences and will likely result in hypovolemic shock |
| What is blood comprised of? | Erythrocytes(Red Blood Cells), Lymphocytes(White Blood Cells), Thrombocytes(Platelets) and plasma |
| What is the ratio of blood cell and platelets to plasma? | 45% blood cells and platelets and 55% plasma |
| Is blood alkaline or acidic? | Alkaline |
| What are the critical functions of blood(3)? | 1)To transport oxygen and nutrients throughout body and hormones from endocrine glands to tissue and cells 2)Regulated PH with buffers and helps to regulate body temperature due to bloods water content and controls water content of its cells as a result of dissolved sodium ions 3)Protects the body from infection by transporting leukocytes and antibodies to the site of infection and prevents blood loss using special clotting mechanisms |
| What is an erythrocyte(RBC)? | A biconcave disk with no nucleus containing cytoplasm and hemoglobin |
| What is hemoglobin> | A substance in blood that carries oxygen from the lungs to the cells as well as CO2 from the cells to the lungs |
| What is Hypochromia? | A decreased amount of hemoglobin causing red blood cell pallor |
| How are RBC sizes described? | Microcytic, Macrocytic or Normocytic |
| What are the normal hemoglobin(Hgb) ranges for men? for women? | Men: 14-18g/dL Women: 12-16g/dL |
| Explain the process by which erythrocytes are created. | When RBC O2 delivery to tissues is lowered, this triggers the release of erythropoietin from the kidneys. This is a hormone which initiates the development of mature erythrocytes. Once an adequate number of erythrocytes have been created, this signal is shut off. |
| Where are erythrocytes produced? | Red Bone Marrow(Vertebrae, ribs, sternum and the proximal ends of the humerus, pelvic girdle and femur |
| What is erythropoiesis? | The process by which erythrocytes are produced. |
| What factors influence erythropoiesis? | Kidney function. healthy bone marrow, and presence of dietary substances such as iron, copper and essential amino acids such as Cobalamin(B12), Folic acid(B9), Pyridoxine(B6) and riboflavin(b2) |
| What is hematocrit? | A measurement of the percentage o total blood volume made up by erythrocytes |
| What is the normal range of hematocrit for men? women? | Men: 42%-52% Women: 37%-47% |
| Hematocrit and Hemoglobin will test high if the patient is suffering from what? What it they are low? | Dehydration, fluid overload |
| Explain the process by which low hemoglobin leads to decreased cellular function. | If the hemoglobin is low then less oxygen is transported to cells. This causes slower break down and use of nutrients which leads to less energy production from the cells. This in turn leads to decreased cellular function |
| What are leukocytes? | Colorless cells which contain nuclei and serve to destroy bacteria and viruses in the body |
| What is the normal leukocyte level? | 5000-10000 mm3 |
| What are the three types of granular leukocytes and their functions? | Neutrophils- Essential to phagocytosis responsible for ingesting and disposing of dead tissue. They are the primary phagocytic cells involved in acute inflammatory response. Eosinophils-Play a role in allergic reactions and some parasitic infestations. Basophils-essential in nonspecific immune response to inflammation due to release of histamine during tissue damage or invasion |
| Normal Ranges for Neutrophils, Eosinophils and Basophils? | Neutrophils-3000-7000mm3 or 60%-70% Eosinophils-30-400mm3 or 1%-4% Basophils-25-100mm3 or 0.5%-1% |
| What are the 2 types of agranular leukocytes and their functions? | Monocytes-function like neutrophils engulfing foreign antigens and cell debris. They are the 2nd type of leukocyte to arrive at the scene of an injury. They are useful in removing dead bacteria and cells in the recovery stage of bacterial infection. Lymphocyte- Divided into T and B type cells which both arise from red bone marrow. B cells seek out and identify and bind with specific antigens and T cells when exposed to and antigen divide rapidly and produce large numbers of T cells that are sensitized to the antigen. Then B cells produce antibodies specific to the antigen. T and B cells then work together to destroy the foreign antigen. |
| What are the normal ranges for Monocytes and Lymphocytes? | Lymphocytes- 1000-4000mm3 or 20%-40% Monocytes- 100-600mm3 or 2%-6% |
| What is a differential white blood cell count? | A measurement of the five types of Leukocytes found in blood represented as a percentage or sometimes as absolute counts |
| What is Bandemia? | When immature neutrophils(bands) increase above 8% of total polymorphonuclear Leukocytes(Polys). This indicates that the red bone marrow has used up its reserves. This indicates serious bacterial infection |
| What are thrombocytes(platelets)? | Circular cell fragments produced by red bone marrow, which serve in hemostasis by assisting in forming clots to seal off breaks in blood vessel walls |
| Normal range of Thrombocytes? | 150,000-400000mm3 |
| What are the 3 actions of hemostasis? | Vessel spasm, platelet plug formation and clot formation |
| What are the nine steps of clot formation? | 1)injury occurs and blood vessel is damaged 2)hemorrhaging begins 3)Platelets activate and clump at the site of damage 4)Thromboplastin is released from the platelets and reacts with calcium ions 5)In the presence of thromboplastin and calcium, prothrombin converts to thrombin 6)Thrombin links with fibrinogen 7)Fibrinogen forms fibrin 8)Fibrin traps erythrocytes and platelets forming a blood clot 9)Blood clot seals the damaged vessels |
| The lymphatic system included: | Lymph vessels, Lymph fluid, lymph tissues, spleen and the thymus |
| What are the functions of the lymphatic system? | 1)Maintenance of fluid balance 2)Production of lymphocytes 3)Absorption and transportation of lipid from the intestine to the bloodstream |
| What are the lymph nodes? | Small, soft bean shaped structures that appear in groups found in the axilla, abdomen, thorax, cervical and inguinal regions. They serve to filter infectious/foreign materials |
| What are the tonsils? | Lymphatic tissue found in the mucous membrane of the pharynx. They contain lymphocytes and macrophages to protect the body and lungs from microorganisms. |
| What is the spleen? | A soft, roughly ovoid, highly vascularized organ located in the left upper quadrant of the abdomen |
| What are the 3 functions of the spleen? | 1)Serves as a blood reservoir storing 500ml or 1 pt of blood 2)stores lymphocytes, monocytes and plasma cells 3)The white blood cells in the lining of the hollow cavities within the spleen engulf and destroy foreign materials as well as damaged erythrocytes that pass through the spleen 4)It produces erythrocytes after birth(Can produce erythrocytes after birth only in cases of extreme hemolytic anemia |
| What is the thymus? | Located in the mediastinum(Upper thorax posterior to the sternum and between the lungs), the thymus functions in utero and for a few months after birth to help develop the immune system. |
| How does the thymus help to develop the immune system? | The thymus develops T lymphocytes which take part in the cell mediated immune response before they migrate to the lymph nodes and spleen. The thymus begins to atrophy at puberty and ceases to function in adulthood |
| What is Mean Corpuscular Volume? | The average size or volume of a single erythrocyte |
| What is a peripheral blood smear? | A test that allows examination of the size, shape and structure of individual blood cells and platelets |
| What is the most informative hematologic test? | Peripheral blood smear |
| What is a schilling test? | A test used to diagnose pernicious anemia, in which radioactive b12 is administered and monitored before and after parenteral injection of intrinsic factor. By evaluation of urinary excretion of vitamin b12 |
| What is gastric analysis? | A test which determines intrinsic factor output and pernicious anemia. It is commonly used in place of schilling test. In pernicious anemia gastric secretions are minimal and pH remains elevated even after histamine injection |
| What is bone marrow aspiration? | A test which helps to determine hematologic issues. Bone marrow is aspirated most commonly from the iliac crest. The tibia and sternum may also be used but less commonly |
| What is anemia? | A condition in which below normal amounts of erythrocytes are present in the blood, causing hemoglobin and hematocrit to read low. |
| What can cause anemia? | Excessive blood loss, prolonged menstrual periods, GI bleeding, conditions leading to decreased erythrocyte production, increased erythrocyte destruction and nutritional deficiencies |
| S/S of Anemia | Fatigue SOB on exertion, dizziness, general malaise, heart palpitation and lightheadedness |
| Blood loss of 1/3 a persons blood volume will result in what symptoms? | Hypotension, respiratory distress and acute mental status changes |
| In acute blood loss of 5g/dL what conditions may occur? | Shock, Severe hypotension, MI, Stroke, confusion and death |
| Common diagnostics used to diagnose anemia? | CBC, Serum Iron, total iron binding capacity, serum ferratin levels, serum folate, reticulocyte count, bone marrow study, peripheral blood smear and megaloblastic anemia profile |
| How is anemia treated? | Hemostasis is the primary goal. Transfusion, iron and b12 replacement may also be necessary |
| What are some adverse reactions to iron supplementation therapy? | Constipation, diarrhea, change in stool color |
| What is hypovolemic shock? | Secondary anemia which occurs when deficiencies in RBCs and other components are caused by abnormally low circulating blood volume. Blood loss of 1L or more will have severe consequences and will likely result in hypovolemic shock |
| What are the signs and symptoms of hypovolemic shock? | Anxiety or agitation, confusion, cool and clammy skin, decreased or no urine output, diaphoresis, general malaise, hypotension, low body temperature, skin pallor, weak and thready pulse, rapid respiration, tachycardia, unconciousness |
| Treatment for hypovolemic shock | Hemostasis is the primary objective, O2 therapy, fluid replacement(IV), Monitoring vitals q15 min, I&Os, A&O, keeping patient flat and warm and systolic pressure above 90 are important to treatment |
| What is pernicious anemia? | A disease that results from the body's inability to absorb vitamin b12 due to a lock of the stomach's inability to produce intrinsic factor. B12 is necessary in the production of erythrocytes |
| What are some possible causes of pernicious anemia | Gastric mucosal atrophy, partial or total gastrectomy and progressive megaloblastic macrocytic anemia |
| S/S Pernicious anemia | Smooth thick and red tongue, numbness or tingling in the extremities, confusion, memory loss, palpitations, nausea, flatulence, constipation or diarrhea, dysphagia, infection around the teeth and gums, personality changes, and paralysis |
| How is pernicious anemia treated? | B12 IM injections qd for 2 weeks then weekly until stabilized, then b12 injections monthly for life and folic acid and iron supplement replacement. |
| What are some nursing considerations for giving iron supplements?` | Take iron 2 hours before/after meals, may change stool color, constipation may occur, Take with Ascorbic Acid(Vitamin C) to improve iron absorption |
| What is aplastic anemia? | A rare disease in which the bone marrow does not produce enough erythrocytes for the body to function properly |
| What are some possible causes of aplastic anemia?(8) | 1)Autoimmune disorder 2)Inherited conditions 3)Certain medicines 4)Infections such as hepatitis, Epstein-Barr virus or HIV 5)Pregnancy 6)Radiation therapy and chemotherapy for cancer 7)Toxic Substances(Pesticides, arsenic and benzene) 8)Unknown causes |
| People with aplastic anemia are usually pancytopenic, what does this mean? | All three major blood elements(RBC,WBC, and platelets) from the red bone marrow are absent or reduced |
| S/S aplastic anemia | Fatigue, SOB, dizziness, headaches, coldness in extremities, skin pallor and chest pain |
| Diagnostics for aplastic anemia? | CBC, Reticulocyte count and bone marrow biopsy |
| Treatments for aplastic anemia? | Treatment is determined by the cause of the patients condition. The treatment of choice is bone marrow transplant. With some antineoplastic medications and radiation therapy bone marrow suppression is expected. Splenectomy may be performed if hypersplenism is present. Steroids and androgens may stimulate bone marrow and immunosuppressive therapy with anti-thymocyte globulin and cyclosporine may be used in cases where bone marrow transplant or SCT. |
| What is Idiopathic Thrombocytopenia Purpura? | A condition in which a persons immune system attacks and destroys platelets leading to anemia. It is treated by splenectomy |
| What is iron deficiency anemia? | A condition in which the erythrocytes contain less hemoglobin than normal. It is commonly caused by excessive iron loss, diet low in iron, bleeding from gastric or duodenal ulcers, esophageal varices, hiatal hernia, colonic diverticula and tumors or non-absorption of b12 |
| What is a common cause of iron deficiency anemia in women? | Blood loss related to menstruation or pregnancy |
| S/S Iron deficiency anemia | Pallor, Glossitis(Red, Smooth tongue), Fatigue, Weakness and SOB |
| What are some common signs indicative of GI bleeding? | Glossitis, Phagophagia, weakness, cold extremities, chest pain |
| What are some diagnostics for iron deficiency anemia? | Peripheral blood counts(Decreased Hct and Hgb) |
| What are some dietary sources of iron? | Dark green vegetables, dried fruits, eggs, iron fortified breads and cereal, legumes and nuts, muscle meats, organ meats, shellfish, whole-grain breads and cereals |
| What are some dietary sources of folic acid? | Asparagus, broccoli, fortified grains, fish, green leafy vegetables, legumes, meat, organ meat, whole-grain bread |
| What are some dietary sources of vitamin B12? | Eggs, Milk and Cheese, muscle meats, organ meats |
| What are some dietary sources of amino acids? | Eggs, fish, legumes, meat, milk products, nuts, poultry |
| What are some dietary sources for vitamin C? | Cantaloupe, citrus, leafy green vegetables, strawberries |