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Terms in this set (52)
The spleen and RBCs
Balances blood cell production with blood cell destruction. It also recycles iron and sends it to the liver.
Assists with immunity (major site of antibody production)
The liver and RBCs/other functions
Produces prothrombin and most of the blood clotting factors
Stores large quantities of whole blood and blood cells
Converts bilirubin to bile
Stores extra iron in the form of ferritin
Vitamin K formation
Hemostasis- vessel wall torn constriction (lasts a minute) platelet adhesion to damage tissue loose plug from platelet aggregation tissue factor released in trauma starts the clotting cascade fibrin meshwork is formed (coagulation) and maintains platelets RBC/WBC become trapped in fibrin
Coagulation inhibitors keep the clot from becoming too large by interfering with the clotting factors. Fibrinolysis keeps the clot from growing too large. Plasminogen activators released by vessel wall dissovle the fibrin strands. They remove the clot once the tissue heals.
_____ may decrease with age. (CBC)
do not break down clots. Just keep platelets from sticking together and making it bigger
break down fibrin of clots (bleeding is a risk- a pt that has had the stroke for a while may not receive b/c the tissue is already necrotic, not worth the risk)
prevent platelets from becoming active and coming together
typically 2% of RBC. If it is higher then hypoxia has occured and kidneys and bone marrow have stimulated production of RBC. If they havent experienced hypoxia they are producing too much RBC.
Normal range of PT
PT 11-13 sec
coumadin goal is 1.5-2.5X normal (CHECK)
coumadin goal is 2-3X normal
heparin goal is 1.5-2x normal
heparin goal is 1.5-2xnormal
Reduction in either the number of red blood cells, the amount of hemoglobin, or the hematocrit
Clinical sign (not a specific disease); a manifestation of several abnormal conditions
Sickle Cell Disease-RBC
RBCs last 120 days normally. With sickle cell disease they last 12-15 days.
If sickle cells become hypoxic they become more sickle shaped. If they get o2 they go back, but they do not last as long. These cells will clump together and get stuck in joints. Pain is a major issue.
Treat pain with O2- trigger of problems. Then hydrate the patients to break up the clumps of RBCs
Plasma is ___% of blood, while blood cells make up ___% of blood.
detects different types of hemoglobin (B or C-scicle cell)
Leukocyte alkaline phosphatase
a protein in Leukocytes.
Lower= certain anemias/leukemias
abs stuck to RBC (marking them for distraction
Can indicate: hemolytic anemias, SLE, tranfusion reactions
Genetic disorder resulting in chronic anemia, pain, disability, organ damage, increased risk for infection, and early death
The main problem of this disorder is formation of abnormal hemoglobin chains
Clinical Manifestations of Sickle Cell Disease
CV: RBC, pulses, capillary refill (clumps decrease profusion)
Abdominal changes: (spleen and liver)
Renal and urinary: priapism is a risk during crisis
CNS changes: rotator drift
What would the following labs show in a person with sickle cell disease?
Hemoglobin S (HbS)
Hemoglobin S (HbS): can be up to 80-100% [indicates number of permanently sickled cells]
Hematocrit: lower b/c life span is decreased
Reticulocyte Count: measures immature RBCs (will be elevated because of hypoxia)
Total WBC: increased
K levels: high b/c it is an intracellular electrolyte
Sickle Cell Disease interventions
Main problem is pain.
They may get IV analgesics.
Oral hydration is important.
Preventing a crisis: BOOK
G6PD Deficiency Anemia
Glucose-6-Phosphate-Dehydrogenase Deficiency Anemia
-most common type of inherited anemia
-Effect of exposure to some drugs, benzene and other toxins
-Screening for this deficiency necessary before donating blood, because cells deficient in G6PD can be hazardous
Iron Deficiency Anemia
This common type of anemia can result from blood loss, poor intestinal absorption, heavy menstruation or inadequate diet.
If mild—symptoms of weakness and pallor.
Evaluate adult patients for abnormal bleeding, especially from the GI tract.
Treatment—increasing oral intake of iron from food sources, oral iron supplements, or IM iron solutions.
If you give an iron IM you must use the Z-track meathod. (Staining and loss of med)
Vitamin B12 Deficiency Anemia
Lack of vitamin B12 causes improper DNA synthesis of RBCs.
Poor intake of foods containing vitamin B12, small bowel resection, tapeworm, overgrowth of intestinal bacteria.
Microcytic and Macrocytic anemia
Microcytic= iron deficiency
Anemia resulting from failure to absorb vitamin B12
Caused by a deficiency of intrinsic factor
Abnormal sensations in hands and feet, memory problems, and abnormal balance. Glossitis (beefy-red, smooth tongue) is common.
Folic Acid Deficiency Anemia
Manifestations similar to those of vitamin B12 deficiency, but nervous system functions remain normal
Common causes—poor nutrition, malabsorption, and drugs
Deficiency of circulating RBCs because of failure of the bone marrow to produce these cells
Injury to the pluripotent stem cell
Pancytopenia common (RBC/WBC/Platelets are not being made)
Treatment: Blood transfusions, Immunosuppressive therapy, Splenectomy
"cancer of the RBCs"
Disease with a sustained increase in blood hemoglobin or hematocrit
Massive production of red blood cells
Excessive leukocyte production
Excessive production of platelets
Treatment: Phlebotomy, Hydration, and Anticoagulants
Group of disorders caused by the formation of abnormal cells in the bone marrow
Blood and platelet transfusions
Chelation therapy: removes excess iron
Drugs for iron overload—deferasirox and deferoxamine mesylate
Leukemia What, classification, precautions
Type of cancer with uncontrolled production of immature white blood cells in the bone marrow
Acute or chronic
Classified by cell type: CBC diff
These patients will be under reverse isolation
Leukemia: clinical manifestations
Respiratory changes: certain breathing, decreased RBC
Central nervous system changes
Miscellaneous changes: lumps in lymph nodes
Leukemia: Laboratory Assessment
Decreased hemoglobin and hematocrit levels- put on o2
Low platelet count
Abnormal white blood cell count; may be low, normal, or elevated but is usually quite high
Bone marrow aspiration and biopsy
Risk for infection
Infection is a major cause of death in the patient with leukemia, and sepsis is a common complication.
Autocontamination: normal flora overgrows into an opportunistic infection
Cross-contamination: from another person
Drug therapy: chemo in 3 different phases>>look up, prophylactic ab/antifungals/virals
Hematopoietic stem cell transplantation
Allogenic vs. Autologous marrow transplants
Autologous: self- has to survive extracting, washing, freezing, and reinfusion
Cancer that starts in a single lymph node or a single chain of nodes
Large, painless lymph node, usually in the neck, becomes painful when alcohol ingested; fever, drenching night sweats, and unexplained weight loss
Stage 1a: disease is present only in a single lymph node region/site.
State 1b: 1a + fever, night sweats, weight loss of 10%+
Stage 2a: disease present in two or more separate lymph nodes/regions on same side of diaphragm.
Stage 2b: 2a + fever, night sweats, weight loss of 10%+
Stage 3a: Disease spreads to lymph nodes on both sides of diaphragm
Stage 3b: 3a + fever, night sweats, weight loss of 10%+
Stage 3c: 3b + disease in spleen
Stage 4: Disease present in many body areas. Includes more non-nodal tissues and organs.
Hodgkin's Lymphoma: Interventions
One of the most treatable types of cancer
Combination radiation and chemotherapy
All lymphoid cancers that do not have the Reed-Sternberg cell
More than 12 types of non-Hodgkin's lymphoma
Non-Hodgkin's Lymphoma: Collaborative Care
Localized radiation therapy
Hematopoietic stem cell transplantation
White blood cell cancer that involves a more mature lymphocyte called a plasma cell
Autologous stem cell transplant
Alternative approaches for pain management
Autoimmune Thrombocytopenic Purpura
Also called idiopathic thrombocytopenic purpura (ITP).
Total number of circulating platelets is greatly reduced even though production in the bone marrow is normal.
Patients make an antibody directed against the surface of their own platelets.
Drug therapy—corticosteroids, azathioprine, IV immunoglobulin, IV anti-Rho, or low doses of chemotherapy
Maintaining a safe environment
Thrombotic Thrombocytopenic Purpura (TTP)
Rare disorder; platelets clump together abnormally in the capillaries, and too few platelets remain in circulation
Inappropriate clotting yet blood fails to clot properly when trauma occurs
Treatment—plasmapheresis, fresh frozen plasma, aspirin, alprostadil, plicamycin, and immunosuppressive therapy
Hemophilia A (classic hemophilia) is deficiency of factor VIII and accounts for 80% of cases.
Hemophilia B (Christmas disease) is deficiency of factor IX and accounts for 20% of cases
Hemophilia: Collaborative Care
Monitor for excessive bleeding from minor cuts, bruises, or abrasions.
Joint and muscle hemorrhages can lead to disabling long-term problems.
Tendency to bruise easily.
Prolonged and potentially fatal hemorrhage after surgery.
Transfusion Therapy- preventing transfusion reactions
Pretransfusion responsibilities to prevent adverse transfusion reactions:
Test donor's and recipient's blood for compatibility.
Examine blood bag for identification.
Check expiration date.
Inspect blood for discoloration, gas bubbles, or cloudiness.
Need an order to transfuse (not type and cross
Provide patient education.
Assess vital signs.
Begin transfusion slowly, and stay with patient first 15 to 30 minutes.
Ask patient to report unusual sensations such as chills, shortness of breath, hives, or itching.
Administer blood product per protocol.
Assess for hyperkalemia.
Types of Transfusions
Red blood cell
Plasma—fresh frozen plasma
Cryoprecipitate: may not match
Granulocyte (white cell)
Autologous Blood Transfusion
Collection and infusion of patient's own blood
Eliminates compatibility problems; reduces risk for transmission of bloodborne disease
Acute normovolemic hemodilution: blood is drained during surgery and replaced with crys/coll therapy. Then replaced after surgery
Intraoperative autologous transfusion: salvaging during surgery
Postoperative blood salvage: collects blood from cavity as wound heals
Which of these two does not change based off of fluid status? Hct or Hgb
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