Blood & Lymph System Review
Below normal range of RBC, hemoglobin and hematocrit. Insufficient O2 delivered to tissues and cells
Failure of normal process of cell generation and development
Disseminated Intravascular Coagulation (DIC)
overstimulation of clotting and anticlotting process in response to disease or injury incl. septicemia, obstetric complication, malignancies, tissues trauma, transfusion reaction, burns, shock and snake bites.
increased in circulating erythrocytes
process of RBC production
disturbing of the clotting factor - absent of antihemophilic factor VIII- 80% of total incidence
Trait: having two different genes ( both HgS and hemoglobin A in RBC ) = pass on to their children
two identical genes inherits from each parent for a given hereditary characteristic
excess of leukocytes accumulates in the bone marrow + lymph nodes
low WBC count ( cause by suppression of bone marrow = fatal condition) <200 neutrophil - normal of 3000-7000
inflammation of one or more lymphatic vessels result from streptococcal or staphylococcal infection in an extremity
primary or secondary disorder. Accumulation of lymph in soft tissue and edema.
malignant neoplastic immunodeficiency disease of bone marrow.
Geri: c/o back pain. protein in urine = Hodgkin's disease
excessive bone marrow production.
all 3 major blood elements (RBC,WBC, and platelets) are reduced or absent
autoimmune disease in which antibodies in the parietal walls of the stomach prevent the production of the intrinsic factor.
large, abnormal, multinucleated cells in the lymph nodes found in Hodgkin's lymphoma.
abnormal hematological condition. Platelets <150000/mm
Hemoglobin (male) 14-18 g/dL (female) 12-16 g/dL
Hematocrit (male) 42-52% (female) 37-47%
3 functions of blood
Transport O2, nutrition and waste
Regulates acid base balance (pH)
protects the body against infection
WBC examination in which different kinds of WBC are counted + recorded
Differential white blood cell count
A, B, AB, O
AB - Universal Reciepient
O - Universal Donor
Rules: 1) Give to same letter 2) + to + / - to everyone 3) O follow rule 1, not rule 2
Erythrocyte = 0
renal erythropoietin factor (kidney) initiates development of mature RBC = increase O2 delivered to tissues = shuts off the signal to increase RBC production.
Less hemoglobin = less O2 transport to cells = slower breakdown / use of nutrients = less energy produced by cells = decrease cellular function = malaise.
LUQ of abdominal. Fucntions: reservoir for blood./ form lymphocytes+monocytes +plasma cells/ destroy worn out RBC/remove bacteria by phgocytosis/ produce RBC before birth. Stores 1 Pint of blood
Schilling test / Megaloblastic Anemia Profile
measure absorption of radioactive vitamin B12 before and after parenteral injection of the intrinsic factor by examination of urine excretion of vitamin B12
Site for bone marrow aspiration
posterior iliac crest
Adverse reaction first 15 minute of bone marrow transplant for aplastic anemia patient
marrow rejection, infections, graft-versus-host disease.
Meds: cyclosporine(immunosuppresant). chemotherapy
Signs/Symptoms of aplastic anemia
Suppression of WBC = infection. Suppression of RBC = anemia. Suppression of thrombocytes = petechiae.
High fever, fatigure, weakness, malaise, dyspnea, palpitation.
Z track injection for iron rationale
prevent skin staining
Sickle cell anemia factors
81% lack Americans has sickle cell trait. 1/600 in US has sickle cell anemia
Sickle cell crisis trigger by
infections = pneumonia, meningitis, influenza and hepatitis
increase in circulating erythrocytes
Secondary cause: hypoxia stimulates erythropoietin in kidneys = increase erythrocyte production.
NI for WBC of 1500
immunocompromised = reverse isolation precaution
Petechiae + echymoses
Signs of low platelet counts in thropmbocytopenia
NI for low WBC for Leukemia patient
prevention of infection
bleeding into a joint space. Small cut = fatal
Test for DIC
D-dimer = elevated (breakdown of fibrin and is a specific marker for the degree of fibrinolysis in the serum
Staging system for Hodgkin's disease
Stage 1: abnormal single lymph nodes
Stage 2: 2 or more abnormal lymph nodes on same side of diaphram.Localized involvement of extranodal site +one or more lymph node regions on same side of diaphram.
Stage 3: Abnomal lymph node regions on both sides of diaphram. Spleen involvment. Subdivided into lymphatic involvement of upper abdomen in the spleen and lower abdominal nodes in the periaccritic, mesenteric, and iliac regions.
Stage 4: Diffuse and disseminated involvement of 1 or more extralymphatic tissues + orgains. H(Hepatic) L(lung) P(pleural) M(marrow) D(derma) O(osseous)
Test for Non-Hosgkin's Lymphoma
Coombs' test (antiglobulin)
Signs and symptoms of what is expected or not in iron therapy
Expected: black, tarry stool
Report to physician: diarrhea or nausea
desire to eat ice, clay or starches
Factors of Iron deficiency Anemia
Excessive iron loss due CHRONIC INTESTINAL OR UTERINE BLEEDING, also from gastric or duodenal ulcers, esophageal varices, hiatal hernias, colonic diverticular and tumors
NI to increase absorption of iron
NI for patient in respiratory arrest
High fowler or Orthopnic
Antidote for heparin
Cinamet, cytotoxin, PLAVIX or Tylenol,abciximab, anagrelide, cilostazol, clopidogrel, dipyridamole, eptifibatide, tirofiban
Teaching for Coumdin
Avoid alcohol, aspirin,soft toothbrush, electric razor, limit food with vitamin K (milk, green bean, broccoli, asparagus )
Teaching for Ecotrin
Contain aspirin. Do not use for headache
Iron deffiency enemia alternative diet sources
apricots, dates, figs, prunes, raisins, dark green veggies, organ meat (liver, heart, tongue), eggs, shell fish, whole grain bread/cereals
Signs/Symptoms of Hodgkin's disease on assessment
Fever, chills, night sweats
Not use for anemia
iron, epogen, folic acid, BETAPASE, B
Teaching for patient with leukemia
Electric razor - risk of bleeding
Normal platelet count
Female of child bearing age on anticoagulants
Use reliable contraceptive
Blood test for Warfarin
Prothrombin Time (PT)
anisindione, warfarin, heparin, low molecular weight heparins ( dalteparin, enoxaparin, tinzaparin,) disirudin, fondaparinux
Teaching for mono patient
Not to smoke, share drinks/food, kiss/exchange spits
urokinase, reteplase, alteplase, treptokinase, tenecteplase
Fat solutble vitamins
Pre-administration of warfarin
Check PT / INR
phytonadione (vitamin K) for warfarin
protamine for heparin
NI for patient with following lab values: pH 7.55 HCO3 22 mm Hg, Pco2 30 mm Hg.
Respiratory alkalosis. Encourage client to slow down breathing
Blood gas results pH 7.55, Pco2 30 mm Hg indicates
Allen test to confirm the adequacy of
Monitoring client with NG tube attached to low suction for which acid base disorder ?
Loss of hydrochloric acid = metabolic alkalosis
Patient with severe diarrhea is monitor which acid base disorder?
Loss of biocarbonate = metabolic acidosis
Client with diabetic ketoacidosis experiencing Kussmaul's respirations
abnormal deep, regular and increased in rate
Patient diagnosed with COPD most like will have which acid base disorder?
chronic or acute respiratory acidosis cause COPD
ABG results for respiratory acidosis condition
pH 7.25 ( normal 7.35-7.45) Pco2 50 mm Hg (normal 35-45)
Client with respiratory alkalosis with pH of 7.5 Pco2 30 mm Hg. What additional lab values is expected
potassium 3.2 mEq/L
Rules of acid base disorder
Resp. acidosis: pH decrease Paco2 increase HCO3 increase K increase
Resp. alkalosis: pH increase Paco2 decrease HCO3 decrease K decrease
Metabolic acidosis: pH decrease Paco2 normal/decrease HCO3 decrease K increase
Metabolic alkalosis: pH increase Paco2 normal/increase HCO3 increase K decrease
Severe infection in peripheral blood smear
shift to the left
Teaching for anifsindione
use electric razor, soft toothbrush to minimize risk of bleeding
Therepeudic effect of warfarin sodium
prevent thromboembolic event
oral contraceptives, barbituates, diuretics, vitamin K interaction to warfarin
Pre-administration assessment for anticoagulant
active bleeding, hemorraghic disease, severe renal/hepatic disease
Diet for anemia patient
Iron( organ meats, eggs, shellfish) folic acid (asparagus, fish)vitamin B12 (milk, cheese), amino acids (poultry,meat), vitamin C(leafy green, strawberries)
Question to ask on assessment for Hodgskin disease
Present of HIV, taking immunosuppresssive drugs.