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Ch. 33
Hematology
| Question | Answer |
|---|---|
| What is included in the hematological system | blood, bone marrow, Reticuloendothelial system (spleen, lymph system) |
| What are three fx of blood | Transportation- O2, nutrients, hormones, wastes Regulation- F&E balance, acid/base bal, body temp Protection- combats pathogens, hemostasis of blood coagulation |
| What are three primary cell types of blood | erythrocytes, leukocytes, thrombocytes |
| what is hematopoiesis | formation of blood cells, done in the bone marrow. Makes up 5-6L of volume in body |
| What is plasma % and what makes it up | 55% of blood volume, consists of albumin, blobulin, fibrinogen, adn other clotting factors plus serum (no clotting factors) |
| Where is blood cell formation done in the body of adults? Where is it typically aspirated from | pelvis, ribs, vertebrae, sternum iliac crest, sternum for study or transplant, consent form |
| What are stem cells | In bone marrow and undifferentiated that can produce RBC, WBC, platelets. |
| What do RBCs do | bi-concave(lg surface area helps in )2 absorption/release) with hemoglobin contains iron. No nuclei in mature RBCs. |
| what are reticulocytes | immature RBCs that get released with some disease states or extreme demand for RBCs. Have nucleus. |
| How do RBCs transport oxygen | the hemoglobin contains iron, heme, which binds to O2 and is carried to lungs as oxyhemoglobin. |
| what is erythropoiesis | process of formation of RBCs. Requires iron, B12(need intrinsic factor in stomach), folic acid, B6, protein, takes 5 days. If spleen takes over, reticulocytes(immature RBC) released, |
| what is erythropoietin | hormone made by kidney to help myeloid cell into erythroblast |
| what is erythrocyte sedimentation rate | measures the rate of settling RBCs, high is inflammation called the "sed rate" |
| what is life span of RBC | 105-120 days(4mos) |
| Stem cells differentiate into two types | myeloid- RBC, WBC, platelets lymphoid- T or B lymphocytes |
| What are megoblasts | abnormally lg RBCs produced when not enough B12 or folic acid and results in megaloblastic anemia, becuase get stuck and block other RBCs |
| What are two categories of WBCs | granulocytes lymphocytes |
| what is normal count of WBC | 4,000-11,000 |
| What are the three granulocytes | eosinophils-prasitic inf 2-4% basophils- allergic, histamine <2% neutrophils-kill bacteria 50-70% band cell(immature neutrophil and lead to "left shift" and release of many in response to infection |
| What are the two types of agranulocytes | monocytes- 4-8%, on site, non circulating, lgst WBC, macrophages (in spleen,liver,peritoneum, alveoli) lymphocytes- B-cells(marrow),T-cells(thymus) |
| What are three different macrophages | residents to protect body Kupffer cells - liver Osteoclasts- go to bone Alveolar macrophages - sit in lung |
| Fx of macrophages | defend, remove old/damaged cells, stimulate inflammatory process, present antigen to immune system |
| what is cellular immunity | T cells kill foreign cells directly |
| what is humoral immunity | plasma cells produce antibodies called immunoglobulins that destroy |
| How is platelet production regulated | by thrombopoietin which stimulates produciton of megakaryocytes from myeloid stem cells. Lifespan of 7-10 days |
| what is fx of spleen | hematopoietic- fetal and adult PRN filtration- RBCs, iron, hgb immunologic- b,t-cell, IgM storage - RBC, platelets |
| what is fx of lymph sustem | return protein/fat from GI to blood, 60% interstitial fluid to blood |
| what is a lymp system adjunct organ | liver - filters, produces pro-coagulants, stores excess iron, excretes bilirubin to common duct |
| what is hemostasis and what are two responses | preventing blood loss: primary-vascular, platelets form plug secondary- intrinsic/extrinsic pathway clotting with fibrin |
| Once fibrin clot is formed and injured vessel is repaired what happens? | fibrinolytic(lyse fibrin clot) system, plasminogen(protein to dissolve clots) to lyse fibrin(basis of blood clot). |
| What does hematocrit measure | % of blood volume consisting of RBCs |
| What are hematemesis, melena, polycythemia, hemarthrosis, petechiae/pupur | hematemesis: bloody vomit melena: blood in stool polycythemia:overproduction RBCs Hemarthrosis: blood in joints petechiae/purpura: red/purple hemorrhages |
| what is normal count for platelets? | 150,000-400,000 Thrombocytopenia: <100,000 Thrombocytosis: excessive platelets |
| What is normal prothrombin time? INR? | Prothrombin: 11-12.5sec INR: 0.8-1.1 or <2.0 (want 2-3 for those on anticoagulation) |
| what is activated partial thromboplastin time (aPTT) | 30-45sec |
| What is D-dimer | fragment fibrin indicating clotting activity |
| What is anemia | Condition that is deficiency of # of RBCs, hemoglobin, or hematocrit. Most common hemotologic condition in elderly |
| Anemia is defect is these three things | loss of RBCs, decr production of RBCs, incr destruction of RBCs, blood loss, deficient iron, B12, folate, hemolytic |
| What look for in CBC for anemia | Hgb, Hct, reticulocyte county, MCV, RDW |
| what do you give for active hemorrhage? For anemia? | whole blood b/c of volume adn clotting factors pRBCs |
| what are morphology of RBCs in anemia | normocytic, normochronmic: normal size, color macrocytic, normochromic: lg size, normal color microcytic, hypochromic: sm size, pale color macrocytic, hypochromic: lg size, pale color |
| s/s of anemia | sudden = more devastating weakness, fatique, malaise, pallor, tachy, dizzy, dyspnea, exertional dyspnea |
| tx for s/s | conserve energy....drink meals. Iron rich foods: organ meats, beans, green leafy vegs, molasses, raisins |
| What is sever anemia hct | <6 |
| what are complications of severe anemia | heart failure, angina, paresthesias, delirium(no O2 to brain). Inf,inflammatory conditions can cause low iron |
| what are some findings wtih anemia | brittle hair/nails, not jaundice, smooth, pale, sore tongue, burning stomatitis |
| Where si iron normally absorbed | duodenum/upper jejunum, only 5-10% is absorbed, 1/3 is stored/recycled, .5-1mg absorbed from sm int. |
| what are nsg interventions | teach dietary sources and Vit C helps absorption, monitor bleeding, give rest, O2 therapy, give liquid iron, but use straw to get over teeth |
| What are patterns of anemia of ESRD(end stage renal disease) | Creatinine >3/100ml, hemodialysis removes folic acid and breaks RBCs, no kidney erythropoietin |
| The tongue looks different wtih iron dificiency anemia and megaloblastic anemia | iron: smooth/red megaloblastic: beefy red/sore |
| what is aplastic anemia | decr bone marrow, lead to panyctopenia, 75% fatal |
| what is the cause of aplastic anemia | congenital, chemical toxins, meds, radiation |
| Tx for pancytopenia | transfusions, immunosuppressive therapy, bone marrow transplant, stem cell transplant |
| nsg mgmt for aplastic anemia | assess for bleeding or inf, reverse isolation, immunosuppressive reactions, manage meds |
| S/S for aplatic anemia | hemorrhage (GI), lg spleen, pupura in extremeties, |
| What is megaloblastic anemias | missing folic acid and B12 and iron, lg shape |
| s/s of folic acid deficiency differs from B12 deficiency | no neurologic s/s vs neurologic s/s |
| what is pernicious anemia | can't absorb B12 b/c lack intrinsic factor in GI, red beefy tongue, painful |
| What test is used to test for Pernicious anemia | Schillings Test(oral radiation to track B12 if absorbed- if radiation in urine, then B12 absorbed |
| what are some hemolytic anemias | break down of heme to bilirubin, decr life of RBCs, Sickle Cell, Thalassemia |
| who is affect most with sickle cell anemia | black children, low O2 bc sickle shape blocks vessels. Very painful, hemoarthrosis(blood in joints) |
| How long do sickle RBCs live | 20 days vs normal 120, jaundice in scelera |
| what are three sickle cell crises | painful sickle crisis: hypoxia/necrosis aplastic crisis: infection with human parvovirus Sequestration crisis: organs pool the sickled cells (spleen/liver/lungs) |
| What are some complications of sickle cell | Hand Foot syndrome: swelling bn 6mos adn 2yr Jaundice: can lead to gallstones Leg Ulcers, stroke, retinal damage, kidney failure, splenectomy, pneumonia, pulmonary HTN(most cause of deathm screen wtih Doplar) |
| What are nsg tx for sickle cell | conserve energy, O2, fluids, transfusion leads to chelation, Prbcs, hydroxurea(chemo) |
| What is Thalassemia | Low hgb so low O2 |
| what is polycythemia Vera and what are two types | excess RBCs, primary, secondary |
| what is primary polycythemia | Male 65yr, incr Hct/WBC/blood vol, fluids, ruddy complexion, lg spleen/liver, pruritus, thrombosis Tx: movement, blood letting |
| What is neutropenia | lack of neutrophils so decr produciton, incr destruction, risk for infection |
| What are nsg interventions for pt with infections | avoid fresh flowers, plants, litter boxes, bird cages, fresh salads, unpeeled fruit/veg, crowds |
| What is most common childhood disease that causes death | Leukemia,neoplastic proliferation of WBCs, acute/chronic, lymphoid, myeloid |
| what are 4 types of leukemia and which affects children and adults more | ALL(acute lymphocytic)- child(boys) AML(acute myeloid) all ages, peak 60, induction therapy(aggressive chemo) CML(chronic myeloid) CLL(chronic lymphocytic) adult50-60, most common, gleevec tx Complictions: tumor lysis syndrome |
| Lymphoid affects what cells myeloid affects what cells | T&B cells monocytes, granulocytes, erythrocytes, platelets |
| What are lymphomas and what are two clssifications | cancer of lymphoid cells, start in nodes Hodgkins - nodular, 20s/50s, painless, pruritus after alcohol, Ree-Sternberg cells Non-Hodgkins - diffuse, all ages, B/T cell origin |
| What is multiple myeloma | malignancy of plasma cells(B lymphocytes) in bone marrow, Men after 40, bone destruction, so bone pain. **back pain and elevated protein |
| nsg interventions for Myeloma | ambulation, bone pain, prevent fractures, fluids for hyperca |
| Bleeding disorders | Thrombocytopenia, Idiopathic Thrombocytopenia Purpura, DIC, Hemophilia, Von Willebrand's Disease |
| What is normal platelet count and counts for various bleeding | normal: 150,000-400,000 no bleeding: 50,000 petechiae, nose/gingival: 20,000 GI/CNS bleed: 5,000 |
| What are signs of ITP, idiopathic thrombocytopenia purpura | bruising, petechiae, heavy menses, children/women, <20,000 count TX: IVIG, immunosuppressive meds, splenectomy, HLS transfusions |
| What is hemophelia what is Von Willebrand's disease | inherited, X-linked, loss of factor VII or IX taxi for VII factor |
| What is first tx for DIC | treat underlying cause, then heparin, then platelets/pRBCs |
| How are transfusions given | IV |
| What is left shift | incr of immature neutrophils, band cells from the bone marrow. |
| what is myelopoiesis | mature neutrophils formed from myeloid blast cells, depends on cytokines |
| where is albumin produced | liver, helps with fluid balance |
| What three factors can help tell if anemia is from destruction or inadequate production | 1. marrows ability to decr RBC AEB incr reticulocyte count 2. amt of immature RBC in marrow 3. end products presence/absence, bilirubin level |
Created by:
palmerag
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