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Consistency of blood
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45% blood cells and 55% blood plasma
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Consistency of blood
45% blood cells and 55% blood plasma
ph
7.35-7.45
volume in blood
10-12 pints
erythrocytes
lives for 120 days; transports o2 and carbon dioxide; continually produced in the red bone marrow; norm is 4.2-6.1 million/mm3
erythropoiesis
the process of RBC production
hematocrit
norm is 37-52%
hemoglobin
norm is 12-18%
leukocytes
primarily involved in body defenses such as destruction of bacteria and viruses
differentiated WBC
exam in which the different kinds of WBCs are counted and reported as percentages of the total examined
granulocytes
neutrophils, eosinophils, basophils
nongranulocytes
monocytes and lymphocytes
neutrophils
phagocytosis; 7 hour life span; 1st one to scene of injury; normal value 60-70%
eosinophils
play a role in allergic reactions and are effective against certain parasitic worms; normal 1-4%
basophils
releases histamine during tissue damage or invasion; if stimulated by an antigen or tissue injury, it will respond by releasing substances within the granules; normal value 0.5-1%
monocytes
engulf foreign antigens and cell debris. 2nd WBC to arrive at the scene of an injury; 2-6%
lymphocytes
responsible for antibody formation, a special protein that combats foreign invaders or antigens; B and T cells; norm is 20-40%
thrombocytes
platelets, smallest cells in the blood; life span of 5-9 days and number 150,000 to 400,000 per mm3 of blood; function in the process of hemostasis; assist in clotting formation, which seals off a break in the continuity of the walls of the blood vessels
hemostasis
body process that arrests the flow of blood and prevents hemorrhage. Three actions: 1. Vessel spasm. 2. platelet plug formation and 3. clot formation
clot formation process
injury, hemorrhage, grouping platelets, thromboplastin released, converts prothrombin to thrombin, links with fibrinogen, formation of fibrin, traps RBCs and platelets, forms clots
universal recipient
type AB (receive any type)
universal donor
type O (give to anyone)
function of lymphatic system
1. Maintenance of fluid balance. 2. Production of lymphocytes and 3. absorption and transportation of lipids from the intestine to the blood stream
lymph nodes functions
1. filter impurities from the lymph 2. produce lymphocytes. Body contains 500-600 lymph nodes; structure of the lymph nodes makes it possible for them to perform two functions defense and WBC production
tonsils
masses of lymphoid tissue embedded in mm of the oral cavity and pharynx and they protect the body against invasion of foreign substances by producing lymphocytes and antibodies. They also trap bacteria and may become enlarged.
spleen
soft, roughly ovoid, highly vascularized organ located in the upper left quadrant of the badominal cavity just below the diaphragm. Its 5-6 inches long and 2-3 inches wide. It contains lymphatic nodules. This stores 1 pint of blood which can be released during emergencies, such as hemorrhage in less than 60 seconds; main function is to 1. serve as a reservoir for blood. 2. to form lymphocytes, monocytes and plasma cells. 3. to destroy worn-out RBCs. 4. To remove bacteria by phagocytosis and 5. To produce RBCs before birth
thymus
functions in utero and a few months after birth to develop the immune system. Responsible for the development of the T lymphocytes of the cell-mediated immune response before they migrate to the lymph nodes and the spleen. At puberty, this atrophies and is eventually replaced with fat and connective tissue
CBC
test that assess three mahor ells formed in the bone marrow that can detect many disorders; includes red and white cell count; hematocrit, hgb, erythrocyte indices, DIFF, and exam of peripheral blood cells.
erythrocyte indices
measurements of the size and hgb content of red blood cells. Provides info about the average volume or size of a single RB
Peripheral smear
often accompanies the DIFF and permits exam of the size, shape and structure of the ind RBCs and platelets; good for different anemias
Schilling test or megoblastic anemia profile
lab blood test for diagnosing pernicious anemia; measures the absorption of radioactive vitamin B12 before and after parenteral injection of the intrinsic factor by exam of the urinary excretion of VB12.
lymphangiography
radiologic exam used to detect metastatic involvement of the lymph nodes. Contrast medium is injected into a lymphatic vessel of the foot or hand, followed by radiological visualization of the lymphatic system, being replaced by CT scan.
anemia
disorder char by RB and hgb and hct levels below normal range; also exhibit increased RBC destruction. Causes delivery of ins amounts of O2 to tissues and cells; factors influencing anemia are blood loss; impaired production of RBCs. increased destruction of RBCs and nutritional deficiencies
clinical manifestations
fatigue, headache, insomnia, pallor, palpitation, vertigo, Hgb levels at or less than 8 g/dL
Nursing diagnosis for anemia
ineffective tissue perfusion r/t reduction of cellular components necessary for delivery of O2 to the cells; impaired gas exchange, r/t RBC, hgb, and hct deficit
hypovolemic anemia
RBC and other component deficiencies caused by an abnormally low circulating blood volume from hemorrhage is classified as secondary anemia. Blood loss of 1000 mL or more in an adult can be severe. Such a loss is usually related to internal or external hemorrhage caused by a surgical procedure, GI bleeding, menorrhagia, trauma or severe burns
clinical manifestations of hypovolemic anemia
weakness, stupor, pale, cool moist skin, hypotension, tachycardia, hypothermia, hgb less than 10 g/100 mL, hct less than 40%
medical management of hypovolemic anemia
control bleeding, treat shock, elevate lower extremities, give O2, replace fluid either by blood transfusions, plasma, dextran, lactated Ringers and Haspan, monitor vs
nursing interventions for hypovolemic anemia
monitor blood and fluid restoration, identify blood loss sites, keep flat and warm, frequent VS, prevent injury, I&O-> oliguria; teach monitor bleeding amount, occasion and associated factors-report to MD immediately
pernicious anemia
absence of intrinsic factor, deficiency in vitamin B12
clinical manifestations of pernicious anemia
extreme weakness, dyspnea, fever, hypoxia, weight loss, jaundice, pallor, GI complaints, dysphagia, sore, burning tongue. Neurological symptoms: tingling of the hands and feet, disorientation, impaired proprioception, personality changes; behavior problems; partial or total paralysis
medical management of pernicious anemia
vitamin B12 1000 units IM daily for two weeks, weekly for one month, monthly for life, folic acid supplement, iron replacement, RBC transfusion, diet: high in protein, vitamins and minerals
nursing diagnosis for pernicious anemia
risk for injury r/t sensory and motor losses, alteration in mental status; imbalanced nutrition: less than body requirement r/t sore mouth and tongue, diarrhea/constipation
aplastic anemia
decrease of bone marrow function; primary-congenital; secondary is viral invastion, medications, chemicals, radiation; chemotherapy
clinical manifestations of aplastic anemia
pancytopenic: RBC, WBC and platelets reduced or absent; repeated infections with high fevers; fatigue, weakness, malaise, dyspnea, palpitations, bleeding tendencies: gums, epistaxis, GI, GU; mortality high from complications of infection and hemorrhage. Diagnosed by bone marrow biopsy - increased yellow marrow (fat content), decreased hematopoietic activity
medical management of aplastic anemia
identify and remove cause; platelet transfusion, splenectomy, steroids and androgens, antithymocyte globulin; bone marrow transplant
nursing diagnosis for aplastic anemia
activity intolerance r/t inadequate tissue oxygenation and risk for infection r/t increased susceptibility
iron deficiency anemia
RBCs contain decreased level of hgb; excessive iron loss caused by chronic bleeding
clinical manifestations of iron deficiency anemia
pallor, fatigue, weakness, sob, angina s/s of heart failure; glossitis; burning tongue; pagophagia desire to eat ice, clays or starches; headache; paresthesia
iron deficiency anemia diagnosis
CBC shows RBC, Hbg and Hct levels decreased; serum iron levels low
medical management of iron deficiency anemia
ferrous sulfate 900 mg daily; ascorbic acid shown to enhance iron absorption; diet high in iron - organ meats, eggs, dark poultry meat, dark green vegetables
nursing interventions for iron deficiency anemia
medication treatment, plan rest periods, educate nutritional needs; teach side effects of iron: green, black tarry stools; report diarrhea or nausea to physician
sickle cell anemia
an abnormal, crescent-shaped RBC; severe, chronic, incurable condition, disease - homozygous haing two identical genes inherited from each parent. trait - heterozygous - having two different genes
clinical manifestations of sickle cell anemia
precipitating factors are dehydration, change in O2 tension in the body; stress; loss of appetite, irritability, weakness, abdominal enlargement, joint and back pain, edema of extremities
sickle cell anemia complications
multisystem failure, infarctions, hemorrhage, and retinal damage leading to blindness
sickle cell anemia diagnosis
eletrophoresis of Hgb is specific for detecting sickle cell crisis or anemia; Hgb and Hct levels below normal
medical management of sickle cell anemia
no specific treatment; alleviate symptoms; supportive care, O2, rest, fluids, analgesics, dietary supplements (folic acid), bone marrow transplant, genetic counseling
sickle cell anemia nursing diagnosis
pain r/t thrombotic crisis
polycythemia
myeloproliferative disorder; increased in circulating erythrocytes, granulocytes, and platelets; erythrocytosis, elevated WBC with basophils secondary hypoxia; hypoxia stimulates erythropoietin in kidneys which stimulates erythrocyte production
clinical manifestations of polycythemia
gradual and progressive, middle age men, venous distention, esophageal varices, epistaxis, GI bleeding, and petechiae; hepatomegaly, splenomegaly, headaches, vertigo, tinnitus
diagnosis of polycythemia
CBC; plasma and RBC volume increased; Hgb, Hct and platelet levels elevated, WBC count with basophilia, alkaline phos, uric acid and histamine levels elevated; bone marrow hypercellularity of RBCs, WBCs and platelets (polycythemia vera)
medical management of polycythemia
repeated phlebotomy, myelosuppressive agents; allopurinol
nursing diagnosis/interventions for polycythemia
ineffective tissue perfusion, cardiopulmonary, cerebral, GI, and peripheral r/t hyperviscosity of fluid and potential bleeding; activity intolerance r/t ischemia
agranulocytosis
severe reduction in the number of granulocytes; WBC < 200/mm3; potentially fatal condition; caused by medication, chemotherapy, radiation, neoplastic disease, viral and bacterial infections
clinical manifestations of agranulocytosis
symptoms of infection, ulcerations of mm, bronchial pneumonia, UTI,
medical management of agranulocytosis
remove cause of bone marrow depression, prevent or treat infections, meticulous hand washing, strict asepsis
nursing Dx for agranulocytosis
risk for infection r/t depressed WBC production
leukemia
malignant disorder of the hematopoietic system, excess leukocytes accumulate in the bone marrow and lymph nodes, spleen and liver; cause unknown, either acute or chronic; proliferating cells (lymphocytic, myelogenous, etc)
Dx for leukemia
WBC; bone marrow biopsy - immature leukocytes; lumbar puncture; CT
clinical manifestations leukemia
anemia, thrombocytopenia; leukopenia; enlarged lymph nodes; splenomegaly, hepatomegaly, bone pain, meningeal irritation; oral lesions
medical management of leukemia
chemotherapy; radiation; bone marrow transplant; medications: Leukeran, hydroxyurea, corticosteroids, Cytoxan
nursing diagnosis for leukemia
risk for infection (neutropenic precautions); risk for injury r/t thrombocytopenia
thrombocytopenia
platelets beow 150,000/mm3
clinical manifestations of thrombocytopenia
petechiae, ecchymoses, bleeding from mm
diagnosis of thrombocytopenia
CBC; peripheral blood smear, and PT/PTT, bone marrow aspiration
medical management of thrombocytopenia
cortiosteroid therapy, splenectomy, gamma globulin, immunosuppressive drugs, platelet transfusions, avoid trauma
nursing dx for thrombocytopenia
ineffective tissue perfusion; pain r/t hemorrhage
hemophilia
disturbance of clotting factor; two types A and B; x-linked hereditary trait; mainly males, females carriers
clinical manifestations of hemophilia
internal and external bleeding; large ecchymoses into tissue; hemarthrosis, excessive blood loss from small cuts and dental procedures
diagnosis of hemophilia
coagulation profiles; normal platelet count, bleeding time, PT and INR; however PTT prolonged; factors VIII and IX concentrate; cryoprecipitate (rich in factor VIII); manufactured factor VIII or IX
nursing diagnosis for hemophilia
ineffective tissue perfusion r/t blood loss from coagulation deficit; ineffective coping r/t long-term illness; deficient fluid volume r/t bleeding
von Willebrand's disease
inherited bleeding disorder; abnormally slow coagulation of blood; mild deficiency of factor VIII; similar to hemophilia; not limited to males
clinical manifestations of von Willebrand's disease
spontaneous episodes of GI bleeding, epistaxis, gingival bleeding
medical management of von Willebrand's disease
cryoprecipitate; fibrinogen, fresh plasma, desmopressin (DDAVP); minimize bleeding-avoid trauma; relieve pain-no aspirin
DIC
overstimulation of clotting and anticlotting processes in response to disease or injury
clinical manifestations of DIC
bleeding; hemoptysis; dyspnea, diaphoresis; cold, mottled digits; purpura on the chest and abdomen; petechiae
diagnosis of DIC
coagulation profile-prolonged clotting, decreased platelets; D-dimer elevated
medical management of DIC
treat underlying cause; cryoprecipitate; heparin; protect from bleeding and trauma
nursing diagnosis for DIC
risk for injury; bleeding and fluid deficit r/t depleted coagulation factors, adverse effect of heparin
multiple myeloma
malignant neoplastic immunodeficiency disease of the bone marrow
clinical manifestations of multiple myeloma
bone pain; pathological fractures; infection; anemia; bleeding; hypercalcemia; renal failure due to high protein and calcium levels causing renal tubular obstruction
diagnosis of multiple myeloma
radiographic skeletal studies; bone marrow bopisy
medical management of multiple myeloma
symptomatic, not curable; radiation; chemotherapy; corticosteroids; IV fluids
nursing diagnosis for multiple myeloma
risk for injury r/t osteoporosis and lytic lesions; pain r/t disease process; deficient fliud volume r/t impaired renal function
lymphangitis
inflammation of one or more lymphatic vessels; usually occurs from acute streptococcal or staphylococcal infection in an extremity
clinical manifestations of lymphangitis
fine red streaks from the affected area; edema; chills; fever; local pain; headache; myalgia
medical management of lymphangitis
penicillin; moist heat for comfort; elevate extremity; aseptic technique promotes healing
lymphedema
priary or secondary disorder; accumulation of lymph in the soft tissue
clinical manifestations of lymphedema
massive edema and tightness of affected extremity; pain
medical management of lymphedema
diuretics; antibiotics; compression pump; elastic stocking or sleeve; resticted sodium diet; avoid constrictive clothing; meticulous skin care
nursing diagnosis for lymphedema
impaired skin integrity r/t impaired lymphatic drainage
malignant lymphoma
non-Hodgkin's lymphoma; neoplastic disorder of lymphoid tissue; tumors usually start in lymph nodes and spread to lymphoid tissue in the spleen, liver, GI tract and bone marrow
clinical manifestations of malignant lymphoma
painless, enlarged cervical lymph nodes; fever; susceptibility to infection; weigh tloss; anorexia; anemia; pruritus; fatigue; malaise
diagnosis of malignant lymphoma
bone scan, biopsies of lymph nodes, liver and bone marrow
medical management of malignant lymphoma
accurate staging of the disease is crucial to determine treatment regimen; radiation; chemotherapy; bone marrow transplant; tumor necrosis factor (TNF)
Hodgkin's disease
painless, progressive enlargement of lymphoid tissue; lymphoid tissue enlargement; the cervical nodes and spleen; Reed-Sternberg cells-atypical histiocytes
clinical manifestations of Hodgkin's disease
enlargement of cervical lymph nodes; pruritus-give soothing baths with an antipruritic medication; low-grade fever; night sweats; anemia; leukocytosis
Diagnosis of Hodgkin's disease
lymph node biopsy reveals presence of Reed-Sternberg cells; bone scans/CT
medical management of Hodgkin's disease
stage I or II (localized); radiation; stage III or IV (generalized) chemotherapy; combination; bone marrow or peripheral stem cell transplantation
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