1. hematolymphatic system consists of:
    • blood
    • bone marrow
    • spleen
    • liver
    • lymphatics
    • thymus
  2. were is blood produced?
    • Bone marrow
    • RES
    • -blood is specialized ORGAN that exists in a fluid state
  3. plasma:
    • fluid portion of blood (55%)
    • water, electrolytes, proteins, nutrients, waste products
  4. Serum:
    same as plasma, just without Fibrinogen
  5. Cellular components of blood:
    • 40-45%
    • RBCs
    • WBCs
    • Platelets
  6. Hematopoiesis:
    • producition of RBCs
    • site is Bone marrow
    • during embryonic developement the liver and the spleen may be involved
  7. Stem cells of the marrow:
    • Myeloid: RBCs, WBCs, Platelets
    • Lymphoid: T and B lymphocytes
  8. RES:
    • macrophages which are made from monocytes
    • spleen is site of activity for macrophages
  9. Hemostasis:
    • preventing or stopping blood loss from an injured vessel
    • needs funtional platelets: >100,000
    • Primary-vessel contricts, platelets come
    • Secondary- formation of fibrin which reinforces platelets plug and anchors it to injury site
  10. Dx procedures:
    • CBC
    • H & H
    • Sed rate of erythrocytes, monitors course of inflammatory disease
    • PT, PTT
    • INR
    • D-Dimer (blood clotting >500)
    • BNP (fluid overload as in CHF)
  11. causes of Anemia:
    • Dietary deficiencies: Iron, folic acid, B12 (as in hypoproliferative-not making enough RBCs)
    • Hereditary disorders:sickle cell
    • Bone marrow damage : due to meds (chemo and radiation)
    • malignancy: tumors
    • overactive spleen
    • Bleeding
  12. Hypoproliferative anemia:
    decreased production of RBCs
  13. Aplastic anemias:
    Bone marrow failure to produce blood cells
  14. Iron-deficiency anemia:
    most common
  15. Megaloblastic anemia:
    • deficiency in B12 and folic acid
    • abnormally large RBCs
  16. Hemolytic anemia:
    • resulting from RBC destruction (hemolysis)
    • can cause jaundice
  17. Anemia caused by bleeding:
    • loss of RBC= anemia
    • can be from GI bleed (check for OB), menorrhagia, epitaxis
  18. All about Aplastic anemia:
    • "bone marrow failure" decrease in marrow stem cells, replacement of marrow w/fat
    • S/S: pallor, fatigue, anemia, dyspnea
    • Tx: BMT Nursing: monitor blood counts, and for signs of infection
  19. Sickle Cell Anemia:
    • inherited sickle hemoglobin gene
    • Hgb defective, rigid and sickle shaped, adhere to endothelium and to each other
  20. Sickle cell crisis:
    • caused by: infection, cold weather, decreased O2 levels, stress
    • S/S: Hgb 7-10 (normal men 14-17), pain in joints, swelling, low grade fever in adults, jaundice, weakness
    • NEED: pain control, O2, fluids
    • Dx: Hgb electrophoriesis
  21. sickle cell tx:
    • Hydroxyuria: antineoplastic med, increase fetal Hgb level and decrease sickle cell formation.
    • folic acid and B6
    • Vanillin & Arginine: so that sickle cells dont stick together
    • Desferal
  22. Desferal:
    • iron chelating agent (helps excrete iron)
    • managment of secondary iron overload syndromes assoc with multiple transfusions
  23. sickel cell tx overall:
    O2, fluids, antibiotics, remove contrictive clothing, transfusion, itching (could be from hypoxia or pain meds) need Benydril, NSAIDs do not seem to help, avoid IM injections
  24. Leukemia:
    uncontrolled proliferation of leukocytes in bone marrow with infiltration of lymph nodes, spleen, liver
  25. 2 tpes of Leukemia:
    • Myelogenous- mono and granulocytes
    • Lymphocytic
  26. AML
    • genetic, viral, or radiation
    • Dx: decreased RBCs, platelets, WBCs can be low normal or high, bone marrow aspiration (excess immature blasts cells), Ayer rods in cytoplasm show AML
  27. S/S of AML:
    • lymphadenpathy (swelling of lymph nodes)
    • pain (enlarged liver or spleen), infection (neutropenia), anemia, weakness, fatigue, bleeding (thrombocytopenia) bruises and petichiae,
    • Tx: chemo, BMT
  28. CML:
    • genetic abnormality (Philedelphia chromosome) 90-95% pts
    • Dx: bone marrow
    • S/S: similar ot AML but less severe
    • Tx: chemo, BMT
  29. ALL
    • most prevalent cancer in young kids
    • Dx: CBC, bone marrow aspiration
    • S/S: hemorrhage, infection, pain
    • Tx: chemo, radiation
  30. CLL:
    • malignancy of older adults (30-50)
    • genetic, viral, radiation
    • Dx: CBC
    • S/S: infection, anemia, enlarged lymphs
    • Tx: Chemo, chlorambucil
  31. Leukemia nursing care:
    monitor for infections, bleeding, provide comfort, emotional support
  32. Hodgkin's disease:
    • unknown origin, originates in lymphatic system
    • histiocytes: Reed-Sterberg cells (giant tumor cells)
    • Dx: excisional lymph biopsy
    • s/s: painless enlargment of lymph nodes, puritis
    • Tx: chemo, radiation
  33. bleeding disorders S/S?
    local bleeding, petecjiae, eccymosis with trauma, see blood infeces, urine, pain may indicate internal bleeding, hypovolemia- decreased BP, tachy, pallor, clammy skin, oliguria
  34. vascular disorders:
    • rupture of small vessels that are defective or injured results in blood leaking into the skin
    • Vit C deficiency
    • S/S petechiae, eccymosis
  35. Thrombocytopenia:
    • platelets below 20,000/mm3 see petechiae along nose and gingival bleeding
    • below 5,000/mm3 spontaneous CNS or GI hemorrhage can occur
  36. Hemophilia:
    • genetic
    • s/s: joint pain, bruises
    • Dx: deficient/defective factor VIII and IX
    • so GIVE factors 8-9
  37. antidote for Coumadin:
    antidote for Heparin:
    • coumadin: warfarin: Vit K
    • Heparin: Protamine sulfate
  38. GVHD:
    • graft versus host disease
    • occurs in about 1/2 allogenic transplants
    • T-lymphocytes of new marrow attack the pts liver, skin and GI
    • can be acute or chronic- 3-6 motnhs after BMT
  39. Acute S/S of GVHD:
    maculopapular rash on palms and soles, green diarrhea, liver enlargement and elevated liver enzymes
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