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50 Cards in this Set

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Bone Marrow
The soft tissue the fills spaces in the interior of the long bones and spongy bones

Manufactures blood cells
Red marrow

Yellow marrow
Red marrow
Manufactures blood cells and hemoglobin

Yellow marrow
Consist of fat cells and connective tissue

¡ Does not manufacture blood cells

¡ Can manufacture under intense stimulation
Blood
Consist of cells suspended in a fluid called plasma

All blood cells are produced from stem cells in the bone marrow
Erythrocytes (RBC)
Flexible, anuclear, biconcave disks covered by a thin membrane through which O2 and CO2 pass freely

The flexibility of erythrocytes allows them to change shape as they travel through capillaries

Their major function is to transport O2 and remove CO2 from the tissues
Erythropoiesis
Production of erythrocytes
Regulated by erythropoietin
A hormone released by the kidneys
Erythrocytes require
Iron
Folate
B vitamins
B12, B6
Hemoglobin
An iron containing pigment attached to erythrocytes

Gives blood its red color

Carries oxygen to the cells of the body

Normal range 12-17.4 g/dL
Leukocytes (WBC)
Perform various protective functions
Circulate in blood and migrate into body tissues to search for and destroy potentially harmful substances

Divided into two categories
Granulocytes
Agranulocytes
Platelets
When a blood vessel is injured, platelets migrate to the injury site

Release a glycoprotein IIb/IIa, which causes the platelets to adhere and form a clot
Lymphatic System
Circulates interstitial fluid and carries it to the veins
Filters and destroys pathogens and removes potentially harmful substances

Includes
Thymus gland
Spleen
Lymphatic vessels
Lymph nodes and lymph
Thymus Gland
Lymphoid tissue in the upper chest that contains undifferentiated stem cells released from bone marrow

The stem cells migrate to the thymus gland and develop into T lymphocytes
Spleen
Largest lymphatic structure

The reservoir of blood and contains phagocytes that engulf damaged erythrocytes and foreign substances
Lymph Nodes
Along the lymphatic network
Axilla
Groin
Neck
Large vessels of thorax and abdomen
Contain T and B lymphocytes
Lymph
Fluid

Flows through the lymphatic system by contraction of skeletal muscles

As lymph pass through the nodes, macrophages attach and engulf foreign substances
Assessment
The nurse collects data by taking a health history, examining the client and monitoring the results of the laboratory test
Physical Examination
Inspection of the skin

VS

Palpation of lymph nodes
Anemia
A deficiency of either erythrocytes or hemoglobin
Most anemias result from
– Blood loss

– Inadequate or abnormal erythrocyte production

– Destruction of formed RBC
Hypovolemic Anemia
Caused by a loss of blood volume which results in fewer blood cells
– Trauma (acute)
– Gastric Bleeding
When blood is lost, bone marrow produces more erythrocytes
– Cells are smaller and have less heme
• Inadequate oxygen supply and accumulated CO2
Assessment Findings
Hypovolemic Anemia
Acute blood loss

– S/S of hypovolemic shock
Management Hypovolemic Anemia
Replacement of blood by transfusions

If it is a chronic blood loss

– Need to treat the underlying cause
Iron deficiency anemia
Develops when iron is insufficient to produce hemoglobin

– Heme cannot be recycled because of blood loss

– Dietary intake of iron is insufficient

– Absorption of iron from food is inadequate

– The need for iron exceeds reserves
Iron deficiency anemia

Assessment findings
Reduced energy

Feel cold all the time

Fatigue

Dyspnea with minor physical exertion

Fast HR
Management

Iron deficiency anemia
Determining the cause and correcting it
Nutritional intake of iron
Oral iron supplements
– Take on empty stomach
– No not take with an antacid
– Take with orange juice
– Dilute if liquid iron
• Drink with a straw
Pernicious anemia
Develops when a client lacks intrinsic factor

– Intrinsic factor is necessary for absorption of vitamin B12
Intrinsic factor
Production decreases with age and gastric mucosal atrophy

Surgical removal of the stomach or small bowel

Without adequate B12, erythrocytes remain in an immature form
Assessment Findings
Intrinsic factor
Stomatitis

Glossitis

Digestion disturbances

Diarrhea
Intrinsic factor
Management
Vitamin B12 IM for life

– Usually 100 g IM daily for 2 weeks

– Then 100 g monthly
Folic Acid deficiency anemia
Causes anemia characterized by immature erythrocytes

Related to an insufficient dietary intake of foods rich in folic acid
Folic Acid deficiency anemia
Assessment Findings
Severe fatigue
Sore and beefy-red tongue
Dyspnea
Nausea
Anorexia
H/A
weakness
Folic Acid deficiency anemia
Management
Oral folic acid supplements

Food high in folate
Sickle cell anemia
Name because erythrocytes become sickle or crescent shaped when oxygen supply in the blood is inadequate

Common genetic disorder

– Primarily in African Americans

• Affects 1 in 600 African Americans in the US
Sickle Cell Crisis
Develops rapidly under hypoxic conditions

During a crisis the sickle shaped cells lodge in small blood vessels, where they block the blood flow and oxygen to the affected tissue

The vascular occlusion causes severe pain

Stroke is a common complication
Chronic hemolytic anemia
Results from defective HbS molecule which shortens the lifespan of affected erythrocytes and causes them to be destroyed prematurely

The spleen becomes obstructed and infarcted with excess dead erythrocytes

The bone marrow enlarges to compensate for decreased erythrocytes
Assessment Findings
Sickle Cell Crisis
One of the unique manifestations of sickle cell disease is Acute chest syndrome
– A type of pneumonia triggered by decreased hemoglobin and infiltrates in the lungs
• Coughing
• Wheezing
• Tachypnea
• Chest pain
Medical Management
Sickle Cell Crisis
Treatment is supportive rather than curative
Regular blood transfusions
Hydroxyurea/ Inhaled nitric oxide
Bone marrow transplantation
Narcotic analgesia
Oxygen

Hydration
Hemolytic anemia
S/S
Management
Chronic premature destruction of erythrocytes

S/S

– Jaundice

– Enlarged spleen

Management

– Remove the cause
Erythrocytosis
Polycythemia Vera

– An increase in circulating erythrocytes

Rapid proliferation of blood cells produced by the bone marrow

Insidious onset and prolonged course

Shorter life span

Blood becomes more viscous
Erythrocytosis
Assessment Findings
Face and lips are reddish-purple

Fatigue

Weakness

H/A

Excessive bleeding after an injury
Erythrocytosis
Management
Phlebotomy

Anticoagulants

Antineoplastic drugs
Erythrocytosis
Patient Teaching
Drinking 3 liters of fluid per day

Avoid crossing legs

Physically active
Pancytopenia
Numbers of all marrow-produced blood cells are reduced

Aplastic anemia

– Inadequate stem cell production in bone marrow

– Possible autoimmune

– Death rate is high
Pancytopenia
Assessment Findings
Infections

Coagulation abnormalities

Small skin hemorrhages

Enlarged spleen
Pancytopenia
Management
Transfusions

Antibiotics

Corticosteroids

Bone marrow transplantation
Thrombocytopenia
Decreased number of platelets or thrombocytes

Occurs when platelet manufacture by the bone marrow is decreased or platelet destruction by the spleen is increased
Thrombocytopenia

Assessment Findings
**Purpura**

Bleeding in other parts of the body

Internal hemorrhage
Management
Thrombocytopenia
Corticosteroids

Platelet transfusion

Splenectomy
Thrombocytopenia
Nursing interventions
– Minimizing bleeding
Hemophilia
A disorder involving an absence or reduction of a clotting factor

3 Types

– Hemophilia A, B and C

Inherited from mother to son

Severity depends on the type inherited

Short life expectancy
Hemophilia
Assessment Findings
Persistent oozing

Spontaneous severe bleeding

Bleeding in the joints
Hemophilia
Management
Transfusions

Factor VIII concentrate

FFP’s

Nurse needs to assess joints

Minimize bleeding episodes