Chap 82 Blood And Lymph Objectives

Front 1

State the main blood types, including the inherited antibodies and antigens for each blood type.

Back 1

Genes are responsible for blood types. Each red blood cell has antigens that are inherited. These antigens or LACK OF THEM determines blood type. ABO Blood type system.
ANTIGENS
Type A blood has the A antigen on the red blood cells.
Type B blood has the B antigen on the red blood cells.
Type O has no antigens on RBC.
Type AB blood has both A and B antigens.
Type D antigen a/k/a Rh Factor. At birth if person has Rh or D antigen on the RBC they are Rh positive AND DOES NOT HAVE Rh ANTIBODY. At birth person may not have Rh antigen on RBC and is Rh-negative and has no antibody against the Rh factor: concern occurs during pregnancy and blood transfusions
ANTIBODIES are inherited.
Type A blood has anti-B antibodies. Type B blood has anti-A antibodies. Type O blood has both anti-A and anti-B antibodies.

Front 2

Describe the following diagnostic studies: indirect Coombs' test, direct Coombs' test, type and screen test, and type and crossmatch test.

Back 2

INDIRECT COOMBS' test screens for the circulating Rh antibodies; it is ordered on an Rh-negative pregnant woman. If Rh antibodies are detected in Mother, fetus is in danger and RhoGAM is anti-Rh antibody that will suppress the mother's production of Rh antibodies.
DIRECT COOMB'S TEST will detect antibodies already attached to the RBC; may be ordered prior to blood transfusion or before administration of certain drugs. Positive or abnormal test may indicate transfusion reactions, certain cancers or rheumatoid arthritis.
TYPE and SCREEN test of the blood determines the ABO blood group, the Rh type, and an indirect Coombs' test; used when client has a low to moderate potential of needing a blood transfusion. cheap and quick.
TYPE and CROSSMATCH is more detailed used for clients who have a greater potential of needing blood tranfusion. Test for ABO blood group and Rh factor. An indirect Coombs test is done on both donor and recipient. Finally both of their blood is combined and tested for compatibility; takes

Front 3

PART ONE (1)
State the function of each of the following tests: RBC count, Hgb, Hct, WBC count, differential, platelett count, blood smear, PT, PTT, APTT and bleed time.

Back 3

RBC count measures the number of circulating RBC in a cubic milliliter of peripheral venous blood; values vary according to age and sex. The test of hemoglobin determines the amount of HgB in a RBC which tells the body's ability to carry oxygen to cells. HcT hematocrit measures the percentage of RBC in the blood. All these type test can indicate the different types of anemias.
WBC count is a deterination of infection. The norm is 5,000 to 10,0000--when infection is present it can be high as 25,000 or higher. In BACTERIA infection neutrophils increase; in VIRAL infection lymphocytes increase; WBC differential is granular vs non-granular to help pinpoint type of infection. LEUKOCYTOSIS increase in WBC: LEUKOPENIA decreae in WBC.
PLATELETT COUNT indicates the bodies' hemostasis (blood clotting) platelettes are fragments of cells and are destroyed every 8 to 12 days.
BLOOD SMEAR looks are RBC, WBC and platelets under a microscope, a close look at all 3.

Front 4

PART TWO (2)
State the function of each of the following tests: RBC count, Hgb, Hct, WBC count, differential, platelett count, blood smear, PT, PTT, APTT and bleed time

Back 4

PT tests the actual amount of time for blood to clot; test can indicate the proper functioning of coagulation factors and the coagulation process. The PT will be longer when certain clotting factors are defective or not present in sufficient quantity. The factors that can affect the PT include fibrinogen I and prothrombins II, V,VII, and X. Normally, the PT is less than 12 seconds (warfarin "Coumadin").
PTT and APTT tests are used to monitor the path-way of clot formation. The APTT differs from the PTT in that the APTT uses different chemicals in the testing process that accelerate or activate the clotting factors. Normal values for the PTT range from 60 to 90 seconds. Normal values for the APTT range from 25 to 27 seconds.The PTT and APTT may be used to monitor heparin anti-coagulation therapy.The antidote for heparin therapy is protamine sulfate
BLEED TIME s a screening test used to detect platelet disorders, evaluate for capillary defects, and determine the client’s ability to stop bleeding.

Front 5

EXPLAINS THES TEST:
Identify at least two nursing considerations related to the following: ESR, blood culture, bone marrow, biopsy, and lymph node biopsy

Back 5

ESR measures the speed at which RBC settle to the bottom of a tube. It is useful in diagnosising infection and the inflammatory process and autoiummone conditions. BLOOD CULTURE is done to discover the presence of bacteria in the blood or the antibiotics that are most effective against a specific organism. BONE MARROW is done to evaluate the number, size, and shape of RBCs, WBCs, and megakaryocytes (platelet precursors) helps determine Leukemia or Hodgkins Disease. BIOPSY uses a large needle to aspirate marrow for testing. LYMPH NODE BIOPSY is done to diagnosis or stage a tumor or diagnosis immunodeficiency disorder.

Front 6

Identify at least two nursing considerations related to the following: ESR, blood culture, bone marrow, biopsy, and lymph node biopsy

Back 6

ESR:

BLOOD CULTURE: Nofity the lab when the client's temp elevates (2) obtain before antibiotic therapy is started or obtain at exact time physician has ordered. TIME the culture is taken is important.
BONE MARROW (1) assure client lie still (2) provide support
BIOPSY (1) administer any pain med that is ordered 30 minutes prior to as this procedure is painful for some (2) supportive LYMPH NODE BIOSPY (1) apply pressure to site (2) observe for ANY bleeding

Front 7

Identify at least two advantages and two limitations for colloid solutions.

Back 7

Advantages: (1) Economical and virus-free; also can be used in emergency when blood is not availabe. (2) can be used to save the life of those whose relegious values prohibit them from receiving another's person's blood. Limitations: hemoglobin and oxygen-carrying capacity are not included in the synthetic colloid products.
(2)

Front 8

PART ONE
Identify the rationale for the administration of the following blood products: whole blood, packed RBC's, platelet concentrates, FFP, albumin, cryoprecipitates, plasmapheresis, IgG, and IgD.

Back 8

A unit of blood can be transfused as whole blood. More commonly, the unit of blood is separated into separate components, which are given for specific purposes.
WHOLE BLOOD is rarely used for transfusions today, except to treat massive acute hemorrhage. The normal circulating blood volume in an adult is approx 6 liters (8–10 pints). Whole blood can be refrigerated for storage for up to 35 days.
PACKED RBC's are produced by centrifuging (spinning) whole blood, which forces the RBCs to the bottom With the addition of a special preservative,packed cells can be refrigerated for storage for up to 42 days.Packed cells are given to clients with anemia who do not needincreased circulating blood volume.
PLATELET CONCENTRATION are used to prevent or to resolve bleeding due to thrombocytopenia or for active bleeding disorders, such as disseminated intravascularcoagulation (DIC).
FFP Fresh frozen plasma
(FFP) contains unconcentrated plasma with clotting factors. It can be used to produce various derivatives an

Front 9

PART TWO
Identify the rationale for the administration of the following blood products: whole blood, packed RBC's, platelet concentrates, FFP, albumin, cryoprecipitates, plasmapheresis, IgG, and IgD

Back 9

ALBUMIN Serum albumin
is a plasma protein that can be given in concentrated, small amounts to increase colloidal osmotic pressure by pulling interstitial fluids (“third-spaced
fluids”) into the intravascular compartment. Albumin is used to treat hypovolemic shock
(low blood volume) or to replace albumin lost because of burns or kidney damage.
CRYOPRECIPITATES Cryoprecipitates
are collected from freshplasma that has been frozen and thawed. They contain factorVIII and other clotting factors that are used to treat hemophilia and other clotting disorders.
PLASMAPHERESIS or apheresisis the separation and removal of specific components of blood. The remainder of the blood is returned to the client at the time of separation; used to collect plateletts.
IgG Immune globulins (Ig), a family of proteins that act as antibodies, include IgA, IgD, IgE, IgM, and IgG. IgG is the principal immunoglobulin in human serum. IgG is collected from multiple donors and may be given to aperson who has been recently exp

Front 10

Allogenetic transfusion is when blood or blood products from donors are used.

Back 10

Autologous transfusion is when the client donotes their own blood days prior to the surgery

Front 11

Identify at least three nursing considerations for autologous and allogeneic BMT.

Back 11

Nursing Considerations for BLOOD TRANSFUSION
(1) Take the client’s baseline vital signs before the procedure, (2) begin the transfusion very slowly, (3) and observe the client carefully for the first 15 minutes as any reactions will occur during first 50 mL of transfusion (4) STOP ASAP if any reactions occur and report to physician and to transfusion service personnel.
NURSING CONSIDER FOR BONE MARROW TRANSPLANT "BMT"
(1) match arm band to fluid to be transfused to confirm right person (2) look for signs of infection due to high dose of chemo adminstered before this type transplant. (3) use protective precautions for first 3 months or until the WBC are producing (4) document thoroughly any reaction on the appropriate form

Front 12

Discuss at least three nursing considertations for each of the following RBC disorders: polycythemia, anemia, sickle cell disease and thalassemia

Back 12

Polycythemia: (1) teach / education the s/s of this disese and risk of NOT treating the symptoms of polycythemia; take rest when feeling tired to avoid hypoxia (2) encourgage fluids.
ANEMIA (1) suggest iron rich foods such as spinach for prevention of anemia (2) drink citrus juice if taking iron supplements for the anemia.
SICKLE CELL DISEASE (1) avoid temperature extremes hot/cold environment (2) take folic acid (3) drink plenty liquids.
THALASSEMIA (1) exercise regularly but not to the extreme (2) reduce stress (3) at first sign of any infection see doctor and get rid of it by taking medication if prescribed. May have brittle bones (4) fall prevention, if weak rest

Front 13

PART ONE
Compare and contrast the following types of anemia: iron deficiency, hemolytic, hemorrhagic, pernicious, aplastic

Back 13

Iron Deficiency Anemia results from either an inadequate absorption or an excessive loss of iron. This condition occurs most often in women, young children and older adults. Primary causes include trauma, excessive menses, bleeding from the gastrointestinal tract, pregnancy, or a diet that lacks iron. Treatment for iron deficiency anemia includes treating the site of blood loss, increasing dietary iron intake, and introducing supplemental iron.
HEMOLYTIC anemia caused by destruction of RBCs prior to their normal lifespan of about 120 days. Manifestations of hypoxemia symptoms relate to the impaired transport of oxygen and include dyspnea and limited exercise tolerance. The cause of hemolytic anemia is related to defects of the cell membrane of the RBC, inherited enzyme defects, certain drugs and toxins, antibodies, or physical trauma. Treatment of this type of anemia relates to diagnosis and to the causative factors. Corticosteroid hormones and splenectomy may also be of beneficial.
HEMORRHAGIC

Front 14

PART TWO
Compare and contrast the following types of anemia: iron deficiency, hemolytic, hemorrhagic, pernicious, aplastic

Back 14

HEMORRHAGIC "acute" develops after a rapid and often sudden blood loss. Causes of such blood loss include trauma that leads to blood vessel rupture, aneurysm, or artery erosion caused by a cancerous lesion or ulcer. ministration of IV fluids, such as saline, albumin, or plasma,and transfusions with fresh whole blood.
Chronic hemorrhagic anemia is usually the result of conditions such as peptic ulcers, bleeding hemorrhoids, excessive emesis, or cancerous lesions in the gastrointestinal tract. Chronic blood loss can eventually lead to iron-deficiency anemia because available iron sources are depleted. Treatment usually includes controlling the site of bleedingand replacing lost iron through diet and supplements
PERNICIOUS caused by a lack of a gastric substance called intrinsic factor, which is produced in the stomach. The body needs intrinsic factor to absorb vitamin B12 from food in the small intestine. Vitamin B12 is necessary for the body’s proper absorption and use of iron and the protection of ner

Front 15

Define the causative factors for the following WBC disorders: neutropenia and leukemia. Identify at least three nursing considerations related to each disorder.

Back 15

NEUTROPENIA, also known as
granulocytopenia, is a decrease inneutrophils, one of the forms of leukocytes. Severe neutropeniais referred to as agranulocytosis, granulocytopenia, or malignant neutropenia. Agranulocytosis implies severe reductions of basophils and eosinophils, as well as neutrophils. Neutropenia can be acquired or congenital. The majorityof cases of neutropenia are the result of cytotoxic drugs used in cancer therapy, such as alkylating agents and antimetabolites, which are designed to suppress bone marrow function in clients with types of leukemias and lymphomas. Radiation therapies for cancer can also cause neutropenia. certain antipsychoticdrugs such as clozapine Drugs such as (Clozaril), and sulfonamides can be causative agents.
LEUKEMIA--affected individuals usually experience recurrent infections that fail to respond to antibiotics.
(1) Take precautions to avoid infection and when susupect infection see dr asap. (2) Use a soft toothbrush (3) No smoke (4) no alcohol.

Front 16

(12) Discuss at least three nursing considerations for each of the following platelet disorders: thrombocythemia, ITP, DIC and hemophilia.

Back 16

(1) monitor for hemorrhage: if the person had any type surgery closely monitor for hemorrhage knowing this is more serious for this client; and (2) for formation of thrombi
ITP (1) ask about over-the-counter medications (2) client must taper off of the use corticosteriods (3) avoid constipation b/c do not want to strain may cause bleeding.
DIC (1) make them aware of the risk factors associated with this condition: shock, viral infections. If they suspect an infection address it immediately and not let it worsen. (2) Let them know if they cut or have a wound and suspect hemorrhage, contact dr. (3) look for drop in blood pressure or bruising which s/s of internal bleeding which could quickly turn deadly due to their condition.
HEMOPHILIA (1) teach injury prevention (2) if dental work, may need special bleeding precautions (3)Make sure family is aware of the s/s of this disorder and the importance of preventive care.

Front 17

(13) Identify the causitive factors for the following lymphatic system disordrers: Hodgkin's disease, non-Hodgkin's lymphoma and multiple meloma

Back 17

Hodgkins Disease:

Front 18

(14) Identify dietary modifications for the client with blood and lymph disorders

Back 18

Clients with Anemia may need to add additional Iron (spinach, dark green and leafy vegtables) and Vitamin B12 (lamb, shellfish such as calms "calm chowder). WE NEED VIT B12 TO ABSORB THE IRON.
Folic Acid (black eyed peas or orange juice and peanut butter). Folic Acid is a B vitamin that we need for cell growth and blood production.

Front 19

PART THREE
Compare and contrast the following types of anemia: iron deficiency, hemolytic, hemorrhagic, pernicious, aplastic

Back 19

Pernicious anemia develops slowly; therefore, signs and symptoms are usually severe when a diagnosis is finally made. Early signs and symptoms include infection, mood swings, gastrointestinal disorders, and cardiac and renal problems. Late classic signs and symptoms include weakness, fatigue, tingling and numbness of the
fingers and feet, sore tongue, difficulty walking, abdominal pain, and loss of appetite and weight. Dietary modifications alone are ineffective. The client must take vitamin B12 (cyanocobalamin, Ener-B) for life by injection. Clients cannot take vitamin B12 orally because they lack the intrinsic factor necessary for absorption. Additionally, clients may receive iron supplements, folic acid, and digestants to enhance vitamin metabolism. Sometimes, blood transfusions are also necessary.
APLASTIC bone marrow depression, describes a condition in which the bone marrow is under-developed or has failed, resulting in a decrease in RBCs, WBCs, and platelets (pancytopenia).

Front 20

(15) Identify common medications for the client with blood and lymph disorders.

Back 20

x

Front 21

(16) Discuss general client and family teaching for clients with a blood and lymph disorder, include ages across the lifespan

Back 21

x

Front 22

The nurse must be aware of the normal and abnormal laboratory values for common tests of RBC's, WBC's and platelets.

Back 22

NORMAL VALUES:
RBC male 4.6-6.2 and
female 4.2-5.9.
HgB/Hemoglobin male 13-18 and female 12-16.
Hct/Hematocrit male 45%-52% female 37%-48%.
WBC (leukocytes) 4300-10,800. Platelets 150,000-350,000.