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136 Cards in this Set
- Front
- Back
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Which of the following laboratory values should be addressed first?
A. INR of 3.0 for a client receiving \Coumadin B. White blood cell count of 500/µl for a client with a history of splenectomy C. Platelet count of 150,000 for a client with a history of hemophilia and pneumonia D. Hemoglobin of 15 for a client receiving heparin |
B. This client is neutropenic and at risk for infection if proper preventive measures are not taken. All other laboratory values are considered normal. INR of 3.0 on a client receiving Coumadin is within normal limits.
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In reviewing laboratory data in a client, the nurse recognizes which hematologic change associated with aging?
A. Decreased red blood cells B. Decreased platelets C. Increased hemoglobin D. Increased white blood cells |
A
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In which of the following situations would the nurse expect to find an elevated reticulocyte count?
A. Infectious process B. Transfusion reaction C. Sickle cell disease D. Slow blood loss |
D
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The nurse implements anticoagulant therapy in order to:
A. Dissolve blood clots B. Decrease the inflammatory process C. Prevent formation of new clots D. Reduce platelet production |
C
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The nurse recognizes that the trigger for erythropoiesis is _____________________.
A. Iron B. Hematocrit C. Tissue oxygen D. Hemoglobin |
C
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The nurse understands that hemostasis starts with:
A. Clot formation B. Leukocytosis C. Vasoconstriction in area of bleeding D. Platelet aggregation |
D
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The hematologic system is concerned with blood formation and storage. Identify the 3 parts that compose the system.
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Blood, blood cells, lymph system
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Define: hemtopoietic
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Blood-forming organ; bone marrow
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Define: RBC (erythrocyte)
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Red blood cells; transports oxygen
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Define: WBC (leukocyte)
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Perform actions critical to inflammation and immunity
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Define: Stem cells
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Bone marrow produces these, which can form a WBC, RBC or platelet, depending on the body's needs
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Define: Erythropoietin
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Produced by kidneys to stimulate RBC production
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Define: Oxygen dissociation
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Occurs when there is a drop in the oxygen in tissues. There is a greater increase in the transfer of oxygen from hemolobin to tissues.
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Define: Hypoxia
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Decrease in tissue oxygenation
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Define: Aggregation
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Clumping of platelets
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Define: Macrocytic
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Larger than normal RBCs
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Define: Microcytic
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Smaller than normal RBCs
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Define: Hyperchromic
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Higher concentration of hemoglobin in RBCs
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Define: Hypochromic
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Lower concentration of hemoglobin in RBCs
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Identify the hematopoietic organ that is also involved in the immune response.
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Bone marrow
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Identify the types of cells produced by the bone marrow.
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RBCs, WBCs, platelets
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Where does the fetus develop cells until the last trimester of gestation?
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Liver and spleen
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The bone marrow in which bones produce blood cells?
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All bones
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Which portion of the long bones producce blood cells after 18 years of age?
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The ends
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Bone marrow produces a stem cell. What happens to the stem cell next?
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It becomes committed
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What are the 3 plasma proteins?
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Albumin, globulin, fibrinogen
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Describe the special features of a RBC:
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bioconcave disk allows it to change shape without breaking. Synthesizes hemoglobin
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What is the normal range for RBC's in an adult?
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M: 4.6-6.1 million/cubic mm
F: 4.0-5.4 million/cubic mm |
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What stimulates production of platelets?
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Thrombopoietin
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What do he nodes of the lymphatic system do in relation to the hematologic system?
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Filter and clean blood
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If edema occurs, what does the lymph system do?
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Pulls the fluid out and back to the vascular space.
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What is hemolysis?
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Splitting of cells; "lysis"
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Where are macrophages located in the mononuclear phagocyte system?
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Either circulating in the blood or fixed.
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Where are Kupffer's cells located?
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Liver and spleen
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What is left when hemoglobin splits?
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An iron subtance and bilirubin.
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If there is an incident and several cells hemolyze, what visible manifestation may we see?
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Jaundice
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Define: poikilocytosis
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Altered cell shape (such as in sickle cell anemia)
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Define: anisocytosis
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Altered cell size
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What may stimulate the production of RBCs?
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Decreased number of RBCs or increased need for RBC
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All disorders that end in -penia indicate:
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A decreased amount in something
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What is a dyscrasia?
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A disease of the blood
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What does pancytopenia mean?
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All of the marrow is not producing orrectly. Decreased RBCs, WBCs and platelets
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What is an anemia?
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A decrease in RBCs
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What is purpura?
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A small amount of blood found under the skin. It looks purple
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What is petechaie?
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Small, pinpoint lesions of blood found under the skin
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Hypochromic cells have a decreased amount of:
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iron
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What is the normal level of hemoglobin found in the blood?
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M: 14-18 g/dl
F: 12-16 g/dl |
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What is the normal hematocrit of the blood?
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M: 42-52%
F: 37-47% |
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What does the hematocrit measure?
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The percentages of RBCs in the blood
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The RBC count in newborns is usually very:
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high
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What is the lifespan of a RBC?
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120 days
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In the formation of platelets, what is the role of the megakaryocyte?
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It breaks into pieces called platelets
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What is the main function of platelets in coagulation?
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Sticks to blood vessel walls and forms platelet plugs to stop leakage at site of injury
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Where are platelets stored?
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Spleen
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The liver produces ____ ____, which are critical to vitamin K production.
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Bile salts
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Explain why platelets do not normally stick together.
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They must be stimulated before they aggregate.
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What is the difference between a platelet plug and a blood clot?
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Platelet plugs stimulate coagulation. They start the cascade leading to a blood clot, which can end bleeding. Platelet plugs are temporary.
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Platelets aggregate in response to extrinsic factors, such as which of the following:
a) trauma b) bacteria c) WBCs d) antibody-antigen reactions |
A
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What is a reticulocyte?
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Immature RBC
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What percentage of RBCs should be reticulocytes?
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0.5-2.0%
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When might the reticulocyte count be higher?
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After an increased need for RBCs, such as bleeding or lysis of cells
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If there are an increased number of reticulocytes, what test might show this?
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RDW (relative distribution of width)
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What does the MCV measure?
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The average size of the RBCs(mean corpuscular volume)
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What is the average size of Rbcs?
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80-95 micrometers cubed
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What does the MCHC measure?
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How much hemoglobin is in the RBC (mean corpuscular hemoglobin concentration)
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What is the average MCHC level?
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32-36%
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What is the average RDW?
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11-14.5%
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What is the average number of platelets in the blood?
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150,000-400,000/cubic mm
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What is the name of the older test that measures how long it takes for blood to clot? What is the average amount of time?
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The Ivy bleeding time
1-9 minutes |
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What is platelet antibody detection?
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It checks to see if there are any antibodies in the blood that fight against your own platelets
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What does APTT stand for?
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Activated partial thromboplastin time
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Whhat is the average APTT?
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25-35 seonds
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What does the APTT measure?
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How clotting factors are working together to form a clot
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What is the antedote to heparin?
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Protamine sulfate IV
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What test is the same as the APTT?
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PTT
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What is the normal PT (prothrombin time) level?
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10-13 seconds
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What does INR stand for?
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International Normalized Ratio
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The normal level for INR is:
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0.7-1.8
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How can Vitamin K be administered?
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PO
SQ IV |
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What is the antedote for Coumadin overdose?
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Vitamin K
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What three problems can cause an increased PT and INR?
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Liver disease
Vitamin K deficiency DIC |
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Why may PT and INR be increased in a person with liver disease?
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Because the liver cannot synthesize the Vitamin K clotting factors
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Why may PT and INR be increased in a person with a Vitamin K deficiency?
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Because the clotting factors are not being made
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What does the fibrinolytic system activity indicate?
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How a body breaks down a clot
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What does FDP/FSP stand for?
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Fibrin split/degradation products
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What is the normal level for FDP/FSP?
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<10 mg/L
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What does a coagulation factor assay look at?
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It pulls the plasma from the blood to see which factors may be deficient
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What does a hemoglobin electrophoresis test look at?
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Types of hemoglobin in the blood
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Which type of hemoglobin is normal in the human body?
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A
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What percentage of hemoglobin is normally type A?
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96-98%
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What percentage of hemoglobin is normally type A2?
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2-3%
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What percentage of hemoglobin is normally type F?
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About 1%
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If a person has type S hemoglobin, which disease do they suffer from?
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Sickle cell anemia
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If a person has type C hemoglobin, which type of disease do they suffer from?
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Some type of hemolytic anemia
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In performing a client examination, the nurse requests a urine specimen. The client asks why this specimen is being collected. What would the nurse explain to answer this question?
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RBCs may appear in the urine and hematuria can help determine a reason for anemia
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Describe abdominal organs the nurse would assess, and explain why this is important in determining a diagnosis of a hematologic disorder.
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Liver and spleen; may become inlarged in hematologic disorders
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An increased MCV may indicate a __________ anemia.
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macrocytic or megaloblastic anemia
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Which drugs are monitored by PT levels?
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Coumadin and warfarin
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What does the ferritin test measure?
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Total body iron stores
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If the body had a serum iron level of 55%, what would the TIBC be?
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45%
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The direct coombs' test detects the presence of:
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antibodies against RBCs attached to RBCs
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The indirect Coombs' test detects the presence of:
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circulating antibodies against RBCs
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The direct Coombs' test is used to detect:
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hemolytic anemia
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The indirect Coombs' test is used before a:
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Blood transfusion
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Hemoglobin electrophoresis is used to identify which 2 diseases?
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Thalassemia
Sickle cell disease |
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Bone marrow aspiration is used when:
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Other tests show persistent abnormal findings
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What is the difference between a bone marrow aspiration and a bone marrow biopsy?
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Aspiration involves cells and fluids suctioned through a needle. Biopsy involves removal of a piece of solid tissue obtained by coring out an area of bone marrow with a large-bore needle.
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What is the most common area for bone marrow aspiration?
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posterior iliac crest
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Is bone marrow aspiration a clean or sterile procedure?
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Sterile
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What is used to stop the bleeding after a bone marrow aspiration or biopsy?
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A sandbag or pressure dressing
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With anemia in general, is there usually an increase or decrease in blood volume?
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Decrease
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Other than an increased destruction, decreased production, or blood loss, what may cause anemia?
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Defective hemoglobin
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What are the general symptoms of any anemia?
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Fatigue. Exertional dyspnea. Pallor. Tachycardia. Irritability. Numbness/tingling.
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What are the 3 major items a nurse will monitor with any type of anemia?
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HR. RR. Peripheral perfusion
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Why is a pulse ox inaccurate in clients with anemia?
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Because there is a decrease in circulating volume, causing the pulse ox to be skewed.
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What lab tests indicate pseudoanemia?
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Normal MCH, RDW
Decreased RBC, Hct, Hgb |
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How much blood can the body lose before seeing any consequences? Why?
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About 500 mL. Blood stored in the spleen enters circulation to restore loss.
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In the early stages of anemia of blood loss, what symptoms do we see?
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weakness and vital sign changes
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In the later stages of anemia of blood loss, what symptoms do we see?
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Decreased Hgb and Hct, shock.
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What shape are cells in anemia of blood loss?
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Normocytic
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Is there a change in hemoglobin in anemia of blood loss?
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No. Normochromic.
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What may be some causes of chronic anemia of blood loss?
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malagnancies, ulces, hemorrhoids, menorrhagia
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What may we see in the labs of a client suffering from chronic anemia of blood loss?
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Decreased hemoglobin, hematocrit, RBC count. Increased RDW and reticulocyte count.
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What are the shape of cells in chronic anemia of blood loss?
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Microcytic
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What happens to the hemoglobin in cells in chronic anemia of blood loss?
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Hypochromic (deccreased Hgb)
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What is the most logical treatment of chronic and acute anemia of blood loss?
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Transfusion
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With most types of anemias that don't deplete WBCs or platelets, what type of transfusion is used?
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Packed RBCs
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What supplement may be necessary for a person suffering from acute or chronic anemia of blood loss? Why?
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Iron, because the blood is being lost and the iron cannot be recycled.
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How often is iron-deficiency anemia caused by low nutritional intake of iron in adults?
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Rarely
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What other things may cause iron-deficiency anemia?
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GI bleeding or menorrhea
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How common is iron-deficiency anemia?
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Most common type of anemia
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In severe iron-deficiency anemia, what three symptoms are present in addition to the normal anemia signs?
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Brittle, spoon-shaped nails, usually with ridges. Tongue is bright red, smooth and shiny. Cheilosis.
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What is the main cause of iron-deficiency anemia in pediatrics? Why?
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Nutritional deficiency. Increased need for iron because of growth spurts.
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If iron-deficiency anemia in a pediatric patient is not treated, what 3 things may occur?
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Growth retardation.
Developmental delays. Systolic murmur. |
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What size are RBCs in iron-deficiency anemia?
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microcytic
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What is the color of RBCs in iron-deficiency anemia?
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Hypochromic
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