Assessment Of Hematologic System

Question 1

Bone marrow

Answer 1

Responsible for blood formation
Produces RBC, erythrocytes, WBC, leukocyte, and platelets
Also involved in immune responses

Question 2

WBC fxn.

Answer 2

Provide protection through inflammation and immunity

Question 3

Red blood cells (erythrocytes) fxn.

Answer 3

Largest proportion of blood cells
Life span of 120 days
Help maintains acid-base balance
Maintain good perfusion with oxygen and for clotting

Question 4

Process of hypoxia

Answer 4

When oxygen is low, kidneys release more erythropoietin which then increases RBC production in bone marrow
When oxygen is normal or high, erythropoietin levels fall, slowing RBC production

Question 5

Platelets fxn.

Answer 5

Stick to an injured blood vessel walls and form platelet plugs to stop the bleeding
Keep small blood vessels intact by initiating repair after damage
Stored in the spleen
80% circulate 20% stored

Question 6

Accessory organs of blood formation

Answer 6

Spleen- contain three tissues, they all help balance blood cell production with blood cell destruction and assist in immunity, destroys old or imperfect RBC, breaks down the Hgb released from the old cells, stores platelets, filters antigens
Anyone with splenectomy has reduced immune functions and increased risk for infection/sepsis
Liver- produced prothrombin and other blood clotting factors, vit K production, stores whole blood, blood cells, and extra iron

Question 7

Hemostasis

Answer 7

Multi stepped process of controlled blood clotting

Starts the formation of a platelet plug and continues with steps that eventually cause formation of a fibrin clot

Question 8

Platelet aggregation

Answer 8

Platelets clumps together

Not blood clots, last only few hours, start the hemostatic process

Question 9

Blood clotting

Answer 9

Cascade triggered by platelet plug

End result is formation of a fibrin clot and local blood clotting (coagulation)

Question 9

Thrombin/Platelet inhibitors

Answer 9

T- heparin & enoxaparin
P- aspirin & clopidogrel
These prevent clots from forming

Question 10

Fibrinolytics

Answer 10

Alteplase & streptokinase

Use once a clot is formed

Question 11

Patient history assessment

Answer 11

Age: Bone marrow fxn and immune activity decrease with age
Gender: women have lower blood cell count than men
Liver fxn
Presence of known immunologic or hematologic disorders
Current drug use
Diet
Socioeconomic status
History of gallstones, jaundice, anemia
Use of blood thinners and NSAIDs

Question 12

Nutritional status assessment

Answer 12

Diet can Alter cell quantity and blood clotting
Iron, protein, mineral, or vitamin deficiency
Diets high in vit K- Green leafy vegetable: increase rate of blood clotting
Alcohol consumption
Finances

Question 13

Family hx

Answer 13

Ask about hemophilia, frequent nosebleeds, PPH, excessive bleeding after tooth extractions, heavy bruising
Sickle cell disease or trait

Question 14

Current health problem assessment

Answer 14

Lymph nodes swelling
Excessive bruising 
Women estimate number of tampons used during menstrual cycle 
SOB on exertion 
Palpitations
Frequent infections
Fever
Wt loss
Fatigue: most common manifestation of anemia

Question 15

Physical assessment

Answer 15

Nail beds for pallor 
Gums active bleeding 
Petechiae: pinpoint hemorrhagic lesions 
Absent hair on lower extremities 
Darker patients: see on roof of tongue, petechiae on palm of hands
Pulse may be weak and thready 
Blood in urine rib tenderness 
Enlarged spleen:if inspect a hematologic problem do not palpate spleen, can rupture easily

Question 16

Diagnostic assessment

Answer 16

Peripheral blood smear- info on size, shape, proportions of different blood cell types
CBC- RBC, WBC, Hct, Hgb
Reticulocyte count- determines bone maroon function, elevated RBCs are being produced and released before mature- polycythemia Vera
Platelets- low increases risk of bleeding, high indicates prolonged bleeding from trauma
Hgb electrophoresis- detects abnormal forms of Hgb
Coombs- blood typing, detects antibodies
Serum ferritin, transferritin, total iron- iron levels, abnormal iron deficiency anemia, increased liver disorder
Pat- how long it takes for blood to clot

Question 17

Bone marrow aspiration

Answer 17

Evaluate the patients hematologic status 
Bone marrow fxn- Production of all blood cells and platelets 
Reduce anxiety 
Site is usually iliac crest or sternum
5-15 min
Sterile technique 
Prevent excess bleeding 
Observe 24 hrs 
Mild Analgesic

Question 18

Patient preparation on a bone marrow aspiration

Answer 18

Help reduce anxiety 
Explain procedure
Typically iliac crest
Place patient in prone, or side lying position 
Invasive and sterile procedure

Question 19

Follow up care of a bone marrow aspiration

Answer 19

Priority: prevention of excessive bleeding
Cover site with dressing for 24 hours
Ice packs
Avoid contact sports for 48 hours

Question 20

80 yo reports fatigue, SOB, HA. What is priority assessment

Answer 20

Can you tell me about your diet
Have u been feeling depressed
What medications do u take
History of CVD

A

Question 21

Pt reports fatigue, malaise, bleeding gums, and chills. What is priority nursing intervention

Answer 21

Document findings
Notify health care provider
Obtain vital signs and give antipyretic
Review labs

D

Question 22

Pt transitioning from IV heparin to oral warfarin. What lab indicates warfarin tx efficacy

Answer 22

Bleeding time of 5 min
PT of 18
INR 2.5
PTT 24.3

C