1. Hematologic and Lymphatic Systems
Chapter 37
Hematologic and Lymphatic Systems

2. Anatomy and Physiology Review
Heart pumps 5 to 6 liters of blood per minute through adult circulatory system
Lymphatic system
Separate vessel system with two main functions:
Transport excess fluid from interstitial spaces to circulatory system
Protect body from infections

3. Function of Blood
Transport O2, CO2, water electrolytes, hormones and enzymes
Heat to regulate body temperature
Immune bodies and antibodies to help prevent disease and infection
To provide clotting of blood in case of injury
Prevent clot formation in blood vessels

4. Formed Elements Erythrocyte Leukocyte Thromobocyte
What is the action of STEM CELLS?

5. Red Blood Cells… Formed in red bone marrow
Needs Vitamin B12, Intrinsic Factor, Iron, Folic Acid for manufacture
Erythropoesis
Carries O2 on the Hgb (12 – 16)
Carries CO2 to lung for elimination
Life span 120 days

6. Erythrocyte

7. Erythropoetin

8. Hemoglobin Millions of Hgb molecules per RBC
Synthesis dependent on iron
Carries O2 to cells of body

9. Hematocrit (Hct)

10. White Blood Cells… MULTIPLE TYPES GRANULOCYTES AGRANULOCYTES ETC.
MADE IN BONE MARROW
FIGHT INFECTION
AGRANULOCYTES
MADE IN LYMPH
KEEP US HEALTHY
ETC.

11. Leukocytes

12. Thrombocytes

13. Plasma
Liquid part of blood; 90% water with 10% dissolved substances (proteins)
Regulates blood volume
Provides nutrition of body cells
Function in clotting of blood
Circulates antibodies

14. Type and Crossmatch

15. Administration of Blood
What is the role of the LPN?

16. Assessment Subjective data:
Biological data, demographical data, occupation, hobbies, military experience, medication history, infections, night sweats, palpitations, bleeding, transfusions, neurological status, headaches, vision changes, alcohol and vitamin intake, surgeries, blood in stool or urine, diet history, and appetite
(continued)

17. Assessment Objective data:
Height, weight, vital signs, laboratory tests, palpation of lymph nodes, inspection of skin for petechiae, bruises, lesions, brittle nails, enlarged abdomen, and swollen joints

18. Iron Deficiency Anemia
Body does not have enough iron to synthesize functional hemoglobin (Hgb)
Symptoms:
Fatigue, palpitations, tachycardia, exertional dyspnea, weakness, pallor, pica, stomatitis, glossitis, and brittle hair
(continued)

19. Iron Deficiency Anemia
Treatment:
Iron preparations and changes in diet

20. Aplastic Anemia Bone marrow decreases or stops functioning Symptoms:
Client not making enough blood cells
Symptoms:
Fatigue, weakness, fever, palpitations, headaches, mouth ulcers, petechiae, gingival bleeding, and epistaxis
Treatment:
Bone marrow transplants and medications

21. Pernicious Anemia Autoimmune disease
Parietal cells and destroyed and gastric mucosa atrophies
Inability to absorb vitamin B12 from absence of intrinsic factor
(continued)

22. Pernicious Anemia Symptoms: Treatment:
Weakness, sore tongue, edema, ataxia, dizziness, dyspnea, headache, fever, blurred vision, tinnitus, jaundice, pallor, poor memory, irritability, loss of bowel/bladder control, and decreased sensitivity to hot and pain
Treatment:
Lifetime replacement of vitamin B12 intramuscularly

23. Acquired Hemolytic Anemia
Destruction of red blood cells releasing iron and Hgb
Symptoms:
Mild fatigue, pallor, jaundice, palpitations, hypotension, dyspnea, and back and joint pain
(continued)

24. Acquired Hemolytic Anemia
Treat to remove cause:
Blood transfusions, erythrocytapheresis, splenectomy, and medications

25. Sickle Cell Anemia (Inherited Hemolytic Anemia)
Genetic disorder
Causes abnormally shaped red blood cells
Symptoms:
Anemia, enlarged heart, fatigue, jaundice, chronic leg ulcers, tachypnea, dyspnea, arrhythmias, and severe pain
(continued)

26. Sickle Cell Anemia (Inherited Hemolytic Anemia)
Sickle Cell Anemia Video

27. Sickle Cell Anemia (Inherited Hemolytic Anemia)
Sickle cell crisis:
Fever, severe pain, and loss of blood supply to affected area
Treatment:
Medications and symptomatic care during crises with pain management, oxygen, and hydration

28. Polycythemia
Increased production of red blood cells along with white blood cells and platelets
Symptoms:
Headaches, dizziness, tinnitus, blurred vision, fatigue, weakness, pruritus, exertional dyspnea, angina, increased blood pressure and pulse, and ruddy appearance
(continued)

29. Polycythemia Complications: Treatment: Thrombus formation and gout
Phlebotomy, medications (low-dose aspirin and anti-gout drugs), and dietary changes

30. WHAT’S THE NORMAL LIFE SPAN FOR HEALTHY RED BLOOD CELLS (RBC’S)?
A – 60 DAYS
B – 90 DAYS
C – 120 DAYS
D – 240 DAYS

31. THE NURSE IS DOCUMENTING CARE FOR A CLIENT WITH IRON DEFICIENCY ANEMIA
THE NURSE IS DOCUMENTING CARE FOR A CLIENT WITH IRON DEFICIENCY ANEMIA. WHICH OF THE FOLLOWING NURSING DIAGNOSES IS MOST APPROPRIATE?
A – IMPAIRED GAS EXCHANGE
B – DEFICIENT FLUID VOLUME
C – INEFFECTIVE AIRWAY CLEARANCE
D – INEFFECTIVE BREATHING PATTERN

32. A 73 YEAR-OLD FEMALE IS ABOUT TO RECEIVE A BLOOD TRANSFUSION TO TREAT SEVERE ANEMIA. SHE ASKS THE NURSE HOW LONG THE PROCEDURE WILL TAKE. THE NURSE EXPLAINS THAT THE TREATMENT TAKES:
A – 8 HOURS
B – AT LEAST 12 HOURS
C – AT LEAST 24 HOURS
D – 4 HOURS

33. Leukemia
Malignancy in which bone marrow produces increased numbers of immature white blood cells that cannot protect body from infections
(continued)

34. Leukemia Four categories: Acute myelogenous (AML)
Acute lymphocytic (ALL)
Chronic myelogenous (CML)
Chronic lymphocytic (CLL)
(continued)

35. Leukemia

36. Leukemia

37. Leukemia
Symptoms:
Fever, chills, fatigue, pallor, malaise, tachycardia, tachypnea, petechiae, bruising, epistaxis, melena, gingival bleeding, increased menstrual bleeding, weight loss, night sweats, swollen lymph nodes, headache, and bone pain
(continued)

38. Leukemia
Treatment:
Chemotherapy, radiation, blood products, antibiotics, and bone marrow transplants
This slide and next slide added.

39. Agranulocytosis Reduced number of granulocytes Symptoms:
Headache, fever, chills, fatigue, mucous membrane ulcerations, and low white blood counts
Treat to remove cause of bone marrow suppression
(continued)

40. Agranulocytosis Treatment or prevention of infection:
Transfusions, Neupogen, and antibiotics

41. WHEN PROTECTIVE ISOLATION IS NOT INDICATED, WHICH OF THE FOLLOWING ACTIVITIES IS RECOMMENDED FOR A CLIENT RECEIVING CHEMOTHERAPY?
A – BED REST
B – ACTIVITY AS TOLERATED
C – WALK TO BATHROOM ONLY
D – OUT OF BED FOR BRIEF PERIODS

42. A CLIENT WITH LEUKEMIA HAS NEUTROPENIA
A CLIENT WITH LEUKEMIA HAS NEUTROPENIA. WHICH OF THE FOLLOWING FUNCTIONS MUST BE FREQUENTLY MONITORED?
A – BLOOD PRESSURE
B – BOWEL SOUNDS
C – HEART SOUNDS
D – BREATH SOUNDS

43. WHICH OF THE FOLLOWING FOODS SHOULD A CLIENT WITH LEUKEMIA AVOID?
A - WHITE BREAD
B – CARROT STICKS
C – STEWED APPLES
D – MEDIUM-RARE STEAK

44. DIC Syndrome of alternating clotting and hemorrhaging
Due to primary disease process or condition
Suspect with predisposing illness and onset of purpura, bleeding tendencies, and renal impairment
(continued)

45. DIC

46. DIC Symptoms: Treat cause Treatment:
Oozing from venipuncture, mucus membrane, and wound
Treat cause
Treatment:
Blood products and medications

47. Hemophilia Inherited bleeding disorder Lack of clotting factors
Symptoms:
Hemarthrosis, pain, swelling, redness, and fever
(continued)

48. Hemophilia Complication: Treatment: Intracranial hemorrhage
Replacement of missing clotting factors

49. Thrombocytopenia Decrease in number of platelets in blood Symptoms:
Petechiae, ecchymoses, and bleeding from mucous membranes
Treatment:
Transfusions of platelets, apheresis, splenectomy, medications, and diet changes

50. Thrombocytopenia

51. A CLIENT WITH THROMBOCYTOPENIA, SECONDARY TO LEUKEMIA, DEVELOPS EPISTAXIS. THE NURSE SHOULD INSTRUCT THE CLIENT TO:
A – LIE SUPINE WITH HIS NECK EXTENDED
B – SIT UPRIGHT, LEANING SLIGHTLY FORWARD
C – BLOW HIS NOSE AND THEN PUT LATERAL PRESSURE ON IT
D – HOLD HIS NOSE WHILE BENDING FORWARD AT THE WAIST

52. WHICH OF THE FOLLOWING CONDITIONS IS NOT CAUSED BY DISSEMINATED INTRAVASCULAR COAGULATION (DIC)?
A – ORGAN TISSUE DAMAGE
B – DEPLETION OF CIRCULATING CLOTTING FACTORS
C – THROMBUS FORMATION IN THE LARGE VESSELS
D – ACTIVATION OF THE CLOTTING-DISSOLVING PROCESS

53. WHICH OF THE FOLLOWING LABORATORY TESTS, BESIDES A PLATELET COUNT, IS BEST TO CONFIRM THE DIAGNOSIS OF ESSENTIAL THROMBOCYTOPENIA?
A – BLEEDING TIME
B – COMPLETE BLOOD COUNT (CBC)
C – IMMUNOGLOBULIN (Ig) G LEVEL
D – PROTHROMBIN TIME (PT) AND INTERNATIONAL NORMALIZED RATIO (INR)

54. WHAT IS THE LIFE SPAN FOR NORMAL PLATELETS?
A – 1 TO 3 DAYS
B – 3 TO 5 DAYS
C – 7 TO 10 DAYS
D – 3 TO 4 MONTHS

55. A 43 YEAR-OLD WOMAN IS UNDERGOING TREATMENT FOR COLON CANCER
A 43 YEAR-OLD WOMAN IS UNDERGOING TREATMENT FOR COLON CANCER. THE PHYSICIAN DOCUMENTS THROMBOCYTOPENIA ON THE CLIENT’S DIAGNOSIS LIST. WHAT OBSERVATIONS CAN THE NURSE EXPECT?
A – DIARRHEA
B – THIN, BRITTLE HAIR
C – BRUISES ON THE SKIN
D – URINARY URGENCY

56. Lymph
VIDEO

57. The Spleen
VIDEO

58. Hodgkin’s Disease
Rare lymphoma usually arising as painless swelling in lymph node
Symptoms:
Painless, enlarged lymph nodes in neck, groin, or above clavicles, weight loss, fatigue, pruritus, recurrent high fever, night sweats, anemia, thrombocytopenia, and susceptibility to infection
VIDEO
(continued)

59. Hodgkin’s Disease
Treatment:
Radiation, chemotherapy, and diet changes

60. Non-Hodgkin’s Lymphoma
Symptoms:
Enlarged, painless lymph nodes in neck, axillary, abdominal, and inguinal areas, fever, night sweats, excessive tiredness, indigestion, abdominal pain, loss of appetite, and bone pain
VIDEO
(continued)

61. Non-Hodgkin’s Lymphoma
Treatment:
Chemotherapy, radiation, and bone marrow or peripheral blood stem cell transplant

62. Myeloma
Plasma cells become malignant, crowd out normal cell production, destroy normal bone tissue, and cause pain
Symptoms:
Bone pain, swollen and tender joints, low-grade fever, and general malaise
(continued)

63. Myeloma
Not curable
Treatment symptomatic

64. Infants with Special Needs: Birth to 12 Months
Chapter 60
Infants with Special Needs: Birth to 12 Months 64

65. Hyperbilirubinemia Also known as jaundice
Yellow discoloration of skin, sclera, mucous membranes, and body fluids
Treat to reduce amount of bilirubin
Treatment:
Phototherapy with bili light or fiber-optic blanket

66. Iron-Deficiency Anemia
Full-term infants have iron stores that last five to six months
Surfaces between 9 and 24 months
Symptoms:
Pallor, tachycardia, lethargy, irritability, and below-normal hemoglobin, hematocrit, and iron levels
(continued)

67. Iron-Deficiency Anemia
Treatment:
Iron replacement

68. Sickle-Cell Anemia
Genetic disorder characterized by production of abnormal hemoglobin
Symptoms after 6 months of age:
Abdominal pain, fever, growth retardation, anemia, and increased risk of infection
(continued)

69. Sickle-Cell Anemia Prevent crises with hydration During crisis:
Bed rest, oxygen, fluids, and analgesics

70. Common Problems: 1–18 Years
Chapter 61
Common Problems: 1–18 Years

71. Cardiovascular, Hematologic, and Lymphatic Systems
Rheumatic fever
Leukemia
Idiopathic thrombocytopenic purpura
Hemophilia

72. Epstein-Barr Virus (Infectious Mononucleosis)

73. It’s time for report…

74. Prioritize the five nursing interventions as you would do them initially:
A – Wash hands.
B – Assess the IV site.
C – Provide fresh water at bedside.
D – Assess oral mucosa.
E – Take the vital signs.