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Chapter 37 Hematologic and Lymphatic Systems. Anatomy and Physiology Review Heart pumps 5 to 6 liters of blood per minute through adult circulatory system.

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Presentation on theme: "Chapter 37 Hematologic and Lymphatic Systems. Anatomy and Physiology Review Heart pumps 5 to 6 liters of blood per minute through adult circulatory system."— Presentation transcript:

1 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 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 –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 B 12 from absence of intrinsic factor (continued)

22 Pernicious Anemia Symptoms: –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 B 12 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: –Thrombus formation and gout Treatment: –Phlebotomy, medications (low-dose aspirin and anti-gout drugs), and dietary changes

30 WHATS THE NORMAL LIFE SPAN FOR HEALTHY RED BLOOD CELLS (RBCS)? –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. 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

37 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

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. 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 Symptoms: –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: –Intracranial hemorrhage Treatment: –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. THE PHYSICIAN DOCUMENTS THROMBOCYTOPENIA ON THE CLIENTS 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 Hodgkins 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 (continued) VIDEO

59 Hodgkins Disease Treatment: –Radiation, chemotherapy, and diet changes

60 Non-Hodgkins 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 (continued) VIDEO

61 Non-Hodgkins 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 Chapter 60 Infants with Special Needs: Birth to 12 Months

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 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 Its 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.


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