blood and lymph lecture PDF

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Blood and Lymph Lecture 12/7 Care of the patient with a blood or lymphatic disorder - Blood: contains oxygen, electrolytes, nutrients (good stuff); bad stuff include carbon dioxide and waste products (uric acid) - Lymphatic system: immune system - Network of green vessels; where there are arteries and veins there is lymphatic fluid - Hematologic and lymphatic system are vital for homeostasis (balance) - Responsible for balance in the body - Blood: transports oxygen to cells; brings good stuff to cells and also removes bad stuff (ie. CO2, uric acid) away from cells - Lymphatic tissue: purifies everything it touches; ie. tonsils, thymus gland, adenoids (lymph nodes everywhere in the body scattered) - Lymph: fluid found in lymphatic circulation - Purifying: removing stuff we do not want (ie. bacteria, viruses, foreign invaders) - Because we know it works with immune system it is rich in WBC (protect body from foreign organisms) - WBC are eating all foreign invaders (these cells do the purifying) - Immune system: resisting or destroying foreign invaders - Lymphatic is one of the tools in immune system - Tonsils in back of throat act like filters: the tonsils purify everything we take in - Characteristics of blood: thick, alkaline; 3 primary cells: RBC, WBC, and platelets make 45% of blood volume → formed elements ** - RBC’s aka erythrocytes (vast majority of 45 is RBC) - RBC’s contain hemoglobin (iron protein) which is responsible for carrying O2 and CO2 - hemoglobin : “chair” - Adults have 5-6 L of blood and it decreases with age - WBC’s aka leukocytes 1% of the 45% - Responsible for inflammation and fighting infection, eats foreign invaders - Phagocytes eat foreign invaders - This action is called phagocytosis - Buffy coat < 1% - Platelets aka thrombocytes (clot cells) 1% of the 45% - Clots are to stop bleeding - Hematocrit: % of RBC in a sample of whole blood if RBC is 45 then Hct is 45 - Women have a lower Hct than men - It is possible for RBC to drop if you drink too much fluid - Amount of plasma can tell how much is the Hct level - Plasma: white-yellowish fluid; remaining 55% of blood volume - Predominantly water (90%) - Will make up the remaining amount percentage of hematocrit

- Plasma has special proteins, hormones and electrolytes pH: acidity or alkalinity of blood - If blood is not within normal pH the body will not work - normal : 7.35-7.45 - Normal ranges are important! - Sodium chloride: salt concentration 0.9%; most closely resembles concentration of salt in blood stream Three critical functions of blood: - First: - Transports oxygen, hormones (plasma): chemical messenger; nutrition to cells - 2nd: regulates acid-base balance (pH) and body temperature - Metabolism: by product is heat (reason why we are warm) - Where there is blood there is oxygen, where there is oxygen there is warmth (metabolism generates heat) - 3rd: protects body against infection (WBC do this) Hormone: chemical messenger - Has different messages to deliver to the rest of the body Red Blood Cells: erythrocytes - Biconcave disk - No nucleus; does not do metabolic things - Hemoglobin: O2 and CO2 sit in this; gives pigmentation of red in RBC - Normal Hgb: - Men: 14-18 g/dL - Women: 12-16 g/dL (12-18)** - Hematocrit (Hct): 42-52% in men; 37-47% in women - 15x3 = 45% - Life span of RBC is 120 days - Erythropoiesis: RBC production on red bone marrow (RBC, WBC, PLT made here) - RBC’s: you need iron, proper diet, hormones, vitamins, folic acid (erythropoietin) → hormone that makes RBC made in kidneys - RBC made in red bone marrow (also produces WBC and platelets) White Blood Cells: goal is to eliminate foreign invaders - Leukocytes: responsible for body defense - Normal WBC: 5,000-10,000 mm3 - Infection: multiplication of microorganisms (If WBC is too low) → won’t have enough defenders to fight off foreign invaders - WBC will multiply to the infection that is growing or spreading - If there is an infection then WBC is high because the body needs to make more WBC to eat the microorganisms - Lymphocytes: lymph cells; T cells (generals), B cells (create antibodies, weapons) -

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- WBC goal: eliminate foreign invaders Thrombocytes (Platelets): forms blood clots (5-9 day lifespan) - Normal: 150,000 - 400,000/ mm3 - Can lead to excessive bleeding if low - If thrombocyte is low there is a risk of bleeding/ hemorrhage - Hemostasis: how clot forms - Ingredients for clots: - Platelets, thromboplastin, calcium, prothrombin, fibrinogen, RBCs Stem cell: any cell that the body needs Blood Types: blood types are determined by presence or absence of antigens (proteins) on the surface of RBCs (depends on the antigen found on the surface of RBC) - antibodies are opposite of antigen on RBC - Antibodies: proteins that respond to specific antigen; protect you from foreign things; not found on surface of RBC, they are floating around it - Antibodies kill stuff - Antigens are proteins - B antibodies will kill B antigens - A antibodies will kill A antigens Rh Factor (Rhesus Factor) - + is rhesus factor is on RBC; - Rh if do not have Rh on RBC - Develops as an immune response after transfusion of during pregnancy - These two blood groups are incompatible when mixed - This will develop hemolysis - Ie. Rh antibodies will kill Rh antigens - Rhlg (antibodies): prevents Rh+ and Rh- from interacting; aka Rhogan Lymphatic System: works with immune and cardiovascular system - Maintains fluid balance; produce lymphocytes (T &B cells which are the strongest WBC); absorbs and transports lipids (fats) from intestine to blood stream - All lymphatic circulation goes back to the heart - High pressure inside artery, low pressure in veins; different pressure in between is where lymph is made - Artery will force as much blood in the low pressure veins, excess bleeds vertically into plasma - Water is able to freely move from the capillary into fluid around it - 50% of whole blood is water - Lymph is plasma; excess plasma that couldn't fit in venous circulation - Lymph nodes are car washes; all lymph collected in the body purifies plasma and drops it off in venous circulation (cardiovascular system) - Lymph goes back to the heart, left/right subclavian vein - Filters impurities - Fights infection: lymph passes through lymph node, bacteria and foreign material are destroyed by macrophages (phagocytes); lymph nodes are full of phagocytes

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- Peyer patches are patches inside the intestinal wall - Absorbs lipids - Tonsils: masses of lymphoid tissue in mucous membrane of oral cavity and pharynx; at risk for infection if tonsils are removed Lymphatic tissue - Spleen: vascular organ in left upper quadrant; stores 500 mL of blood (released from spleen intimes of bleeding in the event of hemorrhage) - Functions: destroys worn-out or defective RBCs; stores lymphocytes, monocytes, and plasma cells (rich in spleen); destroys foregin materials; produces RBCs before birth (red bone marrow produces formed elements in adults) - RBC in infants are produced in the spleen - Thymus - Functions in utero (before birth) and months after to develop immune system - Development of T lymphocytes (t cells) aka strongest WBC in body - Helps develop baby’s immune system Laboratory & Diagnostic Tests - CBC: counting the formed elements (RBC, WBC, PLT) - 4-8 million - Schilling Test: diagnoses pernicious anemia - Anemia: (low RBCs) lack of vitamin B - Diagnoses pernicious anemia - Administration of radioactive vitamin B12 and measured after injection of intrinsic factor (acidic enzyme inside stomach that absorbs vitamin b 12) - Without intrinsic factor you can’t absorb B12 - Anemia patients have a more alkaline stomach because they do not have the intrinsic factor - Gastric Analysis: checks to see acidity of the stomach - Bone marrow Aspiration or Biopsy: feeding a needle into the bone marrow - Bone marrow aspirate w/ needle to see how properly bone marrow is functioning and maturation of cells - Immature RBCs are called reticulocytes - Disorders Associated with Erythrocytes - RBCs: 4-6 million - Function: deliver O2 - HgB: 15 - Hct: 45% Anemia - There are different things that can cause a low RBC count - Not enough RBCs can lead to decrease inHgB and Hct also LOW O2 (low RBC = low O2)

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Low RBC can cause: headache, lightheadedness, pallor, tachycardia, pallor, colder because less metabolism means less heat - Loss of HgB → body shunting blood to vital organs → hypoxia in other areas of the body - Body compensates by forming more RBCs but are immature - Anemia can be so bad that it can lead to shock, severe hypotension, stroke, confusion, death - If parts of brain meant for balance do not get enough O2 then there will be no equilibrium - Nursing Interventions: give warm blanket, give O2 (Dr. order), conserve energy to do ADLs, stop activity when symptoms occur, frequent rest periods Hypovolemic Anemia - Low volume (amount of fluid) in blood - Causes: secondary anemia (caused by underlying bleeding) ie. surgery, GI bleeding, menorrhagia, trauma burns; adults can tolerate 500mL - Body will compensate by premature RBCs being made, and tachycardia (heart pumps faster) - Assessment: thirst, irritability, restlessness - Objective: decreased BP, rapid, weak, thready pulse, rapid respirations, cold, clammy skin with pallor, oliguria (because not enough blood in kidneys so there is no urine) - Medical Management - Stop blood loss by putting patient in supine applying pressure, give O2, give fluids (0.9% NaCl, fresh frozen platelets, packed RBCs) - Nursing intervention: give iron rich food (ie. green leafy foods, red meat) Pernicious Anemia - No B12 due to intrinsic factor; give B12 injection - B12 is responsible for metabolism, synthesis of fatty acids for energy production - If B12 is absent: jaundice, glossitis (ischemia in tongue), flatulence, tingling of hands and feet - Tingling because of neuropathy, not enough oxygen to nerves so the nerves do not have sensation which causes the tingling - Flatulence: peristalsis is not normal - Myoglobin can be destroyed leading to erosion of tongue (tongue breakdown) - When RBC dies bilirubin is released in the bloodstream which then causes yellowing of skin (jaundice) Aplastic Anemia - Without shape anemia; primary cells are unshaped ; deficiency of all formed elements due to bone marrow deficiency - Clinical Manifestations: - Anemia (RBC), petechiae (platelets), infections (WBC), hemorrhage (RBC), ecchymosis: superficial bleeding of skin (PLT), bleeding gums

(PLT), epistaxis: PLT Medical management: identify underlying cause; replace formed elements that have been lost - Splenectomy: removal of spleen, spleen is large because spleen is working hard to get rid of defective RBCs; we remove this so it does not rupture - Immunosuppressive therapy: to slow or shut down the body’s immune system - Autoimmune: body attacking itself - Body’s own immune system is attacking its own bone marrow - Bone marrow transplant: must be compatible - To reduce or prevent infection - Reverse isolation - Hand hygiene - No fresh flowers - No fresh fruits that you can’t peel - No sick children - Avoid large crowds Prevent bleeding - No invasive procedure (IM injections, catheters) APPLY PRESSURE FOR OPEN WOUNDS - Avoid contact sports - Coitus - No rectal insertion - Increase fiber intake - Electrical shave soft bristled toothbrush -

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KNOW NORMAL RANGES! -

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Iron Deficiency Anemia - Anemia due to lack of iron - Fragile fingernails and clubbing because of lack of oxygenation - Expected finding: Green to black stool - Medications are best absorbed in acidic environment ( take iron with vitamin C) aka ascorbic acid - Iron is contraindicated with milk and antacids it impairs the absorption of iron - Pagophagia: underlying condition eating ice or eating things for their lack of iron Sickle Cell Anemia - RBC begin to be sickle (misshapen); abnormal crescent shape RBC (HgB S defective HgB); more fraile - Primary concern is pain - Sickle cells clump and aggregate resulting in occlusion; vicious cycle of spiraling pain - Sickle cell life span in 10-20 days

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Not flexible & clump together; more difficult passing through smaller areas (rigid cells) - Do not have enough O2 - Dies easily Prevent further sickling will prevent further occlusions and preventing occlusions will get more O2 - Clinical Manifestations - Dehydration: makes blood thicker meaning it to be easier to occlude - Keep patient hydrated - Change in oxygen tension: if body makes more RBC to compensate then sickle cell makes more sickle cells if there is more demand in oxygen; oxygen demand goes up with pain - Keep patient out of stress, over exertion, pain and prevent occlusions, stay out of cold weather because of vasoconstriction, no smoking; NO VASOCONSTRICTION because more occlusions will come, avoid situations where oxygen is lower, want vessels to be wide as possible to avoid occlusions - Nursing Interventions - Avoid sickling, avoid high altitudes because there is less air and there will be less oxygen leading to more occlusions - Reduce pressure because there will be ICP: to relieve include: blow nose gently, avoid coughing and straining upon elimination, ROM, good nutrition - Medical management - Pain control - MONA - Fluids - Around the clock pain management - Blood transfusions Polycythemia (Erythrocytosis): higher risk for blood clots - Overproduction of all formed elements due to overgrowth of bone marrow - All formed elements are overgrowth (could be considered cancer) - Wherever there is a cancer that grows on a tissue that secretes stuff, the cancer can increase those secretions or shut down the creation of the tissue secretion (later stage) - There will be high levels of RBC, WBC, and platelets because of the overgrowth - If blood viscosity is high clotting will happen and blocking of arteries and veins; blood is too thick it can increase BP and blood clots - Clot then can travel to anywhere in the body and form an occlusion; cand lodge into anywhere in the body because the clots

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can be small as well Primary problem: blood is thicker forming clots & increase in BP Epistaxis: if BP is too high the artery will rupture and it can cause nosebleed (emergency) Petechiae can happen due to tiny clots in the capillaries Hepatomegaly: clots are occluding portal vein of liver, it is harder for blood to leave the lover making the blood pool in the lover leading to an enlarged liver Splenomegaly: can cause hypovolemic shock because an enlarged spleen can rupture Blood is not moving forward as it should; it can flow backwards into the veins of the esophagus (esophageal varices) Hypoxia causes polycythemia because it means low O2 in the blood. Overproduction of RBC means the body is trying to compensate for the lack of O2 Assessment: sensitivity to hot and cold, tinnitus (because lack of perfusion), eczema, dermatologic changes - For body to cool down, blood vessels widen to get rid of heat; more difficult to control temperature because too much pressure in the vessels, oxygenated blood cant get to wherever it needs to go so it leads to hypertension - If not getting enough O2 metabolic process cant make heat - Because blood is thick there is a problem regulating temperature - Tinnitus: nerves responsible for hearing is not getting enough oxygen - You can't do nerve stuff without blood Diagnostic tests - Alkaline phosphatase: liver/ pancreas test - Uric acid: metabolic waste product found in cells; excreted in the kidney Medical management - Therapeutic phlebotomy: removing 500-2000 mL of blood until blood is no longer thick; this will reduce blood viscosity - Myelosuppressive agents: bone marrow depressive agent; will shut down bone marrow so no more formed elements will be made - Phosphorus: has inverted relationship with calcium; if one is high in the bloodstream the other one goes away to the bone; radioactive phosphorus kills bone marrow - Allopurinol: to lower uric acid Nursing intervention:

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Avoid hypoxia, avoid high altitudes, smoking,stay away from carbon monoxide, fluid management (reduce fluids, or diluting excess RBC), avoid foods high in iron - Report pain, edema, and erythema (DVT) Disorders Associated with Leukocytes - Agranulocytosis: WBC with granules (digestive organelles) granulocyte is WBC; severe reduction of granulocytes; extremely low WBC (leukopenia) - Greater risk of infection - Clinical manifestations: fever, chills, headache, fatigue - Infection: multiplication of micro “fever” heat kills infection which is why there is a fever - Ulceration of mucous membranes: chancre sore - Oral care, give soup or soft foods - Oral hygiene: to prevent lesions from getting worse - Body over secretes in the lungs so we can cough it out - Medical Management: prevent infection - Reverse isolation - Hand hygiene - No kids - No fresh flowers - No unspeakable fruit - Avoid large crowds - Soft, bland diet -

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Leukemia: excessive number of leukocytes; blood cancer= metastasis; deficiency of all formed elements + pain - Accumulate in bone marrow and lymph nodes - Rapidly dividing cancer that spreads everywhere in the body - Normal WBC in bone marrow replaced w/ normal numbers and forms of rapidly dividing cells which spread to rest of the body - At risk for infection, bleeding, and low O2 - Cut / kill / cripple - Cut: remove - Kill: radiation, chemotherapy - Cripple: send cancer into remission asap - Chronic: long-term, more stable - Acute: happens suddenly, more dangerous - Medical management: bone marrow transplant, blood transfusion - Nursing intervention: small frequent meals Disorders of coagulation - Alteration of blood clotting process - Clot cake: fibrin, calcium, platelets, thrombin, prothrombin, clotting factor, vitamins

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Assessment: signs of headache, pain, numbness; liver and splenic tenderness and enlargement, hematoma, internal bleeding - Nursing interventions: monitor hypovolemic shock, prevent trauma to tissues, monitor IV infusions and transfusions - Earliest sign of shock: level of consciousness Disorders Associated with Platelets - Thrombocytopenia - Low production of platelets; platelets free than 150,000/mm3 - Causes: disseminated intravascular coagulation (DIC); widespread coagulation inside blood vessels; when proteins that control the blood in clotting become overactive, blood is clotting for no reason - Thrombocytopenic purpura: immune system attacks itself; mistakenly think platelets are foregin invaders so the platelets get attacked - Medical management: treat underlying cause, corticosteroids - Clotting factor Defects - Platelets, fibrin, calcium, clotting factor - Deficiency of clotting factor - Hemophilia - Bleeding disorder; absence of clotting factors - Hemophilia A: factor VIII - Hemophilia B: factor IX - Nursing intervention: give the missing clotting factor either 8 or 9 - Hemarthrosis: bleeding into a joint space; friction occuring in the joint causes bleeding - Stop bleeding by R.I.C.E. - Rest - Ice - Compress - Elevation - Nursing interventions and patient teaching: refrain from aspirin or blood thinners, medical alert bracelet, obesity prevention - Von Willebrand’s Disease: von willebrand factor is necessary to make a clot - If you don;t have the factor you have the disease - Deficiency slows coagulation of blood and causes bleeding - Desmopressin is treatment of choice: increases von willebrand;s factor and releases storage sites and also factor VIII - Disseminated Intravascular Coagulation - Body is making clots for no reason; overstimulation of clotting and anti clotting processes, depletion of clotting factors - Manifestations: bleeding, black & tarry stools, coffee brown emesis - Main concern: look out for bleeding - Mottled: blotchy, reddish purplish skin - Medical management: correct underlying cause, platelet

transfusion, heparin therapy(thinning of the blood prevents bleeding) - Nursing in...