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Chapter 37
Hematologic and Lymphatic Systems
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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
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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
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Formed Elements
• Erythrocyte
• Leukocyte
• Thromobocyte
What is the action of STEM CELLS?
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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
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Erythrocyte
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Erythropoetin
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Hemoglobin
• Millions of Hgb molecules per RBC
• Synthesis dependent on iron
• Carries O2 to cells of body
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Hematocrit (Hct)
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White Blood Cells…
• MULTIPLE TYPES– GRANULOCYTES
• MADE IN BONE MARROW• FIGHT INFECTION
– AGRANULOCYTES• MADE IN LYMPH• KEEP US HEALTHY
– ETC.
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Leukocytes
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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
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Type and Crossmatch
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Administration of Blood
What is the role of the LPN?
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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)
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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
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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)
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Iron Deficiency Anemia
• Treatment:– Iron preparations and changes in diet
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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
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Pernicious Anemia
• Autoimmune disease
• Parietal cells and destroyed and gastric mucosa atrophies
• Inability to absorb vitamin B12 from absence of intrinsic factor
(continued)
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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 B12
intramuscularly
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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)
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Acquired Hemolytic Anemia
• Treat to remove cause:– Blood transfusions, erythrocytapheresis,
splenectomy, and medications
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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)
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Sickle Cell Anemia (Inherited Hemolytic Anemia)
Sickle Cell Anemia Video
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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
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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)
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Polycythemia
• Complications:– Thrombus formation and gout
• Treatment:– Phlebotomy, medications (low-dose aspirin
and anti-gout drugs), and dietary changes
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• 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
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• 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
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• 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
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Leukemia
• Malignancy in which bone marrow produces increased numbers of immature white blood cells that cannot protect body from infections
(continued)
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Leukemia
• Four categories:– Acute myelogenous (AML)– Acute lymphocytic (ALL)– Chronic myelogenous (CML)– Chronic lymphocytic (CLL)
(continued)
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Leukemia
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Leukemia
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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)
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Leukemia
• Treatment:– Chemotherapy, radiation, blood products,
antibiotics, and bone marrow transplants
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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)
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Agranulocytosis
• Treatment or prevention of infection:– Transfusions, Neupogen, and antibiotics
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• 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
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• 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
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• WHICH OF THE FOLLOWING FOODS SHOULD A CLIENT WITH LEUKEMIA AVOID?– A - WHITE BREAD– B – CARROT STICKS– C – STEWED APPLES– D – MEDIUM-RARE STEAK
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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)
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DIC
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DIC
• Symptoms:– Oozing from venipuncture, mucus membrane,
and wound
• Treat cause
• Treatment:– Blood products and medications
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Hemophilia
• Inherited bleeding disorder
• Lack of clotting factors
• Symptoms:– Hemarthrosis, pain, swelling, redness, and
fever
(continued)
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Hemophilia
• Complication:– Intracranial hemorrhage
• Treatment:– Replacement of missing clotting factors
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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
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Thrombocytopenia
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• 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
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• 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
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• 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)
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• 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
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• 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
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Lymph
VIDEO
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The Spleen
VIDEO
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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
(continued)
VIDEO
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Hodgkin’s Disease
• Treatment:– Radiation, chemotherapy, and diet changes
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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
(continued)
VIDEO
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Non-Hodgkin’s Lymphoma
• Treatment:– Chemotherapy, radiation, and bone marrow or
peripheral blood stem cell transplant
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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)
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Myeloma
• Not curable
• Treatment symptomatic
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Chapter 60
Infants with Special Needs:Birth to 12 Months
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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
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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)
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Iron-Deficiency Anemia
• Treatment:– Iron replacement
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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)
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Sickle-Cell Anemia
• Prevent crises with hydration
• During crisis:– Bed rest, oxygen, fluids, and analgesics
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Chapter 61
Common Problems: 1–18 Years
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Cardiovascular, Hematologic, and Lymphatic Systems
• Rheumatic fever
• Leukemia
• Idiopathic thrombocytopenic purpura
• Hemophilia
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Epstein-Barr Virus(Infectious Mononucleosis)
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It’s time for report…
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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.