Med Surg (105) Exam 3 Study Guide

Med Surg (105) Exam 3 Study Guide. Hematology (Bone marrow, RBC/erythrocytes, WBC, Platelets) Accessory Organs of Blood Formation: Spleen, liver (worry about their bleeding w/ liver failure!) Hemostasis/Blood Clotting - Platelet aggregation - Blood clotting cascade - Intrinsic factors - Extrinsic factors - Fibrin clot formation Anti-Clotting Forces - One action ensures that activated clotting factors are present only in limited amounts - Fibrolysis: the other action that prevents over-enlargement of the fibrin clot Fibrinolytic: the disintegration or dissolution of fibrin, especially by enzymatic action; Process that prevents blood clots from growing and becoming problematic Fibrinolytic/thrombolytic drugs: tissue plasminogen activator (tPA) “clot buster”, streptokinase (SK), urokinase (UK) - All have the ability to effectively dissolve blood clots, they differ in mechanisms in ways that alter their electively for fibrin clots Hematologic Changes w/ Aging - Decreased blood volume - Lower levels of plasma proteins - Bone marrow produces fewer blood cells - RBC & WBC counts are lower - Lymphocytes become less active to antigens and lose immune function - Antibody levels and responses are lower and slower in older adults - WBC count does not rise as high in response to infection - Hemoglobin levels fall after middle age - We have to protect them in the hospital - Not going to respond well to invading pathogens Gordon’s Functional Health Patterns for Hematologic Assessment - Good basic questions related to activity exercise pattern and nutrition-metabolic pattern - Gives the nurse a starting point - Activity-Exercise Pattern o How long does your energy level seem to you compared w/ last year at this time? o Do you feel rested after typical night’s sleep? o Do you experience dizziness or light headedness? o Does your heart seem to pound? o How much exercise do you get? How often? What type? o Do you feel you have enough energy to do what you want or need to do? - Nutrition-Metabolic Pattern o Have you noticed any changes in your skin lately? o How easily do you bruise? o Do your gums ever bleed? o How often do you eat salads or green leafy vegetables? o Has your weight changed by 5 lbs or more this year? Anticoagulants- interfere w/ steps in blood clotting; limit or prevent extension of clots and prevent new clots Fibrinolytics- selectively degrade fibrin threads in the formed blood clot Platelet Inhibitors- prevent platelets from becoming active or activated platelets from clumping together Assessment -nutrition status - Diet has a huge impact so a nurse needs to ask about the diet to collect more data surrounding the possible cause of sx including SOB, fatigue, and headaches. -family hx or genetic risk -hemophilia, frequent nosebleeds, postpardum hemorrhages, excessive bleeding after tooth extractions, heavy bruising after relatively mild trauma, sickle cell disease/trait If notice petechiae ask about hx of bleeding disorders. Need to investigate- something is wrong -current health problems -swelling or lymph nodes, excessive bruising or bleeding, SOB on exertion, frequent infections, recent weight loss, paresthesia, tinnitus, FATIGUE, menorrhagia, palpitations, fevers, headaches, vertigo, sore tongue Chronic alcoholism= malnutrition, causes for anemia, decrease blood clotting **Spleen – normal is NOT palpable Dx Assessment Tests of cell # and function: CBC – most common ****5,000-10,000 mm3 Reticulocyte count Platelet count ****150,000-400,000mm3 “decreased-institute bleeding precautions” Hemoglobulin electrophoresis*** Female 12-16g/dL Male 14-18g/dL Leukocyte alkaline phosphatase Coombs’ test Serum ferritin, transferrin, and total iron-binding capacity Hematocrit ** 37-47%female 42-52%male Test Measuring Bleeding and Coagulation (see how hematologic system is responding) Prothrombin time (PT) International normalized ratio (INR) Partial thromboplastin time (PTT) Anti-Factor Xa Platelet aggregation Bone marrow aspiration and biopsy (require consent, RN witness signature, DR responsible) - Painful, are often afraid - Let them know they’ll have some pain, don’t lie - The more skilled the less it will hurt - Iliac crest or sternum 5-15 min - Follow up care (RN does) o External pressure till bleeding stops (can use sand bags) o Observe site for 24 HRS closely (can do at home) o Monitor site for bruising(internal bleeding) and infection o Assess site every 2 HRS (ice packs, analgesics..) o Avoid sports or any activity that can cause trauma (risk for fall) for 48 HRS but do NOT need to be on bed rest Bone marrow aspiration: cells and fluids are suctioned from the bone marrow (more comfortable than biopsy) Bone marrow biopsy: solid tissue and cells are obtained by coring out an area of bone marrow w/ a large-bore needle Anemia Reduction in either the # of RBC, the amount of hemoglobin, or the hematocrit Clinical sign (not a specific disease); a manifestation of several abnormal conditions Sx: FATIGUE, DYSPNEA (difficulty breathing), cool skin, etc. Classification of anemias: Hypoproliferative: resulting from defective RBC production - Iron deficiency (microcytic) o Common type of anemia, can result from blood loss, poor intestinal absorption, or inadequate diet o If mild- sx of fatigue, weakness, and pallor. If prolonged or severe can also have SMOOTH RED SORE TONGUE, brittle and ridged finger nails and angular chelosis o Lab findings:  Decreased- reticulocytes, iron, ferritin, iron saturation, MCV  Increased- Total Iron Binding Capacity (TIMC) – can bind more, just don’t have it o Evaluate adult pts for abnormal bleeding (GI tract) o Tx- increasing oral intake of iron from food sources, oral iron supplements, or IM/IV iron solutions o Vegetarians usually have o Contributing factor in heavy menstrual FOOD SOURCES HIGH IN IRON: organ meats, red meat, egg yolks, beans, leafy green vegetables, raisins, molasses Taking iron-richfoods w/ vitamin c enhances absorption on iron 10-15 mg of iron IRON SUPPLEMENTS (PILLS); best absorbed on empty stomach (1 HR Before or 2 HRS after meal) but if GI upset occurs take w/ food; antacids or dairy products should NOT be taken w/ iron because they greatly diminish absorption; liquid form can stain teeth=use straw; IV preferred over IM (z track, don’t run injection site) - Vitamin b12 deficiency (megaloblastic) o Lack of b12 causes improper DNA synthesis of RBCs o SX: memory problems, pallor, glossitis (BEEFY SMOOTH RED TONGUE), paresthesia, confusion, difficulty maintaining their balance, lose position sense (proprioception), jaundice, fatigue, weight loss *older adult-high risk for falls  Decreased vitamin b12; increased MCV – measure RMC o Poor intake of foods containing vitamin b12, small bowel resection, tapeworm, overgrowth of intestinal bacteria o Tx: vitamin b12 replacement (diet, oral supplements, IM or new nasal spray) o Pernicious anemia (anemia resulting from failure to absorb vitamin b12); caused by a deficiency of intrinsic factor (vitamin b12 absorption) - Decreased erythropoietin production (eg, from renal dysfunction) - Cancer/inflammation Chronic alcoholism-malnutrition folic deficiency, iron deficiency Bleeding: resulting from RBC loss - Bleeding from GI Tract - Epistaxis (nose bleed) - Trauma - Bleeding from genitourinary tract Hemolytic: resulting from RBC destruction - Classified as inherited or acquired - Inherited: abnormal hemoglobin, RBC membrane abnormality, Enzyme deficiencies - ACQURIED HEMOLYTIC ANEMIA o Results from increased RBC destruction occurring in response to trauma, infection (viral & malarial); exposure to certain chemicals or drugs, and autoimmune reactions o Increase the rate of RBC destruction by causing membrane lysis o Lab findings depends on causative factors o Tx and outlook: severity of how it is and what type it is  Can be sudden or slow.