Adult Health Final
Bone Marrow
Responsible for blood formation
First produces blood stem cells
- Stem cells (immature) are capable of becoming any type of blood cell, depending on the body’s needs
o Red blood cells (RBCs, erythrocytes)
o White blood cells (WBCs, leukocytes)
o Platelets
Also has role in immune responses
Located in flat bones (sternum, skull, pelvic and shoulder girdles) and ends of long bones
Blood Components
Composed of plasma and cells
Plasma is an extracellular fluid with plasma proteins
- Albumin: maintain osmotic pressure of blood
- Globulins: transport of antibodies
- Fibrinogen: important in clotting
Blood cells
- RBCs
o Largest proportion of blood cessl
o Produce hemoglobin which carries oxygen and carbon dioxide
o Iron is important component of hemoglobin
- WBCs
o Role in inflammation and infection protection
- Platelets
o Smallest blood cell
o Stick to injured vessel walls and aggregate to assist clotting
o Stored in spleen
Accessory Organs of Blood Formation
Spleen
- Destroys old or imperfect RBCs
- Breaks down the hemoglobin
- Stores platelets
- Antibody production and filters antigens
o After a splenectomy, patients have reduced immune functions
Liver
- Produces prothrombin and other blood clotting factors
- Assists in the forming of Vitamin K in the intestines
- Stores blood cells
- Stores iron in the form of ferritin
,Hematologic Changes Associated with Aging **
Decreased blood volume
Lower levels of plasma proteins
- Could be related to decrease in protein intake
Bone Marrow produces less blood cells
- RBC and WBC counts decrease
- Platelet counts do not change with age
Hemoglobin levels in men and women fall after middle age
- Could be related to decrease in iron intake
Immune responses change
- WBC counts may be lower
- WBC count does not rise as high in response to infection in older adults
- Antibody levels and responses are lower and slower in older adults
- Lymphocytes become less reactive to antigens
Assessment Methods
Patient history
- Age
- Gender
o Females have lower red blood cells
- Liver function
- Presence of known immunologic or hematologic disorders
- Drug use
o Some medications can cause bone marrow suppression, hemolysis, or disrupt platelet action or
clotting factors
Nutrition status
Environmental exposure
Family history and genetic risk
- Many disorders are inherited
o Ex. Sickle cell, hemophilia
Current health problems
- Lymph node swelling
- Excessive bruising or bleeding
- Common symptoms with hematological disease:
o shortness of breath on exertion, palpitations, frequent infections, fevers, recent weight loss,
headaches, paresthesia
- Most common manifestation of anemia is fatigue as a result of decreased oxygen delivery to cells
Physical Assessment
Skin
- Inspect skin and mucous membranes for pallor
- Assess nail beds for pallor or cyanosis
o Pallor of the gums, conjunctivae, and palmar creases indicates decreased hemoglobin levels and
poor tissue oxygenation
- Inspect for petechiae and ecchymoses
Head & Neck
- Check for pallor or ulceration of the oral mucosa
- Inspect and palpate all lymph node areas
Respiratory
- Assess respirations and dyspnea at rest and on exertion
, - Assess for fatigue
- Orthopnea
Cardiovascular
- Assess pulses, BP
- Abnormal heart sounds
- Irregular rhythms
Kidney & Urinary
- Assess urine for hematuria
Musculoskeletal
- Rib or sternal tenderness may occur with leukemia
- Assess range of joint motion, document any swelling or joint pain
Abdominal
- Evaluate spleen
o Normal adult spleen is usually not palpable
o Enlarged spleen may occur with many hematologic problems
- Stool specimen to check for occult blood testing
Central Nervous System
- Neurologic checks and checks of cognitive function
Bone Marrow Aspiration and Biopsy
Evaluates hematologic status
- Specifically for a possible problem in blood cell production or maturation
Invasive procedure
Aspiration
- Cells and fluids are suctioned from the bone marrow
Biopsy
- Solid tissue and cells are obtained by coring out an area of bone marrow with a large-bore needle
Informed consent needed
Preparation:
- Provide information and emotional support
- Explain the procedure
o Local anesthetic is used and may feel stinging or burning sensation
o Mild tranquilizer or a rapid-acting sedative could be used
o Expect a heavy sensation of pressure and pushing while the needle is being inserted
- Positioning
o Usually use the iliac crest
o Patient should be placed in the prone or side-lying position
Post procedure care:
- Hold pressure briefly to site
- Cover the site with a dressing after bleeding is controlled
- Give mild analgesic for discomfort
- Apply ice bag to the needle site to limit bruising
- Observe site every 2 hours for 24 hours for signs of bleeding, bruising, and infection
- Advise the patient to avoid contact sports or any activity that might result in trauma to the site for 48 hours
Cancer
Mutations of normal cells and are harmful to body tissues
- Cell growth is rapid
Bone Marrow
Responsible for blood formation
First produces blood stem cells
- Stem cells (immature) are capable of becoming any type of blood cell, depending on the body’s needs
o Red blood cells (RBCs, erythrocytes)
o White blood cells (WBCs, leukocytes)
o Platelets
Also has role in immune responses
Located in flat bones (sternum, skull, pelvic and shoulder girdles) and ends of long bones
Blood Components
Composed of plasma and cells
Plasma is an extracellular fluid with plasma proteins
- Albumin: maintain osmotic pressure of blood
- Globulins: transport of antibodies
- Fibrinogen: important in clotting
Blood cells
- RBCs
o Largest proportion of blood cessl
o Produce hemoglobin which carries oxygen and carbon dioxide
o Iron is important component of hemoglobin
- WBCs
o Role in inflammation and infection protection
- Platelets
o Smallest blood cell
o Stick to injured vessel walls and aggregate to assist clotting
o Stored in spleen
Accessory Organs of Blood Formation
Spleen
- Destroys old or imperfect RBCs
- Breaks down the hemoglobin
- Stores platelets
- Antibody production and filters antigens
o After a splenectomy, patients have reduced immune functions
Liver
- Produces prothrombin and other blood clotting factors
- Assists in the forming of Vitamin K in the intestines
- Stores blood cells
- Stores iron in the form of ferritin
,Hematologic Changes Associated with Aging **
Decreased blood volume
Lower levels of plasma proteins
- Could be related to decrease in protein intake
Bone Marrow produces less blood cells
- RBC and WBC counts decrease
- Platelet counts do not change with age
Hemoglobin levels in men and women fall after middle age
- Could be related to decrease in iron intake
Immune responses change
- WBC counts may be lower
- WBC count does not rise as high in response to infection in older adults
- Antibody levels and responses are lower and slower in older adults
- Lymphocytes become less reactive to antigens
Assessment Methods
Patient history
- Age
- Gender
o Females have lower red blood cells
- Liver function
- Presence of known immunologic or hematologic disorders
- Drug use
o Some medications can cause bone marrow suppression, hemolysis, or disrupt platelet action or
clotting factors
Nutrition status
Environmental exposure
Family history and genetic risk
- Many disorders are inherited
o Ex. Sickle cell, hemophilia
Current health problems
- Lymph node swelling
- Excessive bruising or bleeding
- Common symptoms with hematological disease:
o shortness of breath on exertion, palpitations, frequent infections, fevers, recent weight loss,
headaches, paresthesia
- Most common manifestation of anemia is fatigue as a result of decreased oxygen delivery to cells
Physical Assessment
Skin
- Inspect skin and mucous membranes for pallor
- Assess nail beds for pallor or cyanosis
o Pallor of the gums, conjunctivae, and palmar creases indicates decreased hemoglobin levels and
poor tissue oxygenation
- Inspect for petechiae and ecchymoses
Head & Neck
- Check for pallor or ulceration of the oral mucosa
- Inspect and palpate all lymph node areas
Respiratory
- Assess respirations and dyspnea at rest and on exertion
, - Assess for fatigue
- Orthopnea
Cardiovascular
- Assess pulses, BP
- Abnormal heart sounds
- Irregular rhythms
Kidney & Urinary
- Assess urine for hematuria
Musculoskeletal
- Rib or sternal tenderness may occur with leukemia
- Assess range of joint motion, document any swelling or joint pain
Abdominal
- Evaluate spleen
o Normal adult spleen is usually not palpable
o Enlarged spleen may occur with many hematologic problems
- Stool specimen to check for occult blood testing
Central Nervous System
- Neurologic checks and checks of cognitive function
Bone Marrow Aspiration and Biopsy
Evaluates hematologic status
- Specifically for a possible problem in blood cell production or maturation
Invasive procedure
Aspiration
- Cells and fluids are suctioned from the bone marrow
Biopsy
- Solid tissue and cells are obtained by coring out an area of bone marrow with a large-bore needle
Informed consent needed
Preparation:
- Provide information and emotional support
- Explain the procedure
o Local anesthetic is used and may feel stinging or burning sensation
o Mild tranquilizer or a rapid-acting sedative could be used
o Expect a heavy sensation of pressure and pushing while the needle is being inserted
- Positioning
o Usually use the iliac crest
o Patient should be placed in the prone or side-lying position
Post procedure care:
- Hold pressure briefly to site
- Cover the site with a dressing after bleeding is controlled
- Give mild analgesic for discomfort
- Apply ice bag to the needle site to limit bruising
- Observe site every 2 hours for 24 hours for signs of bleeding, bruising, and infection
- Advise the patient to avoid contact sports or any activity that might result in trauma to the site for 48 hours
Cancer
Mutations of normal cells and are harmful to body tissues
- Cell growth is rapid
