LPN 41

Basophils and mast cells to release histamine

• - Spleen
• - Thymus
• - Stem cells
• - WBC (leukocytes)
• - Neutrophils
• - basophils have to do with the blood
• - mast cells have to do with tissue

Macrophages

Histamine

• neutrophils
• basophils
• eosinophils
• neutrophils
• monocytes

• To combat parasitic infections
• They are also associated with allergic reactions and other inflammatory processes.

Can initiate a massive inflammation response that quickly brings other WBC's to the site of the infection.

• Rubor (redness)
• Tumor (swelling)
• Calor (heat)

when a person synthesizes his or her own antibodies in response to a pathogen.

The percentage of WBC's that are neutrophils is greater than 60%.

Only a small percentage of the WBC's are neutrophils.

• Occurs when:
• - the body is overwhelmed with infection
• - bone marrow not producing neutrophils
• (less than 60%)

• decreased bone marrow production
• chemotherapy
• radiation therapy
• certain drugs
• autoimmune reaction

Immune system functioning

Hyposensitivities or hypersensitivities to a particular antigen.

• dust
• pollen
• animal dander
• purified protein derivative
• tuberculin bacillus
• candida albicans

Low platelet count

Thrombocytopenia

Uncooked foods because naturally they contain the bacteria Escherichia coli, Pseudomonas aeruginosa and Klebsiella spp.

• Assess for any evidence of bleeding;
• the lower the platelet count the greater the risk for bleeding

• platelet count <50,000 cell per/mm3
• causes patient to continue bleeding

Delayed hypersensitivity reactions result from immune cells migrating to the sit of exposure days after the exposure to the antigen

• Can occur with;
• contact dermatitis
• measles rash
• tuberculin skin testing
• various drugs
• drug allergies

Idiopathic thrombocytopenia purpura

• sulfonamides
• thiazide diuretics
• chlorpropamide
• quinidine
• gold

because they are destroyed.

filters microorganisms from the blood.

Thrombotic Thrombocytopenia Purpura

Plasmapheresis

because platelets cause extreme clotting and makes the disease worse.

women of child bearing age

• Musculoskeletal symptoms:
• -Arthralgias
• -Myalgias
• Rash and photsensitivity:
• -butterfly shaped rash across the bridge of nose and cheeks.

No treatment

Disturbed body image: rash, avoid sun; use sun block SPF >15

• are experienced by 95% of patients at some time during the course of their disease, includes;
• athralgias (joint pain)
• myalgias (muscle pain)

• Steroid agents; Decadron
• use/action: to prevent rejection of a transplant organ b/c glucocorticoid agents interfere with eicosanoid production.

Also used to treat acute hypersensitivity reaction type I (anaphylaxis)

• Nursing intervention:
• Give these drugs with meals.

Restore hematologic and immunologic systems

• (1) allogenic bone marrow transplant
• (2) autogolus bone marrow transplant
• (3) peripheral blood stem cell transplant

patients own bone marrow is harvested then re-infused

used in solid tumor

bone marrow from a human leukocyte antigen matched donor is infuse into the patient

similar to hemodialysis; stem cells are harvested, which are later returned to the patient.

Antigens ( A and B)

oxygenation and hemostasis (control of bleeding)

manufactures clotting factors

removes old RBC's from circulation

• Fibrinogen (factor I)
• Thrombin (factor II)

bone marrow becomes less productive

• hematologic function not affected unless a person is:
• a person is unusually stressed
• a chronic illness
• treatment for cancer

In conditions necessitating a higher production of blood cells, bone marrow usually responds to the increased demand, given time.

• Sickle cell
• Hemophilia

A genetic hematologic disorder

unexplained nose bleeds

clotting factor disorder

• B/P decreases 15 to 20 points
• Pulse increases 15 to 20 points

• posterior iliac crest
• anterior iliac crest
• sternum
• tibia

• check the site for bleeding
• apply pressure dressing

decrease amount of vitamin D

• RBC male=4.6-6.2/female= 4.2-5.4 million
• Hgb male= 13-18 female= 12-16
• Hct male= 40-54% female= 37-47%
• platelet count- 140,000 to 400,000
• Iron- measures the patients ability to produce RBC's

3x the hemoglobin

Anemia

type O

type AB

Petechiae

too many RBC's

Platelets or Thrombocytes

• Oxygen as ordered
• Blood products (erythropoietin)
• Allow for rest periods
• Elevate patients head with a pillow
• Keep warm (blankets)
• teaching

• Blood transfusions
• Avoid prolonged tourniquet use, IM's, suppositories enemas
• Prevent constipation
• BP
• Hygiene (for everyone)

• RBC
• Platelets
• FFP (fresh frozen Plasma)
• Cryoprecipatate (used for hemophilia)

Signed consent

Using the patients own blood

• *Consent form
• *Sample of blood is drawn and sent to blood
• blood bank to be crossmatched
• *IV line of NS with 18 or 20gauge (16gauge)
• *Check by 2 people
• *Start within 30 mins
• *Take vitals
• *Give blood over 2-4 hrs
• *Stay with patient 5-10 minutes after
• starting blood
• * Check for reaction: such as; back pain,
• fever, chills or decrease b/p and elevated
• temperature
• * Monitor vitals per protocol.

Increase platelet count to 5,000-10,000

FFP (fresh frozen plasma)

• Hemolytic
• Anaphylactic
• Febrile
• Circulatory overload

Some s/s of a reaction are: chest pain, fever, chills, decreased blood pressure, wheezing, coughing. Occurs during the transfusion

After stopping the transfusion, the nurse must immediately notify the physician, nurse supervisor and the blood bank.

The blood product should be returned to the blood bank.

• Erythropoietin (Epogen)
• Stimulates the bone marrow to produce more
• red blood cells.
• Effects on the hematocrit not apparent for
• several days.

• Epogen: stimulates bone marrow to produce
• RBC's
• Neumega:stimulate bone marrow to produce
• platelets
• Ferrous sulfate:iron replacement (causes
• constipation).
• Iron Dextran:iron replacement; administer
• by IM/ Z-track
• Vitamin B12:Replacement; IM injection
• Hydroxyurea:Prevention of sickle cell crisis

• May have too many or too few rbc's
• May be due to acute or chronic blood loss
• Having too few is seen more commonly

• 1. By increasing heart rate and respiratory
• rate.
• 2. Redistribution of blood away from the skin.
• 3. Produces more erythropoietin to produce
• produce new RBC's.

• a condition where too many RBC's are produced.
• Treatment: is to have a unit of blood phlebo-
• tomized, or taken off, to keep the hematocrit normal.

• A complete failure of the bone marrow
• Extremely low RBC count
• Caused by: certain drugs, and exposure to toxic chemicals and radiation.

• pallor
• extreme fatigue
• tachycardia
• shortness of breath
• hypotension
• unusually prolonged or spontaneous excessive bleeding.

• Seen in newborns, can occur after delivery if the mom has Rh-negative blood and the baby has Rh-positive blood.
• Can cause problems to the baby
• Are usually given Rogam

• Pallor
• Extreme fatigue
• Tachycardia
• Shortness of breath
• Hypotension
• Patients may appear Jaundice due to low RBC/Bilirubin.
• Patients have a positive Coombs' antiglubulin blood test, it is common.
• Medical Treatment: Identifying & treating the cause.

• Lack of intrinsic factor
• Gastrectomy/no stomach
• Alcoholic

• fatigue
• pallor
• weakness
• a sore tongue
• numbness of hands or feet
• Treatment include: Monthly injections of vitamin B12 for life for gastrectomy patient.

• A disease which disk shaped rbc's become sickle shape.
• Misshapen cells more fragile than normal rbc's.
• Sickled cells easily rupture as they pass thru small capillaries;they also get stuck in capillaries causing an obstruction of blood flow

• Genetic disease; recessive gene from mom or dad.
• Signs and symptoms:
• low red blood cell count
• fatigue
• jaundice
• cardiomegaly
• elevated respiratory rate

• dehydration
• infection
• smoking
• cold weather changes
• over exertion
• excessive alcohol consumption

there is no test to determine sickle cell crisis

Hydroxyurea- commonly used to treat leukemia; prevents sickle cell crisis.

• too few platelets circulating in the blood; issues is bleeding
• Classic symptoms:petechiae and purpura, gingival bleeding,epistaxis, or unusual bleeding.

• ITP; idiopathic thrombocytopenic purpura
• TTP; thrombotic thrombocytopenic purpura

• A hypercoagulable state
• Over stimulation of normal coagulation cascade; sinultaneous thrombosis and hemorrage.
• Always secondary to another pathologic process; sepsi, shock, major trauma, crush injuries, burns, cancer, acut tumor lysis symdrome or obstetrics complications.

• Uncontrollable bleeding is the hallmark of hemophilia. Occurs after trauma, however, also spontaneously for no reason.
• More common in type A blood
• Factors VIII and IX are missing
• Women who carry the trait pass it to their sons.

• Risk for injury
• Acute pain
• Ineffective therapeutic Regimen management.

• Protect from injury
• First Aid.