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Hematologic HIV Immunologic Disorders
chapter 32 33 34
What are the two components Ige work with?
Basophils and mast cells to release histamine
Anatomic structures and components:
- Stem cells
- WBC (leukocytes)
- basophils have to do with the blood
- mast cells have to do with tissue
What does histamine call upon?
What does Basophil Ige release?
The bone produce WBC's. Five major types of WBC's exist:
Function of Eosinophils;
To combat parasitic infections
They are also associated with allergic reactions and other inflammatory processes.
Function of Basophils;
Can initiate a massive inflammation response that quickly brings other WBC's to the site of the infection.
Multistep of inflammation:
When does Active acquired immunity occur?
when a person synthesizes his or her own antibodies in response to a pathogen.
shift to the left
on a CBC indicates:
The percentage of WBC's that are neutrophils is greater than 60%.
shift to right
on a CBC indicates:
Only a small percentage of the WBC's are neutrophils.
- the body is overwhelmed with infection
- bone marrow not producing neutrophils
(less than 60%)
Neutropenia is caused by:
decreased bone marrow production
Skin test serve as a barometer of:
Immune system functioning
What does the skin test point out?
Hyposensitivities or hypersensitivities to a particular antigen.
Some examples of allergens used in skin testing include:
purified protein derivative
Low platelet count
Regarding infection, patients with leukemia are at great risk for bleeding r/t:
Intervention: risk for injury;
for the patient with acute leukemia includes;
Uncooked foods because naturally they contain the bacteria
Escherichia coli, Pseudomonas aeruginosa and Klebsiella
Assessment for Leukemia:
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
Hypersensitivity Reaction Type IV
Delayed hypersensitivity reactions result from immune cells migrating to the sit of exposure days after the exposure to the antigen
Can occur with;
tuberculin skin testing
What is ITP?
Idiopathic thrombocytopenia purpura
Drugs that induce ITP;
Why don't thrombocytopenia get platelet transfusions?
because they are destroyed.
Function of the spleen;
filters microorganisms from the blood.
What is TTP?
Thrombotic Thrombocytopenia Purpura
Main treatment for TTP;
Transfusions are contraindicated for TTP;
because platelets cause extreme clotting and makes the disease worse.
90% of Lupus patients are;
women of child bearing age
Signs and symptoms of Systemic Lupus Erythematosus;
Rash and photsensitivity:
-butterfly shaped rash across the bridge of nose and cheeks.
Medical treatment for Lupus;
SLE (systemic lupus erythematosus) intervention;
Disturbed body image: rash, avoid sun; use sun block SPF >15
Musculoskeletal symptoms of SLE;
are experienced by 95% of patients at some time during the course of their disease, includes;
athralgias (joint pain)
myalgias (muscle pain)
Drugs used to prevent rejection of a transplant organ:
Steroid agents; Decadron
: 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)
Give these drugs with meals.
Bone marrow Transplant and Peripheral Blood Stem cell Transplant:
Restore hematologic and immunologic systems
Three main types of transplants are:
(1) allogenic bone marrow transplant
(2) autogolus bone marrow transplant
(3) peripheral blood stem cell transplant
(2)Autogulous bone marrow transplant;
patients own bone marrow is harvested then re-infused
used in solid tumor
(1)Allogenic bone marrow transplant;
bone marrow from a human leukocyte antigen matched donor is infuse into the patient
(3)Peripheral blood stem cell transplant;
similar to hemodialysis; stem cells are harvested, which are later returned to the patient.
Red blood cells have proteins called;
Antigens ( A and B)
What is the primary function of the hematologic system?
oxygenation and hemostasis (control of bleeding)
The liver performs many functions for different parts of the body systems. As part of the hematologic system the liver;
manufactures clotting factors
Function of the spleen;
removes old RBC's from circulation
Fibrinogen (factor I)
Thrombin (factor II)
Age-Related changes in hematology;
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.
Family history of hematologic disorders include;
Death of a family member at a young age for reasons other than trauma may indicate;
A genetic hematologic disorder
What is Epistaxis?
unexplained nose bleeds
Epistaxis is an example of a;
clotting factor disorder
Orthostatic changes in b/p and pulse are;
B/P decreases 15 to 20 points
Pulse increases 15 to 20 points
Most common site for a bone marrow biopsy is;
posterior iliac crest
anterior iliac crest
After a bone marrow biopsy, the nurse should;
check the site for bleeding
apply pressure dressing
In a physical assessment: what would cracking at the corners of the mouth indicate?
decrease amount of vitamin D
Blood test:RBC, Hct, Hgb, platelet count for both men and women
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
Hematocrit is usually;
3x the hemoglobin
A reduction in the number of rbc's or in the quatitiy of hgb in the blood is ;
small 1-3 mm red or reddish purple spots on the skin resulting from capillaries breaking and leaking small amounts of blood into the tissues are:
too many RBC's
What activates the blood clotting system?
Platelets or Thrombocytes
:Nursing actions for the patient at
Risk for Injury
from low red blood cell counts:
Oxygen as ordered
Blood products (erythropoietin)
Allow for rest periods
Elevate patients head with a pillow
Keep warm (blankets)
Nursing action for the patient at
Risk for Injury
Avoid prolonged tourniquet use, IM's, suppositories enemas
Hygiene (for everyone)
Common blood products:
FFP (fresh frozen Plasma)
Cryoprecipatate (used for hemophilia)
What is needed prior to a patient receiving a blood transfusion?
Using the patients own blood
Proper order of administration of blood;
*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
*Give blood over 2-4 hrs
*Stay with patient 5-10 minutes after
* Check for reaction
: such as; back pain,
fever, chills or decrease b/p and elevated
* Monitor vitals per protocol.
With a platelet transfusion, each platelet pack should;
Increase platelet count to 5,000-10,000
What blood product used for transfusion does not contain platelets?
FFP (fresh frozen plasma)
Name for the four main types of reactions to blood transfusions;
Some s/s of a reaction are: chest pain, fever, chills, decreased blood pressure, wheezing, coughing. Occurs during the transfusion
If a patient has a reaction to a blood transfusion, what should be done?
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.
Naturally occurring hormones that stimulate the bone marrow to produce more blood cells:
Stimulates the bone marrow to produce more
red blood cells.
Effects on the hematocrit not apparent for
Drugs commonly used to treat hematologic system disorders include;
stimulates bone marrow to produce
:stimulate bone marrow to produce
:iron replacement (causes
iron replacement; administer
by IM/ Z-track
Replacement; IM injection
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
In acute or chronic blood disorders the body compensates in 3 ways:
1. By increasing heart rate and respiratory
2. Redistribution of blood away from the skin.
3. Produces more erythropoietin to produce
produce new RBC's.
What is Polycythemia Vera?
a condition where too many RBC's are produced.
is to have a unit of blood phlebo-
tomized, or taken off, to keep the hematocrit normal.
What is aplastic anemia a result of?
A complete failure of the bone marrow
Extremely low RBC count
: certain drugs, and exposure to toxic chemicals and radiation.
Signs and symptoms of Aplastic Anemia include;
shortness of breath
unusually prolonged or spontaneous excessive bleeding.
Autoimmune Hemolytic Anemia;
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
Signs and symptoms of Autoimmune Hemolytic Anemia:
Shortness of breath
Patients may appear Jaundice due to low RBC/Bilirubin.
Patients have a positive Coombs' antiglubulin blood test, it is common.
: Identifying & treating the cause.
What would cause a person to suffer from pernicious anemia?
Lack of intrinsic factor
Signs & symptoms of pernicious anemia:
a sore tongue
numbness of hands or feet
: Monthly injections of vitamin B12 for life for gastrectomy patient.
Sickle Cell Anemia:
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
What kind of a disease is sickle cell disease?
Genetic disease; recessive gene from mom or dad.
Signs and symptoms:
low red blood cell count
elevated respiratory rate
Sickle cell crisis: triggers are;
cold weather changes
excessive alcohol consumption
How is sickle cell crisis determined?
there is no test to determine sickle cell crisis
Medical treatment for sickle cell crisis
Hydroxyurea- commonly used to treat leukemia; prevents sickle cell crisis.
too few platelets circulating in the blood; issues is bleeding
petechiae and purpura, gingival bleeding,epistaxis, or unusual bleeding.
Examples of thrombocytopenia:
ITP; idiopathic thrombocytopenic purpura
TTP; thrombotic thrombocytopenic purpura
DIC: dissimenated intravascular coagulation
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.
Interventions for Hemophilia:
Risk for injury
Ineffective therapeutic Regimen management.
Hemophilia patient teaching:
Protect from injury