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What makes up the blood?
- 45% formed elements (RBC, WBC, platelets)
- 55% plasma (fluid that formed elements floats around in) mostly water and 7% protien
What is albumin?
- made by liver
- maintains fluid balance
- low levels in liver failure patients or malnutrition
What is a RBC (erythrocytes)?
- bioconcave cell
- more broad that capillaries so it can fold to get through
What is Platelets (thrombocytes)?
aide in formation of clots
What are WBC?
What are neutrophils?
- componant of WBC
- aka-segs and bands
- elevate in response to injury, infection, inflammation
- first responders
Whay are lymphocytes?
- componant of wbc
- natural killers
- B cells and T cells
What are monocytes?
- componant of wbc
- when stimulates can ecome macrophages (phagocytic cells that engulf the invader)
- assist T cells
What are eosinophils?
- componant of wbc
- react in allergic response
What does hemaglobin do?
- enables blood to carry O2 through body
- patients with low hemaglobin have compromised O2 saturations
What is a normal hemaglobin?
What is a normal hematocrit?
What is a normal INR?
- healthy person less than 1
- Theraputic 2-3
- mechanical valve 2.5-3.5
What medication would we give if we need to monitor INR?
What is normal PTT and APTT?
- PTT- 60-70 seconds
- Appt- 30-45 seconds
What medication has us monitor PTT and APTT?
What are modifiable risk factors for bleeding?
- exposure to chemicals, enviroment
- sexual patterns
- aspirin use
- alcohol use
- drug toxicity
- occupational radiation
What are NON-modifiable risk factors for bleeding?
- ethnic background
- malabsorption syndrom
- history of liver disease
- history of malignancy
What is blood dysccrasias?
something abnormal about the blood
What are some types of RBC disorders?
- HYPOproliferation- (anemia)
- HYPERproliferation- (polycythemia)
What is the result of anemias?
decreased production, or distruction of RBC or blood loss
What is polychethemia?
increase in production RBC r/t hypoxia, erythropietin secreating tumors, kidney disease, genetic defects
Why do people living in a higher elevation have a higher H and H?
less O2 is available so they need more hemaglobin to carry o2
What is hypochromic anemia?
Iron or vitamin definciency
Who is at risk for iron defiency amenia?
- women of child bearing age
- pregnant or lactating women
- infants/children/ adolescents in rapid growth phases
- poor diet
- blood loss
- long term aspirin use
- colon cancer
What are signs and symptoms of anemia?
- brittle nails
- PICA (craving unusual substances)
- low iron
- low hgb and hct
What will a nurse do for a patient with anemia?
- assess patient (determine energy level, head to toe exam)
- identify problems
- set goals with patient
- educate patient on diet
- monitor lab work
- educate patient on replacement
what are some dietary sources for iron?
- dark leafy veggies
- dried beans and fruits
- lean meats
- wheat germ
How should iron supplement meds be taken?
- empty stomach is the best for absorption
- Orange juce aides in absorption
If diet does not increase iron levels what else can be done?
- PO supplements
- IV replacement
- Im replacement- use z-track (this medication is staining)
What is Epogen (Epoetin)?
- medication given IM
- stimulates production of RBC
- worried about impaired thinking
- It is man made erythropoietin
- store in fridge
- warm in hands
- do not shake
What is the sgnificance of a CBC with differntial?
It breaks down the blood cells to determine the types and number of cells in blood.
What is the difference between segs and bands?
segs are more mature neutrophils than bands
What are the norms for a differential blood count
- out of 100 cells
- neutrophils - 50-70%
- lymphocytes 25-35%
- monocytes 4-6%
- eosinophils 1-3%
- basophils less than 1%
What is pernicious anemia?
- chronic progressive anemia
- caused by lack of intrinsic factor
- hinders ability to absorb vit B12
Where does intrinsic factor come from?
a protien secreted by the stomach
What are causes of pernicious anemia?
- not enough secreted by stomach
- atrophic gastric mucousa
- auto immune disease against gastric cells
- autoimmunity to IF
- absence of IF (most common)
Whata re risk factors for Pernicious anemia?
- family hx
- northern europe decent
- history of autoimmune endocrine disease
What are signs and symptoms of pernicious anemia?
- sensory and motor never issues
- sortness of breath
- megaloblastic madness (looks like dementia)
How do we treat pernicious anemia?
- vitamin B 12 injections
- increase dairy products and meat intake
life long therapy
Where can you assess a patient to look for s/s of anemia?
- conjuctiva should be bright pink
- if not bright pink patient may have anemia
What is hemophilla?
- clotting disorder
- lack of factor 8 and 9
- body fails to clot
- more common in men
- caried by mom (sex linked trait)
What is Leukopenia?
- a drecrease n circulating WBC
- less than 5000
What is neutropenia?
decrease in neutorphils
precautions should be implemented with patients who have a ANC of 1000 or less per physicians order
What is a ANC?
absolute neutrophil count
How do caluculate ANC?
Total WBC (%segs +% bands)
We want patient to be above 1500
What is pancytopenia?
- a decrease in all cell numbers
- (WBC, RBC, platelets)
What are causes of leukopenia?
- autoimmune disorders (lupus)
- bone marrow diseases
- (leukemia, myelodysplastic syndrome)
What is leukemia?
bone marrow produces an abundance of immature blood cells called stem cells and blast
What is the differnce between chronic and acute leukemia?
- Chronic leukemia is slow and develops over time with a gradual increase in cells
- Acute leukemia has very abnormal rapidly rising blood cells
How is leukemia grouped?
- Chronic or acute
- and type of cell effected
- Lymphocytic= lymphnoid cells
- Myelocytic = myeloid cells
What are the four comon types of leukemia?
- CLL chronic lymphocytic leukemia
- CML chronic myloecytic leukemia
- ALL acute lymphocytic leukemia
- ALM acute myelocytic leukemia
Who most commonly has CLL?
people over 65
Who most commonly has CML?
Who most commonly has ALL?
- most common in children
- most CURABLE
Who most commonly has AML?
adults and kids with downs syndrome
What are risk factors for developing leukemia?
- radiation exposure
- Chemicals such as benzene, formaldhyde
- downs syndrome
- human T cell leukemia virus
- myelodysplastic syndrome
What are s/s of leukemia?
- night sweats
- frequent infections
- weak/ tired
- bleeding bruising
- bone and joint pain
- abdominal sweeling
- swollen lymph nodes
- weight loss
What does the nurse do for leukemia?
- assess patient
- get work hx
- assess for swollen lymph nodes
- CBC with differential
- before and after care for bone marrow biopsy
what should nurse do for bonemarroe biopsy
- comfort patient during procedure
- monitor for s/s of bleeding after
What are nursing Dx for leukemia?
- risk for infections
- altered nutrition
What are nurisng interventions for leukemia?
- educate pt on disease process, infection prevention, radiation, chemo
- be truthful with patient
- offer emotional support
- administer meds as ordered
What are treatments for leukemia?
- bone marrow transplant
- biological therapy
What is the goal for treating leukemia?
What is colony stimulating factor?
medications uses to stimulate production of WBC
What are examples of colony stimulating factors?
- Filgrastim (Neupogen)
- Pegfilgrastim (Neulasta)
- Sargramostim (Leukotine)
What is the action of colony stimultaing factors?
stimulate production of granulocytes and macrophages
What are indications for colony stimulating factors?
- aplastic anemia r/t chemo
- acceleration of bone marrow recovery in malignant lyphoma and hodgkins
- delayed or failed bone marrow transplant
- Increase wbc in patients taking a antiviral (zidovudine, used in HIV patients)
What are contraindications for patients taking colony stimulating factors Filgrastim (Neupogen) and Pegfilgrastim (Neulasta)?
- hypersensitivity to ecoli derived protiens
- because it is grown in ecoli
What are adverse reactions to colony stimulating factors?
- respiratory problems
- supraventricular arrythemias
- bone pain
- arthralgia / myalgia (muscle and joint pain)
- fluid retention
Colony stimulating factor can interact and cause problems with what meds?
What does a nurse do when a patient is taking colony stimulating factors?
- monitor WBC
- monitor s/s of infection
- D/C when ANL in with in normal limits
- teach patient about diet
How can chemotherapy be administered?
- IV- perpipheal or central line
- Into CSF if cancourous cells are found in csf
What is multiple myeloma?
- to many B cells (abnormal plasma cells)
- affects bones, immune system, kidneys and RBC
- cause unknown
What are s/s of multiple myeloma?
- they vary from person to person
- bone pain (back, pelvis, ribs, skull)
- pathological fractures
- frequent infections
- weight loss
- abnormal protien in blood (M protiens)
- protiens in urine (bence jones)
- polydipsia, polyuria, constipation, N/V/ anorexia confusion
What are tumor makers in multiple myeloma?
- bence jones protien in urine
- M protiens in blood
What are risk factors in multiple myeloma?
- sex (more common in men)
- Race (more common in african americans)
- history of monoclonal gammopathy of indetermined significance
What are complications of multiple myeloma?
- immpaired immuntiy (increase risk for infection)
- bone problems (pathological fractures)
- impaired renal function (r/t high calcium)
What is the treatment for multiple myeloma?
- When patient is assymptomatic continue to monitor
- radiation to spleen, and brain..if doesnt work then stem cell transplant
- stem cell transplant
Where can stem cells be obtained from for transplant?
- umbilical stem cell
- bone marrow stem cells
- peripheral stem cells
What are side effects to a bone (stemcell) marrow transplant?
- increased risk for infection
- s/s from high does of chemo and radiation
- transplant reactions
What is Hodgkins Lymphoma?
- reed-sternburg cells
- more curable than non hodgkin's
- enlarged lymph nodes
What is treatment for lymphoma?
- chemo if radiation unsuccessful or advanced stage
What is thrombocytopenia?
- low platelet count less than 150,000
- decreases patients ability to clot
What are s/s of thrombocytopenia?
- sudden onset of petechiae
- signs and symptoms of bleeding such as bruising