Care of the Patient with a Blood or Lymphatic Disorder. ph Volume pints. Red blood cells (RBC) White blood cells (WBC)

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1 Slide 1 Chapter 7 Care of the Patient with a Blood or Lymphatic Disorder 1 Slide 1 Overview of Anatomy and Physiology Characteristics of blood Consistency (viscous) 45% blood cells RBC WBC Platelets 55% blood plasma ph Volume pints Slide Slide 2 2 Overview of Anatomy and Physiology Red blood cells (RBC) Erythrocytes Transport oxygen and carbon dioxide White blood cells (WBC) Leukocytes Body defenses: : destruction of bacteria and viruses (Soldiers) Thrombocytes (platelets) Initiate blood clotting ting Slide Slide 3 3

2 Slide 4 Figure 7-17 (From Thibodeau, G.A., Patton, K.T. [2003]. Anatomy and physiology. [5 th ed.]. St. Louis: Mosby.) Human blood cells. Slide 4 Figure 7-27 (From Thibodeau, G.A., Patton, K.T. [2005]. The human body in health and disease. [4 th ed.]. St. Louis: Mosby.) Blood clotting. Slide Slide 5 5 Overview of Anatomy and Physiology Hemostasis: : clotting process ( prevents hemorrhage) Injury Hemorrhage Grouping platelets Thromboplastin released Links with fibrinogen Formation of fibrin Trap RBCs and platelets Forms clot Slide Slide 6 6

3 Slide 7 Overview of Anatomy and Physiology Blood types (groups) Determined by the presence or absence of specific antigens on the outer surface of the RBC Type A Type B Type AB Universal recipient Type O Universal donor Slide 7 Overview of Anatomy and Physiology Rh factor Rh antibodies may be located on the surface of the RBC Rh positive: antibodies are present Rh negative: antibodies are not present Slide Slide 8 8 Overview of Anatomy and Physiology Lymphatic system Functions 1 Maintenance of fluid balance 2 Production of lymphocytes 3 Absorption and transportation of lipids from the intestine to the bloodstream Slide Slide 9 9

4 Slide 10 Overview of Anatomy and Physiology Lymphatic system Lymph and lymph vessels Lymph is a specialized fluid formed in the tissue spaces transported by way of the lymphatic vessels and reenters the circulatory system Lymphatic tissue Lymph nodes Act as filters, keeping particulate matter such as bacteria from entering bloodstream Slide 10 Lymph system 3 circulatory systems Venous (veins) arterial lymph Slide Slide We have lymph nodes Lymph system Slide Slide 12 12

5 Slide 13 Overview of Anatomy and Physiology Lymphatic tissue (continued) Tonsils Produce lymphocytes and antibodies: trap bacteria Spleen* Reservoir for blood; Stores 1 pt for emergencies; forms lymphocytes, monocytes, and plasma; destroys worn-out out RBCs; ; removes bacteria Thymus Immune system before and a few months after birth; atrophies at puberty Slide 13 Figure 7-47 (From Thibodeau, G.A., Patton, K.T. [2003]. Anatomy and physiology. [5 th ed.]. St. Louis: Mosby.) Principal organs of the lymphatic system. Slide Slide Disorders of the Hematological and Lymphatic Systems Diagnostic tests Complete blood count (CBC) (assesses RBC and WBC) CBC with differential (WBC( WBC s counted in %) Red cell indices Peripheral smear Schilling test Megaloblastic anemia profile Lymphangiography Bone marrow aspiration or biopsy Slide Slide 15 15

6 Slide 16 Blood Disorders (RBC) Anemia Definition Disorder characterized by RBC and hemoglobin and hematocrit levels below normal range Hemoglobin range Men Women Hematocrit ranges Men42-52% Women 37-47% Causes delivery of insufficient amounts of oxygen to tissues and cells Slide 16 Blood Disorders (RBC) anemia 5 Types of anemia 1. Hypovolemic Anemia 2. Pernicious Anemia 3. Aplastic Anemia 4. Iron Deficiency Anemia 5. Sickle Cell Anemia Slide Slide Hypovolemic anemia Abnormally low circulating blood volume due to blood loss 500 ml loss can be tolerated 1000 ml loss can cause severe complications Severity and signs and symptoms depend on how rapid the blood is lost Slide Slide 18 18

7 Slide 19 Blood Disorders - Anemia 1. Hypovolemic anemia (continued) Weakness Stupor; irritability Pale, cool, moist skin Hypotension Tachycardia (rapid, weak, thready pulse) Hypothermia Hemoglobin less than 10 g/100 ml Hematocrit less than 40% Slide Hypovolemic anemia (continued) Control bleeding Treat shock O 2, elevate lower extremities, keep warm Replace fluid Blood transfusion, plasma, dextran, lactated Ringer s Monitor vital signs Slide Slide Pernicious anemia* Absence of the intrinsic factor which is essential for the absorption of Vitamin B 12 * Deficiency of vitamin B 12 * affects growth and maturity of all body cells Vitamin B 12 is also related to nerve myelination (shield) nerves can degenerate Slide Slide 21 21

8 Slide Pernicious anemia (continued) Extreme weakness Dyspnea Fever Hypoxia Weight loss Jaundice (destruction of RBCs) Pallor GI complaints Slide 22 Blood Disorders-Anemia 2. Pernicious anemia (continued) Dysphagia Sore, burning tongue Smooth and erythematous Neurological symptoms Tingling of the hands and feet Disorientation Personality changes; behavior problems Partial or total paralysis Slide Slide Pernicious anemia (continued) Vitamin B 12 units Daily for 1 week Weekly for 1 month Monthly for life** 12 (cyanocobalamin)) 1000 Folic acid supplement Iron replacement RBC transfusion Diet: high in protein, vitamins, and minerals Slide Slide 24 24

9 Slide Aplastic anemia* 3. bone marrow fails to produce enough red blood cells* Primary Congenital Secondary Viral invasion Medications Chemicals Radiation; chemotherapy Slide Aplastic anemia (Aplasia( failure to process cells normally*) Repeated infections with high fevers Fatigue, weakness, malaise Dyspnea Palpitations Bleeding tendencies Slide Slide Aplastic anemia (continued) Identify and remove cause Platelet transfusion for severe thrombocytopenia Splenectomy for hypersplenism Steroids and androgens Antithymocyte globulin Bone marrow transplant Slide Slide 27 27

10 Slide Iron deficiency anemia RBCs contain decreased levels of hemoglobin Excessive iron loss Caused by chronic bleeding intestinal, intestinal, uterine, gastric Pallor Fatigue; weakness Shortness of breath Angina; signs and symptoms of heart failure Glossitis; ; burning tongue Pagophagia Headache Paresthesia Slide Iron deficiency anemia (continued) Ferrous sulfate 900 mg daily Oral or injection (Z-track) Ascorbic acid Diet high in iron Pt teaching: Iron pills causes black tary stool* Slide Slide Sickle cell anemia 5. An abnormal, crescent-shaped shaped RBC Severe, chronic, incurable condition Disease Homozygous Trait Heterozygous 1 in 500 African Americans has it * Slide Slide 30 30

11 Slide Sickle cell anemia (continued) Precipitating factors Dehydration Change in oxygen tension in the body Loss of appetite Irritability Weakness Abdominal enlargement Joint and back pain Edema of extremities Slide Sickle cell anemia (continued) No specific treatment alleviate alleviate symptoms Oxygen Rest Fluids Analgesics Bone marrow transplant Slide Slide Blood Disorders (WBC) Agranulocytosis (caused by) Severe reduction in the number of granulocytes*(leukopenia leukopenia) WBC less than 200/mm 3 (normal ( is ,000) Medications Chemotherapy Radiation Neoplastic disease Viral and bacterial infections Slide Slide 33 33

12 Slide 34 Blood Disorders (WBC) Agranulocytosis (continued) Symptoms of infection (no soldiers!) *avoid infection Ulcerations of mucous membranes Bronchial pneumonia Urinary tract infection Remove cause of bone marrow depression Prevent or treat infections Meticulous handwashing avoid infection* Strict asepsis Slide 34 Blood Disorders (WBC) Leukemia* know definition Leukemia* Etiology/pathophysiology Malignant disorder of the hematopoietic system Excess leukocytes accumulate in the bone marrow and lymph nodes* Cause unknown Classification Acute or chronic Proliferating cells (lymphocytic( lymphocytic, monocytic, etc.) Slide Slide Blood Disorders (WBC) Leukemia (continued) Anemia Thrombocytopenia; leukopenia Enlarged lymph nodes Splenomegaly Chemotherapy; radiation Bone marrow transplant Medications: Leukeran, hydroxyurea, corticosteroids, Cytoxan Slide Slide 36 36

13 Slide 37 Blood Disorders (platelet) Thrombocytopenia Etiology/pathophysiology Condition in which the number of platelets is reduced below 100,000/mm 3 ; may be due to decreased production or decreased survival Petechiae Ecchymoses Platelets below 100,000/mm 3 Bleeding from mucous membranes Slide 37 Blood Disorders (platelet) Thrombocytopenia (continued) Corticosteriod therapy Splenectomy Gamma globulin Immunosuppressive drugs Platelet transfusions Avoid trauma Slide Slide Blood Disorders (platelet) Hemophilia Etiology/pathophysiology Hereditary coagulation disorder,, characterized by a disturbance of clotting factor Hemophilia A; hemophilia B X-linked hereditary trait Clinical manifestations/assessment Internal and external bleeding Hemarthrosis Excessive blood loss from small cuts and dental Excessive blood loss from small cuts and dental procedures Slide Slide 39 39

14 Slide 40 Blood Disorders (platelet) Hemophilia (continued) Minimize bleeding avoid trauma Relieve pain no no aspirin Transfusions Factor VIII or IX concentrate Cryoprecipitate (rich in factor VIII) Manufactured factor VIII or IX Slide 40 Blood Disorders (platelet) Disseminated intravascular coagulation Etiology/pathophysiology Overstimulation of clotting and anticlotting processes in response to disease or injury Bleeding; hemoptysis Dyspnea Diaphoresis Cold, mottled digits Purpura on the chest and abdomen Petechiae Slide Slide Blood Disorders (platelet) Disseminated intravascular coagulation (continued) Treat underlying cause Cryoprecipitate Heparin Protect from bleeding and trauma Slide Slide 42 42

15 Slide 43 Blood Disorders? Multiple myeloma know definition Etiology/pathophysiology Malignant neoplastic immunodeficiency disease of the bone marrow** Bone pain; pathological fractures Infection Anemia; bleeding Hypercalcemia Renal failure Slide 43 Disorders of the Hematological and Lymphatic Systems Multiple myeloma (continued) Symptomatic; not curable Radiation Chemotherapy Corticosteroids IV fluids Slide Slide Lymphatic System Disorder Lymphangitis Etiology/pathophysiology Inflammation of one or more lymphatic vessels Usually occurs from acute streptococcal or staphylococcal infection in an extremity Fine red streaks from the affected area Edema Chills; fever Local pain Mosby items and derived Headache; items 2006, 2003, 1999, 1995, 1991 by Mosby, Inc. myalgia Slide Slide 45 45

16 Slide 46 Lymphatic System Disorder Lymphangitis (continued) Penicillin Moist heat Elevate extremity Slide 46 Disorders of the Hematological and Lymphatic Systems lymphoma Malignant lymphoma Etiology/pathophysiology Non-Hodgkin Hodgkin s s lymphoma most common cancer of blood. (5 th leading cause of cancer death. 25,000 deaths per year) Neoplastic disorder of lymphoid tissue Tumors usually start in lymph nodes and spread to lymphoid tissue in the spleen, liver, GI tract, and bone marrow Slide Slide Lymphatic System Disorder Malignant lymphoma (continued) Painless, enlarged cervical lymph nodes Fever; susceptibility to infection Weight loss; anorexia Anemia Pruritus Fatigue Malaise Slide Slide 48 48

17 Slide 49 Lymphatic System Disorder Malignant lymphoma (continued) Accurate staging of the disease is crucial to determine treatment regimen Radiation Chemotherapy Bone marrow transplant Tumor necrosis factor (TNF) Slide 49 Lymphatic System Disorder Hodgkin s s disease Etiology/pathophysiology Inflammatory or infectious process that develops into a neoplasm Affects males twice as frequently as females Reed-Sternberg cells Slide Slide Lymphatic System Disorder Hodgkin s s disease (continued) Enlargement of cervical lymph nodes Anorexia Weight loss Pruritus Low-grade fever Night sweats Anemia Leukocytosis Slide Slide 51 51

18 Slide 52 Lymphatic System Disorder Hodgkin s s disease (continued) Stage I or II (localized) Radiation Stage III or IV (generalized) Chemotherapy Combination Slide 52 Nursing Process Nursing diagnoses Infection, risk for Injury (trauma) risk for (bleeding, falls) Fatigue Knowledge, deficient Pain, acute and chronic Tissue perfusion, ineffective Gas exchange, impaired Activity intolerance Coping, ineffective Skin integrity, impaired Slide Slide 53 53