Med Surg 2: Hematologic system

What are the blood and blood forming sites?

- Bone marrow - Reticuloendothelial system (RES) *a complex system of cells throughout the body capable of phagocytosis*

Blood Cells?

- Erythrocytes (RBCs) - Leukocytes (WBCs) - Thrombocytes (Platelets)

When stimulated to do so, stem cells can begin a process of differentiation into either myeloid or lymphoid stem cells?

- Myeloid: Erythrocytes, Leukocytes, Platelets -Lymphoid - Lymphocytes: T or B lymphocytes

A nurse cares for a client who has had a bone marrow aspiration. In addition to the client's aspiration site, what locations on the body does the nurse recognize as having bone marrow? Select all that apply.

- Pelvis - Ribs - Vertebrae - Sternum

A nurse is assigned to care for a patient with ascites, secondary to cirrhosis. The nurse understands that the fluid accumulation in the peritoneal cavity results from a combination of factors including an alteration in oncotic pressure gradients and increased capillary permeability. Therefore, the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is:

Albumin

A nurse is assigned to care for a patient with ascites, secondary to cirrhosis. The nurse understands that the fluid accumulation in the peritoneal cavity results from a combination of factors including an alteration in oncotic pressure gradients and increased capillary permeability. Therefore, the nurse monitors the serum level of the plasma protein responsible for maintaining oncotic pressure, which is?

Albumin

The physician performs a bone marrow biopsy from the posterior iliac crest on a client with pancytopenia. What intervention should the nurse perform after the procedure?

Apply pressure over the site for 5-7 minutes *Hazards of either bone marrow aspiration or biopsy include bleeding and infection. The risk of bleeding is somewhat increased if the client's platelet count is low or if the client has been taking a medication (e.g., aspirin) that alters platelet function. After the marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing*

RBC (Erythrocyte)

Carries hemoglobin to provide oxygen to tissue, average lifespan is 120 days

Basophil

Contains histamine; integral part of hypersensitivity reactions

The nurse expects which assessment finding when caring for a client with a decreased hemoglobin level?

Decreased oxygen level

Monocyte

Enters tissue as macrophage, highly phagocytic, especially against fungus; immune surveillance

A client with severe anemia is admitted to the hospital. Because of religious beliefs, the client is refusing blood transfusions. The nurse anticipates pharmacologic therapy with which drug to stimulate the production of red blood cells?

Epoetin alfa *Erythropoietin (epoetin alfa) is an effective alternative treatment for clients with chronic anemia secondary to diminished levels of erythropoietin. This medication stimulates erythropoiesis. Filgratism ( Neupogen) and Sargramostim stimulate granulocytosis( increasing WBC count) , Eltrombopag (Promacta) is used to treat aplastic anemia and thrombocytopenia*

Neutrophil

Essential in preventing or limiting bacterial infection via phagocytosis

Plasma?

Fluid portion of blood; it contains proteins such as albumin, globulin, fibrinogen, and other factors necessary for clotting, also electrolytes, waste products, and nutrients

Platelet (Thrombocyte)

Fragment of megakaryocyte; provides basis for coagulation to occur, maintains hemostasis; average lifespan is 10 days

The bone marrow is the site of

Hematopoiesis or blood cell formation; in adults, blood cell formation is usually limited to the pelvis, ribs, vertebrae, and sternum

A client receiving a blood transfusion experiences an acute hemolytic reaction. What is the nurse's priority intervention?

Immediately stop the transfusion, infuse normal saline solution, call the health care provider, and notify the blood bank.

Lymphocyte

Integral component of immune system

Albumin is important for the maintenance of fluid balance within the vascular system. Albumin is produced by which of the following?

Liver

Where is the only place Albumin is produced?

Liver

Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?

Myeloid stem cell

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse should evaluate the differential count for what type of WBCs, which are the first WBCs to respond to an inflammatory event?

Neutrophils *Neutrophils, the most abundant type of white blood cell, are the first of the WBCs to respond to infection or inflammation. The normal value is 3,000 to 7,000/cmm (males) and 1,800 to 7,700/cmm (females)*

The body responds to infection by increasing the production of white blood cells (WBCs). The nurse should evaluate the differential count for what type of WBCs, which are the first WBCs to respond to an inflammatory event?

Neutrophils *The normal value is 3,000 to 7,000/cmm (males) and 1,800 to 7,700/cmm (females)*

The nurse reviewing laboratory results of a client recovering from abdominal surgery notices an elevated number of reticulocytes. What is the nurse's first action?

Perform an abdominal assessment

Which is a symptom of severe thrombocytopenia?

Petechiae

Which is the major function of neutrophils?

Phagocytosis

Stem cells?

Primitive cells that have the ability to self-replicate, thereby ensuring a continuous supply of stem cells

T lymphocyte

Responsible for cell-mediated immunity; recognizes material as "foreign" (surveillance system)

B lymphocyte

Responsible for humoral immunity; many mature into plasma cells to form antibodies

Plasma cell

Secretes immunoglobulin (antibody); most mature form of B lymphocyte

A nurse is transfusing whole blood to a client with impaired renal function. During the transfusion, the client tells the nurse, "I feel very short of breath all of a sudden." What is the nurse's primary action?

Stop the infusion

The health care provider believes that the client has a deficiency in the leukocyte responsible for cell-mediated immunity. What should the nurse check the WBC count for?

T lymphocytes *T lymphocytes are responsible for cell-mediated immunity, in which they recognize material as "foreign," acting as a surveillance system"

The nurse is caring for a client with hypoxia. What does the nurse understand is true regarding the client's oxygen level and the production of red blood cells?

The kidneys sense low oxygen levels in the blood and produce erythropoietin, stimulating the bone marrow to produce more red blood cells.

Eosinophil

involved in allergic reactions (neutralizes histamine); digests foreign protiens