Med surg Ch 29 Assessment of Hematologic System, Chapter 32: Assessment of Hematologic Function

A client's family member asks the nurse why disseminated intravascular coagulation (DIC) occurs. Which statement by the nurse correctly explains the cause of DIC?

"DIC is caused by abnormal activation of the clotting pathway, causing excessive amounts of tiny clots to form inside organs."

The nurse should provide further teaching about post bone-marrow biopsy procedures when the client makes which statement?

"I'll ask someone to drive me home when I awake from general anesthesia."

A home care nurse visits a client diagnosed with atrial fibrillation who is ordered warfarin. The nurse teaches the client about warfarin therapy. Which statement by the client indicates the need for further teaching?

"I'll eat four servings of fresh, dark green vegetables every day."

A preoperative client is discussing blood donation with the nurse. Which statement by the client indicates to the nurse the need for further teaching?

"My family will donate blood, because it's safer."

Erythrocytes -primary function

-Primary function -transport of gas (O2 and CO2) -assist in maintaining acid-base balance hemoglobin binds to O2 and CO2 hemoglobin is heme (iron) and globin (protein) O2 attaches to the heme portion in the lung and detaches in the capillary. CO2 attaches to the globin portion of hemoglobin and is transported to the lungs for removal. Hemoglobin also acts as a buffer and plays a role in maintaining acid-base balance.

Blood has 3 major functions

3 major functions -transportation regulation protection

A client with a history of congestive heart failure has an order to receive 1 unit of packed red blood cells (RBCs). If the nurse hangs the blood at 12:00 pm, by what time must the infusion be completed?

4:00 pm

A health care provider prescribes one tablet of ferrous sulfate daily for a 15-year-old girl who experiences heavy blood flow during her menstrual cycle. The nurse advises the patient and her parent that this over-the-counter preparation must be taken for how many months before stored iron replenishment can occur?

6 to 12 months

A few minutes after beginning a blood transfusion, a nurse notes that a client has chills, dyspnea, and urticaria. The nurse reports this to the health care provider immediately because the client probably is experiencing which problem?

A hemolytic allergic reaction caused by an antigen reaction

A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving:

A-positive blood to an A-negative client.

The nurse examines the lymph nodes of a patient during a physical assessment. Which assessment finding would be of most concern to the nurse? a. A 2-cm nontender supraclavicular node b. A 1-cm mobile and nontender axillary node c. An inability to palpate any superficial lymph nodes d. Firm inguinal nodes in a patient with an infected foott

ANS: A Enlarged and nontender nodes are suggestive of malignancies such as lymphoma. Firm nodes are an expected finding in an area of infection. The superficial lymph nodes are usually not palpable in adults, but if they are palpable, they are normally 0.5 to 1 cm and nontender

The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient? a. "Do you take salicylates?" b. "Are you taking any oral contraceptives?" c. "Have you been prescribed antiseizure drugs?" d. "How long have you taken antihypertensive drugs?"

ANS: A Salicylates interfere with platelet function and can lead to petechiae and ecchymoses. Antiseizure drugs may cause anemia, but not clotting disorders or bleeding. Oral contraceptives increase a person's clotting risk. Antihypertensives do not usually cause problems with decreased clotting

The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care? a. Avoid intramuscular injections. b. Encourage increased oral fluids. c. Check temperature every 4 hours. d. Increase intake of iron-rich foods.

ANS: A Thrombocytopenia is a decreased number of platelets, which places the patient at high risk for bleeding. Neutropenic patients are at high risk for infection and sepsis and should be monitored frequently for signs of infection. Encouraging fluid intake and iron-rich food intake is not indicated in a patient with thrombocytopenia

A patient with pancytopenia of unknown origin is scheduled for the following diagnostic tests. The nurse will provide a consent form to sign for which test? a. ABO blood typing b. Bone marrow biopsy c. Abdominal ultrasound d. Complete blood count (CBC)

ANS: B A bone marrow biopsy is a minor surgical procedure that requires the patient or guardian to sign a surgical consent form. The other procedures do not require a signed consent by the patient or guardian

The nurse is reviewing laboratory results and notes an aPTT level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication? a. Aspirin b. Heparin c. Warfarin d. Erythropoietin

ANS: B Activated partial thromboplastin time (aPTT) assesses intrinsic coagulation by measuring factors I, II, V, VIII, IX, X, XI, XII. aPTT is increased (prolonged) in heparin administration. aPTT is used to monitor whether heparin is at a therapeutic level (needs to be greater than the normal range of 25 to 35 sec). Prothrombin time (PT) and international normalized ratio (INR) are most commonly used to test for therapeutic levels of warfarin (Coumadin). Aspirin affects platelet function. Erythropoietin is used to stimulate red blood cell production

A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding? a. "Have you had a recent weight loss?" b. "Do you have any history of lung disease?" c. "Have you noticed any dark or bloody stools?" d. "What is your dietary intake of meats and protein?"

ANS: B The hemoglobin and hematocrit results indicate polycythemia, which can be associated with chronic obstructive pulmonary disease (COPD). The other questions would be appropriate for patients who are anemic

The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect? a. Yellow-tinged sclerae b. Shiny, smooth tongue c. Numbness of the extremities d. Gum bleeding and tenderness

ANS: C Extremity numbness is associated with cobalamin (vitamin B12) deficiency or pernicious anemia. Loss of the papillae of the tongue occurs with chronic iron deficiency. Yellow-tinged sclera is associated with hemolytic anemia and the resulting jaundice. Gum bleeding and tenderness occur with thrombocytopenia or neutropenia

A patient who had a total hip replacement had an intraoperative hemorrhage 14 hours ago. Which laboratory result would the nurse expect to find? a. Hematocrit of 46% b. Hemoglobin of 13.8 g/dL c. Elevated reticulocyte count d. Decreased white blood cell (WBC) count

ANS: C Hemorrhage causes the release of reticulocytes (immature red blood cells) from the bone marrow into circulation. The hematocrit and hemoglobin levels are normal. The WBC count is not affected by bleeding

The health care provider's progress note for a patient states that the complete blood count (CBC) shows a "shift to the left." Which assessment finding will the nurse expect? a. Cool extremities b. Pallor and weakness c. Elevated temperature d. Low oxygen saturation

ANS: C The term shift to the left indicates that the number of immature polymorphonuclear neutrophils (bands) is elevated and that finding is a sign of infection. There is no indication that the patient is at risk for hypoxemia, pallor/weakness, or cool extremities

A nurse reviews the laboratory data for an older patient. The nurse would be most concerned about which finding? a. Hematocrit of 35% b. Hemoglobin of 11.8 g/dL c. Platelet count of 400,000/µL d. White blood cell (WBC) count of 2800/µL

ANS: D Because the total WBC count is not usually affected by aging, the low WBC count in this patient would indicate that the patient's immune function may be compromised and the underlying cause of the problem needs to be investigated. The platelet count is normal. The slight decrease in hemoglobin and hematocrit are not unusual for an older patient

The health care provider orders a liver/spleen scan for a patient who has been in a motor vehicle accident. Which action should the nurse take before this procedure? a. Check for any iodine allergy. b. Insert a large-bore IV catheter. c. Place the patient on NPO status. d. Assist the patient to a flat position.

ANS: D During a liver/spleen scan, a radioactive isotope is injected IV and images from the radioactive emission are used to evaluate the structure of the spleen and liver. An indwelling IV catheter is not needed. The patient is placed in a flat position before the scan

When assessing a newly admitted patient, the nurse notes pallor of the skin and nail beds. The nurse should ensure that which laboratory test has been ordered? a. Platelet count b. Neutrophil count c. White blood cell count d. Hemoglobin (Hgb) level

ANS: D Pallor of the skin or nail beds is indicative of anemia, which would be indicated by a low Hgb level. Platelet counts indicate a person's clotting ability. A neutrophil is a type of white blood cell that helps to fight infection

The nurse is caring for a patient who is being discharged after an emergency splenectomy following an automobile accident. Which instructions should the nurse include in the discharge teaching? a. Watch for excess bruising. b. Check for swollen lymph nodes. c. Take iron supplements to prevent anemia. d. Wash hands and avoid persons who are ill.

ANS: D Splenectomy increases the risk for infection, especially with gram-positive bacteria. The risks for lymphedema, bleeding, and anemia are not increased after a person has a splenectomy

The nurse reviews the complete blood count (CBC) and white blood cell (WBC) differential of a patient admitted with abdominal pain. Which information will be most important for the nurse to communicate to the health care provider? a. Monocytes 4% b. Hemoglobin 13.6 g/dL c. Platelet count 168,000/µL d. White blood cells (WBCs) 15,500/µL

ANS: D The elevation in WBCs indicates that the patient has an inflammatory or infectious process ongoing, which may be the cause of the patient's pain, and that further diagnostic testing is needed. The monocytes are at a normal level. The hemoglobin and platelet counts are normal

A patient with pancytopenia has a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure? a. Elevate the head of the bed to 45 degrees. b. Apply a sterile 2-inch gauze dressing to the site. c. Use a half-inch sterile gauze to pack the wound. d. Have the patient lie on the left side for 1 hour.

ANS: D To decrease the risk for bleeding, the patient should lie on the left side for 30 to 60 minutes. After a bone marrow biopsy, the wound is small and will not be packed with gauze. A pressure dressing is used to cover the aspiration site. There is no indication to elevate the patient's head

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

Which nursing intervention should be incorporated into the plan of care to manage the delayed clotting process in a client with leukemia?

Apply prolonged pressure to needle sites or other sources of external bleeding

A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms?

B12

The nurse is caring for a client with type 2 diabetes who take metformin to manage glucose levels. The nurse recognizes the client may be most at risk for which vitamin deficiency?

B12

Which type of leukocyte contains histamine and is an important part of hypersensitivity reactions?

Basophils

Which is a symptom of Cooley anemia?

Bronzing of the skin

The nurse is educating a client about iron supplements. The nurse teaches that what vitamin enhances the absorption of iron?

C

Diagnostic studies labs

CBC RBC -HGB - reduced in cases of anemia, hemorrhage, hemodilution , such as that occuring when the fluid volume is excessive -HCT -spinning in the centrifuge which causes RBC, and plasma to separate. RBCs settle to the bottom. -HCT represents the percentage of RBC compared with the total blood volume WBC -provides 2 sets of info -total WBC count of peripheral blood -elevation is associated with infection, inflammation, tissue injury or death, and malignancies (leukemia, lymphoma) -differential count -measures the percentage of each type of leukocyte PLATELET -counts below 100,000 signify THROMBOCYTOPENIA -bleeding may occur with thrombocytopenia -spontaneous hemorrhage is possible once platelet counts fall below 10,000

When reviewing laboratory results of an older patient with an infection, the nurse would expect to find a. minimal leukocytosis. b. decreased platelet count. c. increased hemoglobin and hematocrit levels. d. decreased erythrocyte sedimentation rate (ESR).

Correct answer: a Rationale: During an infection, an older adult may have only a minimal elevation in the total WBC count. This laboratory finding suggests a diminished bone marrow reserve of granulocytes in older adults and reflects possible impaired stimulation of hematopoiesis.

Significant information obtained from the patient's health history that relates to the hematologic system includes a. jaundice. b. bladder surgery. c. early menopause. d. multiple pregnancies.

Correct answer: a Rationale: Jaundice is a common symptom that occurs with hematologic abnormalities. Jaundice is related to an accumulation of bile pigment that is caused by rapid or excessive hemolysis or liver damage.

An individual who lives at a high altitude may normally have an increased Hgb and RBC count because a. high altitudes cause vascular fluid loss, leading to hemoconcentration. b. hypoxia caused by decreased atmospheric O2 stimulates erythropoiesis. c. the function of the spleen in removing old RBCs is impaired at high altitudes. d. impaired production of leukocytes and platelets leads to proportionally higher red cell counts.

Correct answer: b Rationale: Normal physiologic increases in the red blood cell (RBC) count occur at high altitudes. At high altitudes, less atmospheric weight pushes air into the lungs; the partial pressure of O2 is thereby decreased, which causes hypoxia. Erythropoiesis is stimulated by hypoxia and controlled by erythropoietin, a glycoprotein growth factor synthesized and released by the kidneys. Erythropoietin stimulates the bone marrow to increase erythrocyte production.

If a lymph node is palpated, what is a normal finding? a. Hard, fixed nodes b. Firm, mobile nodes c. Enlarged, tender nodes d. Hard, nontender nodes

Correct answer: b Rationale: Ordinarily, lymph nodes are not palpable in adults. If a node is palpable, it should be small (0.5 to 1 cm), mobile, firm, and nontender to be considered a normal finding.

You are taking care of a male patient who has the following laboratory values from his CBC: WBC 6.5 × 103/µL, Hgb 13.4 g/dL, Hct 40%, platelets 50 × 103/µL. What are you most concerned about? a. Your patient is neutropenic. b. Your patient has an infection. c. Your patient is at risk for bleeding. d. Your patient is at fall risk due to his anemia.

Correct answer: b Rationale: The patient complete blood cell count (CBC) has normal parameters except for the platelet count, which is below normal.

An anticoagulant such as warfarin (Coumadin) that interferes with prothrombin production will alter the clotting mechanism during a. platelet aggregation. b. activation of thrombin. c. the release of tissue thromboplastin. d. stimulation of factor activation complex.

Correct answer: b Rationale: Warfarin inhibits the effective synthesis of vitamin K-dependent clotting factors: II (prothrombin), VII (stable factor), IX (Christmas factor), and X (Stuart-Prower factor) in the extrinsic pathway. Thrombin is not activated, and coagulation is interrupted in the final common pathway of the clotting cascade. Without thrombin activation, fibrinogen is not converted to fibrin, and blood clotting does not occur.

While assessing the lymph nodes, the nurse should a. apply gentle, firm pressure to deep lymph nodes. b. palpate the deep cervical and supraclavicular nodes last. c. lightly palpate superficial lymph nodes with the pads of the fingers. d. use the tips of the second, third, and fourth fingers to apply deep palpation.

Correct answer: c Rationale: To assess superficial lymph nodes, lightly palpate the nodes, using the pads of your fingers. Then gently roll the skin over the area and concentrates on feeling for possible lymph node enlargement.

Malignant disorders that arise from granulocytic cells in the bone marrow will have the primary effect of causing a. risk for hemorrhage. b. altered oxygenation. c. decreased production of antibodies. d. decreased phagocytosis of bacteria.

Correct answer: d Rationale: The primary function of granulocytes is phagocytosis, a process by which white blood cells (WBCs) ingest or engulf any unwanted organism, such as bacteria, and then digest and kill it. In malignant disorders, these phagocytic cells are often reduced in number and function.

Nursing care for a patient immediately after a bone marrow biopsy and aspiration includes (select all that apply) a. administering analgesics as necessary. b. preparing to administer a blood transfusion. c. instructing on need to lie still with a sterile pressure dressing intact. d. monitoring vital signs and assessing the site for excess drainage or bleeding. e. instructing on the need for preprocedure and postprocedure antibiotic medications.

Correct answers: a, c, d Rationale: The needle aspiration or biopsy site is covered with a sterile pressure dressing. Monitor the patient's vital signs until stable, and assess the site for excess drainage or bleeding. If bleeding is detected, advise the patient to lie on the side for 30 to 60 minutes to maintain pressure on the site. If the bed is too soft, have the patient lie on a rolled towel to provide additional pressure. Analgesics for postprocedure pain may be administered. Soreness over the puncture site for 3 to 4 days after the procedure is normal.

A patient with chronic kidney disease is being examined by the nurse practitioner for anemia. The nurse has reviewed the laboratory data for hemoglobin and RBC count. What other test results would the nurse anticipate observing?

Decreased level of erythropoietin

A patient with chronic renal failure is examined by the health care provider for anemia. Which laboratory results will the nurse monitor?

Decreased level of erythropoietin

The charge nurse should intervene when observing a new nurse perform which action after a client has suffered a possible hemolytic blood transfusion reaction?

Disposing of the blood container and tubing in biohazard waste.

You are caring for a 13-year-old diagnosed with sickle cell anemia. The client asks you what they can do to help prevent sickle cell crisis. What would be an appropriate answer to this client?

Drink at least 8 glasses of water every day.

The nurse and the client are discussing some strategies for ingesting iron to combat the client's iron-deficiency anemia. Which is among the nurse's strategies?

Drink liquid iron preparations with a straw.

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

A client with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this client?

Erythropoietin

A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse know is the most likely clinical disorder the patient is being treated for?

Essential thrombocythemia

When conducting a health assessment on a client suspected for having a hematological disorder, the nurse should collect which data? Select all that apply.

Ethnicity Dietary intake Medication use

A teenaged client with hemophilia sustains a leg laceration after falling off of his skateboard and is brought to the emergency department. The laceration is bleeding profusely even with direct pressure to the site. What does the nurse anticipate will be ordered for administration to control bleeding?

Fresh frozen plasma

A male client has a hemoglobin count of 10.2 gm/dl, a hematocrit value of 36%, and a low ferritin level. What question should the nurse ask first?

Have you experienced abdominal pain?

When assessing a client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential?

Health history, such as bleeding, fatigue, or fainting

Which term refers to the percentage of blood volume that consists of erythrocytes?

Hematocrit

A patient has a probable diagnosis of polycythemia vera. The nurse reviews the patient's lab work for which diagnostic indicator?

Hematocrit of 60%

A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse be aware of and monitor the patient for?

Hemorrhage

The nurse cares for several clients with hematological conditions. Which assessment needs will the nurse prioritize for the client with aplastic anemia? Select all that apply.

Infection Bleeding

A patient who has long-term packed RBC (PRBC) transfusions has developed symptoms of iron toxicity that affect liver function. What immediate treatment should the nurse anticipate preparing the patient for that can help prevent organ damage?

Iron chelation therapy

The nurse is performing an assessment for a client with anemia admitted to the hospital to have blood transfusions administered. Why would the nurse need to include a nutritional assessment for this patient?

It may indicate deficiencies in essential nutrients.

During the review of morning laboratory values for a client reporting severe fatigue and a red, swollen tongue, the nurse suspects chronic, severe iron deficiency anemia based on which finding?

Low ferritin level concentration The most consistent indicator of iron deficiency anemia is a low ferritin level, which reflects low iron stores. As the anemia progresses, the MCV, which measures the size of the erythrocytes, also decreases. Hematocrit and RBC levels are also low in relation to the hemoglobin concentration.

Which term refers to a form of white blood cell involved in immune response?

Lymphocyte

The nurse is assessing a patient who is a strict vegetarian. What type of anemia is the nurse aware that this patient is at risk for?

Megaloblastic anemia

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

Myeloid stem cell

A client with a diagnosis of pernicious anemia comes to the clinic complaining of numbness and tingling in his arms and legs. What do these symptoms indicate?

Neurologic involvement

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

A client with multiple myeloma is complaining of severe pain when the nurse comes in to give a bath and change position. What is the priority intervention by the nurse?

Obtain the pain medication and delay the bath and position change until the medication reaches its peak.

A client diagnosed with systemic lupus erythematosus comes to the emergency department with severe back pain. The client is taking prednisone daily and reported feeling pain after manually opening the garage door. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain?

Osteoporosis

A patient receiving plasma develops transfusion-related acute lung injury (TRALI) 4 hours after the transfusion. What type of aggressive therapy does the nurse anticipate the patient will receive to prevent death from the injury? (Select all that apply.)

Oxygen Fluid support Intubation and mechanical ventilation

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

Which is the major function of neutrophils?

Phagocytosis

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters?

Platelet count, prothrombin time, and partial thromboplastin time

The nurse is completing a physical assessment on a client's lymphatic system. The nurse should palpate for enlarged nodes in which areas? Select all that apply.

Popliteal Inguinal Submental Neck

A client awaiting a bone marrow aspiration asks the nurse to explain where on the body the procedure will take place. What body part does the nurse identify for the client?

Posterior iliac crest

The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. What action should the nurse take?

Refuses to administer the blood

The nurse is working at a blood donation clinic. What teaching should the nurse provide to the donor immediately after blood donation?

Remain for observation after eating and drinking.

A nurse cares for several mothers and babies in the postpartum unit. Which mother does the nurse recognize as being most at risk for a febrile nonhemolytic reaction?

Rh-negative mother; Rh-positive child

RH system is based on a third antigen , D, which is also on the RBC membrane . Rh pos people have the D antigen Rh neg people do not a Rh neg person may be exposed to Rh pos blood during pregnancy. After exposure during childbirth , the mother forms an antibody anti-D, which acts against Rh antigens. In subsequent pregnancies the mothers anti-D antibodies can cross the placenta and attack the RBCs of the fetus who is Rh-neg thus causing hemolysis of the RBCs a pregnant Rh, neg woman should receive

Rho(D) immune globulin injections to prevent anti-D antibodies

The nurse is preparing the patient for a test to determine the cause of vitamin B12 deficiency. The patient will receive a small oral dose of radioactive vitamin B12 followed by a large parenteral dose of nonradioactive vitamin B12. What test is the patient being prepared for?

Schilling test

Place the following procedural steps in order for transfusing a unit of packed red blood cells (PRBCs).

Start an intravenous line. Obtain the unit of PRBCs from the blood bank. Double check the labels with another nurse to ensure correct ABO group and Rh type. Initiate the blood transfusion within 30 minutes of receipt. Monitor closely for signs of a transfusion reaction.

Which type of lymphocyte is responsible for cellular immunity?

T lymphocyte

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

The nurse is administering a blood transfusion to a client over 4 hours. After 2 hours, the client reports chills and has a fever of 101°F, an increase from a previous temperature of 99.2°F. What does the nurse recognize is occurring with this client?

The client is having a febrile nonhemolytic reaction.

A patient is taking prednisone 60 mg per day for the treatment of an acute exacerbation of Crohn's disease. The patient has developed lymphopenia with a lymphocyte count of less than 1,500 mm3. What should the nurse monitor the client for?

The onset of a bacterial infection

A nurse cares for a client with anemia after having a total gastrectomy a year ago. Which unique assessment findings will the nurse likely find when assessing this client that may not be present in another client with anemia? Select all that apply.

Tingling in the fingers Poor coordination

A nurse on a hematology/oncology floor is caring for a client with aplastic anemia. Which would not be included in the client's discharge instructions?

Use a disposable razor when shaving.

While caring for a client, the nurse notes petechiae on the client's trunk and lower extremities. What precaution will the nurse take when caring for this client?

Use an electric razor when assisting client with shaving.

plasma contains

albumin , globulin and clotting factors (mostly fibrinogen)

The nurse recognizes that the most common cause of iron deficiency anemia in an adult is

bleeding

bone marrow

blood cell production bone marrow is the soft material that fills the central core of bones. 2 types of bone marrow -yellow (adipose) -red (hematopoitic) red actively produces blood cells -RBC -WBC -Platelets

Structures and functions of Hematologic system Structures are :

bone marrow blood blood cells

Biopsy procedures specific to hematologic assessment are -bone marrow examination -lymph node biopsy

bone marrow examination -aspiration only or -aspiration with biopsy lymph node biopsy -obtains lymph tissue for histologic examination

lymph system consists of : function:

consists of -lymph fluid -lymphatic capillaries, -ducts -lymph nodes function: carries fluid from interstitial spaces to the blood. which is important in preventing edema

An client has pernicious anemia and has been receiving treatment for several years. Which symptom may be confused with another condition in older adults?

dementia

Albumin is a protein that helps maintain oncotic pressure in the blood blood cells are composed of 3 types of blood cells

erythrocytes leukocytes thrombocytes (platelets- promote blood coagulation)

thrombocytosis is defined as

excessive platelets, a disorder that occurs with inflammation and some malignant disorders.

the formation of lymph fluid increases when interstitial fluid increases, therby forcing more fluid into the lymph system. WHen too much interstitial fluid develops or when something interferes with the reabsorption of lymph, lymphedema develops. Lymphedema may occur as a complication of mastectomy, or lumpectomy with dissection of axillary nodes. In this situation , lymphedema is often caused by the obstruction of lymph flow from the removal of lymph nodes. superficial nodes can be palpated, but evaluation of the deep nodes requires radiologic examination A primary funtion of lymph nodes is :

filtration of pathogens and foreign particles that are carried by lymph to the nodes

Spleen located Upper left quadrant of the abd. 4 major functions -hematopoietic -filtration -immunologic -storage

hematopoietic function -ability to produce RBCs during fetal development filtration -ability to remove old and defective RBCs from the circulation -also reuse of iron -filters circulating bacteria immunologic -rich supply of lymphocytes, monocytes and stored immunoglobulins storage -role as storage site for RB and plateletes A PERSON WHO HAS A SPENECTOMY HAS HIGHER CIRCULATING LEVELS OF PLATELETS THAN A PERSON WHO STILL HAS A SPLEEN.

A client has a history of sickle cell anemia with several sickle cell crises over the past 10 years. What blood component results in sickle cell anemia?

hemoglobin S

Leukocytes appear white when separated from blood. leukocytes that do not have granules within the cytoplasm are called agranulocytes and include lymphocytes and monocytes. granulocytes -primary function is phagocytosis The neutrophil is the most common type of granulocyte -primary phagocityic cells An increase in neutrophils in the blood is a common diagnostic indicator of

infection and tissue injury

An client has pernicious anemia and has been receiving treatment for several years. What is the client lacking that results in pernicious anemia?

intrinsic factor

what is necessary for the development of RBC

iron cobalamin folic acid

spleen

lymphoid organ Upper left quadrant of the abd. 4 major functions -hematopoietic -ability to produce RBC's during fetal development -filtration -spleens ability to remove old and defective RBC's -reuse of iron -filtering circulating bacteria -immunologic -rich supply of lymphocytes, monocytes and stored immunoglobulins -storage -storage site for RBC's and platelets

Vitamin B and folic acid deficiencies are characterized by production of abnormally large erythrocytes called

megaloblasts

When the entire CBC is suppressed this is called

pancytopenia -marked decrease in the number of RBC, WBC, and platelets

Increases of hemoglobin are found in what condition

polycythemiaor in states of hemoconcentration which can develop from volume depletion

physical examination for hematologic disorders should include examination of

skin, lymph nodes, spleen and liver

An older adult client is to receive 2 units of packed red blood cells. During the transfusion of the first unit at 125 mL/hour, the client reports shortness of breath 30 minutes into the process. The client exhibits the vital signs shown in the accompanying table. What is the nurse's best intervention?

slow the rate of the transfusion and obtain an order for furosemide

blood has 2 major components : plasma and blood cells Plasma is composed primarily of water but it also contains proteins, electrolytes, gases, nutrients and waste The term serum refers to :

the plasma minus the clotting factors

Normal clotting mechanisms Hemostasis is a term used to describe the arrest of bleeding. -vascular injury and subendothelial exposure -adhesion -activation -aggregation -platelet plug formation -clot retraction and dissolution

vascular injury and subendothelial exposure -blood vessel is injured -vasoconstrictive response -platelet adhesion -collagen and von willebrand factor adhere to platelets -platelet activation -platelets begin an activation process -bind to fibrinogen -PLATELET AGGREGATION -PLATELET PLUG FORMATION -meshwork traps other cells -CLOT RETRACTION AND DISSOLUTION -anticoatulation may be achieved by antithrombin activity -fibrinolysis