Med-Surg Hemotopietic and Lymphatic system

Aplastic anemia symptoms

--is more than just a deficiency of erythrocytes, failure to develop--aplastic-- --clients with aplastic anemia experience all the typical characteristics of anemia, such as weakness and fatigue--have frequent opportunistic infection plus coagulation abnormalities that are manifested by unusual bleeding, small skin hemorrhages called petechiae and ecchymosis--bruises. the spleen becomes enlarged with an accumulation of the client's bllod cells destroyed by lymphocytes that failed to recognize them as normal cells, or with an accumulation of dead transfused blood cells. -the blood cell count shows insufficient numbers of blood cells. - a bone marrow aspiration confirms that the production of stem cells is suppressed.

Definition of coagulopathies

--refers to conditions in which a component that is necessary to control bleeding is missing or inadequate. --bleeding disorder that involves platelets or clotting factors.

Blood administration - type of gauge and fluid utilized and signs and symptoms of reactions

-16-20 gauge perferably an 18 gauge -blood is administered through Y-administration tubing. -this tube contains two branches; one for blood and one for isotonic normal saline. the two branches extend above the filter that removes blood clot and cellular debris. the normal saline infuses before and after the blood infuses. s/s are hypotension, rapid pulse rate, difficulty breathing, back pain, flushing, fever, shaking chills, headache, muscle aches, rash itching, flushing, stable vital signs, hypertension, moist breath sounds, bounding pulse, tingling of fingers, muscle cramps, convulsions, and opportunistic infections

Treatment of lymphadenitis

-A broad-spectrum antibiotic commonly is ordered.

Lymphosarcoma care

-Because chemotherapy and radiation kill many cells, the nurse encourages clients to drink extra fluids. more than or equal to 2500 ml/day to facilitate excertion of the cells destroyed by therapy and compensate for fluids that are lost due to vomiting. - N/V may accompany radiation and chemotherapy. -clients must maintain food and fluids, -offer clear liquids such as carbonated beverages and water, ice pops, and flavored gelatin until nausea subsides. Thereafter, small, frequent, low-fat meals help prevent nausea, improve nutritional intake, and reduce weight loss.

Blood types and compatibility

-There are four blood groups or types- A,B, AB, and O, which are determined by heredity. -Blood type is ascertained by identifying the protein, or antigen, on the red cell membrane. -Group A has A antigen, group B has B antigen, group AB has A and B antigens, and group O has no antigen. -Antibodies, immunoglobulins in plasma that inactivates any substance that is nonself, react with incompatible RBC antigens.

Types of leukemia

-There are general types of leukemia, classified according to the bone marrow stem cell line that is dysfunctional. -acute lymphocytic leukemia (AAL) -chronic lymphocytic leukemia (CCL) -Acute myelogenous leukemia (AML) -Chronic myelogenous leukemia (CML)

Hodgkin's disease-treatments

-carful staging and treatment planning by a multidisciplinary team of cancer specialists are required to determine optimal treatment of client with this disease. --treatment includes localized radiation to affected lymph nodes and chemotherapy with combination of antineoplastic drugs. -antibiotics are given to fight secondary infections. -transfusions are prescribed to control anemia, -if resistance to treatment develops, autologous bone marrow or peripheral stem cells are harvested, followed by high doses of chemotherapy that destroys the bone marrow. -normal stem cells are separated from the malignant cells in the harvested specimen, and a transplant is performed.

Epstein-Barr virus

-causes infectious mononucleosis. the virus most commonly affects young adults, especially those in close living quarters, such as armed services housing and college dormatories. the contagious disorder spreads by direct contact with saliva and pharyngeal secretions from an infected person. it is transmitted by kissing, oral spraying during cough, talking, or sneezing; or shared food, cigarettes, or other items containing oral secretions. the incubation period can be as long as 30 - 50 days - is believed to trigger Hodgkin's lymphoma in approximately 40 % of people with this disease, -a positive slide agglutination test-Monospot, Monotest, Monosticon-- is presumptive evidence that the Epstein-Barr virus is causing the symptoms.

Blood transfusion responsibilities

-help restore the body's hemoglobin -in severe cases, a blood transfusion is necessary, but transfusion is the most expensive and potentially dangerous method for replacing iron.

Sickle cell disease - causes

-is a type of anemia in which erthrocytes become sickle- or crescent- shaped when oxygen supply in the blood is inadequate. - in those affected, factors that cause deoxygenation, such as exposure to cold, dehydration, and infections, also cause hemoglobin polymerization, the formation of crystal-like rods that change the biconcave RBC into an irregular, brittle, sticky, sickled-cell shaped cell. - sickle- cell is a heredity disorder. To manifest this disorder, a person must inherit two defective, one from each parent, in which case all the hemoglobin is inherited abnormal . if the person inherits only one gene, he or she carries sickle cell traits.

patient taking meds that depress hematopoietic system -

look for signs of leukopenia and thrombocytopenia

Hodgkin's disease-diagnosis,

- CT, PET, and MRI demonstrate the size of the lymph node and the spread of the disease in the thorax, abdomen, and pelvis. A bone marrow aspiration and lymph node biopsy may help to confirm the diagnosis or identify abnormalities of other blood cells -after diagnosis the disease is staged from stage I or IV based on the number of positive lymph nodes and the involvement of other organs.

s/s of hypovolemic anemia

- extreme pallor, tachycardia, hypotension, reduced urine output, and altered consciousness. - chronic hyovolemic anemia s/s- pallor , fatigue, chill, postural hypotension, and rapid heart and respiratory beats.

Lymphosarcoma treatment

- is treated with radiation, chemotherapy, or both. the physician may adopt a 'watch and wait' approach for clients with indolent forms of non-Hodgkin's lymph, choosing to treat the client once the disease accelerates. -Immunotherapy with monoclonal, antibodies, and bone marrow transplant also is being used to cure lymphomas or extend the lives of clients with these diseases.

Post-op promotion of lymphatic drainage

- the client elevates the affected part to promote lymphatic drainage and wears an elastic compression garment such as a stocking or sleeve. -A compression garment, which consist of multiple layers of elastic materials with proximal to distal compression gradation, increases local tissue pressure, decreases stretching of the skin, assists muscles to propel lymphatic drainage, and prevents tissues refilling with an excess volume of lymph. - the nurse inspects and measures the affected area to assess the extent of enlargement and the condition of the skin. - he or she encourages the client to move and exercise that affected arm or leg to enhance the flow of lymph from the congested area -the instructs the client to elevate the edeamatous extremities when sitting and teaches how to apply and use elastic garments and mechanical devices. -extensive emotional support is necessary when the edema is severe. the client's self esteem is often decreased , which can lead to social withdrawal. the nurse supports the client's self image by suggesting certain styles of clothing that conceal abnormal enlargement of an arm or leg.

Donor and recipients blood are considered compatible if

there is no clumping or hemolysis-destruction of erythrocytes. when both samples are mixed in the laboratory,

In an emergency

type O blood can be given to recipients with types A, B, AB, or O. -People with Rh positive blood can receive Rh-positive or Rh-negative blood because Rh negative indicates the Rh factor is missing.

Pernicious anemia - neurologic involvement

-Degenerative changes in the nervous system develop. Sometimes damage occurs before treatment begins. -may be accompanied by a dementia with symptoms similar to Alzheimer's Disease. therefore, clients experiencing cognitive changes should be screened because early detection of pernicious anemia is critical to prevent neurologic damage. -Jaundice, irritability, confusion, and depression are present when the disease is severe. Mental changes disappear with treatment. Numbness and tingling in the arms and legs and ataxia are common signs of neurologic involvement. some affected clients lose vibratory and position senses. --clients with permanent neurologic deficits benefit from physical therapy. -if permanent neurologic deficit has occurred , the nurse encourages the client to move about as much as possible to prevent complications associated with immobility, such as contractures and pressure ulcer formation.

Normal blood counts for Hct

-Hematocrit is a blood test that measures the percentage of the volume of whole blood that is made up of red blood cells. -the normal blood count for hematocrit is 40%- 54% in male, and 38%-47% in women.

Food to promote absorption of iron and foods to avoid

-Heme iron is found in animal foods such as beef, pork, lamb, egg yolks, oysters, and the dark meat of poultry. it is well absorbed, and its rate of absorption is influenced only by need, not by other dietary factors. --adding three servings of lean meats per week in the context of a nutrient-rich diet is recommended to help correct iron-deficiency anemia. --NONHEME IRON is found in plant foods, such as enriched and whole-grain breads, iron-fortified cereals, legumes, and nuts. --absorption of NONHEME IRON is greatly affected by other dietary factors. Vitamin C - citrus fruits and juices, strawberries, red peppers, tomatoes, and foods high in heme iron, such as beef, pork, lamb, or egg yolks, ENHANCE the absorption of nonheme iron when eaten at the same time. -To maximize nonheme iron absorption, the client should consume a rich source of vitamin C at every meal and avoid coffee and tea around and during mealtime.

Hodgkin's disease - definition

-Is a malignancy that produces enlargement of lymphoid tissue, the spleen, and the liver, with invasion of other tissues sich as the bone marrow and lungs. -it may appear in several forms- acute, localized, or latent with relapsing pyrexia; splenomegaly, and as hymphogranulomatosis.

Normal blood counts for platelets

-Normal platelet count is 150,000-450,000/mm3, approximately itwo thirds of the total 150,00-350,000/mm3 platelets circulate in the blood and contribute to hemostasis. The remaining one third are sequestered in the spleen, where they remain unless needed in cases of significant bleeding. --Platelets -thrombocytes are dislike, nonnucleated cell fragments with a life span of approximately 7.5 days. they are manufactured in the red bone marrow. -when a blood vessel is injured, platelets migrate to th injury site. the platelets release a substance known as glycoprotein IIb/IIIa, which causes the platelets to adhere, platelet aggregation, and form a plug, or clot, that occludes the injured vessels.

sickle cell disease sign and symptoms

-The client's height and weight may be lower than expected as a result of anaerobic metabolism - the reduced blood flow during sickle cell crisis leads to localized ischemia, severe pain and possible tissure infarction-necrosis- of the oxygen supply is inadequate. -fever, pain, and swelling of one or more joints are common. -other symptoms depend on the blood vessels involved -sickle cell crisis can lead to cerebrovascular accident - stroke- pulmonary infarction, shock, and renal failure. -evidence of the accelerated rate of erythrocytes destruction is manifested by jaundice caused by hyperbilirubinemia, excess bilirubin pigmemt in the blood. - secondary consequences include gallstones or a predisposition to infection when the spleen becomes dysfunctional. -chronic leg ulcers develop from the blockage of the small blood vessels of the legs. -Priapism- prolonged erection- occurs from elayed emptying of thick blood from the penis.

Nursing care during and after a bone marrow aspiration

-The nurse assists the physician, supports the client during the procedure, and monitors the client's status afterwards. --inform the client of the plan and approximate time for the bone marrow aspirations. Allow time to answer questions. -witness the client's signature on a consent form for the procedure as well as for conscious sedation -check the client's medical record for history of allergies, esp to local anesthesia or latex, and the result of coagulation studies that may have been performed. -obtain a sterile bone marrow aspiration tray and they type and the strength of local anesthesia according to the physician's order Determine the site from which the physician intends to obtain the sample of bone marrow, for ex, iliac crest or sternum. the posterior superior iliac crest is the perferred site because no vital organs or blood vessels are nearby. Aspiration from the sternum involves the greatest risk but may be used because the site is near the surface, the bone is thin, and the marrow contains numerous cells. -attach the pulse oximeter to the client's finger to monitor oxygenation that may be compromised when conscious sedation is used. -Position the client on his or her back or side to facilitate access to the aspiration site. -cleanse, clip hair, and drape the skin at the test site. -suggest distraction techniques to avoid focusing on the pressure or discomfort associated with puncturing the bone that may take approximately 20 mins -administer analgesia for discomfort -be prepared to place samples of the aspirate on slides and allow them to dry. - label the biopsy specimen once in perservative and ensure its delivery it delivery to the laboratory - follow standard precaution when there is a potential for contact with blood from the client, equipment, and bedside environment -apply direct pressure followed by a pressure dressing to the site after the needle has been withdrawn -instruct the client to lay on the site for atleast 10 mins or longer. -limit the client's activity to approx. 30 mins after the procedure, -monitor the puncture site frequently for continued bleeding; change or reinforce the dressing as needed. -report prolinged bleeding, ususual pain at the site that is unrelieved by analgesic, fever and other signs of an infection such as swelling and purulent drainage, -delay bathing or showering for 24 hours,

Mononucleosis treatment and precautions

-is a viral disease that affects lymphoid tissues such as the tonsils and spleen. it can also involve other organs such as the brain, meninges, and liver. --the infection is self-limiting. Bed rest, analgesic and antipyretic therapy, and increased fluids intak are recommended. Corticosteroid therapy is prescribed to minimize severe pharyngeal inflammation or if complications such as hepatic involvement occur. if a bacterial infection such as sinusitis or streptococcal pharyngitis accompanies mononucleosis, an antibiotic is prescribed - Standard precaution are used when caring for a client with infectious mononucleosis because its transmission requires intimate contact with saliva; tramsmission as an airborne pathogen is unlikely.. blood transmission is low. - A precautionary guideline is to withhold donating blood for at least 6 months after recovering from the illness. the transmission by blood transfusion is not considered to be a significant health hazard.

Hemophilia precautions

-minor surgical procedure, such as tooth extraction, considerable risk and are best performed in a hospital. transfusion usually are necessary even when minor surgery is performed. -prevent trauma, managing and minimizing bleeding episodes, reducing pain and discomfort, conserving energy, and helping the client learn ways to prevent further bleeding episodes. --eliminate aspirin and NSAIDS because these drugs can increase bleeding tendencies. ---avoid activities that can result in injury. --wear medicAlert bracelet and inform the dentist and others, when appropraite, of the condition --notify the physician promptly if pain, discomfort, or obvious bleeding from the nose and rectum, in vomitus or else where occur, Bleeding in internal organs or structures initially produces only vague symptoms. --use of soft toothbrush and rinse the mouth with warm water between and after meals. --support painful joints on pillows.

Hodgkin's disease-symptoms

-painless enlargment of one or more lymph nodes, the cervical lymph node are the first to be affected. - a sense of fullness in the stomach and epigastric pain, weight loss, anorexia, fatigue, and weakness occur. Low-grade fever, pruritus, and night sweats are common, anemia, and thrombocytopenia develop, causing a tendency to bleed. -Resistance to infection is poor, and staphylococcal skin infections and respiratory tract infection often complicate the illness.

Causes of primary lymphedema

-primary lymphedema usually is congenitally acquired, although manifestations usually do not appear until adolescence or early adulthood. it affects woman more than men

pt teaching -use of a compression garment

-purchase two compression garments so that one can be worn while the other is washed and dried. -change the garment in the morning and again in the evening because the garment becomes stretched after 12 hours of being worn. -limit the time that garment is not worn to no more that 30-60 mins to prevent reaccumulation of tissue fluids and stretch skin. - follow the physicians direction for wearing the garment for shorter amounts of time after the limb has become remodeled, which may take 6-12 months or longer. -wash the removed garment in soap and water each day to prolong its elasticity and remove perspiration, bacteria, or dead skin cells -use air drying out of direct sun to preserve the longevity of the garment -remove the garment when swimming, if desired, as long as the extremity is submerged in water, if worn during swimming, rinse the garment to remove the chlorinated or salt water before washing and drying. - replace a compression garment every 4-6 months,

Multiple myeloma precautions

-safety is paramount because any injury, no matter how slight, can result in a fracture. when the pain is severe, the nurse delays position changes and bathing until an administered analgesic has reached its peak concentration level and the client is experiencing maximum pain relief. The nurse takes measures to reduce the potential for infection

Definition of hematopoiesis

-the manufacture and development of blood cells.

sickle cell treatments

-treatments for most clients is supportive rather than curative. -Regular transfusion decreases the risk of stroke and other complications of infarction. transfused blood, however, increases blood viscosity-thickness-which can potentially do more harm than good. -treatment with hydroxyurea--Hydrea, Droxia-- an anticancer agent, shows evidence that it decreases sickling by stimulating the production of HbF. Drug-induced formation of HbF, which has a highaffinity for oxygen, has several benefits- it promotes round, flexible blood cells that are less sticky so they move better through blood vessels; induced a milder form of the disease; decrease organ damages; lowers the need for blood trasnfusion , lessens the number of hospitalizations, and reduces early mortality. -inhaled nitric oxidea vasodilating agent- used to reduce sickling by promoting the binding of oxygen to hemoglobin- to relieve pain experienced during sickle cell crisis -Poloxamer 188-RheothRx- a form of surfactant and a wetting agent, that is administered by continuous IV infusion for approximately 48 hours at the time of the sickle cell crisis, - ---it decrease the viscosity of blood and reduces the clustering of platelets and erythrocytes, thus promoting increased vascular blood flow. -Bone marrow transplantation has cured sickle cell anemia primarily in children, but the process of destroying all the defective cells in an adult client's bone marrow tends to be more dangerous. -adult fare better with blood stem cell tranplantation, in which a portion of the client's bone marrow is not totally destroyed -clients are given narcotic analgesics on a scheduled basis or can self administer by using an IV pump. O2 may be given to relieve hypoxemia, client remains on complete bed rest, be hydrated with IV fluids, and may be given blood transfusion.

Role of the spleen and liver in erythrocyte metabolism

Erythrocytes circulates in the blood for about 120 days, after which the spleen removes them; the liver removes severely damaged erythrocytes. When Erythrocytes are destroyed, the iron component of hemoglobin is returned to the red bone marrow and reused. The residual pigment is stored in the liver as bilirubin and excreted in bile.

Normal blood counts for WBC

Normal leukocyte count is between 5000 to 10,000/mm3 --Leukoctyes or WBC perform various protective functions such as engulfing invading microorganisms and cellular debris and manufacturing antibodies. they not only circulate in blood but also migrate from the blood into body tissues to search for and destroy potentially harmful substances. -LEUKOCYTOSIS- an increased number of leukocytes -LEUKOPENIA- decreased number of leukocytes. - the life span of leukocytes is only 1 to 2 days; consequently, the demand for the production of WBCs is continuous. The need is even greater with an infection .

Type O blood

are termed universal donors, because they do not have antigens on the red blood membrane. Clients with all blood types can receive type O blood provided the RH factor is compatible. -Those with type O blood, however, can only receive type O blood.

type AB blood

are considered universal recipients because both A and B antigens are present on the red cell membranes -clients with type AB blood can receive blood from persons with any type of blood, but the RH factor must be compatible.

Normal blood counts RBC

The normal number of erythrocyte varies with age, gender, and altitude but ranges between 3.6-5.4 million/mm3. -Infants have more erythrocytes than men. People who live at a high altitude or engage in strenuous activity have an increased number of erythrocytes to maximize the transport of O2 and CO2

The Rh factor

is a specific protein on the RBC membranes. If the protein is present, the person is Rh positive. If the protein is absent, the person is Rh negative.

thrombocytopenia

common example of coagulopathies. is a lower than normal number of platelets or thrombocytes. - occurs when the platelets manufactured by the bone marrow are decreased or platelets destruction by the spleen is increased. -it accompanies leukemia and other malignant blood diseases and is caused by severe infection and certain drugs. -Idiopathic thrombocytopenia purpura is thrombocytopenia without a known cause. - is evidenced by pupura, small hemorrhages in the skin, mucous membrane, or subcutaneous tissues. Bleeding from other parts of the body, such as the nose, oral mucuos membrane, and the GI tract. also occurs. -Internal hemorrhage, which can be severe and even fatal, is possible. -diagnosis is based on symptoms, a low platelet count, and abnormal bleeding and clotting times. -in some instances, bone marrow aspiration is performed - A health history sometimes reveals agents that are associated with drug-induced thrombocytopenia, such as heparin. when possible, the cause is eliminated. Corticosteroids provide symptomatic relief until the platelet count returns to normal. -transfusion of platelet or whole blood are given in a hemorrhagic emergency. If spontaneous recovery does not occur, splenectomy is necessay to stop destruction of platelets in the spleen -Removal of the spleen results in a sin ein the platelet count and relief of symptoms, but there is a lifelong potential for infection because the absent spleen cannot filter bacteria present in the blood. - clients with idiopathic thrombocytopenia often recover spontaneously. if the cause can be removed or treated, the prognosis is good. Thrombocytopenia in conjuction with illness such as leukemia has a poor prognosis. --Refer to nursing interventions for managing and minimizing bleeding and hemorrhage discussed with leukemia -if instituting corticosteroid therapy, the nurse observes the client for adverse drug effects. -the dose and frequency of steriod medication is tapered before discontinuing it to avoid adrenal insufficiency or crisis.

Signs of leukopenia

fatigue, fever, chills, headache, and opportunistic infections in the mouth, throat, nose, rectum, or vagina can develop.

Normal blood counts for Hgb

in adults, the normal amount of hemoglobin is 12.0 to 17.4 g/dL -the red color of blood is caused by hemoglobin, an iron-containing pigment attached to erythrocytes. the Heme portion of the molecule freely binds with O2, forming a substance called oxyhemoglobin. -Hemoglobin carried O2 to the cells of the body -An erythrocytes pass through the lungs, the hemoglobin picks up O2 and releases Co2. Oxygenated blood is bright red and carried by arteries, arterioles, and capillaries to all body tissues. After hemoglobin releases O2 for use by the tissues, the hemoglobin is called reduced or deoxygenated hemoglobin. The blood becomes darker red and returns by way of the veins to the heart and lungs, where Co2 is released and the blood is reoxygenated.

leukopenia-

is a general reduction in all WBC's. Agranulocytosis-refers specifically to a decreased production of granulocytes, neutrophils, and eosinophils. - decreased granulocytes place the client at risk for infection. -the most common cause of agranulocytosis is toxicity from drugs such as sulfonamides, chloramphenicol-Chloromysetin-, antineoplastic, and some psychotropic medications. s/s- fatigue, fever, chills, headache, and opportunistic infections in the mouth, throat, nose, rectum or vagina can develop. -treatment includes removal of the cause, such as discontinuing the drug that is producing agranulocytes. -Nurse determines the names of all drugs the client has used in the past 6-12 months . Neutropenic precautions- is necessary if the leukocyte counts is extremely low. visitors and staff with any type of infection are restricted from close client contact until infection is cleared.

Older adults-

more susceptible to infections

Treatment for thrombocytopenia

when possible, the cause is eliminated. Corticosteroids provide symptomatic relief until the platelet count returns to normal. -transfusion of platelet or whole blood are given in a hemorrhagic emergency. If spontaneous recovery does not occur, splenectomy is necessay to stop destruction of platelets in the spleen -Removal of the spleen results in a sin ein the platelet count and relief of symptoms, but there is a lifelong potential for infection because the absent spleen cannot filter bacteria present in the blood. - clients with idiopathic thrombocytopenia often recover spontaneously. if the cause can be removed or treated, the prognosis is good. Thrombocytopenia in conjuction with illness such as leukemia has a poor prognosis.