Chapter 32, 33, 24

A female patient has a hemoglobin of 6.4 g/dL and is preparing to have a blood transfusion. Why would it be important for the nurse to obtain information about the patient's history of pregnancy prior to the transfusion? - A high number of pregnancies can increase the risk of reaction - If the patient has never been pregnant, it increases the risk of reaction - Obtaining information about gravidity and parity is routine information for all female patients -n If the patient has been pregnant, she may have developed allergies

- A high number of pregnancies can increase the risk of reaction

A patient develops a hemolytic reaction to a blood transfusion. What actions should the nurse take after this occurs? (Select all that apply.) - Administer diphenhydramine - Begin iron chelation therapy - Obtain appropriate blood specimens - Collect a urine sample to detect hemoglobin - Document the reaction according to policy

- Obtain appropriate blood specimens - Collect a urine sample to detect hemoglobin - Document the reaction according to policy

Hgb normal range for females

12-16

Normal platelet count

150,000-400,000

Fibrinogen levels

200-400 mg/dL

Normal TIBC count

250-460 mcg/dL

MCH count

27-31 pg/cell

normal aPTT count

30-40 seconds

Hct count females

37 to 47%

Hct Count Male

42-52%

Normal Iron Levels (Females)

60-160

Normal Iron levels (men)

80-180

MCV count

85-95fL

D-dimer reference range

<0.4mg/dL

Fibrin degradation products levels

<10mcg/dL

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 Decreased total iron-binding capacity Increased mean corpuscular volume Increased reticulocyte count

Decreased level of erythropoietin

A slow infusion rate begun 4 hours ago. What is the nurses most appropriate action?

Discontinue the remainder of the PRBC transfusion and inform the physician.

Involved in allergic reactions (neutralizes histamine); digests foreign proteins

Eosinophil

elevated HGB count

Erythrocytosis COPD Dehydration

A patient is undergoing platelet pheresis at the outpatient clinic. What does the nurse recognize is the most likely clinical disorder the patient is being treated for? - Essential thrombocythemia - Extreme leukocytosis - Sickle cell disease - Renal transplantation

Essential thrombocythemia

the complex process of the formation and maturation of blood cells

Hematopoiesis

Elevated iron levels

Hemochromatosis iron access liver disorder Lead toxicity

A nurse is caring for a patient who has had a bone marrow aspiration with biopsy. What complication should the nurse monitor the patient for? Hemorrhage Infection Shock Splintering of bone fragments

Hemorrhage

decreased PT Count Time

Vitamin K excess Pulmonary embolis Thrombophlebitis

fights infection

WBC (Leukocyte)

elevated INR/prolonged PT

Warfarin therapy

decrease HGB count

anemia hemorrhage kidney disease

kidneys sense a low level of oxygen in circulating blood

erythropoietin levels increase

clotting factor present in plasma

fibrinogen

INR normal range

0.8-1.1 (Desired goal of warfarin therapy is 2-3X)

PT count

11 to 12.5 seconds. 85% to 100% of 1:11 client control ration

Hgb normal range for males

14-18

Prior to administration of a transfusion of PRBCs, what action should the nurse perform?

Assess vital signs to establish baselines.

decreased fibrinogen.

Liver disease Advanced Cancer Malnutrition

Elevated/decreased HCT count

Same as HGB

Persistently elevated hematocrit is an indication

therapeutic phlebotomy

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.) - Performance of serial chest x-rays - Supplemental oxygen - Provision of intravenous fluid support - Intubation and mechanical ventilation - Intra-aortic balloon pump

- Supplemental oxygen - Provision of intravenous fluid support - Intubation and mechanical ventilation

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

B lymphocyte

Contains histamine; integral part of hypersensitivity reactions

Basophil

elevated fibrinogen

Acute inflammation, infection, heart disease

Plasma protein responsible for fluid balance

Albumin

the role of B lymphocytes

Antibody production B lymphocytes are capable of differentiating into plasma cells. Plasma cells, in turn, produce antibodies.

decreased Fibrin degradation levels

Anticoagulation therapy

decrease INR

Cancer

decreased aPTT count

Cancer

increased PT Count time

Clotting Factors II, V, VII, or X Liver disease

decreased Iron Levels

Iron deficiency anemia Chronic Blood loss Inadequate diet of iron

Integral component of immune system

Lymphocyte

integral part of the immune system

Lymphocyte

Decreased TIBC

Malnutrition, cirrhosis, pernicious anemia

elevated MCV

Microcytic RBC Megaloblastic Anemia

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

Monocyte

Largest classification of Leukocyte

Monocyte

Preventing or limiting bacterial infection via phagocytosis

Neutrophil

What age-related change in hematologic function should the nurse integrate into care planning for an older adult who has a hematologic disorder?

Older adults are less able to increase blood cell production when demand suddenly increases.

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

Plasma cell

A lymphoid stem cell defect has the potential for a problem involving which of the following?

Plasma cells

Protein that forms the basis for blood clotting

Plasminogen

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

Platelet (Thrombocyte)

What is the primary advantage of autologous transfusions?

Prevention of viral infections from another persons blood

Carries hemoglobin to provide oxygen to tissues; average lifespan is 120 days

RBC (Erythrocyte)

Elevated/decreased MCH count

Same as MCV

a significant increase in the number of band cells

Signs and symptoms of infection

The site of activity for macrophages

Spleen

Iron deficiency in the adult generally indicates blood loss what are the diagnostic tests?

Stool for occult blood CBC

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

T lymphocyte

Another term of platelet

Thrombocyte

A patient with chronic kidney disease has chronic anemia. What pharmacologic alternative to blood transfusion may be used for this patient? a. GM-CSF b. Erythropoietin c. Eltrombopag d. Thrombopoietin

b. Erythropoietin

Positive D-Dimer

disseminated intravascular coagulation, malignancy

Elevated Fibrin degradation levels

disseminated intravascular coagulation, massive trauma

Decreased Platelet Count

enlarged spleen, hemorrhage, kidney disease

defect in a myeloid stem cell can cause problems with

erythrocyte, leukocyte, and platelet production

normally make up 40% to 45% of the blood volume.

erythrocytes (red blood cells [RBCS], red cells) leukocytes (white blood cells [WBCs]) thrombocytes (platelets)

is a type of transfusion reaction that is associated with fever but not directly with hemolysis. It is most commonly caused by antibodies directed against donor leukocytes and HLA antigens.

febrile nonhemolytic reaction

decrease WBC count

immunosuppression autoimmune disease

increased aPTT count

increased time: K+ deficiency, disseminated intravascular coagulation (DIC) Liver disease, Heparin administration

elevated WBC

infection, inflammation

Elevated TIBC

iron deficiency anemia, polycythemia vera

Increased Platelet Count

malignancy, polycythemia, rheumatoid arthritis

decreased MCV

microcytic, iron deficient anemia

Negative D-Dimer

rules out PE or DVT