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