Med Surg - Exam #2 Content: Chapter 19 Hematologic Function

What are the (three) functions of the hematologic system?

1) Transportation 2) Regulation 3) Protection

Platelets (Plt) normal range:

150,000-400,000 cells/mm3

What is the normal amount of leukocytes (white blood cells) in normal blood?

5,000 - 10,000/mm3

What should the nurse pay attention to if a patient is displaying petechiae?

Abnormalities of the vascular system give rise to local bleeding, usually into the skin. Because platelets are primarily responsible for hemostasis in small vessels, patients with platelet defects develop petechiae, often in clusters; these are most often seen first on the extremities and then the mucous membranes.

After a bone marrow aspiration & biopsy, the patient is requesting Aspirin to resolve his pain. Is the medication safe to give?

Aspirin-containing analgesics should be avoided because of the increased risk of bleeding. A mild analgesic (e.g., acetaminophen) may be useful.

A patient with thrombocytopenia due to chemotherapy develops a nose bleed (epistaxis). What is the nurse's expected response? A) Apply ice to the anterior surface of the nose and place the patient in a supine position B) Apply pressure to the nares and position the patient in a high Fowler position, leaning slightly forward C) Squeeze the nares together firmly and position the patient in prone position with mouth open D) Ask the patient to blow the nose vigorously as the nurse applies firm pressure to the nares

B. Apply pressure to the nares and position the patient in a high Fowler's position, leaning slightly forward. Sitting upright decreases the risk of aspiration of blood and pressure is applied for a minimum of five minutes. Ice may also be applied to the nares. The patient's mouth should be open so that blood can drain rather than be swallowed, which may cause vomiting.

What is the priority nursing diagnosis for a client experiencing anemia? A) Risk for injury related to poor blood clotting B) Fatigue related to decreased cellular oxygenation C) Risk of infection related to decreased leukocytes D) Imbalanced nutrition; less than body requirements related to anorexia

B. Fatigue related to decreased cellular oxygenation. A low red blood cell (RBC) count decreases oxygen availability to the tissues, and fatigue, shortness of breath, and weakness may be noted.

A nurse is caring for a patient who is 73 years old with a platelet count of 5,000/mm3 resulting from myelodysplastic syndrome. At 10 PM, the patient complains of a headache. What should be the nurse's immediate action to take? A) Administer aspirin per p.r.n. order. B) Administer acetaminophen per p.r.n. order. C) Notify the health care provider. D) Administer a nonpharmacologic intervention, such as a cool compress.

C. Notify the healthcare provider. Platelet counts ≤10,000/ mm3 are associated with serious episodes of spontaneous bleeding, including intracranial hemorrhage; thus complaints of headaches or change in the level of consciousness necessitates immediate notification of the health care provider.

What is the major function of erythrocytes (RBC's)?

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

The nurse recognizes this as the most common hematologic condition associated with aging. A) Thrombocytopenia B) Leukopenia C) Agranulocytosis D) Anemia

D. Anemia. Anemia is the most common hematologic condition affecting elderly patients; with each successive decade of life, the incidence of anemia increases. Anemia frequently results from iron deficiency (in the case of blood loss) or from a nutritional deficiency, particularly folate or vitamin B12 deficiency or protein-calorie malnutrition; it may also result from inflammation or chronic disease.

During a bone marrow biopsy, what would cause the need to reposition the needle?

During the biopsy, the patient may feel pressure but should not feel pain; if the patient experiences pain radiating down the leg, repositioning of the needle may be necessary.

Which organs may assist in production of blood cells if there is a disease that causes bone marrow destruction?

In adults with disease that causes marrow destruction, fibrosis, or scarring, the liver and spleen can also resume production of blood cells (extramedullary hematopoiesis).

Where is bone marrow usually aspirated from in adults during a bone marrow aspiration?

In adults, bone marrow is usually aspirated from the posterior iliac crest.

What does a low MCV indicate?

Iron deficiency anemia

Which cells have the lifespan of approximately 7.5 days and one-third of their population remains in the spleen?

Platelets have a life span of approximately 7.5 days. Two-thirds circulate in the blood and contribute to homeostasis. The remaining one-third is stored in the spleen, where they remain unless needed in cases of significant bleeding.

In adults, what part of the skeletal system is there the most marrow activity?

With aging, marrow activity is usually limited to the pelvis, ribs, vertebrae, and sternum.

Hemoglobin (Hgb) normal ranges:

Female: 12 - 16 g/dL Male: 14 - 18 g/dL

Hematocrit (Hct) normal ranges:

Female: 36 - 48% Male: 42 - 54%

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

Hematocrit is the percentage of blood volume consisting of erythrocytes.

Which type of stem cell produces T & B lymphocytes?

Lymphoid stem cells produce either T or B lymphocytes.

What type of blood cell do myeloid stem cells differentiate into?

Myeloid stem cells differentiate into three broad cell types: erythrocytes, leukocytes, and platelets.

What is the major function of thrombocytes (Platelets)?

Platelets play an essential role in the control of bleeding (hemostasis).

What are the risks of a bone marrow aspiration & biopsy?

Risks include infection, bleeding, and pain.

What can the aspirate alone indicate?

The aspirate provides a sample of cells. Aspirate alone may be adequate for evaluating certain conditions, such as anemia.

What is the purpose of a bone marrow biopsy & aspiration?

The bone marrow aspiration and biopsy are indicated to further assess the underlying cause of an abnormal CBC, when additional information is needed to assess the quantity and quality of each type of cell produced within the marrow.

Where is the site of hematopoiesis?

The bone marrow is the site of hematopoiesis, or blood cell formation.

What is the major function of leukocytes (WBC's)?

The major function of white blood cells is to fight infection.

What type of therapy is implemented to reverse the complications of iron overload?

To prevent or reverse the complications of iron overload, iron chelation therapy is commonly implemented.