Chapter 35 Hematology - OVAA Happenings ?· 1 Chapter 35 Hematology Hematology The study of blood and…

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<ul><li><p>1</p><p>Chapter 35 Hematology</p><p>HematologyThe study of blood and blood-forming ______________________________________ Includes the study of the following blood disorders:</p><p> Red blood cell disorders ______________________________________ blood cell disorders Platelet disorders ______________________________________ problems</p><p>Blood ComponentsPlasma</p><p>-sticky yellowish-carries blood cells and ______________________________________</p><p>Erythrocytes (red blood cells)-contain ______________________________________-gives blood its color-carries ______________________________________</p><p>Blood Components______________________________________ : </p><p>-Iron containing oxygen-transport malloprotein in the red blood cells______________________________________(white blood cells)</p><p>-fights infection______________________________________</p><p>-clot formation-usually clots in 4 to 6 minutes</p><p>Lab Values</p><p>Hemoglobin LevelsThe amount of ______________________________________ carrying protein within the </p><p>red blood cellsNormal Adult Female 12-16g/dLNormal Adult Male: 14-18g/dL Low hemoglobin suggests ______________________________________High hemoglobin can suggest lung disease, living at high altitudes, or excessive bone </p><p>marrow production</p><p>HematocritA measure of how much space red blood cells take up in the bloodThe proportion of blood volume that is occupied by red blood cellsNormal adult male: __________%Normal adult female: ___________%Elevated hematocrit indicates ______________________________________ Low levels indicate ______________________________________ </p><p>White Blood Cell LevelsNumber of white blood cellsNormal adult range: 3.8-10.8 thousand/mcLOptimal reading: 7.3</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p></li><li><p>2</p><p>High readings could indicate ______________________________________ or leukemia Low readings can indicate bone marrow disease or enlarged </p><p>______________________________________</p><p>Red Blood Cell LevelsNumber of red blood cellsNormal adult female: 3.9-5.2 mill/mclNormal adult male: 4.2-5.6 mill/mclHigh readings could indicate ______________________________________ disease, cor </p><p>pulmonale, or dehydration Low readings could indicate anemia, leukemia, malnutrition, bone marrow failure, multiple </p><p>myeloma, blood loss, or ______________________________________</p><p>Platelet ValuesNumber of platelet cellsNormal adult range: 150-450 thousand/mclOptimal range: 265 thousandHigh readings could indicate ______________________________________, cigarette </p><p>smoking, or excessive production by the bone marrow Low readings could indicate acute blood loss, drug effects </p><p>(______________________________________), infections, enlarged spleen</p><p>TroponinTroponin is a muscle ______________________________________, that helps muscles </p><p>contractWhen the ______________________________________, muscle is damaged, troponins </p><p>leak out of cells and into the bloodstreamNormal reading is </p></li><li><p>3</p><p>Rh Factor______________________________________ FactorConsists of 50 blood group antigensRh factor is based on the ___________ antigen</p><p> Positive or NegativeUsed to determine the risk of hemolytic disease of the </p><p>______________________________________ as well as transfusion compatibility</p><p>Types of Transfusions______________________________________ blood</p><p> Contains all cells, platelets, clotting factors, and plasma Replaces blood loss from hemorrhage</p><p>Packed Red Blood Cells (PRBC) Red blood cells with some ______________________________________ Replaces RBC in anemic patients</p><p>______________________________________ Platelets with some plasma Replaces platelets in a patient with thrombocytopenia</p><p>Types of TransfusionsFresh Frozen Plasma (FFP)</p><p> Plasma, a combination of fluids, ______________________________________ factors, and proteins</p><p> Replaces volume in a ______________________________________ patientClotting Factors</p><p> Specific clotting factors needed for ______________________________________ Replaces factors missing due to inadequate production as in </p><p>______________________________________ </p><p>Transfusion Reactions</p><p>Hemolytic ReactionsOccurs when a donors and ______________________________________ blood are not </p><p>compatibleSigns &amp; Symptoms</p><p> Facial flushing, hyperventilation, tachycardia, hives, chest pain, wheezing, rales, fever, chills, and ______________________________________ </p><p>Treatment Stop transfusion, change all IV tubing, and initiate IV therapy with NS or LR Consider ______________________________________ , Dopamine, and </p><p>Diphenhydramine.</p><p>Febrile Nonhemolytic ReactionsFebrile Nonhemolytic ReactionsCaused by ______________________________________ to antigens on the white blood </p><p>cells, platelets, or plasma proteinsSigns &amp; SymptomsHeadache, fever, and chillsTreatment:Stop ______________________________________ , change all IV tubing, and initiate IV </p><p>14</p><p>15</p><p>16</p><p>17</p><p>18</p><p>19</p></li><li><p>4</p><p>therapy with NS or LRConsider ______________________________________ and an antipyretic.Observe closely to ensure reaction is nonhemolytic.</p><p>General Assessment and Management of Hematologic PatientsScene Size-upPrimary AssessmentFocused History and Physical ExamSAMPLE history</p><p> Hematological disorders are rarely the chief complaint. Weak and Dizzy is a ______________________________________ complaint</p><p>Physical exam Evaluate ______________________________________ system function.</p><p>Physical Exam of Hematologic PatientsSkin signs</p><p> Jaundice Pallor ______________________________________ : tiny red dots ______________________________________ : large purplish blotches </p><p>Gastrointestinal signs ______________________________________ Bleeding gums Abdominal pain, N/V</p><p>Physical Exam of Hematologic PatientsMusculoskeletal signs</p><p> Pain and swelling of the ______________________________________ Cardiorespiratory signs</p><p> Dyspnea, tachycardia, chest pain Pulmonary edema</p><p>Genitourinary signs ______________________________________ Blood in scrotal sac on males ______________________________________(later stages of sickle cell anemia)</p><p>General Management of Hematologic PatientsMaintain ABCs.</p><p> Provide high-flow oxygen or assist ______________________________________ as indicated.</p><p> Consider ______________________________________ replacement.Monitor cardiac rhythm and vital signs.</p><p> Treat rhythm ______________________________________ .Provide reassurance, comfort care, and transport.</p><p>Managing Specific Patient ProblemsDiseases of the ______________________________________ Blood CellsDiseases of the White Blood CellsDiseases of the ______________________________________ /Blood Clotting </p><p>Abnormalities</p><p>20</p><p>21</p><p>22</p><p>23</p><p>24</p></li><li><p>5</p><p>Other Hematopoietic Disorders</p><p>Anemia______________________________________ number of red blood cellsAnemia is a sign, not a separate ______________________________________ process.Signs and symptoms may not be present until the body is stressed.S/S include: mild dyspnea, fatigue, ______________________________________ , and </p><p>syncope. Possible S/S of shockDifferentiate chronic anemia from ______________________________________ episode.</p><p>Prehospital Treatment of AnemiaTreat signs and symptoms Maximize ______________________________________ Limit ______________________________________ loss.Establish IV therapy if indicated</p><p>Types of Anemias3 causes of Anemias: Inadequate ______________________________________ of red blood cells Increased red blood cell ______________________________________ Blood cell loss or ______________________________________ </p><p>Anemias Caused by Inadequate Production of Red Blood Cells______________________________________ Anemia</p><p> Failure to produce red blood cells______________________________________ Deficiency</p><p> Iron is primary component of hemoglobin</p><p>Anemias Caused by Inadequate Production of Red Blood Cells______________________________________</p><p> Vitamin B12 is necessary for correct rbc division during its development Decreased levels of B12</p><p>______________________________________ Cell Anemia Genetic alteration changes the shape of red blood cells to a C, or sickle, in low oxygen </p><p>states</p><p>Anemias Caused by Increased Red Blood Cell Destruction______________________________________ Anemia</p><p> Body destroys RBCs at greater rate than production</p><p>Anemias Caused by Blood Cell Loss or Dilution______________________________________ Anemia</p><p> Hemorrhage leads to cell loss while excessive fluid leads to a dilution of RBC concentration</p><p>Diseases of the Red Blood Cells</p><p>Sickle Cell Disease Inherited disorder of red blood cell production, so named because the RBCs become sickle </p><p>shaped when ______________________________________ levels are lowPatients with sickle cell disease has chronic anemiaAverage life span of a RBC is _________-__________ days as compared to 120 days for </p><p>normal RBC</p><p>25</p><p>26</p><p>27</p><p>28</p><p>29</p><p>30</p><p>31</p><p>32</p><p>33</p></li><li><p>6</p><p>Primarily affects ______________________________________ -Americans</p><p>Sickle Cell Disease</p><p>Sickle Cell Crises______________________________________ Crises: causes musculoskeletal pain, </p><p>abdominal pain, priapisms, pulmonary problems, renal infarctions, and CNS problems______________________________________ Crises: fall in the hemoglobin level and </p><p>problems with bone marrow function______________________________________ Crises: vulnerable to infectionsManagement</p><p> Supportive measures Fluid replacement as indicated Consider analgesics.</p><p>Polycythemia Overproduction of RBCs.</p><p> Occurs in patients &gt; 50 years old or with secondary dehydration. Increases risk of ______________________________________ </p><p>Results in bleeding abnormalities: ______________________________________ , spontaneous bruising, GI bleeding.</p><p>Management: Follow general treatment guidelines.</p><p>Diseases of the White Blood Cells</p><p>Leukopenia/NeutropeniaToo few white blood cells or ______________________________________ .Person is very susceptible to ______________________________________ Follow general treatment guidelines and provide supportive care.</p><p>LeukocytosisAn ______________________________________ in the number of circulating white blood </p><p>cells, often due to infection or stressCauses include bacterial infections, ______________________________________ , </p><p>rheumatoid arthritis, leukemiaFollow general treatment guidelines and provide supportive care.</p><p>Leukemia______________________________________ of hematopoietic cellsCommon types of Leukemia</p><p> Acute lymphocytic leukemia (ALL) Acute myeologenous leukemia (AML) Chronic lymphocytic leukemia (CLL) Chronic myeologenous leukemia (CML) Hairy cell leukemia</p><p>Leukemia Initial presentation</p><p> Acutely ill, fatigued, febrile and weak, anemic, ______________________________________ </p><p> Often have a secondary ______________________________________ .</p><p>34</p><p>35</p><p>36</p><p>37</p><p>38</p><p>39</p><p>40</p><p>41</p></li><li><p>7</p><p>Management Follow general treatment guidelines. Utilize isolation techniques to limit risk of ______________________________________ . IV therapy ______________________________________</p><p>LymphomasCancers of the ______________________________________ systemPresentation</p><p> Swelling of the lymph nodes Fever, night sweats, ______________________________________ , weight loss, </p><p>fatigue, and pruritis (itching)Management</p><p> Follow general treatment guidelines. Utilize ______________________________________ techniques to limit risk of infection.</p><p>Diseases of the Platelets and Blood Clotting Abnormalities</p><p>ThrombocytosisAn abnormal increase in the number of ______________________________________ Often complicates chronic myelogenous leukemiaMay be secondary to other disorders such as autoinflammatory diseases, acute </p><p>hemmorrhage, and malignant diseasesMost persons are ______________________________________ Prehospital care is ______________________________________ </p><p>ThrombocytopeniaAn abnormal ______________________________________ in the number of platelets Due to decreased platelet production, sequestration of platelets in the spleen, destruction of </p><p>platelets, or a combination of the threeCharacterized by easy ______________________________________ , bleeding, and a </p><p>falling plate count Prehospital care is supportive</p><p>HemophiliaDeficiency or absence of a blood clotting factorDeficiency of factor ___________ causes hemophilia A.Deficiency of factor ____________ causes hemophilia B.Delays or prevents the stoppage of ______________________________________ ______________________________________ injuries can be life threatening</p><p>HemophiliaDeficiency is a sex-linked, inherited disorder.Defective gene is carried on the ___________ chromosome.Females have 2 X chromosomes and ______________________________________ must </p><p>have the defective gene for the female to develop hemophilia Females with only 1 X chromosome with defective gene are </p><p>______________________________________ Males have 1 X (from mother) and 1 Y chromosome (from father)</p><p> If that X chromosome has the defective gene, then that person will have hemophilia</p><p>Hemophilia</p><p>42</p><p>43</p><p>44</p><p>45</p><p>46</p><p>47</p><p>48</p></li><li><p>8</p><p>Signs &amp; Symptoms:Numerous bruises, deep muscle bleeding, and </p><p>______________________________________ bleeding.Often use Medic Alert ______________________________________ Most will know of their condition</p><p>Management of HemophiliaAdminister supplemental oxygenEstablish IV access with great ______________________________________ Be alert for recurrent or prolonged bleeding Prevent additional ______________________________________ Consider ______________________________________ if needed</p><p>Multiple MyelomaA ______________________________________ disorder of plasma cellsMutation in a plasma cell in the bone marrow leading to decreased reduced red blood cell </p><p>productionSigns/Symptoms</p><p> Pain in back or ribs ______________________________________ fractures Fatigue Elevated calcium levels which lead to ______________________________________ </p><p>failure</p><p>Multiple MyelomaNormally treated with chemotherapy, bone marrow transplants, and radiationPrehospital care is supportive</p><p> IV if s/s of ______________________________________ Administer analgesics if needed Protect from ______________________________________ </p><p>49</p><p>50</p><p>51</p></li></ul>

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