Chapter 37

Hematologic and Lymphatic Systems

Anatomy and Physiology Review

• Heart pumps 5 to 6 liters of blood per minute through adult circulatory system

• Lymphatic system– Separate vessel system with two main

functions:• Transport excess fluid from interstitial spaces to

circulatory system• Protect body from infections

Function of Blood

• Transport O2, CO2, water electrolytes, hormones and enzymes

• Heat to regulate body temperature

• Immune bodies and antibodies to help prevent disease and infection

• To provide clotting of blood in case of injury

• Prevent clot formation in blood vessels

Formed Elements

• Erythrocyte

• Leukocyte

• Thromobocyte

What is the action of STEM CELLS?

Red Blood Cells…

• Formed in red bone marrow

• Needs Vitamin B12, Intrinsic Factor, Iron, Folic Acid for manufacture

• Erythropoesis

• Carries O2 on the Hgb (12 – 16)

• Carries CO2 to lung for elimination

• Life span 120 days

Erythrocyte

Erythropoetin

Hemoglobin

• Millions of Hgb molecules per RBC

• Synthesis dependent on iron

• Carries O2 to cells of body

Hematocrit (Hct)

White Blood Cells…

• MULTIPLE TYPES– GRANULOCYTES

• MADE IN BONE MARROW• FIGHT INFECTION

– AGRANULOCYTES• MADE IN LYMPH• KEEP US HEALTHY

– ETC.

Leukocytes

Thrombocytes

Plasma

• Liquid part of blood; 90% water with 10% dissolved substances (proteins)

• Regulates blood volume

• Provides nutrition of body cells

• Function in clotting of blood

• Circulates antibodies

Type and Crossmatch

Administration of Blood

What is the role of the LPN?

Assessment

• Subjective data:– Biological data, demographical data,

occupation, hobbies, military experience, medication history, infections, night sweats, palpitations, bleeding, transfusions, neurological status, headaches, vision changes, alcohol and vitamin intake, surgeries, blood in stool or urine, diet history, and appetite

(continued)

Assessment

• Objective data:– Height, weight, vital signs, laboratory tests,

palpation of lymph nodes, inspection of skin for petechiae, bruises, lesions, brittle nails, enlarged abdomen, and swollen joints

Iron Deficiency Anemia

• Body does not have enough iron to synthesize functional hemoglobin (Hgb)

• Symptoms:– Fatigue, palpitations, tachycardia, exertional

dyspnea, weakness, pallor, pica, stomatitis, glossitis, and brittle hair

(continued)

Iron Deficiency Anemia

• Treatment:– Iron preparations and changes in diet

Aplastic Anemia

• Bone marrow decreases or stops functioning– Client not making enough blood cells

• Symptoms:– Fatigue, weakness, fever, palpitations,

headaches, mouth ulcers, petechiae, gingival bleeding, and epistaxis

• Treatment:– Bone marrow transplants and medications

Pernicious Anemia

• Autoimmune disease

• Parietal cells and destroyed and gastric mucosa atrophies

• Inability to absorb vitamin B12 from absence of intrinsic factor

(continued)

Pernicious Anemia

• Symptoms:– Weakness, sore tongue, edema, ataxia,

dizziness, dyspnea, headache, fever, blurred vision, tinnitus, jaundice, pallor, poor memory, irritability, loss of bowel/bladder control, and decreased sensitivity to hot and pain

• Treatment:– Lifetime replacement of vitamin B12

intramuscularly

Acquired Hemolytic Anemia

• Destruction of red blood cells releasing iron and Hgb

• Symptoms:– Mild fatigue, pallor, jaundice, palpitations,

hypotension, dyspnea, and back and joint pain

(continued)

Acquired Hemolytic Anemia

• Treat to remove cause:– Blood transfusions, erythrocytapheresis,

splenectomy, and medications

Sickle Cell Anemia (Inherited Hemolytic Anemia)

• Genetic disorder

• Causes abnormally shaped red blood cells

• Symptoms:– Anemia, enlarged heart, fatigue, jaundice,

chronic leg ulcers, tachypnea, dyspnea, arrhythmias, and severe pain

(continued)

Sickle Cell Anemia (Inherited Hemolytic Anemia)

Sickle Cell Anemia Video

Sickle Cell Anemia (Inherited Hemolytic Anemia)

• Sickle cell crisis:– Fever, severe pain, and loss of blood

supply to affected area

• Treatment:– Medications and symptomatic care during

crises with pain management, oxygen, and hydration

Polycythemia

• Increased production of red blood cells along with white blood cells and platelets

• Symptoms:– Headaches, dizziness, tinnitus, blurred

vision, fatigue, weakness, pruritus, exertional dyspnea, angina, increased blood pressure and pulse, and ruddy appearance

(continued)

Polycythemia

• Complications:– Thrombus formation and gout

• Treatment:– Phlebotomy, medications (low-dose aspirin

and anti-gout drugs), and dietary changes

• WHAT’S THE NORMAL LIFE SPAN FOR HEALTHY RED BLOOD CELLS (RBC’S)?– A – 60 DAYS– B – 90 DAYS– C – 120 DAYS– D – 240 DAYS

• THE NURSE IS DOCUMENTING CARE FOR A CLIENT WITH IRON DEFICIENCY ANEMIA. WHICH OF THE FOLLOWING NURSING DIAGNOSES IS MOST APPROPRIATE?– A – IMPAIRED GAS EXCHANGE– B – DEFICIENT FLUID VOLUME– C – INEFFECTIVE AIRWAY CLEARANCE– D – INEFFECTIVE BREATHING PATTERN

• A 73 YEAR-OLD FEMALE IS ABOUT TO RECEIVE A BLOOD TRANSFUSION TO TREAT SEVERE ANEMIA. SHE ASKS THE NURSE HOW LONG THE PROCEDURE WILL TAKE. THE NURSE EXPLAINS THAT THE TREATMENT TAKES:– A – 8 HOURS– B – AT LEAST 12 HOURS– C – AT LEAST 24 HOURS– D – 4 HOURS

Leukemia

• Malignancy in which bone marrow produces increased numbers of immature white blood cells that cannot protect body from infections

(continued)

Leukemia

• Four categories:– Acute myelogenous (AML)– Acute lymphocytic (ALL)– Chronic myelogenous (CML)– Chronic lymphocytic (CLL)

(continued)

Leukemia

Leukemia

Leukemia

• Symptoms:– Fever, chills, fatigue, pallor, malaise,

tachycardia, tachypnea, petechiae, bruising, epistaxis, melena, gingival bleeding, increased menstrual bleeding, weight loss, night sweats, swollen lymph nodes, headache, and bone pain

(continued)

Leukemia

• Treatment:– Chemotherapy, radiation, blood products,

antibiotics, and bone marrow transplants

Agranulocytosis

• Reduced number of granulocytes

• Symptoms:– Headache, fever, chills, fatigue, mucous

membrane ulcerations, and low white blood counts

• Treat to remove cause of bone marrow suppression

(continued)

Agranulocytosis

• Treatment or prevention of infection:– Transfusions, Neupogen, and antibiotics

• WHEN PROTECTIVE ISOLATION IS NOT INDICATED, WHICH OF THE FOLLOWING ACTIVITIES IS RECOMMENDED FOR A CLIENT RECEIVING CHEMOTHERAPY?– A – BED REST– B – ACTIVITY AS TOLERATED– C – WALK TO BATHROOM ONLY– D – OUT OF BED FOR BRIEF PERIODS

• A CLIENT WITH LEUKEMIA HAS NEUTROPENIA. WHICH OF THE FOLLOWING FUNCTIONS MUST BE FREQUENTLY MONITORED?– A – BLOOD PRESSURE– B – BOWEL SOUNDS– C – HEART SOUNDS– D – BREATH SOUNDS

• WHICH OF THE FOLLOWING FOODS SHOULD A CLIENT WITH LEUKEMIA AVOID?– A - WHITE BREAD– B – CARROT STICKS– C – STEWED APPLES– D – MEDIUM-RARE STEAK

DIC

• Syndrome of alternating clotting and hemorrhaging– Due to primary disease process or condition

• Suspect with predisposing illness and onset of purpura, bleeding tendencies, and renal impairment

(continued)

DIC

DIC

• Symptoms:– Oozing from venipuncture, mucus membrane,

and wound

• Treat cause

• Treatment:– Blood products and medications

Hemophilia

• Inherited bleeding disorder

• Lack of clotting factors

• Symptoms:– Hemarthrosis, pain, swelling, redness, and

fever

(continued)

Hemophilia

• Complication:– Intracranial hemorrhage

• Treatment:– Replacement of missing clotting factors

Thrombocytopenia

• Decrease in number of platelets in blood

• Symptoms:– Petechiae, ecchymoses, and bleeding from

mucous membranes

• Treatment:– Transfusions of platelets, apheresis,

splenectomy, medications, and diet changes

Thrombocytopenia

• A CLIENT WITH THROMBOCYTOPENIA, SECONDARY TO LEUKEMIA, DEVELOPS EPISTAXIS. THE NURSE SHOULD INSTRUCT THE CLIENT TO:– A – LIE SUPINE WITH HIS NECK EXTENDED– B – SIT UPRIGHT, LEANING SLIGHTLY

FORWARD– C – BLOW HIS NOSE AND THEN PUT LATERAL

PRESSURE ON IT– D – HOLD HIS NOSE WHILE BENDING

FORWARD AT THE WAIST

• WHICH OF THE FOLLOWING CONDITIONS IS NOT CAUSED BY DISSEMINATED INTRAVASCULAR COAGULATION (DIC)?– A – ORGAN TISSUE DAMAGE– B – DEPLETION OF CIRCULATING CLOTTING

FACTORS– C – THROMBUS FORMATION IN THE LARGE

VESSELS– D – ACTIVATION OF THE CLOTTING-

DISSOLVING PROCESS

• WHICH OF THE FOLLOWING LABORATORY TESTS, BESIDES A PLATELET COUNT, IS BEST TO CONFIRM THE DIAGNOSIS OF ESSENTIAL THROMBOCYTOPENIA?– A – BLEEDING TIME– B – COMPLETE BLOOD COUNT (CBC)– C – IMMUNOGLOBULIN (Ig) G LEVEL– D – PROTHROMBIN TIME (PT) AND

INTERNATIONAL NORMALIZED RATIO (INR)

• WHAT IS THE LIFE SPAN FOR NORMAL PLATELETS?– A – 1 TO 3 DAYS– B – 3 TO 5 DAYS– C – 7 TO 10 DAYS– D – 3 TO 4 MONTHS

• A 43 YEAR-OLD WOMAN IS UNDERGOING TREATMENT FOR COLON CANCER. THE PHYSICIAN DOCUMENTS THROMBOCYTOPENIA ON THE CLIENT’S DIAGNOSIS LIST. WHAT OBSERVATIONS CAN THE NURSE EXPECT?– A – DIARRHEA– B – THIN, BRITTLE HAIR– C – BRUISES ON THE SKIN– D – URINARY URGENCY

Lymph

VIDEO

The Spleen

VIDEO

Hodgkin’s Disease

• Rare lymphoma usually arising as painless swelling in lymph node

• Symptoms:– Painless, enlarged lymph nodes in neck,

groin, or above clavicles, weight loss, fatigue, pruritus, recurrent high fever, night sweats, anemia, thrombocytopenia, and susceptibility to infection

(continued)

VIDEO

Hodgkin’s Disease

• Treatment:– Radiation, chemotherapy, and diet changes

Non-Hodgkin’s Lymphoma

• Symptoms:– Enlarged, painless lymph nodes in neck,

axillary, abdominal, and inguinal areas, fever, night sweats, excessive tiredness, indigestion, abdominal pain, loss of appetite, and bone pain

(continued)

VIDEO

Non-Hodgkin’s Lymphoma

• Treatment:– Chemotherapy, radiation, and bone marrow or

peripheral blood stem cell transplant

Myeloma

• Plasma cells become malignant, crowd out normal cell production, destroy normal bone tissue, and cause pain

• Symptoms:– Bone pain, swollen and tender joints, low-

grade fever, and general malaise

(continued)

Myeloma

• Not curable

• Treatment symptomatic

Chapter 60

Infants with Special Needs:Birth to 12 Months

Hyperbilirubinemia

• Also known as jaundice– Yellow discoloration of skin, sclera, mucous

membranes, and body fluids

• Treat to reduce amount of bilirubin

• Treatment:– Phototherapy with bili light or fiber-optic

blanket

Iron-Deficiency Anemia

• Full-term infants have iron stores that last five to six months– Surfaces between 9 and 24 months

• Symptoms:– Pallor, tachycardia, lethargy, irritability, and

below-normal hemoglobin, hematocrit, and iron levels

(continued)

Iron-Deficiency Anemia

• Treatment:– Iron replacement

Sickle-Cell Anemia

• Genetic disorder characterized by production of abnormal hemoglobin

• Symptoms after 6 months of age:– Abdominal pain, fever, growth retardation,

anemia, and increased risk of infection

(continued)

Sickle-Cell Anemia

• Prevent crises with hydration

• During crisis:– Bed rest, oxygen, fluids, and analgesics

Chapter 61

Common Problems: 1–18 Years

Cardiovascular, Hematologic, and Lymphatic Systems

• Rheumatic fever

• Leukemia

• Idiopathic thrombocytopenic purpura

• Hemophilia

Epstein-Barr Virus(Infectious Mononucleosis)

It’s time for report…

Prioritize the five nursing interventions as you would do them

initially:

A – Wash hands.

B – Assess the IV site.

C – Provide fresh water at bedside.

D – Assess oral mucosa.

E – Take the vital signs.