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Hematological System

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Blood formed in liver & spleen of fetus until 3rd trimester. At birth all bones ... Functions of Blood. Transport of oxygen & absorbed nutrients to cells ... – PowerPoint PPT presentation

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Title: Hematological System


1
Hematological System
  • Joyce Smith RN BSN
  • Nursing 202

2
Introduction
  • Blood formed in liver spleen of fetus until 3rd
    trimester
  • At birth all bones
  • Throughout life in flat bones

3
Introduction
  • Each day healthy bone marrow produces
  • 2.5 billion erthrocytes, 80- 120 days
  • 2.5 billion thrombocytes, 8-11 day
  • 1 billion leukocytes

4
Functions of Blood
  • Transport of oxygen absorbed nutrients to cells
  • Transport of waste production to kidney, skin
    lungs
  • Transport of hormones from endocrine glands to
    other tissue
  • Protection of the body from life-threatening
    microorganisms
  • Regulation of body temperature by heat transfer

5
Bone Marrow
  • Soft organic material that fills the cavities of
    the bones
  • Produces RBCs and platlets
  • Majority are produced in the vertebrae, ribs,
    sternum, skull, pelvis and long bones of the legs

6
Blood Components
  • Plasma
  • Albumin
  • Globulin
  • Fibroinogen
  • Erythrocytes
  • Leukocytes
  • Platelets

7
Blood Components
  • Red Blood Cells (RBC)
  • Largest portion of blood cells
  • Normal range 4.4 to 5.5 million/mm3
  • Life span 120 days
  • Responsible for producing hemoglobin
  • Serves as a buffer and maintains acid-base
    balance
  • Eythropoiesis/erythropoietin
  • Anemia

8
Blood Components
  • White Blood Cells (WBC)
  • Formed in the bone marrow
  • Provide immunity
  • Protects from effects of invasion, infection,
    injury
  • Types

9
Blood Components
  • Platelets
  • Smallest of the blood cells
  • Formed in the bone marrow
  • Forms plugs to stop flow of blood from an injury
    site
  • Maintains blood vessel integrity
  • Aggregation
  • Thrombopoietin
  • 80 circulate, 20 stored in spleen
  • Life span 1 to 2 weeks

10
Spleen
  • Encapsulated organ about size of fist, LUQ under
    ribs
  • Blood formation
  • Blood storage
  • Blood filtration

11
Lymph System
  • System of organs, tissues, fluid that deal with
    inflammation, infection, cancer allergic
    response
  • Transports lymph
  • Produces lymphocytes antibodies
  • Phagocytosis
  • Absorption of fats fat-soluble matters from
    intestine

12
Liver
  • Largest organ in body next to skin
  • Beneath diaphragm, most on right side of body
  • 500 functions
  • Reservoir 500-1000cc blood
  • Filters detoxifies blood, kupffer cells

13
Liver
  • Stores nutrients
  • Fat soluble vitamins
  • A, D, E, K, B12, B1, B2, Fe, phospholipid,
    cholesterol
  • Synthesizes
  • bile, serum albumin, globulins, prothrombin,
    fibrogen, blood coagulation factors V, VII, VIII,
    IX, XI, XII, urea
  • Converts bilirubin to bile stores extra Fe as
    ferritin

14
Normal Clotting Mechanism
  • Platelet Aggregation
  • Activated platelets clump together to form plug
    in vessel wall damage
  • Blood-clotting cascade
  • Intrinsic Factor
  • Extrinsic Factor

15
Normal Clotting Mechanism
  • Fibrin Clot Formation
  • Fibrin molecules link together to form fibrin
    threads
  • XIII tightens mesh
  • Platelets stick to threads
  • Firbrinolysis
  • Breaks up fibrin clot

16
Gerontological Considerations
  • Hgb level fall after middle age
  • Fe deficiency most frequent in older
  • Reduced dietary intake of iron-rich foods
  • Dont use oral Fe supplements
  • By age 65 up to 50 of bodys bone marrow
    converted to inactive

17
Anticoagulants
  • Anticoagulants interfere with one or steps in
    blood-clotting cascade
  • Heparin
  • Vitamin K antagonists
  • Platelet aggregation inhibitors

18
Thrombolytic
  • Thrombolytics degrade fibrin thread
  • tPA
  • SK
  • Reteplase
  • Anistreplase

19
Key Symptoms
  • Effects every system of body
  • Low RBCs SOB, weakness,malaise, fatigue
  • Low platelets Unusual or prolonged bleeding
  • Low WBCs fever
  • High lymphocytes Viral infection

20
Health History
  • Time of onset duration of symptoms
  • Continuous or intermittent
  • History of similar signs in parents or siblings
  • History of jaundice or anemia in parents or
    siblings
  • History of blood loss, bruising, petechiae, or
    nosebleed

21
Health History
  • Typical dietary pattern
  • Occupational history
  • Medication history
  • Risk factors for hematological disorder age,
    sex, marital status, religion, race ethnic
    background, recent illnesses treatment

22
Health History
  • Family history of illnesses both living
    deceased realities as well as cause of death
  • Sexual habits promiscuity, male homosexuality
    bisexuality, partners sexual habits
  • Drug abuse history
  • Medical history, including malignancies

23
Physical Assessment
  • Skin
  • Head neck
  • Respiratory
  • Cardiovascular
  • Renal Urinary
  • Muscloskeletal
  • Abdominal
  • CNS
  • Psychosocial

24
Skin
  • Pallor
  • Jaundice
  • Mucous membranes
  • Nail beds
  • Bleeding
  • Ecchymosis
  • Petechiae
  • Bleeding from invasive sites

25
Head Neck
  • Sclera
  • Jaundice
  • Oral mucosal ulceration
  • Fissures at corner of mouth
  • Lymph enlargement or pain
  • Smooth red tongue

26
Respiratory
  • Rate
  • Depth
  • Rest activity
  • 10 word sentences
  • Easily fatigued
  • SOB at rest or exertion
  • of pillows

27
Cardiovascular
  • JVD
  • Edema
  • Phlebitis
  • Murmurs
  • Gallops
  • Irregular rhythm
  • Abnormal B/P
  • S V anemia
  • B/P ? hypercellular conditions
  • Severe anemia
  • R vent. Hypertrophy
  • Heart disease

28
Renal Urinary
  • Overt bleeding
  • Occult bleeding
  • Hematuria
  • Proteinuria

29
Musculoskeletal
  • Rib tenderness
  • Sternal tenderness

30
CNS
  • Cranial nerve assessment
  • Neurological function
  • Mental status
  • GCS
  • Neuromuscular evaluation

31
Psychosocial
  • Chronic illness acute exacerbation of chronic
    disease
  • Social support network
  • Community resources
  • Financial health
  • Compliance with therapy

32
Complete Blood Count (CBC)
  • Measures circulating RBCs WBCs in 1 mm venous
    blood
  • of different leukocytes
  • Hct - of RBCs in total blood volume, total
    amount of Hct in peripheral blood
  • MCV- average volume or size of single RBC
  • MCH- weight Hgb in average RBC
  • MCHC- concentration of Hgb in each RBC

33
Reticulocyte Count
  • Immature RBCs
  • 2 for circulating RBCs normally
  • ? indicates increased production of RBC by bone
    marrow

34
Hemoglobin Electrophoresis
  • Hemoglobin A normal
  • Abnormal form of hemoglobin
  • Hemoglobin S in sickle cell

35
Coombs Test
  • Direct indirect
  • Used for blood typing
  • Direct presence of antibodies against RBCs
  • Certain disease associated with production of
    antibodies against bodys own RBCs, causes
    hemolytic anemia
  • Indirect presence of circulating antiglobins
  • Determines presence of serum antibodies to type
    of RBCs in blood transfusion

36
Serum Ferritin
  • Measures quantity of Fe present as free Fe in
    plasma reflects total body Fe stores
  • Transferrin protein that transports Fe from GI
  • Test is TIBC
  • 30 of transferrin is bound to iron in blood
  • Total Fe-binding capacity of saturation of
    transferrin, varies according to intake,
    reflects livers function

37
Bleeding Time
  • Evaluates vascular platelet activity
  • Use lancet, small incision in forearm with B/P
    cuff inflated 40 mm Hg
  • Blood blotted 30 sec. Intervals timed until
    bleeding stops
  • Normal 1-9 min.

38
Prothrombin Time
  • Measures time for blood to clot
  • Normal 11 to 13 sec.
  • Clotting factors
  • II, V, VII, X
  • ? when one or more clotting factor deficient or
    with liver disease
  • Warfarin therapy 1.5 to 2. X normal
  • Not used often currently except when weaning
    Heparin

39
International Normalized Ratio
  • INR same as PT but standardized
  • 0.7 1.8
  • Warfarin therapy 2.0-3.0

40
Partial Thromboplastin Time
  • PTT
  • Evaluates factors
  • II, V, VIII, IX, X, XII
  • Intrinsic coagulation cascade
  • Evaluates Heparin therapy 1.5 to 2.5 times normal

41
Bone Marrow Aspiration
  • Aspiration
  • Needle
  • Needle biopsy
  • Small incision coring, needle used
  • Site
  • Posterior superior iliac crest
  • Spinous process of vertebrae
  • Tibia
  • Sternum

42
Bone Marrow Aspiration
  • Nursing considerations
  • Signed informed consent
  • Lasts 5 to 15 min
  • Anesthesia or sedation
  • Local anesthetic or rapid acting sedative

43
Bone Marrow Aspiration
  • Complications
  • Soreness at site
  • Bleeding
  • Infection

44
Nursing Responsibilities
  • Cover site with drg.
  • Monitor for bleeding q 2 X 24 hours
  • Monitor P, B/P, T
  • Ice pack, mild aspirin-free analgesic
  • Instruct pt to keep site dry for 24 hours
  • Avoid trauma 48 hours
  • Watch for redness, swelling, T ?
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