Nursing Assessment: Hematologic System

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Nursing Assessment Hematologic System

• NURS1228
• Class 10

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Terms to Know

• Erythrocyte
• Lymphangiography
• Purpura
• Erythropoesis
• Lymphedema
• Reticulacyte
• Hemolysis
• Pancytopenia

• Phagocytosis
• Immunoglobulins
• Petichiae
• Leukocyte
• Platelet
• Meds
• Anticoagulants
• Antithrobins
• Fibrinolytics
• Fibrin Split Products

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Diagnostic Tests

• CBC http//www.medicinenet.com/Complete_Blood_Co
  unt/article.htm
• MCV
• HCT
• Platelets
• HGB

• Sed Rate (ESR)
• RH factor
• MCH
• ABO Blood Typing
• MCHC
• Lymphangiography

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How is the Hematologic System Put Together? What
does it do?
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The System

• Blood Cells
• Bone Marrow
• Spleen
• Lymph system
• What are some of the crucial functions of these
  organs and cells?

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Erythropoesis

• Regulated by
• Stimulated by
• Hormonal control erythropoietin
• Influenced by

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Blood Cell Differentiation

• See figure 28-2 How cells differentiate

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Types of Blood Cells

• Erythrocytes
• Leukocytes
• Granulocytes (polynorphonuclear leukocytes -PMNs)
• Neutrophils
• Band/stab
• Eosinophils
• Basophils
• Monocytes
• Lymphocytes

• Platelets
• Spleen (NOT a blood cell!!)
• Hematopoietic function (Fetal devel)
• Filter Function (and recycles!)
• Immune function
• Storage function

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The Lymphatic System
Palpable superficial lymph nodes From figure
28-6, p. 730
occipital Posterior auricular Preauricular Tonsill
ar Submaxillary Submental Superficial
cervial Deep cervical Supraclavicular Axillary Lat
eral Subscapular Pectoral Epitrochlear Inguinal
Note Lymph Drainage
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Lymph System

• Lymphatic capillaries
• Lymphatic ducts
• Lymph Nodes
• System carries fluids from the interstitial
  spaces to the blood
• Proteins, fat from GI, and hormones return to
  blood
• Returns excess interstitial fluid to blood

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Lymphatic Circulation
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Lymphedema

• Too much interstitial pressure develops or
  something interferes with reabsorbtion of lymph.
• Complication of mastectomy/lumpectomy when lymph
  nodes are removed
• Nodes are a filtration system (along with the
  liver) bacteria and foreign particles. Fluid
  drains into the subclavian veins in the neck.

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The Liver

• Acts as a filter
• Produces all progoagulants essential to
  hemostasis and blood coagulation
• Also has other functions not related to hematology

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Clotting/Hemostasis

• Vascular Response
• Platelet Response
• Plasma Clotting Factors
• Anticoagulants

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Clotting
Scanning electromicrograph of platelets
Scanning electromicrograph of activated
platelets
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Nursing Assessment

• Subjective Data
• Past Health History
• Medications?
• Surgery?
• Functional Health Patterns

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Health Perception-Management

• Identify
• Health perceptions
• Health practices
• Preventive practices (as well as risk factors)

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Nutritional- Metabolic

• Recent changes with weight, appetite, etc? (also
  objectively weigh the patient)
• Dietary History
• Changes in skin, hair, gums, etc.
• Swelling in areas where nodes are present

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Elimination Pattern

• Bleeding?
• Stool appearance?
• Urinary output? Diarrhea?

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Activity-ExerciseSleep-Rest

• Fatigue? Feelings of tiredness? Weakness?
• Malaise? Apathy? Functional inability to perform
  ADLs?
• Feeling of being rested?

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Self ConceptRoles and Relationship

• Effect of any hematologic changes (swelling,
  edema etc.) should be considered
• Occupational or household hazards?
• Viet Nam contact?
• Present illness impact on roles and relationships

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Sexuality-reproductive

• Menstrual History
• Intra/postpartum bleeding?
• Men Impotence?

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Coping -Stress

• Assistance with ADLs required?
• Adequate support system?
• Patients understanding of illness?

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Value-Belief

• Blood transfusion issues
• Bone marrow transplant issues
• Stem cell transplant issues
• Planned therapy

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Objective Data

• Physical Examination
• Level of consciouness
• Abdominal Girth
• Lymph nodes (sequentially)
• Skin inspection
• Liver and spleen palpation

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Objective Data ContinuedDiagnostic Studies

• Any tests for bleeding
• CBC
• RBC (including HH) Know how reported
• WBC (including differential) Lymphocytes
• Neutrophil counts (including a shift to the left)
• Cell maturity
• ESR (Erythrocyte Sedimentation Rate)
• Inflammatory conditions nonspecific disease
  processes
• Routine screening

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Diagnostic Studies Continued

• Blood typing and Rh Factor
• A and B and O blood types AB blood types
• Rh Antigen D on the RBC membrane of some
  people.
• Blood transfusion issues
• Antibody formation
• Transfusion reactions

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Transfusion Reactions

• Why it happens
• Signs and Symptoms
• Coombs test

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Diagnostic Studies continued

• Lymphangiography
• What is it?
• What is its role?
• What contraindications against performing?
• How is it performed?

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Diagnostic Studies continued

• Biopsies
• Bone Marrow
• What is it and how is it accomplished?
• What are nursing responsibilities?
• Lymph Node
• What is it and how is it accomplished?
• What are nursing responsibilities?

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Nursing Responsibilites

• Consent
• Instruction
• Technique
• Pain Relief

• Actual Care
• Dressing changes
• Assessment for toleration of procedure and
  complication.
• Evaluation for wound healing

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Normal vs. Common Abnormal Findings

• Abnormal Findings
• Clotting studies
• Realize that the normal in these may actually
  be abnormal if the person is on anticoagulation
  therapy.
• ESR Increase indicates inflammatory process
• Low HH indicates anemia in general
  MCV,MCH,MCHC may indicate type of anemia involved

• Normal Findings
• See text for values
• P. 731, 732, 733
• Note especially the in the WBC differential
  count
• RBC Indices
• MCV, MCH, MCHC
• All indicate qualities of the red blood cells

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Normal vs. Abnormal FindingsContinued
Diagnostic Studies

• Normal Findings
• See Text p. 734
• Common
• Lymphangiography, CT and MRI scans
• Biopsies Bone marrow and lymph node

• Abnormal Findings
• Lymphangiography is often utilized in the
  diagnosis of Lymphoma or Hodgkins disease
• CT and MRIs can also examine soft tissue, spleen,
  liver, lymph nodes for damage, tumors, etc.
• Biopsies of lymph nodes and bone marrow detect
  malignancies.

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Results What Implications Do They Have?

• Everything from the diagnosis of simple anemia to
  a malignancy requires the RN to be able to
  interact with the patient
• RNs need to know how tests are carried out and be
  prepared for patient instruction at all times.
• Many of these tests and potential results bring
  with them a certain amount of anxiety for the
  patient. It is up to the RN to address the
  issues that may cause anxiety.

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End of Class 10