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Questions and Answers
What should be checked on the blood bag before transfusion?
What should be checked on the blood bag before transfusion?
What is the maximum duration that blood transfusion should last?
What is the maximum duration that blood transfusion should last?
Which of the following is NOT a common transfusion reaction?
Which of the following is NOT a common transfusion reaction?
What should be done during the first 15 minutes of blood transfusion?
What should be done during the first 15 minutes of blood transfusion?
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What action is critical when starting an intravenous blood transfusion?
What action is critical when starting an intravenous blood transfusion?
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What is the primary function of erythrocytes (red blood cells)?
What is the primary function of erythrocytes (red blood cells)?
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Which blood component primarily functions in the process of hemostasis?
Which blood component primarily functions in the process of hemostasis?
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What is the approximate volume of blood in an average adult male?
What is the approximate volume of blood in an average adult male?
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Which type of white blood cell primarily protects against helminthic infections?
Which type of white blood cell primarily protects against helminthic infections?
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What is the normal pH range for blood, indicating its slightly alkaline nature?
What is the normal pH range for blood, indicating its slightly alkaline nature?
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What component of the lymphatic system is specifically involved in the maturation of lymphocytes?
What component of the lymphatic system is specifically involved in the maturation of lymphocytes?
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Which statement correctly describes the viscosity of blood?
Which statement correctly describes the viscosity of blood?
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Which past medical history factor is specifically linked to a reduction in vitamin B12 absorption?
Which past medical history factor is specifically linked to a reduction in vitamin B12 absorption?
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What common over-the-counter medication is known to interfere with platelet aggregation?
What common over-the-counter medication is known to interfere with platelet aggregation?
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Which of the following is NOT typically assessed in the family history regarding hematological disorders?
Which of the following is NOT typically assessed in the family history regarding hematological disorders?
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Which symptom is a neurological sign that may indicate an underlying condition according to physical assessment?
Which symptom is a neurological sign that may indicate an underlying condition according to physical assessment?
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In a physical assessment, what finding is specifically relevant to the respiratory system?
In a physical assessment, what finding is specifically relevant to the respiratory system?
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What should be queried to assess a patient's risk for blood exposure during a physical assessment?
What should be queried to assess a patient's risk for blood exposure during a physical assessment?
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Which lifestyle factor is relevant in personal history to potentially impacting health?
Which lifestyle factor is relevant in personal history to potentially impacting health?
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Which of the following symptoms is indicative of a potential gastrointestinal issue during an assessment?
Which of the following symptoms is indicative of a potential gastrointestinal issue during an assessment?
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Which type of splenic history would be significant to inquire about in the patient's medical history?
Which type of splenic history would be significant to inquire about in the patient's medical history?
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Which complaint is most likely indicative of anemia?
Which complaint is most likely indicative of anemia?
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What does a decreased platelet count indicate?
What does a decreased platelet count indicate?
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Which finding would suggest altered blood clotting?
Which finding would suggest altered blood clotting?
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What does a high MCV indicate in a Complete Blood Count?
What does a high MCV indicate in a Complete Blood Count?
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What is the purpose of measuring the Prothrombin Time (PT)?
What is the purpose of measuring the Prothrombin Time (PT)?
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Which symptom may suggest an infection?
Which symptom may suggest an infection?
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Which of the following does not typically suggest anemia?
Which of the following does not typically suggest anemia?
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What laboratory test measures the average size of individual RBCs?
What laboratory test measures the average size of individual RBCs?
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Which laboratory result is indicative of thrombocytopenia?
Which laboratory result is indicative of thrombocytopenia?
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The WBC differential is primarily used to evaluate what?
The WBC differential is primarily used to evaluate what?
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What is a primary purpose of explaining the procedure to the patient before a bone marrow aspiration?
What is a primary purpose of explaining the procedure to the patient before a bone marrow aspiration?
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What positioning is recommended for a patient undergoing aspiration from the posterior iliac crest?
What positioning is recommended for a patient undergoing aspiration from the posterior iliac crest?
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Which piece of equipment is NOT typically included in a bone marrow aspiration tray?
Which piece of equipment is NOT typically included in a bone marrow aspiration tray?
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Why is it important to administer an analgesic before the bone marrow aspiration procedure?
Why is it important to administer an analgesic before the bone marrow aspiration procedure?
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What skin antiseptic is commonly used during bone marrow aspiration?
What skin antiseptic is commonly used during bone marrow aspiration?
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What action should a nurse take to ensure the desired site is properly exposed during the procedure?
What action should a nurse take to ensure the desired site is properly exposed during the procedure?
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In a case where a patient cannot tolerate the prone position, what is an alternative position for the posterior iliac crest aspiration?
In a case where a patient cannot tolerate the prone position, what is an alternative position for the posterior iliac crest aspiration?
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Which of the following is NOT a reason for pre-procedure care in bone marrow aspiration?
Which of the following is NOT a reason for pre-procedure care in bone marrow aspiration?
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What is the role of PPE during bone marrow aspiration?
What is the role of PPE during bone marrow aspiration?
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Which type of bone marrow aspiration utilizes a disposable punch biopsy needle?
Which type of bone marrow aspiration utilizes a disposable punch biopsy needle?
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Study Notes
Course Information
- Course name: NURSN325F
- Course description: Nursing Therapeutics in General Health Care IV
- Topic: Nursing Management of Disturbances in Hematological Functions (Part 1)
- Instructor: MsAmy Leung
- Week: 1
Learning Outcomes
- Describe the applied anatomy and physiology of hematological nursing.
- Identify nursing assessment and common investigations for hematological nursing and related care.
- Describe the definition, etiology, pathophysiology, clinical features, investigations, and diagnosis of common hematological disorders and the related nursing problems and care.
- Describe the definition, purpose, and technique of blood transfusion and bone marrow transplantation and the related nursing problems and care.
- Develop integrative nursing care plans for clients with hematological disorders.
- Describe the basic pharmacological concepts and clinical drug therapy modalities in daily nursing practice and the related nursing considerations for hematological disorders.
Overview
- Structure and functions of the hematological system.
- Assessment.
- Investigation.
- Blood transfusion.
- Splectomy.
Blood
- Exists in a fluid state.
- Circulates through the heart, arteries, capillaries, and veins.
- Serves as a link between body organs.
- Consists of plasma and cellular components.
- Plasma (55%): water, proteins (albumin, globulins, fibrinogen), inorganic salts, urea, dissolved gases, hormones, enzymes.
- Cellular component (45%): erythrocytes (RBC), thrombocytes (platelets), leukocytes (WBCs).
Blood Components
- Derived from stem cells in bone marrow by hematopoiesis.
- Affected by stem cells (in bone marrow) and nutrients (e.g., vitamin B12, iron).
Characteristics of Blood
- Color: Arterial blood is bright red (due to oxygen bound to hemoglobin); venous blood is dark red (due to lower oxygen content).
- Viscosity: 3-4 times more viscous than water; specific gravity 1.046-1.066.
- pH: Slightly alkaline (pH 7.35-7.45).
- Volume: 70-75 ml of blood/kg of body weight; average male and female adults have approximately 5.5 L and 4.5 L of blood respectively.
Functions of Blood
- Transportation: Transports oxygen, carbon dioxide, nutrients, hormones, and metabolic waste products to kidneys and liver.
- Protection: Transports cells and substances involved in immune reactions; clotting.
- Regulation: Regulates fluid balance, body temperature regulation, and acid-base balance.
Types of Blood Cells
- Erythrocytes (RBCs):
- Major component: hemoglobin (Hb).
- Function: exchange of oxygen and carbon dioxide between lungs and tissues.
- Life span: 100-120 days, then destroyed in the spleen and liver.
- Leukocytes (WBCs):
- Function: protection from bacteria and other foreign substances.
- Types: neutrophils (phagocytosis), eosinophils (helminthic infections), basophils (allergic reactions), lymphocytes (B-lymphocytes produce antibodies; T-lymphocytes regulate immune response), monocytes (phagocytosis).
- Platelets:
- Function: form platelet plug to stop bleeding and promote thrombin production.
Hemostasis
- A process that repairs vascular breaks to reduce blood loss from blood vessels while maintaining blood flow.
- Components: blood vessels, platelets, coagulation factors (I to XIII).
- Phases: vasoconstriction/vessel spasm, formation of platelet plug, formation of fibrin clot.
Coagulation Profiles
- Prothrombin Time (PT): Measures the time it takes for a clot to form; helps diagnose clotting disorders, and monitor anticoagulant therapy.
- Activated Partial Thromboplastin Time (APTT): Evaluate adequacy of factors VIII, IX, XI, XII, and monitor patients taking anticoagulants.
- International Normalized Ratio (INR): An international sensitivity index used to determine dosages of oral anticoagulants and monitor anticoagulation therapy.
Hematological System Assessment
- Patients may have disruptions of the hematological, immune, and coagulation systems.
- Important to consider past medical history, including surgeries, splenic injury/splenectomy, tendency to bleed, infectious diseases (e.g., HIV), and cancer.
- Past medications: over-the-counter medications, vitamins, herbs, nutritional supplements, aspirin/aspirin-containing compounds, non-steroidal anti-inflammatory drugs should be considered.
- Family history of hematological or malignant disorders, allergies, and previous blood transfusions.
- Occupation/Exposure to substances (e.g., benzene, pesticides, ionizing radiation). Social history and lifestyle factors.
- Key components of symptoms and physical examination findings: skin and mucous membranes (bruises, infections, drainage); neurologic symptoms; respiratory symptoms; cardiovascular, gastrointestinal, and genitourinary symptoms.
Chief Complaints
- Patient's chief complaints often include fatigue, frequent infections, swollen glands, bleeding tendencies, changes in blood pressure, pulse and alertness.
- Other relevant chief complaints may include dyspnea, shiny smooth tongue, ataxia, pallor of conjunctiva, nail beds, lips, oral mucosa, hematuria, tarry stools, petechiae, bleeding sites that can indicate anemia and various issues related to blood clotting. Fever, tachycardia, abnormal breath sounds, delirium, oral lesions, erythema, swelling, or drainage of the skin are all relevant chief complaints that suggest infection.
Laboratory Tests
- Complete Blood Count (CBC): measures RBCs, Hb, and platelets in the blood sample.
- WBC differential: assesses different types of WBCs to evaluate potential for infection or various types of leukemia.
- Clotting Profile: assesses prothrombin time (PT), activated partial thromboplastin time (APTT) and INR.
- Iron Profile: evaluates serum ferritin, iron, total iron-binding capacity, folate, and vitamin B12.
- Blood Smear: microscopic viewing of blood, using appropriate stains, to examine cells for abnormalities.
- Bone Marrow Aspiration (BMA) and Biopsy: analyzes bone marrow cells for various types.
Blood Product Transfusion
- Understand blood compatibility, antigens, antibodies and different blood types (e.g. ABO blood group system, and Rh factor or system).
- Understand types of blood products (e.g. whole blood, packed red blood cells, platelet concentrate, fresh frozen plasma, cryoprecipitate).
- Understand preparation, implementation, potential complications, and nursing interventions, when performing a blood transfusion.
Splenectomy
- Surgical removal of the spleen.
- Reasons for surgery: trauma, hemolytic or malignant disorders, splenomegaly.
- Laparoscopic technique.
- Benefits of laparoscopic splenectomy: less postoperative pain, less hospitalization, quicker resumption of normal activity, and better cosmetic results.
- Preoperative nursing care (stabilization, evacuation, monitoring, and other relevant preparations).
- Postoperative nursing care (including monitoring for hemorrhage).
- Possible complications (e.g., pancreatitis, fistula formation, hemorrhage, atelectasis, pneumonia).
- Possible diagnoses and nursing interventions (e.g., ineffective breathing pattern, pain management).
Transfusion Reactions
- Various types of transfusion reactions possible, such as febrile nonhemolytic, hemolytic, allergic, circulatory overload, and bacterial contamination.
- Nursing interventions during transfusion reactions, such as stopping the transfusion, notifying the doctor, changing tubing, monitoring vital signs, and other relevant actions.
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Description
Test your knowledge on blood transfusion practices, including the necessary checks before transfusion, common reactions, and critical actions to take during the process. This quiz covers key concepts related to blood components and their functions in the human body.