Clinical Patient Care and Data Collection

Clinical Considerations

• Clinical considerations involve comprehensive patient care through assessment, interventions, and care for the elderly
• Patient assessment includes gathering patient information like medical history, physical and psychosocial evaluations, and identifying patient needs
• Nursing interventions involve evidence-based practices, administering medications, wound care, vital signs monitoring, and patient/family education
• Gerontological issues address age-related changes, chronic diseases, polypharmacy, appropriate care, independence, quality of life, and relevant ethical issues

Data Collection for Disorders

• Disorder data collection gathers patient information for understanding conditions through health history, physical exams, and subjective/objective data
• Health history includes past/present conditions, surgeries, allergies, medications, family history, genetic predispositions and lifestyle factors
• Physical examination is a systematic assessment of the patient's body, including vital signs and inspecting, palpating, percussing, and auscultating different body systems
• Subjective data is patient-provided information like symptoms, feelings, and perceptions
• Objective data is information obtained through observation, physical examination, diagnostic tests, signs like rashes, swelling and lab results, and measurable/observable findings

Diagnostic Tests

• Diagnostic tests are medical procedures that detect, diagnose, or monitor diseases, conditions, or other medical aspects
• Blood tests involve analyzing blood samples to evaluate health, organ function, detect infections, and monitor overall health, including CBC, chemistry panels, and blood cultures
• Coagulation tests assess the blood's ability to clot properly and are used to diagnose or monitor bleeding disorders or assess the risk of blood clots, including prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR)
• Bone marrow biopsy involves examining a sample of bone marrow to diagnose/evaluate blood disorders, cancers, and infections
• Lymphangiography is an imaging technique that visualizes the lymphatic system by injecting a contract dye to identify blockages and tumors

Lymphatic System Anatomy

• Lymph vessels transport lymph throughout the body, starting as capillaries that merge into larger vessels with valves
• Lymph nodules are localized collections of lymphoid tissue (MALT) that contain lymphocytes to help defend against pathogens
• Spleen is the largest lymphatic organ that filters blood, contains lymphocytes for immune responses, stores blood, and is located in the upper left abdomen
• Thymus is located in the mediastinum, behind the sternum, and is the site of T cell maturation that is active during childhood

Therapeutic Measures

• Therapeutic measures address medical conditions through transfusions, fluid management, and monitoring for potential complications
• Blood administration includes transfusions for conditions like anemia, blood loss, or clotting disorders, with adherence to patient safety protocols
• Fluid compatibility ensures transfused blood is compatible to avoid severe reactions
• Timing of transfusions depends on patient condition and needs
• Filtering uses filters during blood transfusions to remove microaggregates and ensure blood product safety
• Washed or leukocyte-depleted blood reduces the risk of certain reactions, especially with reaction histories
• Warmed blood prevents hypothermia and improves blood flow, especially with massive transfusions
• Closely observe patients for adverse reactions post blood administration
• Febrile reaction is a common reaction of fever often caused by the recipient's antibodies reacting to donor leukocytes
• Urticarial reaction is a mild allergic reaction characterized by hives or itching caused by the recipient's antibodies

Hematologic and Lymphatic Systems

• The hematologic system (blood, blood vessels, and bone marrow) transports oxygen, nutrients, hormones, and waste products
• The lymphatic system (lymph nodes, vessels, spleen, and thymus) is involved in immunity, fluid balance, and fat absorption
• Blood components include plasma, erythrocytes (carry oxygen), and leukocytes (immune function, types: neutrophils, lymphocytes, etc.)
• Lymph nodes filter lymph and are the site of immune cell activity
• Spleen filters blood, stores blood, and houses immune cells
• Thymus is the site of T-cell maturation
• Hemostasis stops bleeding; with vascular spasm, platelet plug formation, and coagulation
• Coagulation cascade leads to fibrin clot formation
• Assessment includes history and physical exam
• Complete blood count (CBC) assess cells, and coagulation studies assess clotting ability
• Bone marrow aspiration/biopsy evaluates cell production
• Lymph node biopsy determines infections or malignancies
• Nursing care involves assessing vital signs, providing interventions, and educating patient
• Measure-wise, use medications, transfusions (blood products), splenectomy (surgical removal of spleen), and stem cell transplant to replace damaged bone marrow

Blood Administration Procedure

• Identify patient, verify product, and monitor for reactions
• Blood product types: packed red blood cells (PRBCs), platelets, fresh frozen plasma (FFP), cryoprecipitate
• Monitor for complications such as transfusion reactions and fluid overload
• Aging causes decreased blood volume, reduced bone marrow activity, reduced immune function, decreased lymphatic vessel function, increased in anemia, infection, and impaired wound healing