Oxygen Carrying Mechanism PDF

CEBU DOCTORS’ UNIVERSITY COLLEGE OF NURSING BATCH 2024 Oxygen Carrying Mechanism Mrs. Francis Grace Cañezo...

CEBU DOCTORS’ UNIVERSITY COLLEGE OF NURSING BATCH 2024 Oxygen Carrying Mechanism Mrs. Francis Grace Cañezo Definition of Terms mother’s immune system to attack the baby’s blood Our body uses transportation to move important elements to cells as foreign. supply to different body parts. Hematopoietic Integrity The state of balance on how the blood and its components are formed. Aplasia It is the incomplete, retarded, or defective development, or cessation of the usual regenerative process. Hypoxia Inadequate cellular oxygenation. Plasma Liquid portion of blood Hematology Purpura Hematologic System A severe bleeding disorder characterized by Unlike the other body systems, hematologic system hemorrhage into the tissue particularly beneath the encompasses the entire human body. skin or mucous membranes. The study of blood and its components is equally important Measures more than 2 mm because it is involved in the body’s internal respiration. Petechiae It consists of blood and its sites where the blood is produced, A tiny purple or red spots appearing in the skin as a including the reticuloendothelial system or what we call RES result of hemorrhage within the dermal or Hematology Is the science or study of blood submucosal area Greek Terms: "Haima" - blood; "Logos" - discourse Measures less than 2mm It encompasses: Ecchymosis o Study of blood cells A skin discoloration that results from bleeding underneath o Analysis of concentration, structure and the skin and is usually larger than 1 cm, or at least 4 inches. function of cells in blood and their Hematoma precursors in the bone marrow It is a solid swelling of clotted blood within the body’s tissues. Cellular Components of Blood Bleeding time It is the time required for blood to stop flowing from a wound. Clotting time It is the time required for blood to form a clot Capillary Fragility Test Also known as the tourniquet test. It measures vascular hemostatic function The intracapillary pressure in the arm is increased by occluding venous outflow or by applying The cellular component of blood consists of 3 primary cell controlled negative pressure on the skin area. types: A blood pressure cuff is inflated to a pressure Erythrocytes: red blood cells halfway between the systolic and diastolic Leukocytes: white blood cells pressure. Thrombocyte: our platelets and the plasma The number of petechiae that forms is more than 5- proteins 10 The cause of excessive bleeding or bruising is Erythrocytes capillary fragility rather than core platelet action. Red blood cell (RBCs) Blood Incompatibility Carry hemoglobin to provide oxygen to the tissues If a baby’s and mother's blood are incompatible, it 175 trillion erythrocytes can lead to fetal anemia, immune hydrops, or Life span is about 100 to 120 days. erythroblastosis fetalis, and other complications. 40%- 45% of the blood volume A common type of blood incompatibility is RH About 20 seconds to make a complete loop from incompatibility of the mother’s blood type of that the heart, to tissue, back to the heart with the child’s blood type. This activates the Erythropoiesis - needs the ff: iron, Vit B12, Copper & Cobalt, folic acid, & Vit. B6 1  CEBU DOCTORS’ UNIVERSITY COLLEGE OF NURSING BATCH 2024 Oxygen Carrying Mechanism Mrs. Francis Grace Cañezo Erythrocytes or the red blood cells carry hemoglobin to As you can see in Hemoglobin is slightly higher in men than provide oxygen to tissues because most blood cells have a in women. Hematocrit on the other hand is the percentage short lifespan the need for the body to replenish its supply of of blood volume consisting of erythrocytes self is continuous this process is term Hematopoiesis is the primary site is the bone marrow Hemoglobin count is varied in pregnancy depending on the Normal hemoglobin specific laboratory cutoffs will differ trimester but generally they’re greater than 10.0g/dL. slightly but in general the normal ranges are as follows: Different of the lower limit of range is actually based on Men 13.5 to 18.0 g/dL factors such as ethnicity, gender, and age. Women 12.0 to 15.0 g/dL Children 11.0 to 16.0 g/dL Let's take time to look at the stage of erythropoiesis Leukocytes Thrombocytes White blood cells (WBCs) Platelets 4,000 to 11,000 cells/𝑚𝑚𝑚𝑚3 in normal blood Smallest of the blood cells, formed as fragments of Perform actions critical for inflammation or a giant precursor cell in the bone marrow, immunity megakaryocyte. Leukocytes are categorized based on the following: 175 billion platelets each day o General Category: granulocytes and Play an essential role in the control of bleeding. agranulocytes It performs most of their functions by aggregation o Its Functions: inflammation, antibody- (clumping) mediated immunity and cell-mediated They circulate freely in the blood or they nurture the immunity endothelium of the blood vessels maintaining its integrity. Leukocytes are categorized by granules and its functions Platelets stick to injured blood vessel walls and form platelet according to general category clog that can stop the flow of blood from the injured site. 60% to 80%: granulocytes (includes eosinophils, Plasma and Plasma Proteins basophils and neutrophils) 90% is water Eosinophils and basophils function in sensitivity Primarily consists of plasma proteins, clotting reactions. The number of granulocytes found in the factors, and other nutrients healthy person is relatively constant. It has 3 major types of plasma proteins: However, in infection large numbers of these cells o Albumin - Which is particularly important are rapidly released into the circulation. for the maintenance of fluid balance 20% to 40%: agranulocytes (includes monocytes within the vascular system and lymphocytes) o Globulin - Are for immune response of the Monocytes are for destruction of bacteria and body cellular debris which matures into macrophage. o Fibrinogen - Is important in the clotting While lymphocytes are very important in both cascade in the calculation process. cellular and humoral immunity Anemia *Just remember the primary function of our lymphocytes, Anemia - is the reduction of the number of RBCs which they are to attach foreign materials inside our body. decreases the oxygen-carrying capacity of our blood. Etiologies: Deficiencies and abnormalities of RBC production Excessive blood loss or destruction of RBCs It may be due to acute or chronic blood loss 2  CEBU DOCTORS’ UNIVERSITY COLLEGE OF NURSING BATCH 2024 Oxygen Carrying Mechanism Mrs. Francis Grace Cañezo Anemia can be caused by its production or destruction Production Destruction Iron Deficiency Anemia (IDA) Sickle Cell Disease Caused by lacking iron intake; caused by diet, chronic A genetic disorder that results in chronic anemia, pain, alcoholism, malabsorption syndromes, partial gastrectomy disability, organ damage, and an increased risk of infection It can also be caused by rapid metabolic activity such as and early death. The main problem is the formation of Pregnancy, in adolescence due to menstruation, or infection abnormal hemoglobin chains. These cells assume a sickle shape, become rigid, clump together and form masses of Vitamin B12 Deficiency Anemia sickle red blood cells that block blood flow. Deficiency in vit b12 or cobalamin which is due to failure to absorb vitamin b12 from the intestinal tract as a result of a G6PD Deficiency Anemia (Glucose-6-phosphate partial gastrectomy or pernicious anemia dehydrogenase) It is the most common type of hemolytic anemia which is due Folic Acid Deficiency Anemia to the deficiency of Glucose-6-phosphate dehydrogenase; an Caused by a deficiency in vitamin b9 or folic acid which caused enzyme critical for the formation of red blood cells. by dietary deficiency malabsorption syndromes. Drugs such as contraceptives, Anticonvulsants, and methotrexate (a drug Immunohemolytic Anemia used to treat severe psoriasis) and other neoplastic diseases Increased red blood cell destruction through hemolysis or commonly cause Folic acid Deficiency anemia breakage of hemoglobin which occurs in response to many situations including trauma, malarial infection, and other Aplastic Anemia autoimmune reactions. The most common type is Caused by myelotoxic agents through radiation, autoimmune hemolytic anemia where the immune system antimetabolites, sulfonamides, anti-infective used to treat products attack the blood cells for unknown reason. urinary tract infections and insecticide. Although it has been believed that it can be caused by Hepatitis b and cytomegalovirus but it has been unproven Polycythemia Vera Number of RBC in the blood that is greater than normal. This condition causes cell life to be shortened which in effect causes a rapid turnover of circulating blood cells Myelodysplastic Syndromes (MDS) Formation of abnormal cells in the bone marrow. It has cancer-like features and it is considered a precursor to cancer specifically leukemia Categorized Based on Size According to Etiology Normocytic Hypoproliferative Normal RBC size and shape; commonly due to blood loss, Caused by defective RBC production chronic disease, bone marrow suppression with Example: chemotherapy IDA Ex. Hemolytic Anemia Aplastic Microcytic Megaloblastic (Vit. 12 and B9) Small RBCs, low levels of hemoglobin due to Iron deficiency Pernicious Ex. IDA, Aplastic Anemia Anemia due to renal diseases (for acute disorders such as acute renal failure, it can cause anemia. This Macrocytic acute condition can cause a mild shortening of Large RBCs due to Vit B12 and folic acid deficiency erythrocyte lifespan and immunodeficiency of Ex. Pernicious (deficiency in Vit B12 absorption. It is erythropoietin where it is produced in the kidney) an organ specific autoimmune disease which the body Anemia due to chronic diseases (for chronic system attacks the lining of the stomach) and Megaloblastic diseases, rheumatoid arthritis, severe and chronic Anemia Infections and many cancers) 3  CEBU DOCTORS’ UNIVERSITY COLLEGE OF NURSING BATCH 2024 Oxygen Carrying Mechanism Mrs. Francis Grace Cañezo Hemolytic Key Features of Anemia Caused by RBC destruction Pallor skin especially of the ears, the nail beds, Examples: palmar creases, the conjunctiva and around the Hereditary Spherocytosis mouth Sickle Cell Anemia Cool to touch Thalassemia Intolerance of cold temperature Polycythemia Vera Nails become brittle and fingers assume clublike G6PH Deficiency Anemia appearance overtime Tachycardia ANEMIA IS A CLINICAL SIGN ONLY, NOT A DISEASE! Murmurs upon auscultation (severe anemia) It is not a specific disease because it is a clinical Orthostatic hypotension manifestation for several abnormal conditions Dyspnea upon extension ↓ O2 saturation levels Somnolence and fatigue Headache Difficulty in concentration Leg cramps Pain (especially sickle cell anemia) Hemostasis The process of preventing blood loss from intact vessels and of stopping bleeding from several vessels, which requires adequate numbers of functional platelets. COAGULATION PROBLEMS: PLATELET DISORDERS These are bleeding disorders caused due to deficiency of clotting factors and leads to defects in normal clotting formation process. Thrombocytopenia Symptoms of Anemia A decrease in the number of platelets below the Those In red are signs and symptoms of severe anemia level needed for human coagulation 150,000-450,000 (normal level) Bleeding disorders may be spontaneous or traumatic, localized or generalized, lifelong or acquired. Risk for serious bleeding is from 10,000-20,000 platelets per microliter. Autoimmune Thrombocytopenia Purpura (ITP) Destruction of a number of platelets by an unknown stimulus The weight of platelet destruction exceeds of that production, so the number of circulating platelets decreases and blood clotting slows Also called idiopathic thrombocytopenia purpura Coyer & Lash (2008) Decreased total number of circulating platelets "Despite the many causes of anemia, the effects of anemia Common among women between ages of 20-40 on the patient and the nursing care needed are similar for all and those with systemic lupus erythematosus (SLE) types of anemia." Thrombotic Thrombocytopenia Purpura (TTP) A client has inappropriate clotting, and the blood clot fails abnormally when trauma occurs. The underlying cause is autoimmune function in blood vessels, specifically the endothelial cells that make platelets clump together in very small blood vessels, as a result, tissue becomes ischemic. 4  CEBU DOCTORS’ UNIVERSITY COLLEGE OF NURSING BATCH 2024 Oxygen Carrying Mechanism Mrs. Francis Grace Cañezo A rare disorder in which platelets clump together CLOTTING FACTOR DISORDER abnormally in the capillaries and too few platelets Coagulation or bleeding disorders can result from remain in circulation clotting factor defect When left untreated, is very fatal Most clotting factors are genetic problems of 1 Heparin-Induced Thrombocytopenia and Thrombosis clotting factor Syndrome (HITTS) The few acquired clotting factor disorders are An immunoglobulin-mediated adverse drug related to a damaged liver, that cannot produce reaction specifically, prolonged used of heparin proper amounts of clotting factors or deficiency of characterized by: clotting factors. o Platelet activation Defects include the inability to produce a specific o Thrombocytopenia clotting factor, production of low quantities or o Thrombotic complications producing a less active form of clotting factors Is caused by antibodies against complexes of Hemophilia platelet factor (4) and heparin. Has two different hereditary bleeding disorders It affects all patients with heparin use. resulting from deficiencies of specific clotting The problem with HITTS is that it is mostly factor. unrecognized by clinicians and diagnoses can be It is an X-linked recessive trait, women who are difficult and confirmed. usually carriers have a 50 percent chance of It generally affects a small percentage of patients transmitting the gene who are then carriers to their taking the drug and it affects a 5% of patients daughters and to their sons who will have overt exposed to heparin. hemophilia. Hemophilia A Pathophysiology of Thrombocytopenia Also known as Classic Hemophilia Caused by deficiency or defective factor VIII Hemophilia B Also known as Christmas disease Caused by deficiency or defective factor IX Clinical Signs & Symptoms Excessive hemorrhage Bruises or abrasions Joint and muscle hemorrhages that lead to disabling long term problems Hematomas common in Hemophilia A Joint swelling and limitation Chronic pain in areas like the joints Decreased sensation and atrophy of the area Clinical Signs & Symptoms when prolonged injury occurs at site. Purpura/petechiae/bruises Hematuria and GI bleeding Prolonged bleeding even in minor cuts Intracranial bleeding Bleeding gums, nose bleeds or mouth Abnormal vaginal bleeding Hematuria or hematochezia (blood in the stool may appear as red blood or as dark, tarry) Headaches and other neurological signs 5  CEBU DOCTORS’ UNIVERSITY COLLEGE OF NURSING BATCH 2024 Oxygen Carrying Mechanism Mrs. Francis Grace Cañezo COAGULATION DISORDER ABO-RH INCOMPATIBILIES Disseminated Intravascular Coagulation (DIC) ABO Incompatibility A clinicopathologic syndrome characterized by ABO group is the most important blood group system in widespread intravascular fibrin formation in human blood transfusion response to excessive blood protease activity that overcomes the natural anticoagulant mechanism Not a disease but a sign of an underlying condition Evidence says that seriously ill COVID-19 patients develop coagulation problems, giving rise to disseminated intravascular coagulation. It is triggered by sepsis, trauma, cancer, shock, abruptio placenta, toxins, allergic reactions and other conditions On the chart, we can see that group AB doesn’t have a specific antibody, that is why it is the universal recipient. But if you take a look a closer look at blood type O, It shows that DIC has two pathways, both causing an you can see that it has both antibodies and it has no impairment in the coagulation process which causes further antigen. This is why people with blood type O are bleeding resulting to organ damage. called universal donor. Clinical Signs & Symptoms GI bleeding, petechiae and ecchymosis, IV lines and catheters bleed Renal failure Pulmonary involvement: dyspnea, hemoptysis and cough Jaundice Life-threatening hemorrhage Most common form of blood incompatibility is the ABO Diffuse or localized thrombosis hemolytic disease of newborn. It results from IgG anti A and Altered consciousness or stupor anti B, and commonly occurs in A and B group babies born to group O mothers Transient focal or neurologic deficits Hypotension, tachycardia, circulatory collapse RH Incompatibility Pleural fracture rub and signs & symptoms of It is the condition which develops when there is a difference ARDS in RH blood type that of the pregnant with RH negative and Hematemesis and hematochezia that of the fetus who is RH positive. Hematuria and azotemia The Rhesus Factor gets its name from experiments Purpura and deep subcutaneous hematomas conducted in 1937 by scientists Karl Lansteiner and Alexander S. Weiner Skin necrosis of lower limbs First demonstrated in rhesus monkey Localized infarction and gangrene Blood groups are classified as (+) and (-) The Rh factor, RH+ or Rh- usually refers specifically to the presence or absence of antigen - D 6  CEBU DOCTORS’ UNIVERSITY COLLEGE OF NURSING BATCH 2024 Oxygen Carrying Mechanism Mrs. Francis Grace Cañezo To better understand the different blood incompatibilities, take a look at the chart above. Positive direct antiglobulin test or DAT can actually identify those infants who are at risk of developing the ABO hemolytic disease. INTERVENTIONS FOR PEOPLE WITH BLOOD OXYGEN MECHANISM DISORDERS Transfusion Therapy o Any blood component may be removed from a donor and transfused to a recipient. o Types of transfusion: RBC transfusion, platelet transfusion, plasma transfusion, cryoprecipitate transfusions, Granulocyte transfusion Oxygen therapy Pain relievers for patients in pain, antiinfectives for patients developing infection Oral hydration Relaxation techniques Positioning with support for affected sites splenectomy for Immunohemolytic anemia Steroid therapy for disorders for immunosuppression Dietary intake for disorders caused by deficiency such as iron, B9 and B12 Erythropoietin therapy for cause is reduction of RBCs Phlebotomy for polycythemia vera to reduce the number of RBCs Maintaining a safe environment Reverse isolation technique is observed Bleeding precautions for bleeding coagulation disorders Aseptic technique Strict medical handwashing Hematopoietic stem cell transplant (HSCT) and Bone marrow transplant 7