Chapter_036.pptx

Chapter 36 Assessment of the Hematologic System Copyright © 2021, Elsevier Inc. All Rights Reserved.  Red Blood Cells Pictured above are normal erythrocytes (red blood cells). Copyright © 2021, Elsevier Inc. All Rights Reserved.  Conce...

Chapter 36 Assessment of the Hematologic System Copyright © 2021, Elsevier Inc. All Rights Reserved.  Red Blood Cells Pictured above are normal erythrocytes (red blood cells). Copyright © 2021, Elsevier Inc. All Rights Reserved.  Concepts  The priority concepts for this chapter are  Clotting  Perfusion Copyright © 2021, Elsevier Inc. All Rights Reserved. 3  Overview  Perfusion—total arterial blood flow through the tissues (peripheral perfusion) and blood that is pumped by the heart (central perfusion)  Clotting—complex, multi-step process by which blood forms a protein-based structure (clot) Copyright © 2021, Elsevier Inc. All Rights Reserved. Anatomy and Physiology Review  Bone marrow  Blood components  Plasma (albumin, globulins, fibrinogen)  Red blood cells (erythrocytes)  White blood cells (leukocytes)  Platelets (thrombocytes)  Accessory organs of blood formation  Spleen  Liver Copyright © 2021, Elsevier Inc. All Rights Reserved.  Hemostasis and Blood Clotting  Hemostasis: Multi-stepped process of controlled blood clotting  Platelet aggregation  Blood clotting  Extrinsic clotting pathway  Intrinsic clotting pathway Copyright © 2021, Elsevier Inc. All Rights Reserved.  Anticlotting Forces The image above demonstrates the process of fibrinolysis. Copyright © 2021, Elsevier Inc. All Rights Reserved.  Hematologic Changes Associated with Aging  Decrease in blood volume with lower levels of plasma proteins  Bone marrow produces fewer blood cells  Total RBC, WBC counts lower  Lymphocytes are less reactive to antigens, and lose immune function  Hemoglobin levels fall after middle-age Copyright © 2021, Elsevier Inc. All Rights Reserved. Assessment: Recognize Cues (1 of 4)  Age, gender  Liver function  Occupation and hobbies, and home location  Drug use (prescribed, OTC, illicit)  Nutrition status  Finances and social support  Family history and genetic risk  Current health problems Copyright © 2021, Elsevier Inc. All Rights Reserved. Assessment: Recognize Cues (2 of 4)  Physical assessment  Skin  Head and neck  Respiratory  Cardiovascular  Kidney and urinary  Musculoskeletal  Abdominal  Central nervous system  Psychosocial Copyright © 2021, Elsevier Inc. All Rights Reserved. Assessment: Recognize Cues (3 of 4)  Diagnostic assessment  Laboratory tests of cell number and function Peripheral blood smear CBC Reticulocyte count Platelet count Hemoglobin electrophoresis Leukocyte alkaline phosphatase (LAP) Coombs’ tests (direct and indirect) Serum ferritin, transferrin, and TIBC  Laboratory tests measuring bleeding and coagulation Prothrombin time (PT) International normalized ratio (INR) Partial prothromboplastin time (PTT) Anti-factor Xa test Platelet aggregation Copyright © 2021, Elsevier Inc. All Rights Reserved. Assessment: Recognize Cues (4 of 4)  Additional diagnostic assessment  Imaging assessment Radioisotopic imaging Standard x-rays  Bone marrow aspiration and biopsy Copyright © 2021, Elsevier Inc. All Rights Reserved. Bone Marrow Aspiration and Biopsy  Patient preparation  Provide accurate information and emotional support  Explain procedure  Procedure  Follow-up care  Teach to inspect the site every 2 hours for 24 hours, avoid activity that could result in trauma  Analgesic (aspirin-free) and ice packs Copyright © 2021, Elsevier Inc. All Rights Reserved.  Bone Marrow Aspiration The image above demonstrates bone marrow aspiration. Study of the bone marrow can be used to identify the presence of leukemia or other malignancies or to determine the cause of anemia. Copyright © 2021, Elsevier Inc. All Rights Reserved.  Chapter 36 Audience Response System Questions Copyright © 2021, Elsevier Inc. All Rights Reserved.  Question 1 The nurse is caring for an 80-year old client with progressive fatigue, shortness of breath, and headaches. What assessment question will the nurse ask? Select all that apply. A. “Do you live with anyone?” B. “Have you been depressed lately?” C. “What medications do you routinely take?” D. “Could you tell me about your dietary habits?” E. “Do you have a history of cardiovascular disease?” Copyright © 2021, Elsevier Inc. All Rights Reserved.  Answer to Question 1 ANS: A  Older clients are likely to experience signs and symptoms of anemia (fatigue, shortness of breath, headaches) related to diet and chronically bleeding GI lesions (peptic ulcer disease). Therefore the nurse will ask questions related to diet, bleeding, and medications that could irritate the GI system. The nurse can ask social history questions and the question about cardiovascular disease (as a medical history) afterward. Copyright © 2021, Elsevier Inc. All Rights Reserved.  Question 2 The nurse is caring for a client with bleeding gums that reports increased fever, fatigue, malaise, and “chills.” What is the priority nursing intervention? A. Notify the health care provider. B. Document assessment findings. C. Administer antipyretic drugs as prescribed. D. Review laboratory data and prepare to obtain blood cultures. Copyright © 2021, Elsevier Inc. All Rights Reserved.  Answer to Question 2 ANS: D  The nurse should initially review the client’s laboratory analysis for signs of pancytopenia related to the client’s report and assessment findings of fatigue (anemia), bleeding gums (thrombocytopenia), and chills (neutropenia). Laboratory data are needed before informing the heath care provider and deciding whether to administer medication. Obtaining blood cultures prior to antibiotic administration is an important intervention. Antipyretic medications may be prescribed to treat the fever. Copyright © 2021, Elsevier Inc. All Rights Reserved.  Question 3 A client is being transitioned from IV heparin to oral warfarin. Which laboratory finding does the nurse identify confirming that warfarin treatment is effective? A. Bleeding time of 5 minutes B. Prothrombin time (PT) of 18 seconds C. International normalized ratio (INR) of 2.5 D. Partial thromboplastin time (PTT) of 24.3 seconds Copyright © 2021, Elsevier Inc. All Rights Reserved.  Answer to Question 3 ANS: C  INR is a more accurate measure of anticoagulation therapy because of variations in PT values across different laboratories. The goal of warfarin therapy is usually to maintain the client’s INR between 2.0 and 3.0 regardless of the actual PT in seconds. Copyright © 2021, Elsevier Inc. All Rights Reserved.