NUR 235 Test 2 PDF

Test 2 **Ch 15** **Functions of Blood** - Transportation of water, oxygen, nutrients, hormones, enzymes, and medications to the cells - Transportation of carbon dioxide (CO2) and other waste products away from the cells - Regulation of fluid volume and electrolyte distribution -...

Test 2 **Ch 15** **Functions of Blood** - Transportation of water, oxygen, nutrients, hormones, enzymes, and medications to the cells - Transportation of carbon dioxide (CO2) and other waste products away from the cells - Regulation of fluid volume and electrolyte distribution - Regulation of pH and acid-base balance with its buffering ability - Regulation of body temperature - Providing clotting factors for hemostasis **Components of Blood** - Blood is composed of formed elements and plasma **Formed elements 45%** - Erythrocytes - Platelets - Leukocytes - Neutrophils 54% - 62% - Lymphocytes 25% - 33% - Monocytes 3% - 7% - Eosinophils 1% - 3% - Basophils 0% - 1% **Plasma 55%** - Proteins 7% - Albumins 54% - Globulins 38% - Fibrinogen 4% - Prothrombin 1% - Water 91% - Other solutes 2% - Ions - Nutrients - Waste products - Gases - Regulatory substances **Functions of the Plasma Proteins** - **Albumin** raises osmotic pressure at the capillary membrane, preventing fluid from leaking into the tissue spaces. - The **alpha and beta globulins** work as carriers for drugs and lipids by combining with them and transporting them throughout the body; **gamma globulins** act as antibodies. - **Fibrinogen** is essential to the formation of blood clots. **Production of Blood Cells** - Blood cells develop from stem cells located in the bone marrow through erythropoiesis. - The kidney makes most of the body\'s erythropoietin, which then prompts erythrocyte production by the bone marrow. - Erythropoiesis requires iron; vitamins B12, C, and E; folic acid; and amino acids---most of which are obtained from proteins. **Functions of Red Blood Cells** - Red blood cells (RBCs, or erythrocytes, the most numerous of the blood cells) contain hemoglobin, which carries oxygen to the cells and a portion of CO2 away from the cells. - Antigens: A, B, AB, or O. - The normal laboratory range of RBCs for adults is 4.2 to 6.2 million/mm3 and varies by gender. - The normal laboratory range for hemoglobin in adults is 12 to 18 g/dL and varies by gender. - Decreased numbers of RBCs or decreased hemoglobin results in a reduction in the amount of oxygen that can be carried to the cells of the body. - RBCs live for approximately 120 days. - The spleen and the liver remove old, damaged RBCs. **Functions of White Blood Cells** - White blood cells (WBCs, or leukocytes) provide the first line of defense against microbial agents. - The normal adult laboratory range for total leukocytes (WBCs) is 4500 to 11,000/mm3; they have a life span of about 13 to 20 days. - Leukocytes migrate from the bone marrow cells into the tissues and are carried by the bloodstream to locations where they are needed. - Leukocytes are divided into granulocytes (meaning "with granules") and agranulocytes (meaning "without granules") in the cell nucleus. - **Granulocytes** are divided into neutrophils, eosinophils, and basophils and are produced in the red bone marrow. - **Neutrophils** make up 54% to 62% of the WBC count and work by engulfing and destroying bacteria through the process of phagocytosis, which means "to consume or swallow up other cells or particles." - An infection in the body stimulates increased production of neutrophils, resulting in a higher-than-normal WBC count, or leukocytosis. - **Eosinophils**, which make up 1% to 3% of the total WBCs, help detoxify foreign proteins; eosinophils increase in number during allergic reactions and in response to parasitic infections. - **Basophils**, which compose up to 1% of the total WBC count, release histamine in response to allergens and help prevent clotting in the small blood vessels. - **Agranulocytes** consist of lymphocytes and monocytes. They are produced in the red bone marrow and in lymphatic tissue. - **Lymphocytes**, which account for 25% to 33% of WBCs, are produced in the red bone marrow and the lymphatic tissue. Lymphocytes occur as B cells and T cells. B lymphocytes change into plasma cells that produce immunoglobulins responsible for the humoral immune response. - Some T cells are killer cells that fight antigens and provide cell-mediated immune response. **Monocytes** compose 3% to 7% of the WBCs and become macrophages (large mononuclear monocytes) that migrate into the tissues, where they become phagocytes, fighting infection and ridding the body of foreign substances. They engulf bacteria and foreign substances and eliminate them from the body. **Platelets and Their Function** - Prevent bleeding by promoting clotting. - Fibrin strands derived from the plasma protein fibrinogen attach to aggregated platelets to help form a clot. - Platelets tend to adhere to damaged or uneven surfaces and to clump together. - The life span of a platelet is about 10 days. **Interaction of the Lymphatic System with the Vascular System** - The spleen, located in the upper left abdominal cavity below the diaphragm and behind the stomach, filters the blood, removing pathogens, old blood cells, and debris, and produces lymphocytes. - The spleen is a reservoir for extra blood; in response to hemorrhage, it contracts, and by contraction the spleen releases some of its stored blood into the cardiovascular system. If the spleen is removed, its functions are taken over by other lymph tissue and by the liver. - Lymph vessels collect fluid and protein from the interstitial spaces and return them to the bloodstream. Lymph nodes (bundles of lymphatic tissue) filter out leukocytes and cell debris from inflammations and infections before the lymph is returned to the bloodstream. **Changes of the Hematologic System That Occur with Aging** - Plasma volume decreases after age 60 - Decreased bone marrow activity - Slower cellular production - Increased coagulation: - Increased risk for thrombosis in coronary and cerebral arteries - Daily low‑dose aspirin **Causes of Hematologic Disorders** - **Genetic Disorders** - Hemophilia - Sickle cell disease - Agranulocytosis - **Hemorrhage (Anemia)** - Surgical blood loss - Blood loss from childbirth or spontaneous abortion - Traumatic blood loss - Gastrointestinal (GI) bleed - **Anemia** - Iron deficiency - Folic acid deficiency - Megaloblastic anemia - Chronic slow blood loss - Aplastic anemia - **Hemolysis** - Blood transfusion reaction - Genetic types of anemia - **Bone Marrow Suppression** - Antineoplastic agents used in treatment of cancer - Radiation treatment used for cancer - Excessive exposure to ionizing radiation - Exposure to toxic chemicals that damage bone marrow - Drugs that suppress the bone marrow - **Bone Marrow Proliferation or Abnormality** - Leukemia **Nutrients Needed for Building Red Blood Cells (Erythropoiesis)** - **Vitamin B12**: Red meats, especially liver - **Folic acid**: Green leafy vegetables, liver, meat, fish, legumes, whole grains - **Iron**: Liver and muscle meats, eggs, dried fruits, legumes, dark green leafy vegetables, whole-grain and enriched bread and cereals, potatoes - **Vitamin C**: Citrus fruits, green leafy vegetables, strawberries, cantaloupe **Cultural Cues Genetic Hematologic Tendencies** - African Americans have the highest incidence of sickle cell disease. - Pernicious anemia is more prevalent among those of Scandinavian descent and among African Americans. - People of Middle Eastern origin may have a genetic predisposition to thalassemia. - Whites have a higher incidence of leukemia, followed by Hispanics. **Physical Assessment** - **Head and Neck** - Color of conjunctiva and sclera of eye - Condition of gums, oral mucous membranes, and tongue - Presence of enlarged cervical lymph nodes - Pale mucous membranes or pale conjunctiva of the eye are better indicators of anemia. - **Skin** - Color (pale) (check conjunctivae, palms of hands, and roof of the mouth in people with dark skin) - Condition of fingernails (brittle, spoon-shaped) - Presence of ecchymosis or petechiae - Jaundice -  Hair (dry, brittle, thinning) - **Chest and Abdomen** - Rapid respirations; shortness of breath on exertion - Presence of swollen lymph nodes in armpits or groin - Rapid pulse rate at rest - Widened pulse pressure - Epigastric tenderness - Abdominal distention - **Extremities** - Presence of swollen or painful joints (hemarthrosis) - Quality of pulses, skin color - **Urine and Stool** - Signs of blood \* Patients with a blood abnormality are at higher risk for infection, so it is extremely important to use aseptic technique. \* Blood dyscrasias may be caused by drugs, radiation, or toxic substances **Common Problems Related to Disorders of the Hematologic System** - Excessive bleeding - Excessive clotting - Fatigue - Anorexia - Pain - Infection - Bone marrow failure **Ch 16** **Anemia** - Healthy red blood cells (RBCs) carry oxygen to tissues. - Anemia is a state in which there are insufficient numbers of functioning RBCs, or a lack of hemoglobin (Hb), to meet the demands of the tissues for oxygen. **There are three major classifications of anemia, according to cause:** - Anemia resulting from blood loss - Anemia resulting from a failure in blood cell production - Anemia associated with a destruction of RBCs **Mild anemia (Hb 11 to 13 g/dL)** - Mild headache, palpitations, and dyspnea on exertion **Moderate anemia (Hb 8 to 10 g/dL)** - Brittle nails, sore tongue, pallor, chronic fatigue, headache, and dizziness or faintness **Severe anemia (Hb \