Chapter 30 Intro to the Hematopoietic and Lymphatic Systems (1) PDF

Timby/Smith: Introductory Medical-Surgical Nursing, 13/e Chapter 41: Introduction to the Hematopoietic and Lymphatic Systems Copyright © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins Hematopoietic and Lymphatic Systems  Immune response: o Hematopoiesis: man...

Timby/Smith: Introductory Medical-Surgical Nursing, 13/e Chapter 41: Introduction to the Hematopoietic and Lymphatic Systems Copyright © 2018 Wolters Kluwer Health | Lippincott Williams & Wilkins Hematopoietic and Lymphatic Systems  Immune response: o Hematopoiesis: manufacture and development of blood cells  See Table 30-1 Functions of Blood Components, p. 500 o Lymphatic system: assist in maturation of lymphocytes (specific types of white blood cells)  Include thymus gland and spleen o Structures in hematopoietic system  Bone marrow  Blood  Lymphatic system Copyright © 2022 Wolters Kluwer · All Rights Reserved Anatomy and Physiology  Hematopoietic System o Structures: bone marrow, blood, blood groups  Bone marrow: soft tissue that fills spaces in interior of long and spongy bones  Manufactures blood cells 2 types of bone marrow  Red marrow: found in ribs, sternum, skull, clavicles, vertebrae, iliac crest, proximal ends of long bone  Manufactures blood cells and hemoglobin  Yellow marrow: consists of fat cells and connective tissue  Can form blood cells under intense stimulation Example: hemorrhage Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic System (cont’d)  Blood: consists of cells suspended in plasma  Pluripotential stem cells: myeloid and lymphoid stem cells Produces all blood cells in bone marrow  Myeloid stem cells convert to form components of blood  Erythrocytes: red blood cells (RBCs)  Leukocytes: white blood cells (WBCs  Platelets: thrombocytes  Lymphoid stem cells convert to lymphocytes  WBCs with immune function Copyright © 2022 Wolters Kluwer · All Rights Reserved Components of Blood Centrifuged Blood Components  Plasma o 55% of total blood  Buff Coat o < 1% of total blood  Leukocytes & Platelets  RBC’s o 45% of total blood Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic System (cont’d)  Erythrocytes (RBCs): transport O2 and remove CO2 from tissues o Flexible to change shape, anuclear, biconcave, circulate for 120 days  Erythropoiesis: production of RBCs  Regulated by erythropoietin – hormone released by kidney Requires iron, B vitamins (B12, B6, and folate) to mature  Erythroblast: immature erythrocytes  Hemoglobin: red color of blood and iron – containing pigment Carries oxygen to cells in body Adult normal range:  12.0 – 17.4 g/dL Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic System (cont’d)  Erythrocytes (cont’d) o Oxyhemoglobin: oxygen saturated hemoglobin, CO 2 is released  Oxygen is picked up passing through alveolar capillary membranes  Circulates through arteries, arterioles, and capillaries to body o Deoxygenated hemoglobin: releases O2 and acquires CO2 from cellular metabolism  Blood becomes darker red, has no O2 o Destroyed RBCs  Iron component of hemoglobin is returned to red marrow  Spleen removes dead RBCs from circulation  Liver removes damaged RBCs from circulation  Bilirubin: residual pigment from destroyed erythrocytes Stored in liver Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 The nurse is educating the client regarding nutrition and the prevention of anemia and low hemoglobin. The nutrients involved with red blood cell formation include all of the following, except: A) Vitamin C enhances the absorption of folic acid and iron. B) Vitamin E protects blood cells from hemolytic anemia. C) Vitamin B12 serves as a coenzyme in hemoglobin formation. D) Iron is the basic nutritional component of heme in hemoglobin. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 C) Vitamin B12 serves as a coenzyme in hemoglobin formation. Rationale: Folic acid and vitamin B12 are essential for the maturation of red blood cells, not hemoglobin formation. Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic System (cont’d)  Leukocytes (WBCs): engulf invading microorganisms and cellular debris, manufacture antibodies, destroy foreign/harmful substances in tissue  Normal range: 5,000 – 10,000mm3 Leukocytosis: increased WBCs Leukopenia: decreased WBCs  Life span: 1 – 2 days Continuous demand Greater during infection  2 categories: Granulocytes: cytoplasmic granules Agranulocytes: no granules Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic System (cont’d)  Granulocytes (PMNs): 3 subgroups o Neutrophils (Microphages):  Major component of inflammatory response  Defend against bacterial infection o Basophils:  Active in allergic reactions  Dermatitis and delayed hypersensitivity o Eosinophils:  Increased in allergies, dermatologic disorders, parasitic infections Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic System (cont’d)  Agranulocytes: 2 groups o Lymphocytes:  B lymphocytes:  Provide humoral immunity Produce antibodies (immunoglobulins)  T lymphocytes:  Provide cellular immunity Cell mediated response o Monocytes (Macrophages):  Phagocytize/engulf large debris, antigen presenting cells, contribute to immune response Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic System (cont’d)  Platelets (Thrombocytes): contribute to hemostasis, control bleeding o Produced in red bone marrow o Life span approximately 7.5 days o Disklike, nonnucleated cell fragment  Normal range:  150,000 – 350,000 mm3 o Migrate to injury sites o release substance (glycoprotein IIb/IIIa), causes platelets to aggregate and form a plug, or clot, occluding injured vessel Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic System (cont’d)  Plasma: liquid (serum) portion of blood o 90% water and 10% protein  Contains and transports:  Proteins: Albumin: helps maintain osmotic pressure, retains fluid in vascular compartment, formed in liver Globulins: prevent/modify infections  Called immunoglobulins  3 groups: alpha, beta, gamma Fibrinogen: forms blood clots  Clotting factors (prothrombin)  Pigments, vitamins, glucose, lipids, electrolytes, minerals, enzymes, hormones Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic System (cont’d)  Blood Groups: o 4 Types: A, B, AB, O  Determined by heredity o Antigen: identifying protein on RBC  Present or not  Example: Type O  Universal donor  Example: Type AB  Universal recipient  Rh factor: rhesus factor D (RhD) o Rh Positive (Rh+): protein present o Rh Negative (Rh-): protein absent  Blood transfusion: both type and Rh compatible, typed and crossmatched o Considered compatible, no hemolysis Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 A client involved in a motor vehicle accident requires a blood transfusion due to excessive bleeding injuries. The client is typed and crossmatched for the blood transfusion and is tested as having type AB blood. What blood type would be compatible for this client? A) Type A blood B) Type B blood C) Type O blood D) Type A, Rh-positive blood Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 C) Type O blood Rationale: In an emergency, type O blood can be given to recipients with type A, B, AB, or O. Copyright © 2022 Wolters Kluwer · All Rights Reserved Lymphatic System  Lymphatic System: o Circulates interstitial fluid and carries to veins o Filters/destroys pathogens, remove harmful substances  Components:  Thymus gland: o Located in upper chest o Produces lymphocytes during fetal development o After birth, thymus gland program T lymphocytes to become regulator or effector T cells Copyright © 2022 Wolters Kluwer · All Rights Reserved Lymphatic System (cont’d)  Lymphatic System Components:  Spleen: Largest lymphatic structure o Located in abdomen o Beneath diaphragm, behind the stomach Hematopoietic/immune functions o Emergency reservoir of blood o Removes bacteria and old and damaged RBCs from circulation Copyright © 2022 Wolters Kluwer · All Rights Reserved Lymphatic System (cont’d)  Lymphatic System Components:  Lymph Nodes: Granular tissue in axilla, groin, neck, large vessels of thorax/abdomen, assist in draining lymph fluid Contain T and B lymphocytes (from bone marrow)  Lymph: fluid (similar to plasma) that passes through the node, macrophages attack and engulf foreign substances Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic and Lymphatic Assessment  Clinical Assessment: o Health history, client exam, monitor/review laboratory results  Includes signs/symptoms  Any abnormalities  When began, severity, frequency  Dietary history  Poor nutrition can interfere with making of blood cells and hemoglobin  Drug history: Prescription and nonprescription medications  Antibiotics or cancer drugs Causes hematopoietic dysfunction  ASA and anticoagulants Interferes with clot formation  Foreign travel  Malaria or parasitic roundworms Mosquito cause anemia Roundworm cause Filariasis (elephantiasis), occlude lymph vessel Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic and Lymphatic System Assessment (cont’d)  Establish if client has had the following: o Prolonged bleeding from an obvious injury and bruises easily. o Unexplained blood loss, rectal bleeding, nosebleeds, bleeding gums, vomiting blood. o Feels fatigued with normal activities, becomes dizzy/faints. o Easily chilled or frequent infections. o Discomfort in the axilla, groin, or neck, difficulty swallowing, localized throat tenderness. o Surgery with lymph node removal or splenectomy, undergoing treatment for cancer treatment, has renal failure—all can affect blood cell volume or lymphatic circulation. o See Pharmacologic Considerations, p. 504 Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic and Lymphatic System Assessment (cont’d)  Physical Examination: o Skin inspection:  Color (red/pallor), temperature, ecchymosis, lesions o Pulse:  Rapid indicates reduced RBCs / inadequate hemoglobin levels o Palpate lymph nodes:  Tenderness or swelling  Tonsil Inspection: o Size and appearance, scale of 1 – 4  Purulent exudate on surface suggest tonsilitis  Unilateral enlargement  Obstruction of lymphatic circulation Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic and Lymphatic System Assessment (cont’d) Tonsilitis  Tonsil Inspection o Grading Scale  1: Tonsils are visible  2: Tonsils extend medially toward the uvula  3: Tonsils touch the uvula  4: Tonsils touch each other Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic and Lymphatic System Assessment (cont’d)  Diagnostic Testing Bone Marrow Aspiration o Blood testing:  CBC  Prothrombin Time (PT)  Fibrinogen  Activated Partial Thromboplastin Time (APTT)  D-Dimer, Factor assays o Bone Marrow:  Determines blood cell formation, cancer  See Nursing Guidelines 30-1, p. 506 Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic and Lymphatic System Assessment (cont’d)  Diagnostic Testing (cont’d) o Schilling Test:  Determines etiology of Vit B12 (cobalamin) deficiency  Causes pernicious anemia (autoimmune disorder) Macrocytic anemia  Caused by Dietary deficiency  Gastrectomy of gastric bypass Deficiency of intrinsic factor  Vegan (no animal protein) Malabsorption syndromes  Crohn’s disease Protease deficiency  Common in pancreatitis Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic and Lymphatic System Assessment (cont’d)  Diagnostic Testing (cont’d) o Non-specific testing  Detect changes and (direct/indirect) relationships to a hematological or lymphatic disorder  Lymph node biopsy  Ultrasound spleen  Lymphangiography (uses contrast)  X-ray  CT  Bone scan  MRI Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 The nurse needs to monitor clients taking medications that can contribute to hematopoietic dysfunction. Medications that interfere with the hematopoietic system include: A) Filgrastim (Neupogen) B) Warfarin (Coumadin) C) Epoetin alfa (Epogen) D) Pegfilgrastim (Neulasta) Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 B) Warfarin (Coumadin) Rationale: Warfarin (Coumadin) and aspirin and other anticoagulants can contribute to bleeding and interfere with clot formation. Copyright © 2022 Wolters Kluwer · All Rights Reserved Hematopoietic and Lymphatic System Nursing Management  Nursing Management o Collects data:  Vital signs, medical and surgical history, allergies, medication history o Assess client’s knowledge of procedures o Describes routine testing o Uses standard precautions when collecting specimens o Notify provider for any adverse response o Analyze and report test results Copyright © 2022 Wolters Kluwer · All Rights Reserved