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Nursing Assessment: Hematologic System

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Title: Nursing Assessment: Hematologic System


1
Nursing Assessment Hematologic System
  • NURS1228
  • Class 10

2
Terms to Know
  • Erythrocyte
  • Lymphangiography
  • Purpura
  • Erythropoesis
  • Lymphedema
  • Reticulacyte
  • Hemolysis
  • Pancytopenia
  • Phagocytosis
  • Immunoglobulins
  • Petichiae
  • Leukocyte
  • Platelet
  • Meds
  • Anticoagulants
  • Antithrobins
  • Fibrinolytics
  • Fibrin Split Products

3
Diagnostic Tests
  • CBC http//www.medicinenet.com/Complete_Blood_Co
    unt/article.htm
  • MCV
  • HCT
  • Platelets
  • HGB
  • Sed Rate (ESR)
  • RH factor
  • MCH
  • ABO Blood Typing
  • MCHC
  • Lymphangiography

4
How is the Hematologic System Put Together? What
does it do?
5
The System
  • Blood Cells
  • Bone Marrow
  • Spleen
  • Lymph system
  • What are some of the crucial functions of these
    organs and cells?

6
Erythropoesis
  • Regulated by
  • Stimulated by
  • Hormonal control erythropoietin
  • Influenced by

7
Blood Cell Differentiation
  • See figure 28-2 How cells differentiate

8
Types of Blood Cells
  • Erythrocytes
  • Leukocytes
  • Granulocytes (polynorphonuclear leukocytes -PMNs)
  • Neutrophils
  • Band/stab
  • Eosinophils
  • Basophils
  • Monocytes
  • Lymphocytes
  • Platelets
  • Spleen (NOT a blood cell!!)
  • Hematopoietic function (Fetal devel)
  • Filter Function (and recycles!)
  • Immune function
  • Storage function

9
The Lymphatic System
Palpable superficial lymph nodes From figure
28-6, p. 730
occipital Posterior auricular Preauricular Tonsill
ar Submaxillary Submental Superficial
cervial Deep cervical Supraclavicular Axillary Lat
eral Subscapular Pectoral Epitrochlear Inguinal
Note Lymph Drainage
10
Lymph System
  • Lymphatic capillaries
  • Lymphatic ducts
  • Lymph Nodes
  • System carries fluids from the interstitial
    spaces to the blood
  • Proteins, fat from GI, and hormones return to
    blood
  • Returns excess interstitial fluid to blood

11
Lymphatic Circulation
12
Lymphedema
  • Too much interstitial pressure develops or
    something interferes with reabsorbtion of lymph.
  • Complication of mastectomy/lumpectomy when lymph
    nodes are removed
  • Nodes are a filtration system (along with the
    liver) bacteria and foreign particles. Fluid
    drains into the subclavian veins in the neck.

13
The Liver
  • Acts as a filter
  • Produces all progoagulants essential to
    hemostasis and blood coagulation
  • Also has other functions not related to hematology

14
Clotting/Hemostasis
  • Vascular Response
  • Platelet Response
  • Plasma Clotting Factors
  • Anticoagulants

15
Clotting
Scanning electromicrograph of platelets
Scanning electromicrograph of activated
platelets
16
Nursing Assessment
  • Subjective Data
  • Past Health History
  • Medications?
  • Surgery?
  • Functional Health Patterns

17
Health Perception-Management
  • Identify
  • Health perceptions
  • Health practices
  • Preventive practices (as well as risk factors)

18
Nutritional- Metabolic
  • Recent changes with weight, appetite, etc? (also
    objectively weigh the patient)
  • Dietary History
  • Changes in skin, hair, gums, etc.
  • Swelling in areas where nodes are present

19
Elimination Pattern
  • Bleeding?
  • Stool appearance?
  • Urinary output? Diarrhea?

20
Activity-ExerciseSleep-Rest
  • Fatigue? Feelings of tiredness? Weakness?
  • Malaise? Apathy? Functional inability to perform
    ADLs?
  • Feeling of being rested?

21
Self ConceptRoles and Relationship
  • Effect of any hematologic changes (swelling,
    edema etc.) should be considered
  • Occupational or household hazards?
  • Viet Nam contact?
  • Present illness impact on roles and relationships

22
Sexuality-reproductive
  • Menstrual History
  • Intra/postpartum bleeding?
  • Men Impotence?

23
Coping -Stress
  • Assistance with ADLs required?
  • Adequate support system?
  • Patients understanding of illness?

24
Value-Belief
  • Blood transfusion issues
  • Bone marrow transplant issues
  • Stem cell transplant issues
  • Planned therapy

25
Objective Data
  • Physical Examination
  • Level of consciouness
  • Abdominal Girth
  • Lymph nodes (sequentially)
  • Skin inspection
  • Liver and spleen palpation

26
Objective Data ContinuedDiagnostic Studies
  • Any tests for bleeding
  • CBC
  • RBC (including HH) Know how reported
  • WBC (including differential) Lymphocytes
  • Neutrophil counts (including a shift to the left)
  • Cell maturity
  • ESR (Erythrocyte Sedimentation Rate)
  • Inflammatory conditions nonspecific disease
    processes
  • Routine screening

27
Diagnostic Studies Continued
  • Blood typing and Rh Factor
  • A and B and O blood types AB blood types
  • Rh Antigen D on the RBC membrane of some
    people.
  • Blood transfusion issues
  • Antibody formation
  • Transfusion reactions

28
Transfusion Reactions
  • Why it happens
  • Signs and Symptoms
  • Coombs test

29
Diagnostic Studies continued
  • Lymphangiography
  • What is it?
  • What is its role?
  • What contraindications against performing?
  • How is it performed?

30
Diagnostic Studies continued
  • Biopsies
  • Bone Marrow
  • What is it and how is it accomplished?
  • What are nursing responsibilities?
  • Lymph Node
  • What is it and how is it accomplished?
  • What are nursing responsibilities?

31
Nursing Responsibilites
  • Consent
  • Instruction
  • Technique
  • Pain Relief
  • Actual Care
  • Dressing changes
  • Assessment for toleration of procedure and
    complication.
  • Evaluation for wound healing

32
Normal vs. Common Abnormal Findings
  • Abnormal Findings
  • Clotting studies
  • Realize that the normal in these may actually
    be abnormal if the person is on anticoagulation
    therapy.
  • ESR Increase indicates inflammatory process
  • Low HH indicates anemia in general
    MCV,MCH,MCHC may indicate type of anemia involved
  • Normal Findings
  • See text for values
  • P. 731, 732, 733
  • Note especially the in the WBC differential
    count
  • RBC Indices
  • MCV, MCH, MCHC
  • All indicate qualities of the red blood cells

33
Normal vs. Abnormal FindingsContinued
Diagnostic Studies
  • Normal Findings
  • See Text p. 734
  • Common
  • Lymphangiography, CT and MRI scans
  • Biopsies Bone marrow and lymph node
  • Abnormal Findings
  • Lymphangiography is often utilized in the
    diagnosis of Lymphoma or Hodgkins disease
  • CT and MRIs can also examine soft tissue, spleen,
    liver, lymph nodes for damage, tumors, etc.
  • Biopsies of lymph nodes and bone marrow detect
    malignancies.

34
Results What Implications Do They Have?
  • Everything from the diagnosis of simple anemia to
    a malignancy requires the RN to be able to
    interact with the patient
  • RNs need to know how tests are carried out and be
    prepared for patient instruction at all times.
  • Many of these tests and potential results bring
    with them a certain amount of anxiety for the
    patient. It is up to the RN to address the
    issues that may cause anxiety.

35
End of Class 10
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