hema nursing anatomy (2)

8/3/2019 Hema Nursing Anatomy (2)

http://slidepdf.com/reader/full/hema-nursing-anatomy-2 1/85

Joaquin P. Venus III,MD,RN



PUTLA MO.

ANEMIC KA

NOH?!

IKAW NANGI-

NGITIM KA NA!

CYANOTIC KA!

INTUBATE KITA!



LumayasCecil: Mare, pwede ba, dito muna ako sa

inyo? Lumayas ako sa amin. Kasi, buntis

ako.

Rain: Dapat, sa taong nakabuntis sa ‘yo

ka pumunta!

Cecil: Kaya nga rito ako pumunta, eh.

Nandiyan ba si pare?



Blood



Functions of Blood

Transport of: Gases, nutrients, waste products

Processed molecules

Regulatory molecules

Regulation of pH and osmosis

Maintenance of body temperature

Protection against foreign substances

Clot formation



Composition of Blood



Plasma

Liquid part of blood Pale yellow made up of 91% water, 9%

other

Colloid: Liquid containing suspended

substances that don’t settle out Albumin: Important in regulation of water

movement between tissues and blood

Globulins: Immune system or transportmolecules

Fibrinogen: Responsible for formation ofblood clots



Formed Elements

Red blood cells (erythrocytes)

White blood cells (leukocytes) Granulocytes

Neutrophils Eosinophils

Basophils

Agranulocytes Lymphocytes

Monocytes

Platelets (thrombocytes)



Production of FormedElements

Hematopoiesis or hemopoiesis: Process of blood cell production

Stem cells: All formed elements

derived from single population Proerythroblasts: Develop into red blood

cells

Myeloblasts: Develop into basophils,

neutrophils, eosinophils Lymphoblasts: Develop into lymphocytes

Monoblasts: Develop into monocytes

Megakaryoblasts: Develop into platelets



Hematopoiesis



Erythrocytes Structure

Biconcave,anucleate

Components

Hemoglobin

Lipids, ATP,carbonic anhydrase

Function

Transport oxygenfrom lungs totissues and a fewcarbon dioxidefrom tissues to

lungs



Hemoglobin

Consists of:

4 globin molecules: Transport carbon dioxide(carbonic anhydrase involved), nitric oxide

4 heme molecules: Transport oxygen

Iron is required for oxygen transport



Erythropoiesis

Production of red blood cells Stem cells proerythroblasts early

erythroblasts intermediate late reticulocytes

Erythropoietin: Hormone to stimulate RBC

production



Hemoglobin Breakdown



Leukocytes

Protect bodyagainstmicroorganisms

and remove deadcells and debris

Movements

AmeboidDiapedesis

Chemotaxis

Types Neutrophils: Small

phagocytic cells

Eosinophils: Reduce

inflammation, allergy Basophils: Release

histamine and increaseinflammatory response

Lymphocytes: Immunity Monocytes: Become

macrophages



Thrombocytes

Cell fragmentspinched off frommegakaryocytes in

red bone marrow Important in

preventing bloodloss

Platelet plugs

Promotingformation andcontraction of clots



Sige lang!Tsugi ka

sa akinmamaya!



LAUGH BREAK

ANAK: ITAY SA SWELDO NYO PUNTATAYO NG SN?

TATAY: ANG LAKI-LAKI MO NA BULOLKA PA? PARA SN LANG!

ANAK: ANO PO BA ANG TAMA?

TATAY: SHOENART! NARYUSIP!



Hemostasis

Arrest of bleeding Events preventing excessive blood

loss

Vascular spasm: Vasoconstrictionof damaged blood vesselsfollowed immediately by

vasodilationPlatelet plug formation

Coagulation or blood clotting



Platelet Plug Formation



Coagulation

Pathways

Extrinsic

Intrinsic

Stages

Activation ofprothrombinase

Conversion of

prothrombin tothrombin

Conversion offibrinogen to fibrin



Clot Formation



Fibrinolysis

Clotdissolved by

activity ofplasmin, anenzyme

whichhydrolyzesfibrin



MOMMY TAPOS

NA PO AKO

LIGO!



LAUGH BREAK

AMO: “DAY BAKIT MAY BUKOL SI JUNIOR?” INDAY: “COMPROMISING SAFETY WITH

USELES AESTHETICS, THE NOT-SO-

WELL ENGINEERED ARCHITECTURALDESIGN OF OUR KITCHEN LAVATORY AFFECTED THE BOY’S CRANIUM WITH A

SLIGHT BOIL AT THE LEFT TEMPLE NEARTHE AUDITORY ORGAN...”

AMO: NAGNONOSEBLEED AKO!!!!

INDAY: OH, IT’S CALLED EPISTAXIS ATI!



Blood Grouping

Determined by antigens(agglutinogens) on surface of RBCs

Antibodies (agglutinins) can bind toRBC antigens, resulting inagglutination (clumping) and

hemolysis (rupture) of RBCs Groups

ABO and Rh



BLOOD CLASSIFICATION

MAJOR BLOOD GROUPS

A, B, AB, O

Blood compatibility andsystems of classification arebased on the presence or

absence of specific antigenspresent on RBC’s as well as

specific antibodies in the

plasma




If the antigen A on the RBC’s of the

donors comes in contact with the

Antibody A of the recipient andvice versa, agglutination andclumping will occur.

E.g.Type A blood transfused into Brecipient




O negative is called the

UNIVERSAL DONOR because

there are no antigens on theRBC’s and the Rh factor is notpresent




AB positive is called the

UNIVERSAL RECIPIENT

because there are noantibodies in the serum, andthe Rh factor is present.




In agglutination and clumpingof RBC’s, hemolysis occurs,

and releases hemoglobin intothe plasma.

Problems occur with thedestruction of the donor’s

RBC’s by the plasma of the

recipient’s cells.

O G



ABO Blood Groups

A l ti ti R ti



Agglutination Reaction



Rh Blood Group

First studied in rhesus monkeys Types

Rh positive: Have these antigens presenton surface of RBCs

Rh negative: Do not have these antigenspresent

Hemolytic Disease of the Newborn(HDN)

Mother produces anti-Rh antibodies thatcross placenta and cause agglutination

and hemolysis of fetal RBCs



Rh factor

Rh is positive, or factor is present, in85% to 95% of the population

Rh is negative, or factor is absent , in 5% to 15% of the population

Normal plasma does not contain Rhantibodies. Antibodies are formed in Rhnegative blood if transfused with Rh

positive blood; thus, the recipient issensitized to the Rh factor andsubsequent Rh positive blood mightresult in a severe transfusion reaction

E th bl t i F t li



Erythroblastosis Fetalis



Diagnostic Blood Tests

Type and crossmatch Complete blood

count

Red blood count

Hemoglobinmeasurement

Hematocritmeasurement

White blood count

Differential whiteblood count

Clotting



MAMA MAYAMOY ISDA!

PARANGNASALOOBNITO!



LAUGH BREAK

BATA 1: ALAM BA NINYO ANG TAPANGNG DAGA SA AMIN. KUMAKAIN NGLASON SA DAGA!

BATA 2: WALA YAN SA DAGA SA AMIN,ANG KINAKAIN NIYA KINUKUHA NIYASA MOUSE TRAP!

BATA 3: WALA PALA IYANG MGA DAGASA AMIN. NANGRE-RAPE NG PUSA!!!



ASSESSMENT



HISTORY

HistoryDisease of bone marrow and/or

producing organs

Treatment that depressed bonemarrow activity (especiallychemotherapy or radiation

therapy)Family history of problems

(inheritance pattern)

Blood transfusion



HISTORY

Bleeding problems occurringduring pregnancy, labor anddelivery, or immediately afterdelivery in both mother andinfant

Presence of chronic disorders ordisease processes

Effects of aging



EFFECTS OF AGING

Assessment areaNail beds ( check for capillary refill)

Pallor, cyanosis, and decreased

capillary refill is often noted inhematologic disorders

In elderly:

Nails are typically thickened anddiscolored. Need to use anotherbody area, such as the lips to

assess capillary refill



EFFECTS OF AGING

HAIR DISTRIBUTION

Thin or absent hair on trunk andextremities may indicate poor oxygenation

and blood supply In elderly:

Older adults are losing body hair, but

often is an even pattern distribution thathas occurred slowly overtime. Lack ofhair on lower legs and toes may indicatepoor circulation



EFFECTS OF AGING

SKIN MOISTURE AND COLOR Skin dryness, pallor and jaundice may occur with

anemia, leukemia, etc

In elderly: Dry skin is a normal aspect of aging and thus

becomes an unreliable indicator of skinmoisture

Pigment loss and skin changes along withsome yellowing occur with aging.

Pallor that is not associated with anemia maybe noted in older adults, because they tend notto go outdoors and get exposed to sunlight



EFFECTS OF AGING

Evaluate effect of hematologic disorderhas on client’s activities of daily living? How long has client experienced

symptoms? What are current activities and metabolic

requirements of the client?

Presence or absence of bleeding episodes

Ability to control pain Presence of appropriate coping or defense

mechanism



EFFECTS OF AGING

Evaluate effect of hematologic disorderhas on client’s activities of daily living?

Assess client’s current nutritional

status

Evaluate current blood values

Evaluate status of respiratory andcardiovascular systems in maintaininghomeostasis



LAUGH BREAK

KONDUKTOR: SAAN PO KAYO BABAMISIS?

MISIS: CUBAO LANG!

KONDUKTOR: ANAK PO BA NINYO IYAN?

BAKIT ANG PANGIT?

MISIS: BUWISIT NA KONDUKTOR IYON.SOBRA KUNG MAMINTAS. ANG TAGALNG INSPECTOR. MAIREKLAMO NGA!



LAUGH BREAK

UMAKYAT ANG INSPECTOR NG BUS....MISIS: SOBRANG MANLAIT ANG

KUNDOKTOR NYO! GUSTO KONG

IREKLAMO!INSPEKTOR: TAMA PO ANG GAGAWIN

NINYO! ETO PO ANG LAPIS AT PAPEL.

ISULAT NINYO ANG INYONGREKLAMO. PARA MAKASULAT KAYOAKIN MUNA ANG UNGGOY NINYO...



DIAGNOSTICS

ACTIVATED PARTIAL



ACTIVATED PARTIALTHROMBOPLASTIN TIME

Evaluates how well the coagulationsequence (INTRINSIC PATHWAY) isfunctioning by measuring the amount of

time it takes for recalcified, citratedplasma to clot after partial thromboplastinis added to it.

The test screens for deficiencies andinhibitors of all factors except VII and XIII

Value : 20 to 36 seconds, depending on

the type of activator used



aPTT Nursing consideration If the client is receiving intermittent

heparin therapy, draw the blood

sample 1 hour before the nextscheduled dose

Do not draw samples from an arminto which heparin is infusing

Transport specimen to the lab

immediately



PROTHROMBIN TIMEand INR

Prothrombin is a Vitamin Kdependent glycoprotein

produced by the liver that isnecessary for firm fibrin clotformation

Each laboratory establishes anormal value or control valuebased on the method used toperform the PT test.

PROTHROMBIN TIME



PROTHROMBIN TIMEand INR

The Pt measures the amount of timeit takes for clot formation and is used

to monitor response to warfarinsodium (Coumadin) therapy or toscreen for dysfunction of theextrinsic system resulting from liver

disease, vitamin K deficiency, or DIC Value: 2 seconds (plus or minus) of

the control is considered normal



PT and INR cont’n

The INR standardized the PT ratioand is calculated in the lab settingby raising the observed PT ratio tothe power of The InternationalSensitivity Index specific to the

thromboplastin reagent used The INR measures the effects of

oral anticoagulants



PT and INR

Values:PT : 9.6 to 11.8 seconds (male

adult ) and 9.5 to 11.3 seconds

( female adult)

INR: 2.0 to 3.0 for standard

warfarin therapy INR: 3.0 to 4.5 for high dose

warfarin therapy



PT and INR

Nursing consideration:A baseline PT should be drawn

before anticouagulation therapy isstarted; note the time of collection onlab form

Provide direct pressure to thevenipuncture site for 3 to 5 minutes ifa coagulation defect is present

Concurrent warfarin therapy withheparin therapy can lengthen the PTfor up to 5 hours after dosing



PT and INR

Nursing consideration: Orally administered anticoagulation

therapy usually maintains the PT at1.5 to 2 times the lab control value

Diets high in green leafy vegetablescan increase the absorption ofVitamin K which shortens the PT

A Pt that is greater than 30 secplaces the client at risk forhemorrhage



CLOTTING TIME

The time required for the interaction of allfactors involved in the clotting process

Value: 8 to 15 min

Nursing considerations: The client should not receive heparin

therapy for 3 hours before specimencollection because the heparin therapy will

affect the results The test results is prolonged by any

anticoagulant therapy, test tube agitation,high temperature changes that may affect

the specimen

SPECIAL HAT (mexican style)



SPECIAL HAT (mexican style)



Religious Daddy: Anak, mabait ba ang boyfriend

mo?Anak: Opo, Tatay.

Daddy: Religious ba siya?Anak: Naku, Sobra talagang religious!Daddy: Saan ba siya nakatira?

Anak: Nandoon po sa simbahan,nagmimisa ngayon!!



PLATELET COUNT Platelet function in hemostatic plug

formation, clot retraction, and coagulationfactor activation

Platelets are produced by the bone marrowto function in hemostasis

Value: 150,000 to 400, 000 cells/ml

Nursing considerations: Monitor venipuncture site for bleeding in clients

with known thrombocytopenia High altitudes, chronic cold weather and exercise

increase platelet counts

Bleeding precautions should be instituted inclients with a low platelet count

ERYTHROCYTE STUDIES



ERYTHROCYTE STUDIES1. ERYTHROCYTE SEDIMENTATION

RATEA. The rate at which erythrocytes settle out of

anti-coagulated blood in 1 hour

B. Not diagnostic of any particular diseasebut indicative that a disease process isongoing

C. Normal Value: 0 to 30 mm/hr, depending onthe age of patient

D. Nursing consideration:

-Fasting is not necessary, but a fatty meal

may cause plasma alterations



ERYTHROCYTE STUDIES

2. HEMOGLOBIN AND HEMATOCRIT Hemoglobin is the main component of

erythrocytes and serves as thevehicle for the transportation of

oxygen and CO2 Hemoglobin determinations are

important in identifying anemia

Hematocrit represents red blood cellmass and is an importantmeasurement in the identification ofanemia and polycythemia



Hemoglobin and Hematocrit

Hemoglobin – Normal value: 14 – 16.5 g/dl (male)

: 12 - 15 g/dl (female)

Hematocrit –

Normal value: 42% - 52% (male): 35% - 47 % (female)



ERYTHROCYTE STUDIES

3. Serum Iron Iron is found mostly in hemoglobin

Acts as a carrier of oxygen from the lungsto the tissues and indirectly aids in the

return of carbon dioxide to the lungs Aids in diagnosing anemias and hemolytic

disorders

Values: male adult : 65 to 175 mcg/dl

Female adult : 50 to 170 mcg/dl

Nursing consideration:

Level of iron will be increased if the client

has ingested iron before the test



ERYHROCYTE STUDIES

RBC COUNTRBC functions in hemoglobin

transport which results in delivery of

oxygen to the body tissuesRBC’s are formed by red bone

marrow, have a life span of 120 daysand are removed from the blood bythe liver, spleen, and bone marrow

RBC COUNT



RBC COUNT

Aids in diagnosing anemia and blooddyscrasias

Evaluates the ability of the body toproduce rbc in sufficient number

Value: female adult : 4 million to 5.5million cells/ul

male adult : 4.5 million to 6.2

million cells/ulNursing consideration:

Fasting not required



LAUGH BREAK

ANAK: INAY, TINGIN KO PO HINDI NANINYO AKO MAHAL. LAHAT NA LANGNG SABIHIN KO AY MALI!

INAY: NAGKAKAMALI KA ANAK! MAHALNA MAHAL KA NAMIN NI TATAY MO!

ANAK: KITA NA NINYO! MALI NA NAMAN

AKO! HMP!



WHITE BLOOD CELL COUNT

Function in the immune defensesystem of the body

Assesses each leukocytedistribution

Value : 4500 to 11000 cells/ul



White blood cell count

Nursing consideration:A shift to the left means that an

increased number of immatureneutrophils are in the peripheral blood

A low wbc count with a left shiftindicates a recovery from the bonemarrow depression or an infection ofsuch intensity that the demand for

neutrophils in the tissue is greater thanthe capacity of the bone marrow torelease them into the circulation



White blood cell count

Nursing consideration:A high wbc count with a left shift

indicates an increased release ofneutrophils by the bone marrow inresponse to an overwhelminginfection or inflammation

A shift to the right means that mature

cells have more than the usualnumber of nuclear segments; foundin liver disease, Down syndrome; ormegaloblastic and pernicious anemia

BONE MARROW



BONE MARROWASPIRATION/BIOPSY

All formed cell elements withinnormal range (erythrocytes,

leukocytes, and platelets) Evaluates presence, absence or

ratio of cells characteristic of asuspected disease

Preferable site: Posterior iliaccrest

BONE MARROW



BONE MARROWASPIRATION/BIOPSY

Client preparation: Local anesthetic is used, as well as

analgesics Feeling of pressure when bone marrow is

entered; pain occurs as marrow is beingwithdrawn After test:

Observe for bleeding at site

Apply pressure to site Bed rest for approximately 30 min

afterward

Analgesics indicated



SICKLE CELL TEST/DEX

Number of hemoglobin S present

Routine screening test for sickle celltrait or disorder

False negative result in infants < 3months

False positive result can occur for up to

4 months after a transfusion of RBCs that are positive for the trait

HEMOGLOBIN



HEMOGLOBINELECTROPHORESIS

Separates various hemoglobins andallows for identification of specific

problem Differentiates between trait or disorder

in sickle cell anemia

Diagnosis of thalassemia andhemolytic anemia



FIBRIN SPLIT PRODUCTS

Increased destruction in DIC

Fibrinolysis occurs in intravascularcoagulation

Abnormally high levels in DIC

LAUGH END



LAUGH END

AMO: Sagutin mo ang telepon inday!INDAY: (baligtad ang hawak ng telephone

receiver) Hilo? Hilo?

AMO: Baligtarin mo!INDAY: Lohi? Lohi?

AMO: Tanga, baligtarin mo ang

telepono!!!!INDAY: Puntili, puntili

ANAK



ANAKANO YAN?

MAMATUTUTULOGNA PO KO...!

LAUGH END



LAUGH END

Have you seen the sexiest star inhollywood today?

A. Paris Hilton?

B. J. Lopez?

C. Beyonce Knowles?

Naaaaahh!........... ALL WRONG PO!

MS. BEAN!



LAUGH END!



LAUGH END!

Sabi Airforce: "No Guts No Glory!"Sabi Marines: "No Retreat NoSurrender!"

Sabi Army: "No Pain, No Gain!"Security Guards: "No I.D.No Entry!“

AU Nursing Students: “No Audit, no

diploma!”

LAW OF THE SEED



LAW OF THE SEED

MOST SEEDS NEVER GROW. FOR 1APPLE TREE TO BEAR 500 APPLES,YOU NEED 10 SEEDS.

IN LIFE, THIS PRINCIPLE MIGHT MEANYOU’LL NEED TO GET 1 JOB, TALK TO

50 PEOPLE TO SELL ONE HOUSE,

MEET 1000 ACQUINTANCES TO HAVE1 SPECIAL PERSON

LAW OF THE SEED



LAW OF THE SEED

IF WE REALLY WANT TO MAKE THINGSHAPPEN, WE USUALLY NEED TO TRYMORE THAN ONCE....

THAT’S THE LAW OF NATURE, JUSTUNDERSTAND AND WORK WITH IT!



LUNCHTIME!

hema nursing anatomy (2)

Documents