Blood, lymph and immune (test 9)

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Production of blood cells
Developed from stem cells located in the bone marrow through erythropoiesis Kidney makes most of bodies erythropoietin stimulating factor that then stimulates liver to release erythropoietin to then produce the RBC's.
Normal range of RBC's
4.2-6.2 million Live for about 120 days
Normal Hemoglobin
Is sickle cell genetic? True or false?
True, inherited from both parents
Sickle cell patho
-composed of an abnormality of hemoglobin S that forms clumps in the red cells causing the "sickle shape". Sickle shaped cells block BV, forming thrombi. The body destroys the cells, causing anemia
Treatment for sickle cell
No specific tx, but: - taking folic acid and eating protein to help build red cells - infection prevention including vaccines
Pt teaching for sickle cell
- Avoid high altitudes - Avoid vigorous exercise - Avoid iced liquids - No alc - Obtain tx for any infections quickly - O2 in case of inadequate oxygenation during a sickle crisis - Push fluids to help stop/slow clumping - Warm blankets to vasodilate
Iron deficiency anemia s/s
- Thin, concave (spoon-shaped) nails with raised edges - dizziness - headache - palor (too little RBC's)
Iron deficiency anemia patho
- not enough iron to produce adequate RBC
Disseminated Intravascular Coagulation (DIC)
DEATH IS COMING - occurs with tissue damage (childbirth, trauma, sepsis) - excessive clotting, depletes the body's clotting factors causing the pt to hemorrhage
S/S of disseminated intravascular coagulation
- bleeding at IV site, oral, vaginal, rectal bleeding.
tx of disseminated intravascular coagulation
Fresh frozen plasma and packed RBCs to restore blood volume and control clotting
Aplastic Anemia patho
Bone marrow suppression/failure - can be caused by some meds such as chemo and antiarthritics. EMERGENCY SITUATION
Aplastic Anemia symptoms
- anemia s/s - ecchymosis - peticia - hemorrhage
Aplastic Anemia tx
- bone marrow transplant common in pts under 45 prevention of hemorrhage and infection are important
Pernicious anemia tx
Vitamin b12 injections.
When should iron supplements be taken?
1 hr before or 2 hours after a meal - antacids may interfere.
polycythemia vera patho
too many RBCs - causing blood to be too thick - blood flow is slowed
Polycythemia vera s/s
- reddish face - purple lips - fatigue - blood clots Genetic mutation of JAK2V617F is + in 95% of cases
Treatment of polycythemia vera
Phlebotomy (removal of blood q 2-3 months) Increased fluid intake Aspirin
Leukemia patho
Too many immature or abnormal WBC's. Type of cancer
S/S and dx of leukemia
- usually no s/s but sometimes severe, persistent infections can occur as a result of abnormal WBC's. -dx by CBC
Multiple Myeloma patho
calcium leaking out of bones - leads to osteoporosis -Type of cancer
Multiple myeloma s/s
similar to that of osteoporosis - easily broken bones - bone pain - hypercalcemia treated with chemo - pain control
How is iron best absorbed?
With vitamin c
What is the most common cause of death from sickle cell anemia?
Acute chest syndrome (damage to lungs)
In pt's who are prone to excessive bleeding, what should the nurse do after giving an IM injection?
Hold pressure for 10 minutes
What is classified as thrombocytopenia
Platelet count <150
Bleeding into the joints - NO ASPRIN
Needle gauge for blood transfusions
18 or bigger 22 for older adults
Ab blood type
universal recipient
O blood type
Universal donor
Blood admin best practice
Y shaped IV line, one side with blood other side with 250 mL of NS. - if reaction occurs shut off blood and run saline
How soon must blood be started after arriving on scene?
30 minutes
Can blood be left at room temp?
Not for more than 4 hours
How long does blood take to infuse?
1.5-4 hours
function of lymph vessels
drain lymph fluid into large veins
Lymph fluid
waste after plasma has delivered nutrients to the cells
Tonsils and adrenals function
Lymph tissue - guards airway
Spleen function
filters blood: - filtering out damaged rbc - recycling hemoglobin
B lymphocytes
formed in the bone marrow and releases antibodies that fight bacterial infections
T lymphocytes
Formed in thymus (located behind breastbone)
Capillaries vs lymphatic system
Capillaries absorb about 80% of fluid
Inflammatory response
Reaction to tissue damage caused by injury or infection: - histamine
Immune response
The body's defensive reaction to invasion by bacteria
Specific immunity
Invader is marked for later if it comes back (part of immune response)
Passive immunity
the short-term immunity that results from the introduction of antibodies from another person or animal. - ex. ebola "vaccine" where bone marrow from survivors is injected into sick - Infants who breastfeed have temporary immunity to lots of diseases
natural active immunity
When body makes own antibodies and T cells. Example when you get a cold
artificial active immunity
vaccination: exposure of a controlled dose of a weakened/dead virus to induce formation of antibodies
innate immunity
present at birth
cell-mediated immunity
type of immunity produced by T cells that attack infected or abnormal body cells
primary humoral immune response
Antibodies mark the cells to kill later
Fat soluble vitamins
Conditions to postpone vaccine
- fever - immune deficiency disease or immunosuppressive therapy - blood transfusion 6-8 weeks before - live vaccine before and during pregnancy
Influenza vaccine recommended for:
All persons 6 months and older
a deficiency of red blood cells
low platelet count
deficiency of white blood cells
Nursing management for fever
Increase nutrition to meet demands of increased metabolic rate
Steroids can cause immunosuppression (true or false)
Anorexia can cause lowered immune system (true or false)
C-reactice protein (CRP)
a protein whose level in the blood increases with inflammation Normal below 8mcg/mL
Rules for patient on neutropenic precautions
- no fresh fruits or flowers - No visitors with infectious diseases
immune deficiency
Body does not make enough antibodies
autoimmune disorder
Antigen in body cannot tell self from invader (body is attacking its own cells)
human immunodeficiency virus HIV 1 most common in US
Caused by HIV
Pre-exposure prophylaxis
- Truvada: approved for pt's of high risk (msm relationships)... works by suppressing HIV replication - Emtricitabine: for patients of high risk - Safer sexual practices - Screening of blood products
HIV Patho
A retroviral virus that inserts its RNA into a healthy cell
Why no HIV/AIDS vaccine?
Constant mutation
HIV Transmission
HIV infected blood
S/S of HIV
Often no obvious symptoms... in the early stages flu like symptoms Later in the disease evidence of the immune system failing
such as s/s of frequent infections (thrush
swollen lymph nodes
Treatment of HIV/AIDS
No cure
Wasting syndrome
Losing more than 10% of weight longside at least 30 days of diarrhea or weakness accompanied by fever
Needle stick injury
Wash with soap and water
Treatment of autoimmune disorders
Replacement or support of lost body function
systemic lupus erythematosus (SLE)
Body creates antibodies that attack own cells Appears after puberty
Symptoms of systemic lupus erythematosus (SLE)
- Butterfly rash under eyes - Painful/swollen joints - Loss of hair - Light sensitivity - Swollen glands - Weakness
What can make systemic lupus erythematosus worse?
- Sun exposure - Birth control pills - Penicillins
Diagnosis of SLE
Must meet 4/11 criteria given by ruematologist
Symptom management of SLE
- Sunblock and clothing - Gulcorticosterious to lower s/s - NSAIDS to lower inflammation - B-lymphocyte protein inhibitor - Corticosteroids
Cancer of lymphocytes (type of WBC)
Hodgkin's lymphoma
More curable! Rarer
S/S of Hodgkin's Lymphoma
- enlarged painless lymph nodes - presence of R-S cells in tissue
Non-Hodgkin's Lymphoma
Less treatable. More common due to link with HIV
S/S of Non-Hodgkin's Lymphoma
Enlarged nodes that skip every other node... one is inflamed
Chronic systemic pain that is not caused by another disease or source Unknown cause
s/s of fibromyalgia
Musculoskeletal pain
increased pain sensation
Pain to non painful stimuli
Tx of fibromyalgia
No cure
Considered systemic immune disorder Common conditions include: anaphylaxis
Diagnosis of allergy
- Radioallergosorbent test (RAST) - IgE to allergen test - Scratch test (needle with allergen) - Patch test (patch with allergen)
Treatment of anaphylaxis
1. Establish airway