hematology
the study of the physiology of blood
what do RBCs do
carry oxygen to the blood
what do WBCs do
fight off infection
what do platelets do
they are involved in clotting
what is hemoglobin
a protein responsible for transporting oxygen in the blood
what is hematocrit
ratio of the volume of RBC's to the total volume of blood
what is bone marrow made of
RBC, WBC (lymphocyte, monocyte, eosinophil, basophil, neutrophil), platelets
what are some elderly considerations
the RBC levels are going to be low
the WBC levels are going to be low (leukopenia)
after middle age, levels continue to fall
what do you want to evaluate in your assessment
history- demographic, personal/family, diet, meds, diagnosis
physical signs- head to toe, functional
what are some types of diagnostic studies
CBC
platelet count
iron studies
bone marrow studies
B12 and folate
a condition in which the blood doesn't have enough healthy RBCs
anemias
types of anemias
iron deficiency
pernicious
acute/chronic blood loss
what to do when diagnosis an anemia
look at the MCV (mean corpuscular volume)
macrocytic:
large cells, normal color
caused by: B12 deficiency, alcohol abuse, folic acid deficiency liver
microcytic:
small cells, pale
caused by: iron deficiency, thallasemia
anemia causes:
macrocytic- pernicious anemia (B12 deficiency)
folate deficiency
microcytic- iro deficiency anemia
normocytic- blood loss
sickle cell anemia
iron deficient diet include
red meat
egg yolk
parsley
spinach
potatoes
beans
broccoli
artichoke
supplemental Fe
ferrous sulfate
SE= black stool, constipation, GI distress
-take 1 hour before meals to enhance absorption
- take with O.J. (absorbed in acidic environment)
what to teach about supplemental Fe
-excess iron exerted through GI
-increase fluid intake for constipation
-avoid tea, coffee, carbonated drinks, dairy
-take undiluted liquid iron with a straw so it doesn't stain your teeth
pernicious anemia
a decrease in HCL acid secretion leads to a decrease of intrinsic factor secretion
intrinsic factor= substance secreted by the stomach that enables the body to absorb B12
- a decrease in RBCs when the body can not absorb enough bitamin B12
pernicious anemia facts
- diagnosis is made with schilling test and lab
- neuromuscular- weakness, tingling in feet/hands, ataxia impaired thought process
- vit B12 injections= daily, weekly, monthly
how to manage acute or chronic blood loss
administer packed RBCs
identify bleeding source
volume expander- dextran, albumin, crystalloid electrolytes
aplastic anemia occurs from
its a rare condition in which the body stops producing enough new blood cells
occurs from radiation, drugs, infection, and chemicals
sickle cell anemia
a group of disorders that cause RBCs to become misshapen and break down
types of chronic disease anemia
ESRD
chronic liver disease
alcohol abuse
malignant tumors
chemo
chronic inflammation
- treat the underlying cause if possible
neutropenia
abnormally low WBC (neutrophils)
risk for infection
what cause neutropenia
chemo
radiation
medication
- put in revers isolation to protect the patient with a low immune system from chemo
- wear glove, mask, gown
-neupogen- helps the body make WBCs after cancer meds also helps with people exposed to radiation
thrombocytopenia
deficiency of platelets in the blood
risk for bleeding
-bruise easily
what causes thrombocytopenia
chemo
radiation
medication
- administer platelets
- avoid injury
- no sharp objects