Medical-Surgical Nursing An Integrated Approach_ 2E Chapter 20.ppt

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					 Medical-Surgical Nursing: An
Integrated Approach, 2E
                  Chapter 20
            NURSING CARE OF
            THE CLIENT:
            HEMATOLOGICAL &
 The heart pumps 5-6 liters of blood per
  minute through the circulatory system.
 Blood is an aqueous mixture consisting of
  plasma and cells.
 A straw-colored liquid consisting of
  approximately 90% water and 10%
 The proteins are albumin, globulins, and
Red Blood Cells
 Also called erythrocites, these are the
  most numerous blood cells in the body.
 RBCs in conjunction with the respiratory
  and circulatory systems oxygenate body
 Hematocrit is the percentage of blood
  cells in a volume of blood.
White Blood Cells
 Also called leukocytes, these fight
  infection and assist with immunity.
 An increased number of WBCs
  (leukocytosis) may signify the presence of
  an infection, inflammation, tissue
  necrosis, or leukemia.
 A decreased number (leukopenia) may
  indicated bone marrow failure, a massive
  infection, dietary deficiency, drug toxicity,
  or autoimmune disease.
   Platelets (thrombocytes) are
    nonnucleated, granular, ovoid, or spindle-
    shaped cell fragments that are active in
    the clotting mechanism of the body.
Blood Types
 There are 14 different blood groups and
  over 100 different antigens. The different
  blood groups vary in number with different
  ethnic groups.
 AB blood types are universal recipients; O
  types are called universal donors. These
  terms, however, are only theoretical.
Rh Factor
   A factor to consider during blood
Blood Transfusions
 Given to replace needed blood
  components because of hemorrhage,
  anemia, clotting disorders, or blood
 Three types of blood reactions: hemolytic
  (severe, shock); febrile (elevated
  temperature, usually mild); allergic (may
  be mild or severe).
 The collection and storage of a patient’s
  own blood for purposes of transfusion.
 May be used for elective surgeries.
Lymphatic System
 A separate vessel system.
 The two main functions are to transport
  excess fluid from the interstitial spaces to
  the circulatory system and to protect the
  body against infectious organisms.
Components of the Lymph
 Lymph Fluid: pale yellow; moves from the
  plasma through the capillary walls and
  becomes interstitial fluid.
 Lymph Nodes: scattered through the body
  and contain dense patches of
  lymphocytes and macrophages.
 Lymph Organs: the spleen and the
Red Blood Cell Disorders:
 Anemia is a common hematopoietic
  disorder in which the client has a
  decreased number of RBCs and a low
  hemoglobin level.
 Causes are a decreased production of
  RBCs, an increased destruction of RBCs,
  or loss of blood.
 Types include: Iron-deficiency,
  hypoplastic (aplastic), pernicious,
  acquired hemolytic anemia, and sickle-
Red Blood Cell Disorders:
Iron Deficiency Anemia
 Most common type. Body does not have
  enough iron to synthesize functional Hgb.
 Symptoms are fatigue, loss of appetite,
  decreased ability to concentrate, and
Red Blood Cell Disorders:
Hypoplastic (Aplastic) Anemia
 The bone marrow decreases or stops
  functioning in a client with aplastic
 Develops without a known cause and
  thought to be genetic.
 Secondary aplastic anemia caused by
  exposure to viruses, chemicals (benzene
  or airplane glue), radiation, or
 Clients are extremely ill.
Red Blood Cell Disorders:
Pernicious Anemia
 An autoimmune disease in which the
  parietal cells of the gastric mucosa are
  destroyed and the gastric mucosa
  atrophies, so that Vitamin B12 cannot be
 Symptoms include extreme weakness,
  sore tongue, numbness and tingling of
  extremities, edema of the legs, etc.
 African American women are especially
  affected with the disease and often
Red Blood Cell Disorders:
Acquired Hemolytic Anemia
 In hemolytic anemias, hemolysis, or
  destruction of RBCs, occurs and iron and
  hemoglobin are released.
 Causes include autoimmune reaction,
  radiation, blood transfusion, chemicals,
  arsenic, lead, or medications.
 Symptoms include mild fatigue and pallor
  or, more severely, jaundice, palpitations,
  dyspnea, and back and joint pain.
Red Blood Cell Disorders:
Sickle Cell Anemia
   Also known as Inherited Hemolytic Anemia, this
    genetic disorder has abnormal hemoglobin S
    rather than hemoglobin A.
   Condition occurs most frequently in African
   Symptoms are enlarged heart, fatigue,
    jaundice, chronic leg ulcers, dyspnea, and
   Sickle cell crisis, which occurs periodically,
    involves severe pain, fever, and loss of blood to
Red Blood Cell Disorders:
 A disease in which there is an increased
  production of red blood cells.
 Occurs most frequently in the middle-
  aged and in Jewish men.
White Blood Cell Disorders:
 A malignancy of blood-forming tissues in
  which the bone marrow produces
  increased numbers of immature white
  blood cells that are incapable of
  protecting the body from infections.
 The increased numbers of WBCs crowd
  out the other cells in the bone marrow,
  causing a decreased production of RBCs
  and platelets, resulting in anemia and
Classifications of Leukemia
 Acute (rapid onset; quick treatment
  necessary for good prognosis
 Chronic (occurs over months or years;
  prognosis depends on severity of the
  disease at time of diagnosis).
White Blood Cell Disorders:
 A severely reduced number of
 Primary cause is adverse reaction to
  medication or medication toxicity.
 Symptoms are those typical of infection:
  fever, headache, chills, fatigue. Also
  mucous membrane ulcerations.
Coagulation Disorders
 Disseminated intravascular coagulation (a
  condition of alternating clotting and
  hemorrhaging; a syndrome that occurs
  because of a primary disease or
 Hemophilia (an inherited bleeding
  disorder in which there is a lack of clotting
 Thrombocytopenia (a decrease in the
  number of platelets in the blood).
Lymph Disorders
 The two types of malignant lymphomas
  are Hodgkin’s Disease and non-Hodgkin’s
  lymphoma. Clients with both types of
  lymphoma have enlarged lymph nodes.
 Hodgkin’s disease is diagnosed by the
  presence of the Reed Sternberg cell in
  the swollen lymph nodes. Non-Hodgkin’s
  lymphoma arises from the B lymphocytes
  and T lymphocytes and does not have the
  Reed Sternberg cell in the lymph system.
Plasma Cell Disorder
 The main plasma cell disorder is Multiple
 The plasma cells, mainly in bone marrow,
  become malignant, crowd out normal cell
  production, destroy bone tissue and
  thereby cause pain.

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