Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 20 NURSING CARE OF THE CLIENT: HEMATOLOGICAL & LYMPHATIC SYSTEMS Blood The heart pumps 5-6 liters of blood per minute through the circulatory system. Blood is an aqueous mixture consisting of plasma and cells. Plasma A straw-colored liquid consisting of approximately 90% water and 10% proteins. The proteins are albumin, globulins, and fibrinogen. 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 tissues. 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 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 transfusions. Blood Transfusions Given to replace needed blood components because of hemorrhage, anemia, clotting disorders, or blood deficiencies. Three types of blood reactions: hemolytic (severe, shock); febrile (elevated temperature, usually mild); allergic (may be mild or severe). Autotransfusion 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 System 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 thymus. Red Blood Cell Disorders: Anemia 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- cell. 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 pallor. Red Blood Cell Disorders: Hypoplastic (Aplastic) Anemia The bone marrow decreases or stops functioning in a client with aplastic anemia. 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 medications. 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 absorbed. 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 Americans. Symptoms are enlarged heart, fatigue, jaundice, chronic leg ulcers, dyspnea, and arrhythmias. Sickle cell crisis, which occurs periodically, involves severe pain, fever, and loss of blood to organs. Red Blood Cell Disorders: Polycythemia 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: Leukemia 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 bleeding. 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: Agranulocytosis A severely reduced number of granulocytes. 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 condition). Hemophilia (an inherited bleeding disorder in which there is a lack of clotting factors). 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 Myeloma. 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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