Chapter 41 Highlights
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This 6 page Study Guide was uploaded by Jess Ressler on Monday January 26, 2015. The Study Guide belongs to NRSE 3230 at Ohio University taught by Penny Roberts in Winter2015. Since its upload, it has received 87 views.
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Date Created: 01/26/15
Chapter 41 Study Guide Anatomv and phvsioloov review 1 Bone Marrow a Tissue responsible for blood formation involved in the immune response b In adults cell producing marrow can be found only in at bones sternum skull pelvic and shoulder girdles and at the ends of long bones c Marrow production slows with aging because fatty tissue slowly replaces active bone marrow Process i Bone marrow produces blood stem cells immature unspecialized cells capable of becoming any type of blood cell that the body needs ii Next committed stem cell aka precursor cell which enters one growth pathway and can then specialize into only one cell type In order for the stem cell to divide they require a speci c growth factor ie erythropoietin is made in the kidneys and is required for RBC production 2 Blood Components a Blood is composed of plasma and cells b Plasma i Part of the body39s extracellular uid ii Contains plasma which is similar to interstitial uid but contains more protein iii Three types of plasma protein albumin globulins and brinogen Albumin maintains the osmotic pressure of the blood preventing the plasma from leaking into the tissues Globulins have many functions such as transporting other substances and as antibodies protecting the body against infection Fibrinogen is an inactive protein that is activated to form brin molecules that assemble together to form mesh structures to aid in blood clotting c Blood cells include RBCs WBCs and platelets i Red blood cells erythrocytes are the largest proportion of blood cells Mature RBC39s have no nucleus and have a biconcave disk shape allowing them to change shape without breaking Norma range 4200000 to 6100000mm3 Healthy mature RBC39s have a lifespan of about 120 days The RBC39s produce hemoglobin 1 The heme part of ea Hgb molecule needs a molecule of iron in order to transport 4 molecules of oxygen 2 The globin portion of Hgb carries C02 3 The most important feature of Hgb is its ability to combine loosely with 02 in order to allow oxygen dissociation Erythropoiesis selective growth of stem cells into mature erythrocytes The kidney produces the RBC growth factor erythropoietin at the same rate as RBC destruction or loss to maintain a constant normal level of circulating RBCs Anemia is the result of any problem that reduces the function or the number of RBCs to the point that tissue oxygen needs are not completely met ii WBC39s WBCs leukocytes perform actions important for protection through in ammation and immunity iii Platelets are the third and smallest of the blood cells formed as fragments of a giant precursor cell in the bone marrow Platelets stick to injured blood vessel walls and form plugs to stop blood ow from injured site Bone marrow production of platelets is controlled by the growth factor thrombopoietin After they leave the bone marrow they are stored in the spleen and released slowly based on body s needs Lifespan of 12 weeks 3 Accessory organs of blood formation a The spleen i ii It contains three types of tissue white pulp red pulp and marginal pulp 1 White pulp is lled with WBCs especially lymphocytes and macrophages It is a major site of antibody production 2 Red pulp contains enlarged blood vessels that store RBCs and platelets 3 Marginal pulp contains the ends of many arteries and other blood vessels The spleen destroys old or imperfect RBCs breaks down the hemoglobin released from these destroyed cells stores platelets and lters antigens b The liver i ii It produces prothrombin and most of the blood clotting factors Vitamin K is an important product because it is needed to produce blood clotting factors Vll IX and X and prothrombin Large quantities of whole blood and blood cells can be stored in the liver it also stores extra iron with the protein ferritin 4 HemostasisBlood Clotting a Hemostasis is the multistep process of controlled blood clotting i When an injury occurs hemostasis begins with the formation of a platelet plug followed by a series of events ending in the formation of a brin clot ii Three sequential processes result in blood clotting platelet aggregation with formation of platelet plug the blood clotting cascade and the formation of a complete brin clot 1 Activation causes platelet membranes to become sticky allowing them to clump together However they aren39t clots and only last a few hours 2 Blood clotting is a cascade triggered by the formation of a platelet plug and then it is rapidly ampli ed The cascade works like a landslide Intrinsic factors conditions directly in the blood itself that rst activate platelets and then trigger the blood clotting cascade circulating debris prolonged venous stasis Extrinsic factors outside of the blood that can also activate platelets The most common extrinsic event is trauma that damages blood vessels and exposes the platelets to collagen activates the platelets to form a plug cascade is started sooner by extrinsic 3 The last two steps in the cascade Activation of thrombin from prothrombin Conversion by thrombin of brinogen into brin 4 Fibrin clot formation is the last phase of blood clotting Fibrinogen is converted to active brin which then links together to form brin threads These make a netlike base to form a blood clot After the mesh is formed clotting factor XIII tightens the mesh making it more dense and stable 5 AntiClotting Forces a Whenever the blood clotting cascade is started anticlotting forces are also started to limit clot formation only to damaged areas b Anticlotting forces involve two types of actions i One action ensures that activated clotting factors are present only in limited amounts ii The other action brinolysis prevents overenlargement of the brin clot Fibrinoysis limits the size of blood clots by dissolving the edges with special enzymes Plasminogen is converted to plasmin plasmin digests brin brinogen and prothrombin thus controlling the size of the brin clot 6 Hematologic Changes Associated with Aging a The older adult has a decreased blood volume with lower levels of plasma proteins b Platelet counts do not change with age c Hemoglobin levels in men and women fall after middle age 7 Assessment Methods a Patient history Consider age and gender Know that bone marrow function and immune activity decrease with age Ask about manifestations that may indicate liver problems jaundice anemia and gallstones Ask about the use of blood thinners and NSAle as they change blood clotting activity Anticoagulant drugs work by interfering with one or more steps involved in the blood clotting cascade They do not break down clots Fibrinolytic drugs aka thrombolytic drugs or quotclot bustersquot selectively break down brin threads present in formed blood clots First line therapy for small localized formed clots Platelet inhibitors prevent either platelet activation or aggregation clumping most widely used is aspirin At all ages women have lower blood cell counts than do men b Nutrition Status Diets high in fats and carbohydrates and low in protein iron and vitamins can cause many types of anemia and decrease functions of all blood cells Certain dietary habits can enhance blood clotting Diets high in vitamin K found in leafy greens may increase the rate of blood clotting c Family History and Genetic Risk Many disorders affecting blood are inherited Ask about family bleeding disorders and sickle cell trait or disease d Current Health Problems Ask about menorrhagia clots lymph node swelling excessive bruising or bleeding and assessrecord whether the patient has had shortness of breath on exertion palpitations frequent infections fevers recent weight loss headaches or paresthesias the single most common symptom of anemia is fatigue e Physical Assessment i ii iii iv V vi Vii Skin Assessment inspect the skin and mucous membranes for paor or jaundice Assess nai beds for paor or cyanosis Check the skin turgor and ask about itching because dry skin can indicate hematologic disease Head and Neck Assessment Check for paor or ulceration of the mouth mucosa Also check the tongue and see if beefy red or smooth Assess for jaundice of the sclera Respiratory Assessment When blood problems reduce oxygen delivery the lungs work harder to make adjustments that can maintain tissue perfusion Note whether the patient can complete a 10word sentence without stopping Cardiovascular Assessment When blood problems reduce oxygen delivery the heart works harder to make adjustments to maintain tissue perfusion Pulses may become weak and thready Observe for distended neck veins edema or signs of phlebitis Systolic BP tends to be lower than normal in patients with anemia and higher than normal when the patient has excessive red blood cells Kidney and Urinary Assessment The kidneys have many blood vessels and bleeding problems may cause gross or occut hematuria Musculoskeletal Assessment Rib or sterna tenderness may occur with leukemia when the bone marrow greatly overproduces cells increasing bone pressure Abdominal Assessment The normal adult spleen is usually not palpable Therefore palpate gently because an enlarged spleen may be tender and easily ruptured Also palpation of the liver can detect hepatic enlargement which often occurs with hematologic problems A common cause of anemia among older adults is a chronically bleeding GI ulcer or polyp viii CNS Assessment Vitamin BlZ de ciency impairs cerebral olfactory spinal cord and peripheral nerve function and severe chronic de ciency may cause permanent neurologic dysfunction 8 Diagnostic Assessment a Prothrombin Time measures how long blood takes to clot This test re ects the level of clotting factors II V VII and X and how well they are functioning b INR international normalized ratio measures the same process as the PT by establishing a normal mean or standard for PT The INR is calculated by dividing the patient s PT by the established standard PT c P39IT partial thromboplastin time assesses the intrinsic clotting cascade and the action of factors II V VIII IX XI and XII d Platelet aggregation tested by mixing the patient39s plasma with an agonist substance that should cause clumping
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