By Diana Blum RN MSN
Metropolitan Community College
Oxygenation
Hemostasis (control of bleeding)
If injury the vessel constricts
Platelets adheres to injured vessel
Them the coagulation cascade begins
 Diagnosis of problems can be difficult
Bone Marrow:
Liver: manufactures clotting factors
Spleen: removes old RBCs from circulation
Blood: transports oxygen from lungs.
Maintains hemostasis
About 6 liters in body
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RBC: made in bone marrow
◦ Transfers oxygen to from lungs to tissues
◦ Hemoglobin makes the transfer of oxygen and
carbon dioxide possible
◦ 120 day life span
◦ Iron and heme are recycled
◦ Have proteins called antigens
 2 major parts are A and B and O
 Rh + and Rh-
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PLATELETS: made in bone marrow
 Numbered I to XIII
 Form stable fiber matrix over wound
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Plasma: clear straw colored fluid that carries
red blood cells, platelets, and clotting factors
◦ Primarily water
◦ Other components are plasma proteins, albumin,
and globulins
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The bone marrow becomes less productive
Hemotologic function is not affected unless
trauma, a chronic illness, or treatment for
cancer
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Health Hx: Chief complaint, Hx of present illness
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Past Medical Hx: Ca, HIV, liver dx, kidney dx, malabsorption dx,
transfusions, clots
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Family Hx: hemophilia, sickle cell dx
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Review System: ask about change in color, skin dryness,
pruritus(itching), vertigo, confusion, pain, headaches (duration, location,
intensity), mental status changes, bleeding, heart palpitations
Functional assessment: occupation, hobbies, self concept, activity,
exercise, sleep and rest, nutrition, relationships, stress, health
perception
See page 607
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Vs
Ht
Wt
Look for cracking of mouth
Monitor for SOB
Look for tachycardia, tachypnea, hypotension
Look for orthostatic changes, dehydration
Look for pale skin or jaundice
Look for bruising (ecchymosis)
Look for purpura: larger than petechiae
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Look for petechiae
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◦ Can be from low platelet count
◦ From large blood vessels breaking
◦ (confused with a rash)
◦ Reddish purple in nature
◦ Severe coughing can cause
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Blood cell count
Hemoglobin
Hematocrit-approximately 3 times the
hemoglobin
Normal platelet ct is
PT and PTT measure bleeding time
Blood typing
To prepare the client tell them that they will
feel a small prick
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Bone marrow Bx: measures how it is making
blood
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Explain the purpose and procedure
Obtain consent
No fasting is necessary
Procedure takes about 30 minutes
Transfusions see page 612-615
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Minimize the # of invasive procedure
Avoid prolonged tourniquet use
Avoid IM injections
Instruct the client to use soft bristled tooth
brush
No strait edge razor shaving only use electric
razor
Avoid NSAIDS
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PRBCs: 250-300ml/unit infuse over 2-4
hours
Platelets: 80-60ml/pack: usually 4-6 packs
are pooled for transfusion infuse as quickly
as the pt tolerates
FFP: 180-270ml/unit infuse in less than 4
hours
Cryoprecipitate:10-15ml/bag; usually 10
bags are pooled for transfusion infuse in less
than 4 hours (contains factor 1 and 8)
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Universal donor=
◦ Does not contain A, B, or Rh antigens
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Universal recipients=
◦ Blood contains A, B, and RH antigens
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Usually blood banks exactly match the pt
blood
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Pt needs 18 or 20 gauge IV needle so cells are not
lysed (destroyed)
Prior to administration, blood needs to be checked
by 2 licensed nurses. Check the expiration date,
name, medical record number, type of blood, blood
band id, pt birthday
◦ Check vitals prior to administration
**blood must be initiated with in 30 minutes of
arrival from lab to floor
Use blood tubing for administration
Monitor for blood reactions
Monitor vitals continuously during administration
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Hemolytic: fever, chills, nausea, dyspnea, chest pain, back pain, hypotension
◦ Antigen/antibody rx to transfusion
◦ Happens shortly after initiation
◦ Tx: stop the transfusion, call md, supportive therapy to maintain HR and
BP
Anaphylactic: urticartia, wheezing, dyspnea, hypotension
◦ Type 1 hypersensitivity rx to plasma proteins
◦ Occurs within 30 minutes of initiation
◦ Tx: stop transfusion, call md, be ready for epi and steroids
Febrile: fever, chills
◦ Recipients antibodies rx to donor leukocyte
◦ Occurs within 30-90minutes of initiation
◦ Tx: stop infusion, call md
Circulatory overload: cough, frothy sputum, cyanosis, decreased BP
◦ cardio system is unable to manage the additional fluid load
◦ Occurs anytime during transfusion and up to several hours after completion
◦ Tx: stop infusion, call for help, be prepared for code, be prepared to administer oxygen and
Lasix
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Start IV of NS using at least 24 gauge needle
◦ Platelets are smaller so a smaller needle can be
used
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Check just like you check blood
Prior to administration check vs
Continue to check vs during administration
Run platelets through blood tubing with a
filter
Infuse as fast as the pt can tolerate
Monitor for rx
 See page 614
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Naturally occuring hormones that stimulate
bone marrow to produce more blood cells
Ferrous sulfate: iron replacement
Iron dextran: iron replacement
Vitamin B12: Vitamin B12 replacement
Hydroxyurea: prevention of sickle cell crisis
Epogen: stimulates the bone marrow to
produce more RBCs
◦ Used frequently with hemodialysis
◦ Used for anemia secondary to HIV or cancer
See page 614
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Too many RBCs produced
◦ Blood more viscous
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s/s: headache, dizziness, ringing in the ears,
blurred vision, ruddy complexion
Tx:
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Complete failure of the bone marrow
Low RBC count
Low WBC
Low Platelet cts
S/S: pallor, fatigue, tachycardia, sob,
hypotension, prolonged/spontaneous bleed,
frequent infections
Tx: transfusion of RBC and Platelet,
antibiotics, corticosteroids, bone marrow
transplant, ICU setting
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Enough RBCs made but they are destroyed
once they are released into circulation
Causes: infection, drug reaction, cancer
s/s: pallor, fatigue, tachycardia, sob,
hypotension, jaundice, high bilirubin levels
Postive direct coombs antiglobulin test
Tx: blood transfusions, corticosteroids
Recovery in few days to weeks
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Low RBC
Low HGB andHCT
Low serum Iron level
Low ferritin level
High TIBC level
Results from diet low in iron
Results from body not absorbing enough iron from
GI tract
◦ Not enough hemoglobin made as result
s/s: fatigue, pallor, orthostatic changes (in severe
cases)
Tx: iron supplements, iron rich foods
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Pt does not absorb vitamin B12 from stomach
Pt may lack intrinsic factor-essential for b12
absorption
Assess hx: gastrectomy,
s/s: weakness, sore tongue, numbness of
hand and feet
Tx: B12 injections monthly
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RBCs normally disc shaped
In sickle cell they are sickle shaped
Easily rupture
Obstruct blood flow
Genetic in nature
Most common in African Americans
Sickle cell is recessive (inherit from mom and
dad)
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Too few platelets
◦ Causes: cancer treatment
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Too many platelets being destroyed
◦ Causes: idiopathic thrombocytopenic purpura,
thrombic thrombocytopenic purpura (chptr 32)
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s/s: petechiae, purpura, gingival bleed,
epistaxis, prolonged bleeding
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Genetic
Lack of blood clotting factor
1-2 cases per 20,000 persons
Types
◦ A: factor VIII is missing-higher incidence
◦ B: factor IX is missing
Trait is carried on x chromosome
Rare for women to have
s/s: uncontrolled bleed especially in joints, skin, GI
tract
Tx: no cure. Transfusions, pain treatment (IV
morphine is common)..monitor for addiction to
opiods.
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Risk for injury r/t bleed. Goal: cessation of bleeding aeb no
visual signs of bleeding and stable vs
Acute pain r/t bleeding into closed spaces(creating pressure
on nerves. Goal: pain relief aeb: patient states pain is
relieved and appears to be in relaxed manner.
Ineffective therapeutic regimen management r/t lack of
knowledge about dx process and self care. Goal: effective
management of condition aeb patient accurately describes
condition and demonstrates self care measures.
THE END