Handout 4: Hematologic System & Lymphatic System
HEMATOLOGIC SYSTEM & LYMPHATIC / IMMUNE SYSTEM
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List the components of the hematologic system and describe their role in oxygenation and hemostasis.
Describe tests and procedures used to diagnose disorders of the hematologic system and nursing considerations
for each.
Describe the pathophysiology, signs and symptoms and treatment for patients with disorders of the hematologic
system.
Discuss the differences in pathophysiology of iron deficiency anemia, pernicious anemia and sickle cell
anemia. Explain the etiology, signs and symptoms, treatment and nursing interventions
Identify the organs involved in immunity
Describe the difference between innate and acquired immunity.
Describe the process of antigen-antibody interactions.
Differentiate between B cells and T cells and their roles in response to antigens.
Describe the pathophysiology, signs and symptoms, and treatments for disorders of the immune system
including HIV/AIDS.
Text: Chapters 19-20; 11 pages 249-260
I.
Structure and Function
A. Hematologic
1.Bone Marrow
a. Location: ______________________ of bone
b. Function: ________, __________ & ______________ production
2.Liver
a. Manufacture _________________ factors
b. Filter _________ and damaged ____________ from circulation
3.Spleen
a. Works with the ___________ to remove old ___________ from circulation
b. Stores _________________________________________
4.Blood
a. Function: ___________________________
1) _________________
2) _________________
To cells / _________________
3) Essential Substances
4) ________________ products
______________ from cells
b. Blood Components
1) Plasma
a)
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b)
Contains: ________________________________
i.
Protein formed in: ______________________
2) Red Blood Cells- AKA: __________________________
a)
Function: Carry ____________________ to the body
b)
Where formed: ___________________ = ______________
Tissue ____________  Kidney  ______________ 
i.
bone _________________  _____ RBC production
c)
Contains: _____________________________
i.
Function: Carry _________________________
ii.
Main ingredient: _________________________
d)
Hemolysis: __________________________
i.
Life span of a RBC _________________________
a. Liver: _____________________ blood
b. Iron: _______________& ______________
c. Heme  _____________________ 
____________  ____________  _________
3) Platelets- AKA: ________________________________
a)
Function: Blood ___________________________
b)
Storage: _________________________________
c)
Hemostasis: Blood ___________________ process
i.
Damage  Vessel ______________
Vaso___________________  ____ blood flow
ii.
Formation of the __________________ plug:
iii.
____ formation: ________cements components together
iv.
____ retraction: _____________ contract  __________
a. Release _____________ factors  tissue ______
v.
Clot ____________________: fibrinolysis ________ the
clot after tissue is ________________________
Small Group Questions
1. What are the primary organs of the hematologic system?
2. What is the primary function of the above organs, in relationship to the hematologic system?
3. What is erythropoiesis and describe the process of Erythropoiesis?
4. What is hemoglobin and what is its primary function?
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5. Define hemolysis and describe the process.
6. What is Bilirubin?
7. What is hemostasis? What blood component is primarily responsible for hemostasis
B. Immunologic / Immune system
1.White Blood Cells – AKA: ___________________________
a. Leukocytosis: ___________ WBC count
b. Leukopenia: ___________ WBC count
c. Can ________________ out of the blood vessel  other ________
d. Neutrophils:
1) Function / Action: _______________________
2) Life span: _____________________________
e. Eosinophils: Function: ________________ reactions
f. Basophils: Function: _________________
g. Monocytes  ____________ Function: __________________cells
h. Lymphocytes:
1) __________________ immune response
a)
_______ lymphocytes
i.
_______________ cells  ________
ii.
_______________ cells  ________
b)
_______ lymphocytes
i.
T-_____________ cells  ___________ other
components of the immune system
ii.
T-_____________ cells  directly destroy
2.Bone marrow: Function: ___________ production
3.Thymus
a. Function: Incubator / specialization of __________________
b. Not needed after ______________________
4.Lymph
a. Lymph fluid: ________________ +______________________
b. Lymph nodes:
1) Housing for ____________________________
2) ____________________ microorganism
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5.Liver
a. __________________ Blood & Stores ______________________
6.Spleen
a. __________________ Blood & Stores ______________________
C. Natural & Acquired Immunity
1.Natural Immunity: A persons ___________________ to foreign substances d/t
a. ___________________________________________________health status
2.Natural acquired immunity: Resistance acquired by developing _______________
3.Artificially acquired immunity: Resistance developed through ________________
Small Group Questions
1. What are the 5 different leukocytes and what is their primary function (individually)
2. Describe how B & T cells function
3. Differentiate between natural acquired and artificially acquired immunity.
4. What is the primary function of the following organs in relationship to the immune system: bone
marrow, thymus, lymph system, liver, spleen
5. Why does a person become jaundice?
II.
Assessment
A. Health History
1._____________ level
2._____________
3.Diet
4.Medications
5.Tobacco, ____________________, drugs
B. Physical Exam
1.Skin & mucus membranes
a. Color
1) ___________________ = ________________
2) ___________________ = ______ O2 to tissue _________
3) ___________________ = _________ Bilirubin
4) Erythemia = ___________________
5) Petechiae = small red ____________ caused by minor ____________
 _________________count
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6) Ecchymosis = _______________________
b. ___________________
c. ___________________ refill
d. ___________________
2.Palpate _________________________________
3.Palpate ________________________ for tenderness
4.Vital Signs
a. Temp
1) ______ = Infection ________________________
2) ______ = Infection _____________________ or _____________
b. Apical vs ___________ pulse
C. Dx tests
1.CBC = _____________________ blood count
2.RBC count
a. Normal:
1) Men: __________ - __________ million / mm3
2) Women: ________ - __________ million / mm3
b. Elevated:
c. Decreased:
3.Hemoglobin
a. Normal:
1) Men: __________ - __________ g/dL
2) Women: ________ - __________ g /dL
b. Elevated: _______________________________________
c. Decreased: ______________________________________
4.Hematocrit
a. Normal:
1) Men: __________ - __________ %
2) Women: ________ - __________ %
b. Elevated: _______________________________________
c. Decreased: ______________________________________
5.Prothrombin time (_____) or Protime Partial Thromboplastin time (______)
a. _________________ time
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b. Elevated = risk of _________________________________
c. Decreased = risk of __________________________________
Small Group Questions:
1. Define cyanosis; jaundice; petechiae and ecchymosis.
2. What s a normal RBC count?
3. What is a normal Hgb level?
4. What is a normal Hct level?
5. What does PT or PTT measure?
6. What can cause a client to have an elevated Hgb or a lower than normal Hct?
7. What is a client at risk for if their PT / PTT is low?
III.
Anemia
A. Definition: _____________ red blood cells
B. S&S
1._____ Oxygen Carrying capacity
2.Resp: __________ pnea, __________pnea
3.C/V: __________ cardia, Palpitations, ______________
4.Neuro: __________, fatigue, ____ concentration, __________
5.Skin: ___________________
6.M/S: Leg ______________, bone ___________, weakness
C. Blood loss anemia
1.____________________________
D. Nutritional Deficit Anemia’s
1.Iron
a. Iron is a necessary component of __________________
b. S&S: ____________: Craving ________________
2.Vitamin B12: AKA _____________________ anemia
a. S&S: _______________________________
3.Folic Acid
a. Necessary for production and ___________________of RBCs
E. Hemolytic Anemia
1.Definition: Premature ________________________ of RBCs
2.Sickle Cell
a. _______________ transmitted
b. ____________________ hemoglobin
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c. Anemia  _____ O2  RBCs ___________  RBC ________  Sickled
cells _____________  ____________ sm. Vessels  Damaged RBCs 
________________
d. S&S
1) _______________: hands & feet
2) _______________ problems
3) _______________________
4) Increased risk of _______________________ or ________
F. Aplastic Anemia:
1.________________________ does not make enough RBC
G. IDT Care:
1.DX tests
a. ______________
b. ______________ levels
2.Medications
a. ____________________, ___________________, ________________
3.Diet:
a. Iron: ________________________________________________________
b. Folic Acid: ___________________________________________________
c. B12: ________________________________________________________
4.________________ transfusions
Small Group Questions
1. What are 5 S&S of a client suffering from anemia?
2. How would a doctor diagnosis anemia?
3. What nutritional deficits can lead to anemia?
4. Describe sickle cell anemia.
5. Identify 4 nursing interventions you would implement for a patient with anemia?
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IV.
Leukemia
A. Definition
1._____________________ disorder of WBC
2.Normal RBC: WBC
___________:___________
3.In Leukemia the ratio changes: _________ WBCs
B. Pathophysiology
1.Stem cells ___________  ____________________  ______-functioning WBC 
________ bone marrow  __________ into blood  ________ out RBC & platelets
 ________________ -__________________ - __________________
C. Etiology: ________________________
D. S&S
1.Anemia
a. ___________________
b. ___________________
c. _____________ cardia
d. _____________ pnea
2.Infection
a. ______________________
b. ___________________
c. ___________________
d. ___________________
e. Septicemia
3.Bleeding / Thrombocytopenia
a. Bruising: ________________________
b. ________________________________
c. ____________ stool
d. ____________ stool
e. __________________________ emesis
E. DX
1._____________
2._____________ w/ differential
F. Tx
1.___________________________: Destroy leukemic cells
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2.___________________________: use to ________________
3.Bone marrow ___________________________
4._____________________ transplant
V.
HIV
A. Mode of transmission:
1.Direct: Person to Person: _______________________
2.Direct: blood contamination: _____________________________________
3.Mother to _________________
B. 3 stages
1.Primary infection
a. _________________
b. Sore ______________
c. General malaise / ________________
d. ______________
e. Rash
f. _______________
g. Night ______________________
h. Weight _____________________
2.Asymptomatic period
3.AIDS & opportunistic disorders
a. Respiratory: Pneumocystic carinii pneumonia
b. GI: ___________________ syndrome
c. Skin: _____________________________ sarcoma
Small Group Questions
1. Identify 3 major S&S of leukemia.
2. What lab results indicate leukemia?
3. How are HIV and AIDS related?
4. What are the three phases of HIV infection?
5. What opportunistic disorders are common with AIDS?
6. How can you protect yourself as a nurse while caring for a client with end stage HIV infection?
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Directed Reading
Chapter 19: The Hematologic and Lymphatic Systems and Assessment
1. What is the function of hemoglobin?
2. What is hemolysis? Compare it to erythropoiesis.
3. What is the primary function of platelets?
4. What is plasma? What is its primary function?
5. What are the 5 leukocytes?
6. Lymphocytes differentiate into what?
7. What will cause an elevated Hgb, Hct or RBC count?
8. What will cause a decreased Hgb, Hct or RBC count?
9. What causes a client to have an elevated PT/PTT?
10. What nursing teaching should be given to a client undergoing a bone marrow aspiration
procedure?
Chapter 20: Caring for Clients with hematologic and Lymphatic Disorders
Pgs 475 - 491 (up to Malignant Lymphoma), 497 – 500 (up to disseminated intravascular coagulation)
1. Define and explain the pathophysiology of anemia.
2. What are common nutritional anemia?
3. What are the priority nursing diagnoses for a client with acute sickle cell anemia?
4. What group of people is mostly affected by sickle cell anemia?
5. With leukemia, what part of the body is malignant and mutates (transforms)?
6. What is the usual cause of death for clients with leukemia?
7. Why are septicemia, thrombocytopenia and anemia associated with leukemia?
8. What are the two classic manifestations of thrombocytopenia?
9. What is the emergency treatment for thrombocytopenia?
10. Identify nursing interventions for a client with leukemia with a priority nursing diagnosis of
imbalanced nutrition: less than body requirements.
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