AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to Blood and Lymphatic Systems
Instructor
Serial/Semester
Location
Start/Finish Time
Date
LESSON OBJECTIVE
Performance: To gain an understanding of the blood and lymphatic systems.
Conditions:
The student will be presented a powerpoint presentation by the instructor and will have
all necessary references made available to him/her.
Standard:
1.
Given a patient with a disorder of the blood or lymphatic system, provide safe and
effective care IAW Christensen
TEACHING POINTS
1. Define key terms related to the blood and
lymphatic system
2. Review the normal function of the blood and
lymphatic systems
3. Identify laboratory and diagnostic tests used
in the diagnosis of blood and lymphatic
disorders
4. Determine appropriate nursing interventions
and patient teaching related to diagnostic
testing for blood and lymphatic disorders
5. Discuss the nursing process for a patient with
a blood or lymphatic system disorder
6.
7.
8
9.
10.
INSTRUCTIONAL STRATEGY
Interactive Lecture
Method:
Instructor
Media:
Classroom
Environment:
OTHER LESSON SPECIFICATIONS
Knowledge Lesson
Type of Lesson:
1/50
Ratio:
Resources:
.
End of Lesson Test: None
Minutes
Instructional Time: 228
Reference(s):
Adult Health Nursing, 4th Edition
Introductory Medical-Surgical Nursing, 8th Edition
513-521
LESSON PLAN APPROVAL
Signature of Standards Officer
Date
AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to Blood and Lymphatic Systems
INTRODUCTION
Allocated Time:
Review:
5 Minutes
You have had previous anatomy and physiology lectures in your combat medic
training, this lecture will build upon prior instruction.
Objective:
To discuss/describe topics related to the nursing process.
Importance:
Nurses work in various health care settings so it is important to gain an
understanding of this subject as it will apply to your clinical practice.
Fit:
The circulatory system is an organ system that passes nutrients (such as amino
acids, electrolytes and lymph), gases, hormones, blood cells, etc. to and from
cells in the body to help fight diseases, stabilize body temperature and pH, and
to maintain homeostasis. This system may be seen strictly as a blood
distribution network, but some consider the circulatory system as composed of
the cardiovascular system, which distributes blood, and the lymphatic system,
which distributes lymph. While humans, as well as other vertebrates, have a
closed cardiovascular system (meaning that the blood never leaves the network
of arteries, veins and capillaries), some invertebrate groups have an open
cardiovascular system. The most primitive animal phyla lack circulatory
systems. The lymphatic system, on the other hand, is an open system. Two
types of fluids move through the circulatory system: blood and lymph. The
blood, heart, and blood vessels form the cardiovascular system. The lymph,
lymph nodes, and lymph vessels form the lymphatic system. The
cardiovascular system and the lymphatic system collectively make up the
circulatory system.
Approach:
You will be presented the subject in lecture format and will be tested using a
written exam at a later date.
Control Statement:
If you have any questions during the lesson please feel free to ask.
BODY
1. Teaching Point: Define key terms related to the blood and lymphatic system
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
1. Key terms
a. Anemia - condition characterized by reduction of red blood cells, a deficiency of
hemoglobin and hematocrit in the blood, or an increased destruction of red blood cells.
Reduction leads to decreased O2 carrying capacity
b. Aplasia - (Aplastic Anemia) failure of the normal process of cell generation and
development
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to Blood and Lymphatic Systems
c. Disseminated Intravascular Coagulation - grave coagulopathy resulting from the
overstimulation of the normal clotting and clot dissolution processes in response to
disease or injury, including septicemia, obstetrical complication, malignancies, tissue
trauma, transfusion reaction, burns, shock, and snake bites
d. Erythrocytosis - abnormal increase in the number of circulating red blood cells and also
increased production of granulocytes and platelets
e. Hemarthrosis - bleeding into a joint space
f. Hemophilia A - absence of Antihemophilic factor VIII; essential for conversion of
prothrombin to thrombin through intrinsic clotting pathway
g. Heterozygous - having two different genes
h. Homozygous - having two identical genes inherited from each parent for a given
hereditary characteristic
i. Idiopathic - cause unknown
j. Leukemia - malignant disorder of the hematopoietic system in which an excess of
leukocytes accumulates in the bone marrow and lymph nodes
k. Lymphangitis - inflammation of one or more lymphatic vessels or channels that usually
results from an acute streptococcal or staphylococcal infection in an extremity
l. Lymphedema - primary or secondary disorder characterized by the accumulation of
lymph fluid in soft tissue, resulting in edema
m. Multiple Myeloma - malignant neoplastic immunodeficiency disease of the bone marrow
n. Myeloproliferative - excessive bone marrow production of myeloid cells (RBC, platelets,
granulocytes and agranulocytes). Does not include B and T cells
o. Pancytopenic - reduction or absence of all three major blood elements (red blood cells,
white blood cells and platelets) from the bone marrow
p. Pernicious - a condition capable of causing great injury, destruction, or death unless
treated
q. Reed-Sternberg cell - atypical macrophages (phagocytes living in tissue) consisting of
large, abnormal, multinucleated cells in the lymphatic system found in Hodgkin's disease.
These cells increase in number and replace normal cells
r. Thrombocytopenia - platelet count below 100,000/mm3
Knowledge Lesson:
Question:
Answer:
Skill Lesson:
Check on Learning
In a knowledge lesson, pose questions to the class.
A disorder characterized by RBC and hemoglobin and hematocrit levels below
normal range is known as?
Anemia
In a skill lesson, provide practice and watch students perform a skill.
2. Teaching Point: Review the normal function of the blood and lymphatic systems
Minutes
Allocated Time:
Introduction:
Learner Participation:
2
AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to Blood and Lymphatic Systems
Knowledge Lesson
Skill Lesson
Learning Support:
Please follow along with your hand outs and take notes.
Powerpoint presentation with associated handouts.
1. Normal function
a. Transports oxygen and nutrients to cells and waste products away from cells
b. Regulates the acid-base balance
c. Protects the body against infection and prevents blood loss
2. Characteristics
a. Normal volume is approximately 5 to 6 liters
b. Plasma - light yellow fluid that comprises 55% of blood
c. Contains 90% water and 10% proteins
d. Includes proteins, clotting factors, pigments, vitamins, glucose, electrolytes, lipids,
minerals, enzymes and hormones
3. Cells
a. Erythrocytes (RBC)
i. Contains cytoplasm and hemoglobin
ii. Transports oxygen and carbon dioxide
iii. Produced in the red bone marrow
iv. Proper production depends on healthy bone marrow and adequate vitamins and
minerals in the body
v. Production is stimulated by a feedback mechanism noting decreased oxygenation
b. Leukocytes
i. Conduct body defense from foreign invaders
ii. Produced in the bone marrow
iii. Two broad categories: granulocytes and agranulocytes
iv. Granulocytes - phagocytes - cells that surround and "eat" invaders
1. Neutrophils - make up 70% of WBC. The initial responder to any
invasion
2. Basophils - key in the inflammatory response
3. Eosinophils - key in allergic responses
v. Agranulocytes
1. Monocytes - phagocytes that circulate in the blood stream and work
similarly to neutrophils
2. Macrophages - mature monocytes that live in tissue (i.e., alveolar
macrophages in the lung and Kupffer cells in the liver)
3. Lymphocytes - T cells and B cells that directly kill invaders and produce
antibodies, respectively. (Lymphoid cells)
vi. Platelets
1. Produced in the red bone marrow
2. Assist in clotting formation
c. Lymphatic system
i. Subdivision of the cardiovascular system
ii. Consists of lymphatic vessels, lymph fluid and lymph tissue
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to Blood and Lymphatic Systems
iii. Functions
1. Maintain fluid balance
2. Produce (mature) lymphocytes
3. WBC produced in the bone marrow but matured in lymph tissue
4. Absorption and transportation of lipids from the intestine to the stream
iv. Lymph fluid
1. Excess fluid and protein that remain in tissues not transported by blood
2. Without lymph drainage, volume overload in tissues would occur
3. Lymph fluid is transported back to the blood stream through the
lymphatic vessels
v. Lymphatic vessels
1. Vessels that connect lymph nodes and collect lymph fluid
2. Connected to the circulatory system for return of lymph fluid to blood
vi. Lymph tissue
1. Lymph nodes
2. Tonsils
3. Spleen
4. Thymus
vii. Lymph nodes – function
1. Filter impurities from the lymph
2. Produce lymphocytes
d. Tonsils
i. Protect the body against invasion
ii. Produce lymphocytes and antibodies
iii. Trap bacteria and may become enlarged
e. Spleen
i. Located in left upper quadrant,
ii. just below the diaphragm
iii. Highly vascular
iv. Functions
1. Serves as a reservoir for blood. Stores approximately 500ml
2. Matures lymphocytes, monocytes and plasma cells (B cells)
3. Destroys worn out RBCs
4. Removes bacteria by phagocytosis (macrophages)
5. Produce RBCs before birth
f. Thymus
i. Located between the lungs in the mediastinum
ii. Functions in utero and for several months after birth to develop the immune
system
iii. Matures T cells
iv. Atrophies at puberty
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to Blood and Lymphatic Systems
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
What WBC is the initial responder to any invasion?
Neutrophils
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
3. Teaching Point: Identify laboratory and diagnostic tests used in the diagnosis of blood and lymphatic
disorders
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
1. Lab diagnostic tests
i. Complete Blood Count (CBC)
ii. Red Cell Indices
iii. Differential Count
iv. Peripheral Smear
v. Schilling Test & Anemia Profile
vi. Gastric Analysis
vii. Lymphangiography
viii. Bone Marrow Aspiration or Biopsy
b. Complete blood count (CBC)
i. Detects many disorders of the hematological system & provides data for the
diagnosis and evaluation of disorders in other body systems
ii. Includes red and white cell counts, hematocrit and hemoglobin level, erythrocyte
(RBC) indices, differential white cell count, and examination of the peripheral
blood cells
iii. Red cell indices
1. Measurements of the size and hemoglobin content of erythrocytes.
These include:
2. Mean corpuscular volume (MCV)
3. Mean corpuscular hemoglobin (MCH)
4. Mean corpuscular hemoglobin concentration (MCHC)
c. Mean corpuscular volume
i. The average volume or size of a single RBC
d. Mean corpuscular hemoglobin
i. The average amount of (weight) hemoglobin within an RBC
e. Mean corpuscular hemoglobin concentration
i. The average concentration or the percentage of hemoglobin within an RBC.
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to Blood and Lymphatic Systems
f.
Differential count
i. Actual cell count of leukocytes
ii. Identifies the number and percentage of individual SBC types
iii. Provides the physician with diagnostic information
g. Peripheral smear
i. Often accompanies the differential WBC count and permits examination of the
size, shape, and structure of individual RBCs, WBCs and platelets
ii. Most informative of all hematologic tests
h. Schilling test and megaloblastic anemia profile
i. Laboratory test that identifies the etiology of pernicious anemia
ii. May involve multiple stages of testing to determine whether B12 intake is low, or
B12 absorption is altered
iii. Absorption in the stomach is dependent on intrinsic factor, which is produced by
the gastric mucosa.
iv. Patients with large resections of the stomach may not produce adequate intrinsic
factor to prevent pernicious anemia
v. Measures the excretion of Vitamin B12 after parenteral administration
vi. Normal findings are excretion of 8% to 40% of radioactive vitamin B12 within
24 hours
i. Gastric analysis
i. Evaluates presence of intrinsic factor
ii. In pernicious anemia the gastric secretions are minimal and the pH remains
elevated, after injection of histamine
j. Lymphangiography
i. A radiological examination used to detect metastatic involvement of the lymph
nodes
ii. Contrast medium is injected into a lymphatic vessel of the foot or hand, followed
by radiological visualization of the lymphatic system
k. Bone marrow biopsy or aspiration
i. Bone marrow aspiration or biopsy is specific for establishing the diagnosis and
for treatment response.
ii. Iliac crest most commonly used, although the sternum can also be used
iii. Bone marrow is soft and semi-fluid and can therefore be removed by aspiration
through a needle
iv. Bone marrow aspiration is most commonly performed in persons with marked
anemia, neutropenia, acute leukemia, and thrombocytopenia
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to Blood and Lymphatic Systems
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
What is the most common site for bone marrow aspiration or biopsy?
Iliac Crest
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
4. Teaching Point: Determine appropriate nursing interventions and patient teaching related to
diagnostic testing for blood and lymphatic disorders
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
1. Nursing interventions
a. Before any diagnostic testing, the nurse:
b. Determines the client's knowledge of the procedure
c. Reviews the test procedure with the client
d. Teaches/assesses understanding of tasks patient must participate in before and during
procedure and discomfort that might be experienced
e. Maintains standard precautions
f. Before any diagnostic testing, the nurse:
g. Inspects specimen for correct labeling and immediately forwards to the lab
h. When tests involve a puncture, assesses the area for excessive bleeding and applies
pressure or pressure dressing to the site as needed
i. Before any diagnostic testing, the nurse:
i. Monitors vital signs, as necessary, to assess the client's recovery
ii. Notifies physician regarding adverse responses
iii. Analyzes and reports test results promptly
j. Lymph node biopsy
i. Teach/assess understanding of procedure. Patient may receive conscious
sedation for this procedure
ii. Witness the client's signature on the consent form
k. Lymphangiography
i. Teach/assess understanding of procedure. Patient may receive conscious
sedation for this procedure. Procedure will be performed in Radiology/Special
procedures
ii. Witness the client's signature on the consent form
iii. ontrast will be injected into the lymph system to identify any blockage
iv. Renal function must be assessed prior to procedure, as contrast may severely
damage poorly functioning kidneys
v. Allergies must be verified with patient and chart to rule out iodine sensitivity
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to Blood and Lymphatic Systems
l.
Ultrasonography, CT, and MRI
i. Teach/assess understanding of procedure. Patient may receive conscious
sedation for this procedure
ii. Performed to visualize size, structure and flow through the spleen or lymph
nodes
iii. No special preparation is required
m. Bone scan
i. Teach/assess understanding of procedure
ii. Performed to identify bone metastasis
iii. Radioactive isotope injected into vein and body scans performed in Nuclear
Medicine
iv. No special preparation required
n. Bone marrow aspiration
i. Teach/assess understanding of the plan and approximate time for the bone
marrow aspiration. Allow patient time for questions and to verbalize
fears/concerns related to procedure
ii. Witness the client's signature on a consent form
iii. Verify history of allergies with the patient and medical record, especially to local
anesthetics or latex
iv. Obtain a sterile bone marrow aspiration tray and add the type and strength of
local anesthetic according to the physician's orders
v. Identify the appropriate site for sample and position the client on his or her back
or side to facilitate access to the aspiration site
vi. Suggest distraction techniques to avoid focusing on the pressure or discomfort
associated with puncturing the bone
vii. Label the specimen and ensure its delivery to the laboratory
viii. Maintain standard precautions
ix. Limit the client's activity for approximately 30 minutes after the procedure
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
What must be checked before performing lymphangiography?
Renal function
Allergies
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
5. Teaching Point: Discuss the nursing process for a patient with a blood or lymphatic system disorder
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
8
AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to Blood and Lymphatic Systems
Learning Support:
Powerpoint presentation with associated handouts.
1. The nursing process
a. Anxiety, related to diagnosis (actual/potential) or diagnostic test
b. Patient verbalizes understanding of need for procedure and has a manageable anxiety
level
c. Anxiety nursing interventions
i. Provide privacy, reassurance and information to all patients
ii. Allow patient to verbalize fears/concerns regarding procedure and prognosis
iii. Provide additional education, as needed
d. Knowledge deficit related to test, patient preparation and recovery
e. Patient verbalizes understanding of procedure, preparation and expected recovery
f. Knowledge deficit nursing interventions
i. Provide patient education regarding specimen collection
ii. Explain procedures and provide written instructions to the patient for procedure
preparation
Knowledge Lesson:
Question:
Answer:
Skill Lesson:
Check on Learning
In a knowledge lesson, pose questions to the class.
Name a nursing diagnosis appropriate for the patient with a disorder of the
blood or lymphatic system.
Anxiety or Knowledge deficit
In a skill lesson, provide practice and watch students perform a skill.
END OF LESSON TEST
Allocated Time:
Instructions:
Test Questions or
Performance
Expected:
Test Key:
0 Minutes
You will be tested on this subject at a later date.
You will be expected to review and study the material taught in this session in
order to pass the associated written test. If you have difficulty with the material
please see me so we can review together.
None.
CONCLUSION
Allocated Time:
Summary:
5 Minutes
Review and re-emphasize the difficult Teaching Points below.
1.
2.
3.
4.
9
Define key terms related to the blood and lymphatic system
Review the normal function of the blood and lymphatic systems
Identify laboratory and diagnostic tests used in the diagnosis of blood
and lymphatic disorders
Determine appropriate nursing interventions and patient teaching
related to diagnostic testing for blood and lymphatic disorders
AFAMS Master Lesson Plan (MLP)
Nursing Program
Introduction to Blood and Lymphatic Systems
5.
Discuss the nursing process for a patient with a blood or lymphatic
system disorder
6.
7.
8
9.
10.
Closing Statement:
Nurses work in various health care settings so it is important to gain an
understanding of this subject as it will apply to your clinical practice.
Re-motivating
Statement:
The circulatory system is an organ system that passes nutrients (such as amino
acids, electrolytes and lymph), gases, hormones, blood cells, etc. to and from
cells in the body to help fight diseases, stabilize body temperature and pH, and
to maintain homeostasis. This system may be seen strictly as a blood
distribution network, but some consider the circulatory system as composed of
the cardiovascular system, which distributes blood, and the lymphatic system,
which distributes lymph. While humans, as well as other vertebrates, have a
closed cardiovascular system (meaning that the blood never leaves the network
of arteries, veins and capillaries), some invertebrate groups have an open
cardiovascular system. The most primitive animal phyla lack circulatory
systems. The lymphatic system, on the other hand, is an open system. Two
types of fluids move through the circulatory system: blood and lymph. The
blood, heart, and blood vessels form the cardiovascular system. The lymph,
lymph nodes, and lymph vessels form the lymphatic system. The
cardiovascular system and the lymphatic system collectively make up the
circulatory system.
10