Term
Hematology Medical Surgical Nursing I Assessment & Diagnostic Tests |
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Medical Surgical Nursing I Assessment & Diagnostic Tests |
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Assessment History Symptoms |
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Symptoms –Many are nonspecific and common to many diseases –may be as a result of disease of another body system affecting the hematopoietic system |
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Fever –common with lymphoma, Hodgkin’s disease, leukemia Night sweats –lymphoma and leukemia |
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Family history –hemophilia, sickle cell anemia, etc Drugs and chemicals –may induce or potentiate hematologic disease –chemotherapy, ASA & Ibuprofen –prolong bleeding time, antibiotics, etc |
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Bleeding disorders –Petechiae –Ecchymosis –Purpura Pernicious anemia, hemolytic disease, liver dysfunction –Jaundice –sclera |
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Pallor –(careful patient may be pale) –look at conjunctiva –Dry skin, dry hair, brittle nails –iron deficiency anemia Ruddy complexion -polycythemia Pruritus –Especially palms of the hands –Common with Polycythemia & Hodgkins |
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Oral mucosa –pallor, bleeding tendency, ulceration Smooth tongue –pernicious anemia & nutritional deficiency Neck –lymph node enlargement Epistaxis –bleeding disorders Confusion –pernicious anemia, hypoxia with severe anemia Decreased LOC & confusion –bleeding disorder |
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Tenderness –sternum –indication of bone pain with leukemia, multiple myeloma Breath sounds –crackles? Rales? –Pneumonia-common with leukemia Tachypnea, tachycardia -anemia |
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Anorexia, pica –iron deficiency anemia Spleenomegaly –luekemia, hemolytic diseases Hepatomegaly –leukemia, hemolytic diseases Hematuria –bleeding disorders |
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Joint pain, deformities –bleeding disorders Pathologic fractures –myeloma Uncoordinated –pernicious anemia Numbness & tingling –pernicious anemia |
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CBC –See Diagnostic Blood Study Sheet CBC includes –WBC •Neutrophils,baso,eos,etc. –RBC •MCV, MCH, MCHC, etc. –HGB/HCT –Platelets |
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Diagnostic Tests Other Measures |
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Mean corpuscular volume (MCV) –Measures the average size or volume of RBC –Normocytic, microcytic, marcrocytic Mean corpuscular hemoglobin (MCH) –Measures the hgb content within RBC of average size –Low with severely anemic patients Mean corpuscular hemoglobin concentration (MCHC) –Measures the average hgb concentration within 100 ml of packed RBC (hgb & hct) –Normochromic, hypochromic |
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Diagnostic Tests Reticulocyte Count |
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Reticulocyte Count (baby RBC) –Reflection of RBC production •Early anemia the reticulocytes may be increased before the patient has an actual total RBC decrease |
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Diagnostic Tests Bone Marrow Biopsy |
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Bone Marrow Biopsy –Aspiration of bone marrow –Provide cytology exam of cells –Multiple myeloma, chronic or acute leukemias, metastatic cancer, etc |
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Diagnostic Tests Bone Marrow Biopsy Procedure |
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Bone Marrow Biopsy –Procedure •Skin prepped & anesthetized •Needle inserted into bone marrow & contents aspirated –Nursing Care •Help relieve anxiety –lay still •Informed consent •Comfortable position & pain management •Monitor puncture site for bleeding |
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Diagnostic Tests Schilling Test |
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Schilling Test –Evaluates vitamin B12 absorption –Normally (in GI tract) vitamin B12 combines with the intrinsic factor and is absorbed in the distal portion of the ileum –Intrinsic factor produced by the parietal cells in the gastric mucosa –Pernicious anemia develops if •Decreased intrinsic factor •Malaborption of vitamin B12 |
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Diagnostic Tests -Schilling Test |
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Definition
Procedure –Patient kept NPO for 8 –12 hours –Radioactive B12 is administered po then IM non-radioactive B12 is given to saturate the tissue-binding sites –24 hour urine collection –Normal absorption the ileum absorbs more vitamin B12 than the body needs and excretes excess in the urine –Impaired absorption of vitamin B12 –little or no vitamin B12 is excreted in the urine |
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Diagnostic Tests-Hgb Electrophoresis |
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Definition
22Diagnostic Tests-Hgb Electrophoresis Hemoglobin Electrophoresis –Separates the blood specimen into the various types of Hgb present •Hemoglobin A –Normal •Hemoglobin S –Sickle cell anemia •Hemoglobin A2 –Thalassemia |
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Diagnostic Tests-Iron Iron metabolism –67% of total body iron is bound to heme in erythrocytes and muscle cells –30% stored bound to ferritin –3% lost daily in urine, sweat, bile, & epithelial cells |
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Diagnostic Tests-Iron Iron metabolism – |
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Diagnostic Tests-Iron Iron metabolism –Most iron is absorbed from duodenum –After absorbed iron combines with transferrin for transport to blood plasma –Iron combines with ferritin to be stored –Excess iron is mostly stored in the liver |
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Diagnostic Tests-Iron Iron Studies – |
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Diagnostic Tests-Iron Iron Studies –Total Iron –measures the amount of iron in serum –Total iron binding capacity –measures the amount of additional iron transferrin can bind •When serum iron , TIBC -suggest need for iron replacement •When serum iron , TIBC –Ferritin •Measurement as the body’s iron stores are depleted |
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26Diagnostic Tests-Coomb’s Direct Coomb’s –Detects antibodies attached to antigen on RBC Indirect Coomb’s –Detects free antibodies in the client’s serum & identifies certain red blood cell antigens Tests for hemolytic disease of newborn, transfusion reaction, RBC sensitization caused by drugs, hemolytic anemia, etc |
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Diagnostic Tests-Clotting Prothrombin Time (Pro Time, PT) |
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27Diagnostic Tests-Clotting Prothrombin Time (Pro Time, PT) –Measures rapidity of blood clotting by analysis of 5 plasma coagulation factors –Monitors Coumadin therapy Internationalized Normalized Ratio (INR) –Provides standard measurement of the response of oral anticoagulant therapy –Therapeutic range generally between 2.0 to 3.0 –Prolonged with vitamin K deficiency, liver disease, poor fat absorption, etc |
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Diagnostic Tests-Clotting |
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28Diagnostic Tests-Clotting Activated Partial Thromboplastin Time (aPTT) –Detects coagulation defects of the intrinsic system –Monitor heparin therapy –Prolonged in hemophilia A & B, liver disease, vitamin K deficiency, etc |
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Diagnostic Tests-Clotting Bleeding Time |
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29Diagnostic Tests-Clotting Bleeding Time –Measures the primary phase of hemostasis –the interaction of the platelet with the blood vessel & the formation of a hemostatic plug –Platelet disorders –Von Willebrand’s disease |
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