Medical Surgical Nursing – Hematological System

PENTAGON REVIEW / SIR VALDEZ

Hematological System & Disorders o Immature platelets –

COVERAGE MEGAKARYOCYTES  Target site of
I. Hematological System Aedes aegypti
a. Composition of Blood
b. Blood Cells  Percentage by Body Weight
II. Anemia o Other fluids and tissue of the body =
a. Iron Deficiency Anemia 92%
b. Megaloblastic Anemia o Blood = 8%
1. Pernicious Anemia
c. Aplastic Anemia  Percentage by volume  Albumin = 58%
1. Plasma – 55% (decreased
I. HEMATOLOGICAL SYSTEM  Water = 91% albumin  EDEMA)
 Consists of:  CHON = 7%  Globulin = 38%
 Blood  Other solutes = 2%
 Fibrinogen = 4%
 Blood vessels
 Ions
 Artery – largest: aorta /  Gases
carotid  Nutrients
 Veins – largest: SVC, IVC,  Regulatory
Jugular vein  Substance
 Capillaries hormones
 Waste product
 Blood forming organs:
1. Bond Marrow – produces all RBC,
60-70% of total WBC and all platelets Blood
2. Lymphatic tissues:
o Spleen Plasma (55%)
- fluid portion Cellular components /
o Thymus gland formed elements (45%)
o Lymph nodes – produces the - It consists of:
lymphocytes (20-30%) of TWBC a. CHON’s
3. Reticuloendothelial tissue 1. Albumin – maintains osmotic pressure /
o Liver oncotic pressure thereby preventing EDEMA
o Spleen 2. Prothrombin & fibrinogen – clotting factor
o Lymph nodes that prevents bleeding
Types:
4. Other organs produces monocytes 3. Globulins
o Alpha Globulins
(4-8%) TWBC o Beta Globulins
o Tonsils o Gamma globulins /
immunoglobulins or
o Lymphoid organs (payer’s antibodies
patches) Immunoglobulins (GAMED)
o IgG – only antibody that can pass
through the placenta thereby
📌
providing passive immunity to fetus
Lymphatic tissue
o IgA – found in all bodily secretions like
sweat, tears, saliva & colostrum ; not
Payer’s patches  Site of salmonella typhi
in urine!
o IgM – Largest antibody involved in
Located between Typhoid Fever
acute inflammation
the small & large
o IgE – allergic reaction
intestine (+) rose spots in the abdomen o IgD – for chronic inflammation

KDS 1
Medical Surgical Nursing – Hematological System
PENTAGON REVIEW / SIR VALDEZ

Plasma CHON (liver)  Substances needed for formation /

2. Globulin maturation of RBC:
o Types: o Iron
1. Alpha Globulins o Folic acid
 Transports steroids, o Vit B6 (Pyridoxine)
hormones, iron and ferritin o Vit B12 (Cyanocobalamin)
2. Beta Globulins o Vit C (Ascorbic acid)
 Transports steroids, o Intrinsic factor
hormones, iron and ferritin o All necessary for RBC
3. Gamma globulins / synthesis during cell division
immunoglobulins or antibodies o Normal average lifespan of
RBC = 90-120 days
3. Prothrombin / Fibrinogen o RBC is destroyed by the liver
o Clotting factors that prevent & spleen (red pulp)
bleeding
o Once activated, it is converted Genesis of RBC
to fibrin (threadlike structures of - Old age RBC (90-120 days)
protein) forming a clot thereby
preventing bleeding Spleen (red pulp)

A. Composition of Blood Hemoglobin

1. RBC
- N = 4-6 million cubic millimeters Heme Globin
Structure:
o Biconcave Ferritin Ferrous
o Anucleate (no nucleus)
Contains of: Biliverdin Bilirubin
o Hemoglobin Hgb (red cell (green pigment) (yellow pigment)
pigment) – gives the red color of
the blood Goes to the intestine
 Transport and carries O2 &  Urobilinogen
CO2
 Women: N=12-14 grams/dl Urobilin Stercobilin
(12-16 grams/dl) (urine) (stool)
 Men = N= 14-16 g/dl (14-
18g/dl)
o Hematocrit Hct – red cell
percentage in whole blood 📌 Note:
 X 3 of Hgb  The stimulus of erythropoiesis (RBC
 Women = 36-42% production) is a decrease of O2 tissue
 Men = 42-48%  Erythropoietin – hormone responsible for
Hypoxia stimulating the bone marrow to produce
RBC
Stimulus for release of erythropoietin  It is released in macula densa of the
(macula densa of the kidneys) kidneys
 Erythropoietin analogue
Hormone that stimulates the bone marrow to o Epogen / Epocrit – stimulates
produce RBC / erythrocytes  Increased production of RBC
RBC

KDS 2
Medical Surgical Nursing – Hematological System
PENTAGON REVIEW / SIR VALDEZ

DISORDERS OF RBC  Memory cells

1) Anemia – decrease in RBC  Suppressor cell:
2) Polycythemia – Increased in RBC release whenever
there is an antigen
2. WBC (Leukocytes) (foreign body) 
- N = 5000 – 10,000 / cubic autoimmune: the
millimeters body is producing
- Acts as scavenger in the blood excessive suppressor
because it carry on phagocytosis T cells that destroys
(engulfing of bacteria / cellular the normal cells /
debris) tissue of the body
Types:  Helper cells / CD4 –
a. Granulocytes (granular) target site of HIV
o Neutrophils – most abundant of 3. Natural Killer Cells (NK cells)
all WBC, constitutes 60-70% of - It has both an anti viral &
total WBC anti tumor
 Involves in short term
phagocytosis  involved 📌 Opportunistic infection
in acute inflammation 1. Pneumocystic carini
 Normal lifespan = 2-4 pneumonia
hours 2. Kaposis’s sarcoma (Skin
o Eosinophils – involved in allergic Cancer)
reaction 3. PTB
o Basophils – involved in parasitic 4. Oral thrush
infections, ingests large fat (mononucleosis)
particles 5. Meningitis

Organ Macrophage
1. Blood Monocytes 3. Platelets (thrombocytes)
2. Brain Microglia - It prevents bleeding by
3. Liver / Kupffer cells promoting hemostasis
Kidneys (prevention of blood clots)
4. Lungs Alveolar macrophage - Baby / immature platelets:
5. Skin Histiocytes megakaryocytes – target site
of dengue virus
b. Non granulocytes (Agranular) - Normal average lifespan: 9-12
o Monocytes – largest WBC days
 Also known as “macrophage
of the blood” II. ANEMIA
 Involve in long term - A decrease in the circulating RBC
phagocytosis  involves in volume  leading to a decrease
chronic inflammation in Hgb count (less than 10g/dl)
o Lymphocytes – integral part of resulting to a decrease tissue
the immune system, consists of: oxygenation (hypoxia)
1. B cell lymphocytes (Humoral
immunity) – antibodies / Ig 1. CLASSIFICATION:
2. T cell lymphocytes (cell a. Secondary to blood loss
mediated immunity) - Acute blood loss / trauma
 Cytotocic cell

KDS 3
Medical Surgical Nursing – Hematological System
PENTAGON REVIEW / SIR VALDEZ

b. Secondary to reduce RBC count

production B. Predisposing Factors
- Iron deficiency anemi 1. Inadequate absorption of Iron
- Megaloblastic anemia – o Chronic diarrhea
pernicious anemia (vit B12 o High cereal intake with low
deficiency) & folate deficiency animan CHON ingestion
anemia o Malabsorption syndrome
c. Bone marrow suppression o Alcoholism
- Aplastic anemia
d. End Stage Renal Disease (ESRD): C. Signs & symptoms
kidneys is the one producing a 1. Usually asymptomatic
hormone erythropoietin  2. Headache
stimulates the bone marrow to 3. Dizziness
produce RBC 4. Dyspnea
5. Tachycardia
A. Iron Deficiency Anemia 6. Palpitations
- Most common type of anemia 7. Pallor
- Characterized by deficiency of 8. Generalized body malaise
iron leading to a decrease in 9. Cold sensitivity
hemoglobin  decrease in 10. Brittleness of hair
oxygen carrying capacity of the 11. Spoon shaped nails (koilonychias)
blood, in turn tissue hypoxia 12. Plummer vinson syndrome
results o Atrophic glossitis
o Dysphagia
A. Incidence Rate o Stomatitis
1. Common among tropical areas 13. Pica – desire for eating non-edible
2. Develop countries
3. Common among women (15-35) D. Diagnostic Procedure
4. Common among poor 1. Complete blood count (CBC): reveals
low serum Hgb, Hct, & RBC
B. Predisposing Factors 2. Decrease or low serum Iron & Ferritin
1. Chronic blood loss due to: o Normal serum iron: 60-
a. Trauma / accidents 170mcg/dl
b. Heavy menstruation o Normal serum ferritin (CHON
c. Pregnancy that stores iro)
d. GIT bleeding: o Women: 12-15ng/dl
o Hematemesis: vomiting of o Men: 12-30ng/dl
blood 3. Bone marrow aspiration
o Melena: passage of black o MOST DEFINITVE TEST
starry stool
o Hematochezia: passage of E. Nursing Priority / Diagnosis
fresh blood per rectum 1. Fatigue
2. Activity intolerance
Amoebiasis  Metronidazole 3. Knowledge deficit
(Flagyl / Flagentyl)
F. Nursing Management
Best given Rarely given 1. Encourage CBR with bathroom
side drip orally privileges
(fast drip) (metallic taste) 2. Monitor for signs of bleeding of all
hematest including urine, stool, & GIT

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Medical Surgical Nursing – Hematological System
PENTAGON REVIEW / SIR VALDEZ

3. Encourage increase of foods rich in

iron: 📌 Drugs given by a straw to
o Organ liver meat prevent staining of the teeth:
o Brown rice 1. Lugol’s solution (SSKI)
o Egg yolk 2. Tetracycline
o Beans 3. Iron
o Raisins and molasses 4. Nitrofurantoin / Macrodantin
o Dried fruits
o All the nuts
o Dark, green leafy vegetables Nursing care when giving parenteral
4. Administer meds as ordered: iron supplements:
o Oral iron supplements: 1. Administer using Z tract method
1. Ferrous SO4 – SE: (DEEP IM) to prevent discomfort
MELENA o Avoid rubbing to prevent
2. Ferrous fumarate – leakage, staining and
SE: MELENA discomfort
3. Ferrous gluconate – 2. Encourage client to ambulate to
SE: GREEN STOOL facilitate absorption
3. Monitor and inform client of the
Nursing care when giving oral iron SE:
supplements: o Pain at the injection site
o Food decreases absorption of o Localized abscess
iron but can cause GIT o Lymphadenopathy
irritation, BEST TAKEN WITH o Pruritus
FOOD to lessen GIT irritation o Fever and chills
o It is best administered with o If (+) hypotension 
orange juice or Vit C to indicative of anaphylaxis
facilitate absorption  administer
o When diluting it in liquid Iron epinephrine because of
prep  administer with its bronchodilating effect
straw to prevent staining of
the teeth B. Megaloblastic Anemia
o Monitor & inform clients of SE:  Megalo – abnormally large
o Anorexia  Blastic – hemolysis / namamatay
o N&V
o Abdominal pain 1. Pernicious Anemia
o Constipation / - This is megaloblastic anemia resulting
diarrhea from a deficiency of intrinsic factor
o Melena (FeSO4), leading to hypochlorhydria (decrease
green stool (Fe in HCL acid secretion)
Gluconate)
- NOTE: if the client is non- A. Predisposing Factors
compliant to oral iron prep  1. Subtotal gastrectomy
administer parenteral iron 2. Hereditary
preparation as ordered 3. Inflammatory disorders of the ileum
o Crohn’s Dse / Regional
enteritis
4. Autoimmune
5. Strictly vegetarian diet

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Medical Surgical Nursing – Hematological System
PENTAGON REVIEW / SIR VALDEZ

6. Degenerative changes – elderly 2. Peripheral blood smear: reveals giant

immature RBC with hyperpigmented
B. Pathophysiology nuclei
3. Intrinsic factor antibody test
Stomach (widest section of GIT)
E. Nursing Priority / Diagnosis
Parietal / oxyntic / argentaffin cells 1. Fatigue
2. Activity intolerance
Produces intrinsic Produces HCL 3. Knowledge deficit
factor acid
F. Nursing Management
Promotes vit b12 aids in digestion 1. Enforce CBR with bathroom privileges
reabsorption food 2. Administer meds as orders:
o Folic acid = 1mg/day
responsible for maintains integrity of o Vit B12 = IM injection, at
maturation of RBC myelin sheath monthly intervals for lifetime
 Route: dorsogluteal
C. Signs and symptoms: or ventrogluteal
1. Anemia like symptoms:  SE: free of toxicity
o Headache o Note: if client with pernicious
o Dizziness anemia is not given with vit
o Dyspnea B12, the patient will die within
o Tachycardia 1-3 years
o Palpitations 3. Provide dietary intake of high
o Generalized body malaise calories, CHON, CHO, Iron, Vit C
o Pallor 4. Avoid heat application
o Cold sensitivity 5. Instruct client to use soft bristled
2. GIT changes: toothbrush avoid irritating
o (+) mouth sores mouthwashes
o Red beefy tounge (sore tounge)
 atrophy of taste buds C. Aplastic Anemia
o Dyspepsia - Stem cell disorder characterized by
o Weight loss bone marrow depression leading to
o Jaundice pancytopenia
3. CNS changes: o Anemia
o Tingling sensation o Leukopenia
o Paresthesia in the hands and o Thrombocytopenia
feet
o Ataxia A. Predisposing Factors:
o Psychosis 1. Environment factors:
o Pesticides
D. Diagnostic Procedures: o Benzene and its derivatives
1. Schilling’s test: reveals inadequate 2. Exposure to radiation
absorption of Vit B12 3. Certain drugs
o Broad spectrum antibiotics:
Injection of non oral ingestion of  Chloramphenicol
Radioactive Vit B12 radioactive Vit B12  Sulfonamides
o Phenothiazines
Urine sample is collected: If (-) to vit B12 = o Chemotherapeutic agents
pernicious anemia

KDS 6
Medical Surgical Nursing – Hematological System
PENTAGON REVIEW / SIR VALDEZ

 Nitrogen mustard (anti 5. Bleeding tendencies

metabolic)
 Methotrexate E. Nursing Management:
1. Removal of underlying tissue
📌 Vincristine – the only 2. Institute blood transfusion as ordered
chemotherapeutic agent that does (whole blood)
not cause bone marrow depression 3. Enforce CBR
4. Administer O2 inhalation
5. Institute reverse isolation
B. Signs & symptoms 6. Monitor for signs of infection
1. Anemia like symptoms: 7. Avoid any parenteral injections
o Headache 8. Provide heparin lock
o Dizziness 9. Administer meds as ordered:
o Dyspnea o Immunosuppressants:
o Tachycardia  Cyclosporine (Sandimmune)
o Palpitations and anti thymocyte globulin
o Generalized body malaise  MOA: it suppresses the activity
o Pallor of immune cells that are
o Cold sensitivity damaging the bone marrow
2. Leukopenia thereby helping the bone
o Increase susceptibility to marrow to repair and
develop infection generate new blood cells
3. Thrombocytopenia o Bone marrow stimulants
o Signs of bleeding tendencies:  Epogen (Epocrit): It stimulates
 Petechiae the production of erythrocytes
 Ecchymosis (RBC)
 Oozing of blood from  Neupogen
venipunctured sites (Filgrastim):stimulates the
 Retinal hemorrhage production of neutrophils /
4. Splenomegaly WBC
o All are decreased & spleen 10. Assists in bone marrow
compensates by transplantation / stem cell treatment
enlargement

C. Diagnostic Procedure
1. CBC: reveals pancytopenia
2. Bone marrow aspiration:
confirmatory test
o Reveals hypoplastic or
acellular marrow replaced by
fats
o Site: posterior iliac crest (hip
bone)

D. Nursing Priority / Diagnosis

1. Fatigue
2. Activity intolerance
3. Knowledge deficit
4. Infection

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