Assessment of the

Hematological
System

Ch. 36
 Concepts
 The priority concepts for this chapter are
 CLOTTING
 PERFUSION
Function
• Maintaining pH
• Maintaining fluid & electrolyte
levels
• Temperature regulation
• Clotting process
• Immunological protection
• Transport of O2 & other
nutrients [glucose] & hormones
• Waste removal [CO2 & other
waste products]
Overview
● Perfusion—total arterial blood flow through the tissues (peripheral perfusion) and
blood that is pumped by the heart (central perfusion)

● Clotting—Process by which blood forms a protein-based structure (clot)

 Bone marrow
Blood components
Plasma proteins
(albumin,
globulins,
fibrinogen)
Red blood cells
(erythrocytes)
White blood cells
Platelets
Accessory organs
of blood formation
Spleen
Liver
• Softy, spongy tissue inside of
Bone
bones
• Makes blood-forming cells [blood
Marrow
stem cells]
• Produces RBC, WBC, PLTs
• Common sites
• _____________: _____________,
_____________, _____________
• _____________
Blood Components
● Plasma proteins
○ Albumin
■ _______________________
■ _______________________
○ Globulins
■ ______________________________________
○ Fibrinogen
■ Critical in what process? __________________________
Blood Components
Red blood cells [RBCs] aka __________

•Normal range: 4,200,000 to 6,100,000/mm3

•What does it transport?___________
•Produce: ________________
•Erythropoiesis
•Erythropoiesis/Erythropoietin

White blood cells [WBCs] aka ________

• ____________
•Normal: 5,000-10,000/mm3

Platelets aka __________ [megakaryocyte precursor cells]

•Normal PLT: 150,000/mm3

•________________

Accessory organs

•Spleen
•Liver
Hematologic Changes Associated with Aging
Decrease in blood volume with lower levels of plasma proteins

Bone marrow produces fewer blood cells

RBC, WBC counts lower

Lymphocytes less reaction to antigens, lose immune function

Hemoglobin levels fall after middle-age

Assessment: Noticing & Interpreting
● Age, gender
● Liver function
● Drug use (prescribed, OTC, illicit)
● Dietary patterns
● Socioeconomic status
● Previous radiation therapy
● Occupation, hobbies
● Location of home
● Use of “blood thinners,” NSAIDs
● Nutrition status
● Family history and genetic risk
● Current health problems
Physical Assessment
● Skin: pallor, jaundice, cyanosis bruising, petechiae
● Head and neck: pallor/ulceration oral mucosa, scleral jaundice, lymph nodes
● Respiratory: Assess Rate/depth respirations, fatigue, SOBOE or @ rest
● Cardiovascular: Assess Pulse strength & quality, JVD, edema, phlebitis
● Kidney and urinary: Hematuria, proteinuria
● Musculoskeletal: Rib/sternal tenderness; decreased ROM, joint pain/edema
● Abdominal: Splenomegaly, hepatomegaly
● Central nervous system: CN assessment, vitamin deficiency, bleeding, tumor
spread, infection, head trauma
● Psychosocial: coping mechanisms, social support, finances
Nursing Safety Priority
● Do not _________ the splenic area of the abdomen for any
patient with a suspected hematologic problem.

● An enlarged spleen ruptures easily and can lead to hemorrhage

and death.
Diagnostic Assessment

 Laboratory tests of cell number and

function
 Peripheral blood smear
 CBC
 Reticulocyte count
 Platelet count
 Hemoglobin electrophoresis
 Coombs tests (direct and indirect)
 Serum ferritin, transferrin, and
TIBC
Bone Marrow Aspiration & Biopsy
● What is a biopsy?

● How is it removed?

● What is the diagnostic purpose?

● Indications?
Bone Marrow Aspiration and Biopsy
● Pre: Provider order; informed consent
● Prep
○ Explain procedure

○ Local anesthetic

○ Teach to expect heavy sensation of pressure & pushing

○ Warn about a “crunching’ sound or scraping sensation as needle hits bone

○ Painful pulling as marrow is aspirated

○ Assist on to table, expose the site [iliac crest] or sternum [if iliac not available or more marrow is
needed]

○ Iliac crest: position ________________

Bone Marrow Biopsy
● Intra-procedure
● Nursing
○ Inform procedure time

○ Reinforce explanation of type of sedation/anesthesia to be used

○ Cleansing site w/antiseptic as per order or agency policy

○ Maintain __________________

○ Assist provider
Bone Marrow
● Post-Procedure
○ PRIORITY: Prevention of excessive ____________

■ Apply a __________dsg

■ Cover site w/dsg after bleeding is controlled

■ Observe closely for 24 h for signs of bleeding/infection

○ Mild analgesic [ASA-free], ice packs at site: minimize pain and bruising

○ Teach to inspect site every 2h at home 1st 24h to assess for bleeding

○ Instruct to avoid any activity leading to trauma to site x48 h