0 évaluation0% ont trouvé ce document utile (0 vote)
234 vues3 pages
Assessment of Hematologic System Patient History Age Gender Decreased bone marrow function decreased immunity Women have decreased blood counts at all ages -- Increased difference during menstrual years. Jaundice Anemia indicates liver problems Gallstones Previous radiation therapy - hematological impairment if marrow-forming bones are in the path.
Assessment of Hematologic System Patient History Age Gender Decreased bone marrow function decreased immunity Women have decreased blood counts at all ages -- Increased difference during menstrual years. Jaundice Anemia indicates liver problems Gallstones Previous radiation therapy - hematological impairment if marrow-forming bones are in the path.
Droits d'auteur :
Attribution Non-Commercial (BY-NC)
Formats disponibles
Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
Assessment of Hematologic System Patient History Age Gender Decreased bone marrow function decreased immunity Women have decreased blood counts at all ages -- Increased difference during menstrual years. Jaundice Anemia indicates liver problems Gallstones Previous radiation therapy - hematological impairment if marrow-forming bones are in the path.
Droits d'auteur :
Attribution Non-Commercial (BY-NC)
Formats disponibles
Téléchargez comme PDF, TXT ou lisez en ligne sur Scribd
Patient
History
Age
• Decreased
bone
marrow
function
• Decreased
immunity
Gender
• Women
have
decreased
blood
counts
at
all
ages
-‐
Increased
difference
during
menstrual
years
(r/t
loss
of
blood
faster
than
production
and
blood
dilution
because
of
water
retention
caused
by
female
hormones)
Liver
Function
• Jaundice
(makes
clotting
• Anemia
indicates
liver
problems
factors)
• Gallstones
• Previous
radiation
therapy
–
hematologic
impairment
if
marrow-‐forming
bones
are
in
the
path
Known
Hematologic
or
Immunologic
Disorders
Drug
Use
• For
past
3
weeks
• Antibiotic
use
–
Prolonged
antibiotic
therapy
can
lead
to
clotting
problems
and
bone
marrow
suppression
• Blood
thinners
&
NSAIDS
–
Indicate
the
person
has
a
clotting
problem
or
health
problem
that
requires
changing
blood
clotting
activity
-‐Anticoagulants
• Interfere
with
one
or
more
steps
in
the
blood
clotting
cascade
(thrombin
• Prevents
new
clots
from
forming
inhibitors,
vitamin
k
• Limits/prevents
extension
of
new
clots
antagonists,
indirect
• Cannot
breakdown
existing
clots
factor
x
inhibitor)
-‐Fibrinolytic/
Thrombolytic
drugs
• Selectiveley
breakdown
fibrin
threads
that
are
already
made
in
a
clot
• Fibrin
degradation
started
by
activation
of
the
inactive
tissue
protein
plasminogen
to
plasmin
(plasmin
attacks
and
degrades
fibrin)
• Selective
breakdown
of
formed
fibrin
clots
(less
effect
on
formed
clots)
• Best
clot
break
down
with
less
disruption
of
blood
clotting
• First
line
therapy
for
small,
local
clots
(MI,
arterial
thrombosis,
thrombotic
strokes)
-‐Platelet
inhibitors
• Either
prevent
platelets
from
becoming
active
or
prevent
activated
platelets
from
clumping
• Aspirin
is
most
widely
used
–
Inhibits
the
production
of
substances
that
trigger
platelet
activation
(thromboxane,
i.e.)
• Other
drugs
change
the
platelet
membrane
–
Reduce
its
stickiness
or
prevent
activators
from
binding
to
platelet
receptor
sites
Other
Collect
information
about:
• Occupation
• Hobbies
• Location
of
housing
This
information
may
indicate
an
exposure
to
agents
or
chemicals
that
affect
bone
marrow
growth
or
hematologic
function
Nutrition
• Diet
can
alter
cell
quality
and
affect
blood
clotting
Status/Dietary
• Record
of
everything
eaten
for
a
week
Patterns
• Use
to
determine
causes
of:
-‐Anemias
(diets
high
in
fats
and
carbs,
low
in
protein,
iron
and
vitamins,
can
cause
many
types
of
anemia
and
decrease
functions
of
all
blood
cells)
-‐protein
deficiency
-‐vitamin/mineral
deficiency
• Alcohol
consumption
–
Can
cause
nutritional
deficiency,
or
have
had
a
liver
transplant
(both
reduce
clotting)
• Blood
clotting
enhanced
by
diets
high
in
Vit
K
(green,
leafy
veggies)
–
increased
rate
of
blood
clotting
(assess
amount
of
salad/raw
veggies)
• Routine
vitamins?
• Amount
of
calcium
in
diet
or
in
supplements
• Assess
ability
to
understand
and
follow
instruction
r/t
diet,
procedures/tests,
prescribed
drugs
or
diets
• Ask
ab
financial
resources
(poor
income
could
mean
they
have
Socioeconomic
a
diet
low
in
iron
and
protein
bc
these
are
more
expensive)
Status/Personal
• Social
support?
Support
Family
History
&
• ACCURATE!
Genetic
Risk
• Many
hematologic/clotting
disorders
are
inherited
• Has
anyone
had:
hemophilia,
frequent
nosebleeds,
postpartum
hemorrhages,
excess
bleeding
after
tooth
extractions,
heaving
bruising
after
relatively
mild
trauma,
sickle
cell
dz/trait
(most
often
seen
among
African
Americans
but
anyone
can
have
trait)
Current
Health
• Swelling
of
lymph
nodes?
Problems
• Excess
beleeding/bruising?
*is
it
spontaneously
or
induced
by
trauma?
*amount
and
duration
of
bleeding
after
routine
dental
work
• Menorrhagia
(excess
menstrual
flow)
–
Estimate
#
of
pads/tampons
used
during
most
recent
menstrual
cycle
(change
from
usual?)
• Menstrual
clots
–
Estimate
clot
size
using
coins
or
fruit
• SOB
on
Exertion?
• Palpitations?
• Frequent
infections?
• Fevers?
• Recent
weight
loss?
• HAs?
• Paresthesthesias?
• Fatigue?
–
single
most
common
symptom
of
anemia
(occurs
because
oxygen
delivery
to
cells
is
less
than
oxygen
needs,
cells
use
oxygen
to
make
ATP
which
is
needed
for
cell
work,
so
if
oxygen
decreases,
ATP
production
decreases,
all
cellular
work
decreases,
fatigue
increases)
-‐feeling
tired
-‐needing
more
rest
-‐losing
endurance
during
normal
activities
-‐compare
activities
to
the
same
time
last
year
-‐other
symptoms?
Vertigo,
tinnitus,
sore
tongue?