Assessment

 of  Hematologic  System  

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?