Transcript Segmented Neutrophils (Mature)

The Cardiovascular System
Rachel S. Natividad, RN, MSN, NP
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Review A & P
2
Circulation through the Heart
3
Diagnostic Studies
CBC


COAGULATION
WBC
RBC

• HGB
• HCT
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
Platelet count
PT/INR
PTT/APTT
CXR
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Blood Components

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Blood Components:
White Blood Cell Differential
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WBC Count

2 Segs, 1 Band
Measurement of total number
of leukocytes (4,000-11,000/uL)
Granulocytes



Neutrophils (55-70%)
• Segmented neutrophils
(Segs)
• Immature band neutrophils
(Bands/Stabs) (0-3%)
Eosinophils (1-2%)
Basophils (<1%)
Agranulocytes


Lymphocytes (30-40%)
Monocytes (5-6%)
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WBC Differential– Cont.
NEUTROPHIL MATURATION
Left Shift or “Bandemia”
Segmented Neutrophils (Mature)
Band Neutrophils (Immature)
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WBC Differential– Cont.
Eosinophils (parasitic infections,
allergies)
Monocytes (phagocytic bacterial action)
Basophils (inflammation from allergies)
Lymphocytes ( immune response)
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RBC – Erythrocyte count

Count of the number
of circulating RBCs

Altered in the same
conditions that alter
Hgb and Hct values
Erythrocytes
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Hemoglobin

HGB LEVEL: Measurement of the
oxygen -carrying capacity of RBC
Increased in:

Hemoconcentration (severe
dehydration, burns, shock,
vomiting), polycythemia vera
Decreased in:


Anemias due to blood
loss or poor nutrition
Hemodilution (fluid volume excess);
other anemias
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Hematocrit

The percentage of whole
blood volume composed
of erythrocytes


Women: 38-47 %
Men: 40-54 %

Altered in same conditions
that alter Hgb

Also reflects pt’s state of
hydration

Hgb high or WNL with low
Hct= dehydration
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Case Study
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Patient Presents…

69 year-old female admitted for left total hip
replacement. Hx of DJD and DM type 2, asthma,
and allergies.

#2 POD
PE: Incision site appears red and edematous
with moderate amt. purulent drainage, JP drain
intact draining reddish tan colored drainage.
VS: Temp 100.9, Resp 22/min, P 98 BPM, BP
138/88.

CBC results 1 day post-op reveal →→→→
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CBC with Differential
Lab Value
Result
Reference
RBC
3.14
4.2- 5.4 m/uL
Hgb
9.3
12-16 g/dL
Hct
25.3
37-47 %
WBC
18,000/uL
5,000-10,000/uL
Neutrophils
90
55-70
Bands
9
0-3
Eosinophils
6
1-2
Basophils
4
<1
Range
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Coagulation Studies
 Monitoring
hemostasis
Bleeding
Clotting
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Coagulation Studies

Platelets – critical to
hemostasis and clot
formation



-
Platelet count – measures
the number of circulating
platelets
Normal range:
150,000-400,000 mm3
Monitor in patients
receiving Lovenox
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How would you proceed?
 You
are to administer Lovenox 40 mg SQ
once daily.
 Pt.’s
Plt. Count = 250,000 mm3
 Pt’s
Plt. Count = 80,000 mm3
 Pt’s
Plt. Count = 450,000 mm3
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Coagulation Studies: Cont.

How long does it take for blood to clot?

PT & INR
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
Assessment of extrinsic coagulation
To monitor patients taking certain medications as well
as to help diagnose clotting disorders
Used primarily to evaluate oral anticoagulant
therapy: warfarin (Coumadin)
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Coagulation Studies: Cont.
 PTT
& aPTT

Assessment of intrinsic coagulation

Used to monitor therapeutic Heparin
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CXR
•Examine lung
fields and heart
size
•Check for normal
heart size and
contour, change in
heart chambers,
displaced heart,
presence of extra
fluid around the
heart
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Cardinal Signs and Symptoms (pp 687-688)
 Chest
Pain
 Palpitations
 Dyspnea
 Edema
 Fatigue
 Pallor
 Syncope
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Angina

Chest pain
due to
reversible
ischemia to
myocardium
 reduced
blood flow
to the heart
Coronary Artery Disease
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Chest Pain: Myocardial Infarction (MI)

Ischemia to the heart
muscle is irreversible
and results in tissue
damage and necrosis

Obstruction of blood
flow
 Atheroma (plaque)
 Thrombosis
 Embolism
CAD with Thrombosis
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Myocardial Infarction

Diminished coronary perfusion


Ischemia – Angina
Infarction – Necrosis
• Fibrous scarring
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Chest Pain: Pericarditis
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Pericarditis

Inflammation of
pericardium

Pleuritic type
chest pain

pericardial
scarring and
fibrosis
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CHEST PAINS
ANGINA
Sudden
Onset;
Precipitating Response to
exertion, emotion,
factors
MI
PERICARDITIS
Sudden
No precip. Factors
Often early am
Sudden
Upright position
Inspiration
stabbing pain or
pressure
Severe
Sharp stabbing
extremes
Quality
squeezing
Severity
Moderate to severe
Location
Substernal
Substernal
Substernal
Region
May spread to
chest, arms, back,
May spread to ant.
Chest, arms, back,
jaw, neck
Usually spreads to left
side or back
Duration,
Relieving
Factors
< 15 min
Rest, Nitro, O2
30 min or longer
Not relived by rest
Relieved with
opiods
Intermittent
Relieved by sitting
upright, analgesia,
Anti-inflammatory
agents
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Locations of Chest Pain
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Other
Symptoms:







SOB
Diaphoresis
N/V
Cold/clammy
skin
Palpitations
Fainting
Loss of
consciousness
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Heart Failure (Pump Failure)

A disorder in which
the heart loses its
ability to pump blood
efficiently throughout
the body

↓Cardiac Output
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Pathophysiology:
Impaired Cardiac Function

Failure to empty ventricles
& reduced delivery of blood
into circulation (↓ CO)

Increased ventricular
pressures

Elevated pulmonary and
systemic pressures

further ↓ CO

Series of compensatory
mechanisms
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Cardiac Function
Recall that Cardiac Output
(CO) is: HR X SV

Which consists of:
Contractility

Preload: filling of the
heart during diastole

Afterload: the resistance
against which the heart
must pump
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Causes
Acute/Chronic ♥ Problems

CAD
 HTN (#1)
 MI
 Valvular ♥ Disease
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Compensatory mechanisms of low CO…
…Starling’s Law/…Ventricular
dilation: ↑ CO
…Ventricular hypertrophy
… cardiac contractility… ↑ CO
…SNS stimulation… ↑ HR and
cardiac contractility… ↑ CO
…Decreased renal blood
flow…increasing Na & H20
retention…increases blood
volume, ↑ HR & CO.
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Clinical manifestations :
Pulmonary Congestion (L)
and Systemic Congestion (R)
Right Heart Failure
Left Heart Failure
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Left Heart Failure-Cont.
Pulmonary edema
 The most severe
manifestation of Left
Heart Failure

Fluid leak into the
pulmonary interstitial
spaces (Pulmonary
congestion)

Hypoxia and poor 02
exchange
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Clinical picture…Left Heart Failure
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Dyspnea
Tachypnea
Cough orthopnea
Paroxysmal nocturnal
dyspnea
Pale, possible cyanotic
Clammy and cold skin
Extra heart sounds – S3,
S4
Crackles/Wheezes
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CXR: Pulmonary edema
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Right Heart Failure

Unresolved Left failure:
eventually leads to right
sided failure by venous
congestion in the
systemic circulation

Clinical picture…

JVD, hepatomegaly
and dependent edema
(LEs, thighs,
abdomen-ascites)
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Review: Subjective Data
Pt. may c/o
 anxiety
 dyspnea at rest/on
exertion (DOE) -most
sensitive
 paroxysmal
nocturnal dyspnea
(PND)
 orthopnea
 productive cough with
pink frothy sputum
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Review: Objective Data
PA may reveal:
 Tachypnea/SOB
 Use of accessory
muscles
 Wheezes/Crackles
 skin
 Clammy/cold
 gray/cyanotic
 peripheral edema
 JVD
 Ascites, enlarged
spleen/liver
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Review: Heart Failure
Left Heart Failure –
pulmonary congestion
 Right Heart Failure –
systemic congestion
 Left Heart failure
often leads to Right
sided heart failure
causing biventricular
failure
→ Cor Pulmonale

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