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Assessment of Hematologic SystemPatient History

Age Decreased bone marrow function Decreased immunity

Gender Women have decreased blood counts at all ages - Increaseddifference during menstrual years (r/t loss of blood fasterthan production and blood dilution because of water retentioncaused by female hormones)

Liver Function(makes clottingfactors)

Jaundice Anemia indicates liver problems Gallstones Previous radiation therapy hematologic impairment if

marrow-forming bones are in the pathKnown Hematologic

or ImmunologicDisordersDrug Use

-Anticoagulants(thrombininhibitors, vitamin kantagonists, indirectfactor x inhibitor)

-Fibrinolytic/Thrombolytic drugs

-Platelet inhibitors

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 bloodclotting activity

Interfere with one or more steps in the blood clotting cascade Prevents new clots from forming Limits/prevents extension of new clots Cannot breakdown existing clots

Selectiveley breakdown fibrin threads that are already madein a clot

Fibrin degradation started by activation of the inactive tissueprotein plasminogen to plasmin (plasmin attacks anddegrades fibrin)

Selective breakdown of formed fibrin clots (less effect onformed clots)

Best clot break down with less disruption of blood clotting First line therapy for small, local clots (MI, arterial thrombosis,

thrombotic strokes)

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Either prevent platelets from becoming active or preventactivated platelets from clumping

Aspirin is most widely used Inhibits the production ofsubstances that trigger platelet activation (thromboxane, i.e.)

Other drugs change the platelet membrane Reduce itsstickiness or prevent activators from binding to plateletreceptor sites

Other Collect information about: Occupation Hobbies Location of housing

This information may indicate an exposure to agents or chemicalsthat affect bone marrow growth or hematologic function

NutritionStatus/DietaryPatterns

SocioeconomicStatus/PersonalSupport

Diet can alter cell quality and affect blood clotting Record of everything eaten for a week Use to determine causes of:

-Anemias (diets high in fats and carbs, low in protein, ironand vitamins, can cause many types of anemia and decreasefunctions of all blood cells)

-protein deficiency-vitamin/mineral deficiency

Alcohol consumption Can cause nutritional deficiency, orhave had a liver transplant (both reduce clotting)

Blood clotting enhanced by diets high in Vit K (green, leafyveggies) 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 havea diet low in iron and protein bc these are more expensive)

Social support?

Family History &Genetic Risk

ACCURATE! Many hematologic/clotting disorders are inherited

Has anyone had: hemophilia, frequent nosebleeds, postpartumhemorrhages, excess bleeding after tooth extractions, heavingbruising after relatively mild trauma, sickle cell dz/trait (mostoften seen among African Americans but anyone can havetrait)

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Current HealthProblems

Swelling of lymph nodes? Excess beleeding/bruising? *is it spontaneously or induced by

trauma? *amount and duration of bleeding after routinedental work

Menorrhagia (excess menstrual flow) Estimate # ofpads/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 (occursbecause oxygen delivery to cells is less than oxygen needs,cells use oxygen to make ATP which is needed for cell work, soif oxygen decreases, ATP production decreases, all cellularwork 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?