Acute Care 2 Flashcards
what are used to determine the functionality of a patient’s clotting ability
blood tests
measures platelet (PLT) functioning by determining the time it takes for a blood clot to form from a punctured capillary
bleeding time
what is normal bleeding time, what would indicate highly significant bleeding time
normal: 3-10 minutes
abnormal: > 15 minutes
tests for functioning of Factor I, fibrinogen Factor V, VII, X (all of which are extrinsic factors) that convert fibrin to stabilize clot)
prothrombin time (PT)
what is fibrin
a protein formed from fibrinogen during clot formation in blood
what happens if there is a malfunction in PT (prothrombin time)
blood will take longer to clot
what is normal prothrombin time
11-13 seconds
can also be used to determine functionality of the clotting cascade by evaluating clotting factors found in the intrinsic pathways (factors I, II, V, VIII, IX, X, XI, XII)
partial thromboplastin time (PTT)
how is PTT drawn and what does it separate
- drawn from venous blood
- separates into plasma and cells
what is PTT used to monitor dosages of
heparin (blood thinner)
what is normal value of PTT
30-45 seconds
if a substance is added to the blood, to activate _____ pathways, the time it takes to form a clot is measured in _____
intrinsic
seconds
test that is done when a substance is used to shorten the clotting time (reading it in less than one hour)
activated partial thromboplastin time (APTT)
what is normal APTT, what signifies spontaneous bleeding APTT
normal: 21-35 seconds
>70 seconds signifies spontaneous bleeding
used to correct for differences in the lab agents used to test the prothrombin time
international normalization ratio (INR)
what is used to monitory dosages of coumadin/warfarin
international normalization ratio (INR)
how is international normalization ratio calculated and what is the formula
patients PT value over control PT
INR = patient PT / control PT
produced by the action of plasma on cross-linked fibrin and the presence in the blood confirms that clotting has occurred
d-dimers
what are d-dimer blood tests used to screen for
DVT, PE, disseminated intravascular coagulation (DIC)
what tests are used to monitor the amount of anticoagulation therapies (heparin/coumadin) used to treat blood clots
PT, PTT, INR
what is important to remember when treating patients with impaired or enhanced clotting
they are at increased risk for bleeding (falls, running into things)
formation of blood clot in a deep vein; life threatening
venous thromboembolism (VTE)
what leads to DVT –> PE –> postthrombotic syndrome (PTS)
venous thromboembolism (VTE)
what percent of people die within 1 month of VTE diagnosis
10-30%
what is the 3rd most common CV illness following acute coronary syndrome and stroke
VTE
how many people die immediately with acute PE
what percent die within 3 months
1/5
40%
a patient dx with DVT is at significantly increased risk of developing
PE
what is the main intervention for DVT
anticoagulation therapy
for patients who are at increased risk of bleeding when dx with DVT, what is an alternative intervention instead of anticoagulants
surgery
when should mobility be started following DVT
started ASAP as immobility is a huge risk factor for developing more clots, but only once intervention has been initiated
what are anticoagulation medications
unfractionated heparin
low molecular weight heprin (LMWH)/fondaparinux
coumadin
new oral anticoagulation drugs (NOAC)
used with patients with high bleeding risk for renal disease
unfractionated heparin
most often used to treat LE DVT or PE
low molecular weight heparin (LMWH) or fondaparinux
used during DVT with pregnancy and patients with active cancer
low molecular weight heparin (LMWH)
primary choice for VTE in OP and home care settings
low molecular weight heparin (LMWH)
not usually the first choice in anticoagulation medication because it takes longer to achieve peak therapeutic levels, but can be used initially along with LMWH or UFH
coumadn
anticoagulation medication that requires no lab monitoring; has rapid time to peak therapeutic levels; less risk of cerebral hemorrhage
new oral anticoagulation drugs (NOAC)
what are NOAC commonly used in
TKA, THA
not yet tested for those with cancer or women who are pregnany