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PT 620 Foundations 2 > Acute Care 2 > Flashcards

Acute Care 2 Flashcards

1
Q

what are used to determine the functionality of a patient’s clotting ability

A

blood tests

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2
Q

measures platelet (PLT) functioning by determining the time it takes for a blood clot to form from a punctured capillary

A

bleeding time

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3
Q

what is normal bleeding time, what would indicate highly significant bleeding time

A

normal: 3-10 minutes
abnormal: > 15 minutes

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4
Q

tests for functioning of Factor I, fibrinogen Factor V, VII, X (all of which are extrinsic factors) that convert fibrin to stabilize clot)

A

prothrombin time (PT)

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5
Q

what is fibrin

A

a protein formed from fibrinogen during clot formation in blood

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6
Q

what happens if there is a malfunction in PT (prothrombin time)

A

blood will take longer to clot

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7
Q

what is normal prothrombin time

A

11-13 seconds

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8
Q

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)

A

partial thromboplastin time (PTT)

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9
Q

how is PTT drawn and what does it separate

A
  • drawn from venous blood
  • separates into plasma and cells
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10
Q

what is PTT used to monitor dosages of

A

heparin (blood thinner)

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11
Q

what is normal value of PTT

A

30-45 seconds

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12
Q

if a substance is added to the blood, to activate _____ pathways, the time it takes to form a clot is measured in _____

A

intrinsic
seconds

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13
Q

test that is done when a substance is used to shorten the clotting time (reading it in less than one hour)

A

activated partial thromboplastin time (APTT)

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14
Q

what is normal APTT, what signifies spontaneous bleeding APTT

A

normal: 21-35 seconds
>70 seconds signifies spontaneous bleeding

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15
Q

used to correct for differences in the lab agents used to test the prothrombin time

A

international normalization ratio (INR)

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16
Q

what is used to monitory dosages of coumadin/warfarin

A

international normalization ratio (INR)

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17
Q

how is international normalization ratio calculated and what is the formula

A

patients PT value over control PT
INR = patient PT / control PT

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18
Q

produced by the action of plasma on cross-linked fibrin and the presence in the blood confirms that clotting has occurred

A

d-dimers

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19
Q

what are d-dimer blood tests used to screen for

A

DVT, PE, disseminated intravascular coagulation (DIC)

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20
Q

what tests are used to monitor the amount of anticoagulation therapies (heparin/coumadin) used to treat blood clots

A

PT, PTT, INR

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21
Q

what is important to remember when treating patients with impaired or enhanced clotting

A

they are at increased risk for bleeding (falls, running into things)

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22
Q

formation of blood clot in a deep vein; life threatening

A

venous thromboembolism (VTE)

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23
Q

what leads to DVT –> PE –> postthrombotic syndrome (PTS)

A

venous thromboembolism (VTE)

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24
Q

what percent of people die within 1 month of VTE diagnosis

A

10-30%

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25
Q

what is the 3rd most common CV illness following acute coronary syndrome and stroke

A

VTE

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26
Q

how many people die immediately with acute PE
what percent die within 3 months

A

1/5
40%

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27
Q

a patient dx with DVT is at significantly increased risk of developing

A

PE

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28
Q

what is the main intervention for DVT

A

anticoagulation therapy

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29
Q

for patients who are at increased risk of bleeding when dx with DVT, what is an alternative intervention instead of anticoagulants

A

surgery

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30
Q

when should mobility be started following DVT

A

started ASAP as immobility is a huge risk factor for developing more clots, but only once intervention has been initiated

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31
Q

what are anticoagulation medications

A

unfractionated heparin
low molecular weight heprin (LMWH)/fondaparinux
coumadin
new oral anticoagulation drugs (NOAC)

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32
Q

used with patients with high bleeding risk for renal disease

A

unfractionated heparin

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33
Q

most often used to treat LE DVT or PE

A

low molecular weight heparin (LMWH) or fondaparinux

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34
Q

used during DVT with pregnancy and patients with active cancer

A

low molecular weight heparin (LMWH)

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35
Q

primary choice for VTE in OP and home care settings

A

low molecular weight heparin (LMWH)

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36
Q

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

A

coumadn

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37
Q

anticoagulation medication that requires no lab monitoring; has rapid time to peak therapeutic levels; less risk of cerebral hemorrhage

A

new oral anticoagulation drugs (NOAC)

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38
Q

what are NOAC commonly used in

A

TKA, THA
not yet tested for those with cancer or women who are pregnany

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39
Q

what are the risks for using anticoagulation medication

A

risk of active bleeding, acute stroke

40
Q

what to watch for on anticoagulation medication for exercise and OOB activities

A

INR

41
Q

range of INR for someone not on anticoagulation

A

0.8-1.2

42
Q

typical INR range for someone on anticoagulaiton

A

2.0-3.0

43
Q

INR of what indicates no resistive exercises, light exercise only with RPE < 11
what may be restricted

A

4-5
ambulation may be restricted if they are unsteady and may fall

44
Q

INF > ____ - check with MD regarding activity

A

> 5.0

45
Q

INR ____ may be on bed rest until corrects

A

> 6.0

46
Q

a short-term catheter placed in a central vein by a physician or surgeon, usually for emergency access

A

non-tunneled temporary central catheters

47
Q

these lines are usually stiffer material, may have 1 to 3 lumens, and are most commonly used in the intensive care areas (typically not a line you would see outside the ICU)

A

non-tunneled temporary central catheters

48
Q

what are common placement sites for non-tunneled temporary central catheters

A

femoral, subclavian or jugular veins

49
Q

how are non-tunneled temporary central catheters held in place

A

sutures or a securement device and covered with a transparent dressing

50
Q

care needed for non-tunneled or percutaneous temporary central catheters

A

flushing
dressing changes
assessment for problems

51
Q

what is the use for central venous access catheters

A

inserted for medications and parenteral nutrition

52
Q

what are central venous access catheters intended to be for how long

A

intermediate to long-term

53
Q

infusions that are hypertonic in nature and too irritating for peripheral veins

A

central venous access catheters

54
Q

in many kids/adults, the __________ is a lifeline that is necessary for success in therapy

A

central venous access catheters

55
Q

what does parenteral nutrition mean

A

receiving nutrients through the blood

56
Q

another name for tunneled central catheters

A

broviacs

57
Q

long-term catheters placed in a central vein by a interventional radiologist or surgeon

A

tunneled central catheters

58
Q

tunneled catheters are usually inserted for intermittent or continuous treatments that will take _____ to ____ such as:

A

months to years
- chemotherapy in oncology patients
- TPN (total parental nutrition) with inflammatory bowel diseases
- neonates requiring months of care in NICU

59
Q

where are the most common placements for central tunneled catheters

A

subclavian or jugular veins

60
Q

after inserted into subclavian or jugular veins, tunneled central catheters are then tunneled under the skin to a distant exit site, usually where

A

mid-chest area

61
Q

tunneled central catheters is sutured at first until the ______ located in a subcutaneous tunnel under the skin takes hold

A

Darcon cuff

62
Q

why is a tunneled central catheter tunneled under the skin

A

to help keep microorganisms from migrating

63
Q

where does the tip of a central venous catheter terminate

A

superior vena cava (or inferior vena cava) - the largest central veins

64
Q

what occurs when medications/chemotherapy are administered into central venous access

A

hyperosmolar solutions (central strength TPN) and irritating medications (chemo) are quickly dispersed and diluted by the rapidly flowing large volume of blood in the vena cavas

65
Q

long-term venous access devices placed in a central vein by interventional radiologist or surgeon; ports are usually inserted for intermittent long term therapy (chemo in oncology patients) and antibiotic therapy (cystic fibrosis)

A

totally implanted central catheters (implanted ports) - accessed (red) or not accessed (yellow)

66
Q

difference between broviac catheters and implanted port

A
  • Broviac: are external
  • implanted port: placed under the skin and only a slight bump can be seen where the port body is implanted and sutured in a pocket under the skin of the chest or arm
67
Q

how to access totally implanted ports

A

accessed with a needle through the skin into the port to use the device

68
Q

if totally implanted ports have 2 lumens, can they both be accessed at the same time

A

yes

69
Q

PICC

A

peripherally inserted central catheter

70
Q

is an intermediate catheter that is placed in a peripheral vein and threaded into a central vein by IV team or interventional radiology

A

peripherally inserted central catheter (PICC)

71
Q

where is peripherally inserted central catheter (PICC) usually inserted

A

antecubital area

72
Q

what are common diagnoses of those who receive peripherally inserted central catheter (PICC)

A

CF, lyme disease, osteomyelitis, crohn’s disease

73
Q

what holds peripherally inserted central catheter (PICC) in place

A

stat-lock and then covered with a transparent dressing

74
Q

PT responsibilities for general assessment and care of central lines

A
  • check site (dressing, dry, clean)
  • secure line if you see it pulling or dragging
  • NEVER thread IV tubing through bedrails (NO tension on central line)
75
Q

CLABSI

A

central line associated blood stream infection

76
Q

central venous catheter complications

A

infection
phlebitis
occlusion
air embolism
malposition
infiltration
catheter breakage/dislodgement
leakage

77
Q

S/s: occurs when blood backfills at insertion site

A

occlusion

78
Q

what to do when IV pump is alarming “occlusion” or “no upstream flow detected”

A

notify nursing

79
Q

may occur if a central lines break (very rare); especially if line is located above the heart

A

air embolism

80
Q

s/s of air embolism complication

A

sudden onset of pallor
cyanosis
dyspnea
cough
tachycardia
syncope

81
Q

what should be done if patient experiences air embolism

A
  • place patient on L side in Trendelenburg (head down)
  • administer O2 and monitor pulse ox
  • notify MD/RN stat to your location, do not move the patient
    *** call for help/rapid response
82
Q

s/s of malposition of CVC and what to do

A

neck/chest swelling, gurgling sound in ears, tachycardia
- notify MD/RN

83
Q

signs of catheter breakage

A

leakage of infusate, bubbling or bulging of the catheter material, dressing is wet

84
Q

what to do when notice catheter is broken

A
  • IMMEDIATELY clamp catheter above the break using non-toothed clamp
  • cover break with sterile gauze and hold onto the end going into the patient
  • if not clamp, fold catheter onto itself, hold onto the end of the catheter, try not to move the catheter (end of catheter can actually get sucked into the vein, so hold on tight!) (you can tie a know in the end of the catheter and cover the end with a sterile gauze to keep it clean and prevent air from entering or blood from leaving
  • stat page MD/RN
85
Q

s/s of of dislodgement

A

external catheter length is longer than noted previously, Broviac cuff is visible

86
Q

what to do when dislodgement occurs

A

page RN, they will stop infusion and notify MD

87
Q

opening (stoma) for part of intestine or colon through abdomen; stool travels out opening, collected in bag

A

colonostomy

88
Q

when is colostomy performed

A

injury, blockage, abscess

89
Q

surgical opening of the bladder to the abdomen to allow for urine drainage; prevents UTIs and damage to kidneys

A

vesicostomy

90
Q

vesicostomy seen in

A

children with bladder obstruction
children with spina bifida

91
Q

a thin, sterile tube used to drain urine from the bladder; used if you aren’t able to use a catheter that is inserted into the urethra

A

suprapubic catheter

92
Q

common populations for suprapubic catheters

A

seen in patients with SCI, spina bifida

93
Q

prolonged hospitalization or ICU stay can cause alterations in mood and psychological functioning; anxiety, delirium, agitation, depression

A

ICU delirium

94
Q

what can cause ICU delirium

A

alterations in sleep patterns/positions
noxious stimuli
noise
loss of circadian light patterns

95
Q

contact precautions

A
  • private room
  • hand hygiene prior to glove application and after glove removal
  • gloves and gown
    don upon entering, doff before exiting
  • dedicated equipment
  • transporting patient –> alert receiving department
96
Q

droplet precautions

A
  • private room
  • hand hygiene prior to glove application and after glove removal
  • gloves and possible gown
  • don upon entering, doff before exiting
  • face mask/googles
  • transporting patient –> pt wear face mask and alert receiving department
97
Q

airborne precautions

A
  • private room required, negative air pressure
  • hand hygiene prior to glove application and after glove removal
  • don appropriate respirator - to be removed after exiting pt’s room
  • visitors wear masks
  • pt on isolation except for special tests or procedures
  • if pt leaves room, needs to war a mask
  • alert receiving department

PT 620 Foundations 2 (9 decks)

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