Ch. 12 Disorders of Hemostasis

Question 1

Hemostatis

Answer 1

the stoppage of blood

Question 2

normal state

Answer 2

blood is fluid. prevention of blood loss is done by sealing of torn vessels

Question 3

abnormal state

Answer 3

inappropriate clotting (thrombus formation) 
insufficient clotting (clots not being made)

Question 4

what are the components of hemostasis?

Answer 4

• platelets
• coagulation system
• anticoagulants
• endothelial lining of blood vessels

Question 5

platelets in relation to hemostasis

Answer 5

thrombocytes - made in bone marrow, stored in spleen (in the ULQ)

Question 6

coagulation system in relation to hemostasis

Answer 6

-plasma clotting factors (synthesized in the liver) that are designated by roman numerals

Question 7

anticoagulants in relation to hemostasis

Answer 7

anticoagulants dissolve clots and prevent clots from forming unnecessarily

PLASMIN

Question 8

endothelial lining of blood vessels in relation to hemostasis

Answer 8

promotes blood flow

Question 9

what is the cascade event?

Answer 9

multistep event that makes the clot and prevents clots from being made. very predictable

Question 10

What are normal steps that occur during injury to vessels?

Answer 10

1. vessel spasm
   
   • vasoconstriction
   • release of platelets
2. platelet plug
   
   • von Willebrand factor
   • platelet aggregation
3. Fibrin Clot Formation
   
   • blood coagulation
   • intrinsic pathway
   • extrinsic pathway
   • coagulation cascade
4. Repaired Vessel
   
   • clot retraction
   • clot dissolution

Question 11

von Willebrand factor

Answer 11

(2nd step) released from the endothelium and causes adhesion of components/platelets to the opening of the vessel wall

Question 12

platelet aggregation

Answer 12

(2nd step) platelets come in contact with the damaged wall and adhere to the wall and get sticky so they can stick to each other

Question 13

intrinsic pathway

Answer 13

(3rd step) activation of specific factors. slow process. Factor XII (12) activation

Question 14

extrinsic pathway

Answer 14

(3rd step) occurs when there is more injury. much faster. Factor X (10).
Factor X changes prothrombin to thrombin (fibrous threads)

Question 15

coagulation cascade

Answer 15

(3rd step) step wise process of fibrinogen into fibrin

Question 16

clot retraction

Answer 16

(4th step) shrinkage of clot over a couple of days. as it shrinks it pulls edges together of the blood vessel at the point of injury. Fibrin strands contract and squeeze out plasm

Question 17

clot dissolution

Answer 17

(4th step)fibrinolysis. strands of the clot are dissolved

Question 18

hypercoagulability

Answer 18

over coagulation. too many platelets.

• thrombocytosis : elevated (abnormal) platelet count
• caused by: reactive disorders like anemia, cancer and rheumatoid arthritis or endothelial injury, vascular wall damage like atherosclerosis

Question 19

atherosclerosis

Answer 19

hardening of arteries caused by hypertension( constant hard pressure on vessels so they stiffen up and become stiff). caused by smoking and high cholesterol

Question 20

what causes increased clotting activity?

Answer 20

Primary: inherited disorders like genetic Factor V deficiency (deep veins prone to thrombosis).
Or
Secondary:Acquired disorders like… bed rest, immobility, hyper viscosity syndrome (polycythemia, Sickle Cell), oral contraceptives, pregnancy

Question 21

what should nurses do to help people who have increased clotting activity?

Answer 21

keep patients hydrated, compression hoes, give anticoagulants

Question 22

Bleeding Disorders

Answer 22

• either not enough or not activating appropriately
• problem in one cascade even (leads to incomplete cascade event)
• problem in vessels

Question 23

ITP (thrombotic thrombocytopenic purpura)

Answer 23

bleeding disorder. autoimmune disorder where there is excessive destruction of platelets with bruising, noise bleeds, blood in stools, spleen enlargement (site where platelet destruction occurs), spontaneous adhesion of platelets these patients do have in small vessels (see a lot of bruising in fingers)

Question 24

Thrombocytopenia

Answer 24

bleeding disorder. decrease number of platelets

Question 25

what are some medications that interfere with platelet formation?

Answer 25

Nsaids (Motrin and Tylenols), Aspirin

Question 26

what are some common places to bleed spontaneously?

Answer 26

skin, mucus membranes in mouth, nose, uterine cavity, GI tract

Question 27

deep vein thrombosis is often seen in who?

Answer 27

patients on bed rest. clots form in the deep veins of their legs

Question 28

people with what sort of disorders should avoid sports?

Answer 28

coagulation… but really shouldn’t they all???

Question 29

Hemophilia

Answer 29

inherited coagulation disorder.

• deficient Factor VIII (8)
• x-linked recessive deficient factor VII
• mainly seen in males
• diagnosed as children because children get a lot of injuries
• could be either no factor 8 or insufficient factor 8

Question 30

von Willebrand disease

Answer 30

inherited coagulation disorder.

• autosomal dominate disorder
• disturbs platelet function and coagulation pathways

Manifestations: mucus membranes bleed excessively and for prolonged periods

Question 31

Acquired Coagulation Disorders

Answer 31

• Liver Disease (Hepatitis or drinking)
• Vitamin K : needed to make clotting factor, made in the liver
• DIC (disseminated intravascular coagulation)

Question 32

DIC

Answer 32

massive activation of coagulation. a process of clothing in some areas (no blood flow) along with hemorrhaging in other areas because there are no platelets flowing in the blood because they are used elsewhere.

with DIC you worry about organ failure or hemorrhaging to death.

DIC is seen in patients with sepsis, massive injury, TSS (toxic shock syndrome: pulls out magnesium?bigger sizes make it worse)