Ch.20 Endocrinehematologic Flashcards
A metabolic disorder in which the ability to metabolize carbohydrates (sugar) is impaired, usually because of a lack insulin
Diabetes mellitus
A flat, solid organ that lies below the liver and the stomach; it is a major source of digestive enzymes and produces the hormone insulin
Pancreas
An abnormally high blood glucose level
Hyperglycemia
An abnormally low blood glucose level
Hypoglycemia
The complex message and control system that integrates many body functions, including the release of hormones
Endocrine system
A balance of all systems of the body
Homeostasis
Endocrine glands secrete messenger__, which are chemical substances produced by a gland.____ travel through the blood to the end organs, tissues, or cells that they are intended to affect. When the____ arrives, the cell, tissue, or organ receives the message and an action or cellular process takes place.
hormones
The brain needs two things to survive:
Glucose and oxygen
One of the basic sugars; it is the primary fuel, in conjunction with oxygen, for cellular metabolism
Glucose
A hormone produced by the islets of langerhans(endocrine gland located throughout the pancreas) that enables glucose in the blood to enter cells; used in synthetic form to treat and control diabetes mellitus
Insulin
Endocrine disorders are caused by an internal communication problem. If a gland is not functioning normally, it may produce more hormone (___) than is needed or it may not produce enough hormone ().
hypersecretion
hyposecretion
Impairs body’s ability to use glucose of fuel
Diabetes mellitus
The pancreas produces and stores two hormones that play a major role in glucose metabolism
Glucagon and insulin
A small portion of the pancreas is filled with the islets of Langerhans. Within these islets are alpha and beta cells. The__ cells produce glucagon and the___ cells produce insulin.
alpha
Beta
Substances formed in specialized organs or glands and carried to another organ or group of cells in the same organism; they regulate many body functions, including metabolism, growth, and body temperature
Hormones
Glands that secrete or release chemicals that are used inside the body
Endocrine glands
The brain needs two things to survive
Glucose and oxygen
___ is necessary for glucose to enter the cells for metabolism
Insulin
Endocrine disorders are caused by an internal communication problem. If a gland is not functioning normally, it may produce more___ (hypersecretion) than is needed or it may not produce enough____ (hyposecretion).
hormone
In a person without diabetes, the pancreas stores and secretes insulin and glucagon in response to the level of____ in the blood (FIGURE 20-1). When a person eats, the level of glucose in his or her blood rises. In response, the pancreas secretes insulin into the blood; this allows the____ to enter the body’s cells and be used for energy. It also allows___ to be stored in the form of glycogen in the liver and skeletal muscles for use at a later time. As blood___ levels return to normal, insulin stops being secreted and the body is said to be in a state of being fed.
glucose
The pancreas produces and stores two hormones that play a major role in glucose metabolism:
Glucagon and insulin
A small portion of the pancreas is filled with the____. Within these islets are alpha and beta cells. The alpha cells produce glucagon and the beta cells produce insulin.
islets of Langerhans
In a person without diabetes, the pancreas stores and secretes insulin and glucagon in response to the level of glucose in the blood (FIGURE 20-1). When a person eats, the level of glucose in his or her blood rises. In response, the pancreas secretes insulin into the blood; this allows the glucose to enter the body’s cells and be used for energy. It also allows glucose to be stored in the form of glycogen in the ____ and skeletal muscles for use at a later time. As blood glucose levels return to normal, insulin stops being secreted and the body is said to be in a state of being fed.
liver
As time passes, the body will become hungry again. If the hungry individual skips or delays a meal, a message is sent to the pancreas to secrete glucagon. Glucagon then stimulates the liver and the skeletal muscles to release____ and converts it back to glucose for use as cellular fuel.
glycogen
____is a disorder of glucose metabolism, such that the body has an impaired ability to get glucose into the cells to be used for energy. The patient with diabetes has either impaired insulin production or not enough functional receptors on the surface of the cells for the insulin to bind to. Glucose cannot get into the cell, the cell goes unfed, and the level of glucose in the blood remains high and continues to rise
Diabetes mellitus
A metabolic disorder in which the ability to metabolize carbohydrates(sugars) is impaired, usually because of a lack of insulin
Diabetes mellitus
There are three types of diabetes:
diabetes mellitus type 1, diabetes mellitus type 2, and pregnancy-induced gestational diabetes.
Diabetes that develops during pregnancy in women who did not have diabetes before pregnancy
Gestational diabetes
Is a state in which the blood glucose level is above normal
Hyperglycemia
Is a state in which the blood glucose level is below normal
Hypoglycemia
Onset, skin, infection of hypoglycemia
Rapid (within minutes )
Pale, cool, and moist
Uncommon
Onset, skin, infection of hyperglycemia
Gradual (hours to days)
Warm and dry
Common
Thirst, hunger, vomiting/abdominal pain of hyperglycemia
Intense
Present and increasing
Common
Thirst, hunger, vomiting/abdominal pain of hypoglycemia
Absent
Absent
Uncommon
Breathing, odor of breath of hyperglycemia
With DKA there are rapid, deep (kussmaul) respirations
With DKA there may be a sweet, fruity odor
Breathing, odor of breath with hypoglycemia
Normal; may become shallow or ineffective if hypoglycemia is severe and mental status is depressed
Normal
Blood pressure, pulse of hyperglycemia
Normal to low
Rapid, week, and thready
Blood pressure, pulse of hypoglycemia
Normal to low
Rapid, weak
Consciousness of hyperglycemia
Restlessness , possibly progressing to coma; abnormal or slurred speech; unsteady gait
Consciousness of hypoglycemia
Irritability, confusion, seizure, or coma; unsteady gait
Treatment response of hyperglycemia
Gradual, within 6 to 12 hours following medical treatment
Treatment response of hypoglycemia
Immediate improvement after administration of glucose
_______is an autoimmune disorder in which the individual’s immune system produces antibodies against the pancreatic beta cells. Essentially, this disease is about the missing pancreatic hormone insulin. Insulin is the “key” to the
“door” of the cell. Without insulin, glucose cannot enter the cell, and the cell cannot produce energy.
The onset of this disorder usually happens from early childhood through the fourth decade of life. The patient’s immune system progressively destroys the ability of the pancreas to produce insulin. Without the insulin from the pancreatic beta cells, the patient must obtain insulin from an external source. Patients with____ cannot survive without insulin.
Patients who inject insulin often need to check their blood glucose levels up to six times per day or more using a lancet and a small capillary blood sample read by using a glucometer
Type 1 diabetes
Many people with type 1 diabetes have an implanted____. Some of these devices continuously measure the body’s glucose levels and provide an (adjustable) infusion of insulin and correction doses of insulin based on carbohydrate intake at mealtimes (FIGURE 20-5). The presence of an___ that automatically measures blood glucose limits the number of times patients have to check their fingerstick glucose level. Some insulin pumps do not measure blood glucose automatically, but rather deliver a continuous baseline dose of insulin that may be supplemented by an additional bolus dose depending on the blood glucose measurement the patient takes at mealtimes. Unfortunately,___ can malfunction and hyperglycemic or hypoglycemic diabetic emergencies can develop. Always inquire about the presence of an__-particularly in patients with type 1 diabetes— and ask the patient if it is working properly.
insulin pump
Type 1 diabetes is the most common metabolic disease of childhood. A patient with_____ will have
symptoms related to eating and drinking:
• Polyuria
• Polydipsia
• Polyphagia
• Weight loss
• Fatigue
new-onset type 1 diabetes
The passage of an unusually large volume of urine in a given period; in diabetes, this can result from the wasting of glucose in the urine
Polyuria
Excessive thirst that persists for long periods despite reasonable fluid intake; often the result of excessive urination
Polydipsia
Excessive eating; in diabetes, the inability to use glucose properly can cause a sense of hunger
Polyphagia
Normal blood glucose level is between
80 and 120
The body’s metabolism is sensitive to the levels of particular substances, such as glucose, in the blood. The____ filter the blood and thus manage all substances present in the blood.
At normal levels, glucose remains in the blood as it is filtered.
When a patient’s blood glucose level is above normal, the____ filtration system becomes overwhelmed and glucose spills into the urine. The increased amount of glucose in the urine causes more water to be pulled out of the bloodstream into the urine. This results in more frequent urination, or polyuria.
kidneys
The autoimmune destruction of the pancreatic beta cell takes time to progress. For this reason, initial symptoms are typically subtle and not readily apparent to the patient. As the lack of insulin becomes more profound, the patient will notice increasing fatigue and malaise along with vague symptoms of generalized illness.
When the body’s cells do not receive the glucose they require for energy, the body resorts to burning fat for energy. When the body burns fat rather than glucose, acid waste is produced. These acids are called ketones. As ketone levels increase in the blood, the ketones also begin to spill into the urine (as does the excess glucose). When the kidneys become saturated with glucose and ketones, they do not work properly to maintain acid-base balance in the body. The body responds with a backup system and the patient begins to breathe faster and deeper. This respiratory pattern is the body’s attempt to reduce the acid level by releasing more carbon dioxide through the lungs. This breathing pattern is known as_____.
Kussmaul respirations
If fat metabolism and ketone production continue, a life-threatening illness called___ can develop
in patients with diabetes.____ may present as:
• Generalized illness, accompanied by:
• Abdominal pain
• Body aches
• Nausea
• Vomiting
• Altered mental status or unconsciousness (if severe)
diabetic ketoacidosis (DKA)
Deep, rapid breathing; usually the result of an accumulation of certain acids when insulin is not available in the body
Kussmaul respirations
A form of hyperglycemia in uncontrolled diabetes in which certain acids accumulate when insulin is not available
Diabetic ketoacidosis (DKA)
Do not attempt to coach the patient to slow his or her breathing if you suspect___. This rapid, deep breathing is helping the patient compensate for acidosis. If breathing is slowed, more acids can accumulate and the patient’s condition will worsen.
Kussmaul respirations
The buildup of excess acid in the blood or body tissues that can result from a primary illness
Acidosis
When a patient with___ has an altered mental status, ask the patient’s family and friends about the patient’s history and
presentation. Obtain a glucose level with a fingerstick using a lancet and a glucometer. (This procedure is covered in Chapter 10, Patient Assessment.) The patient with___ will generally have a fingerstick glucose level higher than 400 mg/dL.
This presentation of the patient with type 1 diabetes in ___ does not only occur when there is an absolute lack of insulin.
___may also present in cases of a relative lack of insulin, which may occur when there is an acute illness, or an untreated infection or other stressor on the body that leaves the patient with type 1 diabetes in a weakened condition.
DKA
_____is caused by resistance to the effects of insulin at the cellular level. Recall that we described insulin as the key to the door of the cell. Insulin resistance means the lock is unable to accept the key. As a review, in type 1 diabetes, no insulin is produced, so there are no keys. In____ there are typically fewer insulin receptors.
Obesity predisposes patients to___; there is an association between obesity and increased resistance to the effects of insulin. As the number of obese people continues to rise, so does the number of patients with__.
When diabetes begins, the individual’s pancreas produces more insulin to make up for the increased levels of blood glucose and dysfunction of cellular insulin receptors. Over time this response becomes inefficient. The blood glucose levels continue to rise and do not respond when the pancreas secretes insulin, a process called insulin resistance. In some cases, insulin resistance can be improved by exercise and dietary modification.
In many instances diet and exercise alone cannot control insulin resistance, and oral medications must be started to better control blood glucose levels. Oral medications used to treat____ vary widely. Some of them increase the secretion of insulin and create a high risk of hypoglycemic reaction, whereas others do not (TABLE 20-2). Injectable medications and various insulin preparations are also used for____ when oral medications alone will not regulate blood glucose.
Type 2 diabetes
_____is often diagnosed at a yearly medical examination. In some cases, the patient’s physician discovers____ when treating the patient for a complaint related to high blood glucose levels. Examples of such complaints include recurrent infection, change in vision, or numbness in the feet.
Diabetes mellitus type 2
___occurs when blood glucose levels are very high. Early signs and symptoms include frequent urination, increased thirst, blurred vision, and fatigue. If the high blood glucose levels go untreated, the patient may present with a fruity odor on his or her breath, nausea and vomiting, shortness of breath, dry mouth, weakness, or altered mental status. The patient is in a state of altered mental status resulting from several combined problems.
Symptomatic hyperglycemia
In type 1 diabetes. hyperglycemia leads to ketoacidosis and dehydration from excessive urination. In type 2 diabetes, hyperglycemia leads to a state of dehydration due to the discharge of fluids from all body systems and eventually out through the kidneys, leading to a much more ominous situation of fluid imbalance known as___.
hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
Hyperglycemia does not always result in a crisis event. If an individual has hyperglycemia for a prolonged time, it is not uncommon for the secondary consequences of diabetes to present. These are wounds that do not heal, numbness in the hands and feet, blindness, renal failure, and gastric motility problems, to name a few.
When blood glucose levels are not controlled in diabetes mellitus type 2,___ can develop.___ can present similarly to the DKA seen in patients with type 1 diabetes. The onset of this disorder is commonly associated with a profound infection or illness.
Key signs and symptoms of___ include the following:
• Hyperglycemia
• Altered mental status, drowsiness, lethargy
• Severe dehydration, thirst, dark urine
• Visual or sensory deficits
• Partial paralysis or muscle weakness
• Seizures
HHNS
Higher glucose levels in the blood cause the excretion of glucose in the urine. Patients respond by increasing their fluid intake precipitously (polydipsia) causing an equally precipitous excretion of fluid (polyuria). In_____, however, the patient cannot drink enough fluid to keep up with the exceedingly high glucose levels in the blood. The kidneys become overwhelmed and the patient’s blood becomes much more concentrated than normal. As___ progresses, the urine becomes rather dark and concentrated. The term hyperosmolarity describes very concentrated blood as a result of relative dehydration. As____ progresses, the patient may become unconscious or have seizure activity due in part to the severe dehydration that results.
HHNS
_____is an acute emergency in which a patient’s blood glucose level drops and must be corrected swiftly. A low blood glucose level can occur in patients who inject insulin or use oral medications that stimulate the pancreas to produce more insulin. When insulin levels remain high, glucose is rapidly taken out of the blood to fuel the cells. If glucose levels fall too low, there may be an insufficient amount to supply the brain. The mental status of the patient declines precipitously and he or she may become aggressive or display unusual behavior. If blood glucose remains low, unconsciousness and permanent brain damage can quickly follow.
_____can occur for many different reasons. Some of the more common reasons for a low blood
glucose level to develop are because the patient or caregiver administered one of the following:
• A correct dose of insulin with a change in routine (the patient exercised more, consumed a meal later than usual, or skipped the meal)
• More insulin than necessary
• A correct dose of insulin without the patient eating a sufficient amount
• A correct dose of insulin and an acute illness developed in the patient
Symptomatic hypoglycemia
_____develops much more quickly than hyperglycemia. In some instances, it can occur in a matter of minutes.
_____can be associated with the following signs and symptoms:
• Normal to shallow or rapid respirations
• Pale, moist (clammy) skin (in dark-skinned people, paleness is more apparent by examining the mucous membranes inside the lower eyelid)
• Diaphoresis (sweating)
• Dizziness, headache
• Rapid pulse
• Normal to low blood pressure
• Altered mental status (aggressive, confused, lethargic, or unusual behavior) e
• Anxious or combative behavior
• Seizure, fainting, or coma
• Weakness on one side of the body (may mimic stroke)
• Rapid changes in mental status
Hypoglycemia
Low blood glucose level events are not uncommon in____. Most children adapt well to the routine of managing their diabetes, but during periods of growth, their blood glucose may be more difficult to regulate. Some toxic ingestions and overdose cause hypoglycemia in children. Children cannot store excess glucose as effectively as adults; therefore, the blood glucose level can drop in children even in the absence of diabetes or medication. As an EMT, you must have a high index of suspicion for a low glucose lever when you encounter a child who has an altered mental status or depressed level of consciousness.
pediatric patients
Hyperglycemia is a complex metabolic condition that usually develops over time and involves all the tissues of the body.
Correcting this condition may take many hours in a well-controlled hospital setting. Hypoglycemia, however, is an acute condition that can develop rapidly. A patient with diabetes who has taken his or her standard insulin dose and missed lunch may have____ before dinner. The condition is just as quickly reversed by giving the patient glucose.
Without the glucose, however, the patient can sustain permanent brain damage. Minutes count.
symptomatic hypoglycemia
A patient with____(rapid onset of altered mental status, hypoglycemia) needs glucose immediately. A patient with____(acidosis, dehydration, hyperglycemia) needs insulin and IV fluid therapy. These patients need prompt transport to the hospital for appropriate medical care.
symptomatic hypoglycemia
symptomatic hyperglycemia
When there is any doubt about whether a conscious patient with diabetes is going into symptomatic hypoglycemia or symptomatic hyperglycemia, most protocols will err on the side of giving glucose, even though the patient may have hyperglycemia or DKA. Untreated hypoglycemia will result in loss of consciousness and can quickly cause significant brain damage or death. The condition of a patient with_____ is far more critical and far more likely to cause permanent problems than the condition of a patient with hyperglycemia or DKA. Furthermore, the amount of sugar that is typically given to a patient with symptomatic hypoglycemia is unlikely to make a patient with DKA significantly worse. When in doubt, consult medical control.
symptomatic hypoglycemia
There are three types of____ preparations available commercially. The most common for EMS providers is a rapidly dissolving gel (FIGURE 20-7). The second preparation comes in a large chewable tablet. The third preparation is a liquid formulation. Glucose gel acts to increase a patient’s blood glucose levels. If authorized by your system, you should administer glucose gel to any patient with a decreased level of consciousness who has a history of diabetes. The only contraindications to oral glucose are an inability to swallow and unconsciousness, because aspiration (inhalation of the substance) can occur. Oral glucose itself has no side effects if it is administered properly; however, the risk of aspiration in a patient who does not have a gag reflex is substantial. A conscious patient (even if confused) who does not really need glucose will not be harmed by it. Therefore, do not hesitate to give glucose under these circumstances.
oral glucose
A simple sugar that is readily absorbed by the bloodstream; it is carried on the Ems unit
Oral glucose
Although seizures are rarely life threatening, you should consider them to be very serious, even in patients with a history of chronic seizures. Seizures, which may be brief or prolonged, are often caused by infections, poisoning,__, trauma, or decreased levels of oxygen, or they may be idiopathic (of unknown cause). In children, they may be caused by fever or epilepsy. Although brief seizures are not harmful, they may indicate a more dangerous and potentially life-threatening underlying condition. Because seizures can be the result of a head injury, consider trauma as a cause. In the patient with diabetes, you should also consider___.
hypoglycemia
Although altered mental status is often caused by complications of diabetes, it may also be caused by a variety of other conditions, including poisoning, infection, head injury, part of the postictal state (period following a seizure), and decreased perfusion to the brain. In diabetes, altered mental status can be caused by____ and by ketoacidosis.
The mnemonic AEIOU-TIPS is easily remembered and covers a multitude of conditions that can lead to altered mental status. As such, many of the conditions covered by the mnemonic can be confused, resulting in a misdiagnosis when the patient’s blood glucose level is not assessed.
hypoglycemia
AEIOU-TIPS stands for the following conditions:
• Alcohol
• Epilepsy, endocrine, electrolytes
• Insulin
• Opiates and other drugs
• Uremia (kidney failure)
• Trauma, temperature
• Infection
• Poisoning, psychogenic causes
• Shock, stroke, seizure, space-occupying lesion, subarachnoid hemorrhage
Is the study of blood-related diseases
Hematology
A hereditary disease that causes normal, round red blood cells to become oblong, or sickle shaped
Sickle cell dease ( also called hemoglobin S disease)
A hereditary condition in which the patient lacks one or more of the bloods normal clotting factors
Hemophilia
A tendency toward the development of blood clots as a result of an abnormality of the system of coagulation
Thrombophilia
The study and prevention of blood-related disorders
Hematology
Blood is made up of four components
Erythrocytes ( red blood cells)
Leukocytes ( white blood cells)
Platelets
Plasma
Cells that carry oxygen to the body’s tissues; also called erythrocytes
Red blood cells
Blood cells that have a role in the body’s immune defense mechanisms against infection; also called leukocytes
White blood cells
Tiny, disc-shaped elements that are much smaller than the cells; they are essential in the initial formation of a blood clot, the mechanism that stops bleeding
Platelets
A sticky, yellow fluid that carries the blood cells and nutrients and transports cellular waste material to the organs of excretion
Plasma
____make up 42% to 47% of a person’s total blood volume.___ contain an important protein,
hemoglobin, which carries 97% of the oxygen in the blood and some of the carbon dioxide.
Red blood cells (RBCs)
___make up 0.1% jo 0.2% of a person’s blood cell volume. In a healthy person,___ collect dead cells and provide for their correct disposal. In times of health,___ levels are low. When an infection develops,___ and all of their complementary defense systems are activated and their numbers grow.
White blood cells (WBCs)
___make up 4% to 7% of a person’s blood cell volume and are essential for clot formation. When damage occurs to your skin or to a blood vessel, platelets are sent to the site of injury to assist in forming a blood clot to stop the bleeding.
Without this protective response, bleeding from a simple cut could be uncontrollable.
Platelets
___serves as the transportation medium for all blood components as well as proteins and minerals.
Plasma
____, is an inherited blood disorder that affects the RBCs. The name sickle cell comes from the first case report of the disease in 1910, when Dr. James Herrick wrote that the RBCs looked like a sickle (FIGURE 20-8). The odd-shaped cells protect the individual from contracting malaria. This protection is useful to people who live in sub-Saharan Africa where malaria is common, but it is not useful to people who do not live in regions endemic for malaria
Sickle cell disease, also called hemoglobin S disease
There are several variants that make up this genetic disease. It is sufficient to simply understand that the issues of sickle cell can happen with any of the variants. This disease is common among people of African, Caribbean, and South American ancestry. It is present but less common in Mediterranean and Middle Eastern people. All newborns in the United States are tested for sickle cell disease shortly after birth, regardless of their race or ethnic background.
The sharp and misshapen cells lead to dysfunction in oxygen binding and unintentional clot formation. These
unintentional clots may result in a blockage known as vasoocclusive crisis.
Sickle cell disease
Ischemia and pain caused by sickle-shaped red blood cells that obstruct blood flow to a portion of the body
Vasoocclusive crisis
The life span of normal____ is approximately 110 to 120 days; sickled cells have a much shorter life span. This results in more cellular waste products in the bloodstream, which can contribute to sludging (clumping) of the blood. Maintaining hydration status is important to these patients, as is maintaining their general health, because insufficient hydration leads to increased clumping of cells.
RBCs
Complications associated with___ include the following:
Anemia
• Gallstones |
• Jaundice
• Splenic dysfunction
• Vascular occlusion with ischemia:
• Acute chest syndrome (hypoxia, dyspnea, chest discomfort, and fever)
• Stroke
• Bone necrosis (avascular necrosis; specifically the head of the femur and the humerus)
• Pain crises
. Acute and chronic organ dysfunction/failure
• Retinal hemorrhages
• Increased risk of infection
sickle cell disease
___is rare; according to the___ Federation of America, there are only approximately 20,000 Americans who have the disorder.
____A mostly affects males. Males inherit the condition from a mother who is a carrier but does not have the
disease; females only inherit the condition if their mother is a carrier and their father has the disease.
People with hemophilia A have a decreased ability to create a clot after an injury. The blood of a healthy individual will clot in as little as 13 seconds after a paper cut and not longer than approximately 7 minutes following a more serious injury that requires direct pressure. Having an extended bleeding time from the inability to clot can be life threatening.
A patient who is otherwise healthy but has hemophilia A can have a serious reaction to a minor trauma, such as a simple ankle sprain while playing soccer. Most people would ignore the sprain and simply continue to play the game. The patient with hemophilia A would begin to experience swelling from uncontrolled bleeding in the region of the injury and continue to do so, making the seemingly minor injury a significant problem.
Acute bleeding from any source may be life threatening, depending on where the bleeding occurs. Patients with hemophilia A can be prescribed medications to replace the missing clotting factors, release the clotting factors that are stored in the patient’s body, or prevent the breakdown of blood clots.
Hemophilia
Common complications of ____include the following:
• Long-term joint problems, which may require a joint replacement
• Bleeding in the brain (intracerebral hemorrhage)
• Thrombosis due to treatment
hemophilia A
A hereditary condition in which the patient lacks one or more of the bloods normal clotting factors
Hemophilia
A blood clot, either in the arterial or venous system. When the clot occurs in a cerebral artery, it may result in the interruption of cerebral blood flow and subsequent stroke
Thrombosis
_____is a disorder in the body’s ability to maintain the viscosity and smooth flow of blood through the venous and arterial systems. In____, the concentration of particular elements in the blood creates what amounts to clogging or blockage issues.
______is a general term for many different conditions that result in the blood clotting more easily than normal.
This results from either inherited (genetic) disorders, medications, or other factors. Patients with cancer are at increased risk of forming life-threatening blood clots. Whatever the risk factors, the common theme is that clots can spontaneously develop in the blood of the patient.
Thrombophilia
____is a common medical problem in sedentary patients and in patients who have had recent injury or surgery. Although several risk factors increase the chance that a___ will develop, there are several methods to prevent blood clot formation, including blood-thinning medications, compression stockings, and mechanical devices all of which you may encounter in the field.
____is a particularly worrisome risk for patients who have had joint replacement surgery. Be suspicious of this in a patient with a recent history of joint replacement who complains of leg swelling. Travelers, truck and long-distance bus drivers, and bedridden nursing home patients all are at higher risk for___ because they are sedentary for long periods of time.
If___ develops in an individual, anticoagulation therapy may be administered. A patient with___ may be treated in the
hospital with IV medications and then transitioned to oral medications or self-administered subcutaneous injectable medications to treat or prevent__. Patients who have been prescribed medications such as heparin, warfarin (Coumadin), dabigatran (Pradaxa), or rivaroxaban (Xarelto) to treat____ are at increased risk of bleeding complications (ie, gastrointestinal bleeding or stroke), and minor trauma is more likely to produce severe internal or external hemorrhage.
A life threat can develop if the clot from the___ travels from the patient’s lower extremity to the lung, causing a pulmonary embolus. Pulmonary emboli can cause chest pain, difficulty breathing, or, if the clots are large, sudden cardiac arrest. Pulmonary embolism is discussed in Chapter 16, Respiratory Emergencies.
Deep vein thrombosis (DVT)
_____is an abnormally low number of RBCs. RBCs contain hemoglobin, an iron-containing pigment that is responsible for 97% of the transport of oxygen from the lungs to the cells of the body. Each hemoglobin molecule is able to bind to and carry four molecules of oxygen.___ may be the result of either chronic or acute bleeding, a deficiency in certain vitamins or minerals, or an underlying disease process. If anemia is present, tissues may become hypoxic because the blood is unable to deliver adequate amounts of oxygen to the tissues, even though the available hemoglobin is fully saturated with oxygen and the lungs are delivering enough oxygen to the blood. In this situation, a pulse oximeter may indicate that there is adequate saturation, even though the tissues are hypoxic. This type of hypoxia is known as hypoxemic hypoxia.
Anemia
