Chap 24

Question 1

Von Willebrands disease

Answer 1

Most common inherited blood disorder occurring in about one in a thousand. Although the patient has a normal number of platelets circulating in the bloodstream, the patients platelets are functionally defective, thus allowing for excessive bleeding when injury occurs

Question 2

Hemophiliacs

Answer 2

Inherited genetic disorders that prevent them from producing certain clotting factors

Question 3

Coagulopathy

Answer 3

Loss of the normal ability to form a blood clot with internal or external bleeding

Coagulopathy can occur when the body forms clots too readily or when the patient clots too slowly, resulting in uncontrolled bleeding

Question 4

Two major components within the blood that are responsible for clotting

Answer 4

Platelets- Clumping of platelets is the body’s most rapid and initial response to stop bleeding

Clotting factors- are a group of proteins that are produced in the liver and released into the bloodstream. Clotting factors circulate in the bloodstream in inactive forms but are activated to initiate clotting when damage occurs to the lining of a damaged blood vessel. Once activated, clotting factors form clots though specified steps that are described as clotting cascades. These clotting factors form the most stable clots, replacing the initial efforts of the platelets to stop bleeding

Question 5

Clumping

Answer 5

Called aggregation. Clumping of platelets is the body’s most rapid response to stop bleeding from an injured site. Some situations the clumping of platelets is not desirable, such as when plaque in a coronary artery ruptured. In this situation the rapid clumping of platelets can cause a clot that then completely blocks the coronary artery. One of the most effective and widely available drugs to prevent the aggregation of platelets is aspirin

Question 6

Cirrhosis

Answer 6

An advanced liver disease that causes the liver to not make adequate clotting factors to form stable clots

Question 7

Atrial fibrillation

Answer 7

Abnormal cardiac rhythms

Commonly takes blood thinners

Question 8

Common blood thinners

Answer 8

Inhibit certain clotting factors
Coumadin (warfarin)
Pradaxa (dabigatran)
Eliquis (apixaban)
Xarelto (rivaroxaban)
Lovenox (enoxaparin)

Inhibit platelet aggregation
Aspirin
Plavix (clopidogrel)

Question 9

Acute anemia

Answer 9

May be the result of trauma or of sudden massive bleeding from the gastrointestinal traction

Sign and symptoms
Shock

Question 10

Anemia

Answer 10

Lack of a normal number of red blood cells in circulation

Question 11

Chronic anemia

Answer 11

Occurs over time and can be caused by conditions such as recurrent heavy menstrual periods, slow gastrointestinal blood loss, or diseases that affect the bone marrow or SCA

Signs and symptoms
More pale than usual( lack of red blood cells circulating)
Fatigue and shortness of breath with exertion (due to lack of adequate oxygen being delivered to the body’s cells.
Only after a long period will a patient exhibit signs of shock

Question 12

SCA

Answer 12

Sickle cell anemia

An inherited disease in which patients have a genetic defect in their hemoglobin that results in abnormal structure of the red blood cells

Usually occurs in African, middle eastern or Indian descent but most common in Africans. 1 in 12 Africans have sickle cell trait

Normal red blood cells are able to be compressed as they move and squeeze through small capillaries to deliver oxygen. Patients with sickle cell disease have red blood cells composed of defective hemoglobin that causes them to lose their ability to have a normal shape and compressibility.

Sludging of the abnormally shapes red blood cell, which cause blockage within the body’s small blood vessels.

Abnormal shapes in RBCs don’t survive in circulation as long as normal RBCs. This result in chronic anemia.

Question 13

Complications of sickle cell anemia

Answer 13

• Destruction of the spleen
  
  • the spleen as it filters the blood becomes blocked by the abnormal RBCs. Because the spleen is important in fighting infections, it’s loss places patients with SCA at higher risk for severe, life-threatening infections
• Sickle cell pain crisis
  
  • Sickle cell crisis is caused by the sludging of sickled RBCs In capillaries which results in severe pain in the arms, legs, chest and abdomen
• acute chest syndrome
  
  • Chest syndrome is characterised by shortness of breath and chest pain associated with hypoxia when blood vessels in the lungs become blocked
• Priapism
  
  • Painful prolonged erections in males occur because sludging RBCs prevent normal blood drainage from the erect penis
• Stroke
  
  • Stroke can occur when sludging RBCs block blood vessels that supply the brain
• Jaundice
  
  • The liver become overwhelmed by the breakdown in red blood cells resulting in yellowish pigmentation of body tissues

Question 14

Acute chest syndrome

Answer 14

Chest syndrome is characterised by shortness of breath and chest pain associated with hypoxia when blood vessels in the lungs become blocked

Question 15

UTI

Answer 15

Urinary tract infection

The most common disease process that afflicts the renal and urinary system.

Caused by bacteria and most UTIs are limited to the bladder, causing symptoms of pain and frequent urination.

Question 16

Pyelonephritis

Answer 16

If a UTI is left untreated, an infection in the bladder can ascend up the ureter and into the kidney called pyelonephritis.

Patients will complain of unilateral flank pain in addition to normal UTI symptoms

Question 17

Kidney stones

Answer 17

Painful and common condition related to the renal system. Usually made of calcium and are formed within the kidney. Usually no symptoms until it leaves the kidney.

Causes severe unilateral flank pain that radiates to the groin. Nausea and vomiting

Question 18

Urinary catheter

Answer 18

A drainage tube placed into the urinary system to allow the flow of urine out of the body

Long term catheters- put into urethra

Self- catheters- catheter put in urethra each tile they urinate

Question 19

Renal failure

Answer 19

Loss of the kidneys ability to filter the blood and remove toxins and excess fluid from the body

Question 20

Acute renal failure

Answer 20

Occur as a result of shock, toxic ingestion, and other causes like dehydration.

Question 21

Chronic renal failure

Answer 21

Inherited diseases such as polycystic kidney disease.
Long term damage is caused by poorly controlled diabetes and or high blood pressure that results in the loss of normal renal function

Question 22

ESRD

Answer 22

End stage renal disease

Irreversible renal failure to the extent that their kidneys cannot longer provide adequate filtration and fluid balance to sustain life

Survival usually requires dialysis

Question 23

Dialysis

Answer 23

The process by which toxins and excess fluid are removed from the body by a medical system independent of the kidneys

Question 24

To general types of dialysis

Answer 24

Hemodialysis and peritoneal dialysis

Question 25

Hemodialysis

Answer 25

The most common form of dialysis, a patient is connected to a dialysis machine that pumps his blood through specialised filters to remove toxins and excess fluid

Patient undergoes three treatments a week and lasting 3-4 hours

Question 26

Peritoneal dialysis

Answer 26

Usually do so in their own home period PD is slower process than HD and requires multiple treatments every day for most patients

Outside the United States and Canada, PD is the most common form of dialysis

Peritoneal dialysis works by using the large surface area inside the peritoneal cavity that surrounds the abdominal organs as a means of removing toxins and excess fluid from the body. Several litres a specially formulated dialysis solution is run into the Abdominal cavity and left in place for several hours where it absorbs waste material and access fluid. then the fluid is drained back out and into the bag and is discarded.

Question 27

Thrill

Answer 27

A vibration felt on a gentle palpation, such as that which typically occurs with in arterial Venus fistula

Question 28

Two Port catheter

Answer 28

One catheter allows blood to flow out of the body into the dialysis machine and the catheter returns blood to the body after filtration

Question 29

Fistula

Answer 29

A surgically created for Fistula in one of their extremities that connects arterial and Venus blood flow. Because a fistula contains turbulent flow between a surgically connected artery and vein, a properly functioning AV fistula will have a characteristic vibration called a thrill, when gently palpated

Question 30

Exchange

Answer 30

one cycle of filling and draining the peritoneal cavity in peritoneal dialysis

Question 31

Two types of peritoneal dialysis

Answer 31

CAPD (continuous ambulatory peritoneal dialysis)

Most common. A gravity exchange process for peritoneal dialysis in which a bag of dialysis fluid is raised above the level of an abdominal catheter to fill the abdominal cavity and lowered below the level of the abdominal catheter to drain the fluid out. Fluid is left in the peritoneal by clamping the catheter for 4-6 hours and repeated several times a day

CCPD (Continuous cycler-assisted peritoneal dialysis)

a mechanical process for peritoneal dialysis in which a machine fills and empties the abdominal cavity of dialysis solution. fluid exchanged 3-5 times during the night while patient sleeps. In the morning the last fill remains in abdomen with a dwell time that lasts the entire day

Question 32

Complications of ESRD

Answer 32

Failure to receive dialysis-EX, miss appointment or bad weather.

Signs of symptoms mimic congestive heart failure. These include shortness of breath because of fluid backup in the lungs and the accumulation of fluids elsewhere, such as ankles, hands and face. Also due to patient no longer can balance and clear excess electrolytes as well as other toxins, patients who have miss dialysis may suffer from electrical disturbances of the heart (dysrhythmias). this is because the proper functioning of the hearts electrical system requires that the balance of electrolytes in the bloodstream be kept within a certain tight range

Question 33

Complications of dialysis

Answer 33

• Bleeding from the site of the AV fistula when the dialysis needles are removed
• Clotting and loss of function of the AV fistula. This results in the fistulas feeling hard to the touch and in loss of the normal thrill felt on palpation
• Bacterial infection of the blood due to contamination at the AV fistula or dialysis catheter site during machine connection and disconnection

Question 34

Peritonitis

Answer 34

bacterial infection within the peritoneal cavity.

Peritonitis may develop abdominal pain, fever, and the telltale sign that their dialysis fluid appears cloudy

If peritonitis is suspected in a patient on peritoneal dialysis, transport the bag of exchanged dialysis fluid with the patient so it may be tested for bacteria at the hospital to confirm diagnosis

Question 35

Drugs that inhibit platelet aggregation

Answer 35

Aspirin and Plavix

Question 36

What to ask every trauma victim during the SAMPLE

Answer 36

Do they take blood thinners