Chapter 24 Hematologic And Renal Emergencies

Question 1

Bloods specific functions

Answer 1

Control of bleeding by clotting,

• delivery of oxygen to the cells
• removal of carbon dioxide from the cells
• removal and delivery of other waste products to organs to provide Filtration and removal such as the kidneys and liver

Question 2

Two major Blood clotting components

Answer 2

Platelets and clotting factors

Question 3

Clotting factors

Answer 3

Group of proteins that are produced in the liver and released into bloodstream

Circulate in the blood stream in inactive forms but are activated to initiate clotting when damage occurs to the lining of a damaged blood vessel

• form clots through specific steps described as clotting cascade’s
• form the most stable clots, replacing initial efforts of the platelets to stop bleeding

Question 4

Coagulopathy

Answer 4

Defined as abnormal clotting of blood

• happens when body forms clots too readily or clots to slowly
• resulting in uncontrolled bleeding

Question 5

Where are clotting factors manufactured?

Answer 5

Liver

Question 6

Advanced liver diseases

Answer 6

Cirrhosis - A liver disease that may not make adequate clotting factors to form stable clots

Inherited genetic diseases
• hemophiliac - Inherited disorder that prevents them from producing certain clotting factors

• von willebrands disease - The most common inherited blood disorder and occurring in about one in a 1000 persons.
- In this disease Patient has a normal number of platelets circulating in the blood stream, the patients platelets are functionally defective that’s allowing for excessive bleeding when injury occurs

Question 7

Blood thinners

Answer 7

There are certain medical conditions in which the normal ability to form clots can worsen the patient’s disease
Ex: heart attacks, strokes, abnormal cardiac rhythms such as atrial fibrillation

Thus the use of blood thinners - that thin the blood and reduce clotting in injuries

Some commonly referred drugs that inhibit certain clotting factors are: caumadin, Prada a, eliquis, xarelto, and lovenox

Question 8

Patient with a history of what kind of dysrhythmia are commonly on blood thinners

Answer 8

Atrial fibrillation

Question 9

Anemia

Answer 9

Lack of a normal number of red blood cells in the circulation

Question 10

Acute Anemia

Answer 10

May be a result of trauma or of sudden massive bleeding from the gastrointestinal tract/G.I. bleed

• showing signs and symptoms of shock, rapid pulse, diaphoretic skin and eventually hypotension

Question 11

Chronic Anemia

Answer 11

Occurs over time and can be caused by condition such as recurrent heavy menstrual periods, slow G.I. bleed’s, diseases that affect the bone marrow or the structure of the hemoglobin molecule

• often appear more pale than normal
• complain of fatigue and shortness of breath
• best way to asses for chronic anemia is to check conjunctiva (under eye lid) for red/ pink color in normal patients

Question 12

Sick cell anemia

Answer 12

And inherited disease in which a genetic defect in the hemoglobin results in abnormal structure of the red blood cells
- can occur in patients of African, Middle Eastern, or Indian descent, most common in African descent

• one in twelve African Americans have sickle cell trait

Question 13

Complications of sickle cell anemia

Answer 13

• destruction of spleen
- A spleen filters blood, becomes blocked by the abnormal RBCs. Spleen is important fighting infection, patients with SCA at a Higher risk for severe, life-threatening infection’s

• sickle cell pain crisis
- caused by sludging of sickled RBCs in capillaries, which results in severe pain in the arms, legs, chest, and/or abdomen

• acute chest syndrome
- characterized by shortness of breath and chest pain associated with hypoxia when blood vessels in the lungs become blocked

• priapism
- a can happen when sickle cell anemia RBCs prevent normal blood drainage from the erect penis

• stroke
- when sludging RBCs block blood vessels that supply the brain

• jaundice
- liver becomes overwhelmed by the breakdown and red blood cells, resulting in yellowish pigmentation of body tissues

Question 14

Kidneys

Answer 14

Responsible for the filtration of the blood and the removal of certain waste products, excessive salt, and excessive fluid from the body
- is the most commonly transplanted organs*****

Question 15

Urinary tract infection (UTI’s)

Answer 15

Most common disease process that Afflicts the Renal and your urinary systems

• caused by bacteria
• Limited to the bladder, causing symptoms of painful and frequent urination

Question 16

Pyelonephritis

Answer 16

An infection that begins in the urinary tract and ascends up the ureter into the kidney

• patients complain of unilateral flank pain
• Life-threatening disease/especially in the elderly, if bacteria spread into the bloodstream

Question 17

Kidney stones

Answer 17

Painful and common condition related to the renal system

• If remains in kidney, they usually cause no symptoms
• usually made of calcium and are formed within the kidney
• can cause severe unilateral flank pain that radiates to the groin area
• Patients often have associated nausea and vomiting

Question 18

Urinary catheters

Answer 18

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

Question 19

Renal Failure

Answer 19

Occurs when the kidneys lose their ability to adequately filter the blood and remove toxins and excess fluid from the body

Question 20

Acute Renal Failure

Answer 20

Can occur as a result of shock, toxic ingestion, And other causes.

Can recover kidneys or underlying cause if the occurrence to the kidneys is rapidly identified and correct

Question 21

Chronic Renal Failure

Answer 21

Causes include inherited diseases such as:
- polycystic kidney disease - forms cysts in ureters and kidneys Rendering them useless

• More commonly the 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

End stage renal disease (ESRD)

Answer 22

Patients with ESRD usually require dialysis to survive.

Approximately 900,000 Americans are being treated for SRD, more than 400,000 of these patients are on chronic dialysis

Question 23

Dialysis

Answer 23

The process by which an external medical system independent of the kidneys Is used to remove toxins and excess fluid from the body

Question 24

Two general types of dialysis

Answer 24

Hemodialysis and peritoneal dialysis

Question 25

Hemodialysis (HD)

Answer 25

Most common form of dialysis
- patient connected to dialysis machine that pumps blood through specialize filters

• Patient is connected to a dialysis machine by two large catheters
• One catheter allows blood to flow out Of the body into the dialysis machine, and other catheter returns blood to the body after filtration
• happens continuously for over several hours

Question 26

Thrill

Answer 26

a vibration felt on gentle palpation, such as that which typically occurs within an arterial Venous fistula

Question 27

Peritoneal dialysis

Answer 27

Slower process than HD and requires multiple treatments every day for most patients
- Patients choose this because they can treat at home - Outside the US and Canada, PD is the most common form of dialysis

Patients have permanent catheter implanted through abdominal wall and into peritoneal cavity

• several liters of specially formulated dialysis solution are run into abdominal cavity and left in place for several hours
• Where it absorbs waste material and excess fluid, fluid is draining back out into bags and discarded

Question 28

There are two types of ports used for hemodialysis

Answer 28

1. A-V port in one of their major veins Or torso
2. A fistula - Surgically connects an artery and a vein in an extremity
   - contains turbulent flow that creates a vibration called a thrill when palpated

Question 29

Exchange

Answer 29

The cycle of filling and draining the Peritoneal cavity is called an exchange

Question 30

Two types of peritoneal dialysis

Answer 30

•Continuous ambulatory Peritoneal dialysis (CAPD)

• most common type of PD
• fluid is left in the peritoneal Cavity by clamping the catheter for 4 to 6 hours – repeat step exchanged several times a day,
• simple gravity exchange process where a bag is elevated above the abdominal catheter to run dialysis fluid then lowered below the level of abdomen to drain fluid out

•Continuous cycler – assisted Peritonealdialysis (CCAP)
- Use the same type of peritoneal catheter, however rather than using gravity exchange, a machine is used to fill and empty the abdominal cavity with dialysis fluid 3 to5 times during the night while person sleeps
– in the morning, the last fill remains in the abdomen with a dwell time that last entire day

Question 31

Medical emergencies in patients with ESRD are broadly divided into two groups

Answer 31

• Those that arise from the loss of normal kidney function

– those that are complications of their dialysis treatment

Question 32

Signs and symptoms of ESRD

Answer 32

• Shortness of breath
  – pulmonary Adema
  – Pedal Edema as well as hands and face
  – dysrhythmia - Caused by unbalanced and clear excess electrolytes as well as other toxins

Question 33

Kidney transplant

Answer 33

• Most commonly transplanted organ

- Proximately 16,000 kidney transplants performed by specialize surgeons in the United States each year

Question 34

Hematology

Answer 34

The medical specialty concerned with blood disorders

Question 35

Nephrology

Answer 35

The medical specialty concerned with renal/kidney diseases

Question 36

Aggregation

Answer 36

Clumping of platelets in the body to stop bleeding from on injured site

Question 37

Cirrhosis

Answer 37

Typically a result of alcoholism or hepatitis

• a disease that effects liver by not making adequate clotting factors to form stable clots
• also causes inflammation and fibrous thickening of tissues

Question 38

Hemophiliac

Answer 38

Inherited genetic disorder that results in coagulopathies a

• prevents them from producing certain “clotting factors”

Question 39

Von willebrands disease

Answer 39

Most common inherited blood disorder occurring in about one in a thousand persons. In this disease patient has normal number of platelets circulating bloodstream, patients platelets are functionally defective, allowing for excessive bleeding to occur