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N323 > Clotting > Flashcards

Clotting Flashcards

1
Q

Peripheral Artery Disease

A

Peripheral artery disease (PAD) involves thickening of artery walls. This results in a progressive narrowing of the arteries of the upper and lower extremities. PAD prevalence increases with age. It typically becomes symptomatic in the sixth to eighth decades of life. In people with diabetes mellitus, PAD occurs earlier. In the United States, PAD prevalence is higher in those of lower socioeconomic status, women, and African Americans.2

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2
Q

Critical Limb Ischemia (CLI)

A

Critical limb ischemia (CLI) is a condition characterized by chronic ischemic rest pain lasting more than 2 weeks, arterial leg ulcers, or gangrene of the leg as a result of PAD. Patients with PAD who also have diabetes, heart failure, and a history of a stroke are at increased risk for critical limb ischemia.6

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3
Q

Thromboangiitis obliterans (Buerger’s disease)

A

Thromboangiitis obliterans (Buerger’s disease) is a nonatherosclerotic, segmental, recurrent inflammatory disorder of the small and medium arteries and veins of the upper and lower extremities. Rarely, systemic manifestations of the disease may involve cerebral, coronary, mesenteric, pulmonary, and/or renal arteries. The disease occurs mostly in young men (younger than 45 years of age) with a long history of tobacco and/or marijuana use and chronic periodontal infection but without other CVD risk factors (e.g., hypertension, hyperlipidemia, diabetes)

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4
Q

Raynaud’s phenomenon

A

Raynaud’s phenomenon is an episodic vasospastic disorder of small cutaneous arteries, most often involving the fingers and toes. It occurs primarily in young women (typically between 15 and 40 years of age), and it is more common in women than men. The pathogenesis of Raynaud’s phenomenon is due to abnormalities in the vascular, intravascular, and neuronal mechanisms that cause an imbalance between vasodilation and vasoconstriction.

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5
Q

Aortic dissection

A

Aortic dissection, often misnamed “dissecting aneurysm,” is not a type of aneurysm. Rather, dissection results from the creation of a false lumen between the intima (inner lining) and the media (middle layer) of arterial wall (Figs. 37-5, D and 37-8). Aortic dissection is classified based on the location of the dissection and duration of onset. Type A dissection affects the ascending aorta and arch. Type B dissection begins in the descending aorta.

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6
Q

Aneurysms

A

Aneurysms are classified as true or false aneurysms (Fig. 37-5, A to C). A true aneurysm is one in which the wall of the artery forms the aneurysm, with at least one vessel layer still intact. True aneurysms are further subdivided into fusiform and saccular types. A fusiform aneurysm is circumferential and relatively uniform in shape. A saccular aneurysm is pouchlike with a narrow neck connecting the bulge to one side of the arterial wall.

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7
Q

Open Aneurysm repair (OAR)

A

The open aneurysm repair (OAR) involves a large abdominal incision through which the surgeon (1) cuts into the diseased aortic segment, (2) removes any thrombus or plaque, (3) sutures a synthetic graft to the aorta proximal and distal to the aneurysm, and (4) sutures the native aortic wall around the graft to act as a protective cover (Fig. 37-6). If the iliac arteries are also aneurysmal, a bifurcated graft replaces the entire diseased segment. With saccular aneurysms, it may be possible to excise only the bulbous lesion, repairing the artery by primary closure (suturing the artery together) or by application of an autogenous or synthetic patch graft.

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8
Q

Endovascular aneurysm repair (EVAR)

A

Minimally invasive endovascular aneurysm repair (EVAR) is an alternative to OAR for select patients. Eligibility criteria include iliofemoral vessels that allow for safe graft insertion and vessels of sufficient length and width to support the graft.26

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9
Q

Plasma

A

Approximately 55% of blood is plasma1 (Fig. 29-2). Plasma is composed primarily of water, but it also contains proteins, electrolytes, gases, nutrients (e.g., glucose, amino acids, lipids), and waste. The term serum refers to plasma minus its clotting factors. Plasma proteins include albumin, globulin, and clotting factors (mostly fibrinogen). Most plasma proteins are produced by the liver, except for antibodies (immunoglobulins), which are produced by plasma cells. Albumin is a protein that helps maintain oncotic pressure in the blood.1

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10
Q

Erythropoiesis

A

Erythropoiesis (the process of RBC production) is regulated by cellular O2 requirements and general metabolic activity. Erythropoiesis is stimulated by hypoxia and controlled by erythropoietin, a glycoprotein growth factor synthesized and released primarily by the kidney. Erythropoietin stimulates the bone marrow to increase erythrocyte production. Approximately 2.5 million erythrocytes are produced per second.

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11
Q

Hemolysis

A

Hemolysis (destruction of RBCs) by monocytes and macrophages removes abnormal, defective, damaged, and old RBCs from circulation. Hemolysis normally occurs in the bone marrow, liver, and spleen. Because one of the components of RBCs is bilirubin, hemolysis of these cells results in increased bilirubin to be processed by the body.

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12
Q

Reticulocyte

A

The reticulocyte is an immature erythrocyte. Reticulocytes can develop into mature RBCs within 48 hours of release into the circulation. Therefore assessing the number of reticulocytes is a useful means of evaluating the rate and adequacy of erythrocyte production.

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13
Q

Iron

A

Iron is obtained from food and dietary supplements. Approximately 1 mg of every 10 to 20 mg of iron ingested is absorbed in the duodenum and upper jejunum. About two thirds of total body iron is bound to heme in erythrocytes (hemoglobin) and muscle cells (myoglobin). The other one third of iron is stored as ferritin and hemosiderin (degraded form of ferritin) in the bone marrow, spleen, liver, and macrophages (Fig. 29-3). When the stored iron is not replaced, hemoglobin production is reduced.

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14
Q

An individual who lives at a high altitude may normally have an increased Hgb and RBC count because a. high altitudes cause vascular fluid loss, leading to hemoconcentration. b. hypoxia caused by decreased atmospheric O2 stimulates erythropoiesis. c. the function of the spleen in removing old RBCs is impaired at high altitudes. d. impaired production of leukocytes and platelets leads to proportionally higher red cell counts.

A

b

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15
Q

Malignant disorders that arise from granulocytic cells in the bone marrow will have the primary effect of causing a. risk for hemorrhage. b. altered oxygenation. c. decreased production of antibodies. d. decreased phagocytosis of bacteria.

A

d

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16
Q

An anticoagulant such as warfarin (Coumadin) that interferes with prothrombin production will alter the clotting mechanism during

a. platelet aggregation.
b. activation of thrombin.
c. the release of tissue thromboplastin.
d. stimulation of factor activation complex.

A

b

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17
Q

When reviewing laboratory results of an older patient with an infection, the nurse would expect to find

a. minimal leukocytosis.
b. decreased platelet count.
c. increased hemoglobin and hematocrit levels.
d. decreased erythrocyte sedimentation rate (ESR).

A

a

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18
Q

Significant information obtained from the patient’s health history that relates to the hematologic system includes a. jaundice. b. bladder surgery. c. early menopause. d. multiple pregnancies.

A

a

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19
Q

While assessing the lymph nodes, the nurse should a. apply gentle, firm pressure to deep lymph nodes. b. palpate the deep cervical and supraclavicular nodes last. c. lightly palpate superficial lymph nodes with the pads of the fingers. d. use the tips of the second, third, and fourth fingers to apply deep palpation.

A

c

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20
Q

If a lymph node is palpated, what is a normal finding?

a. Hard, fixed nodes
b. Firm, mobile nodes
c. Enlarged, tender nodes
d. Hard, nontender nodes

A

b

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21
Q

Nursing care for a patient immediately after a bone marrow biopsy and aspiration includes (select all that apply) a. administering analgesics as necessary. b. preparing to administer a blood transfusion. c. instructing on need to lie still with a sterile pressure dressing intact. d. monitoring vital signs and assessing the site for excess drainage or bleeding. e. instructing on the need for preprocedure and postprocedure antibiotic medications.

A

a,c,d

22
Q

You are taking care of a male patient who has the following laboratory values from his CBC: WBC 6.5 × 103/µL, Hgb 13.4 g/dL, Hct 40%, platelets 50 × 103/µL. What are you most concerned about? a. Your patient is neutropenic. b. Your patient has an infection. c. Your patient is at risk for bleeding. d. Your patient is at fall risk due to his anemia.

A

c

23
Q

What is clotting?

A
24
Q

What is the composition of Blood?

A
25
Q

What is hematopoesis?

A
26
Q

What do red blood cells do?

A
27
Q

What are white blood cells?

A
28
Q

What are platelets?

A
29
Q

What is the complete blood count?

A
30
Q

What are lifespan considerations for infants?

A
31
Q

What are lifespan considerations with pregnancy?

A
32
Q

Lifespan considerations for older adults?

A
33
Q

What is the nursing assessments?

A
34
Q

What are the different types of VTE?

A
35
Q

What is virchows triad?

A
36
Q

What is the pathophysiology of VTE?

A
37
Q

What are VTE symptoms?

A
38
Q

What are VTE complications?

A
39
Q

What are VTE interventions?

A
40
Q

What are nursing implications with anti-coagulants?

A
41
Q
  1. Emerging and reemerging infections affect health care by (select all that apply)
    a. reevaluating vaccine practices.
    b. revealing antimicrobial resistance.
    c. limiting antibiotics to those with life-threatening infection.
    d. challenging researchers to discover new antimicrobial therapies.
  2. Which types(s) of isolation precautions is (are) appropriate for a patient with tuberculosis (select all that apply)?
    a. contact precautions
    b. droplet precautions
    c. airborne precautions
    d. standard precautions
    e. neutropenic precautions
A
  1. a, b, d, 2. c, d,

Standard precautions Includes the use of hand washing and appropriate personal protective equipment

Airborne Precautions: Used for infections spread in small particles in the air such as chickenpox (varicella), measles, and tuberculosis (TB)

Droplet Precautions: Used for infections spread in large droplets by coughing, talking, or sneezing such as influenza and bacterial meningitis

Contact Precautions: Used for infections spread by skin-to-skin contact or contact with other surfaces such as C. difficile, MRSA, and VRE

42
Q
  1. Transmission of HIV from an infected individual to another most commonly occurs as a result of
    a. unprotected anal or vaginal sexual intercourse.
    b. low levels of virus in the blood and high levels of CD4+ T cells.
    c. transmission from mother to infant during labor and delivery and breastfeeding.
    d. sharing of drug-using equipment, including needles, syringes, pipes, and straws.
  2. During HIV infection
    a. reverse transcriptase helps HIV fuse with the CD4+ T cell.
    b. HIV RNA uses the CD4+ T cell’s mitochondria to replicate.
    c. the immune system is impaired predominantly by the eventual widespread destruction of CD4+ T cells.
    d. a long period of dormancy develops during which HIV cannot be found in the blood and there is little viral replication.
A
  1. a, 4. c,
43
Q
  1. Which statements accurately describe HIV infection (select all that apply)?
    a. Untreated HIV infection has a predictable pattern of progression.
    b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS).
    c. Untreated HIV infection can remain in the early chronic stage for a decade or more.
    d. Untreated HIV infection usually remains in the early chronic stage for 1 year or less.
    e. Opportunistic diseases occur more often when the CD4+ T cell count is high and the viral load is low.
  2. A diagnosis of AIDS is made when an HIV-infected patient has
    a. a CD4+ T cell count below 200/µL.
    b. a high level of HIV in the blood and saliva.
    c. lipodystrophy with metabolic abnormalities.
    d. oral hairy leukoplakia, an infection caused by Epstein-Barr virus.
  3. Screening for HIV infection generally involves
    a. detecting CD8+ cytotoxic T cells in saliva.
    b. laboratory analysis of saliva to detect CD4+ T cells.
    c. analysis of lymph tissues for the presence of HIV RNA.
    d. laboratory analysis of blood to detect HIV antigen or antibody.
A
  1. a, b, c, 6. a, 7. d,
44
Q

HIV antiretroviral drugs are used to

a. cure acute HIV infection.
b. decrease viral RNA levels.
c. treat opportunistic diseases.
d. decrease pain and symptoms in terminal disease.
9. Opportunistic diseases in HIV infection
a. are usually benign.
b. are generally slow to develop and progress.
c. occur in the presence of immunosuppression.
d. are curable with appropriate drug interventions.
10. Which statement(s) about metabolic side effects of ART is (are) true (select all that apply)?
a. These are annoying symptoms that are ultimately harmless.
b. ART-related body changes include fat redistribution and peripheral wasting.
c. Lipid abnormalities include increases in triglycerides and decreases in high-density cholesterol.
d. Insulin resistance and hyperlipidemia can be treated with drugs to control glucose and cholesterol.
e. Compared to uninfected people, insulin resistance and hyperlipidemia are more difficult to treat in HIV-infected patients.
11. Which strategy can the nurse teach the patient to eliminate the risk of HIV transmission?
a. Using sterile equipment to inject drugs
b. Cleaning equipment used to inject drugs
c. Taking lamivudine (Epivir) during pregnancy
d. Using latex or polyurethane barriers to cover genitalia during sexual contact
12. What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen?
a. “Set up” a drug pillbox for the patient every week.
b. Give the patient a video and a brochure to view and read at home.
c. Tell the patient that the side effects of the drugs are bad but that they go away after a while.
d. Assess the patient’s routines and find adherence cues that fit into the patient’s life circumstances.

A
  1. b, 9. c, 10. b, c, d, 11. a, 12. d
45
Q

Name a complication of VTE (venous thromboembolism) (Clotting)

PE

Stroke

Post-thrombotic syndrome

Phlegmasia cerulean

A

Stroke

46
Q

The nurse knows that which assessment finding is characteristic of a deep vein thrombosis in the leg?

Bilateral edema of the leg associated with an albumin level of 2 g/dL

Unilateral swelling with redness over the swollen area

Brisk reflexes in the lower extremities

Brownish discoloration of the skin over the lower extremities

A

Unilateral swelling with redness over the swollen area

A deep vein thrombosis of the leg may be associated with edema in the affected leg and erythema. Bilateral swelling of the legs associated with a low serum albumin level is related to decreased oncotic pressure. Brisk reflexes may be the result of a neurological disorder. Brownish discoloration of the lower extremities may be related to chronic venous insufficiency, not a deep vein thrombosis.

47
Q

A patient had a hip replacement 3 days ago. The patient states that the right leg is swollen below the knee and is warm to the touch. The patient has the diagnosis of deep vein thrombosis. Which intervention is appropriate for the patient?

Massage the extremity to decrease pain.

Place the leg in a dependent position.

Apply ice bags to the lower leg.

Elevate the right lower leg when the patient is in the sitting position.

A

Elevate the right lower leg when the patient is in the sitting position.

A patient with a deep venous thrombosis elevates the extremity when sitting or lying to enhance venous return to the heart. Massaging the extremity may dislodge a thrombus. If the leg is in the dependent position, blood return from the venous system will not be enhanced. Applying ice bags to the extremity may cause tissue injury.

48
Q

Which patient has the highest risk for development of a blood clot?

A woman who smokes and is taking estrogen-containing birth control pills

A distance runner

A man with a history of asthma

A woman who is taking aspirin for menstrual cramps

A

A woman who smokes and is taking estrogen-containing birth control pills

The combination of hormones and smoking may cause a hypercoagulability state. Distance running does not increase the risk of forming a blood clot. A patient with asthma does not predispose the formation of a blood clot. A patient taking aspirin will have a decreased risk of development of a blood clot due to the antiplatelet action of aspirin.

49
Q

A patient is admitted to the medical unit with pneumonia. When reviewing home medications, which of the following medications would the nurse recognize as a risk for bleeding?

Diltiazem (Cardizem)

Warfarin (Coumadin)

Acetaminophen (Tylenol)

Metformin (Glucophage)

A

Warfarin (Coumadin)

Warfarin (Coumadin) is a medication that interferes with blood clotting by interfering with the vitamin K-dependent clotting factors. Diltiazem is a calcium channel blocker. Acetaminophen is an over-the-counter medication that does not interfere with blood clotting. Metformin is a medication used for diabetes.

50
Q

Which interventions are most important for preventing bleeding in patients with bleeding disorders?

Select all that apply.

Using a soft-bristle toothbrush

Avoiding over-the-counter medications that contain aspirin

Using a blade razor

Removing obstacles that may result in a fall

Giving medication by intramuscular injection

A

Using a soft-bristle toothbrush

CORRECT

Avoiding over-the-counter medications that contain aspirin

Use of a soft-bristle toothbrush decreases the trauma to the gums with oral care. Avoid the use of aspirin because of its antiplatelet effect. Decrease the fall risk to prevent bleeding from trauma. Do not use a blade razor because of the risk for nicks when shaving. Intramuscular injections are avoided in bleeding precautions due to the risk of bleeding into muscle from the trauma of the injection.

Removing obstacles that may result in a fall

N323 (5 decks)

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