Clotting Flashcards
Heparin is __ acting
Rapid acting
What labs should the nurse monitor while her pt. is on a heparin drip?
PTT
K+ (can cause hyperkalemia)
Antidote for Heparin
Protamine Sulfate
Enoxaparin antidote
Protamine Sulfate
Warfarin is ___ acting
Delayed acting
Warfarin indication
Prevention of DVT, PE
What labs should the nurse monitor if her pt. is on Warfarin?
PT and INR
Antidote for Warfarin
Vitamin K
Side effect of Warfarin
Terotegenesis
Alteplase drug classification
Thrombolytic - breakdown clots
Major adverse effect of Alteplase
Bleeding
Blood transfusions are only administrated with that type of IV fluid?
Isotonic - NS
What is common gauge size for blood admin?
18-20
Universal blood donor
O-
Universal blood receiver
AB+
When starting a blood transfusion the blood must be verified by __ ____
2 nurses
The nurse must stay in the room for ___ min after starting the blood transfusion
15 min
Pt. receiving blood after 2 hours. the pt. is having a reaction. What is the nurse’s first action?
Stop the infusion
Pt. receiving blood after 2 hours. the pt. is having a reaction. Nurse stops the infusion. can the nurse save the rest of the blood for later?
No, after 4 hours of the blood being out of the blood bank to blood has to be sent back
Stages of Hemostasis
Vasospasm Formation of platelet plug Clot formation Clot retraction Fibrinolysis
Von Willebrand’s Factor
Necessary for platelets to be able to stick together
Clot retraction function:
Platelets contract and pull injury together and release growth factor to stimulate tissue repair
Intrinsic Pathway
Injury occur inside the blood vessel
Slower (more steps)
Measured by PTT
Hageman Factor
Factor XII
Extrinsic Pathway
Injury due to elements outside the blood vessel
Faster
Measured by PT
Final Clotting Pathway
Prothrombin to thrombin to fibrinogen to fibrin
Intrinsic pathway lab
PTT
Extrinsic pathway lab
PT
How do antibiotics affect clotting?
They decrease Vitamin K levels
Decrease ability to clot
How does aspirin, salicylates, clopidogrel, NSAIDs, thiazide diuretics, antibiotics, heparin affect clotting?
Interfere with platelet production or function (Decrease clotting)
How does amiodarone, steroids, warfarin, and low weight heparin affect clotting?
Interfere with coagulation factors
Class of drug that breaks down clots
Fibrolytics/Thromobolytics (TPA)
True/False: Anticoagulants break down clots that have already formed
False, anticoagulants only prevent more clots from forming
What time frame must fibrinolytics be given if a pt. is currently presented to ER with MI/Stroke
Must be given within 3-4 hours of the ischemic symptoms
Normal PTT level
60-70 secs
Normal PT level
10-13 secs
Normal INR level
0.8-1.2 secs
Normal RBC Male
4.71-5.1
Normal RBC Female
4.2-4.8
Normal WBC
4,500-11,000
Normal Hemoglobin Male
13.5-16.5
Normal Hemoglobin Female
12-15
Normal Hematocrit Male
43-49%
Normal Hematocrit Female
38-44%
What disease can result from bone marrow suppression?
Anemia
Thrombocytopenia
Symptoms of Anemia
Pale skin, lips, nails Fatigue Dizziness Weakness HA SOB Tachypnea Tachycardia
Neutropenia symptoms
No symptoms unless have infection
Most common site for bone marrow biopsy?
Posterior superior iliac crest
Thrombocytopenia
Low platelets
Neutropenia
Low WBCs
Causes of thrombocytopenia
Malignancy Sulfa meds Infection Autoimmune conditions DIC
Most common autoimmune platelet disorder
Immune thrombocytopenia purpura
Immune thrombocytopenia purpura
Usually follows viral infection
Immune mediated platelet destruction faster than normal
Disseminated Intravascular Coagulation
Follows severe trauma
Pt. clots too much and exhausts clotting factors then not able to clot which leads to lots of bleeding
Symptoms of Thrombocytopenia
Bruising Pink urine Nosebleed Small red/purple spots Bleeding that does not stop w/ pressure
Precautions for thrombocytopenia
Stop NSAIDS or aspirin if can
Use soft toothbrush
Use electric razor
Encourage shoes when out of bed
Maintain clutter free environment
Use stool softener - avoid straining
Avoid rectal thermometers, suppositories, enemas
Do not blow nose
Apply pressure for no less than 5 min after cut
Arterial procedures should be kept to a minimum
Heparin given ___ (route) can cause ___
Heparin given IM can cause severe hematomas
___ nurse always check dose of heparin before it is given
2 nurses always check dose of heparin before it is given
Pt. with immune thrombocytopenia purpura is at risk for:
Bleeding
“-ase” drugs
Fibrinolytics
Platelet inhibitor
Clopidogrel
Clotting factors for Intrisic
XII, XI, IX
All “X” factors but not X
Clotting factor of extrinsic
III, VII
3+7= 10
Anticoagulants effect what clotting factors
II
VII
IX
X
The nurse is assigned to a patient with thrombocytopenia. What is the priority goal of nursing care? A. Prevention of infection B. Prevention of injury C. Prevention of dehydration D. Prevention of nutritional deficit
B - b/c low platelets high risk for injury and bleeding