Clotting Flashcards
increase the risk of DVT
Oral contraceptives, A-fib, truck drivers, 3rd trimester
CVI infection left leg clinical manifestation
skin brown
CVI poc older adult
wear compression socks
Why is bone marrow significant to platelet counts?
Platelets are produced in the bone marrow. If a pt has a low platelet value, they might do a bone marrow biopsy.
What would be done if the platelets are already low before the bone marrow biopsy?
If the platelets are already low during this procedure, an intervention would be putting pressure over the incision or injection site.
What is polycythemia vera
Increased hemoglobin levels (18 or above)
What is ecchymosis?
bruising
What is hemarthorsis?
bleeding in the joint cavity. Suspect upon pt history and physical exam
What is the best diagnosis for hemarthorsis?
Arthrocentesis
What are the risk factors for Hemarthrosis?
RA, athletes, post total joints, joint surgeries
What is the most common place for arterial clots?
Heart
Where can atrial clots travel to?
They can travel to the brain or lungs.
What are venous clots?
usually form in the legs- can travel to the lungs or the heart
What are the s/s of a PE?
SOB, chest pain, cough, bloody sputum, an impending feeling of doom
What are the s/s of a DVT?
Swelling, pain, warmth, and a blue-purple discoloration, 3cm bigger than the other leg
What is thrombocytopenia?
A deceased level of platelets
Why might thrombocytopenia occur?
might occur because of leukemia or an immune disorder, bone marrow disorders, side-effects of meds like heparin
What are the s/s of thrombocytopenia?
- low BP, high HR
- bruit
- Stool- Lower GI= Black tarry stools
- Urine
- Vomiting- looks like coffee grounds
- check the eyes for petechiae
- check for vaginal bleeding especially in post-menopausal women
- Check for bleeding gums
What is hemophilia?
Absent clotting factors in the pathway, genetic, prolonged bleeding time.
What is the difference between local or systemic clotting problems?
Systemic Clotting factors extend to the entire body, and they are usually the result of a significant hematological event.
Localized clotting factors are usually a problem in a vein or an artery, either injury to a vessel or a clot within a vessel.
Give an example of a systemic clotting problem
Disseminated Intravascular Coagulation
What are the s/s of systemic bleeding?
- ecchymosis, petechiae, purpura
- frequent nosebleeds
- blood in stool, urine, emesis
- bleeding gums
- bleeding within joints
- excessive menstrual bleeding
- fatigue
What are the s/s of localized bleeding?
- bleeding or ecchymosis at the injury site
- bleeding at the surgical site
- intracranial bleeding
What does idiopathic mean?
No one knows why it happens
What is immune thrombocytopenia purpura?
Coagulopathy that is an autoimmune disorder in which the lifespan of platelets is decreased by antiplatelet antibodies although platelet production is normal.
Why might idiopathic or immune thrombocytopenic purpura occur?
A viral infection, severe hemorrhage, or cesarean birth.
What are the risk factors for immune or idiopathic thrombocytopenic purpura?
- female sex (age 20-50)
- Secondary conditions (meds, viruses, HIV, Hep. C.)
- Other autoimmune disorders
- Children: recent viruses
How long will acute idiopathic thrombocytopenic purpura last?
1-2 months and it will resolve on its own
What would a nurse assess to find immune or idiopathic thrombocytopenic purpura?
- unusual spontaneous bleeding from the gums and nose (epistaxis)
- oozing, trickling, or flow of blood from incisions or lacerations
- petechiae and ecchymosis
- hematuria
- excessive bleeding from venipuncture, injection sites, or slight traumas
- tachycardia, hypotension, diaphoresis
- organ failure secondary to microemboli
- respiratory distress
What are the lab tests used to diagnose immune or idiopathic thrombocytopenic purpura?
- CBC with platelets
- Hemoglobin decreased
- Platelet levels decreased
- ANA (Antinuclear Antibody Test)- Looks for autoimmune disease
- Serological studies (looks for antibodies in the serum)
- Bone marrow biopsy
What are the interventions for someone with immune or idiopathic thrombocytopenic purpura?
- VS, hemodynamic trends
- monitor for manifestations of organ failure or intracranial bleed (oliguria, decreased level of consciousness)
- administer fluid replacement
- transfuse blood, platelets, or another clotting product
- May need to administer supplemental oxygen
- provide protection from injury
What education is needed for someone with immune or idiopathic thrombocytopenic purpura?
- avoid NSAIDs and activities that could cause bleeding
- avoid the use of needles
- avoid Valsalva maneuver
- Watch for bleeding in the gums, stool, vaginal bleeding, and blood in the urine
- Use a soft bristle toothbrush, visit the dentist regularly
- proper nail care
- herbal meds like ginger, ginseng, and garlic
- eat foods high in iron
- If they are on immunosuppressants they should not get live virus vaccines
Corticosteroids and immunosuppressant teaching
- don’t stop
- take with food
- watch BS
- avoid people that are sic
- watch bone density
If a pt with immune or idiopathic thrombocytopenic purpura doesn’t respond to medical management, what can be done?
A splenectomy
What is the Homan’s sign and what is it used for?
Dorsal flexing the knee and ca produce pain in the calf area to see if there is a DVT
What interventions are needed for a PE?
HOB elevated, oxygen, call provider
What diagnostics are used for a DVT?
- Ultrasound, venogram, arteriogram
- D-dimer
- Wells score
- PTT, PT, INR
- CBC
- Platelet count
Interventions for a DVT
- initial presentation of DVT- bedrest
2. Positioning: elevation of extremity for venous thrombosis, dependent position for arterial thrombus
What are the treatments for a DVT
- Rule out the risk for bleeding conditions (recent surgery, hemorrhagic stroke, active bleeding)
- Anticoagulation therapy
- vena cava filter
- Thrombolysis or embolectomy
What medications are used for initial anticoagulation therapy and for how long?
Heparin, enoxaparin used for 0-10 days
What medications are used for long-term anticoagulation and for low long?
Warfarin, dabigatran, rivaroxaban, and apixaban used for 10 days- 3 months or up to 12 months in some cases
What is used for VTE prophylaxis?
- elastic compression stockings
- administering a SubQ injection
- Using a sequential compression device
- Peripheral vascular assessment
What medications are antiplatelet agents?
Aspirin, clopidogrel
What are the pharmacologic agents used for clotting problems?
- anticoagulant agents
- antiplatelet agent
- thrombin inhibitors
- thrombolytic agents
- clotting factor
- platelet replacement agents
- blood and or platelet transfusion
What are the therapeutic uses of warfarin?
- treatment of venous thrombosis
- treatment of thrombus formation in pt with trail fibrillation or prosthetic heart valves
- prevention of recurrent myocardial infarction, transient ischemic attacks, pulmonary embolus, and DVT
What are the complications of warfarin?
hemorrhage
How would someone monitor for a hemorrhage due to warfarin therapy?
- monitor VS trends
- Observe for bleeding (Increase HR, Decreased BP, bruising, petechiae, hematomas, black tarry stools)
- Baseline PT and monitor INR
- Monitor liver enzymes and assess for Jaundice (Hepatitis)
In case of an overdose of warfarin, what should you do?
Discontinue warfarin and administer vitamin K
What lab values do you monitor for warfarin therapy?
PT and INR
Nursing considerations for warfarin?
- Avoid concurrent use if possible
- instruct clients to observe for the inclusion of aspirin in OTC meds
- If used concurrently, monitor carefully for indications of bleeding and increased PT, INR, and aPTT levels
- Med dosage should be adjusted accordingly
- Concurrent use of phenobarbital, carbamazepine, phenytoin, oral contraceptives, and vitamin K decreases anticoagulant effects
What is the education needed for warfarin?
Avoid foods high in vitamin K (Dark leafy vegetables)
What are the contraindications for someone who is on Warfarin therapy?
- category X
- contraindicated in clients who have low platelet counts
- contraindicated during or following surgeries of the eyes, brain, or spinal cord; lumbar puncture; or regional anesthesia
- Clients who have Vit K deficiencies, liver disorders, and alcohol use disorder due to the additive risk of bleeding
- Use cautiously in clients who have hemophilia, dissecting aneurysm, peptic ulcer disease, severe hypertension, or threatened abortion
What can heparin be used for?
- conditions needing prompt anticoagulation (Stroke, PE, DVT)
- Adjunct for open-heart surgery, renal dialysis, low dose prophylaxis against post-op DVT (hip/knee or abdominal surgery)
What do you do for a heparin therapy overdose?
Administer protamine; do not exceed 100 mg in a 2 hour period. Administer carefully to prevent protamine overdose
What should be done to prevent a hemorrhage secondary to heparin overdose?
- monitor VS
- Advise clients to observe for bleeding; increased HR, decreased BP, bruising, petechiae, hematomas, black tarry stools
- Monitor activated aPTT, keep value at 1-2 times the baseline
What else can heparin cause?
Heparin-induced thrombocytopenia which is evidenced by low platelet count and increased development of thrombi: mediated by antibody development
What are the nursing considerations for a patient taking enoxaparin to prevent neurologic damage from hematoma formed during spinal or epidural anesthesia?
In clients who have spinal or epidural anesthesia: assess the insertion site for indications of hematoma formation, such as redness or swelling. Monitor sensations and movement of lower extremities. Notify provider of abnormal findings
Contraindications for enoxaparin?
- parenteral anticoagulants are contraindicated in clients who have low platelet counts or uncontrollable bleeding
- should not be used during or following surgeries of the eye, brain, or spinal cord; lumbar puncture; or regional anesthesia
- use cautiously in clients who have hemophilia, increased cap permeability, dissecting aneurysm, peptic ulcer disease, severe hypertension, hepatic or kidney disease, or threatened abortion
Interactions with heparin or enoxaparin
- antiplatelet agents such as aspirin, NSAIDs, and other anticoagulants can increase the risk of bleeding
Primary prevention for clotting disorders
- Preventing excessive bleeding (genetic counseling, injury prevention)
- preventing clotting (Smoking cessation, hydration, exercise, prevention of stasis, compression stockings, weight loss)
Clinical management: control of bleeding
- direct pressure on the site of bleeding
- ice application (joint bleeding)
- Topical agents (gel foam, fibrin foam)
- Blood volume replacements
- critical care management if hemorrhage leads to shock
