Coagulation

Question 1

DVT

Answer 1

S/S

Question 2

Peripheral Arterial Disease:

• S/S:

Answer 2

6 Ps: Pulselessness, parathesis, pallor, pain, paralysis, poikilocythemia (cold)
o	Smooth, shiny, dry skin 
o	NO HAIR or EDEMA
o	Round, regular shaped PAINFUL ulcers on distal foot, toes, or webs of toes
o	Dependent rubor
o	Pallor and PAIN when legs are elevated
o	Intermittent claudication
o	Brittle, thick nails

Question 3

Peripheral Arterial Disease:

Patient Teaching:

Answer 3

Instruct patient to walk to the point of claudication, stop and rest, and the walk a little farther.
o Avoid crossing the legs.
o Avoid exposure to cold (vasoconstriction) to the extremities to wear socks for warmth at all times.
o Never apply direct heat to the limb.
o Inspect skin on extremities daily and to report signs of skin breakdown.
o Avoid tobacco and caffeine because of their vasoconstrictive effects.
o Importance of adhering to prescription medications.

Question 4

Chronic Venous Stasis Ulcers:

• S/S:

Answer 4

Normal pulses
o Dependent edema, cyanosis, and pain
o Brown patches of discoloration on lower legs
o Irregular shaped, usually PAINLESS ulcers on lower legs and ankles
o Pain relief when legs are elevated
o No intermittent claudication
o Normal nails

Question 5

Chronic Venous Stasis Ulcers:

S/S of Infection:

Answer 5

Fever, warmth, swelling, elevated WBC

Question 6

Chronic venous stasis ulcers patient teaching.

Answer 6

• Patient Teaching:
o Wear elastic or compression stockings during the day and evening as prescribed.
o Avoid prolonged sitting or standing, constrictive clothing, or crossing legs when seated.
o Elevate the legs for 10 to 20 minutes every few hours per day.
o Elevate legs above heart level when in bed
o Use SCDs intermittently if prescribed. Twice daily for 1 hour in the morning and in the evening.

Question 7

Buerger’s Disease:

• S/S:

Answer 7

Intermittent claudication; cool, numb, or tingling sensation; diminished pulses in the distal extremities; ischemic pain occurring in the digits while at rest; aching pain that is more severe at night; development of ulcerations in the extremities; diminished pulses in the distal extemities

Question 8

Buerger’s Disease:Teaching:

Answer 8

Stop smoking, monitor pulses, avoid injury to the upper and lower extremities, medication therapy regimen

Question 9

Raynaud’s Disease:

• S/S:

Answer 9

Blanching of the extremity, followed by cyanosis during vasoconstriction. Reddened tissue when then the vasospasm is relieved. Numbness, tingling, swelling, and a cold temperature at the affected part.

Question 10

Raynaud’s Disease:Teaching:

Answer 10

Medication therapy regimen. Identify and avoid precipitating factors such as cold and stress. Avoid smoking, Wear warm clothing. Wear warm clothing, socks, and gloves in cold weather. Avoid injuries to fingers and hands.

Question 11

Iron Deficiency Anemia:

• S/S:

Answer 11

Pale skin, delayed wound healing, brittle thinning hair, SOB, dyspnea on exertion, tachypnea, palpitations, postural hypotension, chronic fatigue, weakness, apathy, headache, dizziness, tingling in extremities

Question 12

Iron Deficiency Anemia:Chronic Anemia S/S:

Answer 12

Brittle spoon-shaped nails, cheilosis (small fissures at the corners of the mouth), pica (craving for substances other than food, such as dirt, clay, starch, or ice cubes), and a smooth, painful tongue

Question 13

Iron Deficiency Anemia:Chronic Anemia S/S: Teaching:

Answer 13

Encourage intake of iron rich foods, along with PO or IV iron supplements. 
• Primary Prevention: Identify patients at risk and encourage iron replacement therapies, such as prenatal that are iron fortifies.

Question 14

Pernicious (B12) Anemia: S/S:

Answer 14

Hunter’s glossitis (smooth and shiny tongue); Sclerosis of the spinal cord and megaloblastic anemia; neurological manifestations include polyneuritis, ataxia, and positive Babinski reflexes.

Question 15

Pernicious (B12) Anemia: Treatment:

Answer 15

Parenteral administration of B12 (cyanocobalamin) given by IM injection

Question 16

Folic Acid Anemia:

• S/S:

Answer 16

Pale skin, delayed wound healing, brittle thinning hair, SOB, dyspnea on exertion, tachypnea, palpitations, postural hypotension, chronic fatigue, weakness, apathy, headache, dizziness, tingling in extremities

Question 17

Folic Acid Anemia:Treatment:

Answer 17

Increase dietary intake of folic acid or intake of folic acid (PO or IV) supplements may be necessary. Treatment of folic acid deficiency may require only short-term therapy

Question 18

Sickle Cell Anemia: S/S:

Answer 18

Fatigue, pallor, jaundice, irritability
• Excessive sickling processes can precipitate a crisis because of occluded circulation, sequestering of large amounts of blood in the liver or spleen, and impaired erythropoiesis.

Question 19

Sickle Cell Anemia: Discharge Instruction:

Answer 19

Hydration, pain management, infection control/prevention, maintaining adequate oxygenation and tissue perfusion, reduction of stressors, and nutrition

Question 20

Sickle Cell Anemia: Nursing Consideration:

Answer 20

Immediate correction of acid-base imbalances and dehydration with IV fluids are essential. Bone marrow transplantation is the most definitive approach to treating sickle cell disease. Infections with IV antibiotics. Oxygen administration.

Question 21

Sickle Cell Anemia: Meds:

Answer 21

Antisickling agents, such as urea, cyanate, and carbamoyl phosphate. Folic acid supplements may be given to meet the demands of the RBC production. Blood transfusions are often necessary during times of crisis.

Question 22

Blood Administration:

• Indication:

Answer 22

Excessive blood loss, anemia, kidney failure, coagulation factor deficiencies such as hemophilia, thrombocytopenia/platelet dysfunction

Question 23

Blood Administration:Nursing Consideration:

o Know The Steps:

Answer 23

Assess lab values
 Verify prescription
 Check type and crossmatch
 Initiate large-bore IV access. A 20-guage needle is standard.
 Assess for history of transfusion reactions
 Obtain blood product from the blood bank. Inspect for discoloration, excessive bubbles, or cloudiness.
 Confirm the client’s idenitity, blood compatibility, and expiration time of the blood product with another nurse.
 Prime the blood administration set with 0.9% NS (only compatible fluid). Never add meds to blood products.
 Ascertain whether a filter should be used.
 Obtain baseline VS
 Begin the infusion, and use warmer of indicated
 Remain with patient for the first 15 to 20 mins of the infusion (reactions occur most often during this period) and monitor: VS, rate of infusion, respiratory rate, sudden increase in anxiety, breath sounds, neck-vein distention
 Complete infusion within a 2- to 4-hr time period
 Obtain VS upon completion of infusion
 Dispose of blood administration set in biohazard bag
 Monitor blood lab values as prescribed
•

Question 24

Blood Administration:

• Contraindication:

Answer 24

Transfusion of blood components requires the informed consent of the patient receiving the blood. Some patients refuse blood because of religious beliefs, cultural beliefs, or fear of disease transmission. For those who have religious or cultural concerns, alternatives to blood components should be explored

Question 25

Blood Administration:

• Pharmacology

Answer 25

Lasix:
o Side Effects: Dehydration, hypotension; Excessive loss of potassium, sodium, chloride; hyperglycemia, hyperuricemia; muscle weakness

Question 26

Venous thromboembolism (VTE) on Low-Molecular-Weight Heparin:
•	Side Effects:

Answer 26

Bleeding, hemorrhage, hematuria, epistaxis, ecchymosis, bleeding gums, thrombocytopenia, hypotension

Question 27

Venous thromboembolism (VTE) on Low-Molecular-Weight Heparin:
Nursing Education:

Answer 27

Administer only SC into the anterolateral aspect of the abdominal wall – stay 2 inches away from umbilicus. Do not expel the air bubble from the prefilled syringe or aspirate during injection. Monitor PTT levels throughout therapy The antidote is protamine sulfate.