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NURS 1355 > Critically Ill & Anticoagulantion > Flashcards

Critically Ill & Anticoagulantion Flashcards

1
Q

Findings:

Warmth, redness, pain, inflammation, and induration along course of vein. Appears as palpable cord, Edema Rare

Induration of muscle, venous distention, edema, deep reddish color

Superficial vein Thrombosis/ Venous Thrombosis

A

Warmth, redness, pain, inflammation, and induration along course of vein. Appears as palpable cord, Edema Rare (Superficial vein Thrombosis)

Induration of muscle, venous distention, edema, deep reddish color (Venous Thrombosis)

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2
Q

DVT happen 3 ways

A

Venous statis: Not moving

Endothelial damage: Release clotting factors / Activation of platelets

Blood hypercoagulability: imbalance in clotting mechanism, increase in fibrin production

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3
Q

Biggest concern of DVT

A

PE

Pulmonary Embolism

Obstruction of Pulmonary Vessel by particulate matter, most often a clot

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4
Q

Fat & air emboli

Amniotic fluid

Tumors

Can all cause

A

PE

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5
Q

Long bone being broken

Femur, Pelvis, Sternum

Can cause

A

Fat emboli -> PE

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6
Q

How can an air emboli happen

A

Improper IV med administration

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7
Q

Thrombus from a DVT breaks loose & lodges in a pulmonary artery

Describes

A

PE

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8
Q

Audible S³ or S⁴ heart sound
Petechiae
Hemoptysis
Syncope
Tachy
Hypotension
SUDDEN

A

Manifestaciones of PE

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9
Q

PE

ABG

Describe

A

Start: Respitory Alkalosis

End: Metabolic Acidosis

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10
Q

V/Q Scan does….

A

Illustrates how well they are perfusion & ventilation

Diagnose a PE
It measures the airflow (ventilation) and blood flow (perfusion) in your lungs.

You breathe in and are injected with radioactive material while a provider takes pictures of your lungs

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11
Q

Do you want the clot to break apart in DTV

A

No this will cause PE

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12
Q

How does Heparin disolve a DVT

A

It Doesn’t

Stops it from getting bigger

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13
Q

First thing to do in drug therapy for PE

A

Clotting study drawn as a baseline

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14
Q

5000 - 10000 U Heparin given via IVP
followed by a drip

PTT: Kept between ____

A

50 - 70 seconds

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15
Q

Coumadin (Warfarin) work…

A

Warfarin blocks enzyme that uses vitamin K to make clotting factors.

Ability of blood to clot is reduced.

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16
Q

What is PT

Normal

Normal on anticoagulants

A

Prothrombin time (PT)
Time it takes for (plasma) in blood to clot.

Normal 10–13 seconds

Warfarin (Coumadin) multiply by 1.5 - 2.5

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17
Q

Normally an INR of _____ is normal

Warfarin INR range of_____

A

<1.1

Warfarin 2 - 3

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18
Q

A normal partial thromboplastin time
(PTT) is _____

Heparin PTT

A

25–35 seconds

50 - 70 seconds

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19
Q

INR stands for…

A

International Normalized Ratio

How long it takes blood to clot

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20
Q

Measures how long it takes for a blood clot to form based on a protein called prothrombin. PT detects abnormalities in the extrinsic and common pathways of the coagulation cascade.

Measures how blood clots within a blood vessel (intrinsic pathway). PTT detects abnormalities in the intrinsic pathway

PT or PTT

A

PT
Measures how long it takes for a blood clot to form based on a protein called prothrombin. PT detects abnormalities in the extrinsic and common pathways of the coagulation cascade.

PTT
Measures how blood clots within a blood vessel (intrinsic pathway). PTT detects abnormalities in the intrinsic pathway

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21
Q

Which type of blood clot is likely to cause a stroke

A

Left Atrium of the Heart

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22
Q

How to handle clot once it is formed

Start (this med)

Then

Bridge (this med)

A

Heprin (DVT & PE) / (MI & Unstable Angina)

Bridge (Coumadin aka Warfarin)

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23
Q

When treating blood clots

First give (Heparin)

Bridge with (Coumadin aka Warfarin)

(Coumadin aka Warfarin) is used to treat this condition

A

Coumadin aka Warfarin treats Atrial Fibrillation

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24
Q

Epidural/spinal med administración
Uncontrolled bleeding
Severe thrombocytopenia / HIT (Heparin-Induced Thrombocytopenia)
Hemorrhagic Stroke

Are what?

A

Contraindications for Heparin

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25
Q

4 contraindications for Unfractionated heparin

A

Epidural/spinal med administración
Uncontrolled bleeding
Severe thrombocytopenia / HIT (Heparin-Induced Thrombocytopenia)
Hemorrhagic Stroke

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26
Q

Dosing heparin

___ units / kg/ IV bolus

Then

___ units/ kg/hr adjusted by PTT results

A

80 U / kg / IV bolus

Then

18 U/kg/ hr adjusted by PTT results

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27
Q

Labs

PTT / INR Baseline

Then

PTT __ hrs post-bolus or __ hrs post-rate change

A

PTT 8 hrs post-bolus or 6 hrs post-rate change

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28
Q

Once PTT is stabilized

How often

A

Daily

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29
Q

Dosing of HEPARIN

CBC x __ days

A

3

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30
Q

PT (INR) associated with Coumadin us thus pathway…

APTT associated with heparin is associated with…

A

PT (Extrinsic) Inury outside blood vessel

APTT (Intrinsic) Injury inside blood vessel

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31
Q

Dosing of heparin

Treatment ____ days with/without starting warfarin therapy

A

3 - 5 days

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32
Q

Heparin

Rapid onset

Half-life…

A

1.5 hrs

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33
Q

Protamine Sulfate is….

A

Reversal agent for heparin

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34
Q

Heparin doesn’t lyses clots

How is it adminster

A

IV or SQ

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35
Q

What is the Prophylaxis amount of heparin

How often check PTT in prophylactic treatment?

A

5000 - 10000 U, SQ every 8 - 12 hrs

No need to check PTT

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36
Q

IV heparin always,always requires …

A

IV infusion pump

Guardrail medication

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37
Q

What is required for starting a new bag or changing rate on heparin

(Safety)

A

2nd RN

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38
Q

Low molecular weight heparin aka

A

Enoxaparin (Lovenox)

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39
Q

Half life of

Low molecular weight heparin LMWH
Aka enoxaparin (Lovenox)

A

3-6 hrs

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40
Q

Enoxaparin (Lovenox) LMWH

Indications (3)

A

Treatment VTE
DVT Prophylaxis
Unstable Angina

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41
Q

Dosing of LMWH aka Enoxaparin (Lovenox)

1mg/ kg every 12 hrs for….
40 mg. SQ every 24 hrs for….
30 mg SQ every 24 hrs for….

A

1mg/ kg every 12 hrs for treatment
40 mg. SQ every 24 hrs for Prophylaxis
30 mg SQ every 24 hrs if CrCl <30 ml. min

Creatine Clearance

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42
Q

Coumadin = Vitamin __ Antagonist

A

K

43
Q

Coumadin (vit K Antagonist)

Prevent systemic embolism (4) types

A

A Fib
Valvular heart disease
Prosthetic heart valve
Antiphospholipid antibody syndrome

44
Q

A Fib
Valvular heart disease
Prosthetic heart valve
Antiphospholipid antibody syndrome

Can cause systemic embolism

Which medication can help

A

Coumadin Vitamin K Antagonist

45
Q

Contradictions for…

Epidural/spinal med administración
Uncontrolled bleeding
Severe thrombocytopenia / HIT (Heparin-Induced Thrombocytopenia)
Hemorrhagic Stroke

Pregant
Alcohol liver disease
Going to OR

A

Coumadin Vitamin K Antagonist

46
Q

Safety concerns for Coumadin

PT/ INR Daily + CBC

INR for

A fib, stroke, DVT/PE …
Mechanical valve …

A

A fib, stroke, DVT/PE 2-3
Mechanical valve 2.5-3.5

47
Q

Reversal agent for Coumadin (Warfarin)

A

Vit K

48
Q

List foods high in vitamin K

A

Leafy greens: Kale, spinach, Swiss chard, collard greens, and cabbage
Cruciferous vegetables: Broccoli and Brussels sprouts
Other vegetables: Asparagus and green beans
Fruits: Kiwi and avocado

49
Q

Coumadin (Warfarin)

Interactions: (3)

A

Min alcohol use
NSAIDS
Foods high in vit k

Leafy greens:Kale, spinach, Swiss chard, collard greens, and cabbage

Cruciferous vegetables:Broccoli and Brussels sprouts

Other vegetables:Asparagus and green beans

Fruits:Kiwi and avocado

50
Q

____ is used temp to replace Warfarin before surgery Reduces Bleeding Risk

Called: ____ Bridging

A

Lovenox x 2

51
Q

Dabigatran, rivaroxaban, apixaban

Are all which class of blood thinners

What makes them different from past blood thinners

A

NOAC

Novel oral anticoagulants

Only work on 1 part of the Clotting Cascade.

Dabigatran: Direct thrombin inhibitor

rivaroxaban & apixaban Factor x (10)a

52
Q

Recommend time to hold NOAC: Dabigatran, rivaroxaban, apixaban

PRIOR TO SURGERY

A

1-2 days
(CrCl >50ml / min)

3-5 days
(CrCl<50ml/min)

53
Q

To prevent emboli formation/ dislodgement

Massage legs to help circulation

A

False

This will dislodged emboli

54
Q

SCD, TED hose, ROM, Ambulation & ______

Help in prevention of PE

A

Hydration

55
Q

Pulmonary infarction
Pulmonary HTN
Cor pulmonale
Dysrhthmias

Are all …

A

Complications OF PE

56
Q

4 complications of PE

A

Pulmonary infarction
Pulmonary HTN
Cor pulmonale
(pulmonary heart disease, Right side heart failure. Caused by long-term high blood pressure in the lungs and right ventricle of the heart.)
Dysrhthmias

57
Q

Acute respiratory FAILURE

ABG

PO² = <___ mmHg
PCO² = > ___ mmHg

A

PO² = <60mmHg
PCO² = >50mmHg

58
Q

A syndrome of rapidly progressing non-cardiac pulmonary edema & respiration failure

A

ARDS

Acute respiratory Distress syndrome

59
Q

Positive End Excivatory Pressure
PEEP

Does..

A

Keeps alveoli open during ARDS

60
Q

Fracture of which ribs result in pneumothorax

A

1 - 4

61
Q

Loose segment of chest wall left due to adjacent rib fractures

A

Flail chest

62
Q

Difference between Closed & Open pneumothorax

A

Open: Penitration of chest wall (knife)

Closed: No penetrante of chest wall

63
Q

Pneumothorax

Trachea moves…

(Affected / Unaffected) side

A

Unaffected side

64
Q

Possible leathal

Asymptomatic first, later resp failure

Bloody sputum, decreased breath sounds, crackles/ wheeze

Possible chest tube / intubation

A

Pulmonary contusion

65
Q

How long can a picc line stay in place

A

Long term

Up to a year or longer

66
Q

What can a picc line be used for?

A

Taking blood specimens

Inserting: Blood, IV fluids, Meds, TPN
Total parenteral nutrition

67
Q

One advantage of a PICC line is it can be placed when there is a systemic infection

T or F

A

F

No central venous catheter can be placed during systemic infection

68
Q

Von Willebrand disease (VWD) is ….

A

a bleeding disorder
that affects the blood’s ability to clot
properly. It’s caused by a deficiency in the quality or quantity of von Willebrand factor (VWF), a protein that helps blood cells stick together when you bleed. VWD is the most common hereditary blood-clotting disorder in humans

69
Q

Alteplase is administered for…

When…

A

Saving myocardium post MI

Within 6hrs

70
Q

Phytonadione is…

A

Vitamin K

Antidote to Warfarin (Coumadin)

71
Q

Thrombocytosis vs Thrombocytopenia

A

Thrombocytosis >450,000

Thrombocytopenia <150,000

72
Q

PTT

What is considered a therapeutic Time with a control of 30 seconds?

A

Therapeutic levels for heprin are 1.5 / 2.5 time of the control

45 - 75 seconds

73
Q

DIC Rare Clotting Disease has two stages:

Stage one
Overactive clotting leads to blood clots throughout the blood vessels, which can reduce or block blood flow and damage organs.

Stage two
The overactive clotting uses up platelets and clotting factors that help the blood to clot, leading to bleeding in other areas

Take note of which levels

A

Platelets, PT, PTT

74
Q

Why does a client with cirrhosis have bleeding precautions

A

Due to lack of producing clotting factors

75
Q

Which medication affects INR

A

Warfarin (Coumadin)

76
Q

Which medication affects PT

A

Warfarin (Coumadin)

77
Q

Which medication affects APTT

A

Heparin

78
Q

Homan’s sign is…

Associated with which disease

A

Calf pain upon Dorsiflexion of foot

Thrombophlebitis

79
Q

Which lab value should a nurse monitor when client is receiving warfarin sodium therapy?

A

PT. PT should be 1.5 - 2.5 control value

PTT is monitored with heparin

80
Q

Should a client with thrombophlebitis elevate affected extremity?

Why?

A

Yes

Elevation helps blood flow by gravity and decreases venous pressure (Relieving edema & pain)

81
Q

Why do neonates recieve vit K at birth?

A

They are unable to produce their own

Due to lack of intestinal flora to make the vitamin

82
Q

Difference between pt and irn

A

A prothrombin time (PT) test measures how long it takes for a clot to form in a blood sample.

An INR (international normalized ratio) is a type of calculation based on PT test results

83
Q

What chemical process does PT measure

A

How long it take blood to clot

Turing prothrombin into thrombin

Activates fibrinogen into fibrin

84
Q

PT / INR (Extrinsic)
Normal PT
Normal IRN Value
Anticoagulant IRN Value
(Type of medication associated)

aPTT
Normal value
Anticoagulant associated Value
(Type of Anticoagulant)

A

PT / INR
Norm PT 10 - 12 secs
Normal INR <1.1
Anticoagulant INR Value 2 - 3

aPTT
Normal 25 - 35 seconds
Anticoagulant Value 1.5 - 2.5 Normal Value

85
Q

Approx. Normal range for aPTT results

A

25 - 35 sec

Heparin = 1.5 - 2.5 x this value

86
Q

Patient is receiving a heparin IV drip.
What will therapeutic values be for the aPTT

A

1.5 - 2.5 x normal Values

25 - 35 = Normal values

87
Q

Therapeutic range for Warfarin to be effective

A

INR 2 - 3

88
Q

Approx range for pt values

A

10 - 12 seconds

89
Q

INR of 1 on Warfarin =

A

Not effective in preventing blood clots

90
Q

Patients pt is 30 seconds.

Which of the following contribute to this findings

A. None, it is a normal findings
B. Vitamin K defincey
C. Liver disease
D. Warfarin

A

B. Vitamin K defincey
C. Liver disease
D. Warfarin

91
Q

Patients aPTT time is 32 seconds. The nurse would interpret this as…

A

Normal findings

Between 25 - 35

92
Q

Working on the intrinsic pathway

Inhibits thrombin, which converts (fibinogen to fibrin)

Coumadin/ Heparin

Antagonist of vitamin K, which is used in the liver to make clotting factors.

Coumadin/ Heparin

A

Working on the intrinsic pathway

Inhibits thrombin, which converts (fibinogen to fibrin)

Heparin

Antagonist of vitamin K, which is used in the liver to make clotting factors.

Warfarin

93
Q

Onset
Duration:

Heparin vs Warfarin

A

Heparin = fast 20 - 30 minutes
Warfarin= slow 3 - 5 days

Duration:

Heparin: Hours
Warfarin: Days

94
Q

How is

Heparin

Warfarin

Administered

A

Heparin: IV / SQ

Warfarin: Oral med

95
Q

Which can be used during pregnancy

Heparin or Warfarin

A

Warfarin can be used during pregnancy

96
Q

Osteoporosis can be caused by

Heparin/ Warfarin

A

Heparin

97
Q

Excessive Green leafy vegetables will do what to IRN levels

A

Lower (thicker/ clotting blood)

98
Q

Gold standard test to diagnose PE

A

Pulmonary CT angiography

99
Q

Difference between heparin & Lovenox

Which does require aPTT monitoring

A

Lovenox has a longer half-life

aPTT doesn’t need to be monitored on Lovenox

100
Q

Treatment for ARDS

A

Mechanical ventilation using low tidal volume

Positive end-expiratory pressure prevent alveoli collapse

Prone posistion

Render unconscious

101
Q

aPTT is for…

A

IV heparin

102
Q

Lungs have…

Positive pressure during ( exhalation/ inhalation) and Negative Pressure during ( exhalation/ inhalation)

A

Positive pressureduring exhalation and Negative Pressure during inhalation.

103
Q

PEEP

A

Positive end-expiratory pressure

Used to keep alveoli open

104
Q

D-dimer blood test

A

measures protein fragment present when a blood clot dissolves.

The level of D-dimer in the plasma is usually increased when there is acute pulmonary embolism (PE).

A normal D-dimer level is below 500 micrograms/L

NURS 1355 (12 decks)

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