EC Chp 24 Hematologic & Renal Emergencies

Question 1

Blood has specific functions what are they?

Answer 1

Control bleeding by clotting
Delivery of oxygen to the cells
Removal of carbon dioxide from the cells
Removal and delivery of other waste profits to organs (kidneys and liver) that provide filtration and removal

Question 2

Blood is made up of 4 components what are they?

Answer 2

Red blood cells
White blood cells
Platelets
Plasma

Question 3

What is the special molecule in red blood cells that bind to oxygen and delivery it to cells

Answer 3

Hemoglobin

Question 4

What do platelets do that is crucial?

Answer 4

Formation of clots which is also called clumping or AGGREGATION.

Question 5

What is a situation would you not want clumping to occur in?

Answer 5

When plaque in a coronary artery ruptures. This could cause the rapid clumping and completely block the coronary artery which results in a heart attack (MI)

Question 6

Plasma is the liquid in which blood cells and platelets are suspended but it also contains?

Answer 6

Dissolved nutrients and carries crucial proteins

Question 7

Clotting factors in addition to platelets are proteins that are produced where?

Answer 7

In the liver

Question 8

When are clotting factors activated?

Answer 8

When damage occurs to the lining of a damaged blood vessel

Question 9

Clotting factors form clots through specific steps and they are called ?

Answer 9

Clotting cascades. They are the most stable clots, replacing the initial efforts of the platelets

Question 10

Coagulopathy is

Answer 10

Loss of the normal ability to form a blood clot with internal or external bleeding

Question 11

What are the results of coagulopathy.

Answer 11

The body forms clots too readily or too slowly resulting in uncontrolled bleeding. Possibly due to few platelets or they are not functioning correctly

Question 12

What are certain diseases that make patients to poor clotting?

Answer 12

Advanced liver diseases
Cirrhosis - inadequate clotting factors
Hemophiliac- inherited disorder that don’t allow person to produce the clotting factors
Von Willebrands - most common inherited disease where platelets are functionally defective

Question 13

Those at risk of for heart attack’s strokes or abnormal cardiac rhythms commonly take blood thinners. Examples are ?

Answer 13

Coumadin (warfin), pradaxa, eliquis, Xarelto, lovenox, which inhibit certain clotting factors

Question 14

Other drugs such as asprin and plavix(clopidogrel) do what?

Answer 14

They inhibit platelet aggregation

Question 15

Identifying patients with coagulopathies is based on medical history and medications they are taking. What is an important question to ask a trauma patient to find this out?

Answer 15

Are you on blood thinners?

Question 16

Anemia is

Answer 16

The lack of a normal number of red blood cells in the circulation

Question 17

Acute Anemia may be the result of what?

Answer 17

Trauma or sudden massive bleeding from GI tract. Will show signs and symptoms or shock

Question 18

Chronic Anemia is and can be cussed from what?

Answer 18

Occurs over time and can be caused from heavy current menstrual periods, slow GI blood loss, or diseases that affect the bone marrow or Structure of the hemoglobin molecule.

Question 19

Patients with chronic Anemia will appear…

Answer 19

More pale than normal, complain of fatigue, shortness of breath. Best way to examine is to check the conjunctiva which will be very pale.

Question 20

Sickle cell anemia and an inherited disease in which results in a defect in the hemoglobin resulting in an abnormal structure of red blood cells. What are the most common patients of it?

Answer 20

1. African

Middle eastern or Indian

Question 21

Patients with sickle cell anemia have red blood cells with abnormal shape and they lose compressibility this means

Answer 21

They have less life than regular rbc and results in chronic Anemia and causes blockages within body’s small blood vessels.

Question 22

Complications of SCA include:

Answer 22

Destruction of the Spleen
Sickle cell pain crisis: sludging in capillaries pain in arms, legs, chest and or abdomen
Acute chest Syndrome: shortness of breath/chest pain
Priapism: sludging RBC’s prevent normal blood drainage
Stroke
Jaundice:

Question 23

Treatment for Sickle Cell Anemia includes

Answer 23

Oxygen for patients with respiratory distress
Less than 94-95%
Monitor acute chest syndrome for inadequate resp

Question 24

Renal System is made up of what?

Answer 24

2 kidneys
two ureters
and a single urethra

Question 25

If Urinary Tract Infection (UTI) is left untreated the infection can ascend up the ureter and into the kidney. this condition is called:

Answer 25

Pyelonephritis

Question 26

symptoms of Pyelonephritis can be life threatening especially in the elderly and they are

Answer 26

unilateral flan pain
looking ill
if bacteria spread to bloodstream

Question 27

what causes unilateral flank pain that radiates to the groin area as it descends from the kidney and becomes logged in the ureter?

Answer 27

Kidney Stones

Question 28

urinary catheter is a result of an obstruction of outflow from the bladder or a neurological disorder. does what?

Answer 28

a drainage tube placed into the urinary system to alllow the flow of urine out of the body

Question 29

The most serious disease of the kidney is Renal Failure. What happens when this occurs

Answer 29

The Kidneys lose their ability to adequately filter the blood and remove toxins and excess fluid from body

Question 30

You can have both acute (sudden) renal failure. what is this caused by?

Answer 30

shock, and toxic ingestions. however, they can recover depending on the situation

Question 31

Chronic (Develop over time) renal failure occurs when?

Answer 31

polycystic kidney disease, poorly controlled diabetes, and high BP

Question 32

Patients who go onto develop irreversible renal failure are defined as What and require what?

Answer 32

End Stage Renal Disease (ERSD) and need dialysis to survive.

Question 33

Dialysis is what?

Answer 33

the process by which toxin and excess fluids are removed by a medical system independent of the kidneys

Question 34

what are the 2 general types of Dialysis and which one is most common?

Answer 34

Hemodialysis (most common) at a center 3x a week
Peritoneal Dialysis (at home and daily)
each one at least 3-4 hours

Question 35

Hemodialysis patient is connected to a machine that pumps blood through specialized filters. how many catheters are connecting to the patient

Answer 35

2, one allows blood to flow out to the machine and the other returns blood to the body.

Question 36

Hemodialysis patients will either have a specialized two-port catheter to one of the major veins or a…

Answer 36

Fistula surgically implanted in one of their extremities that connects arterial and venous blood blood

Question 37

A thrill relates to a fistula how?

Answer 37

It is a vibration felt on gentle palpation within the arterial venous Fistula (A-V fistula)

Question 38

Peritoneal Dialysis requires treatments everyday for most patients and is done at home, but how does it work?

Answer 38

by a PERMANENT catheter implanted and using the large surface area inside the peritoneal cavity that surrounds the abdominal organs of removing toxins and fluids.

Question 39

Each cycle of filling and draining the peritoneal cavity is called an

Answer 39

Exchange

Question 40

What are the 2 types of Peritoneal Dialysis?

Answer 40

Continuous ambulatory peritoneal d (CAPD) & common

Continuous cycler-assisted pertioneal dialysis (CCPD)

Question 41

CAPD uses what kind of exchange process

Answer 41

gravit exchange, bag is elevated above the abdominal catheter, then lowered below to drain the fluid (done several times a day)

Question 42

CCPD uses the same catheter as the CAPD but not gravity exchange uses a…

Answer 42

machine to fill the empty abdominal cavity with fluid 3-5 times a night while the person sleep

Question 43

when a patient misses a dialysis, what symptoms they present are familiar to another condition

Answer 43

symptoms similar to those you see in Congestive Heart Failuare.
shortness of breath, Edema in the extremities
dysrhythmias (unbalance of electrolytes)

Question 44

why could you get dysrhythmias from missing dialysis?

Answer 44

you can no longer balance electrolytes and elevated levels of electrolyte potassium are dangerous and can result in death from dysrhythmias

Question 45

Complications of Dialysis include:

Answer 45

Bleeding from the the Site of the A-V
Clotting and loss of function of the A-V Fistula (hard to touch)
Bacterial infection

Question 46

Most common serious complication of ESRD on peritoneal dialysis is acute

Answer 46

Acute Peritonitis

Question 47

Patients with kidney transplants spend the rest of their lives on specialized drugs to prevent organ rejection by doing what?

Answer 47

they suppress the immune system, but make them more susceptible to serious infections.

Question 48

Blood is made up of solid components such as RBC, WBC and platelets but where are they created?

Answer 48

in the the bone marrow

Question 49

Cirrhosis is a disease in which the patient has…

Answer 49

inadequate clotting factors

Question 50

Hemophiliac is an inherited disorder that…

Answer 50

don’t allow person to produce the clotting factors

Question 51

Von Willebrands is the most common inherited disease where…

Answer 51

platelets are functionally defective