Exam # 1 Common Post-op Complications Pt2

Question 0

What are the components of Virchow’s triad?

Answer 0

1) Stasis
2) Vessel wall injury
3) Hypercoagulability

Question 1

What are the 7 Predisposing Factors to DVT?

Answer 1

1) Previous DVT
2) Smoking
3) Contraceptives
4) Age
5) Cardiovascular disorders
6) Weight
7) Gender

Question 2

How do TED Hose work as an intervention for DVT and what level of risk do they pose?

Answer 2

TED hose decrease the risk of DVT by increasing venous return. They are usually low risk but their risk increases to mod/high when used when concurrently taking anticoagulants.

Question 3

What is the difference when Unfractionated Heparin is administered via IV and SQ as a means of managing DVT?

Answer 3

1) IV - DVT treatment

2) SQ - DVT prophylaxis

Question 4

What are the SQ sites that Unfractionated Heparin may be administered and what 4 things should we keep in mind when administering it SQ?

Answer 4

• SQ sites for Unfractionated Heparin are the abdomen and iliac crest. Things to remember are:
  1) Rotate injection sites (prevent scar tissue from forming)
  2) Do not aspirate
  3) Hold skin fold during injection
  4) Do not rub site (rubbing causes bruising)

Question 5

What is the antidote for Heparin and Warfarin

Answer 5

1) Heparin Antidote - Protamine Sulfate

2) Warfarin Antidote - Vitamin K

Question 6

What are the actions of Heparin and Warfarin?

Answer 6

1) Heparin - Inhibits thrombin mediated conversion of fibrinogen to fibrin.
2) Inhibits vitamin K dependent coagulation factors (vitamin k antagonist).

Question 7

What are the therapeutic effects of Heparin and Warfarin?

Answer 7

1) Heparin - PTT normal = 24-36 secs; therapeutic = 46-70 secs
ACT normal = 80-135 secs; therapeutic = 3 mins

2) Warfarin - INR normal = .75-1.25; therapeutic* = 2-3
* Therapeutic levels take 48-72 hours because the vitamin k, once administered, takes time to work.

Question 8

Give two examples of LMWH medications

Answer 8

Fragmin and Lovenox

Question 9

What is Xarleto (Rivaroxaban)

Answer 9

A new anticoagulant PO med found to me effective in preventing DVTs and PEs than Lovenox, yet equally safe.

Question 10

Define Pulmonary Emboli

Answer 10

A blood clot from a vein of lower extremity that breaks loose and travels to the heart or a branch of the pulmonary artery vasculature and may result in pulmonary infarction or right heart strain.

Question 11

What are the 6 defining characteristics of a Pulmonary Emboli?

Answer 11

1) It is sudden
2) Sharp chest pain
3) Extreme apprehension
4) Intense hyperventilation and dyspnea
5) Cough and hemoptysis from ischemic pulmonary parenchymal necrosis
6) ⬇ PO2 and CO2

Question 12

Which 3 drug classes especially interact with Warfarin (Coumadin) and should not be administered concurrently?

Answer 12

1) Barbituates
2) NSAIDs
3) Dilantin

Question 13

Which 3 types of food interact with Warfarin (Coumadin)?

Answer 13

1) Green leafy vegetables
2) Broccoli
3) Spinach
* because they promote Vitamin K which is a clotting factor

Question 14

What are the 5 WBCs and what are their roles?

Answer 14

1) Neutrophils (60-70%) - 1st responders in the inflammatory process. An ⬆ indicates. Bacterial infection.
2) Lymphocytes (20-25%) - Produce antibodies. An ⬆ indicates viral infection.
3) Monocytes (3-8%) - Phagocytosis of larger particles
4) Eosinophils (2-4%) - Counteracts histamine and destroys parasitic worms.
5) Basophils (1%) - Releases histamine in the inflammatory phase

Question 15

Which patients are at greatest risk for not being able to sense when their bladders are full?

Answer 15

Patients who have had Epidurals or Spinal Anesthetics because they have lost the sensation down there

Question 16

What are the therapeutic interventions for DVT?

Answer 16

1) Push fluids
2) Early mobilization
3) ROm & planter and dorsiflexion if patient is on bedrest
4) Have patients sit up in chair for meals 3x per day

Question 17

Why should you never use SCDs on a patient with confirmed VTs?

Answer 17

It will push the clot up towards the heart

Question 18

What are the 2 major side effects of Heparin?

Answer 18

1) Heparin Induced Thrombocytopenia (HIT)

2) Osteoperosis

Question 19

Where does Heparin work in the clotting chain?

*Thrombinase > Prothrombin > Thrombin > Fibrinogen > Fibrin

Answer 19

Heparin stops the clotting chain by preventing fibrinogen from turning into fibrin

Question 20

Why is Heparin given as a prophylaxis to prevent DVT but not indicated for patient with confirmed DVT?

Answer 20

Heparin can not dissolve clots (it is not a thrombolytic) that have already formed, it can only stop the clotting chain at a certain point, thus, preventing clots from forming.

Question 21

What are the 6 types of Blood Products discussed in class?

Answer 21

1) Packed Red Blood Cells
2) Frozen RBCs
3) Platelets
4) Fresh Frozen Plasma
5) Albumin
6) Cryoprecipitates

Question 22

What are the 5 characteristics of PRBCs as a blood product?

Answer 22

1) Prepared from whole blood
2) 1 unit = 250-350 mL
3) Less risk of fluid overload
4) Used to treat anemia
5) Contains some platelets and WBCs but they are not functional

Question 23

What are the 2 characteristics of Frozen RBCs as a blood product?

Answer 23

1) Prepared from RBCs

2) Can be stored for 10 years, but must be used within 24 hrs after thawing.

Question 24

What are the 4 characteristics of Platelets as a blood product?

Answer 24

1) Prepared from whole blood
2) 1 unit = 30-60 mL of platelets
3) Includes multiple platelet donations from one donor
4) Used to treat Thrombocytopenia and bleeding disorders

Question 25

Describe also immunization as it pertains to platelets used for transfusion.

Answer 25

Repeated Tx from different donors lead to ⬇ survival due to alloiimunization. Platelets from a single donor is used for repeated Tx because it ⬇ the risk of alloiimunization by limiting exposure to multiple donors.

Question 26

What are the 4 characteristics of Fresh Frozen Plasma as a blood product?

Answer 26

1) 1L = 200-250 mL of plasma
2) Rich in clotting factors
3) Contains no platelets
4) Used for bleeding disorders

Question 27

What are the 3 characteristics of Albumin as a blood product?

Answer 27

1) Prepared from plasma
2) Causes water to shift from extra vascular space to Intravascular space.
3) Used in Tx of Hypovolemic shock, hypoproteinemia, and burns

Question 28

What are the 5 characteristics of Cryoprecipitates as a blood product?

Answer 28

1) Prepared from Fresh Frozen Plasma

2) Used to replace clotting factors, and to Tx Von Wilebrand’s disease, hypofibrinogenemia, and Hemophilia A.

Question 29

What is the effect of 1 unit of PRBCs and 1 unit of Platelets on the patient?

Answer 29

1) 1 unit of PRBCS = ⬆ Hgb by 1 and ⬆ Hct by 3%

2) 1 unit of Platelets = ⬆ platelets by 10,000

Question 30

What are the normal values for PO2 and CO2 found in ABGs?

Answer 30

1) PO2 - 80-100 mmHg

2) CO2 - 35-45 mmHg

Question 31

What 4 methods are used to manage a Pulmonary Emboli?

Answer 31

1) Give O2
2) Position upright
3) Medication - (Pain, vasodilation, anticoagulant and thromboembolytic).
4) Surgery to remove it

Question 32

What is the “bottom line” significance of an elevated ESR?

Answer 32

⬆ESR = an inflammation somewhere in the body

Question 33

(T/F) Patients with renal disease are susceptible to anemia because of a deficiency in erythropoietin.

Answer 33

True - Renal diseases causes a deficiency in erythropoietin production, which result in inadequate RBC production.

Question 34

What are the 3 different types of blood donations?

Answer 34

1) Directed Donation - From a family or friend and specifically for the patient.
2) Standard Donation - Random donation from anyone (usual)
3) Autologous Donation - Self donated blood

Question 35

What 6 things should the nurse check when giving a blood transfusion?

Answer 35

1) Name
2) Hospital #
3) Blood Unit #
4) PT’s ABO& Rh status against Donor’s ABO & Rh status
5) Blood expiration date
6) Blood product ordered against blood product delivered

Question 36

How soon after the blood product arrives on the floor for transfusion should be spiked and infused?

Answer 36

Should be spiked within 30 mins and infused within 4 hours

Question 37

What are the 7 blood transfusion reactions discussed in class?

Answer 37

1) Acute hemolytic - Incompatable ABOs
2) Febrile
3) Mild allergy
4) Anaphylactic
5) Circulatory overload
6) Sepsis
7) Acute lung injury

Question 38

What are the 9 different types of Anemias discussed in class?

Answer 38

1) Penicious/Megoblastic - Vit B12 deficiency
2) Folate Deficiency
3) Iron Deficiency - Can result from blood loss also.
4) ⬇ Erythropoietin Production
5) Anemia of Chronic Disease - Seen in AIDS, liver disease, etc.
6) Aplastic - Immune response that targets cells in bone marrows.
7) Bleeding
8) Autoimmune Hemolytic Anemia - Can be inherited or acquired
9) Thalessemias - Caused by cellular abnormalities of Hgb