CBC: - platelet count - RBC - H&H

Decreased RBC production: - decreased iron from liver - decreased nutrients from GI tract - decreased erythropoietin from kidney Direct Blood Loss Increased RBC Destruction/Hemolysis - sickle cell disease - meds - incompatible blood (transfusions) - trauma (cardiopulmonary bypass machine)

mild anemia (Hgb 10-12): - exertional dyspnea - palpitations moderate anemia (Hgb 6-10): - palpitations - dyspnea - "roaring in the ears" - fatigue severe anemia (Hgb < 6): - pallor, jaundice, pruritus - smooth tongue - tachycardia - angina, HF, MI - orthopnea - dyspnea at rest - bone pain - sensitivity to cold, weight loss, lethargy

- replacing blood volume to prevent shock - identifying source of bleeding and stopping - supplemental iron (PO or IV) - meds: erythropoietin (for those with kidney dysfunction) - O2 - dietary and lifestyle changes - alternate rest and activities

lab testing - platelet count - PT/INR - aPTT - fibrin split products (clots mad and broken down forms FSP and indicates widespread dissolving clots) - D-dimer elevated FSP and D-dimer are highly predictive of DIC

- prevention - find cause and tx - replacement of clotting factors (packed RBCs, FFP, Platelets, Cryoprecipitate) - anticoagulants (when thrombosis predominates - heparin, thrombin inhibitors)

Hematologic & Vascular Function Flashcards by Kaitlin Hobbs

What does bone marrow make?

RBC
WBC
Platelets

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Normal Platelet Count

150-400 x 10^9/L

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Causes of Decreased Platelets

decreased production

increased destruction

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Thrombocytopenia: S/Sx

petechiae
jaundice
nose bleed
bleeding from gums
blood in urine/stool
unusual heavy menstrual flows
fatigue
enlarged spleen

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Thrombocytopenia: Dx

CBC:

platelet count
RBC
H&H

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Thrombocytopenia: Interventions

bleeding precautions
basic nursing skills
specific preventions

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HIT

occurs w/in days of starting heparin

platelet counts drop below 100

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HIT: Tx

-stop heparin
-give alternate thrombin inhibitor like:
argatroban
-rivaxaban (xarelto)
-dabigatran (pradaxa)
-bivalirudin (angiomax)
-give protamine sulfate if necessary
-platelet transfusion

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ITP

platelets become coated w/ antibodies

body sees them as foreign and spleen destroys them

platelet survive 1-3 days

acute: resolves on it’s own
chronic: corticosteroids, immunoglobulins, splenectomy

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Thrombocytic Thrombocytopenia Purpura

unsure of cause

medical emergency

s/sx = thrombocytopenia, anemia, neuro symptoms, fever

tx = FFP, plasmapheresis, antiplatelets, corticosteroids, chemo

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Anemia: Caues

Decreased RBC production:

decreased iron from liver
decreased nutrients from GI tract
decreased erythropoietin from kidney

Direct Blood Loss

Increased RBC Destruction/Hemolysis

sickle cell disease
meds
incompatible blood (transfusions)
trauma (cardiopulmonary bypass machine)

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Anemia: S/Sx

mild anemia (Hgb 10-12):

exertional dyspnea
palpitations

moderate anemia (Hgb 6-10):

palpitations
dyspnea
“roaring in the ears”
fatigue

severe anemia (Hgb < 6):

pallor, jaundice, pruritus
smooth tongue
tachycardia
angina, HF, MI
orthopnea
dyspnea at rest
bone pain
sensitivity to cold, weight loss, lethargy

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Anemia: Tx

replacing blood volume to prevent shock
identifying source of bleeding and stopping
supplemental iron (PO or IV)
meds: erythropoietin (for those with kidney dysfunction)
O2
dietary and lifestyle changes
alternate rest and activities

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DIC: Causes

sepsis
surgery
trauma
cancer
complications from pregnancy/childbirth

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DIC: Dx

lab testing

platelet count
PT/INR
aPTT
fibrin split products (clots mad and broken down forms FSP and indicates widespread dissolving clots)
D-dimer

*elevated FSP and D-dimer are highly predictive of DIC

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DIC: Tx

prevention
find cause and tx
replacement of clotting factors (packed RBCs, FFP, Platelets, Cryoprecipitate)
anticoagulants (when thrombosis predominates - heparin, thrombin inhibitors)

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Cryoprecipitate

FFP + platelets

PAD

thickening of artery walls

likely to have coronary artery disease

RF: smoking, hyperlipidemia, diabetes, HTN, family hx, obesity, stress

PAD: S/Sx

affects lower extremities
intermittent claudication
paresthesia
shiny, taut, hairless lower extremities
diminished or absent pulses
pallor in response to leg elevation
dependent rubor
delayed wound healing
arterial ulcers over bony prominences
rest pain in toes

PAD: Dx

doppler u/s
ankle-brachial index (divide the ankle systolic BP by the higher left and right brachial systolic BP)
angiography
MRI

PAD: Tx

modify risk factors
decrease HTN
lipid management
exercise therapy (walking, pool activities)
weight loss
meds: antiplatelets, ACE inhibitors

DVT

results from Virchow’s triad:

venous stasis
hypercoagulability
endothelial injury

DVT: S/Sx

in 50% of people:

warmth
redness
pain
swelling

Venous Thrombosis: Risk Factors

advanced age
obesity
recent surgery
previous clot
stoke
OCP
pregnancy
smoking
long distance travel

Venous Thrombosis: Prevention

in hospital: - compression stockings - SCDs - heparin/LMWH (Lovenox)

Venous Thrombosis: Tx

- IV Heparin - Thrombin inhibitors - IVC filter

Acute PE: Definitions

Massive: - sustain hypotension - inotropic support required - PEA or bradycardia w/ shock Submassive: -myocardial necrosis or RV dysfunction w/ no systemic hypotension Low Risk: -normal levels of biomarker, no systemic hypotension or RV dysfunction

PE: Risk Factors

DVT is the primary cause in hospitalized pts: - DVT - more than 7 days of immobilization - obesity - post op

PE: S/Sx

- dyspnea - chest pain w/ inspiration - calf or thigh pain and/or swelling - cough - orthopnea (2+ pillow) - wheezing

PE: Dx

- V/Q scan - pulmonary angiogram - spiral CT - doppler - D-dimer

PE: Tx

- HOB up - O2 - call provider - bed rest to keep clots from moving - clot control: heparin > coumadin, thrombolytics, catheter directed thrombosis, embolectomy, IVC filter

Hospital Risk Assessment for DVT

low risk: - age < 40 - minor surgery moderate risk: - age > 40 - minor surgery - additional risk factors high risk: - age > 60 - surgery highest risk: - age > 40 w/ multiple risk factors - hip or knee surgery/interventions - major trauma - SCI

Hospital Interventions for DVT Prevention

low risk: - early ambulation - elastic stockings/or SCDs moderate risk: -heparin or LMWH (Lovenox) high risk: -same as moderate highest risk: - LMWH, fodaprimnux, or warfarin - SCDs

Aneurysm

outpouching of dilated vessel wall most commonly caused by atherosclerosis True: wall of the artery forms the aneurysm w/ one vessel layer intact False (Pseudo): disruption of all arterial wall layers w/ bleeding contained usually occurs below renal arteries

Aneurysm: S/Sx

- often asymptomatic until pain begins - JVD - edema in face and arms - pulsatile mass in periumbilical area - may present as kidney stones - sharp pain - tearing feeling radiating to back - older adults may have vague symptoms such as hypotension

Aneurysm: Rupture

results in hypovolemic shock grey turner's sign if AAA (bruising on flank) monitor w/ CT, u/s, MRI, angiography, lab tests requires immediate surgical repair

Aneurysm: Surgery

graft autotransfusion *still can develop aneurysm above graft, thrombosis, or infection

Aneurysm: Pre-op Interventions

- NPO - bowel prep - skin cleaning - beta blockers given if hx of CVD

Aneurysm: Post-op

- diuretics and antihypertensives (don't want unnecessary pressure/stress) - monitor ABGs, EKG, pain - aseptic technique on all arterial lines or invasive monitoring lines - if pt has NGT, monitor output and do oral care until NPO status is discontinued - assess LOC and neuro status (at risk for stroke) - monitor peripheral pulses - monitor urine output

Aneurysm: Discharge Instructions

- avoid heavy lifting for 6 weeks post-op (>10lbs) - report fever, pain, or drainage from incision - monitor extremities (CMS) - make sure they are urinating to ensure kidneys are perfusing