Hematologic & Vascular Function Flashcards
What does bone marrow make?
RBC
WBC
Platelets
Normal Platelet Count
150-400 x 10^9/L
Causes of Decreased Platelets
decreased production
increased destruction
Thrombocytopenia: S/Sx
- petechiae
- jaundice
- nose bleed
- bleeding from gums
- blood in urine/stool
- unusual heavy menstrual flows
- fatigue
- enlarged spleen
Thrombocytopenia: Dx
CBC:
- platelet count
- RBC
- H&H
Thrombocytopenia: Interventions
- bleeding precautions
- basic nursing skills
- specific preventions
HIT
occurs w/in days of starting heparin
platelet counts drop below 100
HIT: Tx
-stop heparin
-give alternate thrombin inhibitor like:
argatroban
-rivaxaban (xarelto)
-dabigatran (pradaxa)
-bivalirudin (angiomax)
-give protamine sulfate if necessary
-platelet transfusion
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
Thrombocytic Thrombocytopenia Purpura
unsure of cause
medical emergency
s/sx = thrombocytopenia, anemia, neuro symptoms, fever
tx = FFP, plasmapheresis, antiplatelets, corticosteroids, chemo
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)
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
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
DIC: Causes
sepsis surgery trauma cancer complications from pregnancy/childbirth
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
DIC: Tx
- prevention
- find cause and tx
- replacement of clotting factors (packed RBCs, FFP, Platelets, Cryoprecipitate)
- anticoagulants (when thrombosis predominates - heparin, thrombin inhibitors)
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
