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Marie- NUR 280 > Hemostasis > Flashcards

Hemostasis Flashcards

1
Q

what is hemostasis

A

stopping of bleeding

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2
Q

what is primary hemostasis

A

platelet plug formation

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3
Q

what is secondary hemostasis

A

coagulation cascade to fibrin clot formation

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4
Q

what are the 3 steps of hemostasis

A
  • vasoconstriction
  • platelet plug formation
  • blood coagulation
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5
Q

what is normal platelet level

A

150,000- 400,000

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6
Q

what is thrombocytopenia

A

LOW platelet level (<100,000)

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7
Q

what is thrombocytosis

A

HIGH platelet level (>750,000)

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8
Q

what are the 2 major problems related to hemostasis

A
  • excessive bleeding
  • excessive clotting
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9
Q

what is the normal lifespan of platelets

A

7-10 days

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10
Q

in healthy people, the endothelial lining is…

A

antithrombotic meaning platelets don’t stick

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11
Q

when injured the surface of the endothelial lining is…

A

prothrombotic meaning platelets stick

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12
Q

what is the extrinsic pathway

A

injury happens from the OUTSIDE (ex. laceration, abrasion)

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13
Q

what is the intrinsic pathway

A

injury happens from the INSIDE (ex atherosclerosis)

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14
Q

what does the coagulation cascade require to work properly

A

vitamin k and calcium (pt needs a healthy LIVER)

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15
Q

what lab test is intrinsic pathway measured by?

A

aPTT

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16
Q

what lab test is extrinsic pathway measured by?

A

PT/INR

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17
Q

what does a higher number in lab tests indicate

A

it takes LONGER for blood to clot, leading to BLEEDING

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18
Q

what does a lower number in lab tests indicate

A

it takes SHORTER for blood to clot, leading to COAGULATION

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19
Q

where do both pathways end at?

A

the final common pathway
- where factor X is acted on by factor V to convert prothrombin to thrombin and fibrogen to fibrin leading to a cross linked fibrin clot

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20
Q

why do some people excessively clot

A
  • increased platelet number
  • increased platelet activity/aggregation
  • increased coagulation activity
    • stasis of blood flow
    • increased coagulation factors
    • decrease in antithrombotic factors
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21
Q

what fraction of platelets reside in the spleen?

A

1/3

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22
Q

what fraction of platelets are circulating in the blood stream?

A

2/3

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23
Q

why do some people excessively bleed

A
  • decreased platelet production
  • excessive pooling of platelets in spleen
  • decreased platelet survival
  • impaired platelet activity (d/t meds, renal failure, inherited disorders)
  • deficiencies in clotting factors
  • impaired synthesis of clotting factors
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24
Q

What can taking aspirin give to patients?

A

acquired platelet dysfunction

25
Q

What antiplatelet drugs can be used to treat clotting disorders?

A

-aspirin
- clopidogrel
- hydroxyurea

26
Q

what anticoagulants can be used to treat bleeding disorders

A
  • heparin
  • warfarin
27
Q

what thrombolytic is used to treat bleeding disorders

A

tPA

28
Q

What can be done for life threatening elevations in platelets

A

platelet pheresis

29
Q

what are signs and symptoms of bleeding

A
  • ecchymosis
  • hematoma
  • petechia
  • purpura
  • epistaxis
30
Q

what are signs and symptoms of internal bleeding

A
  • dizzy
  • headache
  • tired
  • abdominal pain
  • SOB
  • chest pain
  • hypotension
  • tachycardia
  • dyspnea/tachypnea
31
Q

what is impaired platelet activity

A

platelets are present in adequate number but they do not function as they should

32
Q

what are some causes of impaired platelet activity

A
  • antiplatelet therapy agents (aspirin, clopidogrel, hydroxyurea)
  • NSAIDs
  • renal failure
  • inherited disorders (genetics)
33
Q

The body needs a healthy _____ to have adequate coagulation

A

liver

34
Q

what vitamin (that the liver stores) does the body need to have adequate coagulation

A

vitamin K

35
Q

what causes drug induced thrombocytopenia

A
  • medications (including herbal and OTC)
  • often misdiagnosed as autoimmune destruction of platelets
36
Q

s/s of drug induced thrombocytopenia

A
  • petechiae appears about 1 week into starting the med
  • dizziness
  • chills
  • fever
  • bleeding
37
Q

what is the treatment for drug induced thrombocytopenia

A

stop the medication causing the problem

38
Q

what causes heparin-induced thrombocytopenia

A

heparin

39
Q

is heparin induced thrombocytopenia associated with bleeding or clotting

A

clotting, the body develops an antibody to heparin

40
Q

what is the treatment for heparin induced thrombocytopenia

A

administer a direct thrombin inhibitor called Argatroban

41
Q

what is thrombotic thrombocytopenic purpura a combination of

A
  • thrombocytopenia
  • hemolytic anemia
  • vascular occlusions
  • fever
  • neurological abnormalities
  • renal disease
42
Q

what is important to remember about thrombotic thrombocytopenic purpura

A
  • autoantibodies lead to a problem with von Willebrand Factor causing platelet aggregation and widespread clot formation
  • happens abrubtly
  • can be fatal!
43
Q

what does thrombotic thrombocytopenic purpura affect

A
  • kidneys
  • brain (stroke)
  • liver
  • heart (MI)
44
Q

risk factors for thrombotic thrombocytopenia purpura

A
  • pregnancy
  • HIV infection
45
Q

s/s thrombotic thrombocytopenic purpura

A
  • petechiae and purpura of lower extremities
  • headache
  • seizures
  • altered consciousness
46
Q

treatment for thrombotic thrombocytic purpura

A

plasmapheresis with 80-90% recovery

47
Q

what factor is missing/greatly reduced with hemophilia A

A

factor VIII

48
Q

what factor is missing/greatly reduced with hemophilia B

A

factor IX

49
Q

s/s of hemophilia

A
  • bleeding with trauma
  • general weakness
  • tachycardia
  • tachypnea
  • easy bruising
  • epistaxis
  • hemoptysis
  • bleeding gums
  • joint pain
  • headache
  • stiff neck
  • intracranial hemorrhages
  • abdominal pain
  • hematemesis
  • melena
  • back pain
  • hematuria
  • post circumcision bleeding in an infant (that is prolonged and hard to stop
50
Q

severe s/s of hemophilia

A

spontaneous bleeding into joints

51
Q

treatment for hemophilia

A
  • factor XIII replacement in hemophilia A
  • factor IX replacement in hemophilia B
52
Q

what is hemolytic uremic syndrome characterized by

A
  • progressive renal failure
  • hemolytic anemia
  • thrombocytopenia
53
Q

s/s of hemolytic uremic syndrome

A
  • bloody diahrrea*
54
Q

treatment for hemolytic uremic syndrome

A
  • supportive
  • antibodies
  • hemodialysis
  • renal transplantation
55
Q

what is disseminated intravascular coagulation

A

disorder of clot formation and bleeding episodes

56
Q

why does disseminated intravascular coagulation happen

A

because clots form and then coagulation factors are depleted leading to elevated fibrinolysis which causes bleeding

57
Q

s/s disseminated intravascular coagulation

A

same as bleeding disorders

58
Q

how is DIC diagnosed

A
  • D-dimer
  • look at clotting times and RBC counts
59
Q

treatment for DIC

A
  • treat underlying disorder
  • transfusions of fresh frozen plasma to correct the clotting factor deficiency

Marie- NUR 280 (12 decks)

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