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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
What antiplatelet drugs can be used to treat clotting disorders?
-aspirin - clopidogrel - hydroxyurea
26
what anticoagulants can be used to treat bleeding disorders
- heparin - warfarin
27
what thrombolytic is used to treat bleeding disorders
tPA
28
What can be done for life threatening elevations in platelets
platelet pheresis
29
what are signs and symptoms of bleeding
- ecchymosis - hematoma - petechia - purpura - epistaxis
30
what are signs and symptoms of internal bleeding
- dizzy - headache - tired - abdominal pain - SOB - chest pain - hypotension - tachycardia - dyspnea/tachypnea
31
what is impaired platelet activity
platelets are present in adequate number but they do not function as they should
32
what are some causes of impaired platelet activity
- antiplatelet therapy agents (aspirin, clopidogrel, hydroxyurea) - NSAIDs - renal failure - inherited disorders (genetics)
33
The body needs a healthy _____ to have adequate coagulation
liver
34
what vitamin (that the liver stores) does the body need to have adequate coagulation
vitamin K
35
what causes drug induced thrombocytopenia
- medications (including herbal and OTC) - often misdiagnosed as autoimmune destruction of platelets
36
s/s of drug induced thrombocytopenia
- petechiae appears about 1 week into starting the med - dizziness - chills - fever - bleeding
37
what is the treatment for drug induced thrombocytopenia
stop the medication causing the problem
38
what causes heparin-induced thrombocytopenia
heparin
39
is heparin induced thrombocytopenia associated with bleeding or clotting
clotting, the body develops an antibody to heparin
40
what is the treatment for heparin induced thrombocytopenia
administer a direct thrombin inhibitor called Argatroban
41
what is thrombotic thrombocytopenic purpura a combination of
- thrombocytopenia - hemolytic anemia - vascular occlusions - fever - neurological abnormalities - renal disease
42
what is important to remember about thrombotic thrombocytopenic purpura
- autoantibodies lead to a problem with von Willebrand Factor causing platelet aggregation and widespread clot formation - happens abrubtly - can be fatal!
43
what does thrombotic thrombocytopenic purpura affect
- kidneys - brain (stroke) - liver - heart (MI)
44
risk factors for thrombotic thrombocytopenia purpura
- pregnancy - HIV infection
45
s/s thrombotic thrombocytopenic purpura
- petechiae and purpura of lower extremities - headache - seizures - altered consciousness
46
treatment for thrombotic thrombocytic purpura
plasmapheresis with 80-90% recovery
47
what factor is missing/greatly reduced with hemophilia A
factor VIII
48
what factor is missing/greatly reduced with hemophilia B
factor IX
49
s/s of hemophilia
- 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
severe s/s of hemophilia
spontaneous bleeding into joints
51
treatment for hemophilia
- factor XIII replacement in hemophilia A - factor IX replacement in hemophilia B
52
what is hemolytic uremic syndrome characterized by
- progressive renal failure - hemolytic anemia - thrombocytopenia
53
s/s of hemolytic uremic syndrome
- bloody diahrrea*
54
treatment for hemolytic uremic syndrome
- supportive - antibodies - hemodialysis - renal transplantation
55
what is disseminated intravascular coagulation
disorder of clot formation and bleeding episodes
56
why does disseminated intravascular coagulation happen
because clots form and then coagulation factors are depleted leading to elevated fibrinolysis which causes bleeding
57
s/s disseminated intravascular coagulation
same as bleeding disorders
58
how is DIC diagnosed
- D-dimer - look at clotting times and RBC counts
59
treatment for DIC
- treat underlying disorder - transfusions of fresh frozen plasma to correct the clotting factor deficiency

Marie- NUR 280 (12 decks)

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