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S4 2539 > M4 Clotting > Flashcards

M4 Clotting Flashcards

1
Q

DIC
Disseminated Intravascular coagulation

A

Inflammation and coagulation due to initial disease process causes microthrombi to form in circulation.

This uses up fibrinogen and platelets causing both excessive clotting and bleading

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2
Q

Initial processes that may cause DIC

A

Sepsis
Cancer
Trauma
Shock
Abruptio Placentae

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3
Q

Due to excessive microthrombi in dic, the primary reflection on the body is

A

multiple organ failure due to ischemia

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4
Q

To correct the ischemia with DIC body will release more potent anticoagulants, this will cause

labs

A

Further bleeding

Elevated fibrin degradation products and D-dimers

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5
Q

1st manifestation of DIC

A

progressive decrease in platelet count

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6
Q

After the organ failure and happens due to excess clotting with DIC, _ starts

A

bleeding

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7
Q

DIC bleeding sights

A

IV sight
Visual changes!
Mucous membranes
GI and Urinary tract

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8
Q

DIC clotting and integument

A

temp and sensation v
pain ^
cyanosis
superficial gangrene

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9
Q

DIC bleeding and integument

A

Petechiae, including periorbital and mucosa

bleeding gums, iv sites, previous injections

epistaxis, ecchymoses, joint pain

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10
Q

DIC clotting and circulation

A

Pulse v
Capillary fill time greater than 3 sec

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11
Q

DIC bleeding and circulation

A

Tachycardia

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12
Q

DIC clotting and resp system

A

Hypoxia - clotting in lungs
Dyspnea
CHEST PAIN (on INSPIRATION)
ULTIMATE SHOCK

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13
Q

DIC bleeding and resp system

A

High-pitched bronchial sounds
Tachypnea
Acute respiratory distress ARDS

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14
Q

DIC clotting and GI

A

Pain
Heartburn

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15
Q

DIC bleeding and GI

A

Hematemesis
Melena

Retroperitoneal bleeding - firm abdomen, distention, tender on palpation,
abdominal girth INCREASE

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16
Q

DIC clotting and renal

A

Urine output v
BUN ^
Creatinine ^

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17
Q

DIC bleeding and renal

A

Hematuria

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18
Q

DIC clotting and neuro

A

v LOC
v pupil reaction
v strength/mobility

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19
Q

DIC bleeding and neuro

A

Anxiety restlessness
HA
LOC change!
Conjunctival hemorrhage

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20
Q

Platelet count

Changes with DIC

A

150,000-450,000mm

v with DIC

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21
Q

PT time

Changes with DIC

A

11-12.5s

^ with DIC

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22
Q

aPTT time

Changes with DIC

A

23-35s

^ with DIC

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23
Q

Thrombin time TT

Changes with DIC

A

8-11s

^ with DIC

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24
Q

Fibrinogen level

Changes with DIC

A

170-340mg/dL

v with DIC

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25
Q

D-dimer level

Changes with DIC

A

0-250ng/ml

^ with DIC

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26
Q

FDP level
fibrin degradation product

Changes with DIC

A

0-5mcg/ml

^ with DIC

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27
Q

Euglobulin clot lysis time

Changes with DIC

A

Greater than 2h

Less than 1h with DIC

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28
Q

DIC scoring system

Platelets
FDP
Prothrombin time
Fibrinogen
0 1 2 3

A

Platelet
0->100,000
1-50,000 to 100,000
2-< 50,000

FDP
0-no increase
2-moderate increase
3-stronge increase

Prothrombin
0-<3s
1-3s to 6s
2->6s

Fibrinogen
0->100mg/dL
1-<100mg/dL

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29
Q

Most critical factor in DIC treatment

A

UNDERLYING CAUSE

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30
Q

Correct tissue ischemia with DIC via

A

O2
Fluid replacement
Correct Lyte abnormalities
Administer vasopressor meds

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31
Q

Vasopressor meds

A

Create pressure in vessels - hence vasopressor

constricts vessels

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32
Q

Vasopressor med names

A

Vasopressin
Phenylephrine

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33
Q

Correct hemorrhage with DIC

A

Replace platelets and coagulation factors

Cryoprecipitate -replaces fibrinogen factor V and VII

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34
Q

Decision to do transfusion support for DIC is based on

A

risk of bleeding out from puncture

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35
Q

Nursing, how to ID pt at risk of DIC

A

ID PT at risk via clotting/bleeding symptoms or labs

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36
Q

Most vulnerable organs in need of support due to DIC ischemia

A

Kidneys
Lungs
Brain
Skin

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37
Q

Treat DIC kidney injury

A

Dialysis

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38
Q

Dialysis needs a large bore catheter so for DIC PTs also give _ and _ with this treatment

A

Platelets
Plasma

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39
Q

Respiratory nursing interventions for DIC
Lungs may fill with blood so…

A

Suction as gently as possible to prevent more bleeding

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40
Q

ITP
Immune Thrombocytopenic Purpura
other names

what is it

A

Idiopathic TP is AUTOIMMUNE!!!

Platelet count less than 100,000mm with no explanation

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41
Q

Primary (autoimmune) ITP cause

A

Pathologic antiplatelet antibodies

Impaired production of megakaryocytes

T-cell mediated destruction or platelets

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42
Q

Secondary ITP cause

A

Other autoimmune disorders
Viral infection
Drugs

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43
Q

Other autoimmune disorder that can cause ITP

A

Antiphospholipid antibody syndrome
RA

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44
Q

Viral infections that can cause ITP

A

Hepatitis C
HIV
Helicobacter pylori

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45
Q

Meds that can cause ITP

A

Cephalosporins - antimicrobials start with (cef-ceph) cefdinir, cephalexin/kelfex

Sulfonamides - antibiotics
Bactrim, Septra, Cotrim

Furosemide

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46
Q

Once platelets are marked for destruction by the body they are destroyed by which system

A

Reticuloendothelial system

RES

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47
Q

Body attempts to compensate for platelet destruction by

A

Increasing production in bone marrow

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48
Q

minor S/S of thrombocytopenia
ITP

A

easy bruising
heavy menses
petechiae

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49
Q

major S/S of thrombocytopenia ITP

A

GI bleeding
Respiratory system bleeding

aka Wet Purpura

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50
Q

Risk factors for severe bleeding

A

Platelet count less than 20,000
History of bleeding episodes
Advanced age

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51
Q

Correlation between H.pylori and ITP

A

Not clear

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52
Q

Diagnosing ITP involves

A

Tests to rule out other causes like
HepC
HIV
Bone marrow aspirate
H pylori

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53
Q

Risk of bleeding increases when platelet count drops to

A

30,000mm

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54
Q

In ITP below 30,000 treat _ _ not _

Decision to treat is based on _ not …

A

Platelet count, not disease

Bleeding, not platelet count

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55
Q

is quinine associated with ITP

A

YES

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56
Q

Can you give transfusions to ITP patients

A

NO

those platelets will die too but you will increase fluid volume and so bleeding into lungs and GI

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57
Q

Emergency med for ITP

A

Aminocaproic acid

Fibrinolytic enzyme inhibitor

slows destruction of clots

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58
Q

Mainstay short term therapy for ITP

work on what cell

A

Immunosuppressive agents

Macrophages

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59
Q

ITP corticosteroids for adults

A

Dexamethasone
Prednisone

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60
Q

Corticosteroids will increase platelet count within…

good for long term use

A

a few days

NO

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61
Q

Surgery for ITP

why

A

Splenectomy

removes site of autoantibody production

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62
Q

Side effects of splenectomy for ITP

A

risk for thrombocytopenia below 30,000

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63
Q

Splenectomy lowers immune system so pt will need to be on top of _

do which once prior to procedure?

A

Shots!

pneumococcal
influenza
meningococcal

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64
Q

Nursing management ITP
pt Hx

A

Lifestyle (sedentary better)

OTC meds, herbs, supplements that can increase bleeding

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65
Q

What meds increase bleeding

A

Sulfa drugs
Aspirin
NSAIDs

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66
Q

Other history of complications ITP

indicates

A

Headaches
Visual disturbances
Viral illnesses

Indicates intracranial bleeding

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67
Q

With wet purpura on admission do

A

Neuro assessment

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68
Q

Avoid what procedures with ITP

A

Injections
Rectal meds

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69
Q

ITP patients may experience what unrelated symptom

A

Fatigue

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70
Q

Teach ITP pt to know

A

Med side effects
Platelet count monitoring
Follow-up appt

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71
Q

ADL recommendations for ITP

A

avoid constipation
use soft toothbrush
electric razor

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72
Q

ITP and corticosteroid complications

A

Osteoporosis
Proximal muscle wasting
Cataract formation
Dental carries

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73
Q

Supplements for ITP

A

Calcium
VitD
Bisphosphonate

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74
Q

HELLP acronym

A

H-hemolysis
EL-elevated liver enzymes
LP-low platelet count

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75
Q

HELLP 101

A

Life threatening pregnancy complications

Variant of preeclampsia

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76
Q

HELLP symptoms can be mistake for

A

gastritis
flu
hepatitis
bladder problems

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77
Q

Common cause of HELLP

A

Preeclampsia
Pregnancy induced hypertension

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78
Q

Previous pregnancy with HELLP…

A

increases risk

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79
Q

Other HELLP Risk factors

A

Age over 25
Caucasian
Multiparous

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80
Q

HELLP S/S

A

Preeclampsia
Indigestion
Pain in upper right quadrant (LIVER distention)
Shoulder pain

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81
Q

HELLP/preeclampsia S/S

A

Headache
NV
Bleeding
Vision changes
Swelling

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82
Q

Biggest signs of HELLP Preeclampsia

A

High BP
Proteinuria

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83
Q

Most common reason for morality with HELLP

A

Liver rupture

Stroke - cerebral edema, cerebral hemorrhage

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84
Q

HELLP severity is based on

A

Platelet count

85
Q

Mild
Moderate
Severe
HELLP platelet numbers

A

Mild, class III- 150,000 to 100,000mm

Moderate, class II- 100,000 to 50,000mm

Severe, class III- less than 50,000

86
Q

HELLP prevention

A

Good health before pregnancy
Regular prenatal visits
Inform Dr. if Hx of preeclampsia, hypertension or HELLP
Education regarding S/S

87
Q

HELLP Treatment UNDER 34 weeks

A

Admission and bedrest
Corticosteroids (for baby lungs)
Magnesium sulfate (prevent seizures)
Blood transfusion (if low pltlt count)
Fetal monitoring

88
Q

Fetal monitoring

A

Biophysical test
Sonogram
Nonstress test
Fetal movement

89
Q

HELLP Treatment OVER 34 weeks

A

Delivery is recommended course of treatment
Trial of labor TOL
Surgery may cause complications due to low plt count

90
Q

HELLP affects on baby

A

Baby’s over 2 pounds have an increased chance of survival, under 2 have a significant decrease

Death due to abruption of placenta and asphyxia

91
Q

Most serious complications of HELLP

A

Placenta Abruption
Pulmonary edema
DIC
ARDS
Renal failure

92
Q

Diagnosing HELLP
hemolysis

A

RBC death
Abnormal peripheral smear
Bilirubin less than 1.2mg/dl

93
Q

Diagnosing HELLP
Elevated Liver enzymes

A

Serum aspartate aminotransferase > 70U/L

Lactate dehydrogenase > 600U/L

94
Q

Diagnosing HELLP
Low Platelets

A

Less than 150,000
and lower determines severity

95
Q

HELLP PT needs daily

A

WEIGHT

96
Q

to monitor HELLP renal function

A

indwelling cath

97
Q

Do abdominal palpations for HELLP

checks on

A

Uterine tone
Fetal sieze
Activity
Position

98
Q

Fetal checks for HELLP

A

NST
BPP

checks for hypoxia due to placental insufficiency

99
Q

Electronic monitoring for HELLP fetal status is done at what rate

A

At least daily

100
Q

HELLP PT room should be near nurses station and have

A

emergency drugs
crash cart
seizure precautions

101
Q

Due to HELLP bedrest pt is at risk of _

intervetions

A

Thromboembolisms

TED hose
SCD boots

102
Q

If severe pulmonary edema and renal failure with HELLP pt will need invasive hemodynamic monitoring for fluid volume. AKA

A

Swan Ganz Catheter

103
Q

HIT
Heparin Induced Thrombocytopenia

Patho/causes

A

Due to LMWH

Platelet factor 4 Binds to LMWH - platelets activate increasing thrombosis - platelets are consumed and macrophages or the RES start to attack existing thrombi - Result is THROMBOCYTOPENIA

104
Q

Risk of LMWH HIT is _%

A

5%

105
Q

HIT T1 101

A

Mild
Onset 1-4 days
100,000 platelet count

106
Q

HIT T2 101

A

Life threatening
Onset 5-10 days
IgG Antibodies
60,000 platelet count

107
Q

S/S of HIT

A

Skin necrosis at injection syte

Fever, chills, tachycardia, dyspnea

Limb ischemia

Organ infarction

108
Q

PF4 testing in HIT

A

ELISA
Colorimetric change OD

109
Q

Functional assay HIT testing

A

Serotonin release assay
SRA

110
Q

4Ts of Thrombocytopenia and HIT

A

Thrombocytopenia - drop in CBC and platelet count

Timing - fall, 5-10 days after heparin initiation

Thrombosis - venous/arterial

no oTher explanations

111
Q

HIT Treatment

A

STOP Heparin
Give Protamine sulfate

112
Q

Hx of complications that may impact blood transufsion

A

Multiple births

Cardiac
Pulmonary
Vascular
problems

113
Q

Before starting transfusion do a

Why

A

Full body assessment

Vitals
fluid status
lungs for clearance
cardiac for edema hf
skin for petechiae ecchymoses

This will help differentiate a reaction if there is one

114
Q

Febrile nonhemolytic reaction

A

Most common reaction

caused by antibodies reaction to donor leukocytes

115
Q

Febrile Nonhemolytic reaction and birth

A

can happen to Rh negative moms who have Rh positive babys

116
Q

Febrile Nonhemolytic reactions and frequent transfusions

A

Increase chance due to increased exposure to different leukocytes

117
Q

For blood transfusion use special tubing that has

A

filter for clots

118
Q

Double check blood with

what to check

A

another nurse

ABO group
Rh type

119
Q

Check blood for

A

Gas bubbles
Unusual color
Cloudiness

120
Q

Start transfusion with _min of removing blood from bank

A

30

121
Q

For first 15 min of transfusion run at

A

5ml/min

then can increase

122
Q

Monitor closely up to

A

30 min

123
Q

Transfusions can not exceed _h

A

4

124
Q

Change tubing after every _ unites

A

2

125
Q

With at risk patients monitor for at list _h for TACO

A

6h

Transfusion Associated Circulatory Overload

126
Q

Fresh Flozen plasma is to be infused over

Before getting from bank start

A

30-60min

line

127
Q

Fresh Frozen Plasma Needle gauge

A

22 or large

128
Q

Febrile Nonhemolytic reaction S/S

A

chills
fever
muscle stiffness

129
Q

Febrile nonhemolytic reaction lifethreatening?

how long to onset

Scary for PT

A

NO

2h after start of infusion

YES

130
Q

Med for Febrile nonhemolytic reaction

can you give it prophylactical ?

A

Tylenol

NO, may mask more serious complications

131
Q

Acute hemolytic reactions

A

Donor blood is incompatible
of ABO (more severe) or Rh (less severe)

MOST DANGEROUS

132
Q

Acute Hemolytic Reactions occur in transfer of as little as

A

10ml of blood
First 15min

133
Q

Acute Hemolytic Reaction mild S/S

A

Fever
Chills

Lower back pain
Chest tightness
Dyspnea
Nausea

134
Q

As RBCs are destroyed in acute reaction, hemoglobin will get filtered through urine resulting in

A

Hemoglobinuria

135
Q

Acute Hemolytic reaction severe S/S

A

Hypotension
Bronchospasms
Vascular collapse

136
Q

Acute Hemolytic reaction Consequences

A

AKI
DIC

137
Q

Blood allergic reaction

A

Urticaria (hives)
Itching
Flushing

during transfusion

138
Q

Treatment for Allergic reaction to blood

A

Stop

Give
Antihistamines

Notify

139
Q

If Blood allergy is severe with
Bronchospasms
Laryngeal edema
Shock

give

A

Epinephrine
Corticosteroids
Vasopressor

140
Q

TACO
Transfusion associated circulatory overload

A

Hypervolemia due too fast infusion of large volume

141
Q

PT at risk of TACO

A

HF
Renal failure
Advanced age
MI

142
Q

For patients who have a high initial volume and are at risk of TACO, give

A

PRBCs

143
Q

Meds to give to lower hypervolemia before initiating transfusion

A

Diuretics

144
Q

S/S of TACO

A

Dyspnea
Orthopnea
^BP
JVD
Pulmonary edema

Coughing pink sputum

145
Q

Body position in a fluid overload

A

Upright
Feet in dependent position

146
Q

How long can it take for TACO to develop

A

As late as 6h

147
Q

Treating dyspnea with TACO admin

A

Morphine
Oxygen

148
Q

When do blood contamination S/S occure

A

A few hours after completion of transfusion

149
Q

S/S of blood contamination

A

Fever
Chills
Hypotension
infection

150
Q

Treatment for blood contamination transfusion

A

Fluids
Broad-spectrum antibiotics
Corticosteroids
Vasopressors

151
Q

What can occur due to contaminated blood

A

Sepsis

152
Q

TRALI
Transfusion Related Acute Lung Injury

A

Most common cause of TRANSFUSION RELATED DEATH

idiosyncratic (dont know why it happened)

153
Q

Onset of TRALI

A

Within 6h of transfusion

Most often within 2

154
Q

S/S of TRALI

A

SOB
Hypoxia
SpO2 less than 90

hypotension
fever
pulmonary edema

155
Q

Treatment for TRALI

A

Aggressive supportive therapy

O2
Intubation
Fluids

156
Q

TRALI is more likely with transfusion of

A

Plasma
Platelets

157
Q

Prevent TRALI by

A

Limiting frequency and amount transfused

158
Q

Delayed hemolytic reactions 101

A

Occur within 14 days

Fever
Anemia
^ Bilirubin
Jaundice

non lifethreatening

159
Q

Delayed hemolytic reactions indicated

A

A potential for more serious reactions in the future

160
Q

Other transfusion complication

A

Iron overload

damages
liver, heart, testes, pancreas

161
Q

Treat iron overload

A

Iron Chelation

162
Q

What to do first if reaction occurs

A

STOP Transfusion
Start normal saline through new tubing

163
Q

After stopping transfusion

A

Assess pt

Vitals
O2
Resp status
Breath sounds

chills
JVD
back pain
urticaria

164
Q

After assessing transfusion pt

A

Notify provider and implement next plan

Notify blood bank

send blood container back to blood bank

DOCUMENT

165
Q

If a hemolytic transfusion reaction of bacterial infection is suspected the nurse will

A

obtain blood specimen from pt

collect urine

document reaction according to institution policy

166
Q

Alternatives to blood transfusion

A

Growth factor
Erythropoietin
G-CSF
GM-CSF
Thrombopoietin

167
Q

Thrombopoietin

A

helps platelet formation

168
Q

G-CSF

A

neutrophil stem cells

improves neutropenia
good for chemo

169
Q

GM-CSF

A

Increases RBCs
Platelets
Monocytes

170
Q

1 contributing factor to DIC

A

Sepsis

171
Q

Coagulation cascade?

A

?

172
Q

Prothrombin and thrombin are what factor

A

10

173
Q

DIC 101

A

Massive activation of coagulation cascades
Uses up all coagulation factors
PT bleeds out

174
Q

DIC leads to MODS

A

Multi Organ Disfunction Syndrome

175
Q

Inotropic drugs for DIC?

A

?

176
Q

DIC nursing diagnosis

A

Impaired perfusion

177
Q

Heparin drip =

if dropping

A

Monitor platelet count

TELL PHYSICIAN

178
Q

When to immediately stop heparin to prevent HIT

A

Platelet drop by half or more

179
Q

HIT can occure within hours of

A

RE EXPOSURE to heparin

180
Q

Drug to give HIT give hit patients

A

Argatroban

181
Q

HELLP is a life threatening _ complications

A

Pregnancy

182
Q

Defining pain of HELLP

A

Right upper abdominal quadrant or epigastric pain

183
Q

LDH
Lactate dehydrogenase

A

Greater than 60u/L
Lethal

184
Q

Difference between preeclampsia and eclampsia

A

having a seizure

185
Q

Mag sulfate and ECG change

A

Watch for widened QRS

186
Q

HELLP can lead to what complication

A

DIC

187
Q

HELLP with mom at 34 weeks

before 27 weeks

A

deliver

still deliver but in 48 to 72 hours after giving corticosteroids and surfactant for baby lung maturity

188
Q

Purpura

A

Bruising

189
Q

A lot of ITP pts have no

A

SYMPTOMS

190
Q

Treatment of choice for ITP

A

Corticosteroid prednisone
IVIG

191
Q

Red flag meds for ITP

A

Sulfa
NSAIDs
Aspirin

192
Q

Can student work with blood

A

NO

193
Q

Why is whole blood rarely given

A

Fluid volume overload in MINUTES
SO you only need to give them what they need

194
Q

4 components of whole blood

A

RBC
Plasma
Platelets
Albumin

195
Q

When to transfuse patients

Why

A

ONLY when symptomatic
even if labs are low

Transfusions are high risk

196
Q

Giving blood to the bank is called a

A

Standard donation

197
Q

Giving blood to a family member is called

A

Direct

198
Q

Giving blood to self for future surgery

A

???

199
Q

Collecting blood during surgery, cleaning, and reinfusing

A

Intraoperative Blood salvage

200
Q

Pulling blood out, and exchanging it with solution. Then reinfusing if needed

A

Hemodilution transfusion

201
Q

Before transfusing blood we need

A

Get order
Teach
Get consent
Type and cross

202
Q

When pulling blood who is involved

A

Lab tech
2 RNs

203
Q

Universal doner

A

O-

204
Q

Kidneys let bone marrow know to produce

A

erythropoietin

205
Q

Synthetic erythropoietin given to ESRD

A

Epoietin

206
Q

After a hemolytic reaction and disconnecting the blood what to do with the IV port

A

Aspirate left over blood out
Start NS to keep line open

207
Q

Only thing to ever hang with blood

A

NORMAL SALINE

208
Q

One of the most important things to do after staring transfusion

A

DOCUMENT

209
Q

When to document

A

Contemporaneous charting
Chart it when you do it

S4 2539 (11 decks)

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