Midterm study guide: hematology Flashcards
DIC: def
A syndrome that causes thrombus (clotting) formation and hemorrhage (bleeding) at the same time
DIC: causes (always a secondary dx) (5)
*Infection
*Massive tissue injury
*Neoplastic disorders
*Obstetric issues
*Misc. things like aneurysms and liver disease
DIC: patho from trauma (4)
Some kind of trauma/sepsis → release of tissue factor and platelet aggregation → widespread microvascular thrombofartwad → vascular occlusion & ischemic tissue damage
DIC patho: thrombosis (4)
thrombosis also → activation of plasmin → lysis of clotting boys → bleeding
DIC: patho fibrinolysis (4)
Fibrinolysis → fibrin split products → inhibition of thrombin and little guys that clot the blood → BLEEDING AGAIN
DIC s/s r/t hemorrhage: skin 6
*bleeding from gums, venipunctures, old surgical sites, epistaxis, ecchymosis and petechiae (petechiae = often first indication)
DIC s/s r/t hemorrhage: cardio 1
Hemoptysis: coughing up blood
DIC s/s r/t hemorrhage: GI 2
ABD distention and bloody stool
DIC s/s r/t hemorrhage: neuro 1
subarachnoid hemorrhage
DIC s/s r/t hemorrhage: renal 1
Hematuria
DIC s/s r/t thrombus: skin 2
peripheral cyanosis (blue guy), gangrene
DIC s/s r/t thrombus: cardiac (5)
dysrhythmias, chest pain, MI, PE, RF
DIC s/s r/t thrombus: renal (3)
*oliguria (only a little pee)
*AKI
*renal failure
DIC s/s r/t thrombus: GI (3)
*Diarrhea
*constipation
*bowel infarct
DIC s/s r/t thrombus: neuro (2)
*altered LOC
*stroke
DIC: Labs to have (1 category, 6 labs)
*coagulation panel: PT, aPTT, platelets, d-dimer, fibrinogen, FDPs
How to detect early DIC and control causative factors (5)
- note high-risk s/s: petechiae, ecchymosis, blood in stool, urine, emesis, aspirate, oral secretions. Are pulses and cap-refill normal?
- monitor labs
- control underlying causes: antibiotics for infection, control source of bleeding, antineoplastics for malignancy, etc…
- 1-2 L of saline
- Administer blood products
DIC: meds (3)
*IV heparin **Controversial bc prolongs bleeding but patients w DIC normally die from thrombosis not hemorrhage so…… yeah
*Aminocaproic acid
*Antithrombin III
DIC: bleeding precautions (6)
*be gentle with skin (try to avoid tape, use adhesive remover if removing tape)
*Use electric razors (not normal razors)
*avoid rectal suppositories and Valsalva maneuver
*Apply local pressure to break in skin
*Less use of BP cuff if possible, utilize art line instead
*Avoid ASA or NSAIDS due to effect on platelet aggregation
DIC: monitor for complications (3)
*hypovolemic shock
*MODS (MULTIPLE ORGAN FAILURE)
*Peripheral and central ischemia
Clinical indications of blood transfusion reaction in an unconscious or sedated patient (6)
*Tachycardia or Bradycardia
*Hypotension
*Fever
*Visible signs of hemoglobin in urine (port-wine colored)
*Oliguria or Anuria
*Bleeding
Nursing actions for suspected transfusion reaction (9)
- STOP transfusion
- Maintain IV access w/normal saline and new administration set
- Reassure the patient; stay at the bedside; monitor VS
- Notify physician and blood bank
- Recheck blood numbers and type
- Treat symptoms appropriately
- Return unused portion of blood in blood bag and administration set to the blood bank
- Collect and send blood and urine samples to the lab
- Document the transfusion reaction and treatment administered
Blood transfusion protocol (9)
- Type and cross match needed (at least 20gtt IV)
- Obtain blood from lab
- Use Y tubing and hang w/ NsCl
- Must double check ID w/ blood product
- Take baseline VS
- Begin transfusion w/i 30 min and start slowly (2ml/min)
- Watch pt carefully for first 15min for reactions
- After 15 min take VS, if no reaction occurred increase rate (whole infusion must be administered w/i 4hrs)
- Continue to monitor VS Q30min up to an hour after infusion)
