Midterm study guide: hematology

Question 1

DIC: def

Answer 1

A syndrome that causes thrombus (clotting) formation and hemorrhage (bleeding) at the same time

Question 2

DIC: causes (always a secondary dx) (5)

Answer 2

*Infection
*Massive tissue injury
*Neoplastic disorders
*Obstetric issues
*Misc. things like aneurysms and liver disease

Question 3

DIC: patho from trauma (4)

Answer 3

Some kind of trauma/sepsis → release of tissue factor and platelet aggregation → widespread microvascular thrombofartwad → vascular occlusion & ischemic tissue damage

Question 4

DIC patho: thrombosis (4)

Answer 4

thrombosis also → activation of plasmin → lysis of clotting boys → bleeding

Question 5

DIC: patho fibrinolysis (4)

Answer 5

Fibrinolysis → fibrin split products → inhibition of thrombin and little guys that clot the blood → BLEEDING AGAIN

Question 6

DIC s/s r/t hemorrhage: skin 6

Answer 6

*bleeding from gums, venipunctures, old surgical sites, epistaxis, ecchymosis and petechiae (petechiae = often first indication)

Question 7

DIC s/s r/t hemorrhage: cardio 1

Answer 7

Hemoptysis: coughing up blood

Question 8

DIC s/s r/t hemorrhage: GI 2

Answer 8

ABD distention and bloody stool

Question 9

DIC s/s r/t hemorrhage: neuro 1

Answer 9

subarachnoid hemorrhage

Question 10

DIC s/s r/t hemorrhage: renal 1

Answer 10

Hematuria

Question 11

DIC s/s r/t thrombus: skin 2

Answer 11

peripheral cyanosis (blue guy), gangrene

Question 12

DIC s/s r/t thrombus: cardiac (5)

Answer 12

dysrhythmias, chest pain, MI, PE, RF

Question 13

DIC s/s r/t thrombus: renal (3)

Answer 13

*oliguria (only a little pee)
*AKI
*renal failure

Question 14

DIC s/s r/t thrombus: GI (3)

Answer 14

*Diarrhea
*constipation
*bowel infarct

Question 15

DIC s/s r/t thrombus: neuro (2)

Answer 15

*altered LOC
*stroke

Question 16

DIC: Labs to have (1 category, 6 labs)

Answer 16

*coagulation panel: PT, aPTT, platelets, d-dimer, fibrinogen, FDPs

Question 17

How to detect early DIC and control causative factors (5)

Answer 17

1. note high-risk s/s: petechiae, ecchymosis, blood in stool, urine, emesis, aspirate, oral secretions. Are pulses and cap-refill normal?
2. monitor labs
3. control underlying causes: antibiotics for infection, control source of bleeding, antineoplastics for malignancy, etc…
4. 1-2 L of saline
5. Administer blood products

Question 18

DIC: meds (3)

Answer 18

*IV heparin **Controversial bc prolongs bleeding but patients w DIC normally die from thrombosis not hemorrhage so…… yeah
*Aminocaproic acid
*Antithrombin III

Question 19

DIC: bleeding precautions (6)

Answer 19

*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

Question 20

DIC: monitor for complications (3)

Answer 20

*hypovolemic shock
*MODS (MULTIPLE ORGAN FAILURE)
*Peripheral and central ischemia

Question 21

Clinical indications of blood transfusion reaction in an unconscious or sedated patient (6)

Answer 21

*Tachycardia or Bradycardia
*Hypotension
*Fever
*Visible signs of hemoglobin in urine (port-wine colored)
*Oliguria or Anuria
*Bleeding

Question 22

Nursing actions for suspected transfusion reaction (9)

Answer 22

1. STOP transfusion
2. Maintain IV access w/normal saline and new administration set
3. Reassure the patient; stay at the bedside; monitor VS
4. Notify physician and blood bank
5. Recheck blood numbers and type
6. Treat symptoms appropriately
7. Return unused portion of blood in blood bag and administration set to the blood bank
8. Collect and send blood and urine samples to the lab
9. Document the transfusion reaction and treatment administered

Question 23

Blood transfusion protocol (9)

Answer 23

1. Type and cross match needed (at least 20gtt IV)
2. Obtain blood from lab
3. Use Y tubing and hang w/ NsCl
4. Must double check ID w/ blood product
5. Take baseline VS
6. Begin transfusion w/i 30 min and start slowly (2ml/min)
7. Watch pt carefully for first 15min for reactions
8. After 15 min take VS, if no reaction occurred increase rate (whole infusion must be administered w/i 4hrs)
9. Continue to monitor VS Q30min up to an hour after infusion)