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MS trauma Flashcards

1
Q

What is the antidote for Heparin???

A

PROTAMINE SULFATE!!!!

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2
Q

Is heparin okay in patients with kidney impairment???

A

YES!!!!!!
Heparin is more preferred in KIDNEY IMPAIRMENT!!!!

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3
Q

What medication can you NOT take anticoagulants with????***

A

DO NOT take ANY ANTICOAGULANT with other medications that impact clotting/platelet aggregation such as NSAIDS!!!!!!!!

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4
Q

WIth continuous heparin infusion, which lab would you want to monitor????????*****

A

aPTT!!!!!!!!!!!!!!!!!

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5
Q

1.How is Heparin given??
2. How is Warfarin (Coumadin) given???

A

Heparin: Subcutaneous!!!!!
Warfarin (Coumadin): PO!!!!!

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6
Q

Do we use warfarin for ***DVT prevention/prophylaxis???? What are its uses????

A

NO!!!!!!! WE DON’T! It’s used to if they already have an EXISTING DVT!!!!!!!
1. Existing DVT!!!
2. Congestive heart failure
3. Thromboembolic stroke
4. Atrial fibrillation
5. PE
6. Myocardial Infarction!!!!

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7
Q

Which of the drugs (heparin or warfarin) is used for LONG TERM???

A

Warfarin (Coumadin)!!!!!!

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8
Q

Average of Warfarin is what????? How often do you give it???????**

A

2-10mg DAILY**!!!!!

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9
Q

WHAT ARE the ANTIDOTE FOR WARFARIN (COUMADIN)?????

A
  1. VITAMIN K
  2. IF ACTIVE bleeding, possible: PRBC, Platelets, Fresh Frozen Plasma (FFP)!!!!!!
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10
Q

What is the Main lab monitoring for Warfarin (Coumadin)??

A

PT WITH INR!!!!!!

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11
Q

In patients who are taking warfarin (coumadin), do you ELIMINATE vitamin K from their DIET?????

A

NOOOOOO!!!! Just bc its the antidote doesn’t mean you eliminate vitamin K!!!!!!

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12
Q

What is the mechanism of action of warfarin????

A

Interferes (blocks) Vitamin K!!!!!!!!!

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13
Q

What are the uses of Warfarin?????

A
  1. PREVENTION of Clot Development:
    - EXISTING DVT
    - Congestive heart failure
    - Thromboembolic stroke
    - A-fib
    - PE
    - Myocardial infarction!!
  2. PO ADMINISTRATION!!!!!
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14
Q

What is the Lab monitoring for Warfarin????

A
  1. Baseline: PT with INR, aPTT, CBC, Creatinine, Liver Functioning Test, Pregnancy test
  2. PT with INR: DAILT until regulated & PERIODIC MONITORING. AVERAGE DOSE: 2-10mg DAILY!!!!!!!!!!
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15
Q

What are the patient teaching for WARFARIN???

A
  1. same as Heparin Patient teaching
  2. LAB MONITORING: PT with INR!!! (Too low INR = Clotting Risk; Too High INR = Bleeding risk!!!!)
  3. DIET CONSIDERATIONS:
  4. DO NOT ELIMINATE VIT.K!!!!!!!!
  5. CONCERNS with BMD and OSTEOPOROSIS risk!!!!!!! (so promote bone health!!!)
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16
Q

Too HIGH INR means what??? TOO LOW MEANS???

A
  1. Too LOW INR = CLOTTING Risk!!!
  2. Too HIGH INR = BLEEDING risk!!!!
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17
Q

What are the 2 medications for Low Molecular Weight Heparins (LMWH)??????*****

A
  1. Enoxaparin (Lovenax)
  2. Daltaparin (Fragmin)
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18
Q

DVT CAN LEAD TO WHAT????

A

PULMONARY EMBOLISM!!!!!

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19
Q

What is Strains?? What is Sprains??

A
  1. Strains- Injury to MUSCLE or TENDON
  2. Sprains- Injury to LIGAMENT
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20
Q

Is it true that bones are stronger after healing from a break than before originally????

A

YEAH….

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21
Q

What are the 2 types of cast?????? What do u need to know about each????

A
  1. Fiberglass – QUICK DRY & Can get a WATERPROOF liner!!
  2. PLASTER – rlly strong & often used on lower extremity
    1) HOURS to dry
    2) Produces HEAT while drying
    3) Handle with PALM!!!!
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22
Q

What are the potential complications for casts???

A
  1. SKIN breakdown & INFECTION of wounds:
    - HOT SPOTS
    - Odor
    - Fever
    - Increased pain — are all signs of the infection
  2. CONTRACTURES!!!!!!!****
  3. MUSCLE ATROPHY!!!!!**
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23
Q

What are the patient teaching for cast???****

A
  1. Keep it DRY
  2. NOTHING in the cast!
  3. REPORT if cast is too tight or too loose
  4. *COOL dryer for ITCHING!!!!
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24
Q

What are cast removal concerns?????

A
  1. Weakness, atrophy, decreased ROM
  2. DISCOMFORT, SCALY DRY skin, SUN-SENSITIVE
  3. Possible Physical Therapy after removal
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25
Q

What would be the 3 reasons why we would want to use external fixation???????

A
  1. Minimal blood loss**
  2. ALIGNMENT for closed fracture that won’t stay align with cast
  3. Access to OPEN WOUND!
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26
Q

What are the nursing care implications for external fixation?????

A
  1. Risk for PIN TRACT INFECTION: Osteomyelitis & Cellulitis
  2. Wound care & monitoring:
    - drainage around the pin sites should be SEROSANGENOUS!!!
    - Temp & WBC count
  3. NV Checks!!!!
27
Q

WHAT IS THE BIGGEST COMPLICATION WOULD U WORRY ABOUT IN SOMEONE WHO HAS DVT????? WHY??

A

PULMONARY EMBOLISM!!! When someone has DVT they’re more likely to have PE because the clot would travel to the right side of the heart and go thru the pulmonary circulation and would get stuck there because alveolies are so small!!!!!! IT WOULDNT BE ABLE TO GET TO THE BRAIN because obv it won’t pass thru the alveolis and move to the left side of the heart~~

28
Q

What are the assessment changes in someone who has pulmonary embolism because of DVT??? WHYYYY???

A
  1. Shortness of breath/ DYSPNEA
  2. Tachycardia
  3. Abnormal breath sounds: CRACKLES THAT LEAD TO WHEEZING!!!!!
29
Q

DOES HEPARIN DISSOLVE A CLOT???

A

NOPEEEE

30
Q

HOW DO YOU NORMALLY Position someone with MUSCULOSKELETAL injury???????? WHY???

A

ELEVATEEEE!!! Because that reduces SWELLING!!!! AND allows venous return!

31
Q

What position should you put your patient in with a COMPARTMENT SYNDROME!!!!!! why???

A

in this case, NEVER ELEVATE!!!!!! because think of how normally in someone with musculoskeletal injury we would want to elevate it to reduce swelling and allow venous return to the heart right? HERE, instead the goal is to get ARTERIAL OUTFLOW!!!!! (bc of the compression in those arteries/BV, we now can’t get blood flow to the extremities!!!!)

32
Q

WHAT ARE THE TWO MAIN THINGS WHY TRACTIONS ARE USED?????

A
  1. Reduce muscle SPASM***
  2. Align and Reduce Fracture***
33
Q

*EXAM A patient is showing signs of dyspnea, tachycardia, wheezing and crackles, pleuritic chest pain, and cyanosis, altered mental status, & confusion DAY 1 AFTER SURGERY!!!!! What is this indicating!?????!!!!!

A

THIS IS SHOWING signs of Fat Embolism in the LUNGS!!!!!
NOT Pulmonary Embolism (due to DVT) because REMEMBER THAT FAT EMBOLISM TAKE 12-48 HRS AFTER SURGERY TO SHOW UP IN THE LUNGS (WAY FASTER than my DVT!!)…..

34
Q

What would you give if an amputee have an Incisional pain?? How about an PHANTOM pain??

A
  1. Incisional pain: NARCOTICS
  2. PHANTOM pain (pt feels pain that doesn’t exist):
    - NON- Narcotics
    - Mirror Therapy
    - Electrical Stem Therapy
35
Q

Patients with what kind of fracture would have the HIGHEST RISK for getting FAT EMBOLISM??????**

A

HIP FRACTURE!!! Also with Pelvis and Femur!!!!!!!

36
Q

what ONE assessment findings that DIFFERENTIATE FAT EMBOLISM FROM PULMONARY EMBOLISM????*****

A

PETECHIA!!!!! it’s a Later finding!!!!
- Head, Subconjunctiva, Neck, Anterior Thorax, and Axilla!!!!

37
Q

What are the Patient care measures with FAT EMBOLISM????? (kmon ez mani)

A
  1. Bedrest, Immobilize fracture!!!
  2. Respiratory Support:
    - oxygen!!!
    - elevate HOB
    - Possible intubation & Vent support
  3. Pulmonary assessment:
    - Observe & inspect
    - Adventitious breath sound: CRACKLES AND WHEEZES (obvi bc it triggers inflammation and fluid moves to third space)
    - O2 sat and ABG: RESPIRATORY ACIDOSIS (pH low, Co2 high, bicarb high)!!! THIS WOULD EVENTUALLY LEAD TO METABOLIC ACIDOSISSSSSS Because ur body would not have enough oxygen to the cells from head to toe!!!
38
Q

WHAT ABG Alteration would you see in FAT EMBOLISM?????? LATER, WHAT ABG ALTERATION WOULD YOU SEE EVENTUALLY!!!!????

A

OBVIOUSLY Respiratory Acidosis (bc it’s impacting gas exchange in the lungs)
- (pH low, CO2 high, bicarb high)
——
Eventually will become METABOLIC ACID bc by then ur body wouldn’t be getting enough oxygen from head to toe

39
Q

What is Sprains and Strains???? WHAT WOULD YOU DO IF SOMEONE HAS THIS (you should know this by now cz everywhere i see online they basically say the same thing!!)

A
  1. Strains- injury to the Muscles or Tendons!!
  2. Sprains- injury to the ligament!!
    ———
  3. Assessment: Swelling, Echymosis, and Deformity
  4. RICE AND NSAIDS!!!!!!!!!!!!!
40
Q

How would you response if You think a patient may have a fracture???????????!!!!!

A
  1. Immobilize!!!!
  2. Put pressure on Active bleeding
  3. Elevate extremity above HEART level!
  4. ** APPLY ICE with clothing to to reduce frozen tissue injury
  5. Refer to medical evaluation
    —
  6. Remove jewelry or cut away clothing
  7. NV assessment!!!!!!!!
41
Q

What medication would u give to someone who has a fracture?????

A

NSAIDS AND NARCOTICS!!!!

42
Q

What’s the concern with Narcotics?????

A
  1. Dependence
  2. Sedation
  3. Constipation
  4. Nausea/Vomiting
43
Q

What labs do we do for HEPARIN!?????????

A

Heparin = aPTT!!!!!!
60-80 seconds!! we want it to be higher bc we want them to take longer time to clot

44
Q

What are the 2 drugs of Low Molecular Weight Heparin (LMWH)??????

A
  1. Enoxaparin (Lovena)
  2. Daltaparin (Fragmin)
45
Q

What are the benefits of taking Low Molecular Weight Heparin (LMWH)??

A
  1. Lower risk of bleeding!! and More stable response
  2. Less frequent lab monitoring
  3. ONCE DAILY DOSING!!!
46
Q

How many dosing of LWMH do you need per day?

A

Once daily dosing

47
Q

What are the 2 limitations of LWMH??

A
  1. Heparin is more preferred for patients with Kidney Impairment!!!!
  2. MORE EXPENSIVE!!!!!!&:&/&/
48
Q

Which of the anticoagulant is more preferred for patients with kidney impairments?? Heparin or Low Molecular Weight Heparin (LMWH)???

A

Heparin!!!!!

49
Q

What are the adverse effects of Heparin and LWMH???

A
  1. BLEEDING!!!
  2. Heparin = Heparin Induced Theombocytopenia (HIT)
  3. Non-immune thrombocytopenia
  4. *SKIN REACTION
  5. *OSTEOPOROSIS!!!!!!
50
Q

What is the drug administration method of Heparin and LWMH??

A

Subcutaneous!!!!!!!

51
Q

What are the 3 main things under Warfarin????

A
  1. Given PO!!!!
  2. Used Long-Term!!!***
  3. NOT FOR DVT PREVENTION!!!!!!**
52
Q

Which of the anticoagulant would you not want to give when we want to prevent DVT in a patient????????**

A

WARFARIN!!! THEYRE NOT USED FOR DVT PREVENTION!!!!!!

53
Q

What is the Machanism of action of WARFARIN????

A

Interferes/blocks Vitamin K!!!!!

54
Q

What’s the Lab monitoring for Warfarin????

A
  1. PT with INR!
  2. PTT
  3. CBC
  4. Creatinine
  5. Liver Function Test!!!
  6. Pregnancy test!!
    ——-
  7. PT with INR: Daily until regulated & periodic monitoring!!!!! AVERAGE DOSE: 2-10mg DAILY!!!!!
55
Q

WHAT ARE MY PATIENT TEACHING FOR WARFARIN????????***

A
  1. same as Heparin pt teaching
  2. Lab monitoring: PT with INR (Too high: bleeding risk; Too low: clotting risk!)
  3. Diet consideration: DO NOT ELIMINATE VIT. K
  4. *COMCERNS WITH BONE MINERAL DENSITY AND OSTEOPOROSIS RISK!!!!
56
Q

Which anticoagulant has risk for bone mineral density and Osteoporosis???? What other anticoagulant would you take instead that has lower risk?????

A

WARFARIN!!!!
- Factor Xa inhibitors have LOWER RISK OF OSTEOPOROSIS than Warfarin!!!!

57
Q

What are the 2 USES of Factor Xa Inhibitors??????

A
  1. PREVENTION of clot development
  2. *GO TO DRUGS FOR HIT (heparin induced thrombocytopenia)!!!!
58
Q

Which anticoagulant is a GO TO DRUG for HIT!?????

A

Factor Xa Inhibitors!!!!!!!

59
Q

What’s the Antidote for Factor Xa inhibitor?????

A

Andexanet Alfa!!!!!! blood products if needed!!!!!

60
Q

What are the advantageous of taking Factor Xa inhibitors than Heparin & Warfarin?????

A
  1. Less Bleeding risk
  2. Less frequent lab monitoring
  3. *LESS FRACTURE RISK THAN WARFARIN!!!!
  4. NOT AS DEPENDENT AS WARFARIN IS ON VITAMIN K!!!
61
Q

What problems can result from clot formation with HIT!?????

A
  1. DVT (tht can lead to PE!!)
  2. Cerebral venous thrombosis!!
  3. Arterial thrombosis:
  4. *LIMB GANGRENE
  5. STROKE!!!
  6. MYOCARDIAL INFARCTION!!!!!
62
Q

What’s the “Gold Standard” for diagnosing HIT?????

A

*Serotonin Release Assay!!!!!!!!

63
Q

What’s the treatment for HIT??????

A
  1. *IMMEDIATELY STOP GIVING HEPARIN!!!!
  2. START ON NON-HEPARIN anticoagulant: like Argatobran!!
  3. If patient has THROMBOTIC event: Anticoagulation is continued for 3-6 months!!!!!!!!
    4 if patient has NO THROMBOTIC event: Anticoagulation continues until platelet count normalizes!!!!!!!!!!!!
64
Q
A

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