MS2 - Quiz 8 Flashcards
INR normal labs
11-12.5 seconds
aPTT normal labs
30-40 seconds
Hgb normal labs
14-18 g/dL (male)
12-16 g/dL (female)
Hct normal labs
42-52% (male)
37-47% (female)
WBC normal
5,000-10,000
Platelet count normal
150,000-400,000
MCH
27-31 pg
MCV
85-95 fL
Reticulocyte count
0.5-2%
Transfusion reactions and nursing interventions
If acute reaction occurs:
- Stop the transfusion
- Maintain patient IV line with saline solution
- Notify the blood bank and HCP immediately
- Recheck identifying tags and numbers
- Monitor vital signs and urine output
- Treat symptoms per physician order
- Save the blood bag and tubing and send them to the blood bank for examination
Thrombocytopenia - definition
Reduction of platelets below 150,000
Acute, severe, or prolonged decreases decreases from this normal range can result in abnormal hemostasis
Can be inherited, acquired via immune, or acquired via nonimmune means – most are acquired (common cause of acquired is ingestion of certain herbs or drugs)
Thrombocytopenia - S/S
Manifests as prolonged bleeding from minor trauma or spontaneous bleeding without injury
Many are asymptomatic
Bleeding -
Mucosal - epistaxis or gingival bleeding; large bullous hemorrhages may appear on buccal mucosa
Into skin - petechiae, purpura, superficial ecchymoses
Prolonged bleeding after routine procedures
Thrombocytopenia - Complications
Hemorrhage - may be insidious or acute, and internal or external
May occur in any area of the body - incl joints, retina, brain (cerebral hemorrhage may be fatal)
S/S vascular ischemic problems may manifest - subtle confusion, headache, seizure, coma
Thrombocytopenia - Patient education/care
Pt education
- Pts should avoid aspirin and other meds that affect platelet function or production
- Notify HCP when having black/tarry stool, black/bloody vomit sputum or urine; bruising or small red/purple spots, headaches or changes in how well you can see
- Do not blow nose forcefully
- Do not bend down with head lower than waist
- Prevent constipation (fluids, stool softener)
- No piercings or tattoos
- Ask HCP before getting invasive procedures done (including manicure, pedicure, dental cleaning)
Care depends on etiology - removal or tx of underlying cause of disorder sometimes is enough
Acute episode - prevent or control hemorrhage
Care:
- ITP - corticosteroids – high doses of IV immunoglobin and a component of IVIG anti-Rho (if pt does not respond to corticosteroids or splenectomy), splenectomy if does not respond to other tx - usually done lap, 60-70% have complete or partial remission
- Heparin - should be d/c immediately, pt should then be started on direct thrombin inhibitor (e.g., Refludan, Acova, Arixtra) - Warfarin should only be started when platelet count reaches 150,000. Clotting severe - plasmapheresis to clear platelet aggregating IgG from blood. Pts who have had HIT should NEVER be given heparin or low-molecular-weight heparin
Neutropenia - definition
A reduction in neutrophils
The faster the drop and longer the duration, the greater the likelihood of life-threatening infection, sepsis, or death
Can occur from drugs, hematologic disorders, autoimmune disorders, infections, or misc other reasons (such as severe sepsis, bone marrow infiltration, transfusion reaction, etc).
When WBC count is depressed - may not see signs of inflammation, pus formation
Low-grade fever is significant - may indicate infection and lead to septic shock or death if not treated promptly - neutropenic fever (>100.4) and neutrophil count of <500 is medical emergency
