Neutropenia & Bleeding Disorders Flashcards
What is neutropenia? What are patients with neutropenia at increased risk of and what nursing management is utilized for neutropenia?
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Neutropenia = decreased production or increased destruction fo neutrophils (< 2,000 / mm^3)
- Patients with neutropenia are at increased risk for infections
- Nursing Management: Patient Education
- over 1,000 in patient’s with neutropenia = infection
- often due to chemotherapy
Describe the following bleeding disorders:
- Thrombocytopenia
- Hemophilia
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- Thrombocytopenia: ↓ platelets = ↑ bleeding
- Hemophilia = no factor 8 leads to bleeding
What is thrombocytopenia?
What are clinical manifestations of thrombocytopenia?
What is used for thrombocytopenia management?
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Thrombocytopenia = Low platelets
- Increased risk of bleeding
- Management: Patient safety & education
- treat the underlying cause to treat thrombocytopenia
Heparin can cause HIT (Heparin Induced Thrombocytopenia) – anyone with HIT can no longer take heparin
What is Hemophilia?
- Clinical Manifestations
- Treatment
- Medical & Nursing Management
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Missing Factor XII (Factor 8; inherited genetic disorder) that leads to increased bleeding (mostly in males – inherited X-linked trait)
Clinical Manifestations
* Hemorrhage into various parts of the body (can be severe even after minimal trauma)
* Falls are significant risk for elderly
* in some cases, bleeding can go to the brain
Medical Management & Treatment
* Recumbent (synthetic) forms of Factor VII (8) & X (10) given are used
* Avoid NSAIDs, herbal supplements, & alcohol
* Analgesics for pain
Medical Management & Treatment of Hemophilia
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- Treatment = Recumbent (synthetic) Factor VII & X
- AVOID NSAIDs, EtOH, & herbal supplements
- Analgesics are used for pain management
What is DIC (Disseminated Intravascular Coagulation)?
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Massive clotting and bleeding that occurs at the same time
Symptoms associated with DIC
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- Fluid Volume Deficit
- Ischemia (due to clotting)
Treatment for DIC (Disseminated Intravascular Coagulation)
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- Treat underlying cause
- Correct tissue ischemia
- Replace fluids & elecrolytes
- Maintain BP
- Replace coagulation factors & use heparin
Triggers of DIC (Disseminated Intravascular Coagulation)
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- Sepsis
- Trauma
- Shock
- Cancer
- Abrupto placenta
- Toxins & allergic reactions
What is DIC (Disseminated Intravascular Coagulation)?
- What are signs & symptoms of DIC?
- What are potential causes of DIC?
- How is DIC treated?
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DIC = massive clotting & bleeding that occurs at the same time
- S/S: fluid volume deficit & ischemia (due to clots)
Causes:
* Sepsis
* Trauma
* Shock
* Cancer
* Abrupto placenta
* Allergic reactions & toxins
Treatment includes: treating the cause, correct tissue ischemia, replace fluids & electrolytes, maintain BP, give clotting factors (and heparin)
Unfractionated Heparin Therapy
1.) What lab level needs to be maintained and what is the range?
2.) Use of heparin can put patients at risk of what?
3.) What is the reversal agent for heparin?
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1.) aPTT = 1.5 - 2.5 times higher than the normal range
2.) At risk for: HIT (heparin induced thrombocytopenia)
3.) Protamine Sulfate = reversal agent
- Also monitor platelets
Warfarin (Coumadin) Therapy
1.) What lab level needs to be maintained & what is the range?
2.) What should the range of the lab value be before patients undergo surgery?
3.) What is the reversal agent?
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1.) INR = 2.0 - 3.0
2.) Before surgery INR should be < 1.0
3.) Vitamin K = reversal agent
What are the reversal agents of Unfractionated Heparin & Warfarin (Coumadin)?
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Heparin = Protamine Sulfate
Warfarin = Vitamin K
