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Nursing 3 Test 1 > Thrombocytopenia: class 3 > Flashcards

Thrombocytopenia: class 3 Flashcards

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0
Q

Platelet

-Action

A
  1. Adhere to the wall of an injured vessel
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1
Q

Platelets

A
  1. Formed by bone marrow as megakaryocytes
  2. Survive 8-10 days
  3. Only fragments of cytoplasm (not cells)
  4. Produced in bone marrow
  5. Stored in spleen and removed by the speen
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2
Q

Thrombocytosis

A
  1. Excess of platelets (over 450,000)
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3
Q

Thrombocytopenia

A
  1. PLT count < 150,000
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4
Q

Anticoagulants

A
  1. Decrease platelet aggregation

2. Prevent further clots from forming

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5
Q

Fibrinolytics

A
  1. Lyse clots that have formed and prevent clotting
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6
Q

Hemostasis (clotting)

-process

A
  1. Thromboxane A2 released when vessel spasms and vessel constricts
  2. Formation of platelet plug
    - platelets attach to vessel wall and each other
    - fibrin holds plug together
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7
Q 
Prothrombin Time (PT) & INR
-Normal values
A
  1. PT : 10-12 seconds

2. INR: 0.8-1.2

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8
Q

Therapeutic INR

-Value?

A
  1. 2.5
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9
Q

Activated partial thromboplastin time (aPTT)

-Normal levels

A
  1. 30-40 seconds
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10
Q

Activated partial thromboplastin time (aPTT)

-Therapeutic Levels

A
  1. 1.5-2.5 X normal
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11
Q

PT & INR

-What drug? What antidote?

A
  1. Warfarin (coumadin)

2. Antidote is Vitamin K

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12
Q

aPTT

-What Drug? What antidote?

A
  1. Heparin

2. Protamein Sulfate

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13
Q

Thrombocytopenia

-considerations

A
  1. PLT count < 150,000
  2. <10,000
    - Spontaneous bleeding (rarely can cause intracranial bleed)
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14
Q

Petechiae & Purpura

A
  1. Petechiae are the small dots of blood

2. Purpura are the larger bruises

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15
Q

Thrombocytopenia

-things to do w/ pt’s

A
  1. Hold pressure over injection sites, IV sticks and blood draw sites
  2. Ensure clotting is occurring
16
Q

Idiopathic Thrombocytopenia Purpura (ITP)

A
  1. Autoimmune, accelerated PLT destruction
  2. More common in:
    - children
    - young women with systemic LUPUS erythematosus
17
Q

Idiopathic Thrombocytopenia Purpura (ITP)

-How it happens

A
  1. Platelets function normally
  2. PLT’s are destroyed early in the spleen
    - antibodies mark PLT’s are foreign causing spleen to attack
    - destroyed in 1-3 days
18
Q

Thrombocytopenia

-Diagnostics

A
  1. PLT Count (150K - 450K)
  2. Hgb & Hct (aplastic can also cause low H&H)
  3. Rule out:
    - Leukemia and Lymphoma
    - Lupus
    - HIT
19
Q

Thrombocytopenia

-Clinical Manifestations

A
  1. Asymptomatic
  2. Bleeding
    - Cutaneous
    - mucosal
    - petechiae
    - ecchymosis
    - hemmorrhage
20
Q

Thrombocytopenia

-Treatment

A
  1. Oral steroids are first (glucocorticoids)
  2. Splenectomy is tried next
  3. Immunoglobulin therapy next
  4. Platelet therapy
    - Only used if the person is bleeding to reverse hemorrhage
21
Q

Thrombotic Thrombocytopenia Purpura (TTP)

A
  1. Idiopathic
  2. Can be caused by drugs / pregnancy / infection/ chemo /
  3. Enhances agglutination of platelets forming microthrombi
22
Q

Thrombotic Thrombocytopenia Purpura (TTP)

-stats

A
  1. Is more common in women

2. Occurs in 1/25,000 pregnancies

23
Q

Thrombotic Thrombocytopenia Purpura (TTP)

-Treatment

A
  1. Plasmapheresis

- decreases mortality rate from 90% to 20%

24
Q

Plasmapheresis

A
  1. Removal of plasma in replacement with donors fresh frozen plasma to remove the antibodies
25
Q

Drug Induced Thrombocytopenia

A
  1. First seen in Pt’s receiving QUININE
    - Multiple medications at once
    - Use of multiple blood products
    - Rule out other causes
  2. Can be Immune or non-Immune response
26
Q

Quinine and Thrombocytopenia

A
  1. Drug-induced thrombocytopenia is first seen in patients receiving quinine
    - can also be caused by chemotherapeutic drugs
27
Q

Drug-Induced Thrombocytopenia

-Manifestations

A
  1. Petechiae
  2. Bruising
  3. Epistaxis (hemorrhage or bleeding from the nose)
28
Q

Drug Induced Thrombocytopenia

-Nursing Priority

A
  1. Stop the offending Drug ***
29
Q

Heparin-induced Thrombocytopenia

-What is it?

A
  1. Immune mediated response to heparin
  2. Promotes PLT aggregation
  3. Decreased circulating PLT’s
  4. Heparin is neutralized
30
Q

Heparin-induced Thrombocytopenia (HIT)

-Nursing consideration?

A
  1. HIT usually occurs 4-14 days after initiation

2. Pt should be monitored every other day from day 4-14 of heparin administration to detect drop

31
Q

Heparin-induced Thrombocytopenia 1

- HIT-1

A
  1. A slight drop in the PLT count after initiation
32
Q

Heparin-induced Thrombocytopenia 2

- HIT-2

A
  1. Thrombosis and thrombocytopenia
33
Q

Clinical Scoring SYstem for HIT

-Score of 0-3?

A
  1. Pt is at low risk
34
Q

Clinical Scoring System for HIT

-Score of 4-5?

A
  1. Intermediate Risk
35
Q

Clinical Scoring System for HIT

-Score of 6-8

A
  1. High risk of developing HIT
36
Q

HIT-2

-Treatment

A
  1. STOP the offending agent immediately
  2. Give Thrombin inhibitor
  3. Plasmapheresis (Plasma exchange therapy)
  4. Protamine Sulfate
  5. THrombolytics
37
Q

If Pt with HIT-2 still needs anticoagulation therapy, Use???

A
  1. Arixtra

Nursing 3 Test 1 (5 decks)

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