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Nursing 283 > Week 10 Hematology and Sepsis > Flashcards

Week 10 Hematology and Sepsis Flashcards

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1
Q

AUTOIMMUNE THROMBOCYTOPENIC PURPURA

A

platelet production is normal

autoimmune against platelets

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2
Q

AUTOIMMUNE THROMBOCYTOPENIC PURPURA manifestations

A

1st seen on skin (bruises)
Anemia
Intracranial bleeding

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3
Q

THROMBOTIC THROMBOCYTOPENIC PURPURA

A

inappropriate clotting
clots don’t form in trauma but form in the blood
Fatal in 3 months without immunosuppressants

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4
Q

Hemophilia

A

deficiency in clotting factors

do not bleed more often, they just bleed for longer

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5
Q

Hemophilia labs

A

prolonged PTT

normal PT

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6
Q

hemophilia tx

A

infusions of clotting factor VIII

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7
Q

Heparin induced thrombocytopenia (HIT)

A

immune reaction that increases platelet activity

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8
Q

HIT symptoms

A

1 thrombocytopenia

DVT
PE

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9
Q

HIT risk factors

A

IV heparin
Female
Heparin use over 1 week

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10
Q

When to use Packed red blood cells (PRBCs)

A

Anemia; hemoglobin <6g/dL, 6-10g/dL, depending on symptoms

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11
Q

When to use washed RBCs (WBC-poor PRBCs)

A

Hematopoietic stem cell transplant patients

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12
Q

When to use pooled plateletes

A

Thrombocytopenia, platelet count <50,000

use single donor if hx of allergic reaction

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13
Q

When to use FFP

A

Deficiency in plasma coagulation factors, Prothrombin or partial thromboplastin time 1.5 times normal

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14
Q

When to use cryoprecipitate

A

Hemophilia VIII or von Willebrand’s disease, Fibrinogen levels <100mg/dL

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15
Q

When to use WBCs

A

Sepsis, neutropenic infection not responding to antibiotic therapy

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16
Q

MAP

A

mean arterial pressure

related to tissue and organ perfusion

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17
Q

Cardiovascular Manifestations of shock

A

Decreased CO, BP, central venous pressure, cap refill, peripheral pulses
Increased HR
Thready pulse, Narrowed pulse pressure, Postural hypotension, Flat neck and hand veins in dependent positions

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18
Q

Respiratory Manifestations of shock

A

Increased RR, Shallow respirations, Increased PaCO2, Decreased PaO2, Cyanosis

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19
Q

Early Neuromuscular Manifestations of shock

A

Anxiety, Restlessness, Increased thirst

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20
Q

Late Neuromuscular Manifestations of shock

A

Decreased CNS activity (lethargy to coma), Generalized weakness, Diminished/absent deep tendon reflexes, Sluggish pupillary response

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21
Q

Kidney Manifestations of shock

A

Decreased urine output, Increased specific gravity, Sugar and acetone present in urine

22
Q

Integumentary Manifestations of shock

A

Cool/cold, Pale/mottled/ cyanotic, Moist, clammy, Mouth dry; paste-like coating present

23
Q

Gastrointestinal Manifestations of shock

A

Decreased motility, Diminished or absent bowel sounds, N/V, Constipation

24
Q

Initial (early) stage of hypovolemic shock

A

MAP < by 10mmHg

Compensatory mechanisms of > HR and vascular constriction are effective in maintaining oxygenation

25
Q

Nonprogressive (compensatory) stage of hypovolemic shock

A

MAP < 10-15
Kidneys are involved to increase blood volume
Acidosis and hyperkalemia occur

26
Q

Progressive (intermediate) stage of hypovolemic shock

A

compensitory mechanisms not effective, organs develop hypoxia
Must correct within 1 hour of onset to save life

27
Q

Refractory (irreversible) stage of hypovolemic shock

A

vital organs have overwhelming damage

28
Q

Multiple organ dysfunction syndrome (MODS)

A

cell damage caused by release of toxic metabolites and enzymes
Small clots form and block oxygenation to organs

29
Q

Changes in BP with vasoconstriction compensation in hypovolemic shock

A

Diastolic (bottom) increases and systolic (top) stays the same causing narrow pulse pressure

30
Q

Decreased urine output

A

early indicator of shock

31
Q

First manifestation of central nervous system changes

A

increased thirst

32
Q

pH in hypovolemic shock

A

Decreased: insufficient oxygenation causing anaerobic metabolism and acidosis

33
Q

PaO2 in hypovolemic shock

A

Decreased: anaerobic metabolism

34
Q

PaCO2 in hypovolemic shock

A

Increased: anaerobic metabolism

35
Q

Lactic acid in hypovolemic shock

A

Normal-3-7

Increased: anaerobic metabolism with buildup of metabolites

36
Q

H&H in hypovolemic shock

A

Increased: fluid shift/dehydration Decreased: hemorrhage

37
Q

K+ in hypovolemic shock

A

Increased: dehydration, acidosis

38
Q

Priority problems for patients with hypovolemic shock

A
  1. Hypoxia (from hypovolemia)
  2. Hypoperfusion (from fluid volume loss, Hypotension)
  3. Anxiety
  4. Confusion (from decreased cerebral perfusion)
39
Q

When is plasma used in hypovolemic shock?

A

to restore osmotic pressure when H&H is normal

40
Q

Adverse effects of inflammatory responses in sepsis/ systemic inflammatory response syndrome (SIRS)

A

widespread vasodilation and blood pooling, mild hypotension, low UO, increased RR, decreased CO

41
Q

SIRS criteria

A

2 must be present plus 1 clinical manifestation to confirm sepsis
temp >100.4
HR >90
RR >20 or PaCO2 12,000 or <4,000

42
Q

Clinical manifestations of sepsis

A

Must has at least 1 plus 2 SIRS criteria for sepsis dx

Hypotension, UO < intake, < cap refill, hyperglycemia (>120), Change in mental status, > creatinine

43
Q

Disseminated intravascular coagulation (DIC)

A

microthrombi formation in hypoxia.
Anaerobic metabolism causes glucose release
HR increases and Pt may look better d/t > CO but is actually worse

44
Q

Clinical manifestations in severe sepsis

A

low O2, rapid RR, </no UO, change in cognition

mortality rate is high

45
Q

Septic shock

A

multiple organ failure and bleeding, capillary leak, death is likely, sx are like hypovolemic shock

46
Q

Hallmark symptoms of sepsis

A

Left Shift: increased serum lactate, normal or low WBC, and decreasing segmented neutrophil with rising band neutrophils

47
Q

Cardiac changes in early sepsis

A

Cardiac output and blood pressure are lower

48
Q

Cardiac changes in late sepsis

A

CO, HR and BP are higher

49
Q

Respiratory changes in early sepsis

A

Rate increases in an attempt to compensate

50
Q

Respiratory changes in late sepsis

A

tissue hypoxia and metabolic acidosis depth and rate of respiration to increases

Nursing 283 (10 decks)

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