Week 11 - HIT Flashcards
what is heparin induced thrombocytopenia (HIT)
- “allergy” to heparin
- risk associated w use of heparin
describe what occurs in HIT
- immune complexes activate platelets = new or worsened clots
- platelet lvls are used up and plt lvls decreased
= disorder of clots and bleeding
what are complications associated w HIT (7)
- venous thrombosis
- arterial thrombus
- pulmonary emboli
- skin necrosis
- stroke
- end-organ damage (ex. kidneys)
- hemorrhage
when is HIT suspected
- when plt lvls drop >50% below pt’s baseline
what are symptoms of HIT (6)
often asymptomatic, but most common is bleeding
- epistaxis
- gum bleeding
- petechiae
- bruising
- prolonged bleeding after routine procedures (ex. IM injection)
- signs of internal blood loss (dizziness, tachy, fainting, abdom pain)
what is included in diagnostic studies r/t HIT (2)
- plt count decreased
- bone marrow exam
- lab tests that assess secondary hemostasis (PT, aPTT) may be normal*
what is included in treatment for HIT
- stop all heparin products (including heparin flushes for vascular catheters & LMWH)
- maintain anticoagulation w a different med
what other meds can maintain coagulation w/ HIT (2)
- fondaparinux
- argutroban
why arent plt transfusions used for treatment of HIT
- enhance the thromboembolic events associated w HIT
what is the goal of acute intervention of thrombocytopenia episodes
- prevent or control hemorrhage
what is included in pt education r/t HIT (13)
- notify the HCP of any signs of bleeding
- do not blow ur nose forecfully
- what to do if a nosebleed occurs
- do not bend down w your head lower than your waist
- prevent constipation by drinking lots of fluids & avoid straining
- shave only w electric razor (not blades)
- do not pluck eyebrows or other body hair
- do not puncture your skin (tattoos, piercing, etc.)
- avoid using meds (aspirin) or herbal products that effect clotting time
- use a soft bristled toothbrush
- if menstruating, keep track of # of pads used per day
- do not use tampons
- ask ur HCP before you have any invasive procedures done (dental, manicure, pedicure, etc)
what are some signs of bleeding that a pt w HIT should notify the HCP about (9)
- black, tarry, or bloody BM
- bruising
- small red or purple spots on skin
- bleeding from mouth or anywhere in the body
- HA
- changes to vision
- difficulty talking
- sudden weakness of an arm or leg
- confusion
what instructions should you give a pt w HIT regarding nose bleeds (3)
- keep your head up & apply firm pressure to the nostrils and bridge of the nose
- if bleeding continues, place an ice bag over the bridge of the nose and nape of the neck
- in unable to stop a nosebleed after 10 min, call HCP
what is included in collab care for pts w HIT (3)
- if subcut injection is unavoidable, use smallest gage possible & apply direct pressure for 5-10 min
- avoid IM injections
- assess for signs of bleeding and clots
a nursing diagnosis r/t thrombocytopenia is impaired oral mucus membrane integirty. what nursing interventions can be done for this (5)
- monitor condition of pts mouth
- encourage avoidance of spicy, salty, acidic, dry, rough, foods
- instruct pt to use soft bristled toothbrush
- instruct pt on freq and quality of proper oral health care
- instruct pt to avoid oral hygeine products w gylcerin, alcohol, or other drying agents
