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NUR2228 > Week 5 - Haematology and Vascular Nursing > Flashcards

Week 5 - Haematology and Vascular Nursing Flashcards

1
Q

What is plasma?

A

Transports nutrients, hormones, and proteins. It is a yellow liquid that makes up about 55% of the body’s blood volume.

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2
Q

What are platelets?

A

Form clots to stop bleeding. Platelets make up less than 1% of blood.

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3
Q

What are red blood cells?

A

Carry fresh oxygen through the body and remove carbon dioxide. Red blood cells make up about 40 to 45% of blood.

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4
Q

What are white blood cells?

A

Part of the body’s immune system, detect and fight viruses and bacteria.

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5
Q

When is hemoglobin considered to be low in men and women for anaemia?

A

In women, anaemia happens when the hemoglobin concentration drops below 120g/L. In men it occurs when the hemoglobin drops below 140g/L.

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6
Q

What is anaemia?

A

Anaemia is a deficiency in the number of erythrocytes (red blood cells - RBC), the quantity or quality of hemoglobin, and/or the volume of red blood cells (hematocrit).

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7
Q

What is hematopoiesis?

A

The process of formation of all blood cells.

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8
Q

What are the main components of hematopoiesis system?

A

The main components of the haematopoietic system are the blood, bone marrow, lymph nodes, thymus and spleen, liver and kidneys.

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9
Q

What is a normal red blood cells lifespan?

A

120 days

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10
Q

Three main causes of anaemia:

A
  • Decreased RBC production
  • Blood loss
  • Increased RBC destruction
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11
Q

Clinical manifestations of anaemia:

A
  • Pallor
  • Systolic murmurs - due to low blood viscosity
  • Breathlessness and exercise intolerance
  • Tachycardia
  • Angina, heart failure and AMI
  • Fatigue
  • Weight loss
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12
Q

Nursing management of anaemia:

A
  • Administration of supportive haematopoiesis medications
  • Support with ADLs - due to fatigue
  • Oxygenation support
  • Relevant risk assessments (falls, skin integrity, cognitive impairment)
  • Nutritional support
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13
Q

What do diagnostic tests of anaemia involve?

A
  • Complete health history: looking for reasons for decreased production or increased destruction and loss of RBCs
  • Thorough physical examination: clinical manifestations of anaemia and potential causes
  • Full blood count and peripheral blood smear: to determine morphology (appearance) of RBCs
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14
Q

Iron supplement adverse reactions:

A
  • Nausea
  • Abdominal cramping
  • Constipation or diarrhoea
    Uncommon but potentially life threatening reactions include:
  • Anaphylaxis (with parenteral (IM or IV) administration)
  • Iron overload
  • Acute iron toxicity (associated with children accidentally swallowing iron tablets)
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15
Q

What is erythropoietin?

A

Replacement of red blood cells is called hematopoiesis and is regulated by growth factors including erythropoietin. This acts on erythropoietin receptors on the surface of erythroid progenitor cells, stimulating maturation of immature erythrocytes.

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16
Q

Indication of erythropoietin:

A

Erythropoietin is used to treat anaemia caused by erythropoietin deficiency including:

  • Chronic kidney disease
  • AIDS
  • Cancer
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17
Q

Erythropoietin mechanism of action:

A

Erythropoietin is a glycoprotein produced in the juxta tubular cells in the kidney, and interestingly also in macrophages. It is responsible for stimulating erythroid progenitor cells to proliferate and generate erythrocytes.

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18
Q

Adverse reactions to erythropoietin:

A

Common:

  • Transient flu-like clinical manifestations
  • Hypertension and headache
  • Increased risk of thrombosis
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19
Q

Nursing care considerations of erythropoietin:

A
  • Iron and folate deficiency must be corrected before starting treatment
  • Erythropoietin is typically given by subcutaneous injection weekly or monthly depending on drug
  • Monitor blood pressure (hypertension is very common) and for thrombosis formation
  • Provide counselling around flu-like clinical manifestations early in treatment
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20
Q

What is venous thrombosis?

A

Venous thrombosis involves the formation of a thrombus in association with inflammation of the vein. It is the most common disorder of the veins and is classified as either deep venous thrombosis (DVT) or superficial venous thrombosis (SVT).

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21
Q

What is DVT?

A

Deep vein thrombosis typically involves the iliac and femoral veins in the leg and pelvis, but can involve the arms as well.

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22
Q

What is VTE?

A

Venous thromboembolism (VTE) is the preferred terminology as it represents the spectrum of pathology from deep/superficial vein thrombosis to pulmonary embolism (PE).

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23
Q

Three factors that promote venous thrombosis:

A
  • Venous stasis
  • Venous endothelial damage
  • Hypercoagulability
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24
Q

What is virchow’s triad?

A

Virchow’s triad represents three qualities in physiology that can result in thrombosis, which can lead to pathologies such as pulmonary embolism and deep venous thrombosis.

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25
Q

What is part of the hypercoagulable state in Virchow’s triad?

A
  • Cancer
  • Oestrogen therapy
  • Pregnancy
  • Acute inflammatory disorder
  • Acute infection
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26
Q

What is part of the endothelial injury in Virchow’s triad?

A
  • Trauma or surgery
  • Venous valve disease
  • Atherosclerosis
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27
Q

What is part of the circulatory stasis in Virchow’s triad?

A
  • Left ventricular dysfunction
  • Immobility
  • Venous insufficiency
  • Previous VTE
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28
Q

DVT clinical manifestations:

A
  • Limb oedema (excessive accumulation of fluid within the interstitial space)
  • Dilated visible superficial veins
  • Dull ache along the limb
  • Paresthesia
  • Warm skin
  • Redness
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29
Q

DVT nursing management:

A
  • Reducing risk factors
  • Providing patient education
  • Administering anticoagulant and/or thrombolytic medications
  • Promoting mobility
  • Monitoring coagulation factors and clotting times
  • Monitoring for bleeding associated with pharmacological therapy
  • Monitoring and managing pain to provide comfort
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30
Q

DVT diagnostic investigations:

A

Diagnostic tests may include;

  • Blood test measuring D-Dimer: D-Dimer is a fragment of fibrin formed as a result of fibrin degradation and clot lysis - elevated level suggests venous thrombosis
  • Duplex Ultrasound: using high frequency sound waves to measure the speed and structure of the blood flow in the arteries and veins
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31
Q

What is coagulation?

A

Coagulation involves the conversion of liquid blood to a solid clot - to plug holes in injured blood vessels to prevent life threatening haemorrhage.

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32
Q

What are the two pathways of the clotting cascade?

A

The clotting cascade has two pathways termed the intrinsic (all coagulation factors are within the blood vessel) and extrinsic (some components outside of the blood vessel) pathways.

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33
Q

Examples of anticoagulants:

A
  • Heparin
  • Warfarin
  • Low molecular weight heparin
  • Novel oral anticoagulants (dabigantin, rivaroxaban)
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34
Q

Examples of antiplatelets:

A
  • Aspirin

- Clopidogrel

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35
Q

What are thrombolytics?

A

Dissolves (lyse) blood clots (thrombi)

  • Tissue plasminogen activator (tPA)
  • Streptokinase (SK)
  • Urokinase (UK)
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36
Q

Heparin mechanism of action:

A

Heparin inhibits coagulation by activating antithrombin III. Antithrombin III inhibits thrombin, which you will remember is part of the coagulation cascade heparin increases the affinity of antithrombin III for the products it binds to.

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37
Q

Heparin indication:

A

Heparin is used for a variety of medical conditions and during several procedures including:

  • Treatment (does not break down the clot, it helps to prevent further clot formation, whilst allowing natural fibrinolysis) and prevention of venous thrombosis
  • Intravascular catheter occlusion prophylaxis
  • During interventional angiography procedures
  • During renal replacement therapy (including dialysis)
38
Q

Heparin adverse reactions:

A
  • Haemorrhage

- Injection site reactions

39
Q

Heparin nursing care considerations:

A
  • Heparin should never be given by intramuscular injection due to risk of haematoma formation
  • Heparin is part of the high-risk APINCHS group of medications and should be checked carefully
  • Injection sites should be rotated every injection and should not be rubbed following injection
40
Q

Examples of Low Molecular Weight Heparin (LMWH):

A
  • Enoxaparin (Clexane)
  • Enoxaparin forte (Clexane forte)
  • Dalteparin
41
Q

Low Molecular Weight Heparin (LMWH) mechanism of action:

A

Their action is similar to that of heparin (unfractionated heparin). Whilst heparin can increase the action of antithrombin III on factor Xa and thrombin, low-molecular weight heparin can only increase the action of antithrombin III on factor Xa, as the molecule is too small to bind to both the enzyme and inhibitor.

42
Q

Low Molecular Weight Heparin (LMWH) indication:

A

LMWH is used for a variety of medical conditions:

  • Treatment and prevention of venous thrombosis
  • Unstable angina
  • Acute STEMI (+ thrombolytic)
43
Q

Low Molecular Weight Heparin (LMWH) adverse reactions:

A
  • Hemorrhage
  • Injection site reactions
  • Reversible increase in liver enzymes
44
Q

Low Molecular Weight Heparin (LMWH) nursing care considerations:

A
  • Injection sites should be rotated every injection and should not be rubbed following injection
  • Provide patient education about the use of LMWH
  • LMWH should never be given by intramuscular injection due to risk of haematoma formation
45
Q

Warfarin indication:

A
  • Treatment and prevention of venous thrombosis
  • Prevention of thromboembolism in atrial fibrillation (AF)
  • Coronary occlusion adjunctive treatment
46
Q

Warfarin mechanism of action:

A

Warfarin is a vitamin K agonist and therefore prevents hepatic formation of vitamin K dependent clotting factors II, VII, IX and X. It takes several days for the effect of warfarin to develop because of the time taken for degradation (destruction) of pre-formed clotting factors.

47
Q

Warfarin adverse reactions:

A
  • Haemorrhage (especially into the bowel and brain)
  • Teratogenic (if taken whilst pregnant): Teratogens are substances or medications that may produce physical or functional defects in a human embryo or fetus after the pregnant woman is exposed to the substance
48
Q

Warfarin nursing care considerations:

A
  • Warfarin comes in two brands - Coumadin and Marevan - and these are not interchangeable
  • Patient requires INR monitoring every few days
  • Diet counselling required as foods high in vitamin K can reduce effectiveness of warfarin
49
Q

Oral anticoagulants indication:

A
  • Prevention of strokes in patients with atrial fibrillation
  • Prevention of deep vein thrombosis after major orthopedic surgery
  • Prevention of recurrent DVT or PE
50
Q

Oral anticoagulants mechanism of action:

A
  • Dabigatran: reversible highly potent competitive direct thrombin inhibition which inhibits the conversion of fibrinogen to fibrin
  • Rivaroxaban: highly selective direct factor Xa inhibition which therefore interrupts the intrinsic and extrinsic pathway
51
Q

Oral anticoagulants adverse reactions:

A
  • Haemorrhage

- Anaemia

52
Q

Oral anticoagulants nursing care considerations:

A
  • Some oral anticoagulants do not have reversal agents (i.e. rivaroxaban)
  • Routine laboratory monitoring is not possible - there is no method to guide dose adjustment
  • INR can be misleading high if measured <24 hours after a dose of oral anticoagulant
    Regular renal function monitoring is recommended, especially for the elderly
  • Counsel the patient that they should not abruptly stop taking this medication, even if they are concerned - see their GP
53
Q

Antiplatelet agents examples:

A
  • Aspirin
  • Clopidogrel
  • Dipyridamole
54
Q

Antiplatelet agent indication:

A
  • Prevention of myocardial infarction and stroke
  • Cerebrovascular disease (including carotid artery stenosis)
  • Peripheral vascular disease
  • Coronary occlusion adjunctive treatment
55
Q

Aspirin mechanism of action:

A

Inhibits platelet aggregation by irreversibly inhibiting cyclo-oxygenase (in platelets), reducing the synthesis of thromboxane A2 (an inducer of platelet aggregation) for the life of the platelet

56
Q

Antiplatelet agents adverse reactions:

A
  • Gastrointestinal irritation
  • Asymptomatic blood loss
  • Increased bleeding time
57
Q

Antiplatelet agents nursing care considerations:

A
  • Take tablets direct from the packet as they rapidly break down when not protected by the packaging
  • There is no evidence that enteric coated products decrease risk of GI bleeding
  • Poor compliance with aspirin treatment is common (>40%)
  • Aspirin resistance can occur with chronic use - there is no treatment
58
Q

Clopidogrel mechanism of action:

A

The active metabolite of the thienopyridines (clopidogrel, prasugrel) irreversibly binds to the platelet P2Y12 receptor and inhibits platelet aggregation for the life of the platelet

59
Q

There are three major classes of fibrinolytic drugs:

A
  • Tissue plasminogen activator (tPA)
  • Streptokinase (SK)
  • Urokinase (UK)
60
Q

Thrombolytic drugs mechanism of action:

A

Thrombolytic drugs dissolve blood clots by activating plasminogen, which forms a cleaved product called plasmin. Plasmin is a proteolytic enzyme that is capable of breaking cross-links between fibrin molecules, which provides the structural integrity of blood clots. Because of these actions, thrombolytic drugs are also called “plasminogen activators” and “fibrinolytic drugs”.

61
Q

Thrombolytic drugs adverse reactions:

A

The greatest risk of thrombolytic medication is life-threatening bleeding, inducing retroperitoneal and intracranial.

62
Q

Thrombolytic drugs nursing care considerations:

A
  • Intramuscular injection should not be administered during thrombolytic therapy
  • Consideration should be given to insertion of intravenous cannula, venepuncture or subcutaneous injections
  • Patient will typically receive 1:1 nursing care during the period of infusion
  • Regular neurological assessment is required to detect intracranial haemorrhage
63
Q

What is an aortic aneurysm?

A

An aortic aneurysm may involve the aortic arch, thoracic and/or abdominal aorta. An aneurysm is a localised dilation or outpouching of a vessel wall. Aneurysms form in arteries when the vessel wall integrity is disrupted, usually from changes in the elastin and collagen fibres which make the vessel more vulnerable to intravascular pressure.

64
Q

Aortic aneurysm pathophysiology:

A

An aneurysm is an outpouching or dilation of a segment of the aorta. The wall of the aorta is under significant pressure when blood is ejected from the left ventricle.

65
Q

Thoracic aneurysm clinical manifestations:

A
  • Diffuse chest pain
  • Angina
  • Hoarseness: from compression of the laryngeal nerve
  • Dysphagia: from compression of the oesophagus
  • Oedema of the arms: from compression of low-pressure veins
66
Q

Abdominal aneurysm clinical manifestations:

A
  • Pulsatile mass in the periumbilical region
  • Vascular sound auscultated over the abdomen
  • Back and groin pain
  • Altered bowel elimination: from nerve compression
67
Q

Stable aortic aneurysm nursing management:

A
  • Reducing risk factors for aneurysmal rupture: hypertension and smoking
  • Analgesia
  • Reminders for regular screening on aneurysm size
  • Explanation of diagnostic procedures
  • Monitoring blood pressure and administration of oral and intravenous antihypertensives
  • Preparation for surgical therapy
68
Q

Ruptured aortic aneurysm nursing management:

A
  • Insertion of large bore intravenous cannulae
  • Administration of blood and blood products
  • Rapid infusion of intravenous fluids
  • Preparing the patient for transfer to the operating theatre
  • Support for family and a discussion about seriousness of complication
  • Activation of a hospitals massive transfusion protocol
69
Q

What does (CRAM) stand for in regards to an aortic aneurysm?

A
  • Colour/cap refill
  • Reduce BP
  • Assess peripheral pulses
  • Monitor kidney functions/labs
70
Q

What is the surgical management of an aortic aneurysm?

A
  • Open aneurysmal repair

- Endovascular graft procedure

71
Q

Diagnostic tests to detect an aortic aneurysm:

A

To rule out an AMI, especially as a thoracic aortic aneurysm can mimic an AMI, the following would be undertaken:
- Electrocardiogram (ECG) and troponin
If an aortic aneurysm is suspected the following would be performed:
- Chest or abdominal x-rays: may show widening of the aorta and calcification
- Echocardiography: demonstrate the function of the aortic valve
- CT scan: provides the most accurate visualization of the aneurysm including leakage
- Angiography: provides helpful information using contrast
- Ultrasound: demonstrates aneurysm and thrombus formation

72
Q

What is peripheral vascular disease?

A

Describes a combination of diseases that affect the peripheral vascular system including the arteries and veins.

73
Q

What does peripheral vascular disease include?

A
  • Peripheral Artery Disease (PAD): arterial ulcers

- Chronic Venous Insufficiency: venous leg ulcers

74
Q

Pathophysiology of peripheral artery disease:

A

The leading cause of PAD is atherosclerosis, a gradual thickening of the intima and media as a result of cholesterol and lipids within the vessel walls. Over time this build-up causes narrowing of the artery lumen.

75
Q

Pathophysiology of chronic venous insufficiency:

A

It is a condition that develops when leg veins and valves fail to keep blood returning to the heart.

76
Q

Clinical manifestations of peripheral artery disease:

A
  • Intermittent claudation
  • Arterial ulcers
  • Exercise intolerance
  • Ischemic rest pain
  • Paresthesia
77
Q

Clinical manifestations of chronic venous insufficiency:

A
  • Characteristic brownish appearance
  • Venous ulcers
  • Eczema
  • Pain when the leg is dependent
  • Osteomyelitis
  • Inverted wine bottle appearance
78
Q

What is Hemosiderin Deposition?

A

Oedema and chronic inflammation in the tissues of the lower leg predispose to tissue destruction. Enzymes in the tissue eventually break down red blood cells, causing the release of hemosiderin which causes a brownish discolouration of the limb. Over time the hemosiderin causes fibrous tissue to form in the lower ankle which results in thick, hardened contracted skin.

79
Q

Nursing management of chronic venous insufficiency:

A
  • Wound care: prior to, during and after compression therapy
  • Compression therapy: the cornerstone treatment for healing venous ulcers
  • Risk factor reduction: achieve and maintain a normal body weight
  • Management of skin grafting that may be required after compression therapy
  • Preparing the patient for surgical therapy of incompetent veins
80
Q

Surgical management of chronic venous insufficiency:

A
  • Sclerotherapy: involves injection of a substance that destroys smaller veins. The procedure results in venous inflammation, thrombosis with resultant death and resorption of the vein.
  • Surgical ligation or ablation: involves surgical removal of the vein and any incompetent branches. Ablation involves insertion of a venous catheter that emits energy to cause the collapse and sclerosis of the vein.
81
Q

Nursing management of peripheral artery disease:

A
  • Risk factor modification: reduce smoking, lower cholesterol, manage hypertension, tight blood glucose control
  • Medication management: antiplatelet agents (aspirin or clopidogrel), mixed antiplatelet + vasodilator agents (cilostazol) and other cardiovascular agents (oxpentifylline)
  • Nutritional support: reduce body mass index, low cholesterol, fat and lipid diet
  • Wound care: management of arterial ulcers or dry necrosis
  • Analgesia: management of ischaemic leg pain
  • Foot care: to maintain skin integrity and prevent further wound formation
82
Q

Surgical management of peripheral artery disease:

A
  • Peripheral artery bypass graft: autogenous vein graft or synthetic graft
  • Endarterectomy to remove arterial plaque
  • Amputation of the toes, forefoot, foot or lower leg for severe disease with necrosis
  • Catheterisation of the artery with balloon dilation and stent deployment
83
Q

Diagnostic tests to clearly differentiate between arterial, venous or mixed vascular disease:

A
  • Ankle-brachial index testing
  • Venography
  • CT-scan
  • Duplex ultrasound
  • Angiography
84
Q

What is a blood transfusion?

A

A blood transfusion is the intravenous administration of whole blood or its components, such as plasma, platelets or clotting factors.

85
Q

What is the purpose of a blood transfusion?

A
  • Increase circulating blood volume when it has been depleted
  • Increase the number of red blood cells to maintain or increase haemoglobin level
  • Provide plasma clotting factors to help control haemorrhage
  • Combat infection due to decreased or defective white cells or antibodies
86
Q

Steps to giving a blood transfusion:

A
  1. Confirm positive patient identification (PPI) and obtain blood sample for group and cross-matching studies
  2. Ensure the medical officer has obtained written consent from the patient for the transfusion
  3. Ensure that intravenous line is patent prior to ordering blood
  4. Ensure you have read the hospital blood transfusion policy
  5. Have two nurses perform PPI and check the blood type, group, quality, donor ID and expiration date and compare to recipient details
  6. Perform a full set of vital signs and answer patient questions about transfusion
  7. Prime the line with the blood transfusion or 0.9% sodium chloride and ensure that a filtered blood administration set is used
  8. Stay with the patient for the first 15 minutes of the transfusion and monitor for a reaction
  9. Perform a full set of vital signs 15 minutes after commencing transfusion
  10. At the conclusion of the transfusion, perform a full set of vital signs and ensure fluid balance chart is complete
87
Q

What IV fluid is administered with blood?

A

0.9% normal saline

88
Q

Types of blood transfusion reactions:

A
  • Acute haemolytic transfusion reaction
  • Febrile, non-haemolytic reaction
  • Minor allergic reaction
  • Anaphylactic reaction
  • Transfusion-associated circulatory overload
  • Sepsis
  • Transfusion-related acute lung injury
89
Q

Management of a transfusion reaction:

A
  1. Immediately stop the blood transfusion and clamp the intravenous line
  2. Maintain a patent IV line with a new intravenous line and 0.9% normal saline (the same IV cannula can be used, if it is still patent)
  3. Notify the nurse in charge and medical team (MET call if required)
  4. Perform a recheck of the blood and patient identifiers
  5. Treat emergency symptoms as they arise whilst monitoring vital signs and urine output
  6. Save the blood and return the blood to the blood bank (save the intravenous line and blood bag)
  7. Document the transfusion reaction and add the reaction to the patients alerts
90
Q

Nursing management during a blood transfusion:

A
  • Monitor patient response to transfusions for potential reactions
  • Assess for circulatory (fluid volume) overload by monitoring vital signs and auscultating chest
  • Ensure accurate fluid balance documentation
  • Patient reassurance where transfusion is providing stable and without complication
  • Ensure patency of intravenous line
  • Transfusion of the blood within the required timeframe

NUR2228 (6 decks)

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