Week 7: Vascular Perfusion textbook Flashcards
what is a thrombus without inflammation?
Phlebothrombosis
what is a Thrombophlebitis?
thrombus that is associated with inflammation - can occur in superficial veins, most common deep veins of lower extremities
what is the most common type of thrombophlebitis?
DVT or deep vein thrombosis - most serious greater risk of PE
what condition is a medical emergency when it comes to clots?
Pulmonary Embolism!!!
where in the body does DVT most often occur?
in the legs BUT can also occur in the upper arms
what is the Virchow Triad?
this is the thrombus formation - associated with stasis of blood flow, endothelial injury and/or hyper coagulability
what is a pre disposing factor of thrombus formation?
patients that underwent hip surgery, total knee replacement, open prostate surgery also heart failure cancer immobility etc.
are people who sit for long periods of time (airplane and computer) are also at risk
yes
is Phlebitis (vein inflammation) associated with invasive procedures ex. IV therapy be at risk for thrombosis? (predisposing)
YES
What would you assess recognize cues for Thrombosis?
history of any type of VTE
assess risks for developing VTE - prolonged sitting/bedrest, recent surgical procedures or factors that may affect coagulation
What is Padua Prediction Score (PPS) used for?
to assess risk for VTE
what are some physical assessments of S&S of VTE?
may be asymptomatic
S&S of DVT: calf or groin tenderness, pain and sudden unilateral swelling of leg
palpate site observe for induration (hardening), warmth and edema, redness
what is the preferred diagnostic test for DVT?
venous duplex ultrasonography
what are you analyzing/ prioritizing hypothesis of VTE
priority problem for most patients with VTE is potential for injury due to complications of VTE and anticoagulation therapy
Planning and Implementation: Generate Solutions and Take Action - VTE
expected no injury from VTE
Interventions:
how to prevent pulmonary emboli - use of drugs
nonsurgical management of VTE:
Patient education
* Leg exercises
* Early ambulation
* Adequate hydration
* Graduated compression stockings
* Intermi ent pneumatic compression, such as sequential
compression devices (SCDs) * Venous plexus foot pump
* Anticoagulant therapy - drug of choice
what is hemostasis?
multistep process of controlled blood clo tting, resulting in localized blood clo tting in damaged blood vessels to prevent excessive
blood loss while continuing perfusion of liquid blood and individual cells to all other areas.
what is platelet aggregation?
begins forming a platelet plug by having platelets clump together, a process essential for blood clo tting
when collagen is exposed what happens due to damaging of blood vessels what happens (extrinsic factors)
collagen activates platelets to form platelet plug within seconds -starts the protective healing process
true or false about clotting factors: they are inactive enzymes that become activated in sequence. At each step, the activated enzyme from the previous step activates the next enzyme.
TRUE
what is the last phase of blood clotting?
fibrin clot formation
true or false: Thus whenever the clo ing cascade is started, anticlo ing forces are also started to limit clot formation only to damaged areas so normal perfusion is maintained everywhere else.
true
true of false: When blood procloting and anticloting actions are balanced, cloting occurs only where it is needed, and normal perfusion is maintained.
true
what is fibrinolysis mean? ** remember lysis means disintegration
is the process that dissolves fibrin clot edges with special enzymes
true or false: Deficiency of any anticloting factor decreases the risk for venous thromboembolism (VTE) such as pulmonary embolism, myocardial infarction (MI), and strokes.
false, increase
what does Prothrombin time (PT) measure
how long blood takes to clot - reflects clotting factors II, V, VII and X and how they function
what does International normalized ratio (INR) measure?
same as PT , established normal mean or standard for PT
anti-factor Xa
measures the amount of anti-activated factor X (anti-Xa) in blood, which is affected by heparin. - used to monitor heparin in patients
true or false: Platelet aggregation, or the ability to clump, is tested by mixing the patient’s plasma with an agonist substance that should cause clumping.
true
what are anticoagulants?
Drugs that activate antithrombin
heparin and enoxaparin
warfarin
whats another word for Vitamin K agonist?
NOTHING! if ur thinking warfarin its a vitamin k Antagonist
what is the action of anticoagulants?
decreases the formation of fibrin - used to prevent thrombosis in veins and atria of heart
what is oral anticoagulants and parental anticoagulants?
oral is PO, for example warfarin
parental is IV or subQ ex Heparin and Enoxaparin
can enoxaparin be administered via IV?
no, its SubQ - longer half life then heparin
what is a low molecular weight heparin? what does it do in MOA?
Enoxaparin, reduces the activity of Xa more than they reduce the activity of thrombin
true or false: Heparin suppresses coagulation by helping antithrombin inactivate clotting factors, primarily thrombin and factor Xa.
true
does heparin only bind to antithrombin when inactivating Xa ?
YES
true or false: By activating antithrombin, and thereby promoting the inactivation of thrombin and factor Xa, heparin ultimately suppresses the formation of fibrin.
true
can heparin be absorbed and cross membranes?
no thats why it is admin via IV and SubQ, Because it cannot cross membranes, heparin does not traverse the placenta and does not enter breast milk.
half life in heparin is short unless renal impairment is present
yes
what are some adverse effects for heparin?
hemorrhage, Spinal/Epidural Hematoma, Heparin-Induced Thrombocytopenia, Hpersensitivity
why does it take days for results to be seen with warfarin?
only works once the clots are decaying, have no effect on clotting factors in circulation (though it acts quickly to inhibit synthesis)
what are some adverse effects of Warfarin?
Hemmorhage, Fetal hemorrhage, use when breast feeding (oral so enters milk)
what is the adverse effects of clopidogrel?
risk of bleeding, thrombotic thrombocytopenic Purpura
what is an antifibrinolytic agent?
Aminocaproic Acid - given IV and tablet
