Exam # 1 Common Post-op Complications Pt2 Flashcards Preview

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Flashcards in Exam # 1 Common Post-op Complications Pt2 Deck (39)
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0
Q

What are the components of Virchow’s triad?

A

1) Stasis
2) Vessel wall injury
3) Hypercoagulability

1
Q

What are the 7 Predisposing Factors to DVT?

A

1) Previous DVT
2) Smoking
3) Contraceptives
4) Age
5) Cardiovascular disorders
6) Weight
7) Gender

2
Q

How do TED Hose work as an intervention for DVT and what level of risk do they pose?

A

TED hose decrease the risk of DVT by increasing venous return. They are usually low risk but their risk increases to mod/high when used when concurrently taking anticoagulants.

3
Q

What is the difference when Unfractionated Heparin is administered via IV and SQ as a means of managing DVT?

A

1) IV - DVT treatment

2) SQ - DVT prophylaxis

4
Q

What are the SQ sites that Unfractionated Heparin may be administered and what 4 things should we keep in mind when administering it SQ?

A
  • SQ sites for Unfractionated Heparin are the abdomen and iliac crest. Things to remember are:
    1) Rotate injection sites (prevent scar tissue from forming)
    2) Do not aspirate
    3) Hold skin fold during injection
    4) Do not rub site (rubbing causes bruising)
5
Q

What is the antidote for Heparin and Warfarin

A

1) Heparin Antidote - Protamine Sulfate

2) Warfarin Antidote - Vitamin K

6
Q

What are the actions of Heparin and Warfarin?

A

1) Heparin - Inhibits thrombin mediated conversion of fibrinogen to fibrin.
2) Inhibits vitamin K dependent coagulation factors (vitamin k antagonist).

7
Q

What are the therapeutic effects of Heparin and Warfarin?

A

1) Heparin - PTT normal = 24-36 secs; therapeutic = 46-70 secs
ACT normal = 80-135 secs; therapeutic = 3 mins

2) Warfarin - INR normal = .75-1.25; therapeutic* = 2-3
* Therapeutic levels take 48-72 hours because the vitamin k, once administered, takes time to work.

8
Q

Give two examples of LMWH medications

A

Fragmin and Lovenox

9
Q

What is Xarleto (Rivaroxaban)

A

A new anticoagulant PO med found to me effective in preventing DVTs and PEs than Lovenox, yet equally safe.

10
Q

Define Pulmonary Emboli

A

A blood clot from a vein of lower extremity that breaks loose and travels to the heart or a branch of the pulmonary artery vasculature and may result in pulmonary infarction or right heart strain.

11
Q

What are the 6 defining characteristics of a Pulmonary Emboli?

A

1) It is sudden
2) Sharp chest pain
3) Extreme apprehension
4) Intense hyperventilation and dyspnea
5) Cough and hemoptysis from ischemic pulmonary parenchymal necrosis
6) ⬇ PO2 and CO2

12
Q

Which 3 drug classes especially interact with Warfarin (Coumadin) and should not be administered concurrently?

A

1) Barbituates
2) NSAIDs
3) Dilantin

13
Q

Which 3 types of food interact with Warfarin (Coumadin)?

A

1) Green leafy vegetables
2) Broccoli
3) Spinach
* because they promote Vitamin K which is a clotting factor

14
Q

What are the 5 WBCs and what are their roles?

A

1) Neutrophils (60-70%) - 1st responders in the inflammatory process. An ⬆ indicates. Bacterial infection.
2) Lymphocytes (20-25%) - Produce antibodies. An ⬆ indicates viral infection.
3) Monocytes (3-8%) - Phagocytosis of larger particles
4) Eosinophils (2-4%) - Counteracts histamine and destroys parasitic worms.
5) Basophils (1%) - Releases histamine in the inflammatory phase

15
Q

Which patients are at greatest risk for not being able to sense when their bladders are full?

A

Patients who have had Epidurals or Spinal Anesthetics because they have lost the sensation down there

16
Q

What are the therapeutic interventions for DVT?

A

1) Push fluids
2) Early mobilization
3) ROm & planter and dorsiflexion if patient is on bedrest
4) Have patients sit up in chair for meals 3x per day

17
Q

Why should you never use SCDs on a patient with confirmed VTs?

A

It will push the clot up towards the heart

18
Q

What are the 2 major side effects of Heparin?

A

1) Heparin Induced Thrombocytopenia (HIT)

2) Osteoperosis

19
Q

Where does Heparin work in the clotting chain?

*Thrombinase > Prothrombin > Thrombin > Fibrinogen > Fibrin

A

Heparin stops the clotting chain by preventing fibrinogen from turning into fibrin

20
Q

Why is Heparin given as a prophylaxis to prevent DVT but not indicated for patient with confirmed DVT?

A

Heparin can not dissolve clots (it is not a thrombolytic) that have already formed, it can only stop the clotting chain at a certain point, thus, preventing clots from forming.

21
Q

What are the 6 types of Blood Products discussed in class?

A

1) Packed Red Blood Cells
2) Frozen RBCs
3) Platelets
4) Fresh Frozen Plasma
5) Albumin
6) Cryoprecipitates

22
Q

What are the 5 characteristics of PRBCs as a blood product?

A

1) Prepared from whole blood
2) 1 unit = 250-350 mL
3) Less risk of fluid overload
4) Used to treat anemia
5) Contains some platelets and WBCs but they are not functional

23
Q

What are the 2 characteristics of Frozen RBCs as a blood product?

A

1) Prepared from RBCs

2) Can be stored for 10 years, but must be used within 24 hrs after thawing.

24
Q

What are the 4 characteristics of Platelets as a blood product?

A

1) Prepared from whole blood
2) 1 unit = 30-60 mL of platelets
3) Includes multiple platelet donations from one donor
4) Used to treat Thrombocytopenia and bleeding disorders

25
Q

Describe also immunization as it pertains to platelets used for transfusion.

A

Repeated Tx from different donors lead to ⬇ survival due to alloiimunization. Platelets from a single donor is used for repeated Tx because it ⬇ the risk of alloiimunization by limiting exposure to multiple donors.

26
Q

What are the 4 characteristics of Fresh Frozen Plasma as a blood product?

A

1) 1L = 200-250 mL of plasma
2) Rich in clotting factors
3) Contains no platelets
4) Used for bleeding disorders

27
Q

What are the 3 characteristics of Albumin as a blood product?

A

1) Prepared from plasma
2) Causes water to shift from extra vascular space to Intravascular space.
3) Used in Tx of Hypovolemic shock, hypoproteinemia, and burns

28
Q

What are the 5 characteristics of Cryoprecipitates as a blood product?

A

1) Prepared from Fresh Frozen Plasma

2) Used to replace clotting factors, and to Tx Von Wilebrand’s disease, hypofibrinogenemia, and Hemophilia A.

29
Q

What is the effect of 1 unit of PRBCs and 1 unit of Platelets on the patient?

A

1) 1 unit of PRBCS = ⬆ Hgb by 1 and ⬆ Hct by 3%

2) 1 unit of Platelets = ⬆ platelets by 10,000

30
Q

What are the normal values for PO2 and CO2 found in ABGs?

A

1) PO2 - 80-100 mmHg

2) CO2 - 35-45 mmHg

31
Q

What 4 methods are used to manage a Pulmonary Emboli?

A

1) Give O2
2) Position upright
3) Medication - (Pain, vasodilation, anticoagulant and thromboembolytic).
4) Surgery to remove it

32
Q

What is the “bottom line” significance of an elevated ESR?

A

⬆ESR = an inflammation somewhere in the body

33
Q

(T/F) Patients with renal disease are susceptible to anemia because of a deficiency in erythropoietin.

A

True - Renal diseases causes a deficiency in erythropoietin production, which result in inadequate RBC production.

34
Q

What are the 3 different types of blood donations?

A

1) Directed Donation - From a family or friend and specifically for the patient.
2) Standard Donation - Random donation from anyone (usual)
3) Autologous Donation - Self donated blood

35
Q

What 6 things should the nurse check when giving a blood transfusion?

A

1) Name
2) Hospital #
3) Blood Unit #
4) PT’s ABO& Rh status against Donor’s ABO & Rh status
5) Blood expiration date
6) Blood product ordered against blood product delivered

36
Q

How soon after the blood product arrives on the floor for transfusion should be spiked and infused?

A

Should be spiked within 30 mins and infused within 4 hours

37
Q

What are the 7 blood transfusion reactions discussed in class?

A

1) Acute hemolytic - Incompatable ABOs
2) Febrile
3) Mild allergy
4) Anaphylactic
5) Circulatory overload
6) Sepsis
7) Acute lung injury

38
Q

What are the 9 different types of Anemias discussed in class?

A

1) Penicious/Megoblastic - Vit B12 deficiency
2) Folate Deficiency
3) Iron Deficiency - Can result from blood loss also.
4) ⬇ Erythropoietin Production
5) Anemia of Chronic Disease - Seen in AIDS, liver disease, etc.
6) Aplastic - Immune response that targets cells in bone marrows.
7) Bleeding
8) Autoimmune Hemolytic Anemia - Can be inherited or acquired
9) Thalessemias - Caused by cellular abnormalities of Hgb