M4 Clotting Flashcards
(209 cards)
1
Q
DIC
Disseminated Intravascular coagulation
A
Inflammation and coagulation due to initial disease process causes microthrombi to form in circulation.
This uses up fibrinogen and platelets causing both excessive clotting and bleading
2
Q
Initial processes that may cause DIC
A
Sepsis
Cancer
Trauma
Shock
Abruptio Placentae
3
Q
Due to excessive microthrombi in dic, the primary reflection on the body is
A
multiple organ failure due to ischemia
4
Q
To correct the ischemia with DIC body will release more potent anticoagulants, this will cause
labs
A
Further bleeding
Elevated fibrin degradation products and D-dimers
5
Q
1st manifestation of DIC
A
progressive decrease in platelet count
6
Q
After the organ failure and happens due to excess clotting with DIC, _ starts
A
bleeding
7
Q
DIC bleeding sights
A
IV sight
Visual changes!
Mucous membranes
GI and Urinary tract
8
Q
DIC clotting and integument
A
temp and sensation v
pain ^
cyanosis
superficial gangrene
9
Q
DIC bleeding and integument
A
Petechiae, including periorbital and mucosa
bleeding gums, iv sites, previous injections
epistaxis, ecchymoses, joint pain
10
Q
DIC clotting and circulation
A
Pulse v
Capillary fill time greater than 3 sec
11
Q
DIC bleeding and circulation
A
Tachycardia
12
Q
DIC clotting and resp system
A
Hypoxia - clotting in lungs
Dyspnea
CHEST PAIN (on INSPIRATION)
ULTIMATE SHOCK
13
Q
DIC bleeding and resp system
A
High-pitched bronchial sounds
Tachypnea
Acute respiratory distress ARDS
14
Q
DIC clotting and GI
A
Pain
Heartburn
15
Q
DIC bleeding and GI
A
Hematemesis
Melena
Retroperitoneal bleeding - firm abdomen, distention, tender on palpation,
abdominal girth INCREASE
16
Q
DIC clotting and renal
A
Urine output v
BUN ^
Creatinine ^
17
Q
DIC bleeding and renal
A
Hematuria
18
Q
DIC clotting and neuro
A
v LOC
v pupil reaction
v strength/mobility
19
Q
DIC bleeding and neuro
A
Anxiety restlessness
HA
LOC change!
Conjunctival hemorrhage
20
Q
Platelet count
Changes with DIC
A
150,000-450,000mm
v with DIC
21
Q
PT time
Changes with DIC
A
11-12.5s
^ with DIC
22
Q
aPTT time
Changes with DIC
A
23-35s
^ with DIC
23
Q
Thrombin time TT
Changes with DIC
A
8-11s
^ with DIC
24
Q
Fibrinogen level
Changes with DIC
A
170-340mg/dL
v with DIC
25
D-dimer level
Changes with DIC
0-250ng/ml
^ with DIC
26
FDP level
fibrin degradation product
Changes with DIC
0-5mcg/ml
^ with DIC
27
Euglobulin clot lysis time
Changes with DIC
Greater than 2h
Less than 1h with DIC
28
DIC scoring system
Platelets
FDP
Prothrombin time
Fibrinogen
0 1 2 3
Platelet
0->100,000
1-50,000 to 100,000
2-< 50,000
FDP
0-no increase
2-moderate increase
3-stronge increase
Prothrombin
0-<3s
1-3s to 6s
2->6s
Fibrinogen
0->100mg/dL
1-<100mg/dL
29
Most critical factor in DIC treatment
UNDERLYING CAUSE
30
Correct tissue ischemia with DIC via
O2
Fluid replacement
Correct Lyte abnormalities
Administer vasopressor meds
31
Vasopressor meds
Create pressure in vessels - hence vasopressor
constricts vessels
32
Vasopressor med names
Vasopressin
Phenylephrine
33
Correct hemorrhage with DIC
Replace platelets and coagulation factors
Cryoprecipitate -replaces fibrinogen factor V and VII
34
Decision to do transfusion support for DIC is based on
risk of bleeding out from puncture
35
Nursing, how to ID pt at risk of DIC
ID PT at risk via clotting/bleeding symptoms or labs
36
Most vulnerable organs in need of support due to DIC ischemia
Kidneys
Lungs
Brain
Skin
37
Treat DIC kidney injury
Dialysis
38
Dialysis needs a large bore catheter so for DIC PTs also give _ and _ with this treatment
Platelets
Plasma
39
Respiratory nursing interventions for DIC
Lungs may fill with blood so...
Suction as gently as possible to prevent more bleeding
40
ITP
Immune Thrombocytopenic Purpura
other names
what is it
Idiopathic TP is AUTOIMMUNE!!!
Platelet count less than 100,000mm with no explanation
41
Primary (autoimmune) ITP cause
Pathologic antiplatelet antibodies
Impaired production of megakaryocytes
T-cell mediated destruction or platelets
42
Secondary ITP cause
Other autoimmune disorders
Viral infection
Drugs
43
Other autoimmune disorder that can cause ITP
Antiphospholipid antibody syndrome
RA
44
Viral infections that can cause ITP
Hepatitis C
HIV
Helicobacter pylori
45
Meds that can cause ITP
Cephalosporins - antimicrobials start with (cef-ceph) cefdinir, cephalexin/kelfex
Sulfonamides - antibiotics
Bactrim, Septra, Cotrim
Furosemide
46
Once platelets are marked for destruction by the body they are destroyed by which system
Reticuloendothelial system
RES
47
Body attempts to compensate for platelet destruction by
Increasing production in bone marrow
48
minor S/S of thrombocytopenia
ITP
easy bruising
heavy menses
petechiae
49
major S/S of thrombocytopenia ITP
GI bleeding
Respiratory system bleeding
aka Wet Purpura
50
Risk factors for severe bleeding
Platelet count less than 20,000
History of bleeding episodes
Advanced age
51
Correlation between H.pylori and ITP
Not clear
52
Diagnosing ITP involves
Tests to rule out other causes like
HepC
HIV
Bone marrow aspirate
H pylori
53
Risk of bleeding increases when platelet count drops to
30,000mm
54
In ITP below 30,000 treat _ _ not _
Decision to treat is based on _ not ...
Platelet count, not disease
Bleeding, not platelet count
55
is quinine associated with ITP
YES
56
Can you give transfusions to ITP patients
NO
those platelets will die too but you will increase fluid volume and so bleeding into lungs and GI
57
Emergency med for ITP
Aminocaproic acid
Fibrinolytic enzyme inhibitor
slows destruction of clots
58
Mainstay short term therapy for ITP
work on what cell
Immunosuppressive agents
Macrophages
59
ITP corticosteroids for adults
Dexamethasone
Prednisone
60
Corticosteroids will increase platelet count within...
good for long term use
a few days
NO
61
Surgery for ITP
why
Splenectomy
removes site of autoantibody production
62
Side effects of splenectomy for ITP
risk for thrombocytopenia below 30,000
63
Splenectomy lowers immune system so pt will need to be on top of _
do which once prior to procedure?
Shots!
pneumococcal
influenza
meningococcal
64
Nursing management ITP
pt Hx
Lifestyle (sedentary better)
OTC meds, herbs, supplements that can increase bleeding
65
What meds increase bleeding
Sulfa drugs
Aspirin
NSAIDs
66
Other history of complications ITP
indicates
Headaches
Visual disturbances
Viral illnesses
Indicates intracranial bleeding
67
With wet purpura on admission do
Neuro assessment
68
Avoid what procedures with ITP
Injections
Rectal meds
69
ITP patients may experience what unrelated symptom
Fatigue
70
Teach ITP pt to know
Med side effects
Platelet count monitoring
Follow-up appt
71
ADL recommendations for ITP
avoid constipation
use soft toothbrush
electric razor
72
ITP and corticosteroid complications
Osteoporosis
Proximal muscle wasting
Cataract formation
Dental carries
73
Supplements for ITP
Calcium
VitD
Bisphosphonate
74
HELLP acronym
H-hemolysis
EL-elevated liver enzymes
LP-low platelet count
75
HELLP 101
Life threatening pregnancy complications
Variant of preeclampsia
76
HELLP symptoms can be mistake for
gastritis
flu
hepatitis
bladder problems
77
Common cause of HELLP
Preeclampsia
Pregnancy induced hypertension
78
Previous pregnancy with HELLP...
increases risk
79
Other HELLP Risk factors
Age over 25
Caucasian
Multiparous
80
HELLP S/S
Preeclampsia
Indigestion
Pain in upper right quadrant (LIVER distention)
Shoulder pain
81
HELLP/preeclampsia S/S
Headache
NV
Bleeding
Vision changes
Swelling
82
Biggest signs of HELLP Preeclampsia
High BP
Proteinuria
83
Most common reason for morality with HELLP
Liver rupture
Stroke - cerebral edema, cerebral hemorrhage
84
HELLP severity is based on
Platelet count
85
Mild
Moderate
Severe
HELLP platelet numbers
Mild, class III- 150,000 to 100,000mm
Moderate, class II- 100,000 to 50,000mm
Severe, class III- less than 50,000
86
HELLP prevention
Good health before pregnancy
Regular prenatal visits
Inform Dr. if Hx of preeclampsia, hypertension or HELLP
Education regarding S/S
87
HELLP Treatment UNDER 34 weeks
Admission and bedrest
Corticosteroids (for baby lungs)
Magnesium sulfate (prevent seizures)
Blood transfusion (if low pltlt count)
Fetal monitoring
88
Fetal monitoring
Biophysical test
Sonogram
Nonstress test
Fetal movement
89
HELLP Treatment OVER 34 weeks
Delivery is recommended course of treatment
Trial of labor TOL
Surgery may cause complications due to low plt count
90
HELLP affects on baby
Baby's over 2 pounds have an increased chance of survival, under 2 have a significant decrease
Death due to abruption of placenta and asphyxia
91
Most serious complications of HELLP
Placenta Abruption
Pulmonary edema
DIC
ARDS
Renal failure
92
Diagnosing HELLP
hemolysis
RBC death
Abnormal peripheral smear
Bilirubin less than 1.2mg/dl
93
Diagnosing HELLP
Elevated Liver enzymes
Serum aspartate aminotransferase > 70U/L
Lactate dehydrogenase > 600U/L
94
Diagnosing HELLP
Low Platelets
Less than 150,000
and lower determines severity
95
HELLP PT needs daily
WEIGHT
96
to monitor HELLP renal function
indwelling cath
97
Do abdominal palpations for HELLP
checks on
Uterine tone
Fetal sieze
Activity
Position
98
Fetal checks for HELLP
NST
BPP
checks for hypoxia due to placental insufficiency
99
Electronic monitoring for HELLP fetal status is done at what rate
At least daily
100
HELLP PT room should be near nurses station and have
emergency drugs
crash cart
seizure precautions
101
Due to HELLP bedrest pt is at risk of _
intervetions
Thromboembolisms
TED hose
SCD boots
102
If severe pulmonary edema and renal failure with HELLP pt will need invasive hemodynamic monitoring for fluid volume. AKA
Swan Ganz Catheter
103
HIT
Heparin Induced Thrombocytopenia
Patho/causes
Due to LMWH
Platelet factor 4 Binds to LMWH - platelets activate increasing thrombosis - platelets are consumed and macrophages or the RES start to attack existing thrombi - Result is THROMBOCYTOPENIA
104
Risk of LMWH HIT is _%
5%
105
HIT T1 101
Mild
Onset 1-4 days
100,000 platelet count
106
HIT T2 101
Life threatening
Onset 5-10 days
IgG Antibodies
60,000 platelet count
107
S/S of HIT
Skin necrosis at injection syte
Fever, chills, tachycardia, dyspnea
Limb ischemia
Organ infarction
108
PF4 testing in HIT
ELISA
Colorimetric change OD
109
Functional assay HIT testing
Serotonin release assay
SRA
110
4Ts of Thrombocytopenia and HIT
Thrombocytopenia - drop in CBC and platelet count
Timing - fall, 5-10 days after heparin initiation
Thrombosis - venous/arterial
no oTher explanations
111
HIT Treatment
STOP Heparin
Give Protamine sulfate
112
Hx of complications that may impact blood transufsion
Multiple births
Cardiac
Pulmonary
Vascular
problems
113
Before starting transfusion do a
Why
Full body assessment
Vitals
fluid status
lungs for clearance
cardiac for edema hf
skin for petechiae ecchymoses
This will help differentiate a reaction if there is one
114
Febrile nonhemolytic reaction
Most common reaction
caused by antibodies reaction to donor leukocytes
115
Febrile Nonhemolytic reaction and birth
can happen to Rh negative moms who have Rh positive babys
116
Febrile Nonhemolytic reactions and frequent transfusions
Increase chance due to increased exposure to different leukocytes
117
For blood transfusion use special tubing that has
filter for clots
118
Double check blood with
what to check
another nurse
ABO group
Rh type
119
Check blood for
Gas bubbles
Unusual color
Cloudiness
120
Start transfusion with _min of removing blood from bank
30
121
For first 15 min of transfusion run at
5ml/min
then can increase
122
Monitor closely up to
30 min
123
Transfusions can not exceed _h
4
124
Change tubing after every _ unites
2
125
With at risk patients monitor for at list _h for TACO
6h
Transfusion Associated Circulatory Overload
126
Fresh Flozen plasma is to be infused over
Before getting from bank start
30-60min
line
127
Fresh Frozen Plasma Needle gauge
22 or large
128
Febrile Nonhemolytic reaction S/S
chills
fever
muscle stiffness
129
Febrile nonhemolytic reaction lifethreatening?
how long to onset
Scary for PT
NO
2h after start of infusion
YES
130
Med for Febrile nonhemolytic reaction
can you give it prophylactical ?
Tylenol
NO, may mask more serious complications
131
Acute hemolytic reactions
Donor blood is incompatible
of ABO (more severe) or Rh (less severe)
MOST DANGEROUS
132
Acute Hemolytic Reactions occur in transfer of as little as
10ml of blood
First 15min
133
Acute Hemolytic Reaction mild S/S
Fever
Chills
Lower back pain
Chest tightness
Dyspnea
Nausea
134
As RBCs are destroyed in acute reaction, hemoglobin will get filtered through urine resulting in
Hemoglobinuria
135
Acute Hemolytic reaction severe S/S
Hypotension
Bronchospasms
Vascular collapse
136
Acute Hemolytic reaction Consequences
AKI
DIC
137
Blood allergic reaction
Urticaria (hives)
Itching
Flushing
during transfusion
138
Treatment for Allergic reaction to blood
Stop
Give
Antihistamines
Notify
139
If Blood allergy is severe with
Bronchospasms
Laryngeal edema
Shock
give
Epinephrine
Corticosteroids
Vasopressor
140
TACO
Transfusion associated circulatory overload
Hypervolemia due too fast infusion of large volume
141
PT at risk of TACO
HF
Renal failure
Advanced age
MI
142
For patients who have a high initial volume and are at risk of TACO, give
PRBCs
143
Meds to give to lower hypervolemia before initiating transfusion
Diuretics
144
S/S of TACO
Dyspnea
Orthopnea
^BP
JVD
Pulmonary edema
Coughing pink sputum
145
Body position in a fluid overload
Upright
Feet in dependent position
146
How long can it take for TACO to develop
As late as 6h
147
Treating dyspnea with TACO admin
Morphine
Oxygen
148
When do blood contamination S/S occure
A few hours after completion of transfusion
149
S/S of blood contamination
Fever
Chills
Hypotension
infection
150
Treatment for blood contamination transfusion
Fluids
Broad-spectrum antibiotics
Corticosteroids
Vasopressors
151
What can occur due to contaminated blood
Sepsis
152
TRALI
Transfusion Related Acute Lung Injury
Most common cause of TRANSFUSION RELATED DEATH
idiosyncratic (dont know why it happened)
153
Onset of TRALI
Within 6h of transfusion
Most often within 2
154
S/S of TRALI
SOB
Hypoxia
SpO2 less than 90
hypotension
fever
pulmonary edema
155
Treatment for TRALI
Aggressive supportive therapy
O2
Intubation
Fluids
156
TRALI is more likely with transfusion of
Plasma
Platelets
157
Prevent TRALI by
Limiting frequency and amount transfused
158
Delayed hemolytic reactions 101
Occur within 14 days
Fever
Anemia
^ Bilirubin
Jaundice
non lifethreatening
159
Delayed hemolytic reactions indicated
A potential for more serious reactions in the future
160
Other transfusion complication
Iron overload
damages
liver, heart, testes, pancreas
161
Treat iron overload
Iron Chelation
162
What to do first if reaction occurs
STOP Transfusion
Start normal saline through new tubing
163
After stopping transfusion
Assess pt
Vitals
O2
Resp status
Breath sounds
chills
JVD
back pain
urticaria
164
After assessing transfusion pt
Notify provider and implement next plan
Notify blood bank
send blood container back to blood bank
DOCUMENT
165
If a hemolytic transfusion reaction of bacterial infection is suspected the nurse will
obtain blood specimen from pt
collect urine
document reaction according to institution policy
166
Alternatives to blood transfusion
Growth factor
Erythropoietin
G-CSF
GM-CSF
Thrombopoietin
167
Thrombopoietin
helps platelet formation
168
G-CSF
neutrophil stem cells
improves neutropenia
good for chemo
169
GM-CSF
Increases RBCs
Platelets
Monocytes
170
#1 contributing factor to DIC
Sepsis
171
Coagulation cascade?
?
172
Prothrombin and thrombin are what factor
10
173
DIC 101
Massive activation of coagulation cascades
Uses up all coagulation factors
PT bleeds out
174
DIC leads to MODS
Multi Organ Disfunction Syndrome
175
Inotropic drugs for DIC?
?
176
DIC nursing diagnosis
Impaired perfusion
177
Heparin drip =
if dropping
Monitor platelet count
TELL PHYSICIAN
178
When to immediately stop heparin to prevent HIT
Platelet drop by half or more
179
HIT can occure within hours of
RE EXPOSURE to heparin
180
Drug to give HIT give hit patients
Argatroban
181
HELLP is a life threatening _ complications
Pregnancy
182
Defining pain of HELLP
Right upper abdominal quadrant or epigastric pain
183
LDH
Lactate dehydrogenase
Greater than 60u/L
Lethal
184
Difference between preeclampsia and eclampsia
having a seizure
185
Mag sulfate and ECG change
Watch for widened QRS
186
HELLP can lead to what complication
DIC
187
HELLP with mom at 34 weeks
before 27 weeks
deliver
still deliver but in 48 to 72 hours after giving corticosteroids and surfactant for baby lung maturity
188
Purpura
Bruising
189
A lot of ITP pts have no
SYMPTOMS
190
Treatment of choice for ITP
Corticosteroid prednisone
IVIG
191
Red flag meds for ITP
Sulfa
NSAIDs
Aspirin
192
Can student work with blood
NO
193
Why is whole blood rarely given
Fluid volume overload in MINUTES
SO you only need to give them what they need
194
4 components of whole blood
RBC
Plasma
Platelets
Albumin
195
When to transfuse patients
Why
ONLY when symptomatic
even if labs are low
Transfusions are high risk
196
Giving blood to the bank is called a
Standard donation
197
Giving blood to a family member is called
Direct
198
Giving blood to self for future surgery
???
199
Collecting blood during surgery, cleaning, and reinfusing
Intraoperative Blood salvage
200
Pulling blood out, and exchanging it with solution. Then reinfusing if needed
Hemodilution transfusion
201
Before transfusing blood we need
Get order
Teach
Get consent
Type and cross
202
When pulling blood who is involved
Lab tech
2 RNs
203
Universal doner
O-
204
Kidneys let bone marrow know to produce
erythropoietin
205
Synthetic erythropoietin given to ESRD
Epoietin
206
After a hemolytic reaction and disconnecting the blood what to do with the IV port
Aspirate left over blood out
Start NS to keep line open
207
Only thing to ever hang with blood
NORMAL SALINE
208
One of the most important things to do after staring transfusion
DOCUMENT
209
When to document
Contemporaneous charting
Chart it when you do it
