Week 10 Hematology and Sepsis

Question 1

AUTOIMMUNE THROMBOCYTOPENIC PURPURA

Answer 1

platelet production is normal

autoimmune against platelets

Question 2

AUTOIMMUNE THROMBOCYTOPENIC PURPURA manifestations

Answer 2

1st seen on skin (bruises)
Anemia
Intracranial bleeding

Question 3

THROMBOTIC THROMBOCYTOPENIC PURPURA

Answer 3

inappropriate clotting
clots don’t form in trauma but form in the blood
Fatal in 3 months without immunosuppressants

Question 4

Hemophilia

Answer 4

deficiency in clotting factors

do not bleed more often, they just bleed for longer

Question 5

Hemophilia labs

Answer 5

prolonged PTT

normal PT

Question 6

hemophilia tx

Answer 6

infusions of clotting factor VIII

Question 7

Heparin induced thrombocytopenia (HIT)

Answer 7

immune reaction that increases platelet activity

Question 8

HIT symptoms

Answer 8

1 thrombocytopenia

DVT
PE

Question 9

HIT risk factors

Answer 9

IV heparin
Female
Heparin use over 1 week

Question 10

When to use Packed red blood cells (PRBCs)

Answer 10

Anemia; hemoglobin <6g/dL, 6-10g/dL, depending on symptoms

Question 11

When to use washed RBCs (WBC-poor PRBCs)

Answer 11

Hematopoietic stem cell transplant patients

Question 12

When to use pooled plateletes

Answer 12

Thrombocytopenia, platelet count <50,000

use single donor if hx of allergic reaction

Question 13

When to use FFP

Answer 13

Deficiency in plasma coagulation factors, Prothrombin or partial thromboplastin time 1.5 times normal

Question 14

When to use cryoprecipitate

Answer 14

Hemophilia VIII or von Willebrand’s disease, Fibrinogen levels <100mg/dL

Question 15

When to use WBCs

Answer 15

Sepsis, neutropenic infection not responding to antibiotic therapy

Question 16

MAP

Answer 16

mean arterial pressure

related to tissue and organ perfusion

Question 17

Cardiovascular Manifestations of shock

Answer 17

Decreased CO, BP, central venous pressure, cap refill, peripheral pulses
Increased HR
Thready pulse, Narrowed pulse pressure, Postural hypotension, Flat neck and hand veins in dependent positions

Question 18

Respiratory Manifestations of shock

Answer 18

Increased RR, Shallow respirations, Increased PaCO2, Decreased PaO2, Cyanosis

Question 19

Early Neuromuscular Manifestations of shock

Answer 19

Anxiety, Restlessness, Increased thirst

Question 20

Late Neuromuscular Manifestations of shock

Answer 20

Decreased CNS activity (lethargy to coma), Generalized weakness, Diminished/absent deep tendon reflexes, Sluggish pupillary response

Question 21

Kidney Manifestations of shock

Answer 21

Decreased urine output, Increased specific gravity, Sugar and acetone present in urine

Question 22

Integumentary Manifestations of shock

Answer 22

Cool/cold, Pale/mottled/ cyanotic, Moist, clammy, Mouth dry; paste-like coating present

Question 23

Gastrointestinal Manifestations of shock

Answer 23

Decreased motility, Diminished or absent bowel sounds, N/V, Constipation

Question 24

Initial (early) stage of hypovolemic shock

Answer 24

MAP < by 10mmHg

Compensatory mechanisms of > HR and vascular constriction are effective in maintaining oxygenation

Question 25

Nonprogressive (compensatory) stage of hypovolemic shock

Answer 25

MAP < 10-15 Kidneys are involved to increase blood volume Acidosis and hyperkalemia occur

Question 26

Progressive (intermediate) stage of hypovolemic shock

Answer 26

compensitory mechanisms not effective, organs develop hypoxia Must correct within 1 hour of onset to save life

Question 27

Refractory (irreversible) stage of hypovolemic shock

Answer 27

vital organs have overwhelming damage

Question 28

Multiple organ dysfunction syndrome (MODS)

Answer 28

cell damage caused by release of toxic metabolites and enzymes Small clots form and block oxygenation to organs

Question 29

Changes in BP with vasoconstriction compensation in hypovolemic shock

Answer 29

Diastolic (bottom) increases and systolic (top) stays the same causing narrow pulse pressure

Question 30

Decreased urine output

Answer 30

early indicator of shock

Question 31

First manifestation of central nervous system changes

Answer 31

increased thirst

Question 32

pH in hypovolemic shock

Answer 32

Decreased: insufficient oxygenation causing anaerobic metabolism and acidosis

Question 33

PaO2 in hypovolemic shock

Answer 33

Decreased: anaerobic metabolism

Question 34

PaCO2 in hypovolemic shock

Answer 34

Increased: anaerobic metabolism

Question 35

Lactic acid in hypovolemic shock

Answer 35

Normal-3-7 | Increased: anaerobic metabolism with buildup of metabolites

Question 36

H&H in hypovolemic shock

Answer 36

Increased: fluid shift/dehydration Decreased: hemorrhage

Question 37

K+ in hypovolemic shock

Answer 37

Increased: dehydration, acidosis

Question 38

Priority problems for patients with hypovolemic shock

Answer 38

1. Hypoxia (from hypovolemia) 2. Hypoperfusion (from fluid volume loss, Hypotension) 3. Anxiety 4. Confusion (from decreased cerebral perfusion)

Question 39

When is plasma used in hypovolemic shock?

Answer 39

to restore osmotic pressure when H&H is normal

Question 40

Adverse effects of inflammatory responses in sepsis/ systemic inflammatory response syndrome (SIRS)

Answer 40

widespread vasodilation and blood pooling, mild hypotension, low UO, increased RR, decreased CO

Question 41

SIRS criteria

Answer 41

2 must be present plus 1 clinical manifestation to confirm sepsis temp >100.4 HR >90 RR >20 or PaCO2 12,000 or <4,000

Question 42

Clinical manifestations of sepsis

Answer 42

Must has at least 1 plus 2 SIRS criteria for sepsis dx | Hypotension, UO < intake, < cap refill, hyperglycemia (>120), Change in mental status, > creatinine

Question 43

Disseminated intravascular coagulation (DIC)

Answer 43

microthrombi formation in hypoxia. Anaerobic metabolism causes glucose release HR increases and Pt may look better d/t > CO but is actually worse

Question 44

Clinical manifestations in severe sepsis

Answer 44

low O2, rapid RR,

Question 45

Septic shock

Answer 45

multiple organ failure and bleeding, capillary leak, death is likely, sx are like hypovolemic shock

Question 46

Hallmark symptoms of sepsis

Answer 46

Left Shift: increased serum lactate, normal or low WBC, and decreasing segmented neutrophil with rising band neutrophils

Question 47

Cardiac changes in early sepsis

Answer 47

Cardiac output and blood pressure are lower

Question 48

Cardiac changes in late sepsis

Answer 48

CO, HR and BP are higher

Question 49

Respiratory changes in early sepsis

Answer 49

Rate increases in an attempt to compensate

Question 50

Respiratory changes in late sepsis

Answer 50

tissue hypoxia and metabolic acidosis depth and rate of respiration to increases