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clotting
pathophysiology NUR 304
| Question | Answer |
|---|---|
| Platelets are also known as? | thrombocytes |
| What is the normal range for platelets? | 150,000-400,000 cells/uL |
| Define Thrombocytopenia | low platelet count (<100,000 cells/uL); levels between 10,000 and 20,000 can cause bruising and spontaneous bleeding |
| Define thrombocytosis | abnormally high platelet count (>750,000 cells/uL) |
| Thrombocytopenia can cause? | bleeding |
| thrombocytosis can cause? | excessive clotting |
| platelet formation is stimulated by what hormone? | thrombopoietin |
| Define thrombopoietin | is synthesized by the liver |
| what stimulates thrombopoietin? | A reduction in platelet number in the bone marrow |
| What is the lifespan for a normal platelet? | 7-10 days |
| Where do 1/3 of platelets reside? | spleen |
| Define Hemostasis | a protective mechanism where the formation of a thrombus prevents excessive blood loss from the body; PROTECTS US FROM BLEEDING OUT |
| What are the three phases of Hemostasis? | vasoconstriction (vascular phase), development of platelet plug (aggregation phase), and blood coagulation (coagulation phase) |
| What is the Vasoconstriction stage of hemostasis? | blood vessel constricts in attempt to hold on to blood volume and not bleed out |
| What is the platelet plug stage of hemostasis? | Platelets form a plug to provide a barrier against blood flow |
| What is the blood coagulation phase of hemostasis? | fibrin clot is formed; fibrin holds clot together |
| the finished __________ clot is the thrombus | fibrin |
| What are the two coagulation pathways? | intrinsic and extrinsic |
| intrinsic pathway is activated by? | turbulent or stagnant blood flow (Afib, Arteriosclerosis) |
| extrinsic pathway is activated by? | external trauma/injury (laceration) |
| both the intrinsic and extrinsic pathway end at a? | final common pathway |
| What is the final common pathway in clotting and where does it occur? | Prothrombin-> thrombin-> fibrinogen-> fibrin (finished clot); occurs after FACTOR X |
| What is the coagulation cascade? | The series of steps beginning with the intrinsic or extrinsic pathways of coagulation and proceeding through the formation of a fibrin clot |
| Where does the synthesis of coagulation factors occur? | liver |
| What is an important electrolyte involved in clotting? | Calcium |
| What vitamin is important in clotting? | Vitamin K |
| Clotting time of an extrinsic pathway is measured by? | prothrombin time (PT) |
| Clotting time of an intrinsic pathway is measured by? | partial thromboplastin time (PTT) |
| Both PT and PTT are measured in? | seconds; the time it takes for the blood to clot |
| What is the normal range for PT? | 10-14 seconds |
| What is the normal range for PTT? | 25-40 seconds |
| Define Fibrinolysis | dissolution (break down) of a clot |
| Define thrombosis | an occlusive thrombus (blocks blood flow) |
| arterial thrombi are referred to as? | white thrombi because they are rich in platelets but scarce in RBCs. |
| venous thrombi are referred to as? | red thrombi because they have a large number of RBCs and small number of platelets. |
| What is evidence of a clotting problem? | deep venous thrombosis (DVT), Pulmonary embolism (PE), myocardial infarction (MI), ischemic stroke (CVA) |
| Explain Arterial thrombosis | disease of the arteries in periphery where inflammatory mediators lead to plaque formation on the lining of the artery walls that can rupture & lead to platelet aggregation (clotting) which blocks artery fully, partially, or dislodge & go to other organs. |
| Partial occlusion of an artery can lead to? | a slowing of blood flow to extremities (intermittent claudication) |
| What can increase susceptibility to clot formation? | arteriosclerosis, increased estrogen, pregnancy and postpartum, venous stasis, carotid stenosis, Afib |
| What are some CM of arterial thrombi? | coldness, lack of pulse, lack of movement, tingling of numbness, pain or spasms in muscles, pale skin, feeling weak, ulcers that don't heal, appearance of shedding skin, tissue death, stroke symptoms (MEDICAL EMERGENCY) |
| Define venous thromboembolism | blood clots forming in large veins of legs and typically breaks away and gets lodged in the pulmonary artery causing decreased O2 to area of lung |
| venous thromboembolism results from? | Virchow's triad |
| Define Virchow's triad | Stasis of blood flow, hypercoagulability, endothelial damage/injury |
| What are some CM of venous thromboembolism? | calf pain on dorsiflexion (Homan's sign), unilateral limb edema, superficial thrombophlebitis, reddish purple discoloration, Pulmonary embolism (acute onset of pain in chest, dyspnea, anxiety, coughing, bloody sputum, irregular HR) |
| What are some things that can cause bleeding? | thrombocytopenia, NSAIDs, clotting disorders, cirrhosis of liver, vitamin k deficiency, vitamin k antagonists, thrombolytic agents (tPA: clot buster), leukemia, lymphoma, disseminated intravascular coagulation (DIC) |
| What is some evidence of a bleeding problem? | petechiae:pinpoint red areas of bleeding; resembles a rash, purpura: larger purple areas of bleeding, ecchymosis: bruising, spontaneous bleeding (ex: nosebleed that won't stop) |
| What are some coagulation disorders? | Immune thrombocytopenic purpura (ITP), Thrombotic thrombocytopenic purpura (TTP), Hemophilia, Von Willebrand disease, Hemolytic uremic syndrome, Disseminated intravascular coagulation (DIC) |
| Diagnosis of Clotting Disorder includes? | Complete blood count (CBC) with platelet count, Peripheral blood smear, PT, aPTT, NR (international normalized ratio) |
| What is INR (international normalized ratio)? | easier laboratory test used to monitor bleeding and clotting tendency |
| What is the Normal INR? | 1.0 |
| to anticoagulate, what should you aim to increase INR to? | 2-3 times the normal range which would be 2.0-3.0 |
| What is Immune Thrombocytopenic Purpura (ITP)? | Common autoimmune disorder caused by autoantibodies that develop against platelets; Causes bleeding, antigenic target= platelet glycoprotein complex (GP llb/llla), acute ITP seen in children after viral illness |
| Define Hemophilia | An X-linked recessive disorder in which blood fails to clot properly, leading to excessive bleeding, there are two different types (A and B) |
| What form of hemophilia is the most common? | A |
| What are some CM of hemophilia? | bleeding into joints and muscles, pain, edema, tenderness, limited ROM, paresthesia, muscle atrophy, ischemia & gangrene, signs of decreased perfusion (restlessness, anxiety, confusion, pallor, decreased urine output, hypotension, tachycardia), |
| Disseminated Intravascular Coagulation (DIC) | Disorder of both clot formation and bleeding episodes in critically ill patients (uncontrolled synthesis of thrombin and suppression of anticoagulant mechanisms) |
| what is the most sensitive lab value to DIC and why? | D-dimer because it occurs with fibrinolysis (breakdown of clots) and all of the little clots that are formed with this disorder are broken down in random surges of hemorrhage. |
| What are some clinical manifestations of DIC? | cutaneous oozing, petechiae, bleeding from surgical or IV sites, bleeding from GI/urinary tracts or vagina, cyanosis of extremities, abnormal bleeding with no other blood disorders, platelet count <100,00, decreased fibrinogen levels, PT prolonged to > 15 |
| What three substances decrease clot formation and dissolve clots? | plasmin, plasminogen, tissue plasminogen activator(tPA) |
| What are CBC labs (complete blood count)? | set of tests that include all WBC, RBC and platelet measurements, measures hemoglobin, measures hematocrit, measures size and shape of RBCs, WBCs, and platelets |
| What do D-dimer labs measure? | Fibrin degradation products |
| What do Fibrin degradation products reflect? | clotting activity |
| What do Fibrinogen lab result reflect? | clotting ability and activity |
| What do platelet aggregation labs evaluate? | platelets ability to adhere and form clumps |
| Define Prothrombin Time (PT) | clotting time of the extrinsic pathway |
| Define Partial Thromboplastin Time (PTT) | clotting time of the intrinsic pathway |
Created by:
keiondraharden
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