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Med-Surg - Clotting
Med-Surg - Clotting EX#2
| Term | Definition |
|---|---|
| What is life-saving therapy that requires adherence to procedures and policies along with close monitoring of patient? | Blood Transfusions |
| What are the five components of blood? | Platelets, granulocytes, clotting factors, albumin, RBCs |
| What is the most common type of blood transfusion to give? | Red blood cells |
| True or false: blood is screened multiple times and rendered relatively free of transmissible disease is like a syphilis, hepatitis, HIV and now Covid. | True |
| How many times are blood products checked before to the client receiving even a drop? | Three times |
| Always obtain a ________________ if able and an _____________ for blood admin | client's consent; order |
| What is the only type of infusing solution used in flushing administration set, IV access side, and in the administration of any blood components? | 0.9% Sodium Chloride (NaCl) NS |
| What is a well-known cultural or religion to refuse blood products? | Jehovah's Witness |
| RBC, Plasma and platelets use _____________________ to stop small clots or other debris from moving. | 170-260 micron filter |
| The blood bank or lab carefully matches what three intended components of the clients blood to ensure compatibility? | ABO, Rhesus, and human leukocyte antigen |
| What are all the things the nurse must ensure before administering blood? | The type and screen provided by the lab matches the clients blood type, client identifiers, ABO and RH compatibility, expiration date of blood product, kind of check off with a nurse, admin start time, blood band number |
| At the bedside, after blood has been received, how many nurses will verify the information again to ensure patient safety? | Two nurses must sign-off and verify the information |
| When administering blood, the primary nurse will stay with the client for ____________ to determine if the patient may have hemolytic transfusion reaction. | 15 minutes |
| If client has a hemolytic transfusion reaction what will you do as the nurse, 3 actions? | 1. Always stop the infusion and notify the provider immediately 2. Obtain vital signs and then depending what type of reaction then the next steps after will follow 3. If RBC can't be given within 4 hours rest of it must be bagged and sent back to lab |
| What are two reasons to give red blood cells? | acute blood loss, chronic symptomatic anemia |
| Name two types of red blood cells? | Irradiated and leukocyte-reduced |
| What is the function of irradiated RBCs? | They inactivate donor lymphocytes and reduce allergic and febrile reaction in some immunocompromised patients. |
| What is the function of leukocyte-reduced RBCs? | Leukocyte reduced decrease febrile (fever) reaction in patient's with high leukocyte antibodies, most blood products today will be leukocyte-reduced to help reduce febrile reactions |
| What are some reasons to give a patient platelets? | Platelets are given to help or prevent bleeding from low levels of platelets for example--> thrombocytopenia |
| Why would a patient receive albumin? | Albumin is given to correct hypoalbuminemia, help patients with severe burns by improving their intravascular volume to reduce possibility of edema |
| What is hemostasis? | complex process balances the production/dissolution of certain clotting factors |
| A complex process that stops bleeding by balancing the production and dissolution of clotting factors is called what? | Clotting cascade |
| What are the five stages of hemostasis? | Vasospasm (damage), formation of the platelet plug (Von willebrand's factor), clot formation (fibrin forms meshwork via clotting factors), clot retraction (30 min; pulls together), clot dissolution (fibrinolysis) |
| The clotting cascade continues by converting __________________ to thrombin, which acts on _______________ to produce fibrin, leading to final clot formation. | Prothrombin Fibrinogen |
| The coagulation process can be initiated by two pathways? | Intrinsic Extrinsic |
| What are intrinsic factors? | (blood or vessel injury) Substances located directly within the blood that first make platelets clump and then trigger the coagulation cascade. This pathway is initiated when the blood is exposed to a stimulus-damage subendothelium |
| What are extrinsic factors? | Elements outside the cell that can also stimulate platelet plug formation. They usually result from changes in blood vessels, such as tissue trauma, rather than inside the blood. |
| What are clotting factors? | In active enzymes that become activated depending on which pathway, intrinsic or extrinsic |
| A slower pathway, is measured by PTT (partial thromboplastin time), uses factors XII, XI, IX and calcium ions (factor IV): these are characteristics of what pathway? | The intrinsic pathway |
| A faster pathway because it bypasses steps, is measured by PT (prothrombin time), uses factors III, VII, and calcium ions (factor IV): these are characteristics of what pathway? | The extrinsic pathway |
| Nutrition questions to ask your patient? | Ask about usual diet including protein, vitamin and mineral intake. |
| What does diet high in potassium (vitamin K) do to your blood? | Increase the rate of blood coagulation which means you make clots faster |
| Chronic alcohol use can lead to liver impairment which means decreased ability to? | clot |
| Name this Vitamin: Facilitate calcium and non-heme (vegetable) Iron absorption by increasing the solubility of nonheme iron; synthesizes leukocytes and other immune cell components. | Vitamin C (ascorbic acid) - asparagus, broccoli, sweet and hot peppers, spinach, |
| Name this vitamin: Promotes red cell formation; classified as a hematopoietic vitamin. | Folacin (folic acid) - liver, legumes, green leafy vegetables |
| Name this vitamin: required for a normal development and function of red blood cells; needed for normal synthesis of hemoglobin; classified as a hematopoietic vitamin. | Vitamin B6 (pyridoxine) - meat, poultry, fish, shellfish, whole-grain products, green leafy vegetables. |
| Names this vitamin: assist in division and maturity of red blood cells. | Vitamin B12 (cobalamin) - meat, poultry, fish, shellfish, eggs, dairy products. |
| Name this vitamin: necessary for formation of prothrombin and other clotting factors in the liver. | Vitamin K - cabbage, cauliflower, cereals, broccoli, dark leafy vegetables, fish, liver, beef, eggs. |
| Name this mineral: aids in maturation of red blood cells (as part of b12 molecule) | cobalt - organ meats, meats |
| Name this mineral: catalyst for hemoglobin formation | Copper - Cereals, nuts, legumes, liver, shellfish, grapes, meats |
| Medications that interfere with platelet production or function? | antibiotics: penicillin, cephalosporins Anticancer/antimetabolite Aspirin and salicylates NSAIDS Gold compounds Clopidogrel |
| What are some medications that interfere with coagulation factors? | Amiodarone, anabolic steroids, warfarin, oral anticoagulants(dabigatran, rivaroxaban), heparin |
| How do anticoagulants affect clotting factors? | Anticoagulants inhibit or delay the synthesis of factors two II, seven VII, nine IX, and 10 X. Also do not break down existing clots, only help to stop them from getting bigger. |
| What are fibrinolytics and why are they given? | Fibrinolytics are given to break down formed fibrin clots and are to be given within 12 hours after onset of ischemic symptoms like a myocardial infarction or a thrombotic stroke. |
| What are platelet inhibitor's and why are they giving? | Platelet inhibitor's are given to prevent platelets from clumping together, some will change the platelet membrane that affects activators from binding to receptors sites. (clopidogrel) |
| What are normal PTT lab values and what does it measure? | PTT 60-70 secs. Measures effectivity of meds like heparin and argatroban. Evaluates intrinsic and common pathway factors like XII, XI, IX, VIII, X, V, II and I |
| What are normal PT lab values and what does it measure? | PT - 10-13 secs, measures how long blood clots in relation to warfarin therapy. Evaluate prothrombin, fibrinogen, and factors 1,2,5,7 and 10 on the extrinsic and common pathways |
| What are normal INR range? | INR - 0.8-1.2 therapeutic range for warfarin is 2-3 |
| What is the difference between (PTT) and (aPTT)? (both used for heparin) | Partial thromboplastin time and activated partial thromboplastin time are used to test for the same functions; however aPTT an activator is added that speeds up the clotting time and results in a narrower reference of range. aPTT =more sensitive version |
| Normal lab value for RBCs for men and women? | M - 4.71-5.14 F - 4.2-4.87 |
| Normal Lab Value for WBC? | 4,500-->11,000 |
| Normal Lab Value for Platelets? | 150,000-->450,000 |
| Normal Lab Value for Hemoglobin men and women? | M - 13.5 - 16.5 F - 12-15 Carries 02 throughout the body and gives blood it's red color |
| Normal Lab Value for Hematocrit men and women? | M - 43-49% F - 38-44% |
| Hemoglobin and hematocrit (H/H) test help monitor what three things? | anemia, dehydration, bleeding |
| What is bone marrow suppression? What does it do? | It is the decrease of bone marrow function to produce new blood cells which means lower red blood cells, lower white blood cells in lower platelets. Typical signs and symptoms will be according to white blood cells the client is low in. |
| Low RBCs means what? | Anemia |
| Low WBCs means what? | neutropenia |
| Low platelets means what? | thrombocytopenia |
| What are some symptoms of anemia? | Pale skin, lips, and nails, fatigue, feeling dizzy, weakness, headaches, SOB, rapid breathing (tachypnea), fast heart rate (tachycardia) |
| What are some symptoms of neutropenia? | Neutropenia doesn't have symptoms. But if you get an infection you might have fever of 100.5 or more, chills, shaking, feeling dizzy, trouble breathing, sore throat, mouth sores, diarrhea, wound that's red, swollen, or warm to the touch. |
| How do they test for bone marrow suppression? | Bone marrow aspiration and biopsy is to diagnose thrombocytopenia, leukemias, granulomas, anemias, and primary and metastatic tumors. |
| What is the most common site for bone marrow biopsy? | back of hip-posterior superior iliac crest |
| What are some causes of thrombocytopenia? | Malignancy, infection, sulfa meds, autoimmune conditions, DIC (disseminated intravascular coagulation) |
| What are some symptoms of thrombocytopenia? | Bruising, pink urine, nosebleeds, small red or purple spots on the body petechiae. Bleeding that does not stop with pressure. |
| What is ITP? | ITP - Idiopathic thrombocytopenic Purpura. Is usually 70% of the thrombocytopenia cases |
| What is a D-dimer used for? | used to screen for DVT and PE |
| What is a Arteriogram? | Invasive test injecting contrast medium to identify arterial narrowing/occlusion, DVT's; observe for bleeding; priority is the five P's |
| What is doppler ultrasound for? | noninvasive using sounds waves to detect DVT |
| What is bone marrow aspiration testing for? | used to detect thrombocytopenia/ITP; watch for bleeding ITP = idiopathic thrombocytopenia Purpura is usually 70% of the thrombocytopenia cases. |
Created by:
bolenrocks
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