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Nursing 3 Test 3


Hemostasis the clotting process-control of bleeding and clotting
Stages of Hemostasis Injury, Vascular Spasm, Platelet Plug formation, Formation of fibrin clot, clot dissolution or fibrinolysis
Platelet Plug platelets are activated, combine with von Willebrand factor, adhesion & aggregation of platelets, formation of soft platelet plug
formation of stable blood clot clotting factors activated in a chain reaction(cascade), soluble firbrinogen converted to insoluble fibrin, fibrin strands form a mesh, RBC's.platelet plug & other cells trapped
Clotting factors inactive circulating plasma proteins, assigned names and Roman numerals, must be activated to initiate clotting, activated factor:Roman numeral and "a",
Intrinsic clotting cascade XII(12) to XI(11) to IX(9) to VIII(8) then to common pathway
Extrinsic clotting cascade VII(7) then to common pathway
common pathway clotting cascade X(10) to II(2)-Prothrombin to thrombin to I(1)-Fibrinogen to Fibrin
Intrinsic intravascular injury, triggering events: venous stasis, bacterial endotoxins, catheter insertion(foreign body), can be initiated by exposre to glass(blood in a glass bottle)
Extrinsic extrinsic to blood vessels, damaged tissue cells release tissue factor, shorter faster pathway
common pathway both pathways lead to activation of Factor X, Prothrombin(II) converts into Thrombin and Thrombin converts fibrinogen(I) into fibrin
Clot dissolution (fibrinolysis), damaged tissues release t-PA(tissue plasminogen activator), t-PA causes lysis of the clot, end result of lysis: FDP's or FSP's (fibrin degradation/split products)
FDP fibrin degradation
FSP fibrin split products
Role of Liver in hemostasis Liver synthesizes factor VII(12), Prothrombin(II), fibrinogen(I) and other factors
Role of Vit K needed to make factors
Liver disease or low Vit K causes... decreased prothrombin and increased bleeding
Coagulation Tests... detect increased bleeding tendency, detect increased risk of thrombus formation, monitor effects of anticoagulant drugs
Types of Coagulation tests platelet count, Prothrombin time(PT) & INR, aPTT, fibrin degradation products, D-Dimer
Normal platelet count 150,000-300,000/uL
low platelet count thrombocytopenia
elevated platelet count thrombocytosis
risk of severe bleeding at this platelet count <50,000 u/L
risk of spontaneous and fatal bleeding at this platelet count <20,000 u/L
platelet transfusion given at this platelet count <10,000 u/L
Prothrombin time(PT) measures factors of the extrinsic pathway, measures effectiveness of coumadins
normal PT value 12-15 secs
INR expresses PT as a ratio
Target therapeutic range of INR varies... 1-2(prevention of DVT), 2.5-3.5(aortic valve)
aPTT tests the intrinsic pathway, if prolonged, test to determine which factor is defecient or defective, monitors heparin therapy
Normal aPTT is 30-45 secs
therapeutic range of aPTT 1.5-2.5 times mean value
Fibrin Degradation Products (FDP's), present in DIC, monitors fibrinolytic therapy
D-Dimer measures one of the fragments, present DIC, MI and DVT
anticoagulant indications treatment and prophylaxis, DVT & PE, MI, atrial fibrillation, cardiovascular disease
Heparin given when coumadin is contra-indicated, effectiveness monitored by PTT(aPTT)
Heparin is contraindicated in pt's with hemophilia and thrombocytopenia
antidote for Heparin protamine sulfate
LMWH Low Molecular Weight Heparin
LMWH given subQ
LMWH used for DVT prophylaxis and when coumadin is contraindicated
Advantages of LMWH over Heparin longer action:more predictable, may be self administered, does not require frequent testing
examples of LMWH Enoxaparin(Lovenox) and Dalteparin(Fragmin)
Fondaparinux Arixtra-factor Xa inhibitor, non-heparin anticoagulant, given SQ for DVT prophylaxis, contraindicated in renal dx, can cause thrombocytopenia, check CBC(platelet),and serum creatinine periodically
Warfarin (coumadin)-given PO, Vit K antagonist, Onset of effects slow(takes 48-96hrs), No concurrent use of ASA,NSAID, interacts w/many drugs & herbals
antidote for warfarin(coumadin) Vit K
contraindications for warfarin(coumadin) teratogenic(absolutely contraindicated in pregnancy), avoid brest feeding(switch to heparin)
Aspirin Inhibits platelet adhesion, 80mg is sufficient, effects lasts the life of the platelets(5-7 days), prophylactic use(reduction of risk for stroke & second MI)
Adverse effects of Aspirin GI, heartburn, epigastric pain, ulcer, bleeding
Clopidogrel (Plavix)-prevents platelet activation and aggregation, oral agent, reduces risk of thrombosis in stroke, MI, Less GI disturbances than Aspirin
anticoagulants: nursing intervention understand concentration, drip rates, weigh pt(how doses are determined, esp heparin), monitor for signs of bleeding, have antidotes available
anticoagulants: patient teaching avoid or limit foods high in Vit K(warfarin), limit alcohol, follow up care, meidic alert, notify if undergoing invasive tests,surgery, avoid IM, blood sticks, use existing IV's, older adults:fall risk
Created by: jbittner