Term
| What is thrombocytopenia? |
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Definition
Low platelet level
Causes:
Bone marrow decreased production
Increased destruction of platelets
Increased consumption of platelets |
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Term
| How is thrombocytopenia treated? |
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Definition
| Management of the underlying cause |
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Term
| At what platelet loss level can there be bleeding/petechiae? |
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Definition
| Platelets <20,000 - 50,000 |
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Term
| What can be done for severe thrombocytopenia? |
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Definition
| blood or platelet transfusions |
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Term
| What is used in defense of platelet destruction that is autoimmune? |
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Definition
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Term
| Where are clotting factors mostly made? |
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Definition
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Term
| What does a prolonged PT/INR indicate? |
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Definition
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Term
| Does a transfusion of FFP replace the missing clotting factors or just platelets? |
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Definition
| Clotting factors AND platelets |
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Term
| What can FFP transfusion replace? |
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Definition
| Vitamin K dependent coagulation |
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Term
| What clotting factors are created in result of an injury? |
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Definition
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Term
| What can coagulation defects cause? |
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Definition
| bleeding occurs deep within (not on skin surface) causing subq or IM hematomas, hemorrhage into joints. |
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Term
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Definition
this blood test measures how long it takes blood to clot and can be used to check for bleeding problems related to warfarin
Extrinsic pathway |
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Term
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Definition
| measure time to clot, related to heparin |
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Term
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Definition
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Term
| What patient education is there with Coumadin? |
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Definition
-Take at the same time each day
-Avoid drugs/alcohol that interfere with Coumadin
-Keep a diet containing CONSISTENT vitamin K
-Schedule regular follow up visits
-Notify HCP of signs of bleeding
-Notify HCP of any upcoming surgeries |
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Term
| How does Coumadin work cellularly? |
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Definition
| Interferes with prothrombin production, inhibits vitamin K dependent clotting factors. Inhibits thrombin activation, without thrombin fibrinogen can’t be converted to fibrin. |
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Term
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Definition
| Prevents platelet aggregation - DOES NOT BREAK UP CLOTS. |
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Term
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Definition
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Term
| What pt teaching is involved with Heparin? |
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Definition
Inform patients why the drug is needed
Report any bleeding
Bleeding precautions
Lab draws to monitor levels |
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Term
| What is used as DVT/PE prophylaxis post hip surgery? |
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Definition
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Term
| What is Rivaroxaban (Xarelto)? |
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Definition
| Factor Xa inhibitor, reduce stroke risk nonvalvular afib |
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Term
| What does Dabigatran (Pradaxa) and Apixaban (Eliquis) do? |
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Definition
| Reduce risk of stroke and thrombosis in patient with nonvalvular afib |
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Term
| What factor do Dabigatran (Pradaxa) and Apixaban (Eliquis) inhibit? |
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Definition
| Specifically inhibit factor Xa and thrombin |
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Term
| What labs are important to monitor with the new oral anticoagulants? |
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Definition
| Partially excreted by kidneys – monitor CrCl |
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Term
| What reverses the NEW oral anticoagulants? |
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Definition
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Term
| What is Kcentra used for? |
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Definition
| indicated for the urgent reversal of Vitamin K antagonist |
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Term
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Definition
Disseminated Intravascular Coagulation - clots everywhere.
Massive activation of the coagulation system leading to clot formation. Usage of the clotting factors inappropriately leads to bleeding |
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Term
| What is DIC indicative of? |
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Definition
| Another more serious underlying disorder/disease (trauma, sepsis etc.) |
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Term
| What lab tests are reviewed with DIC? |
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Definition
Low platelets
Increase in fibrinogen degradation products (FDPs) measured by increased D-Ddimer
Low serum fibrinogen
Prolonged PT, PTT |
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Term
| What is the treatment geared towards for DIC? |
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Definition
aimed at correcting the underlying cause and
prevent end-organ damage due to microthrombi |
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Term
| What generally causes death in DIC? |
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Definition
end-organ damage induced
by microvascular thrombosis is responsible for
most of the morbidity and mortality |
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Term
| What are some of the treatments of DIC? |
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Definition
| avoiding hemodilution and allowing permissive hypotension, preventing hypothermia and acidosis (affects fibrin and fibrinogen), evaluating blood component therapy |
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Term
| What are the nursing diagnoses for DIC? |
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Definition
| Impaired skin integrity, ineffective tissue perfusion, risk for fluid volume deficit related to bleeding |
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Term
What lab values would you expect to see in a patient who is in DIC?
Increased fibrinogen, increased platelets
Decreased fibrinogen, no change in platelets
Decreased fibrinogen, decreased platelets
No change in fibrinogen, decreased platelets |
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Definition
| Decreased fibrinogen, decreased platelets |
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Term
When assessing a patient who has a diagnosis of thrombocytopenia, the nurse should understand that the patient may present with what sign or symptom of the disease?
Petechiae
Cherry angiomas
Alopecia
Pruritus |
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Definition
A. Petechiae
Rationale: Petechiae are pinpoint red or purple hemorrhagic spots on the skin that can result from low platelet levels. Alopecia (hair loss), pruritus (itching), and cherry angiomas (benign red spots on the skin surface) are not associated with thrombocytopenia |
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Term
Is the following statement true or false?
When providing care for a patient who has DIC, the nurse should pay particular attention to the patient’s levels of RBCs, hematocrit, and hemoglobin when reviewing laboratory results. |
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Definition
False
Rationale: Priority lab results for the patient with DIC are those related to coagulation, such as PT, aPTT and D-dimer. |
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Term
| What is the teaching for people with bleeding disorders? |
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Definition
Assess themselves frequently for bleeding (skin, gums, nose)
Avoid contact sports
Can do fecal occult testing at home |
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Term
| When receiving whole blood, what is the mixture? |
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Definition
| 450ml of blood and 50 ml anticoagulant |
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Term
| When receiving PRBC, what is the mixture? |
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Definition
| Plasma is removed, Hct 70% |
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Term
| What is factor 8 used to treat? |
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Definition
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Term
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Definition
| concentrated IgG, prepared from plasma, used in patients at risk for recurrent bacterial infections, autoimmune disorders. |
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Term
| What are the contraindications for autologous blood donation? |
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Definition
Acute infection
Chronic disease
Hgb <12.5 g/dL
Hct < 38%
Unstable angina
Acute cardiovascular or cerebrovascular disease |
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Term
| When is a cell saver used? |
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Definition
Massive trauma
Vascular surgery
Orthopedic surgery
Thoracic surgery
Must be infused within 4 hours of collection |
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Term
| What is directed donation? |
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Definition
| Donating blood or products for a specific person's use |
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Term
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Definition
| Donating your own blood for your own use usually prior to surgery |
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Term
| What are the steps to blood transfusion? |
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Definition
-Patient must be typed and cross-matched before receiving blood
-When drawn blood band must match label placed on blood tube
-Blood must be double checked with another licensed provider prior to transfusion
-Monitor for transfusion reactions |
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Term
| What are some of the risks associated with blood transfusions? |
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Definition
| chest pain, orthostatic hypotension or tachycardia unresponsive to fluid resuscitation, or congestive heart failure. |
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Term
| What patients have hgb transfused at 7 gm/dl? |
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Definition
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Term
| What patients have hgb transfused at 8gm/dl? |
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Definition
| postoperative or symptomatic |
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Term
| What are the symptoms of Febrile nonhemolytic transfusion reaction (FNHTR)? |
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Definition
Increase in temperature 1.8°F
Chills/fever/muscle aches |
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Term
| What are the symptoms of Acute hemolytic reaction? |
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Definition
| causes usually errors in blood component labeling and patient misidentification. Chills, fever, low back pain, hypotension, hematuria, bleeding, anxiety, dyspnea, chest tightness |
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Term
| What are the symptoms of delayed hemolytic rxn? |
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Definition
| fever, anemia, increase bilirubin due to hemolysis of RBCs, gradual and due to a reaction to antibodies, usually mild |
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Term
| What does an allergic rxn to a blood transfusion look like? |
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Definition
Hives, itching, flushing
include pruritus, urticaria, and headache, if previous reaction can be pretreated with antihistamines and corticosteriods |
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Term
| What do you do if a patient has a blood reaction? |
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Definition
-Stop transfusion/notify DR
-Change IV tubing
-Treat the present symptoms (O2, fluids, epi.)
-Recheck crossmatch record with unit |
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Term
| What do you do for a hemolytic rxn? |
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Definition
-Obtain 2 blood samples distal to infusion site
-Obtain first Ua test for hemoglobinuria
-Monitor fluid/electrolyte balance
-Evaluate serum calcium levels |
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Term
| How fast can we give blood components? |
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Definition
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Term
| How fast is blood transfused in a non-emergent situation? |
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Definition
| begin infusion slowly at no more than 5 ml/minute to allow for recognition of an acute adverse reaction |
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Term
| When can the infusion rate of PRBC be increased? |
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Definition
| After 15 minutes, the remainder of the blood can be infused to adults at a rate of 60-80 ml per hour |
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Term
| What is the preferred time frame of a blood transfusion? |
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Definition
| Complete the transfusion within two hours unless the patient cannot tolerate the expansion of the intravascular volume. The infusion time should not exceed 4 hours |
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Term
| Should platelets be infused slowly? |
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Definition
NO!!!
Platelets, plasma and cryoprecipitate generally are transfused at a rate of 10 ml per minute. In order for a patient to receive maximum benefit platelets need to be transfused rapidly to get control of bleeding. |
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Term
| How should platelets be stored and handled? |
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Definition
| Platelets should be stored at room temperature no more than 5 days. Gently rotate bag to prevent clumping, use tubing with filter (not blood tubing), NOT ABO/Rh compatibility but HLA lymphocyte |
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Term
| When is a spleenectomy done? |
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Definition
| May be removed due to severe trauma, ITP, autoimmune hemolytic anemia |
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Term
| What does an enlarged spleen cause? |
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Definition
| Enlarged spleen causes excessive destruction of RBCs and thrombocytopenia |
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Term
| What effect does spleenectomy have on circulating platelets at first? |
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Definition
| initially a high number of plts enter the circulation |
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Term
| What does a spleenectomy put the pt at risk for? |
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Definition
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Term
| What is therapeutic apheresis? |
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Definition
| Blood is taken from the patient and passed through a centrifuge to remove a specific component |
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Term
| What is Therapeutic phlebotomy? |
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Definition
USED IN POLYCYTHEMIA VERA!
Removal of a certain amount of blood under controlled conditions
Can lead to iron deficiency |
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Term
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Definition
| Immune-mediated, occurring 4-10 days after exposure to heparin, with life-threatening thrombotic complications. |
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Term
| What are the symptoms of HIT? |
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Definition
| skin lesions at injection sites, or acute systemic reactions (chills, fever, chest pain, dyspnea) after an IV bolus |
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Term
| What are the characteristics of HIT? |
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Definition
-A decrease in baseline platelet count of over 50%
-Venous thromboembolism (DVT, PE) are the most common complications
-Large vessel venous or arterial thrombosis with thrombocytopenia |
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Term
|
Definition
Stop all heparin products including any heparin flushes
Draw labs, key to recognition is platelet count
Begin on alternate anticoagulation |
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Term
| What is important to note about HIT alternative anticoagulant therapy? |
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Definition
-Warfarin alone can cause microthrombosis
-Give direct thrombin inhibitor (DTI)
-Argatroban and bivalirudin both
approved for use |
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Term
Which laboratory information will the nurse monitor to detect heparin-induced thrombocytopenia (HIT) in a patient who is receiving a continuous heparin infusion?
Prothrombin time (PT)
Erythrocyte count
Fibrinogen degradation products
Activated partial thromboplastin time (aPTT) |
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Definition
Activated partial thromboplastin time (aPTT)
Platelet aggregation in HIT causes neutralization of heparin, so that the aPTT time will be shorter and more heparin will be needed to maintain therapeutic levels. The other data will not be affected by HIT. |
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Term
| What are the causes of anemia? |
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Definition
Iron deficiency
Suppression of erythropoietin
Trauma
Phlebotomy
Coagulopathies
Adverse effects or reactions to meds
Hemolysis or suppression of erythropoietin
Stress induced GI bleeding |
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Term
| What are the 3 drugs most often identified as causing drug-induced hemolytic anemia? |
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Definition
| piperacillin, cefotetan, and ceftriaxone |
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Term
| What drugs suppress release of erythropoietin in some patients? |
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Definition
| angiotensin-converting enzyme inhibitors (Lisinopril)and angiotensin-receptor blockers (Losartan) (for treatment of high blood pressure), calcium channel blockers (Nifedipine), theophylline, and β-adrenergic blockers (metaprolol) |
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Term
| What does anemia result from? |
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Definition
Loss of RBCs
Reduction in production of RBCs
Increased destruction of RBCs
Shorter life span of RBCs |
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Term
| What are the strategies to conserve blood loss in phlebotomy? |
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Definition
Using pediatric tubes
Reduce daily blood draws
Closed loop system to return blood ordinarily wasted back to the patient
Continuous and noninvasive hemoglobin monitoring by pulse co-oximetry |
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Term
| Why is phlebotomy a problem in ICU patients? |
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Definition
| Diagnostic phlebotomy can result in a mean daily loss of up to 70 mL of blood per day in an ICU patient |
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Term
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Definition
| Transfusion Related Acute Lung Injury |
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Term
| What are the risk factors for TRALI? |
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Definition
| age, illness severity, time on cardiopulmonary bypass |
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Term
| What signs should you monitor for with TRALI? |
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Definition
| Monitor for signs of respiratory distress (cough, dyspnea) |
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Term
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Definition
Pulmonary edema
Hypoxemia
Respiratory distress
Radiographic evidence of new bilateral pulmonary infiltrates (white lung)
Fever, tachycardia, cyanosis, hypotension, frothy sputum |
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Term
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Definition
| minutes to 6 hours after transfusion: |
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Term
| What is administered in patient's with a history of TRALI? |
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Definition
| Administer leukocyte-reduced PRBC |
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Term
| What blood products are TRALI associated with mostly? |
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Definition
| whole blood, PRBCs, FFP and platelets |
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Term
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Definition
Transfusion Associated Circulatory Overload
Unable to compensate for rapid or high-volume infusions of blood products |
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Term
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Definition
CHF
Renal failure
Respiratory failure
Left ventricular dysfunction |
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Term
| What are the S/S of TACO? |
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Definition
| Crackles/rales, dyspnea, orthopnea, wheezing, elevated jugular venous pressure, cyanosis, tachypnea, hypertension, S3 heart sound, a rapid increase in blood pressure, and distended neck veins. |
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Term
| What is the difference between TACO and TRALI? |
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Definition
HYPERTENSION = TACO
HYPOTENSION = TRALI
The pulmonary edema in TACO is cardiogenic. BNP will be elevated so you can tell the difference. |
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Term
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Definition
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Term
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Definition
Transfusion Related Immunomodulation
Can develop postoperative bacterial infections in additions to other nosocomial infections. WBCs may play the most important role |
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Term
| What can you not delegate? |
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Definition
Planning
Assessment
Collaboration
Evaluation
Teaching
Planning such as care plans, can not delegate primary or initial assessments. Can’t delegate consults or collaboration with other departments. |
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Term
| What is the most important clotting factor? |
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Definition
| 10A! Where the intrinsic and extrinsic pathways meet |
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Term
| What factor do most anticoagulants effect? |
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Definition
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Term
| What is the intrinsic pathway's job? |
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Definition
| amplifies cascade, when a factor is activated it has an “a” behind its number. Factor Xa turns prothrombin to thrombin |
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Term
| What is the extrinsic pathway's job? |
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Definition
| cascade occurs when there is tissue damage which releases tissue factor |
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Term
| What triggers the extrinsic system? |
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Definition
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Term
| What system STARTS the clotting cascade? |
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Definition
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Term
| What system ENDS the clotting cascade? |
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Definition
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Term
| Which pathway is a PT test associated with? |
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Definition
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Term
| Which pathway is a PTT test associated with? |
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Definition
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Term
| If DIC is suspected and your pt has a low platelet count, what test should be performed next? |
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Definition
| Fibrinogen Degradation Products |
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Term
| What does D-Dimer test for? |
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Definition
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Term
| What is the best way to raise your hematocrit? |
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Definition
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Term
| When would you not give heparin? |
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Definition
-Allergic
-Had already had HIT(T) |
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Term
| What causes the TRIM rxn? |
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Definition
BECAUSE OF LEUKOCYTES OR ANTIGENS
BLOOD GIVEN FROM MOTHER WHO HAS HAD A CHILD IS GREATER CHANCE OF RXN |
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