clotting 2, Clotting

What is PTT used for?

Tests heparin

Anticoagulant suffix

-arin

Thrombolytic agents suffix

-ase

722. A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3 mEq/L and is complaining of anorexia. The health care provider prescribes determination of the serum digoxin level to rule out digoxin toxicity. The nurse checks the results, knowing that which value is the therapeutic serum level (range) for digoxin? 1.0.5 to 2 ng/mL 2.1.2 to 2.8 ng/mL 3.3.0 to 5.0 ng/mL 4.3.5 to 5.5 ng/mL

1. Therapeutic levels for digoxin range from 0.5 to 2 ng/mL. The ranges in the remaining options are incorrect.

Clotting Cascade: Extrinsic Pathway

1. Factor VII 2. Factor X 3. Factor V 4. Factor II (Thrombin-Thrombia) 5. Factor I (Fibrinogen)

Clotting Cascade: Intrinsic Pathway

1. Factor XII 2. Factor XI 3. Factor IX 4. Factor X 5. Factor V 6. Factor II (Thrombin-Thrombia) 7. Factor I (Fibrinogen)

729. The nurse is monitoring a client who is taking digoxin (Lanoxin) for adverse effects. Which findings are characteristic of digoxin toxicity? Select all that apply. 1.Tremors 2.Diarrhea 3.Irritability 4.Blurred vision 5.Nausea and vomiting

2,4,5 Digoxin (Lanoxin) is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea. Subsequent manifestations include headache; visual disturbances such as diplopia, blurred vision, yellow-green halos, and photophobia; drowsiness; fatigue; and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. Therapeutic levels for digoxin range from 0.5 to 2 ng/mL.

724. The nurse is monitoring a client who is taking propranolol (Inderal LA). Which assessment data indicates a potential serious complication associated with this medication? 1.The development of complaints of insomnia 2.The development of audible expiratory wheezes 3.A baseline blood pressure of 150/80 mm Hg followed by a blood pressure of 138/72 mm Hg after two doses of the medication 4.A baseline resting heart rate of 88 beats/minute followed by a resting heart rate of 72 beats/minute after two doses of the medication

2. Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. β-Blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in blood pressure and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.

720. A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hour. The nurse determines that the client is receiving the therapeutic effect based on which results? 1.Prothrombin time of 12.5 seconds 2.Activated partial thromboplastin time of 60 seconds 3.Activated partial thromboplastin time of 28 seconds 4.Activated partial thromboplastin time longer than 120 seconds

2. Common laboratory ranges for activated partial thromboplastin time are 20 to 36 seconds. Because the activated partial thromboplastin time should be 1.5 to 2.5 times the normal value, the client's activated partial thromboplastin time would be considered therapeutic if it was 60 seconds.

732. Intravenous heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit? 1.Vitamin K 2.Protamine sulfate 3.Potassium chloride 4.Aminocaproic acid (Amicar)

2. The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage should occur. Vitamin K is an antidote for warfarin sodium. Potassium chloride is administered for a potassium deficit. Aminocaproic acid is the antidote for thrombolytic therapy.

725. A client with atrial fibrillation secondary to mitral stenosis is receiving a heparin sodium infusion at 1000 units/hour and warfarin sodium (Coumadin) 7.5 mg at 5:00 PM daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT)=32 seconds; internationalized normalized ratio (INR)=1.3. The nurse should plan to take which action based on the client's laboratory results? 1.Collaborate with the health care provider (HCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed. 2.Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed. 3.Collaborate with the HCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range. 4.Collaborate with the HCP to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate (Pradaxa) in place of warfarin sodium.

2. When a client is receiving warfarin (Coumadin) for clot prevention due to atrial fibrillation, an INR of 2 to 3 is appropriate for most clients. Until the INR has achieved a therapeutic range the client should be maintained on a continuous heparin infusion with the aPTT ranging between 60 and 80 seconds. Therefore, the nurse should collaborate with the health care provider to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed.

Coumadin INR value:

2.0-3.0 INR If it too low, give more coumadin IF it is too high, give less and give vitamin K

733. A client receiving thrombolytic therapy with a continuous infusion of alteplase (Activase) suddenly becomes extremely anxious and complains of itching. The nurse hears stridor and notes generalized urticaria and hypotension. Which nursing action is the priority? 1.Administer oxygen and protamine sulfate. 2.Cut the infusion rate in half and sit the client up in bed. 3.Stop the infusion and call the health care provider (HCP). 4.Administer diphenhydramine (Benadryl) and continue the infusion.

3. The client is experiencing an anaphylactic reaction. Therefore, the priority action is to stop the infusion and notify the HCP. The client may be treated with epinephrine, antihistamines, and corticosteroids as prescribed.

727. The nurse is planning to administer hydrochlorothiazide to a client. The nurse understands that which is a concern related to the administration of this medication? 1.Hypouricemia, hyperkalemia 2.Increased risk of osteoporosis 3.Hypokalemia, hyperglycemia, sulfa allergy 4.Hyperkalemia, hypoglycemia, penicillin allergy

3. Thiazide diuretics such as hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

734. The nurse should report which assessment finding to the health care provider (HCP) before initiating thrombolytic therapy in a client with pulmonary embolism? 1.Adventitious breath sounds 2.Temperature of 99.4 ° F orally 3.Blood pressure of 198/110 mm Hg 4.Respiratory rate of 28 breaths/minute

3. Thrombolytic therapy is contraindicated in a number of preexisting conditions in which there is a risk of uncontrolled bleeding, similar to the case in anticoagulant therapy. Thrombolytic therapy also is contraindicated in severe uncontrolled hypertension because of the risk of cerebral hemorrhage. Therefore the nurse would report the results of the blood pressure to the HCP before initiating therapy.

726. A client is diagnosed with an ST-segment elevation myocardial infarction (STEMI) and is receiving tissue plasminogen activator, alteplase (Activase, tPA). Which action is a priority nursing intervention? 1.Monitor for kidney failure. 2.Monitor psychosocial status. 3.Monitor for signs of bleeding. 4.Have heparin sodium available.

3. Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychosocial status are important but are not the most critical interventions. Heparin may be administered after thrombolytic therapy, but the question is not asking about follow-up medications.

Normal lab values for aPTT

30-45 seconds

730. Prior to administering a client's daily dose of digoxin, the nurse reviews the client's laboratory data and notes the following results: serum calcium, 9.8 mg/dL; serum magnesium, 1.2 mg/dL; serum potassium, 4.1 mEq/L; serum creatinine, 0.9 mg/dL. Which result should alert the nurse that the client is at risk for digoxin toxicity? 1.Serum calcium level 2.Serum potassium level 3.Serum creatinine level 4.Serum magnesium level

4. An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function. The calcium, creatinine, and potassium levels are all within normal limits. The normal range for magnesium is 1.6 to 2.6 mg/dL and the results in the correct option are reflective of hypomagnesemia.

731. A client being treated for heart failure is administered intravenous bumetanide. Which outcome indicates the medication has achieved the expected effect? 1.Cough becomes productive of frothy pink sputum 2.The serum potassium level changes from 3.8 to 3.1 mEq/L 3.B-natriuretic peptide (BNP) factor increases from 200 to 262 pg/mL 4.Urine output increases from 10 mL/hour to greater than 50 mL hourly

4. Bumetanide is a diuretic and expected outcomes include increased urine output, decreased crackles, and decreased weight. Options 1, 2, and 3 are incorrect.

721. The nurse provides discharge instructions to a client who is taking warfarin sodium (Coumadin). Which statement, by the client, reflects the need for further teaching? 1."I will avoid alcohol consumption." 2."I will take my pills every day at the same time." 3."I have already called my family to pick up a Medic-Alert bracelet." 4."I will take Ecotrin (enteric-coated aspirin) for my headaches because it is coated."

4. Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.

735. A client is prescribed nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? 1."It is not necessary to avoid the use of alcohol." 2."The medication should be taken with meals to decrease flushing." 3."Clay-colored stools are a common side effect and should not be of concern." 4."Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing."

4. Flushing is a side effect of this medication. Aspirin or a nonsteroidal antiinflammatory drug can be taken 30 minutes prior to taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals to decrease gastrointestinal upset; however, taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the health care provider (HCP).

728. The home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which statement, by the client, indicates the need for further education? 1."Constipation and bloating might be a problem." 2."I'll continue to watch my diet and reduce my fats." 3."Walking a mile each day will help the whole process." 4."I'll continue my nicotinic acid from the health food store."

4. Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin needs to be avoided. Constipation and bloating are the two most common side effects. Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

723. A client is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take first? 1.Measure the heart rate on the rhythm strip. 2.Administer prescribed nitroglycerin tablets. 3.Obtain a 12-lead electrocardiogram immediately. 4.Auscultate the client's apical pulse and obtain a blood pressure.

4. Signs of toxicity from procainamide include confusion, dizziness, drowsiness, decreased urination, nausea, vomiting, and tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first. Although measuring the heart rate on the rhythm strip and obtaining a 12-lead EKG may be interventions, these would be done after the vital signs are taken. Nitroglycerin is a vasodilator and will lower the blood pressure.

Heparin PTT value

60-70

Normal lab values for PTT

60-70 seconds

you're educating a patient about Warfarin (Coumadin) and how it is used to treat blood clots. Which statements by the patient require you to re-educate them about how this medication works? Select all that apply A.This medication will help dissolve the blood clot B.This medication will prevent another blood clot from forming C.This medication will help prevent the blood clot from becoming bigger in size D.This medication is working immediately after the first dose

A D

In a patient with DIC, which lab value would you expect? a. prolonged PT b. Increased platelets c. reduced D dimer d. elevated aPTT

A and D

Patho PE

A collection of particulate matter (solid, liquid or gas) lodges in the pulmonary vessels, causing obstruction of blood flow and reducing gas exchange.

For a patient with deep vein thrombosis (DVT), the nurse would include in the plan of nursing care the intervention of: A) Raising the foot of the bed 8 inches. B) Maintaining the legs in the dependent position. C) Restricting fluids. D) Applying cool compresses to the area

A) Raising the foot of the bed 8 inches

A patient admitted to the hospital in preparation for a splenectomy for treatment of immune thrombocytopenia purpura (ITP) asks the nurse about the benefits of the splenectomy. The nurse explains the expected effect of the splenectomy is A) Reduced destruction of platelets by macrophages B) Promotion of platelet sequestration and release by the liver C) Increased RBC production to compensate for blood loss. D) Increased production of platelets by the bone marrow.

A) Reduced destruction of platelets by macrophages

Nonsurgical management of PE

Administer and monitor oxygen. Anticoagulation therapy is started as soon as possible Submassive or low risk PE: Heparin, Low-molecular weight heparin Massive PE: Fibronolytic therapy: alteplace (Activase, tPA) Heparin is continued for 5-10 days, then oral anticoagulation May be for 3-6 weeks or may be life-long, depending on patient risk factors.

What is ateplase reversal?

Aminocaprioc Acid (Amicar)

Examples of antiplatelets

Aspirin Clopidogrel (Plavix)

The nurse is caring for four clients on IV heparin. Which lab value indicates that a serious side effect may have occurred? a. INR of 1.2 b. platelet count 82,000 c. RBC of 4.8 d. WBC 8,7

B

You're developing a plan of care for a patient who is at risk for the development of a deep vein thrombosis after surgery. What nursing intervention below would the nurse NOT include in the patient's plan of care to prevent DVT formation? A. The patient will eat all meals out of the bed daily by sitting in the bedside chair B. The nurse will apply SCDS per physicians order to the patient's lower extremities every night at bedtime C. The nurse will administer per physicians order Enoxaparin in the subcutaneous tissue of the abdomen D. The patient will ambulate daily

B

Which nursing intervention will be included in the plan of care for a patient with ITP? A) Restrict activity to passive and active range of motion. B) Avoid intramuscular (IM) and subcutaneous (SC) injections. C) Place patient in a private room. D) Use rinses rather than a soft toothbrush for oral care.

B) Avoid IM and SQ injections.

A one week post-partum patient calls the nurse line. She describes symptoms of discomfort, erythema, and swelling to her left calf. What post-partum complication is the call center RN most concerned for in this patient? A) Post-partum eclampsia B) Deep vein thrombosis C) Venous stasis D) Venous varicosity

B) DVT

A patient's family member asks the nurse what caused the patient to develop disseminated intravascular coagulation (DIC). The nurse tells the family member that DIC A) Is a complication of cancer chemotherapy. B) Is caused by an abnormal activation of clotting. C) Occurs when the immune system attacks platelets. D) Is caused when hemolytic processes destroy erythrocytes.

B) Is caused by abnormal activation of clotting

Which of the following statements about Heparin is true? A) It can be affected by a diet high in Vitamin K. B) Its antagonist is protamine sulfate. C) It has an unpredictable duration of action. D) It can be administered by mouth.

B) It's antagonist is protamine sulfate

What is the most common cause of postpartum hemorrhage? A) Retained placental fragments. B) Uterine atony C) Sub-involution of placental site. D) Lacerations of birth canal.

B) Uterine atony

Based on Virchow's Triad, select which patients below are at RISK for the development of a deep vein thrombosis? Select all that apply: A. A 55 year old male with hyperlipidemia and diabetes B. A 70 year old female with severe sepsis C. A 25 year old male who uses intravenous drugs D. A 65 year old female who is post op day 1 after joint replacement surgery

BCD

Your patient has a deep vein thrombosis in the left lower extremity. The patient is prescribed continuous IV Heparin. Select all the nursing interventions that are appropriate for this patient A. Apply cool compresses to affected extremity B. Measure leg circumference C. Massage affected extremity D. Elevate affected extremity above heart level E. Encourage frequent ambulation F. Monitor the patients INR level G. Monitor the patients aPTT level H. Apply sequential compression device to the affected extremity

BDG

Treatment for venous and arterial clots?

Blood thinners and remove risk factors

A patient is receiving continuous IV Heparin for anticoagulation therapy for the treatment of a DVT. In order for this medication to have a therapeutic effect on the patient, the aPTT should be? A. 0.5-2.5 times the normal value range B. 2-3 times the normal value range C. 1.5-2.5 times the normal value range D. 1-3.5 times the normal value range

C

A nurse is providing discharge teaching for a client on newly prescribed warfarin (Coumadin). Which assessment finding by the nurse may indicate the greatest possible barrier to medication self-management? A) Poor visual acuity B) Refusal to stop smoking C) Only eats the foods they grow D) Reports wanting to lose weight

C Fluctuations in Vitamin K intake

Which of the following lab test results would the nurse expect to find in a pregnant woman with disseminated intravascular coagulation (DIC)? A) Increased fibrinogen level B) Increased platelets C) Positive fibrin split products D) Shortened prothrombin time

C) Positive fibrin split products

The nurse is assessing a patient, who has many risk factors for the development of a DVT, for signs and symptoms of a deep vein thrombosis. What signs and symptoms below would possibly indicate a deep vein thrombosis is present? a. Cool extremity b. Decreased pulses c. Redness d. Pain e. Warm Extremity f. Swelling g. Cyanosis

CDEF

DVT S/S

Calf or groin tenderness with or without swelling Warm skin that is tender to the touch Positive Homans' sign (false-positives are common)

The nurse is caring for a patient with a PE. They are on O2 therapy, but his oxygen saturation has not significantly improved. When the patient's spouse asks about this, what is the most appropriate response? a. Your husband is breathing so rapidly, it interferes with oxygenation b. your husband may be in a condition known as respiratory distress syndrome c. if your husband does not improve, he will require rapid intubation d. the blood clot in your husbands lungs ar preventing the blood from becoming oxygenated.

D

As the RN in a busy obstetric clinic, you are coordinating the care for Dawn. She has been hypertensive since her 24th week of pregnancy and today her blood pressure is 142/94. Urinalysis indicates a protein content of 3+. Further testing reveals a platelet count of 95,000 and elevated AST and ALT levels; she has begun to experience nausea with some vomiting and epigastric pain. What orders do you anticipate receiving from the obstetrician? A) Send the patient home with an increased dosage of hydralazine and return to clinic tomorrow. B) Send the patient to the OB triage area to monitor fetal heart tone for 3 hours. C) Admit the patient to the OB unit for observation status. Monitor fetal heart tones and monitor LFTs every 6 hours. D) Admit the patient to OB to prepare for patient stabilization and delivery of baby.

D) Admit patient to OB to prepare for patient stabilization and delivery of baby.

HELLP syndrome is most closely associated with which pregnancy complication? A) Gestational diabetes B) Gestational hypertension C) Rh compatibility D) Pre-eclampsia

D) Pre-eclampsia

Surgical management PE

Embolectomy Surgical removal of the clot Inferior Vena Cava Filtration A filter may be put into the IVC to prevent further clots from reaching the lungs May be left in place, but often removed after a few months.

Diagnosis PE

Decreased oxygen saturation Arterial or venous blood gas D-dimer Troponin/BNP Chest X-ray Pulmonary Angiogram Gold Standard Angiography requires contrast dye: Assess for allergy or decreased kidney function Ventilation-Perfusion Scan The V/Q scan evaluates the different regions of the lung and allows comparisons of the percentage of ventilation and perfusion in each area

S/S PE

Difficulty breathing - sudden onset SOB Pleuritic chest pain Dry or productive cough Hemoptysis (Bloody sputum) Tachycardia Distended neck veins Cyanosis Hypotension Anxiousness/Restlessness/Anxiety Feeling of impending doom

How to manage ineffective clotting

Direct pressure on the site of bleeding (if possible) Ice application Topical agents Gelfoam Fibrin foam Blood volume replacements Packed red blood cells Platelets Critical care management if hemorrhage leads to shock

EXEMPLARS

EXEMPLARS

What is the last thing to form in the clotting cascade?

Fibrin

How does fibrin clot formation work?

Fibrin is activated by thrombin and links to form fibrin threads Threads link to form mesh like base for clot formation Factor XIII More platelets stick, attracts other blood cells and proteins to form actual blood clot

Intrinsic pathway of coagulation

Happens in blood vessels when collagen fibers of the basement membrane are exposed to blood PTT

Goals for PE patient

Increase perfusion Thrombolytic therapy - within therapeutic levels Patient verbalizes understanding of condition, therapy regimen, and medication side effects. Display hemodynamic stability. Manage Pain/Report pain is relieved or controlled. Anxiety relieved

Arterial clotting S/S

Intermittent claudication (pain in the muscles during movement resulting from low blood supply) loss of hair and scaly skin of the extremity thickened toenails cold limbs with diminished pulses ulcer formations gray-blue color of the limbs

How is the hematologic system changed with aging?

Older adults have increased risk for clotting because of expected physiological changes that occur with advanced age such as increased platelet adhesiveness, which promotes blood stasis.

anticlotting factors

Once the clotting cascade has begun, it would cause widespread clotting without the body's anti-clotting mechanisms. These mechanisms limit clotting to only the area where clotting is needed, and they break down the clot once tissue injury has healed. Plasmin: digests fibrin, fibrinogen and prothrombin, controlling the size of the fibrin clot. Fibrinolysis: dissolves fibrin clot

Normal lab values for PT/INR

PT - 10-15 seconds INR <2.0

Lab tests for clotting

PT/INR PTT

Clotting clinical management

Phlebotomy Catheter-directed thrombolysis Thrombectomy Filter placement

Normal blood clotting

Platelet plug -> blood clotting -> fibrin clot

What is localized clotting?

Problem is local, is usually a problem in a vein or an artery, either injury to a vessel or a clot within a vessel

Diagnostic tests

Prothrombin time Partial thromboplastin time International normalized ratio (INR) Anti-factor Xa D-dimer RBC, H/H Platelet count Arteriogram Venogram Ultrasound

RN interventions

RRT Elevate the head of the bed Administer oxygen (>95%) Monitor cognitive status Collect sample for ABG analysis Ensure patent IV access Assess for pallor or cyanosis Prepare for appropriate diagnostic exams when patient stable (CT-PA or VQ Scan)

Examples of thrombin inhibitors

Synthetic thrombin inhibitors Factor Xa inhibitors

How does diet alter or affect clotting?

Several clotting factors are vitamin K dependent clotting factors. You have to have vitamin K. if you don't eat enough Vitamin K, you cant clot. Also need a functioning liver.

how do venous clots form?

Stasis Somebody sits on an airplane for 14 hours

What is systemic clotting?

The problem extends to the entire body, is usually a result of a significant hematologic event

What is fibrin activated by?

Thrombin and links to form fibrin threads

How does tissue injury lead to platelet plug?

Tissue injury causes platelets to "activate" and secrete substances to activate and call in other platelets to help seal off the point of injury. *Platelet activation*: recognition of injury and activation *Platelet Aggregation*: Platelet clumping and formation of platelet plug *Once the platelet plug is formed, the clotting cascade is initiated, resulting in the formation of a fibrin clot.*

What is PT/INR used for?

To test coumadin

Examples of anticoagulants (blood thinners)

Warfarin (Coumadin) Heparin Low-molecular-weight heparin (Enoxaparin (Lovenox) / dalteparin (Fragmin))

How do arterial clots form?

You can form them in your heart if youre not in sinus rhythm Can also form heart attack cltos

Embolus definition

anything that travels through the blood vessels until it reaches a vessel that is too small to let it pass. When this happens, the blood flow is stopped by the embolus. An embolus is often a small piece of a blood clot that breaks off (thromboembolism)

A patient with severe SOB is found to have a very large PE. Vs are 145 bpm, 36 RR, 79/52, 86%. Bloods work reveals a troponin of 1.2. Which medication should the nurse anticipate a. enoxaparin (Lovanox) b. Alteplace (Activase) c. Rivaroxaban (Xareito) d. Warfarin Sodium (Coumadin)

b. It is a clot buster Hypotension + increased troponin level = massive PE

Risk factors PE

blood clot or thrombus but there are other types of emboli: fat, air, amniotic fluid, septic

Thrombus definition

blood clot that forms in a vein

A patient is diagnosed with acute ITP. What would the nurse expect as the patient's initial treatment? a. Splenectomy b. Recombinant factor VIII c. prednisone d. prophylactic penicillin

c to suppress immune system

A nurse is caring for a patient with newly diagnosed hemophilia A. Which statement from the patients would require further teaching? a. I am going to have to quit football and join the track team instead b. Even if I get a headache, I cannot take ibuprofen c. I am going to have to start factor VIII infusions d. If I fall and hit my knee, heat compression may help with the pain

d Ice instead

Antiplatelet agents and clots

decrease platelet aggregation and inhibit thrombus formation. Stop platelets from sticking together (aggregating) and prevents the formation of clots

what does plasmin do?

digests fibrin, fibrinogen and prothrombin, controlling the size of the fibrin clot.

What does fibrinolysis do?

dissolves fibrin clot

Anticoagulant Agents and clots (blood thinners)

do not break down existing clots They just prevent new clots from forming

extrinsic pathway of coagulation

factors released by damaged tissues begin cascade PT

https://www.registerednursern.com/sickle-cell-anemia-nclex-questions/

https://www.registerednursern.com/dvt-deep-vein-thrombosis-nclex-questions/

If I am concerned this patient has a bleeding disorder, clotting disorder, or is on certain medications: What will I ask them about current health problems? What will I assess?

sickle cell anemia. When affected persons experience hypoxia, dehydration, low temperature, or metabolic acidosis, their red blood cells change to a shape of a sickle, which results in abnormal clotting in peripheral arteries, causing ischemia and pain. Underlying Medical Conditions that lead to alterations in clotting: Thrombocytopenia, Hemophilia, Polycythemia, and Atrial Fibrillation. Presence of chronic diseases

Examples of thrombolytic agents

streptase eminase activase Tenecteplase

hematostasis

the process which stops bleeding after an injury. This is the expected physiological clotting processes in the middle of the continuum.

______ form mesh like base for clot formation

threads

Why are plasmin and fibrolysis released?

to ensure clots are broken down when no longer needed

Does genetics play a factor in clotting?

·Hemophilia A - factor VIII is deficient ·Hemophilia B - factor IX is deficient von Willebrand's disease - an autosomal dominant genetic disorder affecting both genders; affected individuals have a deficiency in von Willebrand factor coagulation protein and factor VIII as well as a platelet dysfunction