module 3: clotting (nsg 210)

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3 factors associated with thrombus formation

-circulatory stasis -hypercoag. disorders -vascular damage

explain the common pathway of clotting

-factor X combines with Factor V to form prothrombin activator -prothrombin converts to thrombin -thrombin converts fibrinogen to fibrin -fibrin binds w platelets = clot

DIC s/s findings

-gum/nose bleeds -oozing from veni punture site or urinary catheter -petechiae (ex. on the arm where the BP cuff is) -bruising -GI bleeding -tachycardia -sweating

what is the preferred anticoagulant for pregnant px? why?

-heparin -warfarin crosses placenta, teratogenic effects -H&W safe for lactating women

labs in DIC

-increased PT and PTT -decreased platelets and fibrinogen -increased D-dimer

risk factors for DIC

-intrauterine fetal death -abruptio placentae -amniotic fluid embolism -infection

describe platelet plug formation

-one end of the exposed collagen fibers binds with von Willebrand factor and attaches to vessel wall other end of -collagen fiber binds with platelets which aggregate and form plug

complications of HELLP syndrome

-placental abruption -kidney failure -hemorrhage (DIC)

other risk increases for DIC (pregnant mom)

-preeclampsia -fetal death -amniotic fluid embolism -septic abortion -placental abruption -HELLP syndrome

explain DIC's general process

1.) SOMETHING (usually sepsis or trauma) causes the clotting cascade to begin 2.) clots start to form systemically 3.) the widespread clotting overwhelms body and it can't clot anymore leading to extensive hemorrhage ?

what can trigger DIC

1.) tissue damage 2.) release of tissue factors 3.) endotoxin/microorganisms 4.) trauma 5.) sepsis 6.) pregnancy complications

3 steps of the clotting process

1.) vasoconstriction 2.) platelet plug formation 3.) coagulation cascade

what trimester does HELLP mainly occur?

3rd trimester

what does HELLP syndrome stand for?

Hemolysis Elevated Liver enzymes Low Platelet count

what labs do we look at for Warfarin?

PT/INR

what labs to check before giving heparin IV?

PTT prior AntiXa: draw in 6 hours post administration - used more commonly

s/s of HELLP

RUQ epigastric pain n/v blurry vision bleeding fatigue swelling HTN proteinuria hyperbilirubinemia/jaundice

both intrinsic and extrinsic pathway activate factor _____ and merge into ______

X; common pathway

HELLP treatment

delivery of fetus and placenta ASAP

the nurse assesses a client and finds the Bishop score for her cervical status is 6. which medication would be administered to this client? oxytocin dinoprostone mifepristone methylergonovine

dinoprostone - prostaglandin; cervical ripening/induce labor mifepristone induces abortion methylergonovine: reduce PPH oxytocin: enhance/induce labor

a client develops DVT in her leg 3 weeks post partum and is admitted for anticoagulant therapy. the nurse anticipates a teaching plan for which anticoagulant? enoxaprin clopidogrel warfarin herparin

heparin - used during acute phase of DVT warfarin: long-acting oral anticoagulant. started after acute stage

how does hemostatic changes in pregnant women increase DIC risk?

increased clotting factors decreased anticoagulation

DIC lab findings

increased: -D dimer -PTT -PT

D-dimer test

measures fibrin degradation products produced from fibrinolysis (clot breakdown)

a px was given oxytocin to induce labor, but px wasn't responsive to treatment. which oral stimulant would nurse identify as an alternative to oxytocin? why? mifepristone dinoprostone misoprostol methylergonovine

misoprostol rationale: -dinoprostone induces labor but is only vaginal use -methylergonovine prevents PPH -mifeprostone induces elective abortion

what labs do you check before SQ heparin

platelets

HELLP is associated with what condition?

preeclampsia/eclampsia

what's the antidote for aspirin?

sodium bicarbonate


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