Chapter 22 / Hematologic system

Complications of DVT

- CVA - pulmonary embolism - chronic venous insufficiency

What pathway does warfarin affect

- Extrinsic - Common

Which medication is known to interfere with the body's ability to control bleeding?

- Heparin - Warfarin - Nonsteroidal anti-inflammatory drugs (NSAIDs)

Which test for warfarin is used to evaluate the function? List Reference Range and Therapeutic Range

- PT ( Prothorombin test) RR: 11- 13 seconds TR: 30 seconds -INR ( The international normalized ratio) RR: 0.9-1.1 TR: 2.5

Functions of Warfarin

- acts by decreasing prothrombin and other procoagulation factors. - It alters vitamin K in a manner that reduces its ability to participate in synthesis of the vitamin K-dependent coagulation factors in the liver ** BLOOD THINNER - decreases formation of blood clots - decreases risk of stroke or heart attacks - Used to prevent blood clots in veins and arteries

deep vein thrombosis

- an acute condition - characterized by inflammation and thrombus formation - refers to thrombosis in the deep vein of the legs - can be progressive and lead to lethal pulmonary embolism - begins with localized inflammation

Treatment of DVT

- bed rest with elevation of the affected arm or leg -compression stockings - anticoagulants - analgesics - warm, moist soaks over the affected area

diagnostic test results of DVT

- duplex dooper ultrasonography - CT scan - blood work - cougulation studies

What is Transient vessel vasospasm initiated with and what causes it ?

- endothelial injury and caused by local and humoral mechanism

causes of DVT

- idiopathic - endothelial damage - accelerated blood clotting - reduced blood flow, stasis - virchows triad

What are warfarin and heparin used for?

- prevention of thromboembolic disorders - DVT - Pulmonary embolism

risk factors of DVT

- prolonged bed rest - trauma, hip fracture - surgery : hip, knee, gynecologic surgery - childbirth - hormonal contraceptives: estrogen - age over 40 - obesity - cancer

functions of heparin

- suppresses formation of fibrin - decreases the clotting ability of the blood and help prevent harmful clots from forming in blood vessels

A nurse is assessing a client and finds these results: Areas of bruising (purpura) on the client's arms and legs Pinpoint hemorrhages (petechiae) on the legs Pinpoint hemorrhages (petechiae) in the mouth Platelets level of 90,000/μL (90 ×109/L) What condition should the nurse suspect the client is exhibiting?

- thrombocytosis EXPLANATION - Thrombocytopenia refers to a decrease in the number of circulating platelets to a level less than 150,000/μ

elevated luekocytes causes

- trauma - stress - any infection

signs and symptoms of DVT

- vary with site - pain or tenderness - fever and chills - malaise - edema ( unilateral ) - redness and warmth over affected area - palpable vein - surface veins more visible - lymphadenitis

Stages of hemostasis

1) vessel vasospam 2) platelet plug 3) fibrin clot formation 4) clot retraction 5) clot dissolution

Anticoagulant drugs prevent thromboembolic disorders. How does warfarin, one of the anticoagulant drugs, act on the body? page 554

Alters vitamin K, reducing its ability to participate in the coagulation of the blood

best describes the production of T lymphocytes.

Bone marrow → thymus → lymph nodes

A 57-year-old man is diagnosed with thrombocytopenia. The nurse knows that thrombocytopenia refers to a decrease in the number of circulating platelets. The nurse also knows that thrombocytopenia can result from what?

Decreased platelet production

A nurse working in an ambulatory care unit is working with a client who has recently been diagnosed with a V Leiden mutation. The nurse tells the client the importance of smoking cessation to avoid:

Deep vein thrombosis (DVT)

A client is admitted to the hospital with a diagnosis of deep vein thrombosis and started on intravenous heparin therapy. Seven days later, the client's lab values identify a rapid decrease in platelets. The health care provider recognizes this as:

Drug-induced thrombocytopenia

Following a lecture on hemostasis, a nursing student accidently cuts her hand while preparing supper for her family. She watches the laceration very closely. Sure enough, the first thing she notes is

Initially, it takes a few seconds for blood to appear as a result of vessel spasm.

International Normalized Ratio (INR)

Monitors individuals who are being treated with the blood thinning medication ( commonly performed on patients taking anticoagulants (i.e. coumadin/warfarin) - extrinsic pathway

The physician reviews a client's lab results and notes that the neutrophil count is 900/μL (0.90 x 109/L). This is known as:

Neutropenia

what test is used to evaluate the function of heparin? list Reference range and Therapeutic range

PTT ( The partial thromboplastin time) RR: 30-40 seconds TR: 60 seconds - intrinsic pathway

A 75-year-old client with a history of heart valve replacement arrives at the outpatient clinic with multiple red pinpoint lesions. The nurse identifies the lesions as: - perpura - petechie - hemmorages - bruises

Petechiae Explanation: Petechiae are pinpoint red lesions caused by bleeding under the skin and can be noted in the presence of many bleeding disorders, including structural weakening of blood vessels that comes with age.

A nurse performing a skin assessment on an older adult notes small pinpoint hemorrhages and purple areas of bruising over the lower extremities. The nurse documents these as the presence of which abnormality?

Petechiae and purpura

A client has an impaired platelet function that may have developed from inheritance, drugs, disease, or extracorporeal circulation. The health care provider would document this as: -pancytopenia - thrombocytophthia -basopenia -esosinopenia

Thrombocytopathia Explanation: Thrombocytopathia results from inherited disorders of adhesion and/or acquired defects such as drugs, disease process, or extracorporeal circulation. Plasmapheresis is the process of removal of plasma from withdrawn blood and replacement with fresh frozen plasma. Fibrinolysis is the process in which a blood clot is dissolved.

The coagulation cascade is the third component of the hemostatic process. The other two are: Page 546

Vessel spasm Platelet aggregation Explanation: Spasm of the blood vessel and platelet aggregation are the first and second steps of hemostasis. Agglutination is the sticking of blood cells together due to antibodies. Hematopoiesis is the formation of blood cell

luekopenia

abnormally low WBC count - chemotherapy - immune suppression

To form a platelet plug, platelets are attracted to the damaged vessel. What then occurs within the blood vessel? page 546

adhesion of the platelets EXPLANATION: - There are two processes involved in platelet plug formation, the first of which is platelet adhesion to the vessel subendothelial layer. Fibrinolysis is the process of clot dissolution.

shift to the left

bacterial infection High neutrophils low lymphocytes

side effect of warfarin

bleeding

pancytopenia

deficiency of all types of blood cells

Prothombrin Time PT

helps evaluate a persons ability to appropriately form blood clots - extrinsic pathway

what pathway does heparin affect?

intrinsic pathway

Partial Thromboplastin Time (PTT) and Activated PP

medical test that characterizes blood coagulation - intrinsic pathway

The nurse knows that the second step of hemostasis is ? - fibrin clot formation - clot retraction - clot dissolution - transient vessel vasospasm - platelet plug

platelet plug

therapeutic range

range measure the blood clotting and NOT the drug - 2-21/2 times higher than the reference range - indirect measures the process of how rapidly the process is working ( are we giving enough of the drug )

First stage of hemostasis

vascular spasm

shift to the right

viral infection high lymphocytes and low Neutrophils