module 3: clotting (nsg 210)
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