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Coagulation Disorder
NUR
| Question | Answer |
|---|---|
| Hemostasis: | Complex process involving multiple steps. Involves large number or enzymes and clotting factors. Fianl product is a fibrin clot that stops blood loss. |
| Clotting Process: | Blood vessel injury causes vessel spasm (constriction). Platelets are attached to and adhere to injured area. Aggregation of platelets forms plug. Normal clotting occurs in 6 min. |
| Coagulation Cascade: | Intrinsic or extrinsic pathways lead to formation of fibrin clot. Injured cells release prothrombin activator. Prothrombin activator changes prothrombin to thrombin. Thrombin changes fibrogen to fibrin. Fibrin forms web over injury to stop blood flow. |
| Fibrinolysis: | Clot removal. Initiated by release of tissue plasminogen activator(tPA) Natural way to break down clots. TPA converts plasminogen to plasmin. Plasmin digest fibrin strands-circulation is restored. Regulated so unwanted clots are removed and fibrin left. |
| Diseases of Hemostasis: | Thromboembolic disorders-caused by thrombi, emboli. Thrombocytopenia. Bleeding Disorders-hemophilia, Von WIlliebrand's Disease. |
| Action of Coagulation Modifiers: | Inhibiting specific clotting factors. Dissolving fibrin. Inhibiting platelet function. |
| Anticoagualants: | Prevent formation of clots. Inhibit specific clotting factors in coagulation cascade. Diminish clotting action of platelets. Both ways increase time it takes to form clots. |
| Thrombolytics: | Dissolve life threatening clots. TPA=thrombolytic. |
| Hemostatics: | Promote formation of clots. Inhibit removal of fibrin. |
| After surgery: | Most pts get Lovenox or Heprin to prevent blood clots. |
| Anticoagulants: | Most serious side effect is bleeding. To assess internal bleeding: monitor CBC, lumbar pain, abdominal bulging, guaiac test on stool. Essential for pt safety to monitor coag. studies. |
| Anticoagualnts Continued: | Bleeding risk increases during transition from heparin to warfarin. Do not give warfarin to preg. pts. Heparin, low molecular wt heparin can be given to preg. pts. Monitor intake of vitamin K-rich foods; limit intake of garlic. |
| Antiplatelet Agents: | Monitor for bleeding. Prolonged pressure needed to control bleeding at puncture sites. Monitor for gastrointestional upset w/asprin and Ticlid. May increase menstrual bleeding. |
| Thrombolitics: | Assess for exclusions to therapy. Monitor baseline coagulation studies. Monitor level of consciousness, for symptoms of cerebral hemorrage. Observe for reperfusion arrhythmias. Teach client about increased risk of bleeding. |
| Hemostatics: | Monitor for clotting. Admin. IV or SQ: monitor closely. Assess for myopathy and myoglobinuria (reddish brown urine). Teach client to report symptoms of clotting or bleeding. Do not take asprin. |
| Antiplatelet Drugs: | Asprin, ADP receptor blockers. Glycoprotein llb/llla receptor antagonist. Agents for intermittent claudication. (Pain in leg intermittently) |
| Plavix: | Action: To alter the plasma membrane of platelets so they cannot aggregate. Use: to prevent thrombi formation after a stroke or MI. AE: abnormal bleeding. |
Created by:
ke123
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