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Nursing 3 Test 3
Hemorrhagic Disorders
| Question | Answer |
|---|---|
| hemorrhagic disorders | abnormal or increased bleeding due to devect in factors controlling hemostasis |
| Platelet hemorrhagic disorders | ITP, TTP, Thrombocytopenia |
| clotting factor hemorrhagic disorders | hemophilia, DIC |
| ITP | Immune Thrombocytopenic Purpura |
| pathophysiology of ITP | abnormal destruction of circulating platelets, auto-immune disease(antibodies against own platelets), platelets are destroyed in spleen |
| where are the platelets destroyed in ITP? | spleen |
| what is the cause of ITP? | unknown |
| Acute ITP | often occurs following viral infection, occurs in children 2-6 yrs(boys greater than girls), self-limiting(80% recover spontaneously in about two months) |
| Acute ITP s/s | fever, splenomegaly, weakness, lethargy, hemorrhage: skin-petechiae,purpura,ecchymosis, mucous membranes-epistaxis,bleeding gums, GI & GU, Rarely intra-cranial hemorrhage |
| Chronic ITP | lasting longer than 6 months, In adults 20-40 yrs old(greater in women), complication of EBV,CMV,rubella, long history of mild bleeding in mouth,nose,GI or GU tracts, in women vaginal, bruising and petchiae |
| ITP diagnostic studies | platelet count <20,000/uL, prolonged bleeding time, Hgb & Hct levels decreased, ANA(attacks own body cells), test to rule out causes, no definitive tests |
| ITP treatment | corticosteroids, IVIG(IV immunoglobulin G), immunosuppressants, platelet transfusion |
| when is a platelet transfusion done for a pt with ITP? | onley when less than 10,000 or to treat acute bleeding |
| ITP Treatement | plasmapheresis,splenectomy |
| plasmapheresis | plasma exchange, removes antibodies, short term therapy |
| splenectomy is done when | pt is stabel and site of antibody roduction & platelet destruction |
| TTP | Thrombotic THrombocytopenic Purpura |
| TTP | seen in young adults, women affected more than men, maybe precipitated by pregnancy, cause unknown |
| TTP pathophysiology | enzyme deficiency with vWF defect, enhanced platelet aggregation(thrombi in microcirculation, low circulating platelets, hemolytic anemia), simultaneous bleeding and clotting, medical emergency-can be fatal if untreated |
| TTP s/s | fever,weakness,anemia,SOB,tachycardia, bleeding into skin & mucous membranes(pupura & petechiae) |
| s/s of ischemic organs in TTP | Neuro-h/a,altered LOC, MI, increased bili, RBC's get destroyed, Renal-kidneys not working increased BUN/Creatinine |
| TTP diagnositic tests | decreased platelet count & Hgb & Hct, increased LDH, increased creatinine and proteinuria & hematuria |
| TTP treatment | plasmapheresis daily until improvement(supplies deficient enzyme and vWF), corticosteroids(suppress inflammation),immunosuppresants, splenectomy, platelet transfusion generally contraindicated |
| Hemophilia | Group of hereditary bleeding disorders, caused by defective or defecient clotting factor |
| Hemophilia A | deficiency of factor VIII(8) or anti-hemophilic factor(AHF), 80% of all hemophilia cases, X-linked recessive disorder |
| hemophilia A is also called | classic hemophilia |
| Hemophilia B | Deficiency of factor IX(9)/christmas factor, 20% of hemophilia cases, X-linked recessive disorder |
| hemophilia B is also called | christmas disease |
| hemophilia A & B transmission | affected male & unaffected female-all carrier daughters,no affected males unaffected male & affected female-50% chance dghter and 50% chance son |
| hemophilia C | factor XI(11) deficiency, autosomal recessive, ashknazi jews, mild disorder |
| von Willebrand's Disease | deficiency of vWF(necessary for platelet adhesion), most common congenital bleeding disorder, autosomal dominant(affects both men and women)most cases are mild |
| hemophilia pathophysiology | platelet plugs,no stable fibrin plug, slow prolonged bleeding with any trauma, bleeding may be mild,moderate, or severe depends on amt of factor present |
| hemophilia s/s | easy bruising & hematomas, prolonged bleeding w/minor injury, uncontrollabe bleeding following sx/dental wk, bleeding into joints(hemarthrosis),into tissues:SQ and IM bleeding, spontaneous hematuria, epistaxis, GI bleeding, intracranial bleeding |
| hemophilia s/s | pain, limited motion, deformities |
| hemophilia treatment | replacement of missing factor(VIII, IX or XI), recombinant factor, prophylactic: surgery,dental work, DDAVP, local bleeding(gelfoam,fibrin foam,thrombin) |
| New rec for prophylactic in children with hemophilia | children 16 and younger they must have prophylactic before surgery and dental work to prevent bleeding and joint damage |
| DDAVP | 1-deamino-8-arginine vasopressin, increases plasma levels of factor VIII and vWF |
| factor assay | tests for which factor is missing |
| hemophilia tx | gene transfer therapy(experimental), infreq used: cryoprecipitate, fresh frozen plasma(has clotting factors) |
| cryoprecipitate | clotting factors precipitated from pooled plasma |
| nursing assessment w/patients with bleeding disorder | physiologic assessment, developmental(gross & fine motor skils,limitations), psychosocial(coping skills, over protection, knowledge, finances) |
| nursing interventions w/pt's with bleeding disorders | monitor v/s, I&O, labs, for bleeding, admin meds & transfusions, protect pt from injury, prevent bleeding, control bleeding, prevent complications |
| nursing interventions for hemarthrosis | (RICE) Rest, Ice, Compression, Elevation-above heart level pain meds, ROM after bleeding stops(gentle to prevent deformities),wt control(pressure joints |
| nursing interventions: client teaching | s/s of bleeding, how to control bleeding, how to administer factor(hemophilia), precautions to prevent bleeding, avoid contact sports, avoid asa and other drugs that interfere w/coagulation |
| Risk for Injury: In-hospital | no rectal temps,suppositories, use stool softeners(no straining), check bp w/cuff infrequently, avoid IM,SQ injections, IV heplock instead of repeat IV, pressure for 5-15 mins to puncture sites, no heparin/asa, paper or silk tape, mouth care q2-3 hrs |
| DIC stands for | Disseminated Intravascular Coagulation |
| DIC... | complex ABNORMAL response of body's normal clotting mechanism in response to injury |
| DIC is an acute disorder characterized by... | paradoxical cltting and bleeding |
| DIC occurs secondary to... | shock, extensive sx, trauma, burns,sepsis,cancer, abruptio placenta, eclampsia, transfusion reactions, snake bites |
| DIC pathophysiology sequence | tissue damage, initiation of clotting cascade, widespread clot formation, depletion of the clotting factors, activation of diffuse fibrinolysis, hemorrhage |
| DIC s/s | bleeding of abrupt onset, bleeding from surgical site, oozing from IV sites, hematuria, oliguria, spontaneous ecchymosis, cyanosis, GI bleeding,hemoptysis,dyspnea, tachypnea, hypotension, tachycardia, change in mental status |
| DIC diagnostic tests | decreased serum fibrinogen due to abnormal consumption, decreased platelet count, increased PT and PTT:depletion of clotting factors, FDPs indicating widespread dissolution of clots |
| DIC treatment | prompt assessment & treatment result in good prognosis, identification & treatment of primary disorder |
| DIC treatement | pt usually transferred to ICU, replacement of platelets & clotting factors, hemodynamic & cardiovascular support, anticoagulant therapy w/herparin(controversial) |
| Risk for Injury at home | safe age appropriate toys, helmet, knee pads, pad furniture, no throw rugs, soft tooth brush, electric razor, avoid picking nose & forceful blowing, avoid alcohol, avoid straining of stools, avoid contact sports, hazardous recreation, no asa & NSAID's |
| normal results of aPTT | 21-36 secs |
| normal results of PTT | 12-16 secs |
| normal results of INR | <2 |
| RBC | 3.9-5.0 |
| Hgb | 12-16 g/dL |
| Hct | 36-47% |
| WBC | 4.1-10.7 |
| platelets | 150,000-300,000 |
Created by:
jbittner
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