Lecture 12: Bleeding and Clotting

med-surg notes Lecture 12: February 26 Bleeding and Clotting Clotting & Coagulation Pathophysiology of Coagulation Benevts and DisadRantages of Clotting Stage 1: Hemostasis Formation of platelet plug Aggregation over a wound' healing Platelet aggregation Possibility of PVD6DVT, which can result in an thromboembolism Stage 2: Coagulation Drugs for Thromboembolic Disorders Anticoagulants Disrupt coagulation cascade, suppressing Ibrin production Antiplatelets →nhibit platelet aggregation Traveling to the brain R stroke Intrinsic coagulation pathway: Endothelial damage within the blood vessel Thrombolytics Traveling to the heart R (→ Promote lysis of Ibrin R thrombi dissolution Extrinsic coagulation pathway: External trauma causing blood to escape the vascular system Anti-thrombin: Protein that prevents clots and regulates hemostasis Venous Thromboembolism Plasmin: Physiologic breakdown of clots Thrombosis Deep Vein Thrombosis )DVTj Arterial thrombosis (C thrombophlebitis Venous thrombosis Thrombus formation associated with stasis of blood /ow, endothelial inUury, and6or hypercoagulability Types of Thrombi Virchow's triad: Hypercoagulability, inUury, stasis Characteristics Red Thrombus White Thrombus Bate of formation Fast Slow Composition B-Cs in Ibrin mesh Platelets and amorM phous debris in Ibrin mesh Consistency Soft Firm or hard (echanism Form in areas of low pressure or stagnation Shear activation of platelets by turbuM lence Association with naM tive circulation Venous system Arterial system (echanistic tx Anticoagulant agent Antiplatelet agent Assessment: History & Noticing Joint Commission VTE Core Measure Set Calf or groin tenderness6pain VTE Prophylaxis and (anagement Sudden onset of unilateral leg edema )localiJedj VTEM1: VTE prophylaxis Checking HomanNs sign is not advised VTEM2: →Cq VTE Venous /ow studies )venous duplexj VTEM;: HospitalMaczuired' preventable qltrasonography or (B→ DMdimer and clotting factor labs Nonsurgical Management Best, preventive measures )SCDsj Surgical Management Analysis: Interpreting Pharmacological Therapy Thrombectomy: BeM moval of clot Potential for inUury due to complications of VTE and anticoagulation therapy qnfractionated heparin ↓owMmolecularMweight heparin )↓(< Hj Inferior vena cava interruption: →VC Ilter' catch emboli Goint Commission LPSW include elements of performance to reduce the likelihood of patient harm associated with the use of anticoagulants < arfarin )Coumadinj Direct oral anticoagulants )apixabanj ↓ongMterm anticoagM ulation to avoid clots on Ilter Care and Transition Coordination ↓ess monitoring rezuired Thrombolytics Ligation or external clips: Cutting o vessel Home care, selfMmanagement education VTE Complications: Pulmonary Embolism PE kisx Factors Best Practice: PreRention Assessment Findings Prolonged immobiliJation Smoking cessation Central venous catheters < eight loss, increase activity Dyspnea, tachypnea Surgery: ↓one bone fracture →f sitting for long periods: Pleuritic chest pain besity, advancing age Wet up frezuently ccupational risk )ex3 driversj Drink plenty of /uids Conditions that + clotting Bespiratory History of thromboembolism xygen therapy )LC or maskj Dry cough' hemoptysis Cardiac Befrain from massaging6 compressing leg musM cles Abnormal heart sounds BightMsided HF Due to underlying lung disease Cont3 monitoring )pulse ox, telej btain adezuate venous access Pharmacological Therapy Anticoagulants, Ibrinolytics Tachycardia, abnormal ECW Cor Pulmonale Implementing InterRentions Diagnostic Assessment Distended neck veins Examine all stool, urine, drainage, vomitus of gross blood Syncope, cyanosis Test for occult blood Systemic hypotension (onitor laboratory values Hypoxemia can trigger anxiety and sense of impending doom Assess for bleeding z2h Surgical (anagement Embolectomy, →VC Iltration Bleeding: Anemia Causes of Anemia Acute -lood loss Chronic →nadezuate B-C production )hypoproliferativej →ncreased B-C destruction )hemolyticj DeIciency of necessary components )folic acid, iron, erythropoietin, vitamin -12j E pected Findings of Anemia Varies based on severity and length of time to develop Complete -lood Count RBCs: (aUor carriers of Hgb xygen DeIcit Pallor, fatigue, HA, irritability, numbness and tingling of exM tremities, dyspnea on exertion, cold intolerance Hgb moves 2 C 2 to6from cells Hct percentage of B-Cs in relation to the total blood volume B-C →ndices qsed to determine the type and cause of most anemias S -, tachycardia, palpitations, diJJiness, syncope, pale nail beds or mucous membranes Coagulation Lab Tests for Coagulation Laboratory Tests for Anemia Evaluates siJe and color of B-Cs Blood Transfusions Causes of Coagulation Blood Transfusion Process Transfusion keactions < hole blood or components of it for replacement: Acute Hemolytic Beaction Hemoglobin: ↓ikely 0 Alteration in platelets Platelet count: 4 1..,... Altered clotting factors Packed B-Cs Fibrinogen levels: Lormally 2..M5.. mg6d↓ Combination of both < ashed B-Cs )< -CMpoor B-Csj Prothrombin time (PT): LorM mally 113.M123↑ secs Partial thromboplastin time (PTT): Lormally O.M5. secs D-dimer: + with D→C and PE Fresh froJen plasma )FFPj Cryoprecipitate )cryoj Platelets (ethods Standard donation Autologous transfusions →ntraoperative blood salvage →mmune system destroys transfused cells Febrile Beaction Sudden rise in body temp during or after transfusion Allergic Beaction →mmune system reacts to components of the blood