Podcast
Questions and Answers
A patient on warfarin therapy has a PT result that varies significantly from previous tests performed at a different lab. Which test result should be used to guide dosage adjustments?
A patient on warfarin therapy has a PT result that varies significantly from previous tests performed at a different lab. Which test result should be used to guide dosage adjustments?
- The PT result from the current lab, without standardization.
- The aPTT result from either lab, as it measures overall clotting time.
- The PT result from the lab with the lowest reported value.
- The INR, as it standardizes PT results across different labs. (correct)
A patient presents with prolonged bleeding times. Initial tests include both PT/INR and aPTT. If the PT/INR is within normal limits but the aPTT is prolonged, which clotting pathway is most likely affected?
A patient presents with prolonged bleeding times. Initial tests include both PT/INR and aPTT. If the PT/INR is within normal limits but the aPTT is prolonged, which clotting pathway is most likely affected?
- The extrinsic pathway, involving factors like VII.
- The intrinsic pathway, involving factors like VIII, IX, XI, and XII. (correct)
- The common pathway, involving factors like I, II, V, and X.
- Both the extrinsic and intrinsic pathways equally.
A doctor orders both aPTT and PT/INR tests for a patient. What is the most likely reason for ordering both tests?
A doctor orders both aPTT and PT/INR tests for a patient. What is the most likely reason for ordering both tests?
- To assess platelet function.
- To diagnose a vitamin K deficiency.
- To monitor heparin and warfarin therapy, respectively. (correct)
- To evaluate the risk of developing hypertension.
Which of the following conditions is NOT typically associated with thrombocytopenia?
Which of the following conditions is NOT typically associated with thrombocytopenia?
A patient with a history of chronic alcohol use is diagnosed with thrombocytopenia. What is the most likely mechanism contributing to the patient's low platelet count?
A patient with a history of chronic alcohol use is diagnosed with thrombocytopenia. What is the most likely mechanism contributing to the patient's low platelet count?
A patient's platelet count is 15,000 per microliter. Which assessment finding is MOST important for the nurse to monitor?
A patient's platelet count is 15,000 per microliter. Which assessment finding is MOST important for the nurse to monitor?
A patient with thrombocytopenia is prescribed aspirin for a cardiac condition. What action should the nurse take FIRST?
A patient with thrombocytopenia is prescribed aspirin for a cardiac condition. What action should the nurse take FIRST?
A patient with thrombocytopenia reports frequent nosebleeds. Which instruction is MOST important for the nurse to include in the patient's teaching?
A patient with thrombocytopenia reports frequent nosebleeds. Which instruction is MOST important for the nurse to include in the patient's teaching?
A nurse is reviewing the lab results of a patient and notices a platelet count of 40,000 per microliter. Which activity should the nurse caution the patient to avoid?
A nurse is reviewing the lab results of a patient and notices a platelet count of 40,000 per microliter. Which activity should the nurse caution the patient to avoid?
A patient is diagnosed with Immune Thrombocytopenic Purpura (ITP). What is the underlying pathophysiology the nurse should consider when planning care?
A patient is diagnosed with Immune Thrombocytopenic Purpura (ITP). What is the underlying pathophysiology the nurse should consider when planning care?
A child is diagnosed with acute Immune Thrombocytopenic Purpura (ITP) following a viral infection. Which statement BEST describes the typical course of this condition?
A child is diagnosed with acute Immune Thrombocytopenic Purpura (ITP) following a viral infection. Which statement BEST describes the typical course of this condition?
A patient's lab results indicate pseudothrombocytopenia. What is the MOST likely cause of this finding?
A patient's lab results indicate pseudothrombocytopenia. What is the MOST likely cause of this finding?
A nurse is providing discharge teaching to a patient with thrombocytopenia. Which statement indicates a need for further teaching?
A nurse is providing discharge teaching to a patient with thrombocytopenia. Which statement indicates a need for further teaching?
A patient with thrombocytopenia is preparing for discharge. Which of the following instructions is MOST important to include in their discharge teaching plan to minimize bleeding risks?
A patient with thrombocytopenia is preparing for discharge. Which of the following instructions is MOST important to include in their discharge teaching plan to minimize bleeding risks?
A patient with ITP is prescribed corticosteroids. Which statement indicates the patient understands the nurse's teaching regarding this medication?
A patient with ITP is prescribed corticosteroids. Which statement indicates the patient understands the nurse's teaching regarding this medication?
An elderly patient is prescribed both aspirin for cardiovascular health and an NSAID for arthritis pain. Which of the following nursing interventions is MOST important to implement?
An elderly patient is prescribed both aspirin for cardiovascular health and an NSAID for arthritis pain. Which of the following nursing interventions is MOST important to implement?
Which lab result would the nurse correlate to the intrinsic pathway?
Which lab result would the nurse correlate to the intrinsic pathway?
A patient receiving a blood transfusion develops dyspnea, wheezing, and hypotension. What is the MOST appropriate immediate nursing intervention?
A patient receiving a blood transfusion develops dyspnea, wheezing, and hypotension. What is the MOST appropriate immediate nursing intervention?
A patient is scheduled for a blood transfusion. Which of the following actions is MOST important for the nurse to take to ensure patient safety?
A patient is scheduled for a blood transfusion. Which of the following actions is MOST important for the nurse to take to ensure patient safety?
A patient with a history of transfusion reactions requires a blood transfusion. Which of the following actions is MOST likely to minimize the risk of another reaction?
A patient with a history of transfusion reactions requires a blood transfusion. Which of the following actions is MOST likely to minimize the risk of another reaction?
A patient on warfarin has an elevated INR of 5.0. Which intervention is MOST appropriate?
A patient on warfarin has an elevated INR of 5.0. Which intervention is MOST appropriate?
Flashcards
Coagulation Laboratory Values
Coagulation Laboratory Values
Values that indicate the blood's ability to clot and identify bleeding disorders.
Thrombocytopenia
Thrombocytopenia
A condition characterized by abnormally low platelet count, leading to increased bleeding risk.
Patient Education for Bleeding
Patient Education for Bleeding
Teaching patients to recognize bleeding signs and lifestyle changes to prevent bleeding.
ITP (Immune Thrombocytopenic Purpura)
ITP (Immune Thrombocytopenic Purpura)
Signup and view all the flashcards
Aspirin and NSAID therapy
Aspirin and NSAID therapy
Signup and view all the flashcards
Blood Component Therapy
Blood Component Therapy
Signup and view all the flashcards
Pre-Transfusion Assessments
Pre-Transfusion Assessments
Signup and view all the flashcards
PT (Prothrombin Time)
PT (Prothrombin Time)
Signup and view all the flashcards
INR
INR
Signup and view all the flashcards
PT
PT
Signup and view all the flashcards
aPTT
aPTT
Signup and view all the flashcards
Symptoms of Thrombocytopenia
Symptoms of Thrombocytopenia
Signup and view all the flashcards
Severe Thrombocytopenia
Severe Thrombocytopenia
Signup and view all the flashcards
Immune Thrombocytopenic Purpura (ITP)
Immune Thrombocytopenic Purpura (ITP)
Signup and view all the flashcards
Acute ITP
Acute ITP
Signup and view all the flashcards
Chronic ITP
Chronic ITP
Signup and view all the flashcards
Pseudothrombocytopenia
Pseudothrombocytopenia
Signup and view all the flashcards
Platelet count thresholds
Platelet count thresholds
Signup and view all the flashcards
Study Notes
Hematologic Disorder Part #22
- Course: NSG 2060
- Semester: Spring 2025
- Instructor: Professor Hong
- Institution: PLNU
Class Announcements
- Dosage Calculation Quiz due February 5, 2025, at 7 PM. No extensions allowed.
- Prep-U Chapter 20 posted.
Learning Objectives (Coagulation & Platelet Disorders)
- Accurately interpret coagulation lab values and relate abnormal results to potential patient care implications.
- Formulate a comprehensive nursing care plan for patients with thrombocytopenia, considering individual needs.
- Prioritize interventions to prevent bleeding, including patient education on activity restrictions.
- Outline nursing interventions to support patients diagnosed with ITP, emphasizing treatment plan adherence.
- Understand implications of aspirin and NSAID therapy, emphasizing balanced effects and potential bleeding risks.
- Address unique challenges and complications associated with platelet disorders, incorporating pharmacological and non-pharmacological interventions.
Learning Objectives (Blood Component Therapy)
- Explain clinical indications for blood component therapy and recognize contraindications and potential risks.
- Summarize nurse's role in administering blood components, accurately identifying and calculating infusion rates.
- Demonstrate pre-transfusion assessments, monitoring vital signs during transfusions, recognizing reactions.
- Describe the importance of accurate blood typing in preventing transfusion reactions.
- Provide information to patients and families about blood component therapy.
Hemostatic Process
- A Blood vessel constriction → primary hemostasis (platelet plug)→ secondary hemostasis (coagulation cascade) fibrin mesh
- B Vessel wall damage leads to: vasoconstriction & endothelial dysfunction → primary hemostasis → platelet plug → secondary hemostasis → fibrin mesh
Secondary Hemostasis (Coagulation Cascade)
- Contact activation (intrinsic): initiated by factors exposed by damaged surfaces (e.g., collagen)
- Tissue factor (extrinsic): initiated by tissue damage and release of tissue factor.
Labs to Know
- PT (Prothrombin Time): Measures time it takes for blood to clot, focusing on extrinsic and common pathways, used for warfarin monitoring.
- INR (International Normalized Ratio): A standardized measure compared across labs for warfarin monitoring.
- aPTT (Activated Partial Thromboplastin Time): Measures time for blood to clot, focusing on intrinsic and common pathways, used for heparin monitoring.
Thrombocytopenia
- Condition characterized by low platelet counts.
- Causes include impaired platelet production, increased platelet destruction, or increased consumption.
- Clinical manifestations range from asymptomatic to bleeding, severity related to platelet count.
- Management includes careful assessment and prevention of bleeding, with appropriate pharmacological and non-pharmacological interventions.
Immune Thrombocytopenic Purpura (ITP)
- An autoimmune disorder characterized by low platelet counts due to the immune system attacking and destroying platelets.
- Types include acute (often in children, following viral infections, self-limiting, and often resolves spontaneously) and chronic (more common in adults, requiring long-term treatment).
- Management options vary based on platelet counts, ranging from observation to corticosteroids and IVIG, splenectomy.
Patient and Caregiver Teaching (ITP)
- Recognizing and managing bleeding symptoms (internal and external).
- Preventing bleeding with activity restrictions, safety measures, and careful personal hygiene.
- Medication education regarding interactions with bleeding risk.
- Monitoring bleeding symptoms.
- Surgical precautions.
Nursing Interventions (Thrombocytopenia)
- Implement special precautions to prevent bleeding.
Control Bleeding
- Apply direct pressure
- Use correct positioning for nosebleeds (high Fowler's) and apply ice
- Use hemostatic agents at bleeding sites.
Questions
- Question: What sign or symptom of disease does a patient with thrombocytopenia present with? Answer: Petechiae.
Von Willebrand Disease (vWD)
- Most common inherited bleeding disorder, equally affecting both genders.
- Caused by deficiency, dysfunction, or absence of von Willebrand Factor
- vWF is essential for Factor VIII activity.
- Lab results often show normal or slightly prolonged PTT.
Acquired Coagulation Disorders
- Liver disease
- Vitamin K deficiency
- Disseminated Intravascular Coagulation (DIC)
Disseminated Intravascular Coagulation (DIC)
- A medical emergency.
- A complication of underlying conditions (e.g., sepsis, trauma, cancer), not a disease.
- Characterized by widespread clotting and subsequently bleeding.
- Management includes treating underlying cause, supportive care targeting oxygenation, fluid balance, electrolytes, and blood products (if needed)
Blood Donation Eligibility Requirements
- Donor must be healthy and feeling well
- Must meet minimum age and weight criteria
- No fever or signs/symptoms of infection.
- Normal blood pressure and hemoglobin.
Blood Donation Contraindications
- History of viral hepatitis, blood transfusion/transfusion of blood derivatives (except serum albumin).
- History of untreated malaria, syphilis or gonorrhea, IV drug abuse.
- Possible exposure to HIV, recent tattoos, recent immunizations.
- Pregnancy, cancer, hemochromatosis, active skin infections, whole blood donation within last 56 days.
Blood Processing (Blood Typing/Compatibility)
- Blood (donor and recipient) must be carefully tested for compatibility prior to transfusion.
- Systems like ABO and Rh systems are used to match compatible blood types.
Pretransfusion Assessment
- Assess patient history (including previous transfusions, pregnancies, and relevant medical conditions).
- Obtain patient’s vital signs/ baseline vital signs
- Assess patient for signs and symptoms of conditions requiring additional caution.
- Determine the appropriate blood product and quantity.
Providing Patient Teaching
- Information about transfusion reactions and how to report potential issues.
Potential Complications (Febrile Non-Hemolytic Transfusion Reaction)
- Symptoms: fever and chills post-transfusion.
- Causes: antibodies to donor leukocytes in the transfused blood.
- Risk Factors: Previous transfusions, Rh-negative women, and platelet transfusions.
Potential Complications (Acute Hemolytic Transfusion Reaction)
- Symptoms: chills, fever, chest tightness, dyspnea, nausea, vomiting, flank pain, hematuria, hypotension, anxiety.
- Management: Stop the transfusion immediately.
Potential Complications (Delayed Hemolytic Reaction)
- Symptoms: fever, anemia, increased bilirubin, jaundice, rarely hemoglobinuria.
- Management: mild reactions require no intervention.
Potential Complications (Allergic Reaction)
- Symptoms: hives, itching, rash, wheezing, bronchospasm, laryngeal edema.
- Management: mild reactions respond to antihistamines. Moderate/severe reactions require epinephrine, corticosteroids, and supportive care.
Potential Complications (Transfusion Related Acute Lung Injury)
- Symptoms: new-onset lung injury, shortness of breath, low oxygen saturation on room air, and bilateral infiltrates on chest x-ray, hypoxia.
Potential Complications (Transfusion-Associated Circulatory Overload)
- Symptoms: rapid volume expansion may lead to pulmonary edema and other associated issues in susceptible patients.
- Management includes monitoring for these issues and adjusting the transfusion rate.
Potential Complications (Bacterial Contamination)
- Symptoms: chills, fever, hypotension, confusion, back pain, dyspnea.
- Prevention includes proper handling and storage of the blood product
Transfusion of Packed RBCs (PRBCs)
- Patient information (including medical history, medications, and allergies) should be carefully reviewed.
- The reason for the transfusion should be clearly documented.
Pre-Transfusion
- Steps that must be taken prior to blood transfusion, including screening for necessary items/information, procedures, consent, and preparation.
During Transfusion
- Steps that must be taken during blood transfusion, monitoring, and addressing potential issues during a blood transfusion
Post-Transfusion
- Necessary steps to be taken after blood transfusion and the processes of documenting the vital signs, disposal of equipment, and documentation.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
This quiz covers coagulation testing (PT/INR, aPTT) and thrombocytopenia. It focuses on interpreting test results, identifying affected clotting pathways, understanding reasons for test orders, and recognizing conditions associated with thrombocytopenia. Mechanisms of thrombocytopenia related to chronic alcohol use are also explored.
