Session 3: Coagulation and GI Issues

Session 3 Coagulation and GI Issues 

 

Prothrombin time PT

    • Monitor Warfarin therapy

 

  • Normal: 11-13
  • INR: 1-3

 

    • INR is the ratio between PT and PTT
  • Extrinsic system
  • Warfarin’s antidote is vitamin K, so have the patient on a diet that has consistent Vit K levels.

Activated Partial Thromboplastin time

  • Monitor Heparin therapy
  • Intrinsic system
  • 21-38 seconds

Platelet count

  • 150,000 – 350,000
  • Thrombocytopenia
    • Low platelet count
    • Around 50,000 is where s/s tend to arise
    • s/s: LOC, SOB, fatigue, Bloody stools, skin color changes

 

Immune Thrombocytopenic Purpura

  • ITP
  • Autoimmune
  • Platelets are seen as foreign by the spleen and are destroyed. The spleen are recognizing the antibodies on the platelet.
  • Treatment: corticosteroids, splenectomy, transfuse platelets

 

TTP

  • Schistocytes – abnormal blood cell
  • Normal PT and aPTT
  • Treatment: immunosuppression, Splenectomy, DO NOT GIVE PLATELETS, plasmapheresis

 

HIT

    • Heparin induced Thrombocytopenia
    • No heparin once this develops
    • Use a Direct thrombin inhibitor instead of Heparin (argatroban)

 

  • Table 31-16 on page 654

 

 

Hemophilia – genetic X linked recessive disorder where the person makes low amounts of a clotting factor.  

  • Person cannot make enough clotting factor
  • Type A – low in factor VIII, most common
  • Type B – low in factor IX
  • Tend to bleed in joints.
    • Rest the joint once there is bleeding, RICE, Passive range of motion ONCE BLEEDING STOPS.
  • Administer clotting factor
  • Education of when to come in: joint swelling, bruise getting worse/bigger, after trauma, confusion,
  • No contact sports for these patients.
  • Wear a med bracelet

 

DIC

  • Disseminated intravascular Coagulation
  • Thrombotic phase – fibrin and platelets in the microvasculature
  • Anticoagulant phase – Bleeding
  • Replacement of blood products when bleeding
    • Treat symptoms and chase labs to get to a therapeutic level.

 

Acute Gastrointestinal Diseases

 

  • Upper GI bleed
    • Bright red vomit
    • Coffee stools
  • Lower GI bleed
    • Bright red stool or tarry
    • Vomit may have dark red/black blood
  • Acute bleed
    • H/H may drop with in 4 hours of bleed
    • Give fluids
  • Giving blood
    • Need a type and screen sample within 72 hours
    • Co Sign with another nurse
    • MRN, name, expiration date.
    • Chills (shivering), Back pain, fever, flushed skin, are a sign of a Hemolytic transfusion reaction
      • Temperature and Blood pressure changes.

 

  • Functions of the liver
    • Metabolize fats/ steroids, Make bile, Detoxification, storage of glycogen, and vitamins.
    • Cirrhosis
      • Caused by, Hep C, Alcohol intake, Right sided Heart failure, Non alcoholic fatty liver disease.
      • Diagnostic levels – increased ALT, AST, and ammonia, Decreased Proteins, Increased PT and PTT
      • Hepatic encephalopathy – ammonia levels increased and can cause changes in LOC
      • Decreased protein diet (this may change in the future)
      • These people should not have alcohol
      • These people tend to be hypokalemia, Potassium replacement is necessary to avoid Arrhythmias.

 

  • Acute liver failure
    • Usually due to overdose of tylenol
    • Severe liver impairment correlated with hepatic encephalopathy
    • Can last 8 – 26 weeks after s/s onset
    • 40% morbidity rate.

 

  • Pancrease
    • Secretes enzymes, 90% proteolytic, Amylolytic, or Lipolytic
    • Secretin –  stimulates bicarb and water to control pH in the intestines
    • Acute Pancreatitis – pancreatitis inflammation
      • Caused by – Gallbladder disease, trauma, biliary sludge, surgery
      • Results from premature enzyme activation causing digestion of the pancreas and surrounding organs.
      • s/s: Left upper quadrant pain that is piercing, continuous and gets worse with eating, reduced bowel sounds, Shock, hypovolemia
      • Diagnosis – increase amylase and lipase, liver enzymes, bilirubin, and decrease calcium
      • Treatment plan: relieve pain, prevent shock, reduce pancreatic secretions, correct fluid and electrolyte imbalances, antibiotic prophylaxis, remove the cause if possible.
      • Prevention – stop smoking, drinking, restrict fats, don’t binge, may have permanent damage.
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