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
- 150,000 – 350,000
- 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
- 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
- Schistocytes – abnormal blood cell
- Normal PT and aPTT
- Treatment: immunosuppression, Splenectomy, DO NOT GIVE PLATELETS, plasmapheresis
- 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
- 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.
- 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.
- 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.