NURS 443 Lecture Notes - Lecture 7: Infant Respiratory Distress Syndrome, Hypervolemia, Blood Film

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7 May 2018
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Clotting
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A. Blood product therapy
a. Packed RBC
i. Indication: severe or symptomatic anemia, acute blood loss,
ii. Prepared from whole blood by sedimentation or centrifugation. One unit
contains 250-350 mL.
iii. Can be stored up to 35 days depending on processing
iv. Is a less danger of fluid overload and are preferred choice since they are more
component specific
b. Frozen RBC
i. Indication: autotransfusion, stockpiling or rare donors for pts. w/ alloantibodies
ii. Are prepared from RBC using glycerl for protection and frozen. Can be stored
for 10 yrs.
iii. Must be used w/I 24 hrs of thawing
c. Platelets
i. Indication: bleeding caused by thrombocytopenia; but not for ITP, heparin
induced thrombo unless life threatening
ii. Are prepared from fresh whole blood and contains 30-60 mL of plt.
Concentrate.
iii. Can be kept at room temp for 1-5 days depending on type of collection and
storage bag.
d. Fresh frozen plasma
i. Indication: bleeding due to deficiency in clotting factors, (DIC, hemorrhage,
massive transfusion, liver disease, vitamin K deficiency, excessive warfarin)
ii. Is rich in clotting factors but contains no platelets.
iii. Can be stored for >1 yr but must be used w/I 24hr after thawing
e. Albumin
i. Indication: hypovolemic shock, hypoalbuminemia
ii. Albumin is prepared from plasma. It can be stored for 5 yr.
iii. Acts by moving water from extravascular to intravascular space. It is heat
treated and does not transmit viruses
f. Cryoprecipitate and Commercial Concentrates
i. Indication: replacement of clotting factors (VIII, von willebrand factor, and
fibrinogen)
ii. Prepared from fresh frozen plasma and can be stored for 1 yr. once thawed
must be used w/I 5 days.
B. DIC (Disseminated Intravascular Coagulation)
a. Definition: serious bleeding and thrombotic disorder that results from abnormally
initiated and accelerated clotting.
i. It is not a disease but an abnormal response to disease process or disorder
b. Cause --------excessive clotting & hemorrhaging
i. Antithrombin III and protein C, are depressed. Excessive clotting activates
fibrinolytic system, which in turn breaks down already formed clots which
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creates fibrin split products (FSP). These products have anticoagulant properties
inhibiting normal blood clotting.
1. Can lead to shock, organ failure, or death
c. Risks
i. Hemorrhagic/ cardiogenic/anaphylactic shock,
ii. septicemia,
iii. transfusion of mismatched blood, acute hemolysis,
iv. abrupto placentae, amniotic fluid embolism, septic abortion, HELLP,
v. acute leukemia, lymphoma tumor syndrome
vi. burns/trauma, heatstroke, severe head injury, transplant rejection, postop
damage, fat/pulmonary emboli, snakebites, glomerulonephritis, acute anoxia,
prosthetic devices fulminant hepatitis
vii. liver disease, lupus, malignancy
d. S&S
i. Integumentary manifestations: pallor, petechiae, purpura, oozing blood,
venipuncture site bleeding, hematomas, and occult hemorrhage
ii. Respiratory: tachypnea, hemoptysis, orthopnea
iii. Cardio: tachycardia, hypotension
iv. GI/ GU: upper and low GI bleed, abd. Distention, bloody stool, hematuria
v. Neuro: vision change, dizzy, headache, change in mental status, irritability
vi. Skeletal: bone and joint pain.
e. Diagnostic tests
i. D-Dimer, PT, PTT, aPTT, fibrinogen, plts, fibrin split products, factor assay,
Antithrombin III, protein C&S, peripheral blood smear
f. Treatment: underlying cause must be treated
i. If caused by malignancy-chemotherapy is treatment of choice
g. Interventions
i. Provide oxygen and volume replacement
ii. Blood products such as plts, cryoprecipitate, fibrinogen, fresh frozen plasma
(FFP)
1. Plts are usually given if less than 20,000 or 50,000
2. Cryopreciptate is given to replace factor VIII
3. Fibrinogen is given if less than 100
4. FFP replaces all clotting factors except plts.
iii. Heparin is only give if the benefit (reduce clotting) outweighs the risk (further
bleeding)
C. Thrombocytopenia
a. Definition: A reduction of plt below 150,000.
i. Acute, severe, or prolonged decrease can result in abnormal hemostasis and
manifest prolonged bleeding from minor trauma or spontaneous bleeding w/o
injury
1. ITP (idiopathic thrombocytopenic purpura): autoimmune disease in
which Plts are coated w/ antibodies, the spleen then recognizes them as
foreign and destroyed.
2. TTP (Thrombotic thrombocytopenic purpura): hemolytic anemia,
thrombocytopenia, neuro abnormalities, fever, and renal abnormalities.
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