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TRCC NUR125 Exam 2 With Complete Solution
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TRCC NUR125 Exam 2 With Complete SolutionPulmonary circulation - Response from the right side of the heart
Systemic circulation - Response -from the left side of the heart
-responsible for moving blood to peripheral areas of the body, organs, brain
coronary circulation - Response vessels that supply blood to the heart muscle
thrombus - Response clot that forms in the vein or artery
thrombosis - Response -formation of a blood clot
-venous thrombosis occurs in the vein
-superficial vs deep venous thrombosis (DVT)
Thrombophlebitis - Answer clot forms and occludes one or more veins
Virchow's Triad - Answer -Circulatory stasis/venous stasis (dysfunctional valves or
muscle inactivity)
-Vascular damage (stimulates the clotting cascade and platelet aggregation)
-Hypercoagulability (predisposition to thrombus formation)
Venous Stasis can occur from: - Answer -bed rest
-Immobility (r/t: bedrest, prolonged surgical procedure, prolonged travel limited
mobility)
-spinal cord injury
,-shock
-venous obstruction
Hypercoagulability can occur from: - Answer -genetic factors
trauma, pregnancy and childbirth of the lower extremity hormonal contraceptives/
menopausal hormone therapy(read: ESTROGEN) dehydration (enser blood viscosity)
Vascular damage may occur from: - Answer -surgery
-massive trauma
-pelvic and lower fractures
-sepsis
Clinical manifestations of DVT - Answer -may be unilateral
-asymptomatic at times
-aching pain in effected extremity
-tenderness, swelling, warmth, erythema due to inflammatory process that
accompanies the thrombus
-edematous extremity, may see cyanosis
Labs used to dx DVT -Answer -D-Dimer assay >500ng/ml (is a fibrin degradation product,
lysis of fibrin clot)
-PT/INR (baseline for Tx w/ Coumadin; INR 2.5-3 times is therapeutic)
-aPTT or Anti-XA (per heparin protocol; 40-60 seconds)
Diagnostics to diagnose DVT -Answer -Duplex Venous Ultrasonography (Gold standard
for detection, non-invasive)
-Plethysmography (non-invasive, measures changes in blood flow through the vein
-MRI (visual thrombosis of vena cava and pelvic veins, non-invasive)
-Ascending contrast venography (invasive, expensive, uncomfortable; most sensitive;
, administration of contrast agent performed in IR)
Heparin - Replacement question -Prophylaxis dosing= 5,000mg subQ daily
-treatment dose according to protocol
-nursing implications and instruction
-Lab draws: aPTT, AntiXA
-antidote=protamine sulfate
Low Molecular Weight Heparin (LMWH) - Replacement question-Lovenox
-prophylaxis dose= 30-40mg subQ daily
-treatment dose=1-1.5mg/kg subQ
-less hemorrhage and thrombocytopenia
Coumadin- Replacement question-Lab draws: PT/INR
-Heparin to Coumadin bridge
-Nursing considerations/teaching (dietary: green leafy vegetables; avoid herbal
supplements; compliance to out ration coagulation testing; risk for bleeding
precautions)
-antidote=Vitamin K
-Fastest way to reverse is fresh frozen plasma
Direct Thrombin Inhibitors -Response -Dabigatran (Pradaxa): only oral preparation
-Inactivates thrombin and prevents formation of fibrin clots
-Monitor aPTT
-Monitor Kidney function
-Risk for bleeding precautions
Factor XA inhibitors -Response -Apixaban (Eliquis), Rivaroxaban (Xarelto)
-Directly impeding the function of Factor XA in the clouting cascade
-used to prevent or treat dvt
-Used to reduce the risk of clots and stroke in patients with A Fib
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