Medical-Surgical Nursing, 9th Ed., Ignatavicius & Workman, 2018 | Registered Nurse (RN) School Study Aid
Whole Blood Composition
- Plasma
- Electrolytes And Other Solutes
- Proteins
- Albumin
- Fibrinogen
- Globulins
- Water
- Formed Elements
- Buffy Coat
- White Blood Cells (WBC)
- Platelets
- Red Blood Cells (RBC)
Hemoglobin
- Hemoglobin Has Four Iron Hemes
- Lots Of Hemoglobin In Red Blood Cells
- High O2 Levels Increase O2 Binding
- High Temperature Reduces O2 Binding
- High CO2 Levels Reduce O2 Binding
- Low pH Reduces O2 Binding
- Myoglobin Binds Oxygen in Muscle
Hypoxia (Early Symptoms)
- Diaphoresis
- Restlessness
- Tachypnea
- Dyspnea on Exertion
- Tachycardia
- Hypertension
- Arrhythmias
- Decreased Urine Output
- Unexplained Fatigue
Hypoxia (Late Symptoms)
- Cyanosis
- Cool, Clammy Skin
- Use of Accessory Muscles
- Retractions
- Hypotension
- Arrhythmias
Clotting Overview
- Endothelial Cells are Damaged
- Platelets Respond to Exposed Collagen and Stick
- Platelets Release Recruiting Factors
- More Platelets are Attracted
- Soluble Fibrinogen Turns to Insoluble Fibrin
- Fibrin Seals the Clot
- Clot Dissolves
- Liver Produces Clotting Factors
Coagulation Cascade Overview
- Secondary Hemostasis
- Intrinsic Pathway
- Partial Thromboplastin Time (PTT)
- Heparin
- Extrinsic Pathway
- Prothrombin Time (PT)
- Warfarin
- Common Pathway
- Thrombin
- Convert Fibrinogen to Fibrin
- Stabilizes the Platelet Plug
Vitamin K1 (Phytonadione)
- Synthesizes Clotting Factors II, VII, IX, X
- Hypoprothrombinemia
- Newborn Prophylaxis
- Bleeding from Warfarin Overdose
- Shock
- Kernicterus
- Cardiac Arrest
- Bile Salts required for Intestinal Absorption
- Increased Risks with IV Administration
Aspirin (Acetylsalicylic Acid)
- Inhibits Platelet Aggregation
- NSAID
- Thrombotic Event Prevention
- General Pain
- Inflammatory Conditions
- Fever
- Pancytopenia
- GI Ulcers
- Bleeding
- Withhold Before Surgery 7-10 Days
- Reye's Syndrome
Enoxaparin (Lovenox)
- Inhibits Clotting Factors
- Factor Xa
- Clot Formation Prevention
- Heparin Induced Thrombocytopenia (HIT)
- Bleeding
- Medication Education
- Subcutaneous Injection
- 2 Inches from Umbilicus or Incisions
- Protamine Sulfate
Warfarin (Coumadin)
- Inhibits Clotting Factors
- Atrial Fibrillation
- Venous Thrombosis
- Pulmonary Embolism
- PT/INR Levels
- Observe for Bleeding
- Pregnancy
- Vitamin K and Fresh Frozen Plasma
- Prolonged Therapeutic Onset
- Maintain Same Diet
Alteplase
- Tissue Plasminogen Activator
- Thrombosis
- Bleeding
- Intracranial Hemorrhage
- Internal Hemorrhaging
- Minimize Bleeding
- Monitor for Shock
- Aminocaproic Acid
Abciximab and Tirofiban (GP IIb/IIIa Inhibitors)
- IIb/IIIa Receptor Inhibitors
- Inhibits Platelet Aggregation
- Thrombotic Event Prevention
- Acute Coronary Syndrome (ACS)
- Percutaneous Coronary Intervention (PCI)
- Bleeding
- Expensive
- Combination Drug Therapy
Neurovascular Assessment 6 P's
- Pain
- Paresthesia
- Pulse
- Pallor
- Pressure
- Paralysis
Cobalamin (Vitamin B12)
- Vitamin B12
- Vitamin Deficiency
- Pernicious Anemia
- Hypokalemia
- Arthralgia
- Dizziness
- IM Injection for Pernicious Anemia
- Never Give IV
Red Blood Cell Count (RBC) Lab Values
- Women: 3.5-5.5 million cells/ MuL
- Men: 4.3-5.9 million cells/ MuL
WBC Differential Lab Value
- White Blood Cells (WBC)
- 5-10 (5,000-10,000)
- Neutrophils (50%-70%)
- Bands (2%-5%)
- Segs (50%-70%)
- Lymphocytes (20%-40%)
- Monocytes (4%-8%)
- Eosinophils (2%-4%)
- Basophils (0.5%-1.5%)
Hemoglobin (Hgb) Lab Values
- Men: 13 - 17 g/dL
- Women: 12 - 16 g/dL
Hematocrit (Hct) Lab Values
- Women: 36% - 46%
- Men: 41% - 53%
INR Lab Value
- 0.8-1.2 Normal Range
- Warfarin
- 2.0-3.0
PT/PTT Lab Values
- Prothrombin Time (PT)
- 10-14 seconds
- Activated Partial Thromboplastin Time (PTT or aPTT)
- 25-35 seconds