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 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 Hemophilia
Genetic Mutation Prolonged Bleeding Pain Hemarthrosis Clotting Factor Replacement Therapy DDAVP (Desmopressin Acetate) Antifibrinolytic Therapy Analgesics Genetic Counseling Prevent Injury Disseminated Intravascular Coagulation (DIC) Assessment
Improper Initiation of Clotting Cascade Systemic Bleeding Petechiae, Purpura, Ecchymosis Change in LOC Increased PT and PTT Cyanosis Increased Fibrin Degradation Products (FDP) Decreased Platelets and Fibrinogen 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 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 Venous Thromboembolism (DVT) Interventions
Anticoagulants Prevention Education Frequent Ambulation Leg Exercises Compression Stockings or SCD's Avoid Nicotine and Oral Contraceptives Surgery Heparin (Unfractionated)
Suppresses Coagulation Deep Vein Thrombosis (DVT) Pulmonary Embolism Hemorrhage Heparin-Induced Thrombocytopenia (HIT) Monitor aPTT Preferred (Safe) During Pregnancy Protamine Sulfate Abdominal Aortic Aneurysm (AAA) Assessment
Atherosclerosis Bruit Pulsation in Abdomen Abdominal or Lower Back Pain Tearing Pain Ultrasound Rupture Shock Surgical Repair 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 Peripheral Artery Disease (PAD)
Atherosclerosis Intermittent Claudication Pain with Exercise Paresthesias Arterial Ulcers Critical Limb Ischemia Amputation Ankle-Brachial Index (ABI) Disseminated Intravascular Coagulation (DIC) Interventions
Risk for Shock Renal Failure Treat Underlying Cause Manage Bleeding Maintain Fluid and Hemodynamic Balance Transfusion Oxygenation Heparin Drip Heparin Induced Thrombocytopenia (HIT)
5-10 Days After Heparin Exposure Heparin-Platelet Factor 4 Complex Autoantibodies Form Against Complex Heparin-Platelet Factor 4-Antibody Complex Binds Platelets Platelet Aggregation Procoagulant Release Thrombocytopenia Serotonin Release Assay (SRA) Stop Heparin, Start Direct Thrombin Inhibitor PT/PTT Lab Values
Prothrombin Time (PT) 10-14 seconds Activated Partial Thromboplastin Time (PTT or aPTT) 25-35 seconds Stable Angina
Chest Pain with Exertion Relieved within 15 Minutes ST Depression Nitroglycerin Up to 3 Doses q 5 Minutes Rest Antiplatelet Medication CABG Angioplasty Unstable Angina
Chest Pain with Rest or Exertion Limits ADLs > 15 Minutes Less Likely Relieved by Nitroglycerin ST Depression Fatigue Acute Coronary Syndrome (ACS) Treatment Emergency Treatment Coronary Artery Bypass Grafting (CABG)
ST-Segment Elevation Myocardial Infarction (STEMI) Cardiovascular Disease (CAD) Uncontrolled Angina Internal Mammary Artery Saphenous (Leg) Vein Transient Limb Edema Closely Monitor Patients Venous Thromboembolism (VTE) Prophylaxis Incentive Spirometer Heart Failure Interventions
Echocardiogram Invasive Hemodynamic Monitoring High Fowler's Position Oxygen Advanced Airway Diuretics Beta Blockers Angiotensin II Receptor Blockers (ARBs) ACE Inhibitors Digoxin (Lanoxin) Pacemaker View More
GET PLAYLIST