Week 1-3: Fluid Balance, IV Access, and Cardiac Health

Intrinsic Pathway

Triggered by blood vessel damage; leads to clotting.

Calcium and VWF

Essential for clot formation and stabilization.

Prothrombin Time (PT)

Measures extrinsic pathway clotting time in seconds.

International Normalized Ratio (INR)

Standardizes PT; normal range 0.8-1.1.

Activated Partial Thromboplastin Time (aPTT)

Measures intrinsic pathway clotting time; normal 25-30 seconds.

Hypocoagulability Disorders

Conditions increasing bleeding risk due to clotting issues.

Thrombocytopenia

Low platelet count leading to bleeding risk.

Hemophilia

Genetic disorder causing deficiency in coagulation factors.

Von Willebrand's Disease

Deficiency or defect in von Willebrand factor.

Leukemias

Hematological malignancies affecting blood cell production.

HELLP Syndrome

Pregnancy complication with hemolysis, elevated liver enzymes.

Signs of Bleeding

Symptoms include bruising, hematuria, and excessive menstruation.

PT (INR)

Prothrombin Time; measures blood clotting time.

PTT

Partial Thromboplastin Time; assesses intrinsic pathway.

Vitamin K

Essential for synthesizing clotting factors.

Vitamin K Deficiency

Increased bleeding risk; high PT & PTT.

Warfarin Overdose

Reversed with Vitamin K administration.

Disseminated Intravascular Coagulation (DIC)

Condition causing widespread clotting and bleeding.

DIC Causes

Includes infection, trauma, and obstetrical emergencies.

DIC Pathology

Uncontrolled thrombin leads to microclots.

DIC Symptoms

Petechiae, bruising, fatigue, shortness of breath.

Hypercoagulability

Increased tendency to form blood clots.

Thrombocytosis

Elevated platelet count; risk for clotting.

Thrombophilia

Genetic predisposition to abnormal clotting.

Protein C Deficiency

Inherited condition; increases clotting risk.

Factor V Mutation

Genetic defect leading to clotting disorders.

Antiphospholipid Syndrome

Autoimmune disorder increasing clotting risk.

Sepsis

Severe infection that can lead to clotting issues.

Acetylsalicylic Acid (ASA)

Aspirin; mild anticoagulant and anti-inflammatory.

Heparin

Anticoagulant that inactivates thrombin.

Protamine sulfate

Antidote for heparin overdose.

Apixaban

Anticoagulant that requires monitoring for bleeding.

Transfusion reactions

Adverse responses to blood transfusions.

Antigens

Substances that trigger immune response in blood.

Pre-transfusion assessment

Vitals signs

Respiratory

Cardiovascular

Integumentary

Pre-medication may be required if prior reaction

Blood Pickup Timing

Start within 30 minutes, complete within 4 hours.

5 Rights of Transfusion

Right Patient, Product, Amount, Rate, Time.

Initial Monitoring Period for transfusion

Monitor closely for first 15 minutes.

Transfusion Rate Increase

Adjust rate after 15 minutes if stable.

Packed Red Blood Cells (PRBCs)

Most common transfusion for bleeding or anemia.

PRBCs Administration

Initiate transfusion slowly

Transfuse over 1.5 to 2 hours typically.

Expected Hgb Change after PRBCs

Increase of ~10g/L in 4-6 hours.

Fresh Frozen Plasma (FFP)

Used for volume expansion and clotting factors.

Administered over 30 minutes - 2 hours

Platelets Administration

Control bleeding in thrombocytopenia patients.

Administered over 60 minutes

Transfusion Reaction S&S

Monitor for fever, chills, rash, hives, itchiness, dyspnea, nausea, headache,

Minor Allergic Reaction

Mild rash, itching, warm; treat with antihistamines and slow transfusion

Anaphylaxis Reaction

Difficulty breathing, loss of airway, hives; emergency response required; stop transfusion.

Febrile Non-Hemolytic Reaction

Low-grade fever and rigors; administer antipyretics and slow transfusion

Bacterial Sepsis

Potentially fatal reaction from contaminated blood.

Rigors, high fever, severe chills, hypotension, tachycardia, nausea, dyspnea; stop transfusion

Acute Hemolytic Reaction

Fatal reaction from blood group incompatibility; hypotension, back pain, fever, dark urine; Stop transfusion

TRALI (transfusion related acute lung injury)

Acute hypoxemia; emergency; rapid onset dyspnea and tachypnea, spo2 < 90 on RA, fever, cyanosis, hypotension; Stop transfusion

TACO (transfusion associated circulatory overload)

mild fluid volume overload; hypertension, crackles, increased RR, dyspnea, increased HR; administer diuretics and slow transfusion

Hypotensive Reaction

Rare bradykinin-mediated hypotension; Emergency; rapid drop in BP; stop transfusion.

Perfusion

Blood flow through circulatory system to oxygenate cells and remove waste

Perfusion depends on?

cardiac output & blood pressure

Electrocardiogram (ECG)

Measures electrical activity of the heart.

Echocardiogram (ECHO)

Assesses mechanical function of the heart.

Lab Values for cardiac health

Includes K, troponin, BNP for cardiac assessment.

Risk Factors in cardiac labs

BUN/Cr, BG, HbA1C

Atrial Fibrillation

Irregular heart rhythm caused by uncoordinated contraction of atrial muscles

rapid, chaotic and irregular contraction pattern of the atria

A-fib heart rate

Usually exceeds 100 beats per minute.

A-fib rhythm

Characterized by irregular heartbeat.

A-fib P wave

Absent in atrial fibrillation.

A-fib causes

hypertension

diabetes

smoking

obesity

alcohol

A-fib outcomes

clot formation (TIAs, stroke, MI, PE, HF)

poor perfusion

Non-Modifiable Risk Factors for A-fib

Age, gender, genetics, family history.

Modifiable Risk Factors for A-fib

Lifestyle choices affecting heart health.

comorbidities of A-fib

HTN, hyperthyroidism, hypokalemia, hypomagnesmia

Pharmacological interventions for A-fib

Calcium channel blockers

Beta blockers

Cardiac Glycoside

Oral anticoagulants

Medications for A-fib target

Heart rate. rhythm, coagulation

Synchronized Cardioversion

shock given at a specific time in cardiac rhythm to convert heart back to normal sinus rhythm

Catheter Ablation

Procedure to destroy tissue causing A-fib.

Angina

Ischemia of partial thickness of myocardial muscle

Myocardial Infarction (MI)

Ischemia of full thickness of myocardial muscle

Causes of Angina

stenosis, vasospasm, thickening of heart wall

Causes of MI

stenosis, plaque lodge

ST-segment elevation (STEMI)

Indicates significant heart muscle damage on ECG.

Non-ST-segment elevation (NSTEMI)

Partial blockage with less severe ECG changes.

Troponin I

biomarker for cardiac muscle damage

elevates 3-6 hours post MI, peaks 12-16 hours

Cardiac biomarkers

troponin, creatine kinase, myoglobin

Percutaneous Coronary Intervention (PCI)

Procedure to open blocked coronary arteries.

Complications of MI

dysrhythmias, pulmonary edema, MI, cardiogenic shock, heart failure.

ST Depression

Suggests angina or ischemia on ECG.

Systolic Dysfunction

Impaired heart contraction leading to reduced output.

Diastolic Dysfunction

Impaired heart filling leading to reduced output.

Left Sided CHF

Heart failure causing respiratory congestion, dyspnea, SOB, crackles and decreased SpO2

Right Sided CHF

Heart failure causing peripheral edema, fluid volume overload, weight gain, ascites, reduced RBCs

B-Type Natriuretic Peptide (BNP)

increase = heart failure

Preserved Ejection Fraction (HFpEF)

Ejection fraction > 50%; indicates preserved heart function.

Mid-Range Ejection Fraction (HFmEF)

Ejection fraction 41-49%; transitional heart failure stage.

Reduced Ejection Fraction (HFrEF)

Ejection fraction < 40%; indicates significant heart dysfunction.

Complications of HF

Cardiogenic shock

Pulmonary edema

Venous disorder

S&S of Pulmonary Edema

SOB, tachypnea, low SpO2, cyanosis, frothy pink sputum, restlessness, weak peripheral pulses

Nursing Management for Pulmonary Edema

High Fowler's

Apply O2

Initiate IV access/administer diuretics, morphine

Monitor ECG

cardiogenic shock

compromised cardiac function to the point that it cannot maintain cardiac output and adequate tissue perfussion

Venous Stasis Ulcers

Skin excavation due to inadequate perfusion; inflamed tissue.

Stage one heart failure medication

ACEi or ARB

Stage two heart failure medication

ACEi or ARB + Beta Blocker

Stage three heart failure medication

ACEi or ARB + Beta Blocker + Diuretic

Stage four heart failure treatment

Palliative or heart transplant