Overview of perfusion alterations in medical-surgical nursing.
Red Blood Cells (Erythrocytes): Carry oxygen.
White Blood Cells (Leukocytes): Key players in the immune response.
Platelets: Essential for blood clotting, preventing excessive bleeding.
Plasma: Contains nutrients (e.g., amino acids, glucose) and water, serving as the medium for transporting cells and other substances.
Definition: A condition characterized by low platelet counts, leading to increased risk of bleeding.
Involves:
Vascular endothelium
Platelets
Coagulation factors
All components must function together to prevent hemorrhage and repair vascular injuries.
Disruption in any element may result in bleeding or thrombosis.
Defined as a reduction of platelets below normal levels (normal range not specified).
Leads to:
Abnormal hemostasis
Prolonged or spontaneous bleeding
Commonly acquired from high doses of particular medications.
Patients may be asymptomatic until platelet counts drop below 50,000/μL.
Symptoms include:
Mucosal or cutaneous bleeding
Petechiae: Microhemorrhages
Purpura: Bruising from multiple petechiae
Ecchymosis: Larger areas of hemorrhage
Prolonged bleeding may occur after routine procedures.
Possible internal bleeding symptoms: Weakness, fainting, dizziness, tachycardia, abdominal pain, hypotension.
Notable concern for hemorrhage, which may be acute or gradual.
Acquired Causes:
Immune thrombocytopenic purpura (ITP)
Thrombotic thrombocytopenic purpura (TTP)
Heparin-induced thrombocytopenia (HIT)
Description: Most common acquired thrombocytopenia; results from abnormal platelet production and destruction.
Associated with autoimmune disorders (like Lupus), infections (H. pylori, HIV).
Platelets become coated with antibodies, leading to their destruction in the spleen.
Reduced platelet count (<150,000/μL).
Testing includes peripheral blood smear, ITP antigen-specific assay, medical history evaluation, clinical examination.
Interprofessional Care: Begins if platelet counts drop below 30,000/μL or if symptomatic.
Initial Treatment: Corticosteroids (e.g., prednisone, methylprednisolone).
Advanced Treatments:
Romiplostim (Nplate)
Eltrombopag (Promacta) - can cause liver damage and ineffective with high-calcium foods.
High doses of IV immunoglobulin (IVIG) compete with antiplatelet antibodies.
Rituximab (Rituxan) targets B cells.
Indicated: For life-threatening hemorrhages or when platelet count is very low (<10,000/μL).
Not used prophylactically due to possible antibody formation.
Performed in non-responsive cases or for chronic conditions; it may compromise immunity.
Description: Uncommon syndrome encompassing hemolytic anemia, thrombocytopenia, and various systemic symptoms.
Microthrombi formation in small vessels leads to complications (notably kidney injury).
Deficiency of plasma enzyme ADAMTS13, autoimmune disorders, drug toxicities, pregnancy, infections.
Treat underlying conditions; urgent plasmapheresis may be necessary to reverse platelet consumption.
Corticosteroids and immunosuppressant therapies are sometimes indicated.
A serious immune reaction that occurs in some patients after the administration of heparin.
Symptoms include:
Significant drop in platelet counts (≥50%) within 5-10 days of heparin therapy initiation.
Major concern for venous and arterial thromboembolic events.
Immediate cessation of all heparin; critical notes in medical records.
Warfarin usage should start only when platelets are stable above 150,000/μL.
Other treatments for severe cases include plasmapheresis and thrombolytic therapy.
Prevent Hemorrhage: Vigilantly monitor for bleeding and provide safety measures; avoid IM injections when possible.
Encourage patient education on safety measures to reduce bleeding risks.
Monitor platelet counts and educate on menstrual blood loss management.
Overview: Angina represents ischemia; myocardial infarction indicates irreversibility leading to tissue necrosis.
Caused by increased oxygen demand; often linked to underlying atherosclerosis.
New or changing chest pain indicates cardiac ischemia, potential transition to an MI.
Resulting from complete blood vessel occlusion, leading to significant tissue death.
Important to assess and provide rapid care during chest pain episodes:
Position upright, apply oxygen, monitor VS, conduct ECG, and administer medications as required.
Cardiac Enzymes: Troponin and CK-MB levels used in diagnosis; troponin is particularly sensitive.
Definition: The heart's incapacity to provide adequate blood to meet physiological demands, leading to systemic complications.
Associated with cardiac output issues; dysfunction can arise from left- or right-sided failure, or both.
Key contributors include hypertension, coronary artery disease, diabetes, and lifestyle factors.
Symptoms such as dyspnea, fatigue, and changes in vital signs indicate worsening heart failure.
Constantly monitor respiratory status, administer necessary medications, and educate patients on dietary restrictions.