Blood Clotting, Hemorrhage, and Anemia

Circulatory System & Blood

• Circulatory system contains arteries and veins (and capillaries).
• Blood consists of RBCs, white blood cells, and platelets.

Blood Clot Formation

• Interruption of blood flow.
• Dislodged clot travels to heart, brain, or lungs (usually lungs).
• Impacts overall health by disrupting oxygen flow to tissues.
  • Psychosocial Impact:
    • Anxiety and PTSD due to the scary nature of the event, especially pulmonary embolism (PE).
• Safety Concerns:
  • Aging adults are at risk.
  • Post-op patients are at risk due to immobility.

Risk Factors for Clots

• Immobility.
• Older age.

Clinical Presentation of Clots

• PE (Pulmonary Embolism).
• Myocardial Infarction (MI), also known as a heart attack.
• Stroke.

Lab Tests for Blood Clots

• D-dimer: The most specific test.
• PT/PTT (Prothrombin Time/Partial Thromboplastin Time).
• Ultrasound and CT scan may also be ordered.

Role of the Nurse

• Acknowledge client needs and safety concerns.
• Consider environmental and individual factors.
• Client education.

Deep Vein Thrombosis (DVT)

• Usually occurs in lower extremities.
• Dehydration can contribute to DVT risk.

Psychophysiological/Psychosocial Considerations

• Potential long-term complications.

Prevention

• Compression stockings or boots for post-op patients.

Aging Adults & Anticoagulation Therapy

• Pay attention to falls due to risk of bleeding on blood thinners like Warfarin (Coumadin).
• Newer anticoagulants are also used.

Clinical Presentation of DVT

• Redness, swelling in the lower extremity.

Diagnostic Tests for DVT

• Venous Doppler.
• Contrast Phenography.

Role of the Nurse (DVT)

• Monitor post-op patients for shortness of breath and chest pain (PE).
• Pay attention to labor and delivery patients (risk of AFE - Amniotic Fluid Embolism).

Hemorrhage

• Significant blood loss.
• Adults can tolerate approximately 14% blood loss.
• Related to shock.
• Bleeding, bleeding.

Safety Concerns

• Monitor blood pressure for orthostatic hypotension.
• Aging adults have comorbidities, increasing safety concerns.

Clinical Presentation of Hemorrhage

• Hemoptysis (coughing up blood).
• Vomiting blood.
• Bright red blood (fresh) vs. brownish (old).
• Intracranial hemorrhages (brain).
• Traumatic injuries.

Lab Testing & Diagnostics

• Identify the source of bleeding.

Role of the Nurse

• Determine the source of the bleed.

Clinical Judgment

• Prioritize care for hemorrhaging patients in the ER.
• Assess BP (blood pressure).
• Consider SHOP (Suction, Head of bed, Oxygen, Pressure).

Anemia

• Red blood cells should be nice and red under a microscope; pale cells indicate anemia.
• Acute hemorrhage vs. slow bleeding (e.g., GI bleed).
• Pica: craving non-food items like ice.
• Iron pills or iron infusions get Iron up quickly.

Iron Infusions

• Quicker than pills and fewer side effects.
• May require premedication due to allergic reactions.

Iron Deficiency Anemia (IDA)

• Shortness of breath.
• Fatigue.
• Pallor.
• Heart palpitations.
• Dizziness.

Lab & Diagnostic Studies

• CBC (Complete Blood Count).
• Clotting factor tests (PT/PTT) if bleeding.

Iron Deficiency Anemia Management

• Iron-rich foods, supplements, and iron infusions.
• Supply and education.

Environmental Factors

• Pregnancy: Hemodilution increases risk; prenatal vitamins with iron are recommended.
• Vegetarians: Risk of nutritional deficiencies (protein, iron).
• Elderly: Vitamin B12 deficiency increases fall risk.

B12 Deficiency

• Labs for vitamin B12 deficiency.