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.