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  1. Anticoagulants
    Substances that prevent or delay coagulation of the blood. (p. 434)
  2. Antifibrinolytic drugs
    Drugs that prevent the lysis of fibrin and in doing so promote clot formation. (p. 435)
  3. Antiplatelet drugs
    "Substances that prevent platelet plugs from forming, which can be beneficial in defending the body against heart attacks and strokes. (p. 434)"
  4. Antithrombin III
    "A substance that inactivates (“turns off”) three major activating factors of the clotting cascade: activated factor II (thrombin), activated factor X, and activated factor IX. (p. 436)"
  5. Clot
    "Insoluble solid elements of blood (cells, fibrin threads, etc.) that have chemically separated from the liquid (plasma) component of the blood. (p. 433)"
  6. Coagulation
    "The process of blood clotting. More specifically, the sequential process by which the multiple coagulation factors of the blood interact in the coagulation cascade, ultimately forming an insoluble fibrin clot. (p. 433)"
  7. Coagulation cascade
    The series of steps beginning with the intrinsic or extrinsic pathways of coagulation and proceeding through the formation of a fibrin clot. (p. 433)
  8. Embolus
    "A blood clot (thrombus) that has been dislodged from the wall of a blood vessel and is traveling throughout the bloodstream. Emboli that lodge in critical blood vessels can result in ischemic injury to a vital organ (e.g., heart, lung, brain) and result in disability or death. (p. 433)"
  9. Enzyme
    A protein molecule that catalyzes chemical reactions of other substances without being altered or destroyed in the process. (p. 437)
  10. Fibrin
    "A stringy, insoluble protein produced by the action of thrombin on fibrinogen during the clotting process; a major component of blood clots or thrombi (see thrombus). (p. 433)"
  11. Fibrin specificity
    "The property of newer thrombolytic drugs of activating the conversion of plasminogen to plasmin only in the presence of established clots having fibrin threads rather than inducing systemic plasminogen activation throughout the body, which increases bleeding risk. (p. 445)"
  12. Fibrinogen
    A plasma protein that is converted into fibrin by thrombin in the presence of calcium ions. (p. 440)
  13. Fibrinolysis
    "The continual process of fibrin decomposition produced by the actions of the enzymatic protein fibrinolysin. It is the normal mechanism for removing small fibrin clots and is stimulated by anoxia, inflammatory reactions, and other kinds of stress. (p. 434)"
  14. Fibrinolytic system
    An area of the circulatory system undergoing fibrinolysis. (p. 434)
  15. Hemophilia
    "A rare, inherited blood disorder in which the blood does not clot normally. (p. 434)"
  16. Hemorheologic drugs
    Drugs that alter the function of platelets without compromising their blood-clotting properties. (al 432)
  17. Hemostasis
    "The arrest of bleeding, either by the physiologic properties of vasoconstriction and coagulation or by mechanical, surgical, or pharmacologic means. (p. 433)"
  18. Hemostatic
    "Refering to any procedure, device, or substance that arrests the flow of blood. (p. 435)"
  19. Plasmin
    The enzymatic protein that breaks down fibrin into fibrin degradation products; it is derived from plasminogen. (p. 434)
  20. Plasminogen
    A plasma protein that is converted to plasmin. (p. 434)
  21. Pulmonary embolism
    "The blockage of a pulmonary artery by foreign matter such as fat, air, tumor, or a thrombus (which usually arises from a peripheral vein). (p. 436)"
  22. Stroke
    "Occlusion of the blood vessels of the brain by an embolus, thrombus, or cerebrovascular hemorrhage, resulting in ischemia of the brain tissue. (p. 436)"
  23. Thromboembolic events
    "Events in which a blood vessel is blocked by an embolus carried in the bloodstream from the site of its formation. The tissue supplied by an obstructed artery may tingle and become cold, numb, cyanotic, and eventually necrotic (dead). (p. 436)"
  24. Thrombolytic drugs
    Drugs that dissolve thrombi by functioning similarly to tissue plasminogen activator. (p. 435)
  25. Thrombus
    "The technical term for a blood clot (plural: thrombi); an aggregation of platelets, fibrin, clotting factors, and the cellular elements of the blood that is attached to the interior wall of a vein or artery, sometimes occluding the vessel lumen. (p. 433)"
  26. Tissue plasminogen activator
    A naturally occurring plasminogen activator secreted by vascular endothelial cells in the walls of blood vessels. Thrombolytic drugs are based on this blood component. (al 433)
  27. types of Chronic Thromboembolism
    Varicose Veins & Chronic venous insufficiency
  28. Thrombophlebitis
    "Defined as a blood clot forms on wall of a vein, accompanied by inflammation of vein wall and some degree on obstructed venous blood flow"
  29. types of acute Thrombophlebitis
    Superficial Thrombophlebitis & DVT (deep vein thrombosis)
  30. Superficial Thrombophlebitis
    Often caused from an IV or an IV infusion of a caustic solution
  31. DVT (deep vein thrombosis)
    "a thrombus in the deep veins; Often occur after surgery, orthopedic procedure, in women or hospitalized clients; 80% in calf of leg"
  32. S&S Superficial Thrombophlebitis
    "Localized pain and tenderness over vein, Redness along vein, Warmth along vein, Palpable cord along vein, Swelling and redness in surrounding tissue"
  33. S&S DVT
    "Asymptomatic; Dull, aching pain esp. when walking; Possible tenderness, erythema along vein; Cyanosis; Edema of affected extremity"
  34. treatment of Superficial Thrombophlebitis
    Heat (from a K pad) to relieve discomfort; Elevation of extremity to assist in the increase of venous return; Ted hose or support stockings with ambulation
  35. Virchow’s Triad
    "is primarily responsible for thrombus formation. This triad includes; Venous stasis, Hypercoagulability, & Injury to the vein wall-causes of injury include: (Fractures, IV injections)"
  36. Pharmacological measures to prevent clots
    Low-molecular weight heparins & ASA (inhibits platelet aggregation)
  37. Nursing measures to prevent clots
    "Elevate foot of bed knees slightly flexed ok (to increase venous return); Early ambulation; Leg exercises, have client move ankles and feet while in bed; Sequential compression devices(SCD’s) per MD order; Teds"
  38. Tests for DVT
    Duplex venous ultrasonography Or MRI & D-dimer
  39. Anticoagulants for clots
    Anticoagulants DO NOT dissolve the clots; Used to prevent the formation of new thrombus from forming. The body will break down existing clot by fibrinolysis over time
  40. common types of anitcoagulants for clots
    Heparin & coumadin
  41. IV Heparin therapy
    "Interferes with the clotting cascade; Heparin is ordered by the MD once a DVT has been confirmed; While on Heparin, aPPts (a lab test) are ordered q6hrs for at least 24hrs then at least daily after that to determine if adjustments in drug rate is necessary; When IV is discontinued, clotting times return to normal in 2-6 hours"
  42. Nursing role for heparin
    "Educate client to avoid shaving unless with an electric razor, use of soft toothbrush, avoid vit K rich foods( these foods will interfere with coagulation); keep protamine sulfate handy as this is the antidote for heparin, monitor aPTTs, Test stools of OB"
  43. Coumadin therapy
    "Acts by interfering with synthesis of vit K-dependent clotting factors by the liver; May be started concurrently with heparin; Monitor INR(lab test), goal is 2.0-3.0; Treatment usually continues for 3 months, prolonged with recurrent DVT, cancer, or altered coaguability"
  44. Nursing role for coumadin
    "Monitor PT and INR, H/H lab results, check for drug interactions, Avoid giving when pregnant,; Vit K is antidote for Coumadin; Education: if bleeding – do not take prescribed dose, report rash, dark urine, malaise, yellow skin, take pill at same time usually in the evening in case dose needs altered"
  45. Surgeries for Thrombophlebitis
    "Vein ligation, Venous thrombectomy, & Greenfield filter"
  46. Venous thrombectomy
    "Removal of the thrombus, prevents extension into deep veins; Rapid improvement of venous circulation"
  47. Greenfield filter
    ability to trap emboli within its apex while maintaining patency of the vena cava; Sometimes a filter is placed into the vena cava to capture emboli from the pelvis and lower extremities
  48. Vein ligation
    "If several valves in a vein and the vein itself are heavily damaged, the vein (or the diseased part of the vein) is usually removed (stripped). An incision is made below the vein, a flexible instrument is threaded up the vein to the first incision, and the vein is grasped and removed"
  49. Chronic Venous Insufficiency
    "Inadequate venous return over long period; DVT most frequent cause, also varicose veins or leg trauma; DVT or increased pressure in other veins damages valve leaflets"
  50. S&S of Chronic Venous Insufficiency
    Lower leg edema; Itching of skin; Discomfort of affected extremity that increase with prolonged standing; Cyanosis of lower legs while dependent; Recurring stasis ulcers; Eczema or stasis dermititis
  51. management of Chronic Venous Insufficiency
    "Increase venous blood return/ decreasing venous pressure; Reduce edema by elevating legs while sitting; Instruct client to not cross legs; Treat ulcers; Wet compresses ; Corticosteroid creams, zinc oxide or broad spectrum antifungal cream; Elevate legs above level of heart at night 6”; BR during acute phase; Pad bony prominences to decrease pressure points"
  52. Varicose veins
    "Irregular, tortuous veins with incompetent valves; Affect 2%, more common in women >35-peaks between 50-60 years; long standing periods increase venous pressure and stretch vessel walls – reducing blood return to heart, blood pools – further stretching"
  53. risks for Varicose veins
    "pregnancy, increasing age, occupation with prolonged standing although studies havent completely supported this)race, obesity, venous thrombosis, "
  54. S&S of Varicose veins
    "May be asymptomatic; Severe leg aching, pain; Leg fatigue; Leg heaviness; Itching; Feelings of heat in the legs; Discolored ankles; Complications: venous insufficiency, and venous stasis ulcer formation"
  55. management of Varicose veins
    "No cure aim is to relieve symptoms and prevent complications; Properly fitted below the knee compression stocking; Regular, daily walking; Leg elevation; Compression sclerotherapy – chemical obliteration; Surgery – remove diseased veins"
  56. types of Lymph disorders
    "Lymphadenopathy, Lymphangitis, & Lymphedema"
  57. Lymphadenopathy
    "enlarge lymph nodes – local or generalized, resulting from inflammatory process"
  58. Lymphangitis
    "inflammation along lymph vessels draining infected area –heat , pain, swelling, fever, chills"
  59. Lymphedema
    Accumulation of lymph fluid in the interstitial spaces that causes swelling in the arms and legs
  60. Types of Lymphedema
    primary & secondary
  61. primary Lymphedema
    "uncommon, associated genetic syndromes"
  62. secondary Lymphedema
    "from repeated infection damage, obstruction or removal of lymph vessels as in a mastectomy"
  63. S&S of Lymphedema
    Unilateral edema of the limb
  64. venoustreatment of Lymphedema
    Meticulous skin and foot care; Exercise and elevation of extremities; Compression stockings; Antibiotics; Diuretic therapy; There is no cure for lymphedema once the swelling is present—Goal is to remove as much fluid from tissues as possible!
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