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NURS 5031 Study Guide:Disorders of the Hematologic System ("Blood Dyscrasias")

NURS 5031 Study Guide:Disorders of the Hematologic System ("Blood Dyscrasias")

  • Assess subjective and objective data (differentiating between normal and abnormal findings) related to the different types of anemias 
  • General Objective Data
  • Morphological classifications
  • Normocytic, normochromic
  • MCV 80-95 fL (mean corpuscular volume)
  • MCH 27-31 pg (mean corpuscular hemoglobin)
  • Microcytic, hypochromic
  • MCV <80 fL
  • MCH <27 pg
  • Macrocytic, normochromic
  • MCV >95 fL
  • MCH >31 pg
  • Anemia Severity
  • Mild - Hgb 10-12 g/dL or 100-120 g/L
  • Exertional dyspnea
  • Palpitations
  • Moderate - Hgb 6-10 g/dL or 60-100 g/L
  • Bounding pulse
  • Roaring in the ears
  • Severe - Hgb <6 g/dL or 60 g/L
  • Transfusions required for severe
  • Findings: pale, all systems affected
  • Bone pain, because bones are trying to make new cells
  • Tachycardia, HF, MI, anorexia, dyspnea at rest
  • Insomnia, headaches
  • Iron-Deficiency Anemia
  • Basically just the same type of objective and subjective symptoms listed above
  • Due to iron deficiency, as the name would suggest
  • Due to: blood loss, low intake, malabsorption, hemolysis, or pregnancy to name a few
  • Chronic Blood Loss Anemia
  • A type of iron deficiency anemia, usually due to a GI blood loss like a peptic ulcer - may see black stools
  • Could also be menstrual bleeding
  • S/Sx
  • Pallor - pale
  • Glossitis (tongue inflammation)
  • Stool blood test
  • Endoscopy, colonoscopy, blood labs
  • Thalassemia
  • Inadequate production of normal Hgb
  • All three are thalassemia:
  • 1) Reduced RBC production
  • Abnormal Hgb synthesis either:
  • 2) Alpha globin issues
  • 3) Beta globin issues
  • Thalassemia Minor S/Sx
  • Frequently asymptomatic
  • Moderate anemia - typically Microcytosis Hypochromic
  • Body adapts - no treatment indicated
  • Thalassemia Major S/Sx
  • Life-threatening
  • Physical and mental growth slows
  • Pale and jaundiced
  • Splenomegaly, hepatomegaly, cardiomyopathy
  • Sx start in childhood
  • Treatment
  • No specific drug or diet is effective - DO NOT GIVE IRON
  • Can give a chelating agent to bind up excess iron
  • Stem cell transplant is the only cure, but must weigh risks/benefits
  • Splenectomy
  • Zinc supplements (b/c zinc decreases w/ chelation therapy)
  • Pt pop is at increased risk for blood borne infections due to the frequent blood transfusions required
  • Megaloblastic Anemia
  • Know its a B12 deficiency, most commonly pernicious anemia
  • S/Sx
  • Neurological impairments for heat and pain
  • Tests and Treatment
  • Normal B12 should be 3-16 mg/mL
  • Give 1mg B12 daily PO to replace B12, and eat lots of folic acid rich foods
  • Anemia of Chronic Disease
  • Key here is to treat the underlying disorder
  • Chronic inflammation
  • Autoimmune or infectious issues (HIV, Hep, Malaria)
  • HF
  • Malignant diseases
  • Frequent bleeding
  • Normocytic normochromic RBCs, but just underproduced.
  • Either due to short life span or EPO issues
  • Treatment
  • Can treat with EPO to rectify the initial problem, but really you are going to want to treat the underlying disease
  • Aplastic Anemia
  • ALL blood cell types are affected
  • In addition to the general anemia symptoms, you will also see neutropenia
  • Usually due to an autoimmune component
  • Assessment:
  • Should see hypocellular bone marrow with increased yellow marrow (fat content)
  • Mgmt
  • Infection risk due to low neutrophils (prevention and education very important!)
  • Bleeding mgmt
  • Stem cell transplant and immunosuppression (ATG, cyclosporin, or cytoxan)
  • Acute Blood Loss Anemia:
  • Normal blood volume = 5-6L
  • 1000 mL loss = beginning of symptoms like orthostatic hypotension
  • 1500 mL loss = maybe some fatigue with rest
  • 2000 mL loss = BP problems at rest, thready pulse, clammy skin
  • 2500 mL loss = shock, lactic acidosis, death
  • Signs and symptoms will tell you more than labs will for this condition specifically!
  • Explain the nursing and interprofessional management of Sickle Cell Anemia and emergent complications
  • Sickle cell anemia Etiology/Pathophysiology
  • Presence of abnormal Hgb in RBC (Hemoglobin S)
  • Homozygous for Hgb S, inherited autosomal recessive disorder
  • Incurable and often fatal by middle age
  • Hemoglobin S is sensitive to changes in O2 content, hypoxia causes cells to assume sickle shape and clump together, obstructing capillary blood flow.
  • Circulating sickled cells are hemolyzed by the spleen causing anemia
  • Sickle cell emergencies
  • Sickle cell crisis
  • Acute exacerbation of sickling causes vaso-occlusive crisis
  • Hypoxia leads to tissue necrosis
  • Shock is a result of severe O2 depletion and reduction of fluid volume
  • Acute chest syndrome
  • Pulmonary complications that include pneumonia, tissue infarction, and fat embolism
  • Fever chest pain, dyspnea, cough
  • Leads to multiple serious complications
  • Sickle Cell Complications
  • Infections
  • Major cause of morbidity and mortality
  • Spleen function becomes compromised due to sickle RBCs (spleen becomes small)
  • Pneumococcal pneumonia most common
  • Severe infections can cause aplastic crisis and result in shutdown of RBC production
  • Pain
  • Often pain tolerant
  • Under treatment is major problem
  • Require continuous and breakthrough analgesia with morphine and hydromorphone.
  • Sickle Cell Manifestations
  • Pain from tissue hypoxia
  • Pallor of mucous membranes
  • Jaundice from hemolysis
  • Sickle Cell  Nursing/Interprofessional management
  • O2 for hypoxia to control sickling
  • Promote rest with DVT prophylaxis
  • Administration of fluids and electrolytes
  • Pain management
  • Encourage consumption of high-calorie, high-protein diet, with folic acid supplementation
  • Understand nursing priorities when caring for a patient undergoing a hematopoietic stem cell transplant[a]
  • Basic principle = conditioning
  • Two functions of the conditioning regimen
  • 1) Myeloreduction
  • Make space in the marrow by highly toxic drugs like Cytoxan, Busulfan, or Melphalan
  • Total body irradiation (NOT LOCAL)
  • 2) Immunosuppression
  • Anti-thymocyte Globulin
  • Cytoxan, or other strange drgus
  • Irradiation
  • What are we worried about?
  • Risk of bleeding and infection due to the reduction in myelocytes + immunosuppression regiment
  • HLA Matching
  • Just know that bone marrow transplants must be HLA matched due to the “extreme polymorphism” in those genes
  • 25% chance that a sibling will match, and it’s not useful to test non-sibling relatives or neighbors because there is such a low chance of there being a match - must use a database of donors
  • Describe the nursing management of the patient receiving transfusions of blood and blood components. Note potential complications of blood transfusions, safety considerations, and nursing management of complications.
  • Nursing management for transfusions:
  • Complete baseline physical assessment
  • Check IV line (appropriate needle, catheter, patency)
  • Double check patient identification and blood product with another RN
  • Adjust infusion rate according to patient needs, order, and agency policy
  • Assess patient for signs of transfusion reactions
  • Take vitals as directed
  • Evaluate therapeutic effect (improvement in CBC, increased BP, decreased bleeding)
  • Monitor for signs of circulatory overload (shortness of breath)
  • Complications of transfusions:
  • Transfusion reactions: mild to life-threatening, can be acute or delayed, includes acute hemolytic reaction, allergic reactions, circulatory overload reactions, sepsis, delayed hemolytic reaction, hepatitis B and C, iron overload
  • Safety considerations:
  • Do not use solution other than 0.9% saline for giving blood because they will cause RBC hemolysis
  • Do not give any additives, including medications, in the same tubing as the blood unless you first clear the tubing with saline
  • Do not be complacent
  • Make sure provider has discussed risks, benefits, and alternative with the patient
  • Make positive identification of blood product and recipient (often dual checking system in place)
  • Take vitals, if abnormal call provider to determine if blood should be given
  • Start within 30 minutes of receiving blood (or return to blood bank for storage)
  • Stay with patient for first 15min to look for adverse reactions
  • Continue to observe during and up to 1 hour after infusion
  • Transfusion should not take more than 4 hours due to increased risk for bacterial growth in the product once it is unrefrigerated 
  • Nursing management of complications:
  • Stop the transfusion
  • Maintain patent IV line with saline solution
  • Notify blood bank and provider immediately
  • Recheck ID tags and numbers
  • Monitor vitals and urine output
  • Treat symptoms per provider’s orders
  • Send blood bag and tubing to blood bank for examination
  • Collect required blood and urine specimens to evaluate for hemolysis
  • Document transfusion reaction
  • Know what supplements are appropriate and their common routes of administration for the different types of anemia
  • Iron supplements
  • DO NOT GIVE IRON FOR THALASSEMIA (condition with too much iron)
  • DO give iron for iron deficiency anemia or chronic blood loss anemia
  • Oral
  • Inexpensive and convenient
  • Take between meals for maximum absorption
  • Vitamin C increases absorption (orange juice)
  • Do not take with milk or antacids
  • Parenteral
  • Given IM or IV
  • IM may stain skin
  • One of the only IM injections given z-track
  • Indicated for malabsorption, oral iron intolerance, need for iron beyond normal limits, poor patient compliance
  • Side effects include black stools, heartburn, constipation, and foul aftertaste
  • Liquid iron stains teeth so it should be taken through a straw and teeth should be brushed after
  • Erythropoietin: epoetin alfa
  • GIVE EPO FOR ANEMIA OF CHRONIC DISEASE
  • Used to increase production of RBC
  • Monitor Hgb and Hct twice per week
  • Vitamin B12 supplements
  • Give for Megaloblastic/Pernicious anemia
  • Oral
  • given if deficiency is due to inadequate dietary intake
  • Parenteral
  • Given due to lack of intrinsic factor (pernicious anemia) being produced by the parietal cells in the stomach or malabsorption syndrome
  • Lifelong treatment if patient has pernicious anemia
  • Also given intranasally
  • Folic Acid supplements
  • Give for sickle cell anemia
  • Oral/parenteral
  • Large doses of folic acid can mask vitamin B12 deficiency and turn urine dark yellow
  • Know the pathophysiology of deep vein thrombosis and preventative strategies in the immobilized patient. Consider complications of these therapies, particularly nurse administered anticoagulants, and interventions to manage these complications. 
  • DVT
  • Formation of a clot in deep vein
  • Type of VTE
  • Veins most susceptible
  • Pelvic area, lower leg, hip
  • Risk factors (Virchow’s Triad)
  • Stasis of venous circulation 
  • Immobilized, varicose veins, surgery, traveling for long hours without moving, late pregnancy, obesity, heart failure, A-fib
  • Hypercoagulability (increased clotting)
  • Cancer, severe illness, dehydration, estrogen, heparin induced (HIT), pp period
  • Endothelial damage
  • IV drug usage, indwelling device (CVC, IV line, heart valve), medications, trauma or injury to a vessel (surgery)
  • Manifestations
  • Redness, swelling, very warm, look different than other extremity
  • Homan’s sign -> positive sign is pain when the foot is dorsiflexed.
  • Nursing interventions for patient with DVT
  • Elevate affected extremity above heart level
  • Ensure bedrest
  • Pharmacological measures
  • Anticoagulants (prevent clots from getting bigger and new clots from forming)
  • Heparin (indirect thrombin inhibitors)
  • Fast onset; given IV or subQ
  • Monitor aPTT
  • Warfarin (Vit K antagonist)
  • Given PO
  • Slow onset
  • Monitor PT/INR
  • Warm/moist compress to affected extremity
  • Monitor for s/sx of pulmonary embolism
  • Compression stockings
  • Preventing DVT in immobilized patient
  • Pneumatic compression devices; need to fit properly
  • Wear all times in bed
  • Ambulate and get out of bed when possible!
  • Leg and feet exercises several times a day
  • Apply compression stockings per MD order
  • Prophylactic anticoagulant, typically subQ lovenox
  • Complication: heparin-induced thrombocytopenia. Immediately + permanently stop heparin therapy and flushes, note in medical record, start on direct thrombin inhibitor
  • Complications of DVT
  • Dislodgement of clot
  • Pulmonary embolism
  • s/sx include SOB, decreased O2 sats, tachycardia, chest pain, anxiety

NURS 5031 Study Guide:Disorders of the Hematologic System ("Blood Dyscrasias")

  • Assess subjective and objective data (differentiating between normal and abnormal findings) related to the different types of anemias 
  • General Objective Data
  • Morphological classifications
  • Normocytic, normochromic
  • MCV 80-95 fL (mean corpuscular volume)
  • MCH 27-31 pg (mean corpuscular hemoglobin)
  • Microcytic, hypochromic
  • MCV <80 fL
  • MCH <27 pg
  • Macrocytic, normochromic
  • MCV >95 fL
  • MCH >31 pg
  • Anemia Severity
  • Mild - Hgb 10-12 g/dL or 100-120 g/L
  • Exertional dyspnea
  • Palpitations
  • Moderate - Hgb 6-10 g/dL or 60-100 g/L
  • Bounding pulse
  • Roaring in the ears
  • Severe - Hgb <6 g/dL or 60 g/L
  • Transfusions required for severe
  • Findings: pale, all systems affected
  • Bone pain, because bones are trying to make new cells
  • Tachycardia, HF, MI, anorexia, dyspnea at rest
  • Insomnia, headaches
  • Iron-Deficiency Anemia
  • Basically just the same type of objective and subjective symptoms listed above
  • Due to iron deficiency, as the name would suggest
  • Due to: blood loss, low intake, malabsorption, hemolysis, or pregnancy to name a few
  • Chronic Blood Loss Anemia
  • A type of iron deficiency anemia, usually due to a GI blood loss like a peptic ulcer - may see black stools
  • Could also be menstrual bleeding
  • S/Sx
  • Pallor - pale
  • Glossitis (tongue inflammation)
  • Stool blood test
  • Endoscopy, colonoscopy, blood labs
  • Thalassemia
  • Inadequate production of normal Hgb
  • All three are thalassemia:
  • 1) Reduced RBC production
  • Abnormal Hgb synthesis either:
  • 2) Alpha globin issues
  • 3) Beta globin issues
  • Thalassemia Minor S/Sx
  • Frequently asymptomatic
  • Moderate anemia - typically Microcytosis Hypochromic
  • Body adapts - no treatment indicated
  • Thalassemia Major S/Sx
  • Life-threatening
  • Physical and mental growth slows
  • Pale and jaundiced
  • Splenomegaly, hepatomegaly, cardiomyopathy
  • Sx start in childhood
  • Treatment
  • No specific drug or diet is effective - DO NOT GIVE IRON
  • Can give a chelating agent to bind up excess iron
  • Stem cell transplant is the only cure, but must weigh risks/benefits
  • Splenectomy
  • Zinc supplements (b/c zinc decreases w/ chelation therapy)
  • Pt pop is at increased risk for blood borne infections due to the frequent blood transfusions required
  • Megaloblastic Anemia
  • Know its a B12 deficiency, most commonly pernicious anemia
  • S/Sx
  • Neurological impairments for heat and pain
  • Tests and Treatment
  • Normal B12 should be 3-16 mg/mL
  • Give 1mg B12 daily PO to replace B12, and eat lots of folic acid rich foods
  • Anemia of Chronic Disease
  • Key here is to treat the underlying disorder
  • Chronic inflammation
  • Autoimmune or infectious issues (HIV, Hep, Malaria)
  • HF
  • Malignant diseases
  • Frequent bleeding
  • Normocytic normochromic RBCs, but just underproduced.
  • Either due to short life span or EPO issues
  • Treatment
  • Can treat with EPO to rectify the initial problem, but really you are going to want to treat the underlying disease
  • Aplastic Anemia
  • ALL blood cell types are affected
  • In addition to the general anemia symptoms, you will also see neutropenia
  • Usually due to an autoimmune component
  • Assessment:
  • Should see hypocellular bone marrow with increased yellow marrow (fat content)
  • Mgmt
  • Infection risk due to low neutrophils (prevention and education very important!)
  • Bleeding mgmt
  • Stem cell transplant and immunosuppression (ATG, cyclosporin, or cytoxan)
  • Acute Blood Loss Anemia:
  • Normal blood volume = 5-6L
  • 1000 mL loss = beginning of symptoms like orthostatic hypotension
  • 1500 mL loss = maybe some fatigue with rest
  • 2000 mL loss = BP problems at rest, thready pulse, clammy skin
  • 2500 mL loss = shock, lactic acidosis, death
  • Signs and symptoms will tell you more than labs will for this condition specifically!
  • Explain the nursing and interprofessional management of Sickle Cell Anemia and emergent complications
  • Sickle cell anemia Etiology/Pathophysiology
  • Presence of abnormal Hgb in RBC (Hemoglobin S)
  • Homozygous for Hgb S, inherited autosomal recessive disorder
  • Incurable and often fatal by middle age
  • Hemoglobin S is sensitive to changes in O2 content, hypoxia causes cells to assume sickle shape and clump together, obstructing capillary blood flow.
  • Circulating sickled cells are hemolyzed by the spleen causing anemia
  • Sickle cell emergencies
  • Sickle cell crisis
  • Acute exacerbation of sickling causes vaso-occlusive crisis
  • Hypoxia leads to tissue necrosis
  • Shock is a result of severe O2 depletion and reduction of fluid volume
  • Acute chest syndrome
  • Pulmonary complications that include pneumonia, tissue infarction, and fat embolism
  • Fever chest pain, dyspnea, cough
  • Leads to multiple serious complications
  • Sickle Cell Complications
  • Infections
  • Major cause of morbidity and mortality
  • Spleen function becomes compromised due to sickle RBCs (spleen becomes small)
  • Pneumococcal pneumonia most common
  • Severe infections can cause aplastic crisis and result in shutdown of RBC production
  • Pain
  • Often pain tolerant
  • Under treatment is major problem
  • Require continuous and breakthrough analgesia with morphine and hydromorphone.
  • Sickle Cell Manifestations
  • Pain from tissue hypoxia
  • Pallor of mucous membranes
  • Jaundice from hemolysis
  • Sickle Cell  Nursing/Interprofessional management
  • O2 for hypoxia to control sickling
  • Promote rest with DVT prophylaxis
  • Administration of fluids and electrolytes
  • Pain management
  • Encourage consumption of high-calorie, high-protein diet, with folic acid supplementation
  • Understand nursing priorities when caring for a patient undergoing a hematopoietic stem cell transplant[a]
  • Basic principle = conditioning
  • Two functions of the conditioning regimen
  • 1) Myeloreduction
  • Make space in the marrow by highly toxic drugs like Cytoxan, Busulfan, or Melphalan
  • Total body irradiation (NOT LOCAL)
  • 2) Immunosuppression
  • Anti-thymocyte Globulin
  • Cytoxan, or other strange drgus
  • Irradiation
  • What are we worried about?
  • Risk of bleeding and infection due to the reduction in myelocytes + immunosuppression regiment
  • HLA Matching
  • Just know that bone marrow transplants must be HLA matched due to the “extreme polymorphism” in those genes
  • 25% chance that a sibling will match, and it’s not useful to test non-sibling relatives or neighbors because there is such a low chance of there being a match - must use a database of donors
  • Describe the nursing management of the patient receiving transfusions of blood and blood components. Note potential complications of blood transfusions, safety considerations, and nursing management of complications.
  • Nursing management for transfusions:
  • Complete baseline physical assessment
  • Check IV line (appropriate needle, catheter, patency)
  • Double check patient identification and blood product with another RN
  • Adjust infusion rate according to patient needs, order, and agency policy
  • Assess patient for signs of transfusion reactions
  • Take vitals as directed
  • Evaluate therapeutic effect (improvement in CBC, increased BP, decreased bleeding)
  • Monitor for signs of circulatory overload (shortness of breath)
  • Complications of transfusions:
  • Transfusion reactions: mild to life-threatening, can be acute or delayed, includes acute hemolytic reaction, allergic reactions, circulatory overload reactions, sepsis, delayed hemolytic reaction, hepatitis B and C, iron overload
  • Safety considerations:
  • Do not use solution other than 0.9% saline for giving blood because they will cause RBC hemolysis
  • Do not give any additives, including medications, in the same tubing as the blood unless you first clear the tubing with saline
  • Do not be complacent
  • Make sure provider has discussed risks, benefits, and alternative with the patient
  • Make positive identification of blood product and recipient (often dual checking system in place)
  • Take vitals, if abnormal call provider to determine if blood should be given
  • Start within 30 minutes of receiving blood (or return to blood bank for storage)
  • Stay with patient for first 15min to look for adverse reactions
  • Continue to observe during and up to 1 hour after infusion
  • Transfusion should not take more than 4 hours due to increased risk for bacterial growth in the product once it is unrefrigerated 
  • Nursing management of complications:
  • Stop the transfusion
  • Maintain patent IV line with saline solution
  • Notify blood bank and provider immediately
  • Recheck ID tags and numbers
  • Monitor vitals and urine output
  • Treat symptoms per provider’s orders
  • Send blood bag and tubing to blood bank for examination
  • Collect required blood and urine specimens to evaluate for hemolysis
  • Document transfusion reaction
  • Know what supplements are appropriate and their common routes of administration for the different types of anemia
  • Iron supplements
  • DO NOT GIVE IRON FOR THALASSEMIA (condition with too much iron)
  • DO give iron for iron deficiency anemia or chronic blood loss anemia
  • Oral
  • Inexpensive and convenient
  • Take between meals for maximum absorption
  • Vitamin C increases absorption (orange juice)
  • Do not take with milk or antacids
  • Parenteral
  • Given IM or IV
  • IM may stain skin
  • One of the only IM injections given z-track
  • Indicated for malabsorption, oral iron intolerance, need for iron beyond normal limits, poor patient compliance
  • Side effects include black stools, heartburn, constipation, and foul aftertaste
  • Liquid iron stains teeth so it should be taken through a straw and teeth should be brushed after
  • Erythropoietin: epoetin alfa
  • GIVE EPO FOR ANEMIA OF CHRONIC DISEASE
  • Used to increase production of RBC
  • Monitor Hgb and Hct twice per week
  • Vitamin B12 supplements
  • Give for Megaloblastic/Pernicious anemia
  • Oral
  • given if deficiency is due to inadequate dietary intake
  • Parenteral
  • Given due to lack of intrinsic factor (pernicious anemia) being produced by the parietal cells in the stomach or malabsorption syndrome
  • Lifelong treatment if patient has pernicious anemia
  • Also given intranasally
  • Folic Acid supplements
  • Give for sickle cell anemia
  • Oral/parenteral
  • Large doses of folic acid can mask vitamin B12 deficiency and turn urine dark yellow
  • Know the pathophysiology of deep vein thrombosis and preventative strategies in the immobilized patient. Consider complications of these therapies, particularly nurse administered anticoagulants, and interventions to manage these complications. 
  • DVT
  • Formation of a clot in deep vein
  • Type of VTE
  • Veins most susceptible
  • Pelvic area, lower leg, hip
  • Risk factors (Virchow’s Triad)
  • Stasis of venous circulation 
  • Immobilized, varicose veins, surgery, traveling for long hours without moving, late pregnancy, obesity, heart failure, A-fib
  • Hypercoagulability (increased clotting)
  • Cancer, severe illness, dehydration, estrogen, heparin induced (HIT), pp period
  • Endothelial damage
  • IV drug usage, indwelling device (CVC, IV line, heart valve), medications, trauma or injury to a vessel (surgery)
  • Manifestations
  • Redness, swelling, very warm, look different than other extremity
  • Homan’s sign -> positive sign is pain when the foot is dorsiflexed.
  • Nursing interventions for patient with DVT
  • Elevate affected extremity above heart level
  • Ensure bedrest
  • Pharmacological measures
  • Anticoagulants (prevent clots from getting bigger and new clots from forming)
  • Heparin (indirect thrombin inhibitors)
  • Fast onset; given IV or subQ
  • Monitor aPTT
  • Warfarin (Vit K antagonist)
  • Given PO
  • Slow onset
  • Monitor PT/INR
  • Warm/moist compress to affected extremity
  • Monitor for s/sx of pulmonary embolism
  • Compression stockings
  • Preventing DVT in immobilized patient
  • Pneumatic compression devices; need to fit properly
  • Wear all times in bed
  • Ambulate and get out of bed when possible!
  • Leg and feet exercises several times a day
  • Apply compression stockings per MD order
  • Prophylactic anticoagulant, typically subQ lovenox
  • Complication: heparin-induced thrombocytopenia. Immediately + permanently stop heparin therapy and flushes, note in medical record, start on direct thrombin inhibitor
  • Complications of DVT
  • Dislodgement of clot
  • Pulmonary embolism
  • s/sx include SOB, decreased O2 sats, tachycardia, chest pain, anxiety