NURS 5315 ADVANCED PATHOPHYSIOLOGY- Hematologic System Core Concepts and Objectives with Advanced Organizers - $11.99   Add to cart

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NURS 5315 ADVANCED PATHOPHYSIOLOGY- Hematologic System Core Concepts and Objectives with Advanced Organizers

NURS 5315 ADVANCED PATHOPHYSIOLOGY Hematologic System Core Concepts and Objectives with Advanced Organizers Hemostasis 1. Analyze the process of hemostasis: a. Analyze the platelet structure and the 4 phases of platelet plug formation: Platelet Structure Function peripheral zone Outermost layer. Made of phospholipids. Contains many receptors responsible for platelet adhesion and aggregation sol-gel zone Middle layer of the platelet. Provides structural support. Organelle Zone Innermost layer. Contains calcium, dense granule and alpha granules, Four Phases of Platelet Plug Formation Function Activation First step of platelet plug formation. Injury to endothelium exposes collagen, vWf, fibronectin, thrombospondin. Collagen is potent platelet activator. Platelets become aware of injury Adherence Process by which Platelets adhere to endothelium. vWf is attracted to collagen, and platelets attach to vWf via GP1B. This results in activation of GP2B3A receptors. Collective binding anchors platelets in place. Aggregation Process by which platelets bind together. Multiple GP2B3A receptors allow platelets to bind to one another Secretion Platelet granules release their contents ● ADP o Enhances adhesion, activates and recruits platelets ● Serotonin o Recruits platelets ● Fibronectin and thrombospondin o Proteins which stabilize platelets that are adhered to site of injury ● Thromboxane A2 o Product of the arachidonic acid pathway but is stored inside of the platelet too. Causes vasoconstriction and enhances platelet aggregation ● Growth factors o Promote tissue repair but also have a role in the development of atherosclerosis b. Differentiate between the functions of the extrinsic and intrinsic arms of the coagulation cascade: · Extrinsic Pathway – It’s considered the primary pathway of coagulation, the extrinsic pathway needs tissue factor (therefore needs tissue damage) in order to occur and to produce clotting; the extrinsic pathway has to have tissue factor in order to activate the other clotting factors; · Intrinsic Pathway – the intrinsic pathway can occur without damage. It will occur when you take blood and put it in a glass vial (anionic surface). This will immediately cause the blood to clot (It is a parallel pathway for thrombin activation by factor XII) the intrinsic pathway just always has the factors it needs present in the blood · Contributions from both the extrinsic and intrinsic pathways are necessary for maximal induction of factor Xa and effective clotting Note: coagulation starts with the extrinsic arm. As soon as you make a little Xa, the extrinsic arm is turned off. The small amount of thrombin that has been generated during the action of the extrinsic system goes up and turns on the intrinsic arm, which finishes out the job of making the rest of the fibrin. c. Analyze the coagulation cascade, the key coagulation factors and their function: Coagulation Cascade Key Plasma Proteins Function Tissue Factor Initiator of extrinsic pathway. VII Forms complex with tissue factor (III) and activates factors IX and X X Activates Prothrombin through activated Xa form Prothrombinase Complex (prothrombin and activated factors X and V) that activates prothrombin into thrombin Prothrombin Factor II, source of thrombin that activates fibrinogen Thrombin cleaves the extracellular domain of G-protein–coupled protease-activated receptors (PARs), thereby initiating transmembrane signaling. Fibrinogen moves between the beta and gamma regions but is removed during the formation of serum; precursor of fibrin clot Fibrin Used to stabilize clot XIII Fibrin – stabilizing factor – cross links fibrin through XIIIa to strengthen clot XII Hageman Factor. Initiator of intrinsic pathway VIII VIIIa is a component of tenase complex IX IXa is a component of tenase complex, activates factor X Antithrombin it inhibits thrombin and several activated clotting factors (e.g., VIIa, IXa, Xa, XIa, XIIa). Protein C in the circulation binds to thrombomodulin in a thrombin-dependent manner and is converted to activated protein C Protein S degrades factors Va and VIIIa t-PA a serine protease that reaches maximal enzymatic activity after binding to fibrin and proteolytically activates plasminogen to plasmin Disorders of Hemostasis 2. Examine the etiology, clinical ma

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