NURS 5463 Quiz 2: NURS 5463 Quiz 2 Study Guide: Updated Solution: Questions & Answers

Causes of Prolonged PT/INR (Ans – - Vitamin K deficiency: poor nutrition, prolonged antibiotic use - Liver dysfunction: decrease synthesis of clotting factors - Deficiency of factors II, V, VII, X, or fibrinogen - Use of warfarin PT/INR, aPTT Normal Values (Ans – PT: 8.3 - 10.8 seconds INR: 0.9 - 1.2 aPTT: 21 - 33 seconds Thrombin Time (Ans – - Measures the conversion of fibrinogen to fibrin - Normal value: 14 - 16 seconds - Prolonged by: Disorders of fibrinogen, presence of heparin, presence of direct thrombin inhibitors, presence of fibrin degradation productsWells Criteria for PE (Ans – Not to be confused with Wells criteria for DVT Clinical prediction rule to help determine the probability of a PE *Score: Low Probability: 2 points (3.4%) Moderate Probability: 2-6 points (27.8%) High probability: 6 points (78.4%)* Systemic Heparin Therapy (Ans – Used in the hospital as parenteral infusion - 80 units/kg initial IV bolus then 18units/kg/hr infusion - Titrate for aPTT 1.5-2.5 times normal (aPTT 60-85 seconds) - Check aPTT prior to infusion, 6 hours after starting infusion, & 6 hours after any dose change - Reversal: protamine sulfate - Risk for HIT; Monitor platelets at baseline, daily to every other day- Ok to use in renal failure - Do not use if platelets 50,000 Systemic Enoxaparin Therapy (Ans – - 1mg/kg subcutaneous injection - No reversal agent, protamine may help - Moderate risk for HIT; Do not use if platelets 50,000 - Contraindicated in creat clearance 30ml/minute Systemic Fondaparinux Therapy (Ans – - Weight based 5-10 mg subcutaneous injection - No reversal agent available - Low risk of HIT; do not use if platelets 50,000 - Contraindicated in creat clearance 30ml/minute Somogyi Effect (Ans – Nocturnal hypoglycemia ( 3AM) followed by morning (7AM) rebound hyperglycemia to increase counter-regulatory hormones