How to Survive the Surgical ICU - AP_Hematology
AssessmentPlan
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ASSESSMENT

Look for signs of

  • Anemia - symptomatic or asymptomatic
  • Hypercoagulability - potential for deep venous clot formation
  • Hypocoagulability - bleeding tendency

Subjective:
Complaint of chest pain.

VS: Heart Rate and Blood Pressure:
Orthostatic hypotension.
Tachycardia- blood loss, anemia.

Hematocrit:
Hgb <7 mg/dl or Hct < 21%

Coags:
PT: 11-15 seconds - factor VII - extrinsic pathway-prolonged in liver
disease
PTT: 20-35 seconds - VIII, IX, XI,XII.- intrinsic

Physical:
General: Alert?
Pulmonary Exam: Tachypneic?
Skin color: cyanosis? Pale? Bruising. Petechiae.
Extremities: Calf tenderness.
Rectal: guaic - or +
Ongoing bleeding from any site.

Medications:
Coumadin: blocks vitamin K, increases PT (+/- PTT)
Heparin: activates antithrombin III, increases PTT

Problems

  1. Deep Venous Thrombosis Prophylaxis
  2. Anemia: complicated MI/angina/tachycardia
  3. Thrombocytopenia
  4. Bleeding from low coagulation factors-due to coumadin, liver disease, low vitamin K.
  5. Pulmonary Embolism/ Deep venous thrombosis
  6. DIC
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Copyright © 2004, University of California San Diego, School of Medicine