CLOTTING
RNSG 2371
Concept-Based Transition to Professional Nursing Practice
Concept- CLOTTING
Concept Definition
A physiologic process in which blood is converted from a liquid to a semisolid gel.
Exemplars
Deep vein thrombosis
Hemophilia
Objectives
1.
2.
3.
4.
Explain the concept of clotting (including definition, antecedents, and attributes).
Analyze conditions which place a patient at risk for clotting imbalance.
Identify when clotting imbalance (negative consequence) is developing or has developed.
Apply the nursing process (including collaborative interventions) for individuals experiencing
clotting imbalance which will promote hemostasis (normal clotting).
5. Explain the correlation between the exemplars (Deep Vein Thrombosis and Hemophilia) and
the concept of clotting.
Sub-objectives for Exemplars
Deep Vein Thrombosis:
1. Describe the pathophysiology and clinical manifestations of deep vein thrombosis
2. Identify the risk factors for deep vein thrombosis
3. Identify priority nursing diagnosis for deep vein thrombosis
4. Develop a plan of care for a patient with deep vein thrombosis
5. Discuss treatments available for a patient with deep vein thrombosis
Hemophilia:
1. Describe the pathophysiology and clinical manifestation of Hemophilia.
2. Identify the genetic factors that cause the two types of Hemophilia.
3. Explain the major treatment modalities for Hemophilia.
4. Identify the priority nursing diagnosis for Hemophilia.
5. Develop a plan of home care for a patient with severe Hemophilia.
Concept Analysis Diagram
Note: Diagram is on separate page.
Explanation of Clotting Diagram:
Before normal Clotting can exist, the Antecedents of normal: prothrombin time (PT), partial
thromboplastin time (PTT), international normalized ratio (INR), fibrinogen, platelet count and the
absence of D-Dimers should exist. If these do not exist or are malfunctioning then the concept either
does not exist or it does not exist at its optimal level.
To determine if Clotting is functioning at an optimal level, the Attributes of normal clotting time,
vasoconstriction, formation of platelet plug, coagulation cascade and formation of insoluble fibrin
should be measured. When these Attributes are met, the Positive Consequence(s) of warm/normal
temperature and pulses, tissue/vessel integrity, and normal activity usually result. When the
measurements of Attributes are less than those listed there either are, or soon will be, Negative
Consequence(s) such as hemorrhage, hypo/hyperthermia, limited movement, decreased circulation
CLOTTING
which results in hypoxia and/or pain.
Interrelated Concepts which either affect or are affected by the Concept of Clotting include Gas
Exchange, Mobility, Comfort, Immunity, Perfusion, and/or Intracranial Regulation.
Sub-Concepts included in teaching the concept of Clotting include endothelial damage, bleeding
disorders, hypercoagulability states, and venous stasis.
The need for Nursing Care is triggered by: Compromised Antecedent(s), Decreased quality of
Attribute(s), Negative Consequence(s), and a negative impact or potentially negative impact from an
Interrelated Concept(s).
Assignments
Prior to class:
1. Review definitions of inter-rated concepts on concept analysis diagram.
2. Review concept analysis diagram.
3. Assigned reading:
*Page numbers, pre-class assignments, and other lecture information will be posted on
blackboard.
 Giddens, J.F. (2013). Concepts for nursing practice. St. Louis. MO: Mosby Elsevier.
 Chapter 17: Clotting
 Lewis, S.L., Heitkemper, M.M., Dirksen, S.R., O’Brien, P.G., & Bucher, L.
(2014). Medical surgical nursing (9th ed). St. Louis: Mosby Elsevier.
 Chapter 31: Hematologic Problems
 Chapter 38: Vascular Disorders
4. Internet resources to review:
 Life of Blood part 1
http://www.youtube.com/watch?v=6myuX4ubWRQ
 Life of Blood part 2
http://www.youtube.com/watch?v=7AWfzy7wdv4
 Life of Blood part 3
http://www.youtube.com/watch?v=7AWfzy7wdv4
Concept Content Outline:
Concept:
Clotting
Sub Concepts: Endothelial damage
Bleeding disorders
Hypercoagulability states
Venous stasis
Risk Factors: Modifiable:
Non-Modifiable:
Age
Additional Risks
Assessment: Comprehensive history
Physical assessment
Physical and psychological clinical manifestations
Diagnostic tests
Positive Outcomes:
Warm/normal temperature and pulses
Tissue/vessel integrity
Normal activity
CLOTTING
Negative Outcomes:
Physiological
Psychological
Clinical Management:
Nursing interventions
Collaborative interventions
Pharmacological therapy
Non Pharmacological therapy
Diagnostic studies
Exemplars:
Deep vein thrombosis
Hemophilia
N:ADN Syllabus/CBCCurriculum/Transition Summer 2015/Transition Clotting
4/15