CHAPTER 29-BLEEDING
DISORDERS
Chapter 29
Objectives
 Specify the etiologies and the medical and nursing
management of patients with secondary polycythemias
and bleeding and thrombotic these disorders
 Use the nursing process as a framework for care of the
patient with disseminated intravascular coagulation
Chapter 29 Vocabulary
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What is a bleeding
disorder?
Causes of bleeding
disorder:
Bleeding Disorders
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Bleeding Disorders
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Thrombocytopenia
• Reduced production of platelets
in bone marrow
• Increased destruction of
platelets
• See Table 29-3 (pg. 932)
Thrombocytopenia
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Assessment/Diagnostics
Bone marrow aspiration and biopsy. Checking
hepatitis B&C labs
Autosomal dominant, autosomal recessive, xlinked mutations are genetic causes
Will see an increase in megakaryocytes and
normal or increase platelet production as body
attempts to compensate for decreased platelets
in circulation
Thrombocytopenia
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Immune Thrombocytopenic Purpura (ITP)
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ITP: Pathophysiology
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ITP: Clinical Manifestations
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Assessment/Diagnostic
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Medical Management
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Goal is PLT high enough to achieve
homeostasis
Short term: Immunosuppressive therapy
(block binding receptors on macrophages
reducing platelet destruction)
IVIG (binds to receptors on macrophages)
Immune Thrombocytopenic Purpura
Patient assessment
Avoid herbal therapies
Medication history
Avoid OTCs
History of recent viral illness
Avoid constipation
Fatigue
Soft bristle toothbrush
Patient and family education
Bone mineral density
Monitoring platelet count
Supplemental vitamins
PLATELET DEFECTS
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-ASA can induce PLT disorder
-NSAIDS can impair PLT function
-ESRD, MDS, multiple myeloma
-Cardiopulmonary bypass
-Herbal remedies
-Medications can cause PLT dysfunction
(chart 29-9 on pg.935)
PLATELET DEFECTS: Clinical
Manifestations/Management
• Ranges from mild to severe:
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• Severity not necessarily related to PLT count
or tests that measure PT
(Prothrombin)/aPTT (activated partial
thromboplastin time)
Avoid: ASA, NSAIDs, herbal/nutritional
supplements, alcohol
Notify physicians before procedures,
especially the dentist
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HEMOPHILIA
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WHAT IS HEMOPHILIA
HEMOPHILIA
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Hemophilia
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Hemophilia
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Hemophilia
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Von Willebrand Disease (vWD)
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MANIFESTATIONS/ASSESSMENT/DIAGNOSTIC
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MANAGEMENT
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ACQUIRED BLEEDING DISORDERS
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ACQUIRED BLEEDING DISORDERS
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ACQUIRED BLEEDING DISORDERS
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Disseminated intravascular
coagulation (DIC)
DIC:
PATHOPHYSIOLOGY
SEQUENCE OF DIC:
COAGULATION CASCADE:
Review
DIC MANIFESTATIONS:
DIC DIAGNOSTIC
TESTS:
DIC MEDICAL
MANAGEMENT: