Week 11 - HIT

Question 1

what is heparin induced thrombocytopenia (HIT)

Answer 1

• “allergy” to heparin

- risk associated w use of heparin

Question 2

describe what occurs in HIT

Answer 2

• immune complexes activate platelets = new or worsened clots
• platelet lvls are used up and plt lvls decreased
  = disorder of clots and bleeding

Question 3

what are complications associated w HIT (7)

Answer 3

• venous thrombosis
• arterial thrombus
• pulmonary emboli
• skin necrosis
• stroke
• end-organ damage (ex. kidneys)
• hemorrhage

Question 4

when is HIT suspected

Answer 4

• when plt lvls drop >50% below pt’s baseline

Question 5

what are symptoms of HIT (6)

Answer 5

often asymptomatic, but most common is bleeding

• epistaxis
• gum bleeding
• petechiae
• bruising
• prolonged bleeding after routine procedures (ex. IM injection)
• signs of internal blood loss (dizziness, tachy, fainting, abdom pain)

Question 6

what is included in diagnostic studies r/t HIT (2)

Answer 6

• plt count decreased
• bone marrow exam
• lab tests that assess secondary hemostasis (PT, aPTT) may be normal*

Question 7

what is included in treatment for HIT

Answer 7

• stop all heparin products (including heparin flushes for vascular catheters & LMWH)
• maintain anticoagulation w a different med

Question 8

what other meds can maintain coagulation w/ HIT (2)

Answer 8

• fondaparinux

- argutroban

Question 9

why arent plt transfusions used for treatment of HIT

Answer 9

• enhance the thromboembolic events associated w HIT

Question 10

what is the goal of acute intervention of thrombocytopenia episodes

Answer 10

• prevent or control hemorrhage

Question 11

what is included in pt education r/t HIT (13)

Answer 11

• notify the HCP of any signs of bleeding
• do not blow ur nose forecfully
• what to do if a nosebleed occurs
• do not bend down w your head lower than your waist
• prevent constipation by drinking lots of fluids & avoid straining
• shave only w electric razor (not blades)
• do not pluck eyebrows or other body hair
• do not puncture your skin (tattoos, piercing, etc.)
• avoid using meds (aspirin) or herbal products that effect clotting time
• use a soft bristled toothbrush
• if menstruating, keep track of # of pads used per day
• do not use tampons
• ask ur HCP before you have any invasive procedures done (dental, manicure, pedicure, etc)

Question 12

what are some signs of bleeding that a pt w HIT should notify the HCP about (9)

Answer 12

• black, tarry, or bloody BM
• bruising
• small red or purple spots on skin
• bleeding from mouth or anywhere in the body
• HA
• changes to vision
• difficulty talking
• sudden weakness of an arm or leg
• confusion

Question 13

what instructions should you give a pt w HIT regarding nose bleeds (3)

Answer 13

• keep your head up & apply firm pressure to the nostrils and bridge of the nose
• if bleeding continues, place an ice bag over the bridge of the nose and nape of the neck
• in unable to stop a nosebleed after 10 min, call HCP

Question 14

what is included in collab care for pts w HIT (3)

Answer 14

• if subcut injection is unavoidable, use smallest gage possible & apply direct pressure for 5-10 min
• avoid IM injections
• assess for signs of bleeding and clots

Question 15

a nursing diagnosis r/t thrombocytopenia is impaired oral mucus membrane integirty. what nursing interventions can be done for this (5)

Answer 15

• monitor condition of pts mouth
• encourage avoidance of spicy, salty, acidic, dry, rough, foods
• instruct pt to use soft bristled toothbrush
• instruct pt on freq and quality of proper oral health care
• instruct pt to avoid oral hygeine products w gylcerin, alcohol, or other drying agents

Question 16

a nursing diagnosis r/t thrombocytopenia is risk for bleeding. what nursing interventions are done for this (8)

Answer 16

• monitor for S&S of bleeding
• monitor coagulation studies, plts, fibrin, etc.
• avoid injections (if cant, use smallest gauge)
• have pt use an electric razor instead of straight edge razor blader
• protect pt from trauma
• admin blood products (plts, fresh frozen plasma –> no plts for HIT)
• tell pt to avoid invasive procedures, if theyre necessary monitor closely for bleeding
• instruct pt to avoid aspirin & other anticoagulants