Neurogenic

Neurogenic

1. result of an imbalance between P & S stimulation of vascular smooth muscle.

   a. parasymp. (activates vasodilation) &

   b. sympath. (activates vasoconstriction)

2. If parasymp. overstimulation or sympath. understimulation persists, sustained vasodilation occurs, which leads to ↓

3. blood pools in the venous & capillary beds

4. seen in

   a. spinal cord injury

   b. insulin shock

   c. syncopy (fainting)

   d. is short-lived

   e. skin is warm & dry

   f. hypotension & bradycardia (slow heart rate)

Disseminated Intravascular Coagulation "DIC" *seen with infections (pg 1146 lemone)

1. characterized by widespread intravascular clotting & bleeding

2. low platelet & fibrinogen levels

3. prolonged PT, PTT, & thrombin time

4. elevated fibrin degradation products (FDPs) or fibrin split products (FSPs)

5. D-dimers

6. *seen with infections ie. fetus dies in utero, abrutio placenta

7. symptoms due to↑fibrinolysis

   a. oozing at IV site

   b. bleeding when brushing teeth

Interventions – treat the cause

1. correct secondary effects of tissue ischemia

   a. give O₂

   b. fluids

   c. correct electrolyte imbalances

   d. administer vasopressors

   e. no RBCs because plasma has clotting factors

2. fresh frozen plasma & platelet concentrate

3. Heparin – interferes with clotting cascade

Blood Types – lemone 262-263, Taylor 1716-1717

A type A agglutinogen agglutinin B (antibodies will clot with addition of B)

B type B agglutinogen agglutinin A (antibodies will clot with addition of A)

AB type A&B agglutinogen neither (universal recipient)

O Neither A or B both A & B (universal donor)

autologous donation – pt donates own blood for use after own surgery

Blood & Blood Components

1. whole bloodstream

2. packed RBC PRBC

3. platelets

4. plasma

5. cryoprecipitate

6. clotting factors

7. prothrombin

8. albumin

Risks

1. Circulatory overload

2. electrolyte imbalances

3. infectious diseases

4. reactions

   a. febrile (primary reaction – withing 15 min)

   b. hypersensitivity: if get reaction, *stop transfusion & give Benadryl if needed

   c. hemolytic reactions – rarest reactions – wrong blood (will clump) ✰check urine for blood

   d. can get transfusion reaction in pt with frequent transfusions, get pre-medication to prevent

✽precautions✽

1. nurse must check blood type & date and sign form

2. write start & end time of transfusion

3. hang saline drip to rinse line before doing drip.

4. sit with pt & check V/S every 5 minutes for 1^st 15 minutes

   Hemorrhage – (pg 74) treatment – shock position, stop bleeding, get order for IV blood,

1. primary: time of operation

2. intermediary: 1^st 24 hrs past surgery

3. secondary: later from erosion / infection

4. capillary: slow ooze

5. venous: bubble dark

6. arterial: spurt with every beat, bright,

7. evident

8. concealed✴symptoms: apprehensive, thirsty, pale cold, rapid pulse, weak,↓temp, rapid - deep respirations, cardiac output ↓, BP↓, cyanosis, spots before eyes