Different blood tests given for bleeding disorders or blood dyscrasiaTickendra Das
The document discusses blood dyscrasias, which are pathological conditions of the blood that usually involve disorders of the cellular elements of blood. Blood dyscrasia can refer to diseases where platelets, white blood cells, or red blood cells are too high or too low. Common blood dyscrasias include diseases that affect platelets like ITP and TTP, diseases that affect clotting factors like hemophilia and von Willebrand's disease, and diseases that affect red blood cells like sickle cell anemia. Tests used to diagnose blood dyscrasias include complete blood count, bleeding time, activated partial thromboplastin time, platelet aggregation test, and prothrombin time.
Approach to the adult with bleeding disorderAli S. Mayali
The normal clotting process involves platelets and coagulation factors working together to form a clot and stop bleeding. Platelets initially aggregate at the site of injury and release substances to enhance clotting. Coagulation factors are then activated through initiation and amplification pathways, leading to thrombin generation and fibrin strand formation to stabilize the clot. Bleeding disorders can occur if there are deficiencies or dysfunctions of platelets, coagulation factors, or excessive fibrinolysis. Laboratory tests including platelet count, bleeding time, prothrombin time, activated partial thromboplastin time, and thrombin time are used to evaluate the hemostatic system and identify the cause of bleeding disorders.
Key coagulation disorders covered in this document include hemophilia A caused by a factor VIII deficiency, hemophilia B from a factor IX deficiency, and von Willebrand disease where von Willebrand factor is defective
This document discusses various bleeding disorders including hemophilia, von Willebrand disease, and acquired bleeding disorders. It defines hemophilia as a rare genetic bleeding disorder caused by a deficiency in clotting factors such as VIII or IX. Von Willebrand disease is described as the most common inherited bleeding disorder caused by a defect in the von Willebrand factor. The document also outlines different types of acquired bleeding disorders and their causes, including deficiencies in clotting factors due to conditions like liver disease, vitamin K deficiency, or effects of anticoagulant drugs.
Bleeding, clotting,platelet disorder and it's managementRakhiYadav53
This document provides information on various bleeding, clotting, and platelet disorders and their nursing management. It discusses hemophilia, disseminated intravascular coagulation (DIC), hypoprothrombinemia, and idiopathic thrombocytopenic purpura. For each disorder, it covers definition, etiology, clinical manifestations, risk factors, diagnostic findings, medical management, complications, and nursing management. Hemophilia is defined as a hereditary coagulation disorder caused by a deficiency in clotting factor VIII or IX. DIC is an abnormal blood clotting response triggered by underlying diseases or conditions that causes clotting throughout the blood vessels. Nursing focuses on pain management, monitoring
Factor v deficiency is rare
first described in a Norwegian patient in 1943, Identified by Dr. Paul Owren .
Fewer than 200 cases of congenital factor V deficiency have been reported worldwide since 1943.
inheritance of factor V deficiency is autosomal recessive.
usually only needed for severe bleeds or before surgery.
there is no concentrate containing only factor V.
fresh plasma or (FFP) infusions are used to correct the deficiency temporarily and should be given daily during a bleeding episode.
Different blood tests given for bleeding disorders or blood dyscrasiaTickendra Das
The document discusses blood dyscrasias, which are pathological conditions of the blood that usually involve disorders of the cellular elements of blood. Blood dyscrasia can refer to diseases where platelets, white blood cells, or red blood cells are too high or too low. Common blood dyscrasias include diseases that affect platelets like ITP and TTP, diseases that affect clotting factors like hemophilia and von Willebrand's disease, and diseases that affect red blood cells like sickle cell anemia. Tests used to diagnose blood dyscrasias include complete blood count, bleeding time, activated partial thromboplastin time, platelet aggregation test, and prothrombin time.
Approach to the adult with bleeding disorderAli S. Mayali
The normal clotting process involves platelets and coagulation factors working together to form a clot and stop bleeding. Platelets initially aggregate at the site of injury and release substances to enhance clotting. Coagulation factors are then activated through initiation and amplification pathways, leading to thrombin generation and fibrin strand formation to stabilize the clot. Bleeding disorders can occur if there are deficiencies or dysfunctions of platelets, coagulation factors, or excessive fibrinolysis. Laboratory tests including platelet count, bleeding time, prothrombin time, activated partial thromboplastin time, and thrombin time are used to evaluate the hemostatic system and identify the cause of bleeding disorders.
Key coagulation disorders covered in this document include hemophilia A caused by a factor VIII deficiency, hemophilia B from a factor IX deficiency, and von Willebrand disease where von Willebrand factor is defective
This document discusses various bleeding disorders including hemophilia, von Willebrand disease, and acquired bleeding disorders. It defines hemophilia as a rare genetic bleeding disorder caused by a deficiency in clotting factors such as VIII or IX. Von Willebrand disease is described as the most common inherited bleeding disorder caused by a defect in the von Willebrand factor. The document also outlines different types of acquired bleeding disorders and their causes, including deficiencies in clotting factors due to conditions like liver disease, vitamin K deficiency, or effects of anticoagulant drugs.
Bleeding, clotting,platelet disorder and it's managementRakhiYadav53
This document provides information on various bleeding, clotting, and platelet disorders and their nursing management. It discusses hemophilia, disseminated intravascular coagulation (DIC), hypoprothrombinemia, and idiopathic thrombocytopenic purpura. For each disorder, it covers definition, etiology, clinical manifestations, risk factors, diagnostic findings, medical management, complications, and nursing management. Hemophilia is defined as a hereditary coagulation disorder caused by a deficiency in clotting factor VIII or IX. DIC is an abnormal blood clotting response triggered by underlying diseases or conditions that causes clotting throughout the blood vessels. Nursing focuses on pain management, monitoring
Factor v deficiency is rare
first described in a Norwegian patient in 1943, Identified by Dr. Paul Owren .
Fewer than 200 cases of congenital factor V deficiency have been reported worldwide since 1943.
inheritance of factor V deficiency is autosomal recessive.
usually only needed for severe bleeds or before surgery.
there is no concentrate containing only factor V.
fresh plasma or (FFP) infusions are used to correct the deficiency temporarily and should be given daily during a bleeding episode.
The Public Presentation does not include any confidential information or findings from this Team Masters Project with BioMarin Pharmaceutical.
BioMarin and KGI titled our project as:
"Recurrent bleeding in patients with mechanical flow devices: an environmental study."
The document discusses various coagulation disorders including:
1. Congenital coagulation disorders such as hemophilia A and B which are caused by deficiencies in coagulation factors VIII and IX.
2. Acquired coagulation disorders including disseminated intravascular coagulation (DIC), vitamin K deficiency, liver disease, and antibodies against coagulation factors.
3. The pathogenesis, clinical features, laboratory findings, and treatment of various coagulation disorders are explained.
Approach to a bleeding disorder: These presentation has the approach for a patient of bleeding disorder. it has History, physical finding, Investigations.
This document discusses bleeding disorders and provides details on specific disorders such as von Willebrand disease, hemophilia, and immune thrombocytopenia. It describes the pathophysiology of hemostasis and the coagulation cascade. Signs and symptoms of bleeding disorders are outlined depending on whether they affect the primary or secondary phase of hemostasis. The diagnostic approach and differential diagnosis for evaluating bleeding disorders is also summarized.
This document discusses common bleeding disorders in children. It covers bleeding disorders caused by defects in blood vessels, platelets, or coagulation factors. Specific disorders mentioned include hemophilia A/B, von Willebrand disease, immune thrombocytopenia, and platelet function disorders. Signs, symptoms, diagnosis, and management are described for each condition. The document provides an overview of evaluating children for bleeding disorders and differentiating between qualitative and quantitative platelet and coagulation factor defects.
Reversal of warfarin associated coagulopathy prothrombin complex concentratesTÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
This document provides an overview of venous thrombo-embolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). It discusses the prevalence and impact of VTE, defining key terms like anticoagulants and thrombolytics. The presentation contents are outlined as covering the prevalence, diagnostic modalities and algorithm, and updates to the medical management of VTE. Diagnostic tests for VTE include ultrasound Doppler, D-dimer testing, and imaging studies like CT scans. Treatment involves anticoagulation or thrombolysis to prevent clots from growing or causing harm.
Demands for Haemophilia tratment centres to fullfull universal health access...SEJOJO PHAAROE
Haemophilia ia a rare disease that affect 1: 10 000 people. Demands for services, medication and access to cheap effective clotting factors is a human right for people living with haemophilia. A haemophilia registry is a demand from the Government at large .. Essential drug list should also contain haemophilia medication.
we need to be contacted for more information
www.thinktankent.com
This document summarizes a seminar presentation on approaches to bleeding disorders in pediatric patients. It provides an overview of homeostasis and the blood clotting process, as well as some common bleeding disorders seen in pediatrics. The diagnosis of bleeding disorders involves taking a medical history, performing a physical exam, and conducting laboratory investigations such as platelet count, bleeding time, prothrombin time, activated partial thromboplastin time, and thrombin time to evaluate the platelet count and function, as well as factors in the intrinsic and extrinsic coagulation pathways.
The document provides guidelines for diagnosing and managing disseminated intravascular coagulation (DIC). It states that DIC diagnosis requires both clinical and laboratory information. The International Society for Thrombosis and Haemostasis scoring system objectively measures DIC and correlates with clinical outcomes. The cornerstone of DIC treatment is treating the underlying condition. Transfusions are generally reserved for bleeding patients, though platelets may be considered for patients with platelet counts under 50 · 109/l who are at high risk of bleeding or will undergo an invasive procedure.
This document discusses various bleeding disorders including:
1. Disorders of primary haemostasis including vessel wall abnormalities like hereditary haemorrhagic telangiectasia and scurvy, as well as platelet function disorders and thrombocytopenia.
2. Coagulation disorders including haemophilia A, haemophilia B, von Willebrand disease, and acquired bleeding disorders.
3. Specific details are provided on hereditary haemorrhagic telangiectasia, scurvy, idiopathic thrombocytopenic purpura, haemophilia A, haemophilia B, and von Willebrand disease. Management strategies are discussed for treating bleeding episodes in these
Hemophilia A is the most common form of hemophilia, caused by reduced levels or activity of coagulation factor VIII. This leads to prolonged and unstable clot formation when bleeding occurs. Symptoms can range from bleeding after circumcision or venipuncture in infants to spontaneous bleeding in joints in older patients. Diagnosis involves tests that show prolonged activated partial thromboplastin time and low factor VIII levels. Treatment replaces the missing clotting factor, with severity and location of bleeding determining dosage. Preventative treatment and education on self-administered factor replacement can help manage symptoms.
This document discusses hemostasis and various bleeding disorders. It defines hemostasis and describes the primary and secondary stages. The primary stage involves platelet plug formation from platelet adhesion, activation, and aggregation. The secondary stage activates the intrinsic and extrinsic coagulation pathways. The document outlines various signs and symptoms of bleeding disorders and provides examples. It discusses screening tests like complete blood count, prothrombin time, activated partial thromboplastin time, and bleeding time. Finally, it analyzes several case scenarios involving abnormal coagulation test results.
Bleeding disorders are genetic disorders characterized by prolonged or increased bleeding due to abnormalities in the blood's ability to clot. They result from decreased levels or function of one of the eleven clotting factors involved in clot formation. The three stages of normal clotting are vessel constriction, platelet plug formation, and fibrin clot formation. In bleeding disorders, the first two stages function normally but a mature fibrin clot does not form due to the missing clotting factor, leading to repeated bleeding and clotting. The most common types are hemophilia A and B which result from factor VIII and IX deficiencies. A detailed patient history, especially of abnormal bleeding in male family members, is important for diagnosis
This document discusses various factors that can lead to intravascular thrombosis, known as the Virchow triad of endothelial injury, abnormal blood flow, and hypercoagulability. It focuses on how endothelial injury and activation from physical or chemical insults can promote a prothrombotic state. Abnormal blood flow from turbulence or stasis is also prothrombotic by damaging endothelium and allowing platelets to adhere. Hypercoagulability can be inherited through gene mutations or acquired through conditions, medications, cancers, or age. Specific acquired hypercoagulable states of concern are heparin-induced thrombocytopenia and anti-phospholipid antibody syndrome.
This document provides an overview of approach to bleeding and evaluation of bleeding disorders. It discusses the basics of hemostasis including platelets and clotting factors. Common bleeding disorders like thrombocytopenia, hemophilia, and von Willebrand disease are described. The evaluation of bleeding disorders includes history, physical exam, and screening laboratory tests. Specific coagulation factor deficiencies, liver disease, disseminated intravascular coagulation, and acquired coagulation factor inhibitors are also reviewed. Treatment focuses on supporting hemostasis and addressing underlying causes.
Hemophilia is a group of inherited bleeding disorders caused by deficiencies in clotting factors VIII or IX. The main types are hemophilia A (factor VIII deficiency) and hemophilia B (factor IX deficiency). Symptoms include prolonged bleeding from minor injuries, excessive bruising, and bleeding into joints and muscles. Treatment involves replacing the missing clotting factor through infusions of factor concentrates. Nursing care focuses on preventing and controlling bleeding episodes, limiting joint damage, managing pain, providing education and emotional support to patients and families, and ensuring proper long-term home management of the condition.
Von Willebrand disease (VWD) is the most common inherited bleeding disorder, caused by mutations resulting in decreased or impaired von Willebrand factor (VWF). VWF promotes clotting by forming bridges between platelets and injured endothelium, and between platelets. It also carries and protects factor VIII. VWD is classified into three main types - type I is most common due to VWF deficiency; type II involves functional defects; type III is most severe with very low VWF. Treatment involves desmopressin, VWF replacement, or factor VIII depending on type and severity of bleeding. Careful management is needed around surgery, delivery, and circumcision.
Hemophilia is a genetic bleeding disorder caused by deficiencies in coagulation factors VIII or IX. It affects males primarily and can range from mild to severe. The main types are hemophilia A (factor VIII deficiency) and hemophilia B (factor IX deficiency). Treatment involves replacing the missing clotting factor through prophylactic or on-demand regimens to prevent or treat bleeding episodes. Complications can include hemarthrosis, joint damage, fractures, and pseudotumors, so treatment seeks to maintain adequate factor levels and address medical issues promptly. Proper diagnosis and laboratory testing are needed to determine severity and guide personalized management.
You will submit your proposal as a text-based Word or PDF file. AnastaciaShadelb
You will submit your proposal as a text-based Word or PDF file.
Your research proposal should include the following:
Your selected global ethical dilemma
Background/explanation of why this is a global ethical issue
Make connections to issues of cultural diversity
Research question
Two scholarly, peer-reviewed sources connected to your selected topic (cited in current APA format)
***NOTE***
RESEARCH IS ON GENDER DISCRIMINATION
...
What is Family Resource Management and why is it important to tAnastaciaShadelb
"What is Family Resource Management and why is it important to today's American family?"
Goldsmith, E. B., & GOLDSMITH, E. B. (2003). Resource Management. In J. J. Ponzetti Jr. (Ed.),
International encyclopedia of marriage and family
(2nd ed.). Farmington, MI: Gale. Retrieved from
RESOURCE MANAGEMENT
from
International Encyclopedia of Marriage and Family
Resource management
is the process in which individuals and families use what they have to get what they want. It begins with thinking and planning and ends with the evaluation of actions taken. Three fundamental concepts in resource management are
values, goals
, and
decision making.
Values such as honesty and trust are principles that guide behavior. They are desirable or important and serve as underlying motivators. Values determine goals, which are sought-after end results. Goals can be implicit or explicit. They can be short-term, intermediate-, or long-term. Decisions are conclusions or judgments about some issue or matter.
Decision making
involves choosing between two or more alternatives and follows a series of steps from inception to evaluation.
Through choices, individuals and families define their lives and influence the lives of others. The study of resource management focuses on order, choices, and control, and how people use time, energy, money, physical space, and information. As an applied social science, it is an academic field that is fundamental to our understanding of human behavior. "The knowledge obtained through the study of management is evaluated in light of its ability to make an individual's or family's management practice more effective" (Goldsmith 2000, p. 5).
Individuals and families have characteristic ways of making decisions and acting called their
management style.
Although similar styles are exhibited within families (such as a tendency to be on time or to finish tasks to completion), there are also wide ranges of styles within families making the study of management intrinsically interesting, especially from a
socialization
point of view. Why do such differences exist and how does the individual's style mesh with that of the other members' styles in the family?
Measuring devices, techniques, or instruments that are used to make decisions and plan courses of action are called management tools. For example, time is a resource and a clock or stopwatch is a management tool.
Resources can be divided up into human and material resources, assets that people have at their disposal.
Material resources
(e.g., bridges, roads, houses) decline through use whereas
human resources
(e.g., the ability to read, ride a bicycle) improve or increase through use.
Human capital
describes the sum total of a person's abilities, knowledge, and skills. Education is one way to develop human capital. Related to this is the concept of social capital. The term
social capital
is gaining in importance in the family-relations field and management is considered ...
The Public Presentation does not include any confidential information or findings from this Team Masters Project with BioMarin Pharmaceutical.
BioMarin and KGI titled our project as:
"Recurrent bleeding in patients with mechanical flow devices: an environmental study."
The document discusses various coagulation disorders including:
1. Congenital coagulation disorders such as hemophilia A and B which are caused by deficiencies in coagulation factors VIII and IX.
2. Acquired coagulation disorders including disseminated intravascular coagulation (DIC), vitamin K deficiency, liver disease, and antibodies against coagulation factors.
3. The pathogenesis, clinical features, laboratory findings, and treatment of various coagulation disorders are explained.
Approach to a bleeding disorder: These presentation has the approach for a patient of bleeding disorder. it has History, physical finding, Investigations.
This document discusses bleeding disorders and provides details on specific disorders such as von Willebrand disease, hemophilia, and immune thrombocytopenia. It describes the pathophysiology of hemostasis and the coagulation cascade. Signs and symptoms of bleeding disorders are outlined depending on whether they affect the primary or secondary phase of hemostasis. The diagnostic approach and differential diagnosis for evaluating bleeding disorders is also summarized.
This document discusses common bleeding disorders in children. It covers bleeding disorders caused by defects in blood vessels, platelets, or coagulation factors. Specific disorders mentioned include hemophilia A/B, von Willebrand disease, immune thrombocytopenia, and platelet function disorders. Signs, symptoms, diagnosis, and management are described for each condition. The document provides an overview of evaluating children for bleeding disorders and differentiating between qualitative and quantitative platelet and coagulation factor defects.
Reversal of warfarin associated coagulopathy prothrombin complex concentratesTÀI LIỆU NGÀNH MAY
Để xem full tài liệu Xin vui long liên hệ page để được hỗ trợ
: https://www.facebook.com/thuvienluanvan01
HOẶC
https://www.facebook.com/garmentspace/
https://www.facebook.com/thuvienluanvan01
https://www.facebook.com/thuvienluanvan01
tai lieu tong hop, thu vien luan van, luan van tong hop, do an chuyen nganh
This document provides an overview of venous thrombo-embolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). It discusses the prevalence and impact of VTE, defining key terms like anticoagulants and thrombolytics. The presentation contents are outlined as covering the prevalence, diagnostic modalities and algorithm, and updates to the medical management of VTE. Diagnostic tests for VTE include ultrasound Doppler, D-dimer testing, and imaging studies like CT scans. Treatment involves anticoagulation or thrombolysis to prevent clots from growing or causing harm.
Demands for Haemophilia tratment centres to fullfull universal health access...SEJOJO PHAAROE
Haemophilia ia a rare disease that affect 1: 10 000 people. Demands for services, medication and access to cheap effective clotting factors is a human right for people living with haemophilia. A haemophilia registry is a demand from the Government at large .. Essential drug list should also contain haemophilia medication.
we need to be contacted for more information
www.thinktankent.com
This document summarizes a seminar presentation on approaches to bleeding disorders in pediatric patients. It provides an overview of homeostasis and the blood clotting process, as well as some common bleeding disorders seen in pediatrics. The diagnosis of bleeding disorders involves taking a medical history, performing a physical exam, and conducting laboratory investigations such as platelet count, bleeding time, prothrombin time, activated partial thromboplastin time, and thrombin time to evaluate the platelet count and function, as well as factors in the intrinsic and extrinsic coagulation pathways.
The document provides guidelines for diagnosing and managing disseminated intravascular coagulation (DIC). It states that DIC diagnosis requires both clinical and laboratory information. The International Society for Thrombosis and Haemostasis scoring system objectively measures DIC and correlates with clinical outcomes. The cornerstone of DIC treatment is treating the underlying condition. Transfusions are generally reserved for bleeding patients, though platelets may be considered for patients with platelet counts under 50 · 109/l who are at high risk of bleeding or will undergo an invasive procedure.
This document discusses various bleeding disorders including:
1. Disorders of primary haemostasis including vessel wall abnormalities like hereditary haemorrhagic telangiectasia and scurvy, as well as platelet function disorders and thrombocytopenia.
2. Coagulation disorders including haemophilia A, haemophilia B, von Willebrand disease, and acquired bleeding disorders.
3. Specific details are provided on hereditary haemorrhagic telangiectasia, scurvy, idiopathic thrombocytopenic purpura, haemophilia A, haemophilia B, and von Willebrand disease. Management strategies are discussed for treating bleeding episodes in these
Hemophilia A is the most common form of hemophilia, caused by reduced levels or activity of coagulation factor VIII. This leads to prolonged and unstable clot formation when bleeding occurs. Symptoms can range from bleeding after circumcision or venipuncture in infants to spontaneous bleeding in joints in older patients. Diagnosis involves tests that show prolonged activated partial thromboplastin time and low factor VIII levels. Treatment replaces the missing clotting factor, with severity and location of bleeding determining dosage. Preventative treatment and education on self-administered factor replacement can help manage symptoms.
This document discusses hemostasis and various bleeding disorders. It defines hemostasis and describes the primary and secondary stages. The primary stage involves platelet plug formation from platelet adhesion, activation, and aggregation. The secondary stage activates the intrinsic and extrinsic coagulation pathways. The document outlines various signs and symptoms of bleeding disorders and provides examples. It discusses screening tests like complete blood count, prothrombin time, activated partial thromboplastin time, and bleeding time. Finally, it analyzes several case scenarios involving abnormal coagulation test results.
Bleeding disorders are genetic disorders characterized by prolonged or increased bleeding due to abnormalities in the blood's ability to clot. They result from decreased levels or function of one of the eleven clotting factors involved in clot formation. The three stages of normal clotting are vessel constriction, platelet plug formation, and fibrin clot formation. In bleeding disorders, the first two stages function normally but a mature fibrin clot does not form due to the missing clotting factor, leading to repeated bleeding and clotting. The most common types are hemophilia A and B which result from factor VIII and IX deficiencies. A detailed patient history, especially of abnormal bleeding in male family members, is important for diagnosis
This document discusses various factors that can lead to intravascular thrombosis, known as the Virchow triad of endothelial injury, abnormal blood flow, and hypercoagulability. It focuses on how endothelial injury and activation from physical or chemical insults can promote a prothrombotic state. Abnormal blood flow from turbulence or stasis is also prothrombotic by damaging endothelium and allowing platelets to adhere. Hypercoagulability can be inherited through gene mutations or acquired through conditions, medications, cancers, or age. Specific acquired hypercoagulable states of concern are heparin-induced thrombocytopenia and anti-phospholipid antibody syndrome.
This document provides an overview of approach to bleeding and evaluation of bleeding disorders. It discusses the basics of hemostasis including platelets and clotting factors. Common bleeding disorders like thrombocytopenia, hemophilia, and von Willebrand disease are described. The evaluation of bleeding disorders includes history, physical exam, and screening laboratory tests. Specific coagulation factor deficiencies, liver disease, disseminated intravascular coagulation, and acquired coagulation factor inhibitors are also reviewed. Treatment focuses on supporting hemostasis and addressing underlying causes.
Hemophilia is a group of inherited bleeding disorders caused by deficiencies in clotting factors VIII or IX. The main types are hemophilia A (factor VIII deficiency) and hemophilia B (factor IX deficiency). Symptoms include prolonged bleeding from minor injuries, excessive bruising, and bleeding into joints and muscles. Treatment involves replacing the missing clotting factor through infusions of factor concentrates. Nursing care focuses on preventing and controlling bleeding episodes, limiting joint damage, managing pain, providing education and emotional support to patients and families, and ensuring proper long-term home management of the condition.
Von Willebrand disease (VWD) is the most common inherited bleeding disorder, caused by mutations resulting in decreased or impaired von Willebrand factor (VWF). VWF promotes clotting by forming bridges between platelets and injured endothelium, and between platelets. It also carries and protects factor VIII. VWD is classified into three main types - type I is most common due to VWF deficiency; type II involves functional defects; type III is most severe with very low VWF. Treatment involves desmopressin, VWF replacement, or factor VIII depending on type and severity of bleeding. Careful management is needed around surgery, delivery, and circumcision.
Hemophilia is a genetic bleeding disorder caused by deficiencies in coagulation factors VIII or IX. It affects males primarily and can range from mild to severe. The main types are hemophilia A (factor VIII deficiency) and hemophilia B (factor IX deficiency). Treatment involves replacing the missing clotting factor through prophylactic or on-demand regimens to prevent or treat bleeding episodes. Complications can include hemarthrosis, joint damage, fractures, and pseudotumors, so treatment seeks to maintain adequate factor levels and address medical issues promptly. Proper diagnosis and laboratory testing are needed to determine severity and guide personalized management.
You will submit your proposal as a text-based Word or PDF file. AnastaciaShadelb
You will submit your proposal as a text-based Word or PDF file.
Your research proposal should include the following:
Your selected global ethical dilemma
Background/explanation of why this is a global ethical issue
Make connections to issues of cultural diversity
Research question
Two scholarly, peer-reviewed sources connected to your selected topic (cited in current APA format)
***NOTE***
RESEARCH IS ON GENDER DISCRIMINATION
...
What is Family Resource Management and why is it important to tAnastaciaShadelb
"What is Family Resource Management and why is it important to today's American family?"
Goldsmith, E. B., & GOLDSMITH, E. B. (2003). Resource Management. In J. J. Ponzetti Jr. (Ed.),
International encyclopedia of marriage and family
(2nd ed.). Farmington, MI: Gale. Retrieved from
RESOURCE MANAGEMENT
from
International Encyclopedia of Marriage and Family
Resource management
is the process in which individuals and families use what they have to get what they want. It begins with thinking and planning and ends with the evaluation of actions taken. Three fundamental concepts in resource management are
values, goals
, and
decision making.
Values such as honesty and trust are principles that guide behavior. They are desirable or important and serve as underlying motivators. Values determine goals, which are sought-after end results. Goals can be implicit or explicit. They can be short-term, intermediate-, or long-term. Decisions are conclusions or judgments about some issue or matter.
Decision making
involves choosing between two or more alternatives and follows a series of steps from inception to evaluation.
Through choices, individuals and families define their lives and influence the lives of others. The study of resource management focuses on order, choices, and control, and how people use time, energy, money, physical space, and information. As an applied social science, it is an academic field that is fundamental to our understanding of human behavior. "The knowledge obtained through the study of management is evaluated in light of its ability to make an individual's or family's management practice more effective" (Goldsmith 2000, p. 5).
Individuals and families have characteristic ways of making decisions and acting called their
management style.
Although similar styles are exhibited within families (such as a tendency to be on time or to finish tasks to completion), there are also wide ranges of styles within families making the study of management intrinsically interesting, especially from a
socialization
point of view. Why do such differences exist and how does the individual's style mesh with that of the other members' styles in the family?
Measuring devices, techniques, or instruments that are used to make decisions and plan courses of action are called management tools. For example, time is a resource and a clock or stopwatch is a management tool.
Resources can be divided up into human and material resources, assets that people have at their disposal.
Material resources
(e.g., bridges, roads, houses) decline through use whereas
human resources
(e.g., the ability to read, ride a bicycle) improve or increase through use.
Human capital
describes the sum total of a person's abilities, knowledge, and skills. Education is one way to develop human capital. Related to this is the concept of social capital. The term
social capital
is gaining in importance in the family-relations field and management is considered ...
What can you do as a teacher to manage the dynamics of diversityAnastaciaShadelb
What can you do as a teacher to manage the dynamics of diversity in your classroom? How can you differentiate for the culturally diverse students in your classroom to ensure a safe, supportive, compassionate, and caring learning environment without compromising your personal values and spiritual beliefs?
...
Week 4 APN Professional Development Plan PaperPurpose The purAnastaciaShadelb
Week 4: APN Professional Development Plan Paper
Purpose
The purpose of this assignment is to provide the student with an opportunity to explore the nurse practitioner (NP) practice requirements in his/her state of practice, NP competencies and leadership skills to develop a plan to support professional development.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the ability to:
1. Examine roles and competencies of advanced practice nurses essential to performing as leaders and advocates of holistic, safe, and quality care. (CO1)
2. Analyze essential skills needed to lead within the context of complex systems. (CO3)
3. Explore the process of scholarship engagement to improve health and healthcare outcomes in various settings. (CO4)
Due Date
Assignment should be submitted to the Week 4 Roles in APN Professional Development Plan dropbox by Sunday 11:59 p.m. MST at the end of Week 4.
When the assignment is placed in the dropbox, it will automatically be submitted to Turnitin. You may submit the assignment one additional time before the due date to lower the Turnitin score. If you choose to resubmit, the second submission will be considered final and subject to grading. Once the due date for the assignment passes, you may not resubmit to lower a Turnitin score.
This assignment will follow the late assignment policy specified in the course syllabus.
Students are expected to submit assignments by the time they are due. Assignments submitted after the due date and time will receive a deduction of 10% of the total points possible for that assignment for each day the assignment is late. Assignments will be accepted, with penalty as described, up to a maximum of three days late, after which point a zero will be recorded for the assignment.
In the event of a situation that prevents timely submission of an assignment, students may petition their instructor for a waiver of the late submission grade reduction. The instructor will review the student's rationale for the request and make a determination based on the merits of the student's appeal. Consideration of the student's total course performance to date will be a contributing factor in the determination. Students should continue to attend class, actively participate, and complete other assignments while the appeal is pending.
Total Points Possible: 200
Requirements
A
Week 4 Paper Template to be used for your assignment is required for this assignment.
1. The
APN Professional Development Plan paper is worth 200 points and will be graded on the quality of the content, use of citations, use of Standard English grammar, sentence structure, and overall organization based on the required components as summarized in the directions and grading criteria/rubric.
2. Submit the paper as a Microsoft Word Document, which is the required format at Chamberlain University. You are encouraged to use the APA Academic Writer and G ...
TopicTransitions of Care in Long- Term Care (LTC)Discuss CAnastaciaShadelb
Topic:
Transitions of Care in Long- Term Care (LTC):
Discuss Care Coordination, Subacute Care, Post-Acute care, and the impact of U.S Healthcare Policies and Regulations on transitions of care
Details:
·
2 pages
·
APA 7 th edition reference style with recent references within the last 5 years
·
3 references
Health Financial ManagementRead this article: Hirsch, J.A., Harvey, H.B., Barr, R. M., Donovan, W. D., Duszak, R., Nicola, G. N., ... & Manchikanti, L. (2016): ‘’Sustainable Growth Rate Repealed, MACRA Revealed: Historical Context and Analysis of Recent Changes in Medicare Physician Payment Methodologies’’
Once you have read the article, discuss the Medicare Sustainable Growth Rate. “The SGR target is calculated on the basis of projected changes in 4 factors:
1) fees for physicians’ services,
2) the number of Medicare beneficiaries,
3) US gross domestic product, and
4) service expenditures based on changing law or regulations (Hirsch, et al. 2016).”
How have these 4 factors been tied to fiscal performance? Find some additional sources and support your position in few paragraphs.
Details
- 2 pages
- 3 PARAGRAPHS ONLY
· Paragraph 1 – answer the question, supporting your answer by citing from the RELIABLE SOURCES using proper APA format. Terms need to be defined in order to receive as many points as possible.
· Paragraph 2 – expand your answer by including additional information and opinions
·
· Paragraph 3 – Summarize your answer, concluding with a thought or an opinion of your own.
- APA 7 th edition reference style with recent references within the last 5 years
- 3 references
...
Topic Hepatitis B infection Clinical Practice PresenAnastaciaShadelb
Topic: Hepatitis B infection
Clinical Practice Presentation . The focus of the presentation
must reflect current treatment recommendations from accepted professional organizations.
Clinical Standard of Practice Presentation
Students are expected to expand their use of resources for evidence-based practice beyond the required text and explore nursing and related literature to improve their understanding and application of advanced interventions. Each student will present a Clinical Practice Presentation. The focus of the presentation must reflect current treatment recommendations from accepted professional organizations. Presentations will be evaluated related to the criteria listed.
Presentations must be no more than twelve slides in a PowerPoint format with a Reference List in APA format which once done must be sent by email to me and/or posted on week of the due time frame. Topics will be listed, and students must sign up for presentation by the second week of the course..
image1.png
...
The Fresh Detergent CaseEnterprise Industries produces Fresh, AnastaciaShadelb
The Fresh Detergent Case
Enterprise Industries produces Fresh, a brand of liquid detergent. In order to more effectively manage its inventory, the company would like to better predict demand for Fresh. To develop a prediction model, the company has gathered data concerning demand for Fresh over the last 33 sales periods. Each sales period is defined as one month. The variables are as follows:
·
Period = Time period in month
·
Demand = Y = demand for a large size bottle of Fresh (in 100,000)
·
Price = the price of Fresh as offered by Ent. Industries
·
AIP = the Average Industry Price
·
ADV = Enterprise Industries Advertising Expenditure (in $100,000) to Promote Fresh in the sales period.
·
DIFF = AIP - Price = the "price difference" in the sales period
Only the trend of PRICE is negative. Other four variables have positive trends. However, the R2 values suggest that for ADV and DEMAND only the linear model is explained by the data points moderately (66% and 51% respectively). For all the other three variables, the R2 values are too poor to accept the models as adequates because very few percent of data points actually represents the linear model.
As expected, the Demand is negatively correlated with Price. But the regression line equation cannot be relied upon due to poor R2 value. For other three variables, there is a positive correlation. Out of these, for the ADV variable, the regression line can be adequate for the R2 value is moderately higher.
Interpretation
Strong positive correlation is found between
1. PERIOD and ADV
2. PERIOD and DEMAND
3. AIP and DIFF
4. DIFF and ADV
5. DIFF and DEMAND
6. ADV and DEMAND
Strong negative correlation exists between
1. PRICE and DIFF
2. PRICE and ADV
3. PRICE and DEMAND
PERIOD
DEMAND
Forecast
MA(3)
Forecast
MA(6)
Absotute Error - MA(3)
Absotute Error - MA(6)
1
9.4
2
10.3
3
11.5
4
11.1
10.4
0.7
5
11
11.0
0.0
6
10.5
11.2
0.7
7
10.2
10.9
10.6
0.7
0.4
8
8.9
10.6
10.8
1.7
1.9
9
8.3
9.9
10.5
1.6
2.2
10
8.12
9.1
10.0
1.0
1.9
11
8.8
8.4
9.5
0.4
0.7
12
9.8
8.4
9.1
1.4
0.7
13
10.1
8.9
9.0
1.2
1.1
14
11.3
9.6
9.0
1.7
2.3
15
12.5
10.4
9.4
2.1
3.1
16
12.4
11.3
10.1
1.1
2.3
17
12.1
12.1
10.8
0.0
1.3
18
11.8
12.3
11.4
0.5
0.4
19
11.5
12.1
11.7
0.6
0.2
20
11
11.8
11.9
0.8
0.9
21
10.2
11.4
11.9
1.2
1.7
22
10.3
10.9
11.5
0.6
1.2
23
10.9
10.5
11.2
0.4
0.2
24
11.2
10.5
11.0
0.7
0.2
25
12.5
10.8
10.9
1.7
1.7
26
13.4
11.5
11.0
1.9
2.4
27
14.7
12.4
11.4
2.3
3.3
28
14.1
13.5
12.2
0.6
1.9
29
14
14.1
12.8
0.1
1.2
30
13.5
14.3
13.3
0.8
0.2
31
13.5
13.9
13.7
0.4
0.2
32
13.1
13.7
13.9
0.6
0.8
33
12.5
13.4
13.8
0.9
1.3
34
13.0
13.5
MAD =
0.9
1.3
Since MAD of MA(3) is less than that of MA(6), we should be preferring MA(3) over MA(6). However, Moving average may not be a good choice for predicting the demand because there is a clear p ...
tables, images, research tools, mail merges, and much more. Tell us AnastaciaShadelb
tables, images, research tools, mail merges, and much more. Tell us how these features can help you collaborate and work with others? What feature surprised you the most? Do you think you can do better research documents after this week? Why are tools such as spelling and translation so important specially in the United States? Add a PowerPoint and a word document
...
TBSB NetworkThe Best Sports Broadcasting Network is home to alAnastaciaShadelb
TBSB Network
The Best Sports Broadcasting Network is home to all college football games, events, and updates. From Alabama and Clemson to Mount Union and Wheaton College, Division 1 to Division 3 top to bottom 24/7 college football. Being a college football athlete myself and having played at Clemson University and now here at University of Maryland I understand the different levels of exposure programs and athletes get even across power 5 conferences there is some exposure but different and some more than others. What my goal and plan for TBSB is that we bring the same amounts of awareness and exposure to their programs that the Clemson’s and Alabama’s receive to their programs.
After conducting many research experiments on former college athletes as well as parents, family members of student athletes, and fans I learned that they are not happy with not having the chance to always support and watch programs who aren’t top tier and do not have the same lime light as others. I also found that there is not one particular network that shows all power 5 conference football games on Saturdays, there are different networks you have to pay for monthly to keep up with all football games from different conferences. For example, you have ACC Network, Big 10 Network, and SEC Network for each of these networks you need a different subscription and or certain cable plan. With TBSB we are putting all of these networks under one station to give families, fans, and much more the best possible experience.
I feel like this network will be beneficial to many different people starting with the players. Giving all players who are not receiving a lot of exposure this prime television opportunity for family and friends to watch and cheer them on. Also giving these players opportunities to be evaluated, and scouted by the NFL for those who have that desire. This network will also be beneficial to the university itself, football programs have a chance to increase school’s revenue at any given time. Putting these different schools in the lime light will increase the chances to help up school’s revenue. Last but not least TBSB will be beneficial to families, friends, fans, and much more the people who are not able to make it to the games but would still love to support and cheer on these programs. With the click of a button all of their problems are solved with TBSB giving them the chance to watch not only the games of their loved ones but any other college football games of their choice.
Currently, I am in the process of finalizing the concept and sources of revenue, as of now my guaranteed sources of revenue will come from customers who sign up they will pay a monthly fee. My next source of revenue I want to work with television companies to have TBSB added to their channel listings and work with these different companies for another stream of revenue. These are my biggest “road blocks” at the moment. I also will have to find workers who are willing and dedica ...
SU_NSG6430_week2_A2_Pand
ey_R.docx
by Ram Pandey
Submission date: 04-Sep-2020 06:47PM (UTC-0400)
Submission ID: 1379955415
File name: SU_NSG6430_week2_A2_Pandey_R.docx (20.8K)
Word count: 685
Character count: 4114
89%
SIMILARITY INDEX
42%
INTERNET SOURCES
2%
PUBLICATIONS
89%
STUDENT PAPERS
1 89%
Exclude quotes Off
Exclude bibliography Off
Exclude matches Off
SU_NSG6430_week2_A2_Pandey_R.docx
ORIGINALITY REPORT
PRIMARY SOURCES
Submitted to South University
Student Paper
FINAL GRADE
/20
SU_NSG6430_week2_A2_Pandey_R.docx
GRADEMARK REPORT
GENERAL COMMENTS
Instructor
PAGE 1
PAGE 2
PAGE 3
PAGE 4
SU_NSG6430_week2_A2_Pandey_R.docxby Ram PandeySU_NSG6430_week2_A2_Pandey_R.docxORIGINALITY REPORTPRIMARY SOURCESSU_NSG6430_week2_A2_Pandey_R.docxGRADEMARK REPORTFINAL GRADEGENERAL COMMENTSInstructor
SOAP NOTE
Name: MT
Date:12/3/19
Time: 0930
Encounter 2
Age: 32
Sex: Female
SUBJECTIVE
CC:
“I need to start on birth control, I just don’t know which one to go on as there are so many to choose from.”
HPI:
30 -year-old Asian American female that presents to the clinic requesting to start birth control.
Medication: (list with reason for med)
PT is not taking any medication currently
PMH: None
Allergies: Does not have any food or drug allergies
Medication Intolerances: None
Chronic Illnesses/Major traumas:
Patient denies any medical trauma
Chronic Health Problems: No known chronic health problems
Hospitalization/Surgeries: None
Family History: Mother Healthy. Father HTN. Sister Healthy. Brother autism
Social History:
Social history is negative for ETOH and she denies past or present illicit drug use. Denies present use of tobacco. States she does exercise regularly, and is not on a specific diet. Pt is currently in school for accounting.
ROS
General:
Patient denies weight change, fatigue, fever, chills, night sweats, energy level
Cardiovascular:
Denies any episodes of chest pain, palpitations, syncope or orthopnea.
Skin:
Denies any skin lesions.
Respiratory:
Patient denies dyspnea. Denies cough
Eyes:
Patient states no changes in vision, no blurred or double vision.
Gastrointestinal:
Patient denies any change in appetite, denies nausea and vomiting. denies any bowel changes
Ears:
No recent hearing loss, tinnitus, denies any ear discharge or pressure.
Genitourinary/Gynecological:
Patient denies any itching, burning or discharge
Last PAP: 9/11/18
Mammogram: 11/2/18
Pregnancy: G4P3
Not on any contraception, is currently sex ...
Sheet1Risk Register for Project NameDateProject NameID No.RankRisAnastaciaShadelb
This document appears to be a risk register template for a project that lists risks by ID number, rank, description, category, root cause, potential triggers, responses, risk owner, probability, impact, and status. However, the document contains no further details to summarize as it appears to be an empty template.
1
2
Final Project Topic
Final Project Topic
I selected the question: Analyze differences among research, evidence-based practice, practice-based evidence, comparative effectiveness research, outcomes research, and quality improvement. How do these practices affect nursing and patient outcomes?
Selected References
Davis, K., Gorst, S. L., Harman, N., Smith, V., Gargon, E., Altman, D. G., ... & Williamson, P. R. (2018). Choosing important health outcomes for comparative effectiveness research: An updated systematic review and involvement of low and middle-income countries. PloS one, 13(2), e0190695.
Davies, C., Lyons, C., & Whyte, R. (2019). Optimizing nursing time in a daycare unit: Quality improvement using Lean Six Sigma methodology. International Journal for Quality in Health Care, 31(Supplement_1), 22-28.
Eppley, K., Azano, A. P., Brenner, D. G., & Shannon, P. (2018). What counts as evidence in rural schools? Evidence-based practice and practice-based evidence for diverse settings. The Rural Educator, 39(2).
Fiset, V. J., Graham, I. D., & Davies, B. L. (2017). Evidence-based practice in clinical nursing education: A scoping review. Journal of Nursing Education, 56(9), 534-541.
Forsythe, L., Heckert, A., Margolis, M. K., Schrandt, S., & Frank, L. (2018). Methods and impact of engagement in research, from theory to practice and back again: early findings from the Patient-Centered Outcomes Research Institute. Quality of Life Research, 27(1), 17-31.
Gargon, E., Gorst, S. L., Harman, N. L., Smith, V., Matvienko-Sikar, K., & Williamson, P. R. (2018). Choosing important health outcomes for comparative effectiveness research: 4th annual update to a systematic review of core outcome sets for research. PloS one, 13(12), e0209869.
...
12
Capstone Project
Olivia Timmons
Department of Nursing. St. Johns River State College
NUR 4949: Nursing Capstone
Dr. C. Z. Velasco
November 14, 2021
Capstone Project
There is a saying that states one can only learn through doing it, practically and physically. It is the explanation as to why it is very important to implement the skills acquired in theory into practice to ascertain one’s competence. This is even more crucial in the medical field as they have no choice but just to be perfect at what they are doing, the only secret is through practice. Practicums connect the two worlds of theory and classwork, thus breaking the monotony alongside connecting what was taught in class with what happens in the field. They are important as apart from sharpening the student’s skills, they also open a window of opportunity and build up connections that will come in handy for the student later on. They will feel the experience and the pressure that comes with it thus preparing themselves accordingly.
Statement of the Problem
Timing is essential in the nursing field and the Emergency Room is notorious for its long wait times. The goal of a clinical laboratory is to deliver medically useful results for patients on a timely basis. This goal can be hindered by the new paradigm of the modern laboratory – “do more with less" (Lopez, 2020). When implementing new care models for patients, the patient perspective is critical. The objective of this study was to describe and develop an understanding of the information needs of patients in the ED waiting room concerning ED wait time notification (Calder, 2021). As a patient arrives at the ER waiting area, it's critical to have lab results for the provider to evaluate. I can give you an example of a patient that waited in the waiting room for over 3 hours, no labs were completed because they were waiting for the patient to go back into a room. The patient was suffering from a heart attack and his troponins were elevated and no one knew until 3 hours later. If POC labs were done on all patients as soon as they arrived, mistakes like these can be avoided. Completed POC blood can cut the wait times in half and the laboratory also won't be backed up on resulting lab specimens.
PICOT Question
Question: Is there a significant decrease in Emergency Department patient length of stay (LOS) for those whose blood was analyzed using POC testing versus those whose blood was analyzed using laboratory testing?
· P-Population= emergency room patients
· I-Intervention or Exposure= POC testing of blood specimens
· C-Comparison= Laboratory blood specimens
· O-Outcome= Decrease patient stay in the emergency room
· T-Time = N/A
History of the Issue
The length of patient stay in the emergency department (ED) is an issue that not only increases the severity of illnesses but also reduces the quality of patient care. Serious health conditions including diabetes and hypertension can worsen while patients are ...
12
First Name Last Name
Plaza College
MGT1003 Section 8 – Supervisory Management
Professor Aicha Cesar
Spring 2022
1. Do you believe that Joe Trosh has the right to carry a concealed weapon in the hospitaldue to being harassed for visiting casinos?
Part IA: The Purpose of the Report and the Problem
The purpose of the report is to solve the problem of whether or not Joe Trosh has the right to carry a concealed weapon in the hospital as a reason for self-defense against discrimination and harassment from the staff of a rural hospital in Oklahoma. According to the U.S. Equal Employment Opportunity Commission, harassment is a form of employment that violates Title VII of the Civil Rights Act of 1964, Age Discrimination Employment Act of 1967, and Americans with Disabilities Act of 1990 ("Equal Employment Opportunity Commission," n.d.).
The Equal Employment Opportunity Commission outlined that “harassment’’ based on race/color discrimination means unwelcome conduct that is based on color, religious background, sex, national origin, older age, disability, or genetic information that is based on medical history ("U.S. Equal Employment Opportunity Commission," n.d.).
Hirsch (2018) stated that the impact of discrimination on racism often creates challenges that the human resource manager is responsible for overcoming. In a workplace, racism is evident through macroaggression, defined as indirect, subtle, and unintentional acts of discrimination against marginalized groups.
Harassment based on stereotypes can affect an organization’s decision-making process in many ways, such as making a quick judgment without looking at the consequences. It also makes people feel preconceptions about a specific group of people leading to harsh treatment.in addition, harassment of stereotypes leads to fixed beliefs about the place of women and men in society.
Managers need to know about the Second Amendment right to bear arms and U.S. Supreme Court Cases that examine this issue because it will protect the hospital from legal matters ("Cornell Law School," n.d.). The District of Columbia v. Heller case in which the supreme court held in 2008 on the second Amendment regarding firearm possession. It gives one the right to possess firearms, independent of service in state militia use the guns for self-defense.
A potential legal issue the Supervisor must consider is how to handle discipline decisions that involve employees who have experienced discrimination through harassment by co-workers. According to the Oklahoma Self-Defense Act, it is “not right for a person to identify themselves as a licensed handgun or as lawfully in possession of any other firemen if the law does not demand information."
Part 1B The Research Experience
To perform my research, I began with online research. I used Google and searched for articles rights of carrying weapons to work as a form of self-defense and discrimination and harassment in the place of work.
I have foun ...
12Epic EMR ImplementationComment by Author 2 Need a AnastaciaShadelb
1
2
Epic EMR Implementation
Comment by Author 2: Need a running head. Ex:
RUNING HEAD: Implementation of EMR
Implementation of Electronic Medical Records (EMR) Comment by Author 2: Your topic is very broad. You should have a unique identification of basically what you are trying to investigate with your research. Basically, you need to try to funnel it. For instance, The impact of the EMR on ...... Comment by Author 2: Also, the title doesn't tell the story of your research. Basically, the reader should be attracted to your topic just by reading the title. That is why is very broad and doesn't present an attractive meaning. Comment by Author 2: Example: The Implementation of EMR: Tjhe Role of Data in ... Comment by Author 2: Or, Barriers to Implementing the EMR in ....
HCIN 699-51 – B-2021/Summer
Applied Project in Healthcare Informatic
Dr. Chaza Abdul and Dr. Glenn Mitchell
Prepared by:
Name: Bolade Yusuf
Student ID: 273092
Harrisburg University
08/18/21
Table of Contents
INTRODUCTION 3
1.1 Background to research problem 3
1.1.1 Electronic Medical Records (EMR) 3
1.1.2 Patient’s Data 4
1.2 Problem Statement 4
1.3 Objectives 5
1.4 Research Questions 5
1.5 Significance of the Research 5
LITERATURE REVIEW 6
2.1 Introduction 6
2.2 Features of an Effective EMR 6
2.3 Barriers to adoption of EMR 8
2.4 Addressing EMR adoption barriers 9
2.5 Related Work 11
RESEARCH METHODOLOGY 12
3.0 Introduction 12
3.1 Research Philosophy 12
3.2 Research design 12
3.3 Study Population Sample 13
3.4 Sample Size and Sampling Procedure 13
3.5 Data Collection 14
DATA ANALYSIS AND FINDINGS 15
4.1 Data Analysis 15
4.2 Findings 15
4.3 Benefits of epic EMR 16
Conclusion 17
References 18
Appendix 1: Survey Questionnaire 20
Appendix 2:Survey Questions Response Analysis 21
INTRODUCTION1.1 Background to research problem
Health care is critical in any society. Managing patient’s data goes a long way in ensuring good treatment measures are taken. Health care information therefore must be collected correctly and stored in a manner which abides by the principled of confidentiality, integrity and accessibility (Kaushal et al., 2009). Data regarding a patient should be kept confidential as much as possible and only retrieved when needed. A good health records management system should be able to confidentially store patient’s data. Each patient should have an account within the system where their data is stored. Access to this data should be given on privileges basis and only to individuals who will use it for treatment of the patient. The patient’s data in a good health information management system should be of high integrity. Data should be collected from the source (the patient) and recorded during the collection process. Having an intermediary stage where data is recorded in in a secondary avenue before being transferred to the primary system could lead to errors thus compromising its integrity. A good health information management system should also ...
12Facebook WebsiteAdriana C. HernandezRasmussen UnAnastaciaShadelb
1
2
Facebook Website
Adriana C. Hernandez
Rasmussen University
COURSE#: MA242/BSC2087C
Jenessa Gerling
05/01/2022
Thesis Statement: Facebook, which emerged as a standalone website, is used worldwide. Facebook has emerged as one of the 21st century's largest companies, with a consumer base of people who understand the word internet.
Title of Paper: Facebook Website
I. Introduction
A. Attention grabbing sentence about topic
Facebook, which emerged as a standalone website, is used worldwide. Skyrocketing revenues' simplified version of the term perception is a way of perceiving or viewing things and refers to how the brain knows how things are or processes things (Mosquera et al.,2020).
B. Thesis statement
Facebook, which emerged as a standalone website, is used worldwide. Facebook has emerged as one of the 21st century's largest companies, with a consumer base of people who understand the word internet.
II. First paragraph main point – topic sentence
The case in this study involves deciphering the website perception elements and related responses to the same crucial points as follows:
A. Supporting details (in-text citation for outside resource used as support/evidence)
1. Details about the supporting details
Sensory response refers to the way we respond to specific website visual elements. The website contains both a design pattern and a logo which most individuals worldwide are aware of today.
2. Details about the supporting details
The image of the logo is a letter f-like. The most dominant colour in the ad on Facebook is blue and white shades used to design and highlight the tangible symbol.
B. Supporting details (in-text citation)
There are also lines and shapes in the logo, and as mentioned, the logo lines include lines and a square box forming a bold character, 'f' and highlighting the Facebook company name (Plantin et al.,2018). Contrast and balance are also incorporated. There is contrast present and light colours in the image that easily distinguish the Facebook symbol from other symbols such as WhatsApp and YouTube. The balance is indicated in the proper depiction of the 'F' symbol, highlighting everything around the same.
C. Transition sentence
On the other hand, perceptual response refers to the number of groups of persons attracted to the ad and those not attracted.
III. Second paragraph main point – topic sentence
Though perceptual response targets a potential user base involving many people from any age group, ethnicity, or age, it is more dominant among the youth, in my view.
A. Supporting details (in-text citation)
The aged have no more time in the Facebook like the youth who are in desire remain informed and have interest in sharing their feelings and information through the platform (Plantin et al.,2018).
1. Details about the supporting details
The technical response involves specific elements, including buttons and dropdowns worldwide, which technically impact the user.
2. Details about the supporting details
T ...
1
2
Experience
During my clinical placement in a neurosurgical unit, we would occasionalJy exa mine epilepsy
patients to document any seizures. These patients rarely require substantial nursing care, and
most are self-sufficient with only 1-2 prescriptions administered every six hours. I was working
an early shift, and my buddy nurse assigned me to three patients, one of whom was under
examination for a seizure. My buddy nurse handed me the drawer keys and indicated the
medication was in the side drawer when I went with my nurse to provide the patient medication.
Looking over the initial purchase, I began my safety check prior to dispensing the prescription
and discovered that it had expired in February 2019. I requested that my preceptor come over
and take a look at the package. She realized the medication was out of date when she noticed the
expiration date. She then went out of the room with the packaging. When she returned, she
indicated that she had reported the event to the NUM. I then inquired if there was anything else
we needed to do, but I was respectfully told to stay out of it. I took a set of vitals on the patient,
which were all normal, and the buddy nurse was given a new pack of medication that was still
usable. I felt accomplished at the end of my shift since I had followed the procedure for providing
the correct medication and had identified the problem. Being a part. of event reporting and alerting
the doctors, on the other hand, would have been a great experience. Overall, I followed NSHQS's
safety requirements and medication standards when performing my nursing responsibilities.
h
...
1
2
Dissertation Topic Approval
Dissertation Topic Approval
Topic
How can the fourth industrial revolution technologies be used to address the current climatic issues facing the world?
General Reasoning
I selected this research topic because climatic change has become a major concern today, with world leaders and researchers trying to develop ways to address this concern. There are several adverse impacts of climatic change on the world. One of the adverse effects is that humans and animals face new challenges for their survival due to the consequences of climatic change. Climatic change has resulted in increased temperature levels in the world, rising sea levels, shrinking glaciers, and increased ocean temperatures. It has resulted in frequent and intense droughts, storms, and heat waves threatening animals' lives. It has also resulted in biodiversity loss due to limited adaptability and the economic implications of these climatic changes. One of the ways that can be used to deal with climatic issues is through the use of technology which can help reduce greenhouse gas emissions. The fourth revolution technologies such as the internet of things, artificial intelligence, and cloud computing can play a vital role in addressing these climatic challenges.
Potential thesis
The fourth industrial revolution technologies such as the internet of things, artificial intelligence, and cloud computing can play a vital role in addressing these climatic challenges; therefore, it is important to determine how these technologies can be utilized to achieve the environmental objectives of the world.
Thesis map for your Literature Review
The literature review will consist of articles that have been published over the five years. It will consist of journals and articles that have researched fourth industrial revolutions that can be used to address climatic change.
The research topic I selected for my dissertation is related to the program goals and core courses by addressing the revolution of technology and its applications in addressing the world's challenges.
...
12Essay TitleThesis Statement I. This is the topicAnastaciaShadelb
The document outlines the structure for a Rogerian argument essay on school uniforms. It provides instructions for introducing opposing viewpoints in three paragraphs, then addressing the proponents' viewpoints in three more paragraphs. It instructs to then write a paragraph presenting a compromise viewpoint. Each main point should have an introductory topic sentence, a quote or paraphrase with citation, commentary, and transitional statement. The outline concludes by stating the conclusion paragraph should reiterate the compromise and benefits of accepting it.
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
Philippine Edukasyong Pantahanan at Pangkabuhayan (EPP) CurriculumMJDuyan
(𝐓𝐋𝐄 𝟏𝟎𝟎) (𝐋𝐞𝐬𝐬𝐨𝐧 𝟏)-𝐏𝐫𝐞𝐥𝐢𝐦𝐬
𝐃𝐢𝐬𝐜𝐮𝐬𝐬 𝐭𝐡𝐞 𝐄𝐏𝐏 𝐂𝐮𝐫𝐫𝐢𝐜𝐮𝐥𝐮𝐦 𝐢𝐧 𝐭𝐡𝐞 𝐏𝐡𝐢𝐥𝐢𝐩𝐩𝐢𝐧𝐞𝐬:
- Understand the goals and objectives of the Edukasyong Pantahanan at Pangkabuhayan (EPP) curriculum, recognizing its importance in fostering practical life skills and values among students. Students will also be able to identify the key components and subjects covered, such as agriculture, home economics, industrial arts, and information and communication technology.
𝐄𝐱𝐩𝐥𝐚𝐢𝐧 𝐭𝐡𝐞 𝐍𝐚𝐭𝐮𝐫𝐞 𝐚𝐧𝐝 𝐒𝐜𝐨𝐩𝐞 𝐨𝐟 𝐚𝐧 𝐄𝐧𝐭𝐫𝐞𝐩𝐫𝐞𝐧𝐞𝐮𝐫:
-Define entrepreneurship, distinguishing it from general business activities by emphasizing its focus on innovation, risk-taking, and value creation. Students will describe the characteristics and traits of successful entrepreneurs, including their roles and responsibilities, and discuss the broader economic and social impacts of entrepreneurial activities on both local and global scales.
This presentation was provided by Rebecca Benner, Ph.D., of the American Society of Anesthesiologists, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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2. trauma. However, it is important to recognize when bleeding
problems are more serious or
more frequent due to an underlying hemostatic abnormality.
Abnormal bleeding represents an important health care problem.
For example, in the
United States, it has been estimated that at least 5% to 10% of
women of childbearing age
seek medical care for menorrhagia and have bleeding severe
enough to require medical
intervention. Among the many defects that can cause abnormal
bleeding, inherited and
acquired von Willebrand disease (VWD) and platelet function
disorders are much more
common than defects in coagulation and fibrinolytic proteins.
PATHOPHYSIOLOGY
REVIEW OF NORMAL HEMOSTASIS
Hemostasis consists of the following steps: (1) initiation and
formation of the platelet
plug, also known as primary hemostasis; (2) propagation and
amplification of the clotting
“cascade” or secondary hemostasis, which involves activation of
a series of coagulation
factors resulting in the generation of thrombin that cleaves
fibrinogen to fibrin; (3) cross-
linking of fibrin; (4) termination of procoagulant response by
antithrombotic control
mechanisms; (5) removal of the clot by fibrinolysis; and (6)
tissue repair and regeneration.
When a vessel is injured, platelets adhere to exposed collagen
and other components
of the subendothelium as the first defense against bleeding. This
3. initial adhesion is
dependent on von Willebrand factor (VWF) as well as specific
platelet receptors (eg,
glycoprotein IbIXV) for VWF and collagen. This adhesion leads
to platelet activation and
shape change as well as platelet aggregation, which promotes
recruitment of additional
platelets.
Coagulation is initiated in vivo when endothelial or vascular
cells are damaged. This
results in exposure of blood to tissue factor (TF), which binds
to factor VII (FVII) and its
activated form, factor VII (FVIIa). TF-FVIIa complexes
(extrinsic tenase) then activates
factors IX and X directly. Activated factor IX can also form a
complex with factor VIIIa as
well as phospholipids and calcium, called the intrinsic tenase
complex, which promotes
further conversion of factor X to factor Xa. The generated
factor Xa associates with
activated factor V, phospholipids, and calcium to form the
prothrombinase complex that
activates prothrombin to thrombin. Intrinsic and extrinsic tenase
are needed to generate
enough thrombin for normal hemostasis. Once thrombin is
generated, it cleaves fibrinogen
to fibrin, which leads to formation of a fibrin clot and promotes
platelet activation and the
generation of activated factors V and VIII. Thrombin also
results in the formation of
activated XIII, an enzyme that cross-links fibrin to make the
clot more resistant to
fibrinolysis (the cleavage of the fibrin clot).
When coagulation is activated, fibrinolysis is activated, leading
5. formation, due to the
associated factor VIII deficiency. Drugs that inhibit platelet
function (eg, aspirin,
nonsteroidal anti-inflammatory drugs, serotonin reuptake
inhibitors) and those that inhibit
coagulation (eg, heparin, warfarin) are important causes to
consider when evaluating and
managing an individual with bleeding.
TABLE 172-1 Questions to Consider when Evaluating a Patient
for a Possible Bleeding
Disorder
What are the patient’s bleeding symptoms?
• Is there a personal or family history of bleeding with trauma
or procedures?
• What are the site(s) of bleeding?
• For women: Is there a history of prolonged, heavy periods or
bleeding with childbirth?
• What is the severity of bleeding?
• What is the duration of bleeding events?
• Has the patient required any treatments for bleeding?
Does the history suggest a congenital or acquired problem?
• Note: For congenital bleeding disorders, the bleeding
symptoms may date back to
childhood and may affect other family members; acquired
bleeding disorders should be
considered when the bleeding problems are more recent, and a
drug-induced defect
should be excluded.
What is the timing of the bleeding?
• Is the bleeding immediate or delayed (onset one or more days
after challenges)?
Is the bleeding systemic or local?
7. WHEN TO SUSPECT A BLEEDING DISORDER
In general, a bleeding disorder should be suspected when
bleeding occurs with minimal or
no provocation, when it is more severe than expected for a
given challenge, and when
bleeding episodes occur repeatedly with challenges. Care should
be taken to avoid asking
very subjective questions about bleeding. For example, it is
preferable to ask women about
menstrual periods lasting longer than 7 days, with more than 2
to 3 days of heavy flow,
and/or periods that interfere with their lifestyle than to ask if
they experience “heavy”
periods. Similarly, asking about bruises as big as or larger than
oranges and/or bruises
appearing without provocation is better than asking about “easy
bruising.”
While individuals with severe bleeding problems may report
spontaneous bleeding and
serious bleeding with major and minor hemostatic challenges,
individuals with milder
defects can report abnormal bleeding with some but not all
significant hemostatic
challenges. While inherited, severe bleeding problems typically
present early in life, milder
inherited bleeding problems and acquired bleeding problems
often get diagnosed in adult
life. The clinical assessment should be directed toward
identifying the type and severity of
bleeding problems experienced by an individual, in order to
plan appropriate laboratory
testing and therapy.
KEY COMPONENTS OF THE HISTORY
8. What are the patient’s bleeding symptoms?
The patient should be questioned about his or her current
bleeding symptoms and past
bleeding symptoms and a family history of bleeding problems
(Table 172-2). The
following characteristics of the bleeding should be determined:
association with trauma or
procedures and if it occurred with some or all minor and major
procedures; site(s)
(including joint bleeds); severity (eg, bleeding resulting in
additional interventions such as
blood transfusions, intensive care unit admission, and/or
prolongation of hospitalization
stay); duration of bleeding; and any treatments that were given
to control bleeding (types
of drugs or blood products). It may be helpful to determine if
the patient received
anticoagulants or drugs that inhibit platelet function. Female
patients should be asked
questions about menstrual periods and abnormal bleeding with
childbirth and pregnancy
losses. Mucocutaneous bleeding (ie, abnormal bruising, gum
bleeding, and epistaxis) is
more suggestive of a defect in primary hemostasis. Some
bleeding symptoms, such as
deep tissue bleeding, joint hemorrhages, and spontaneous
unexplained hematuria are
uncommon but can occur in severe inherited coagulation protein
deficiencies. Some
bleeding problems, such as epistaxis, can be experienced by
individuals without bleeding
disorders. Bleeding after trauma should be considered but can
be difficult to evaluate
because it is not specific to individuals with bleeding disorders.
11. The bleeding history is often used to assess when abnormal
bleeding occurred (eg, same
day or days later) relative to invasive surgical or dental
procedures. Bleeding during,
immediately after, or on the same day as the challenge is
suggestive of a disorder of
primary hemostasis (see Disorders of Primary Hemostasis later
in this chapter), whereas
bleeding that becomes problematic one or more days after a
challenge is more typical of a
factor deficiency or a fibrinolytic defect.
Is the bleeding disorder congenital or acquired, and are there
aggravating or
contributing factors?
Inherited problems tend to present earlier in life than acquired
problems unless they are
mild. Inherited problems are often associated with a positive
family history, which may be
negative if the condition is recessive or X-linked. A thorough
bleeding history should
include questions about potential aggravating or contributing
factors such as new
medications (eg, aspirin or antidepressant therapy).
Individuals with acquired bleeding disorders often describe
bleeding that is more recent
in onset. Causes of an acquired bleeding disorder are listed in
Table 172-2 and include
liver disease, vitamin K deficiency, autoimmune-mediated
conditions (eg, immune
thrombocytopenic purpura), hypothyroidism, acquired factor
VIII deficiency or acquired
VWD, and other conditions such as Cushing syndrome.
12. It is important to emphasize that the patient’s entire bleeding
history must be assessed
in order to determine if the problem is mild or severe and if it is
likely congenital or
acquired.
Has the patient experienced any hemostatic challenges?
Patients should be questioned about how many operative and
invasive dental procedures
they have undergone, and how many of these were associated
with abnormal bleeding. It
may be helpful to ask if the patient has experienced any
unusually large ecchymosis
around incisions when evaluating the surgical bleeding history.
It is important to note that
individuals who have undergone a number of common surgical
and dental procedures (eg,
tonsillectomy, wisdom tooth extraction) without experiencing
abnormal bleeding might
still have a mild bleeding problem (particularly if other aspects
of their bleeding history are
abnormal); however, they are unlikely to have a severe bleeding
disorder. Alternately, it is
important to recognize that sometimes abnormal bleeding occurs
in healthy individuals
undergoing a major procedure due to technical complications.
What is the patient’s general medical history? Is there a
systemic disease that is causing
or contributing to the patient’s bleeding symptoms?
An evaluation of a patient’s general medical history for new or
worsening bleeding, and
other changes in health, is important for assessing undiagnosed
liver, kidney, or endocrine
14. clopidogrel, serotonin reuptake
inhibitors, or fish oil supplements); or defective coagulation
(eg, due to heparin or
warfarin).
PHYSICAL EXAMINATION
The physical examination is often not very informative in
individuals with a bleeding
disorder. An initial assessment of acute bleeding should
determine the patient’s
hemodynamic status and if there are signs of anemia. Blood
blisters in the mouth,
hemorrhages on the bite margins in the mouth, and petechiae
(tiny red-colored skin lesions
that reflect small hemorrhages into the skin, particularly on
dependent parts of the body
and at sites of trauma) may suggest significant
thrombocytopenia. Large bruises or
purpura may suggest a defect in primary hemostasis or acquired
hemophilia. Sometimes
the purpuric skin lesions of severe anticoagulant protein
deficiencies (eg, purpura
fulminans due to severe congenital protein C deficiency) are
mistaken for skin bleeding.
Abnormalities in joints, lymph nodes, spleen, and liver should
raise concern for the
possibility of a secondary bleeding disorder.
DIFFERENTIAL DIAGNOSIS BASED ON CLINICAL
ASSESSMENT
Table 172-3 outlines the differences between disorders of
primary and secondary
hemostasis.
16. Menorrhagia Common May occur
Inheritance (if congenital) Dominant or recessive Most common
cause
(hemophilia) is X-linked
Disorders of primary hemostasis
Patients with disorders of primary hemostasis will often
describe experiencing abnormal
bleeding during or within a few hours of a surgical or dental
procedure. These problems,
with or without mucocutaneous bleeding symptoms, should raise
questions about VWF
and platelet abnormalities (both qualitative and quantitative) or,
less commonly, blood
vessel abnormalities. Defects in primary hemostasis can also
present as troublesome
epistaxis and/or gingival bleeding, petechiae, superficial
bruising or ecchymosis, and
menorrhagia. Petechiae are very suggestive of a platelet or
vascular disorder.
Disorders of secondary hemostasis
Disorders of secondary hemostasis typically manifest as
delayed-onset bleeding that
becomes evident in the days following trauma or surgical
procedure. When there is a
severe factor deficiency, there can be spontaneous bleeding into
joint spaces
(hemarthroses) and into deep, soft tissues (eg, muscle
hematomas). The most common
inherited disorders of secondary hemostasis include hemophilia
A (factor VIII deficiency)
17. and hemophilia B (factor IX deficiency). Acquired hemophilia,
due to an antibody directed
against factor VIII, accounts for about 10% of all hemophilia.
Factor XIII deficiency and
fibrinolytic disorders can also present with delayed bleeding,
but these conditions are less
common. Acquired autoantibodies against coagulation proteins
are important but
infrequent causes of bleeding and most commonly affect factor
VIII, VWF, factor XIII or
factor V.
HOW SHOULD THIS PATIENT WITH A SUSPECTED
BLEEDING DISORDER BE
INVESTIGATED?
Investigations for bleeding problems need to consider the
etiologies of mild and severe
and common and rare disorders. Figure 172-1 summarizes a
stepwise approach to
investigation, some of which may be performed at the time of a
specialist evaluation.
Often, a broad range of tests is needed to assess an individual
with a suspected bleeding
disorder (see Figure 172-1). A complete blood count is helpful
to evaluate for
thrombocytopenia and to determine if there are other
hematologic abnormalities such as
anemia (which may reflect acute or chronic bleeding), or white
blood cell abnormalities
that may suggest an underlying bone marrow disorder. An
assessment for iron deficiency
(which may be present without anemia) should be considered. A
blood group and
antibody screen should be done before surgery in individuals
with a history of abnormal
19. coagulation tests.
TABLE 172-4 Differential Diagnosis of Coagulation Test
Abnormalities
PT APTT
Thrombin
Time Fibrinogen Platelet Count
Reference Intervals
~ 10-
13 s
Ranges
Vary
Ranges
Vary
150-400 mg/dL
1.5-4.0 g/L
150-400 ×
106/mL
Fibrinogen deficiency N – ↑ N – ↑ ↑ ↓ N
Factor VII deficiency ↑ N N N N
Factor VIII, IX, or XI
deficiency
N ↑ N N N
Factor II, V, X deficiency ↑ ↑ N N N
20. Factor deficiencies not
associated with bleeding
(factor XII, high-
molecular-weight
kininogen or prekallikrein
deficiency)
N ↑ N N N
Acquired hemophilia and
congenital hemophilia
with inhibitors
N ↑* N N N
Lupus anticoagulant N – ↑ N – ↑† N – ↑ N N
Heparin therapy or
sample contamination
N – ↑ ↑ ↑↑ N N
Liver disease N – ↑ N – ↑ N – ↑ ↓ – N – ↑ ↓ – N
Vitamin K deficiency ↑ N – ↑ N N N
Fibrinolytic therapy ↑ ↑ ↑ ↓ N
Consumptive
coagulopathy
N – ↑ ↑ ↑ ↓ ↓
Dilutional coagulopathy N – ↑ N – ↑ N – ↑ ↓ – N ↓
von Willebrand disease N N – ↑ N N N ↓ in type 2B
22. Additional tests can be helpful to evaluate if there is a history
of acquired bleeding,
which could reflect liver or renal disease or an endocrine
disorder such as hypothyroidism
or Cushing syndrome. As fibrinolytic defects are uncommon,
testing is rarely done except
by specialists.
PRACTICE POINT
In general, the patient’s symptoms, not the laboratory values,
should be treated. Local
factors can be significant contributors to bleeding and should be
considered in the
plans for investigation and treatment, even in patients with
documented
coagulopathies. Always consider risks and benefits (including
those of treating or not
treating) when deciding on appropriate therapies as the risks of
certain therapies
include increased prothrombotic risks. Patients with congenital
bleeding disorders are
best managed in a multidisciplinary care setting to plan
treatment and prevention of
acute bleeding episodes and to deal with complications (eg,
hemophilic arthropathy).
Information on the patient’s bleeding problem and the treatment
plans must be
communicated to both the patient and their health care
providers.
HOW SHOULD THIS PATIENT WITH A BLEEDING
DISORDER BE TREATED?
The management of each patient with a bleeding disorder
24. anticoagulants, anti-
inflammatory drugs that inhibit platelet function) should be
modified because of the
patient’s bleeding problems.
Information on the patient’s bleeding problem and the treatment
plans must be
communicated to both the patient and his health care providers.
Patients with
congenital bleeding disorders must be “taught” that prophylactic
treatment is required
prior to invasive procedures.
Patients with congenital bleeding disorders are best managed in
a multidisciplinary
care setting to plan treatment and prevention of acute bleeding
episodes and to deal
with complications (eg, hemophilic arthropathy).
OTHER ISSUES TO CONSIDER FOR TREATMENT OF
CONGENITAL BLEEDING
DISORDERS
Treatments for factor deficiencies
Individuals with moderate-to-severe clinically significant factor
deficiencies often require
factor concentrates (recombinant products generally preferred
over plasma-derived
products), although some conditions and circumstances (eg,
mild hemophilia due to
factor VIII deficiency with mild bleeding) may be managed with
desmopressin. Fibrinolytic
inhibitor drugs (aminocaproic acid and tranexamic acid) are
often used as an adjunctive
therapy for some procedures, such as dental and oral-nasal
surgeries. Fibrinolytic inhibitor
drugs are the treatment of choice for fibrinolytic disorders.
26. GENERAL MANAGEMENT OF COMMON ACQUIRED
BLEEDING DISORDERS
Liver disease
The coagulopathy related to liver disease is multifactorial, as
the liver is the major source
of all hemostatic proteins in plasma except for VWF and tissue
plasminogen activator.
Individuals with liver disease often have deficiencies of
multiple coagulation factors, and
in mild liver disease, there can be low levels of factors VII and,
at times, factors XI and XII.
Fibrinogen deficiency is typically only seen with severe liver
disease. In fact, fibrinogen
levels are often elevated in mild liver disease. Sometimes
patients with liver disease have
additional hemostatic defects such as vitamin K deficiency,
thrombocytopenia,
dysfibrinogenemia, platelet function abnormalities, and
disseminated intravascular
coagulation (DIC). If an individual with coagulopathy from
liver disease requires treatment
(ie, for active bleeding or, in some instances, before a procedure
associated with a
significantly increased risk of bleeding), one or more of the
following treatment options
should be considered: vitamin K replacement (if deficient),
plasma infusion (typically
requires four or more units to have measurable effects),
fibrinogen replacement (with
cryoprecipitate or fibrinogen concentrate), and/or platelet
transfusion. The role of
prothrombin complex concentrates in patients with liver disease
is uncertain.
27. Anticoagulant medications
Treatment of serious bleeding due to anticoagulants may require
reversal of the
anticoagulant. Patients on an oral vitamin K antagonist, who
require reversal to treat
bleeding, should receive vitamin K, and when more rapid
reversal is required (eg, to treat
life-threatening gastrointestinal bleeding), prothrombin complex
concentrate (if available)
or plasma infusion should be considered. Protamine sulfate can
be considered when there
is a need to rapidly reverse unfractionated heparin or low -
molecular-weight heparin
because of bleeding. However, this treatment reverses only
about 60% of the antifactor Xa
activity of low-molecular-weight heparin. Unfortunately, agents
are not currently available
to rapidly reverse some of the newer, novel anticoagulants that
are direct inhibitors of
thrombin or factor Xa. However, specific antidotes for direct
thrombin inhibitors and factor
Xa inhibitors have been developed and are undergoing clinical
testing. It is unclear
whether bleeding from these newer agents is improved by
treatment with desmopressin
acetate, fibrinolytic inhibitor drugs, or other treatments, such as
prothrombin complex
concentrates and factor VIIa.
Vitamin K deficiency
Acquired bleeding due to vitamin K deficiency results from
decreased gamma-
carboxylation of the vitamin K-dependent factors II, VII, IX,
and X and can be treated by
29. Haemophilia Center Doctors’ Organisation (UKHCDO)
guideline approved by the British
Committee for Standards in Haematology. Haemophilia.
2008;14:671-684.
Mannuci PM, Duga S, Peyvandi F. Recessively inherited
coagulation disorders. Blood.
2004;104:1243-1252.
Nichols WL, Hultin MB, James AH, et al. von Willebrand
disease (VWD): evidence-based
diagnosis and management guidelines, the National Heart, Lung,
and Blood Institute
(NHLBI) Expert Panel report (USA). Haemophilia.
2008;14:171-232.
Rydz N, James P. Approach to the diagnosis and management of
common bleeding
disorders. Semin Thromb Hemost. 2012; 38:711-719.
Rojas-Hernandez CM, Garcia DA. The novel anticoagulants.
Semin Thromb Hemost.
2012;39:117-126.
Verhovsek M, Moffat KA, Hayward CP. Laboratory testing for
fibrinogen abnormalities. Am
J Hematol. 2008;83:928-931.