B.

Paper and Pencil Test: (Identification and Essay Exam to be submitted via messenger or Gmail
account)

1. Describe the normal anatomy and physiology of the hematologic system.

Hematologic or hematopoietic system include the blood, blood vessels, and blood-forming
organs (bone marrow, spleen, liver, lymph nodes, and thymus gland). The hematologic system also pays
an important role in hormone transport, the inflammatory and immune responses, temperature

Blood transport gases, nutrients, waste products, processed molecules, and regulatory
molecules. It regulates pH, fluid and ion balance. It is also involved in temperature regulation and
protects against foreign substances like microorganisms and toxins, and it is also part of tissue repair
and prevents fluid and cell loss. Blood vessels on the other hand is where blood is being pumped from
the heart. It has three layers the tunica intima, tunica media and outer tunica adventitia. Hematopoiesis
is a process involving the bone marrow, spleen, liver, lymph nodes and thymus glands. An alteration to
any of these would result to a disease process involving hematologic or hematopoietic system.

2. A 63-year-old man presents to the emergency department (ED) with unilateral swelling and pain of
the left lower extremity, which is diagnosed as a DVT. He reports this is the third time he has had a
VTE.

How would you determine if he is at risk for having a hypercoagulable disorder?

He is at risk of having a hypercoagulable disorder if there is a decreased in circulation

coagulation inhibitors (which increase coagulation), impaired hepatic, and there is an absence of
fibrinolytic enzymes, and platelet aggregation promoting tortuous or atherosclerotic vessels. Thrombosis
may be an early symptom or a pre-existing cancer complication with an occult malignancy. Also, it can
be the product of more than one predisposing factor such as inherited or acquired deficiency conditions,
including hyperhomocysteinemia, AT deficiency, protein C deficiency, protein S deficiency, APC
resistance, and factor V Leiden deficiency. They are referred to as hypercoagulable states or
thrombophilia.

What would you include in your health history to assist you?

It is essential to assess the patient's lifestyle and also his laboratory findings. Furthermore, the
nurse could also educate genetic testing to the patient. Patients with a history of varicose veins,
hypercoagulation, neoplastic disease, cardiovascular disease, or recent major surgery or injury are at
high risk. Other patients at high risk include those who are obese or older adults and women taking oral
contraceptives (Cheever and Hinkle, 2018, p. 2335).

How would you respond if he asks you if he will “ever get off Coumadin”?

Most experts recommend continuing anticoagulation indefinitely for people with two or more
episodes of venous thrombosis or if a risk factor for clotting persists. The nurse should explain what
Coumadin is, what it does, how blood levels are monitored, and why the physician has ordered this
drug. It is also essential to explain thoroughly to the client the risks and benefits of Coumadin for further
understanding.

What would you include in your patient education to aid him in adhering to lifelong Anticoagulation?
 The patient needs to be educated about the disease's lifelong process, and thus therefore needs
lifelong care. The nurse should also explain what could happen if the patient does not adhere to the
medication regimen and treatment.

3. You are caring for a 32-year-old woman who has had repeated hospitalizations for sickle cell crisis.

What is the evidence that indicates which factors should be assessed to determine the patient’s
educational, coping, and pain management needs?

Many patients have considerable difficulty coping with chronic pain and repeated episodes of
sickle cell crisis and may find it difficult to adhere to a prescribed treatment plan. Some patients with
sickle cell anemia develop problems with substance abuse due to excruciating pain. This results from
invalidation of chronic pain which then promotes mistrust of the health care system and the need to
seek care from other sources. Prevention of crisis, adequate pain management, utilization of positive
coping skills and relaxation techniques, and education are essential to adequate sickle cell management.

What is the strength of that evidence? Identify the evidence base that supports concepts that you will
incorporate into the patient’s discharge plan.

The strength of the evidence is average. Evidence supporting the ideas that the nurse can
integrate into the discharge plan comes from studies done with sickle cell disease patients that have
proven to be statistically important in minimizing repeated sickle cell crises and helping patients control
their needs and cope with their disease. An evidence base is provided by the Sickle Cell Disease
Association of America, Inc.

References
Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth's Textbook of Medical-surgical Nursing (14th
ed.). Philadelphia, USA: Lippincott Williams and Wilkins.

Menaka, P., and Douketis, J. (2020). Patient education: Deep vein thrombosis (DVT) (Beyond the Basics).
Retrieved on November 14, 2020 at https://www.uptodate.com/contents/deep-vein-
thrombosis-dvt-beyond-the-basics#H18

Seeley, R. R., Stephens, T. D., & Tate, P. (2007). Essentials of Anatomy and Physiology (6 ed.). New
York:USA: McGraw-Hill Educatio.