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Questions and Answers
What is the MOST important instruction to give a patient who is starting Warfarin (Coumadin) therapy?
What is the MOST important instruction to give a patient who is starting Warfarin (Coumadin) therapy?
- Increase intake of green leafy vegetables to enhance the drug's effectiveness.
- Discontinue use if any minor bruising occurs.
- Take medication on an empty stomach to improve absorption.
- Maintain a consistent intake of Vitamin K through diet. (correct)
A patient is receiving both Warfarin and Heparin concurrently. What is the PRIMARY reason for this 'bridging' therapy?
A patient is receiving both Warfarin and Heparin concurrently. What is the PRIMARY reason for this 'bridging' therapy?
- To prevent heparin-induced thrombocytopenia.
- To immediately achieve a therapeutic INR while waiting for Warfarin to become effective. (correct)
- To reduce the risk of bleeding by combining two different anticoagulants.
- To enhance the absorption of Warfarin in the gastrointestinal tract.
What laboratory value is MOST important to monitor in a patient receiving IV Heparin?
What laboratory value is MOST important to monitor in a patient receiving IV Heparin?
- INR (International Normalized Ratio)
- CBC (Complete Blood Count)
- ALT (Alanine Aminotransferase)
- PTT (Partial Thromboplastin Time) (correct)
Which intervention is MOST important when administering thrombolytic therapy?
Which intervention is MOST important when administering thrombolytic therapy?
A patient on Clopidogrel (Plavix) is scheduled for surgery. What is the PRIMARY concern related to this medication?
A patient on Clopidogrel (Plavix) is scheduled for surgery. What is the PRIMARY concern related to this medication?
Which sign or symptom should a nurse IMMEDIATELY report when monitoring a patient receiving Heparin?
Which sign or symptom should a nurse IMMEDIATELY report when monitoring a patient receiving Heparin?
If a patient on Heparin develops Heparin-Induced Thrombocytopenia (HIT), what physiological response should the nurse monitor for?
If a patient on Heparin develops Heparin-Induced Thrombocytopenia (HIT), what physiological response should the nurse monitor for?
What is a PRIMARY contraindication for the use of Enoxaparin (Lovenox)?
What is a PRIMARY contraindication for the use of Enoxaparin (Lovenox)?
A patient taking Prednisone reports increased swelling and inflammation. What is the MOST appropriate nursing action?
A patient taking Prednisone reports increased swelling and inflammation. What is the MOST appropriate nursing action?
What dietary recommendation is MOST important for a patient prescribed Prednisone?
What dietary recommendation is MOST important for a patient prescribed Prednisone?
A patient taking inhaled steroids should be instructed to do what to prevent adverse effects?
A patient taking inhaled steroids should be instructed to do what to prevent adverse effects?
A patient presents with easy bruising, thin skin, and a buffalo hump. What endocrine disorder does this presentation suggest?
A patient presents with easy bruising, thin skin, and a buffalo hump. What endocrine disorder does this presentation suggest?
A patient is admitted with severe hypotension, altered mental status, and a history of long-term steroid use that was abruptly discontinued. What condition is MOST likely?
A patient is admitted with severe hypotension, altered mental status, and a history of long-term steroid use that was abruptly discontinued. What condition is MOST likely?
A patient taking Oseltamivir (Tamiflu) should be instructed to do what to maximize the effectiveness of the medication?
A patient taking Oseltamivir (Tamiflu) should be instructed to do what to maximize the effectiveness of the medication?
A patient is prescribed Acyclovir to manage herpes simplex virus. What is the MOST important information to emphasize regarding transmission?
A patient is prescribed Acyclovir to manage herpes simplex virus. What is the MOST important information to emphasize regarding transmission?
What is a MAJOR adverse effect to monitor for in a patient receiving HIV therapy?
What is a MAJOR adverse effect to monitor for in a patient receiving HIV therapy?
Which instruction is MOST important for a female patient of childbearing age who is prescribed Ribavirin?
Which instruction is MOST important for a female patient of childbearing age who is prescribed Ribavirin?
What education should the nurse give to the patient starting Rifampin regarding body secretions?
What education should the nurse give to the patient starting Rifampin regarding body secretions?
A patient is prescribed Isoniazid (INH) for tuberculosis. What supplement is typically recommended to prevent a common side effect?
A patient is prescribed Isoniazid (INH) for tuberculosis. What supplement is typically recommended to prevent a common side effect?
When is the BEST time to obtain a sputum culture for a patient being evaluated for tuberculosis?
When is the BEST time to obtain a sputum culture for a patient being evaluated for tuberculosis?
Flashcards
When to notify healthcare provider
When to notify healthcare provider
Notify healthcare provider for falls, bruising, bleeding, or critical lab values.
Bridging Therapy
Bridging Therapy
Warfarin and heparin are combined until INR is therapeutic because Warfarin takes 5 days to be therapeutic.
Therapeutic INR range for Warfarin
Therapeutic INR range for Warfarin
An INR of 2-3 is required for a patient on Warfarin.
Therapeutic INR range with a mechanical valve
Therapeutic INR range with a mechanical valve
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Dietary considerations with Warfarin
Dietary considerations with Warfarin
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Warfarin reversal agent
Warfarin reversal agent
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Warfarin drug interactions
Warfarin drug interactions
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Bleeding precautions (patient education)
Bleeding precautions (patient education)
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Enoxaparin (Lovenox) Patient Teaching
Enoxaparin (Lovenox) Patient Teaching
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Enoxaparin (Lovenox) Contraindications
Enoxaparin (Lovenox) Contraindications
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IV Heparin reversal agent
IV Heparin reversal agent
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IV Heparin Lab Monitoring
IV Heparin Lab Monitoring
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Thrombolytic therapy adverse reactions
Thrombolytic therapy adverse reactions
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Clopidogrel uses
Clopidogrel uses
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Signs to watch for
Signs to watch for
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Heparin induced thrombocytopenia
Heparin induced thrombocytopenia
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Prednisone contraindications
Prednisone contraindications
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Prednisone Therapeutic Response
Prednisone Therapeutic Response
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Prednisone Patient Teaching
Prednisone Patient Teaching
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Prednisone Side Effects
Prednisone Side Effects
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Study Notes
Coagulation Modifier Drugs
- Healthcare providers should be notified in the event of falls, bruising, bleeding, or critical lab values
Warfarin (Coumadin)
- Heparin and warfarin are used together until the INR reaches a therapeutic level
- Warfarin requires about 5 days to become therapeutic
- The therapeutic INR range is 2-3
- For mechanical valves, the INR goal is 2.5-3.5
- Diet should have consistent, but not necessarily limited, Vitamin K intake
- Vitamin K is the reversal agent
- NSAIDs and OTC medications can interact with Warfarin
- Bleeding precautions include monitoring Vitamin K intake, informing the doctor of falls, using a soft toothbrush, and applying pressure to stop bleeding
Enoxaparin (Lovenox)
- Patient teaching includes avoiding NSAIDs and alcohol and reporting any changes in bleeding
- Enoxaparin is contraindicated in patients with indwelling epidural catheters due to the risk of epidural hematoma
IV Heparin
- Protamine sulfate acts as the reversal agent
- Lab monitoring includes PTT
Thrombolytic Therapy
- Adverse effects include bleeding, cardiac dysrhythmias, and decreased blood pressure
Antiplatelets
- Clopidogrel can maintain stent patency after catheter placement, thereby preventing clots
Other Info
- Signs to watch for include hematuria, dark tarry stool, bruising, bleeding gums, petechiae, and blood in stool/urine/vomit
- Monitor for heparin-induced thrombocytopenia, which increases clotting
Adrenal Drugs
- Contraindications include immunosuppression, severe infections, and allergies
Prednisone
- Prednisone's therapeutic response includes decreased swelling and inflammation
- Patient teaching includes avoiding NSAIDs and alcohol, taper the dose, take with food in the morning, and avoid people with infections
- N/V/D and fatigue and potential side effects
Inhaled Steroids
- Patient teaching includes rinsing mouth after use
Cushing's Syndrome
- Results in too much cortisol, hypertension, easy bruising, thin skin, moon face, buffalo hump, abdominal fat, thin limbs, muscle weakness, and hyperglycemia
Addison's Disease
- Results in too little cortisol, hypotension, hyperpigmentation, weight loss, and muscle wasting
Adrenal Crisis
- Adrenal Crisis can be caused by abruptly stopping medications
- Can cause severe hypotensive shock, altered mental status, severe hypoglycemia, and severe low sodium with severe high potassium
Adverse reaction
- Cardiac adverse effects include potassium imbalance, increased blood pressure, and fluid retention
- CNS effects: irritability, mood swings, insomnia, anxiety
- Endocrine effects: increased appetite, weight gain, hyperglycemia
- GI effects: ulcers
- Integumentary effects: delayed wound healing, bruising, frail skin
- Musculoskeletal effects: muscle loss, weakness, osteoporosis
- Ocular effects: cataracts
- Nursing implications: monitor fluid balance, baseline skin condition, vitals, and signs of bleeding/infection
Oseltamivir/Zanamivir
- Therapy should start within 2 days of symptom onset
- Adverse effects include nausea, vomiting, cramping, and headache; taking with food may help
- Indication: reduce duration and severity of symptoms
Acyclovir
- Indications include reducing herpes simplex virus
- Take every day to reduce the risk of transmission and potential breakouts
HIV Therapy
- Adverse effects include bone marrow suppression, which can lead to low WBC or RBC counts, potentially requiring discontinuation of the drug
- Effectiveness is measured by a decrease in symptoms
- Patient education includes understanding it's not a cure, to take as directed with food, it is lifelong, and infection is to be reported
Antiviral vs. Antiretroviral
- Antivirals are for viruses, antiretrovirals are for HIV
Ribavirin
- Indication: Treats RSV (respiratory syncytial virus)
- Precautions: Avoid in pregnant or expecting women due to risk of miscarriage/birth defects if in the same room
Resistant Mycobacterium Infection
- Requires allergen support and treatment with 2+ drugs
Rifampin
- Patient education includes that medication can cause body secretions (urine, sweat, tears) to turn orange/brown, take with food, and render oral contraceptives ineffective, and can cause photosensitivity
- Liver function tests are important for lab monitoring
Isoniazid
- Patient education: take vitamin B6, avoid alcohol, take with food, report worsening signs, and be aware of possible numbness/tingling
- B6 supplementation may be necessary
Isoniazid
- Liver function tests for lab value monitoring
Sputum Culture
- Best time to obtain sputum culture is in the morning
Math
- Weight-based dosing: requires conversion of pounds to kilograms
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