Podcast
Questions and Answers
What is the primary mechanism of action of heparin in preventing blood clot formation?
What is the primary mechanism of action of heparin in preventing blood clot formation?
- Dissolving existing clots by directly breaking down fibrin.
- Directly inactivating thrombin and factor Xa.
- Activating antithrombin, which then inactivates thrombin and factor Xa. (correct)
- Inhibiting platelet aggregation, thereby preventing clot initiation.
Which of the following conditions is a therapeutic use for unfractionated heparin?
Which of the following conditions is a therapeutic use for unfractionated heparin?
- Preventing blood clots in prosthetic heart valves.
- Long-term outpatient treatment of deep vein thrombosis (DVT).
- Routine prophylaxis for all surgical patients.
- Acute management of an evolving stroke. (correct)
How do low molecular weight heparins (LMWH) differ from unfractionated heparin in their mechanism of action?
How do low molecular weight heparins (LMWH) differ from unfractionated heparin in their mechanism of action?
- LMWH activates antithrombin to inactivate both thrombin and factor Xa, similar to unfractionated heparin.
- LMWH primarily inhibits factor Xa, while unfractionated heparin inhibits both thrombin and factor Xa. (correct)
- LMWH enhances platelet aggregation, while unfractionated heparin prevents it.
- LMWH directly dissolves existing clots, whereas unfractionated heparin only prevents new clot formation.
Which of the following is a primary therapeutic use for low molecular weight heparins (LMWH)?
Which of the following is a primary therapeutic use for low molecular weight heparins (LMWH)?
Fondaparinux, an activated factor Xa inhibitor, is primarily used for:
Fondaparinux, an activated factor Xa inhibitor, is primarily used for:
Protamine sulfate is administered as an antidote to counteract the effects of which medication?
Protamine sulfate is administered as an antidote to counteract the effects of which medication?
A patient receiving heparin develops signs of toxicity. What is the most important nursing action?
A patient receiving heparin develops signs of toxicity. What is the most important nursing action?
Why is it important to administer protamine slowly when reversing the effects of heparin?
Why is it important to administer protamine slowly when reversing the effects of heparin?
When administering a subcutaneous injection of enoxaparin, why is it important to avoid rubbing the injection site after administration?
When administering a subcutaneous injection of enoxaparin, why is it important to avoid rubbing the injection site after administration?
A client is prescribed warfarin and reports regularly consuming large amounts of green leafy vegetables. How should the nurse advise the client regarding their diet?
A client is prescribed warfarin and reports regularly consuming large amounts of green leafy vegetables. How should the nurse advise the client regarding their diet?
A nurse is preparing to administer a subcutaneous injection to a client who is of larger stature. Which needle length would be the MOST appropriate to ensure the medication reaches the subcutaneous tissue?
A nurse is preparing to administer a subcutaneous injection to a client who is of larger stature. Which needle length would be the MOST appropriate to ensure the medication reaches the subcutaneous tissue?
Why is it important to use an electric razor instead of a traditional razor for clients taking enoxaparin or warfarin?
Why is it important to use an electric razor instead of a traditional razor for clients taking enoxaparin or warfarin?
A client on warfarin is also prescribed phenytoin for seizure control. What adjustments might be necessary regarding the warfarin dosage?
A client on warfarin is also prescribed phenytoin for seizure control. What adjustments might be necessary regarding the warfarin dosage?
A nurse discovers that a client receiving heparin has an aPTT level of 95 seconds. Which action should the nurse anticipate taking?
A nurse discovers that a client receiving heparin has an aPTT level of 95 seconds. Which action should the nurse anticipate taking?
A nurse is teaching a client about potential interactions with warfarin. Which over-the-counter supplement should the nurse advise the client to avoid?
A nurse is teaching a client about potential interactions with warfarin. Which over-the-counter supplement should the nurse advise the client to avoid?
What is the primary reason for rotating subcutaneous injection sites when administering medications like enoxaparin?
What is the primary reason for rotating subcutaneous injection sites when administering medications like enoxaparin?
A client on warfarin therapy is scheduled for a dental procedure. What instructions should the nurse provide regarding the warfarin dosage?
A client on warfarin therapy is scheduled for a dental procedure. What instructions should the nurse provide regarding the warfarin dosage?
A client with atrial fibrillation is prescribed warfarin to prevent thrombotic events. What is the expected pharmacological action of warfarin in this scenario?
A client with atrial fibrillation is prescribed warfarin to prevent thrombotic events. What is the expected pharmacological action of warfarin in this scenario?
A client receiving warfarin has an INR of 1.2. Which of the following actions should the nurse anticipate?
A client receiving warfarin has an INR of 1.2. Which of the following actions should the nurse anticipate?
When administering a deep subcutaneous injection in the abdomen, what is the recommended minimum distance from the umbilicus?
When administering a deep subcutaneous injection in the abdomen, what is the recommended minimum distance from the umbilicus?
For a client receiving subcutaneous enoxaparin, which of the following findings should the nurse immediately report to the healthcare provider?
For a client receiving subcutaneous enoxaparin, which of the following findings should the nurse immediately report to the healthcare provider?
What is the correct angle of insertion for a subcutaneous injection?
What is the correct angle of insertion for a subcutaneous injection?
A client has accidentally taken an excessive dose of warfarin. Which medication should the nurse prepare to administer?
A client has accidentally taken an excessive dose of warfarin. Which medication should the nurse prepare to administer?
A client receiving heparin via continuous IV infusion begins to vomit blood. After stopping the infusion, which medication should the nurse prepare to administer?
A client receiving heparin via continuous IV infusion begins to vomit blood. After stopping the infusion, which medication should the nurse prepare to administer?
Which laboratory value is most critical for the nurse to monitor in a client receiving heparin to prevent hemorrhage?
Which laboratory value is most critical for the nurse to monitor in a client receiving heparin to prevent hemorrhage?
A client is receiving enoxaparin. Which of the following assessment findings should the nurse immediately report to the provider?
A client is receiving enoxaparin. Which of the following assessment findings should the nurse immediately report to the provider?
A client is prescribed fondaparinux. Which of the following conditions would be a contraindication to receiving this medication?
A client is prescribed fondaparinux. Which of the following conditions would be a contraindication to receiving this medication?
A nurse is preparing to administer heparin subcutaneously. Which of the following techniques is correct?
A nurse is preparing to administer heparin subcutaneously. Which of the following techniques is correct?
Which of the following instructions should a nurse include when educating a client who is prescribed enoxaparin for home use?
Which of the following instructions should a nurse include when educating a client who is prescribed enoxaparin for home use?
A client receiving heparin develops heparin-induced thrombocytopenia (HIT). Which of the following actions should the nurse anticipate?
A client receiving heparin develops heparin-induced thrombocytopenia (HIT). Which of the following actions should the nurse anticipate?
A client is scheduled for a lumbar puncture and is currently receiving enoxaparin. The nurse should be aware of the increased risk for which of the following complications?
A client is scheduled for a lumbar puncture and is currently receiving enoxaparin. The nurse should be aware of the increased risk for which of the following complications?
A client is prescribed heparin. Which of the following medications should the nurse question due to its potential to increase the risk of bleeding?
A client is prescribed heparin. Which of the following medications should the nurse question due to its potential to increase the risk of bleeding?
A client is receiving heparin intravenously. The baseline aPTT is 30 seconds. Which aPTT value would indicate that the heparin dose is within the therapeutic range?
A client is receiving heparin intravenously. The baseline aPTT is 30 seconds. Which aPTT value would indicate that the heparin dose is within the therapeutic range?
A nurse is caring for a client receiving fondaparinux. Which of the following findings requires immediate intervention?
A nurse is caring for a client receiving fondaparinux. Which of the following findings requires immediate intervention?
A client with a history of peptic ulcer disease is prescribed heparin. What precaution should the nurse prioritize?
A client with a history of peptic ulcer disease is prescribed heparin. What precaution should the nurse prioritize?
A client is prescribed enoxaparin postoperatively to prevent deep vein thrombosis (DVT). Which assessment finding indicates the medication is effective?
A client is prescribed enoxaparin postoperatively to prevent deep vein thrombosis (DVT). Which assessment finding indicates the medication is effective?
A nurse is providing discharge teaching to a client prescribed enoxaparin. Which statement indicates a need for further teaching?
A nurse is providing discharge teaching to a client prescribed enoxaparin. Which statement indicates a need for further teaching?
A client is receiving heparin and reports sudden onset of chills, fever, and urticaria. Which of the following actions should the nurse take FIRST?
A client is receiving heparin and reports sudden onset of chills, fever, and urticaria. Which of the following actions should the nurse take FIRST?
A client taking warfarin is starting amiodarone for atrial fibrillation. Recognizing the interaction, how should the nurse adjust the plan of care?
A client taking warfarin is starting amiodarone for atrial fibrillation. Recognizing the interaction, how should the nurse adjust the plan of care?
A client with a history of heparin-induced thrombocytopenia (HIT) requires anticoagulation. Which medication is most appropriate?
A client with a history of heparin-induced thrombocytopenia (HIT) requires anticoagulation. Which medication is most appropriate?
A client is prescribed dabigatran following a hip replacement. What discharge instructions should the nurse emphasize regarding medication administration?
A client is prescribed dabigatran following a hip replacement. What discharge instructions should the nurse emphasize regarding medication administration?
A client on warfarin therapy has an elevated INR of 6.0. Which intervention is the priority?
A client on warfarin therapy has an elevated INR of 6.0. Which intervention is the priority?
Which statement indicates the client understands discharge teaching regarding warfarin?
Which statement indicates the client understands discharge teaching regarding warfarin?
A patient with atrial fibrillation is prescribed dabigatran. Which pre-existing condition would cause the most concern?
A patient with atrial fibrillation is prescribed dabigatran. Which pre-existing condition would cause the most concern?
A client is prescribed warfarin. The nurse knows which lab value guides safe dosing of this medication?
A client is prescribed warfarin. The nurse knows which lab value guides safe dosing of this medication?
A client taking warfarin reports starting a new herbal supplement, ginkgo biloba. What instruction should the nurse provide?
A client taking warfarin reports starting a new herbal supplement, ginkgo biloba. What instruction should the nurse provide?
A client receiving dabigatran develops acute bleeding. Which medication should the nurse prepare to administer?
A client receiving dabigatran develops acute bleeding. Which medication should the nurse prepare to administer?
What is the expected pharmacological action of dabigatran?
What is the expected pharmacological action of dabigatran?
A client on warfarin is scheduled for elective surgery. When should the medication be discontinued prior to the procedure?
A client on warfarin is scheduled for elective surgery. When should the medication be discontinued prior to the procedure?
Which of the following medications, if taken concurrently with warfarin, would cause the most concern?
Which of the following medications, if taken concurrently with warfarin, would cause the most concern?
A nurse is caring for a client who has atrial fibrillation and a new prescription for dabigatran. The nurse should monitor the client for which of the following adverse effects?
A nurse is caring for a client who has atrial fibrillation and a new prescription for dabigatran. The nurse should monitor the client for which of the following adverse effects?
A client who is prescribed warfarin asks the nurse why they need to have their blood tested so often. What is the nurse's best response?
A client who is prescribed warfarin asks the nurse why they need to have their blood tested so often. What is the nurse's best response?
A nurse is reviewing a client's medication list and identifies multiple potential interactions with warfarin. What is the most important nursing action?
A nurse is reviewing a client's medication list and identifies multiple potential interactions with warfarin. What is the most important nursing action?
A client is starting dabigatran therapy. Which intervention is most important for the nurse to implement?
A client is starting dabigatran therapy. Which intervention is most important for the nurse to implement?
A client is prescribed rivaroxaban for stroke prevention related to atrial fibrillation. Which instruction should the nurse include in the client's education?
A client is prescribed rivaroxaban for stroke prevention related to atrial fibrillation. Which instruction should the nurse include in the client's education?
A client who is receiving rivaroxaban reports experiencing unusual bruising and bleeding gums. Which lab value should the nurse prioritize?
A client who is receiving rivaroxaban reports experiencing unusual bruising and bleeding gums. Which lab value should the nurse prioritize?
A client is prescribed aspirin for primary prevention of myocardial infarction. What teaching should the nurse provide regarding minimizing gastrointestinal side effects?
A client is prescribed aspirin for primary prevention of myocardial infarction. What teaching should the nurse provide regarding minimizing gastrointestinal side effects?
A client is prescribed abciximab following percutaneous transluminal coronary angioplasty (PTCA). What nursing intervention is essential for monitoring the client?
A client is prescribed abciximab following percutaneous transluminal coronary angioplasty (PTCA). What nursing intervention is essential for monitoring the client?
A nurse is caring for a client receiving rivaroxaban who concurrently takes amiodarone for a heart condition. What potential interaction should the nurse monitor for?
A nurse is caring for a client receiving rivaroxaban who concurrently takes amiodarone for a heart condition. What potential interaction should the nurse monitor for?
A client is prescribed clopidogrel after experiencing a transient ischemic attack (TIA). Which adverse effect should the nurse instruct the client to report immediately?
A client is prescribed clopidogrel after experiencing a transient ischemic attack (TIA). Which adverse effect should the nurse instruct the client to report immediately?
A client with a history of intermittent claudication is started on cilostazol. What therapeutic effect should the nurse monitor to determine the medication's effectiveness?
A client with a history of intermittent claudication is started on cilostazol. What therapeutic effect should the nurse monitor to determine the medication's effectiveness?
A client on aspirin therapy reports tinnitus. What action should the nurse take?
A client on aspirin therapy reports tinnitus. What action should the nurse take?
A client reports they are planning to take St. John's Wort. The client is also taking Rivaroxaban. What is the the MOST important teaching that the nurse can provide?
A client reports they are planning to take St. John's Wort. The client is also taking Rivaroxaban. What is the the MOST important teaching that the nurse can provide?
What discharge teaching should the nurse provide a cardiac patient that is going home on an antiplatelet?
What discharge teaching should the nurse provide a cardiac patient that is going home on an antiplatelet?
A client is taking aspirin for its antiplatelet effects. Which of the following over-the-counter medications should the client avoid due to increased risk of bleeding?
A client is taking aspirin for its antiplatelet effects. Which of the following over-the-counter medications should the client avoid due to increased risk of bleeding?
A nurse is reviewing a client's medication list and notes the client is taking rivaroxaban and rifampin. What is the primary concern related to this combination?
A nurse is reviewing a client's medication list and notes the client is taking rivaroxaban and rifampin. What is the primary concern related to this combination?
A client is prescribed aspirin 81 mg daily. Which of the following statements indicates the client understands the purpose of this medication?
A client is prescribed aspirin 81 mg daily. Which of the following statements indicates the client understands the purpose of this medication?
A nurse is caring for a client receiving intravenous heparin and plans to transition the client to oral rivaroxaban. Which laboratory test result is most important for the nurse to review before starting rivaroxaban?
A nurse is caring for a client receiving intravenous heparin and plans to transition the client to oral rivaroxaban. Which laboratory test result is most important for the nurse to review before starting rivaroxaban?
A nurse is caring for a patient receiving clopidogrel. Which assessment finding requires immediate intervention?
A nurse is caring for a patient receiving clopidogrel. Which assessment finding requires immediate intervention?
A patient is prescribed dipyridamole. What instruction should the nurse include in the patient's education?
A patient is prescribed dipyridamole. What instruction should the nurse include in the patient's education?
A nurse is reviewing the medication list of a patient who is about to start taking aspirin daily. Which concurrent medication would be of most concern?
A nurse is reviewing the medication list of a patient who is about to start taking aspirin daily. Which concurrent medication would be of most concern?
A patient receiving alteplase begins to show signs of intracranial bleeding. Which intervention is the most important?
A patient receiving alteplase begins to show signs of intracranial bleeding. Which intervention is the most important?
A patient is prescribed clopidogrel after a myocardial infarction. The patient is also taking pantoprazole for gastroesophageal reflux disease (GERD). What is the nurse's primary concern regarding this combination?
A patient is prescribed clopidogrel after a myocardial infarction. The patient is also taking pantoprazole for gastroesophageal reflux disease (GERD). What is the nurse's primary concern regarding this combination?
A client receiving alteplase begins to show signs of excessive fibrinolysis. Which medication should the nurse prepare to administer?
A client receiving alteplase begins to show signs of excessive fibrinolysis. Which medication should the nurse prepare to administer?
When administering alteplase for an acute myocardial infarction, what is the priority nursing action?
When administering alteplase for an acute myocardial infarction, what is the priority nursing action?
Before administering alteplase for an acute myocardial infarction, which of the following conditions in a patient's history would be a contraindication?
Before administering alteplase for an acute myocardial infarction, which of the following conditions in a patient's history would be a contraindication?
A patient with a history of peptic ulcer disease is prescribed aspirin for its antiplatelet effects. Which intervention is most important to include in the patient's plan of care?
A patient with a history of peptic ulcer disease is prescribed aspirin for its antiplatelet effects. Which intervention is most important to include in the patient's plan of care?
A patient is receiving alteplase. The nurse observes oozing from a previous IV insertion site. What is the priority nursing action?
A patient is receiving alteplase. The nurse observes oozing from a previous IV insertion site. What is the priority nursing action?
A nurse is caring for a patient receiving abciximab. Which of the following assessments is most critical to report to the provider immediately
A nurse is caring for a patient receiving abciximab. Which of the following assessments is most critical to report to the provider immediately
A nurse is caring for a client receiving alteplase. Which laboratory value is most important to monitor during therapy?
A nurse is caring for a client receiving alteplase. Which laboratory value is most important to monitor during therapy?
A patient is scheduled for elective surgery and is currently taking clopidogrel. What is the recommended timeframe to discontinue clopidogrel prior to the surgery?
A patient is scheduled for elective surgery and is currently taking clopidogrel. What is the recommended timeframe to discontinue clopidogrel prior to the surgery?
A client who is on concurrent anticoagulant therapy is about to receive alteplase. Which action should the nurse anticipate?
A client who is on concurrent anticoagulant therapy is about to receive alteplase. Which action should the nurse anticipate?
How fast should thrombolytic agents be administered after the onset of symptoms?
How fast should thrombolytic agents be administered after the onset of symptoms?
A patient is prescribed both aspirin and an NSAID for pain relief. To minimize the risk of reduced cardioprotective effects of aspirin, what should the nurse instruct the patient?
A patient is prescribed both aspirin and an NSAID for pain relief. To minimize the risk of reduced cardioprotective effects of aspirin, what should the nurse instruct the patient?
After thrombolytic therapy, which medications are typically administered to reduce the risk of rethrombosis?
After thrombolytic therapy, which medications are typically administered to reduce the risk of rethrombosis?
A nurse is educating a patient about the long-term use of low-dose aspirin. What potential adverse effect should the nurse emphasize?
A nurse is educating a patient about the long-term use of low-dose aspirin. What potential adverse effect should the nurse emphasize?
Which intervention is most important for the nurse to implement following thrombolytic therapy to prevent GI bleeding?
Which intervention is most important for the nurse to implement following thrombolytic therapy to prevent GI bleeding?
A patient receiving alteplase for acute ischemic stroke develops a sudden, severe headache. What action should the nurse take first?
A patient receiving alteplase for acute ischemic stroke develops a sudden, severe headache. What action should the nurse take first?
Which of the following conditions is a contraindication for the administration of abciximab?
Which of the following conditions is a contraindication for the administration of abciximab?
A nurse is teaching a client about clopidogrel. What is the primary therapeutic effect of this medication?
A nurse is teaching a client about clopidogrel. What is the primary therapeutic effect of this medication?
A patient is prescribed dipyridamole and warfarin concurrently. What laboratory value should the nurse monitor most closely?
A patient is prescribed dipyridamole and warfarin concurrently. What laboratory value should the nurse monitor most closely?
When should clopidogrel be discontinued before elective surgery to minimize the risk of bleeding?
When should clopidogrel be discontinued before elective surgery to minimize the risk of bleeding?
What instructions should a nurse provide to a client prescribed clopidogrel regarding potential adverse effects?
What instructions should a nurse provide to a client prescribed clopidogrel regarding potential adverse effects?
Following the administration of alteplase for a pulmonary embolism(PE), a nurse observes blood oozing from the patient's IV site. What is the most appropriate initial nursing action?
Following the administration of alteplase for a pulmonary embolism(PE), a nurse observes blood oozing from the patient's IV site. What is the most appropriate initial nursing action?
A client on clopidogrel reports experiencing abdominal pain, nausea, and diarrhea. What should the nurse instruct the client to do?
A client on clopidogrel reports experiencing abdominal pain, nausea, and diarrhea. What should the nurse instruct the client to do?
Concurrent use of clopidogrel with what other medication significantly increases the risk for bleeding?
Concurrent use of clopidogrel with what other medication significantly increases the risk for bleeding?
A client has received alteplase. The ECG 75 minutes after the start of therapy shows a reduction in the initial ST segment injury pattern. What does this indicate?
A client has received alteplase. The ECG 75 minutes after the start of therapy shows a reduction in the initial ST segment injury pattern. What does this indicate?
A nurse is reviewing the client's medication list and notes the client is prescribed NSAIDs. What is the significance of this finding when administering alteplase?
A nurse is reviewing the client's medication list and notes the client is prescribed NSAIDs. What is the significance of this finding when administering alteplase?
Flashcards
Coagulation Modifiers
Coagulation Modifiers
Medications used to prevent clot formation or break apart existing clots, increasing circulation and preventing tissue damage.
Heparins
Heparins
A class of anticoagulants including unfractionated heparin, LMW heparins, and activated factor Xa inhibitors.
Heparin's Action
Heparin's Action
Inactivates both thrombin and factor Xa, inhibiting fibrin formation and preventing clotting.
Heparin Uses
Heparin Uses
Signup and view all the flashcards
LMW Heparins Uses
LMW Heparins Uses
Signup and view all the flashcards
Fondaparinux Uses
Fondaparinux Uses
Signup and view all the flashcards
Heparin Toxicity Treatment
Heparin Toxicity Treatment
Signup and view all the flashcards
Protamine
Protamine
Signup and view all the flashcards
Heparin-Induced Hemorrhage
Heparin-Induced Hemorrhage
Signup and view all the flashcards
Nursing Actions for Hemorrhage
Nursing Actions for Hemorrhage
Signup and view all the flashcards
Signs of Bleeding
Signs of Bleeding
Signup and view all the flashcards
Monitor hematoma
Monitor hematoma
Signup and view all the flashcards
Heparin-Induced Thrombocytopenia (HIT)
Heparin-Induced Thrombocytopenia (HIT)
Signup and view all the flashcards
HIT Nursing Actions
HIT Nursing Actions
Signup and view all the flashcards
Enoxaparin Hemorrhage Actions
Enoxaparin Hemorrhage Actions
Signup and view all the flashcards
Hematoma Signs After Spinal/Epidural
Hematoma Signs After Spinal/Epidural
Signup and view all the flashcards
Platelet Count Threshold
Platelet Count Threshold
Signup and view all the flashcards
Bleeding Risk Interactions
Bleeding Risk Interactions
Signup and view all the flashcards
Heparin Lab Monitoring
Heparin Lab Monitoring
Signup and view all the flashcards
Heparin Dosage
Heparin Dosage
Signup and view all the flashcards
Heparin Injection Site
Heparin Injection Site
Signup and view all the flashcards
Bleeding Precautions
Bleeding Precautions
Signup and view all the flashcards
Subcutaneous Injection
Subcutaneous Injection
Signup and view all the flashcards
Subcutaneous Needle Size
Subcutaneous Needle Size
Signup and view all the flashcards
Deep Subcutaneous Injection Site
Deep Subcutaneous Injection Site
Signup and view all the flashcards
Post-Subcutaneous Injection Care
Post-Subcutaneous Injection Care
Signup and view all the flashcards
Bleeding Indications
Bleeding Indications
Signup and view all the flashcards
NSAIDs/Aspirin/Salicylates to Avoid
NSAIDs/Aspirin/Salicylates to Avoid
Signup and view all the flashcards
Heparin aPTT Target
Heparin aPTT Target
Signup and view all the flashcards
Warfarin Action
Warfarin Action
Signup and view all the flashcards
Warfarin Antidote
Warfarin Antidote
Signup and view all the flashcards
Warfarin Toxicity Signs
Warfarin Toxicity Signs
Signup and view all the flashcards
Warfarin Contraindications
Warfarin Contraindications
Signup and view all the flashcards
Warfarin Monitoring
Warfarin Monitoring
Signup and view all the flashcards
Vitamin K Rich Foods
Vitamin K Rich Foods
Signup and view all the flashcards
Herbs That Increase Bleeding Risk
Herbs That Increase Bleeding Risk
Signup and view all the flashcards
Warfarin Medication History
Warfarin Medication History
Signup and view all the flashcards
Warfarin and Acetaminophen
Warfarin and Acetaminophen
Signup and view all the flashcards
Warfarin Administration
Warfarin Administration
Signup and view all the flashcards
Warfarin Toxicity Antidote
Warfarin Toxicity Antidote
Signup and view all the flashcards
Warfarin Onset Time
Warfarin Onset Time
Signup and view all the flashcards
Warfarin Duration
Warfarin Duration
Signup and view all the flashcards
Warfarin Interactions
Warfarin Interactions
Signup and view all the flashcards
Warfarin Alert
Warfarin Alert
Signup and view all the flashcards
Warfarin and Personal Care
Warfarin and Personal Care
Signup and view all the flashcards
Dabigatran Uses
Dabigatran Uses
Signup and view all the flashcards
Dabigatran and Bleeding
Dabigatran and Bleeding
Signup and view all the flashcards
Dabigatran Antidote
Dabigatran Antidote
Signup and view all the flashcards
Dabigatran GI Side Effects
Dabigatran GI Side Effects
Signup and view all the flashcards
Dabigatran Administration Tips
Dabigatran Administration Tips
Signup and view all the flashcards
Rivaroxaban's Action
Rivaroxaban's Action
Signup and view all the flashcards
Rivaroxaban Uses
Rivaroxaban Uses
Signup and view all the flashcards
Rivaroxaban Complications
Rivaroxaban Complications
Signup and view all the flashcards
Rivaroxaban: Nursing Actions (Bleeding)
Rivaroxaban: Nursing Actions (Bleeding)
Signup and view all the flashcards
Rivaroxaban: Liver Effects
Rivaroxaban: Liver Effects
Signup and view all the flashcards
Rivaroxaban Contraindications
Rivaroxaban Contraindications
Signup and view all the flashcards
Rivaroxaban Administration
Rivaroxaban Administration
Signup and view all the flashcards
Antiplatelet Action
Antiplatelet Action
Signup and view all the flashcards
Antiplatelet Uses
Antiplatelet Uses
Signup and view all the flashcards
Aspirin: GI Effects
Aspirin: GI Effects
Signup and view all the flashcards
Aspirin: Hemorrhagic stroke
Aspirin: Hemorrhagic stroke
Signup and view all the flashcards
Aspirin Overdose Symptoms
Aspirin Overdose Symptoms
Signup and view all the flashcards
Aspirin: Tinnitus/Hearing Loss
Aspirin: Tinnitus/Hearing Loss
Signup and view all the flashcards
Abciximab: Cardiovascular Effects
Abciximab: Cardiovascular Effects
Signup and view all the flashcards
Abciximab: Nursing Actions (Bleeding)
Abciximab: Nursing Actions (Bleeding)
Signup and view all the flashcards
Aspirin's Antiplatelet Action
Aspirin's Antiplatelet Action
Signup and view all the flashcards
Gastric Bleed Signs
Gastric Bleed Signs
Signup and view all the flashcards
Clopidogrel's Bleeding Risk
Clopidogrel's Bleeding Risk
Signup and view all the flashcards
Dipyridamole Administration
Dipyridamole Administration
Signup and view all the flashcards
Aspirin in the Elderly
Aspirin in the Elderly
Signup and view all the flashcards
Abciximab Contraindications
Abciximab Contraindications
Signup and view all the flashcards
Antiplatelets & Bleeding Risk
Antiplatelets & Bleeding Risk
Signup and view all the flashcards
Aspirin and NSAID Timing
Aspirin and NSAID Timing
Signup and view all the flashcards
Corticosteroids and Aspirin
Corticosteroids and Aspirin
Signup and view all the flashcards
Clopidogrel & PPI Interaction
Clopidogrel & PPI Interaction
Signup and view all the flashcards
Clopidogrel Before Surgery
Clopidogrel Before Surgery
Signup and view all the flashcards
Thrombolytics Mechanism
Thrombolytics Mechanism
Signup and view all the flashcards
Thrombolytics: Reduce Bleeding Risk
Thrombolytics: Reduce Bleeding Risk
Signup and view all the flashcards
Signs of Internal Bleeding
Signs of Internal Bleeding
Signup and view all the flashcards
Aminocaproic Acid
Aminocaproic Acid
Signup and view all the flashcards
Alteplase Contraindications
Alteplase Contraindications
Signup and view all the flashcards
Alteplase Nursing Actions
Alteplase Nursing Actions
Signup and view all the flashcards
Alteplase Effectiveness
Alteplase Effectiveness
Signup and view all the flashcards
Clopidogrel's Action
Clopidogrel's Action
Signup and view all the flashcards
Clopidogrel Therapeutic Use
Clopidogrel Therapeutic Use
Signup and view all the flashcards
Clopidogrel Adverse Effects
Clopidogrel Adverse Effects
Signup and view all the flashcards
Clopidogrel Nursing Interventions
Clopidogrel Nursing Interventions
Signup and view all the flashcards
Clopidogrel and Surgery
Clopidogrel and Surgery
Signup and view all the flashcards
Medications Increasing Bleeding Risk
Medications Increasing Bleeding Risk
Signup and view all the flashcards
Alteplase Cautions
Alteplase Cautions
Signup and view all the flashcards
Pre-Administration Assessments for Alteplase
Pre-Administration Assessments for Alteplase
Signup and view all the flashcards
Treating Life-Threatening Bleeding
Treating Life-Threatening Bleeding
Signup and view all the flashcards
Preventing GI Bleeding
Preventing GI Bleeding
Signup and view all the flashcards
Study Notes
- Medications affecting coagulation either prevent clot formation or break down existing clots, working by altering the clotting cascade, preventing platelet aggregation, or dissolving clots, all with a significant risk of bleeding.
- The goal of these medications is to improve circulation and perfusion, reduce pain, and prevent further tissue damage.
- Medication groups include oral and parenteral anticoagulants, antiplatelet medications, and thrombolytic agents.
- Anticoagulants consist of heparins, vitamin K antagonists, direct thrombin inhibitors, and direct factor Xa inhibitors.
Heparins
- Prototype medication: Heparin (unfractionated)
- Low molecular weight (LMW) heparins prototype: Enoxaparin
- Other medications: Dalteparin
- Activated factor Xa inhibitor prototype: Fondaparinux
Purpose and Action
- Heparin prevents clotting through activating antithrombin, inactivating thrombin and factor Xa, which inhibits fibrin formation.
- LMW heparins and activated factor Xa inhibitors selectively inactivate factor Xa.
Therapeutic Uses of Heparin
- Used for conditions needing immediate anticoagulant action like evolving stroke, pulmonary embolism (PE), and massive deep-vein thrombosis (DVT).
- Serves as an adjunct for open-heart surgery or dialysis patients
- Low-dose for postoperative venous thrombosis prophylaxis.
- Used for disseminated intravascular coagulation treatment.
Therapeutic Uses of Low Molecular Weight Heparins
- Prevent DVT in postoperative patients
- Treat DVT and PE
- Prevent complications in angina, non-Q wave MI, and ST elevation MI.
Therapeutic Uses of Activated Factor Xa Inhibitor (Fondaparinux)
- Prevent DVT and PE postoperatively
- Treat acute DVT or PE alongside warfarin.
Complications of Heparin
- Toxicity can occur
- Treatment includes administering protamine slowly IV (no more than 20 mg/min or 50 mg in 10 min, not exceeding 100 mg in 2 hours), which binds with heparin.
- Monitor carefully for protamine toxicity.
Hemorrhage
- Hemorrhage occurs due to heparin toxicity or high activated partial thromboplastin time.
- Risk factors: bleeding disorder history or concurrent antiplatelet medications.
- Nursing actions: Monitor vital signs and aPTT (maintain 1.5 to 2 times the baseline value). Report hemorrhage immediately.
- Patient Education: Watch for bleeding signs (increased heart rate, decreased blood pressure, bruising, black stools).
Epidural or Spinal Hematoma
- Increased risk with heparin, other anticoagulants/antiplatelets, spinal issues, or epidural catheters.
- Monitor for neurological changes indicating hematoma.
Heparin-Induced Thrombocytopenia
- Indicated by low platelet count and increased thrombi.
- Monitor platelet count, especially in the first month of treatment, for antibody development.
Hypersensitivity Reactions
- Manifest as chills, fever, urticaria.
- Administer a small test dose before full administration.
Complications of Enoxaparin
- Hemorrhage can occur
- Nursing actions: Monitor vital signs and platelet count.
- Patient Education: Watch for bleeding signs and avoid aspirin.
- Neurologic Damage: Monitor those with spinal/epidural anesthesia
- Monitor insertion site for hematoma signs (redness, swelling). Assess sensation and movement in lower extremities.
- Heparin-Induced Thrombocytopenia: Assess Platelets
- Stop if platelets drop below 100,000/mm3.
- Toxicity: Follow heparin toxicity protocol.
Fondaparinux Complications
- Hemorrhage can occur
- Monitor vital signs and platelet count.
- Patient Education: Observe for bleeding signs and avoid aspirin.
- Neurologic Damage: Monitor those with spinal/epidural anesthesia
- Observe insertion site for hematoma signs (redness, swelling). Assess sensation and movement in lower extremities.
- Decreased Platelet Count: Assess Platelets
- Stop if platelets drop below 100,000/mm3.
Contraindications/Precautions
- Pregnancy: Heparin use with caution, LMW heparins safety not established, fondaparinux only if needed.
- Lactation: Heparin use with caution, LMW heparins and fondaparinux safety not established.
- Contraindicated with low platelet counts or uncontrollable bleeding.
- Avoid during/after eye, brain, spinal cord surgeries; lumbar puncture; or regional anesthesia.
- Use cautiously with hemophilia, dissecting aneurysm, peptic ulcer disease, severe hypertension, or liver/kidney disease.
- Antiplatelet agents increase bleeding risk. Avoid concurrent use if possible, and monitor for bleeding or injury.
- Garlic, ginger, glucosamine, or ginkgo biloba can increase bleeding risk.
- Feverfew increases bleeding risk with antiplatelets or anticoagulants.
Nursing Administration of Heparin
- Cannot be absorbed in the intestinal tract; administer subcutaneously or IV.
- Obtain baseline vital signs, aPTT, platelet count, and hematocrit levels.
- Verify heparin dosages with another nurse due to varied concentrations and units.
- Administer deep subcutaneous injections in the abdomen (2 inches from the umbilicus) without aspirating. Use a 25- to 31-gauge needle.
- Apply gentle pressure post-injection for 1 to 2 minutes and rotate injection sites.
- Patient Education: Monitor for bleeding, avoid OTC NSAIDs/aspirin, and use electric razors and soft toothbrushes.
Enoxaparin/Fondaparinux
- Monitoring not required, suitable for home use.
- Prefilled syringes available. Do not expel air bubble unless dose adjustment needed.
- Subcutaneous injections: Use a 25- to 31-gauge needle. Inject into abdomen (2 inches from umbilicus). Pinch skin, inject at 90° angle. Inject all contents and do not rub site.
- Rotate injection sites.
- Patient Education: Monitor for bleeding, avoid OTC NSAIDs/aspirin, and use electric razors and soft toothbrushes.
Nursing Evaluation of Medication Effectiveness
- Heparin: aPTT levels of 60 to 80 seconds
- Heparin, enoxaparin, fondaparinux: Absence of venous thrombi or emboli development.
Vitamin K Inhibitors (Coumarins)
- Prototype: Warfarin
Purpose and Action
- Warfarin antagonizes vitamin K, preventing synthesis of coagulation factors VII, IX, X, and prothrombin.
Therapeutic Uses
- Prevents venous thrombosis and PE.
- Prevents thrombotic events in atrial fibrillation or prosthetic heart valve patients.
- Reduces risk for recurrent transient ischemic attacks or myocardial infarction.
Complications
- Hemorrhage may occur
- Nursing actions: Monitor vital signs, PT, and INR levels (report bleeding)
- Patient education: Observe for bleeding (increased heart rate, decreased blood pressure, bruising, black stools).
- Hepatitis can occur
- Monitor liver enzymes and observe for jaundice.
Toxicity
- Give vitamin K1 to aid synthesis of coagulation factors VII, IX, X, and prothrombin.
- Administer IV vitamin K1 slowly in diluted solution to prevent anaphylactoid reactions.
- Use small vitamin K1 doses to avoid warfarin resistance.
- If vitamin K1 is ineffective, administer fresh frozen plasma or whole blood.
Contraindications/Precautions
- Pregnancy: Warfarin is contraindicated.
- Lactation: Warfarin is safe, but monitor infant for bruising or bleeding.
- Reproductive: Use with caution, notify provider if pregnancy is planned.
- Contraindicated with low platelet counts or uncontrollable bleeding and during/after specific surgeries.
- Use cautiously with vitamin K deficiencies, liver/alcohol use disorders, hemophilia, dissecting aneurysm, peptic ulcer disease, or severe hypertension.
- Heparin, aspirin, acetaminophen, glucocorticoids, sulfonamides, and parenteral cephalosporins increase warfarin effects, raising bleeding risk. Avoid concurrent use if possible.
- Phenobarbital, carbamazepine, phenytoin, oral contraceptives, and vitamin K decrease anticoagulant effects.
- Foods high in vitamin K (leafy greens, cabbage, broccoli) can decrease effectiveness. Maintain consistent intake.
- Resveratrol and saw palmetto increase bleeding risk through antiplatelet effects.
- Coenzyme Q-10 (CoQ-10) can decrease warfarin effectiveness
- Feverfew, garlic, ginger, glucosamine or ginkgo biloba can increase the risk of bleeding.
Nursing Administration
- Administer orally, once daily, at the same time.
- Monitor PT (therapeutic level 18 to 24 seconds) and INR levels (therapeutic levels 2 to 3). Withhold dose if levels exceed therapeutic ranges.
- Administer vitamin K1 for warfarin toxicity.
- Monitor PT frequently for clients prescribed medications that interact with warfarin.
- Patient Education
- Anticoagulation effects take 8 to 12 hours, with full effect in 3 to 5 days. Hospitalized patients need continued heparin when starting warfarin.
- Anticoagulation effects can last 5 days post-discontinuation.
- Avoid alcohol, OTC, and nonprescription medications to prevent adverse effects/interactions.
- Prevent thrombi by avoiding prolonged sitting, avoiding constrictive clothing, and elevating/moving legs.
- Wear a medical alert bracelet, record dosage, and follow up with providers regularly for PT/INR monitoring.
- Use a soft-bristle toothbrush and electric razor.
Nursing Evaluation of Medication Effectiveness
- PT 1.5 to 2 times control.
- INR of 2 to 3 for acute myocardial infarction, atrial fibrillation, venous thrombosis, or tissue heart valves.
- INR of 2.5 to 3.5 for a PE.
- INR of 3 to 4.5 for mechanical heart valve or recurrent systemic embolism.
- Resolution of venous thrombi.
Direct Thrombin Inhibitors
- Prototype: Dabigatran
- Other Medications: Hirudin analogs (Bivalirudin, desirudin), Argatroban
Purpose and Action
- Inhibits thrombin, preventing thrombus development.
Therapeutic Uses
- Dabigatran prevents stroke/embolism in atrial fibrillation patients (non-valvular). Treats/prevents DVT and PE.
- Bivalirudin is given with aspirin for percutaneous coronary angioplasty/intervention patients.
- Argatroban prevents/treats thrombosis in heparin-induced thrombocytopenia patients.
- Desirudin prevents DVT in hip replacement surgery patients.
Complications
- Bleeding
- Report bleeding to the provider
- For severe bleeding, administer idarucizumab. Dialysis or recombinant factor VIIa injections can be used.
- Stop dabigatran before elective surgery.
- GI Effects: GI discomfort, nausea, vomiting, esophageal reflux, ulcer formation
- Take dabigatran with food and consider proton pump inhibitors or H2 receptor antagonists.
- Other Effects:
- Bivalirudin: Back pain, pelvic pain, anxiety, bradycardia, hypotension, headache.
- Desirudin: Injection-site mass, anemia, deep thrombophlebitis.
Contraindications/Precautions
- Pregnancy: Dabigatran safety not established; Argatroban and bivalirudin only if needed.
- Lactation: Dabigatran use with caution; Argatroban contraindicated; Bivalirudin safety not established.
- Reproductive: For dabigatran, notify provider if pregnancy is planned/suspected.
- Contraindicated with active bleeding or allergy to medication.
- Use cautiously with liver impairment or bleeding risks
- Dabigatran, bivalirudin, and desirudin cautiously in kidney impairment.
- Rifampin decreases dabigatran levels. Meds that inhibit P-glycoprotein (ketoconazole, verapamil, quinidine) can increase blood levels of dabigatran.
- Thrombolytics/anticoagulants increase bleeding risk with argatroban, desirudin, bivalirudin, or dabigatran.
- Feverfew, garlic, ginger, glucosamine, ginkgo biloba, resveratrol, or saw palmetto increases bleeding risk.
Nursing Administration
- Dabigatran: Oral capsules, swallow whole, with or without food. Use container within 30 days of opening. Stop other anticoagulants when starting dabigatran.
- Bivalirudin: IV by direct bolus or continuous infusion.
- Argatroban: IV by continuous infusion; stop heparin and check aPTT before starting.
- Desirudin: Deep subcutaneous injection into abdomen or thigh.
Nursing Evaluation of Medication Effectiveness
- Prevention/reduction of thrombus formation.
Direct Inhibitor of Factor Xa
- Prototype: Rivaroxaban
- Other Medications: Apixaban, Dabigatran
Purpose and Action
- Selectively inhibits factor Xa, preventing thrombin formation and anticoagulation.
Therapeutic Uses
- Stroke prevention in atrial fibrillation patients
- Prevention of postoperative DVT/PE for hip/knee replacement patients
- Treatment of DVT/PE unrelated to orthopedic surgery.
Complications
- Bleeding: GI, GU, cranial, retinal, or epidural bleeding following epidural catheter removal
- Report bleeding, bruising, headache, or eye pain.
- Monitor hemoglobin/hematocrit.
- Wait 18 hours after last dose to remove epidural catheter and 6 hours after removal before restarting rivaroxaban.
- Administer andexanet alfa (apixaban, rivaroxaban) or idarucizumab (dabigatran) for reversal. Activated charcoal can be given to prevent further absorption.
- Elevated Liver Enzymes and Bilirubin: Monitor baseline and periodic liver functions (ALT, AST, and GGT).
- Contraindications/Precautions
- Pregnancy:Rivaxoroban only if it outweighs from the baby
- Lactation: Contraindicated
Interactions
- Itraconazole, ritonavir, or ketoconazole can increase rivaroxaban blood levels. Amiodarone, quinidine, diltiazem, verapamil, ranolazine, and macrolide antibiotics can increase rivaroxaban blood levels in renal impairment.
- Monitor carefully for bleeding if these medications are taken concurrently.
Nursing Administration
- Administer tablets orally, once daily with or without food, at the same time each day.
- For stroke and systemic embolism prevention, administer orally once daily with the evening meal.
- Monitor hemoglobin, hematocrit, and liver and kidney function periodically during treatment.
Antiplatelets
- Prevents Platelets from clumping together by inhibiting enzymes and factors that normally lead to arterial clotting.
- Antiplatelet medications inhibit platelet aggregation at the onset of the clotting process. These medications alter bleeding time.
Types
- Antiplatelet/cyclooxygenase inhibitor: Aspirin
- Antiplatelet/glycoprotein inhibitors: Abciximab, Eptifibatide, tirofiban
- Antiplatelet/ADP inhibitors: Clopidogrel, Ticagrelor
- Antiplatelet/arterial vasodilator: Dipyridamole, Cilostazol
Uses
- Primary prevention of acute myocardial infarction
- Prevention of reinfarction following an acute myocardial infarction
- Prevention of ischemic stroke or transient ischemic attack
- Acute coronary syndromes (abciximab, tirofiban, eptifibatide, clopidogrel)
- Intermittent claudication (cilostazol, dipyridamole)
- Routes of administration
- Aspirin: PO
- Abciximab: IV
- Clopidogrel: PO
- Dipyridamole: PO
Complications of Aspirin
- GI effects (nausea, vomiting, dyspepsia)
- Concurrent use of a proton pump inhibitor (omeprazole) might decrease GI effects.
- Use enteric-coated tablets and to take aspirin with food.
- Hemorrhagic stroke
- Prolonged bleeding time, gastric bleed, thrombocytopenia
- Tinnitus, hearing loss
- Contraindications/Precautions
- Pregnancy: Use with caution, avoid during the third trimester
- Lactation: Safety not established
- Contraindicated in clients who have bleeding disorders and thrombocytopenia
- Use cautiously in clients who have peptic ulcer disease and severe kidney or hepatic disorders. Do not give to children or adolescents who have fever or recent chickenpox.
- Use with caution in older adults
Abciximab Complications
- Hypotension and bradycardia
- Prolonged bleeding time, gastric bleed, thrombocytopenia, bleed from cardiac catheterization site
- Contraindications/Precautions
- Pregnancy: Safety not established.
- Lactation: Contraindicated.
- Contraindications include clients who have thrombocytopenia, recent stroke, AV malformation, aneurysm, uncontrolled hypertension, and recent major surgery.
Clopidogrel Complications
- Bleeding
- Prolonged bleeding time, gastric bleed, thrombocytopenia
- GI effects (diarrhea, dyspepsia, pain)
- Contraindications/Precautions
- Pregnancy: Use only if needed.
- Lactation: Contraindicated.
- Notify provider if pregnancy is planned or suspected.
- Contraindications include clients who have thrombocytopenia, history of bleeding due to peptic ulcer disease, and intracranial bleed.
- Use cautiously in clients who have peptic ulcer disease and severe kidney or hepatic disorders.
Dipyridamole
- Dyspepsia nausea, vomiting. This can be controlled by taking it with food.
Interactions
- Feverfew, garlic, ginger, glucosamine, ginkgo biloba, resveratrol, or saw palmetto can increase the risk of bleeding with asprin.
- Concurrent use of other medications that enhance bleeding (heparin, warfarin, thrombolytics, antiplatelets) increases risk for bleeding.
- Urine acidifiers (ammonium chloride) can increase aspirin levels.
- Non-aspirin NSAIDs can reduce the antiplatelet effects of immediate-release aspirin.
- Corticosteroids can increase aspirin excretion and decrease aspirin effects. These medications can increase risk for GI bleed.
- Caffeine can increase aspirin absorption.
- Abciximab and Clopidogrel: Concurrent usage of other medications that enhance bleeding increases risk.
Nursing Administration
- Aspirin 325 mg should be taken during initial acute episode of myocardial infarction
- Clopidogrel is sometimes prescribed concurrently with aspirin, which increases the risk for bleeding. Clopidogrel should be discontinued 5 to 7 days before an elective surgery. Preventions of strokes, myocardial infarctions, and reinfarction can be accomplished with low-dose(81mg) aspirin.
- Notify the provider regarding aspirin use. Nursing Evaluation of Medication Effectiveness
- Absence of arterial thrombosis, adequate tissue perfusion, and blood flow without occurrence of abnormal bleeding.
Thrombolytic Medications
- Prototype: Alteplase (tPA)
Purpose and Action
- Dissolves clots that have already formed by converting Plasminogen to plasmin, which destroys fibrinogen and other clotting factors.
Therapeutic Uses
- Treats acute myocardial infarction (all three medications).
- Treat massive PE (alteplase only).
- Treat acute ischemic stroke (alteplase only).
- Restore patency to central IV catheters (alteplase only).
- Route of Administration: IV only by RN
Complications
- High risk of bleeding at different sites
- Internal Bleeding: GI or GU tracts and cerebral bleeding
- Superficial Bleeding: Wounds, IV catheter sites
- Monitor for changes in vital signs, alterations in level of consciousness, weakness, and indications of intracranial bleeding.
- Monitor aPTT and PT, Hgb, and Hct.
- For severe bleeding, fibrinolysis following alteplase can be reversed by administration of aminocaproic acid IV.
- Contraindications/Precautions Warnings:
- Pregnancy: Alteplase safety is not established.
- Lactation: Altersplase safetly is not established
- Any prior intracranial hemorrhage (hemorrhagic Stroke).
- Known structural cerebral lesion ( arteriovenous malformation, neoplasm).
- Active internal bledding.
- Ischemic Stroke within the past 3 months other than the current episode (within prior 4.5hr).
Interactions
- Concurrent use of other medications that enhance bleeding (NSAIDs, heparin, warfarin, thrombolytics, antiplatelets) increases risk for bleeding.
- If used concurrently, monitor carefully for indications of bleeding.
Nursing Administration
- Use of thrombolytic agents should take place as soon as possible after onset of manifestations.
- Clients receiving a thrombolytic agent should be monitored in a setting that provides for close supervision and continuous monitoring during and administration of the medication. Obtain the client’s weight to calculating the dosage. Ensure baseline platelet counts, hemoglobin (Hgb), hematocrit (Hct), aPTT, PT, INR, and fibrinogen levels are obtained. Monitor periodically. Obtain baseline vital signs (heart rate, blood pressure), and monitor frequently per protocol. Nursing care includes assisting with the continuous monitoring of hemodynamic status to monitor therapeutic and adverse effects of thrombolytic (relief of chest pain, indications of bleeding). Follow facility protocol. Assist with the provision of client safety per facility protocol. Ensure adequate IV access for administration of emergency medications and availability of emergency equipment. Ensure medications are not mixed in a IV with thrombolytic agents. Minimize bruising or bleeding by limiting venipunctures and subcutaneous/IM injections. Hold direct pressure to injection site or ABG site for up to 30 min until oozing stops. Assist with the discontinuation of thrombolytic therapy if life-threatening bleeding occurs and the treatment of blood loss with whole blood, packed red blood cells, and/or fresh frozen plasma. Ensure IV aminocaproic acid is available for administration in the event of excessive fibrinolysis. Following thrombolytic therapy, administer heparin or aspirin as prescribed to decrease the risk of rethrombosis. Following thrombolytic therapy, administer beta blockers as prescribed to decrease myocardial oxygen consumption and to reduce the incidence and severity of reperfusion arrhythmias. Administer H2 antagonists or proton pump inhibitors (omeprazole) as prescribed to prevent GI bleeding.
Nursing Evaluation of Medication Effectiveness
- Thrombus lysis and restoration of circulation (relief of chest pain, reduction of initial ST segment injury pattern as shown on ECG 60 to 90 min after start of therapy).
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
Explore the mechanisms, uses, and management of heparin and related anticoagulants. Understand the differences between unfractionated heparin and low molecular weight heparins. Learn about antidotes and nursing considerations for patients on heparin therapy.
