Anticoagulant Medications and Heparin Induced Thrombocytopenia

Heparin Induced Thrombocytopenia (HIT)

• Heparin induced thrombocytopenia (HIT) occurs when the body's immune system reacts to the presence of heparin, leading to a low platelet count.

Anticoagulation Agents

• Low-Molecular-Weight Heparin (LMWH) is used to prevent and treat blood clots.
• Fondaparinux (Arixtra) is a type of anticoagulant that inhibits the formation of blood clots.
• Oral anticoagulants, such as warfarin (Coumadin), are used to prevent and treat blood clots.
• The antidote for warfarin (Coumadin) is vitamin K.

Blood Work

• International Normalized Ratio (INR) is a test used to measure the effectiveness of warfarin (Coumadin) therapy.
• Activated partial prothrombin time (aPTT) is a test used to measure the effectiveness of heparin therapy.
• Prothrombin time (PT) is a test used to measure the blood's clotting ability.
• Platelet count is a test used to measure the number of platelets in the blood.
• Hemoglobin (HGB) and hematocrit (HCT) are tests used to measure the amount of red blood cells in the blood.

Anticoagulation Therapy Monitoring

• INR and aPTT are used to monitor the effectiveness of anticoagulant therapy.
• Platelet count is used to monitor for thrombocytopenia (low platelet count).
• Bleeding is a complication of anticoagulation therapy.
• Numerous drug interactions can occur with anticoagulation therapy.

Thrombocytopenia

• Thrombocytopenia is a decrease in platelets, which can lead to bleeding.
• Platelet count is used to diagnose thrombocytopenia.

Anticoagulation Therapy Management

• Anticoagulation therapy is used to prevent and treat blood clots.
• Numerous drug interactions can occur with anticoagulation therapy.
• Bleeding is a complication of anticoagulation therapy.

Pulmonary Embolism (PE)

• PE occurs when a blood clot travels to the lungs and blocks an artery.
• PE risk factors include immobility, cancer, and surgery.
• Signs and symptoms of PE include chest pain, shortness of breath, and coughing.
• Diagnostic tests for PE include D-dimer, CT scan, and ventilation/perfusion scan.
• Interventions for PE include anticoagulation therapy, thrombolytic therapy, and surgery.

Hemorrhage

• Hemorrhage is a loss of a large amount of blood externally or internally in a short period of time.
• Classification of hemorrhage includes type of vessel and visibility.
• WHO grading system is used to measure bleeding.
• Signs and symptoms of hemorrhage include tachycardia, hypotension, and tachypnea.

Pain Assessment

• Pain assessment tools include visual analog, FACES, and numerical rating scales.
• Affective responses to pain include anxiety, fear, and depression.
• Behavioral responses to pain include changes in sleep, appetite, and activity.
• Physiological responses to pain include increased heart rate, blood pressure, and respiratory rate.

Pharmacological Pain Management

• Non-opioid analgesics, such as acetaminophen and NSAIDs, are used to treat mild to moderate pain.
• Opioids, such as morphine and codeine, are used to treat moderate to severe pain.
• Adjuvants, such as antidepressants and anti-inflammatories, are used to treat pain.
• Routes of administration for pain medications include oral, intravenous, and epidural.

Opioids

• Tolerance, physical dependence, and addiction are risks associated with opioid use.
• Patient-controlled analgesia (PCA) is a method of pain management that allows patients to self-administer pain medication.
• Epidural analgesia is a method of pain management that involves injecting pain medication into the epidural space.

Non-Pharmacological Pain Therapy

• Non-pharmacological approaches to pain management include relaxation, distraction, and guided imagery.
• Complementary or alternative therapies, such as biofeedback, therapeutic touch, and reiki, can be used to manage pain.
• Collaboration with patients and families is necessary in making pain management decisions.

Heparin Induced Thrombocytopenia (HIT)

• Low platelet count due to heparin use
• Risk of thrombosis and bleeding

Anticoagulation Agents

• Low-Molecular-Weight Heparin (LMWH)
• Fondaparinux (Arixtra)
• Oral Anticoagulants (e.g. warfarin)

Antidote for Warfarin (Coumadin)

• Vitamin K

Systemic Thrombolytic Therapy

• Used to dissolve blood clots

Surgical Management

• Indicated for bleeding, severe trauma, severe liver or renal disease, CVA, and other conditions
• Contraindications: bleeding, severe trauma, and other conditions

Blood Work

• INR (International Normalized Ratio): 0.9-1.1
• aPTT (activated partial prothrombin time): 28-38 seconds
• PT (prothrombin time): 10-14 seconds
• Platelet count: 150-400 x 10^9/L
• Hemoglobin (HGB): 135-170 g/L (male), 115-160 g/L (female)
• Hematocrit (HCT): 0.4-0.51 (male), 0.34-0.48 (female)

Anticoagulation Therapy Monitoring

• Monitor INR, aPTT, PT, and platelet count
• Monitor for bleeding and thrombosis

Bleeding

• Monitor for signs of bleeding (e.g. tachycardia, hypotension, petechiae)
• Manage bleeding with fluid replacement, blood transfusion, and surgical intervention

Thrombocytopenia

• Decreased platelet count
• Monitor for signs of bleeding

Anticoagulation Therapy Management

• Manage anticoagulation therapy to prevent bleeding and thrombosis
• Monitor for signs of bleeding and thrombosis

Numerical Drug Interactions

• Monitor for interactions with other medications

Client Comfort and Healing

• Promote comfort and healing through pain management and wound care

Adjuncts to Therapy

• Use of compression stockings, ambulation, and other therapies to promote healing

Pulmonary Embolism (PE)

• Blockage of pulmonary artery by blood clot
• Risk factors: immobility, surgery, cancer, and others
• Signs and symptoms: chest pain, dyspnea, tachycardia, and others

Shock

• Definition: inadequate perfusion of tissues
• Stages: compensatory, progressive, and irreversible
• Clinical signs: hypotension, tachycardia, tachypnea, and others
• Classifications: hypovolemic, cardiogenic, distributive, and others
• Management: fluid resuscitation, vasopressors, and others

Types of Pain

• Acute pain: short-term, severe pain
• Chronic pain: long-term, persistent pain
• Idiopathic pain: pain without clear cause

Physiology of Pain

• Nociceptors: specialized nerve cells that detect pain
• Gate-control theory: pain transmission through spinal cord

Factors Influencing Pain

• Age, anxiety, and others
• Nursing responsibilities: pain assessment and management

Pain Assessment Tools

• Visual Analog Scale (VAS)
• FACES scale
• PQRST assessment

Responses to Pain

• Affective: emotional response to pain
• Behavioral: physical response to pain

Physiological Responses to Pain

• Acute pain is a warning to the body
• Chronic pain can lead to physiological changes