Podcast
Questions and Answers
What is a common adverse effect of aspirin?
What is a common adverse effect of aspirin?
Which vitamin is necessary for the effectiveness of Epoetin Alfa?
Which vitamin is necessary for the effectiveness of Epoetin Alfa?
Why should loop diuretics be administered in the morning?
Why should loop diuretics be administered in the morning?
What symptom is a manifestation of potassium deficiency with loop diuretics?
What symptom is a manifestation of potassium deficiency with loop diuretics?
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What is the priority intervention for status asthmaticus?
What is the priority intervention for status asthmaticus?
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What should patients be monitored for when taking Theophylline?
What should patients be monitored for when taking Theophylline?
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What timing instruction is given for taking Montelukast?
What timing instruction is given for taking Montelukast?
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Which factor can cause Heparin-Induced Thrombocytopenia (HIT)?
Which factor can cause Heparin-Induced Thrombocytopenia (HIT)?
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Which medication interaction with Warfarin is particularly concerning for increasing bleeding risk?
Which medication interaction with Warfarin is particularly concerning for increasing bleeding risk?
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What is the target INR range for a patient on Warfarin therapy?
What is the target INR range for a patient on Warfarin therapy?
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What sign should a patient taking Warfarin be educated to watch for as a sign of potential bleeding?
What sign should a patient taking Warfarin be educated to watch for as a sign of potential bleeding?
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Which dietary supplement should be avoided when taking Warfarin due to its interaction?
Which dietary supplement should be avoided when taking Warfarin due to its interaction?
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What is essential to do before and during a blood transfusion?
What is essential to do before and during a blood transfusion?
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What common complication should a nurse monitor for patients taking Clopidogrel?
What common complication should a nurse monitor for patients taking Clopidogrel?
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What position should the injection be administered when giving Enoxaparin?
What position should the injection be administered when giving Enoxaparin?
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What should a patient taking Hydrochlorothiazide be aware of as a potential adverse effect?
What should a patient taking Hydrochlorothiazide be aware of as a potential adverse effect?
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Study Notes
Warfarin (Coumadin) Management
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Interactions:
- Medications: Antibiotics (metronidazole), NSAIDs, Oral contraceptives, carbamazepine, phenytoin, glucocorticoids and other anticoagulants.
- OTC/Herbals: Avoid garlic, ginkgo, COQ-10, feverfew, glucosamine, saw palmetto, resveratrol, and St. John's Wort.
- Food: Consistent intake of vitamin K (leafy greens); avoid large fluctuations, mayo, canola/soybean oil.
- Drinks: Avoid alcohol (thins blood, increase bleeding risk).
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Health Promotion:
- Educate on signs of bleeding (bruising, blood in urine/stool).
- Importance of regular INR monitoring.
- Use soft bristle toothbrushes.
- Use electric razors for shaving.
- Avoid tight fitting clothes.
- Elevate & move legs when sitting.
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Laboratory Values:
- INR: Target usually between 2.0-3.0 -- therapeutic range -- (COUMADIN).
- PT: Monitors effectiveness of therapy. -- 18 to 24 seconds therapeutic range –COUMADIN).
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Antidotes
- Warfarin: Vitamin K.
- Heparin: Protamine sulfate.
Blood Transfusion Management
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Nursing Actions
- Verify patient ID and blood type. 2 nurse check.
- Monitor vital signs before transfusion.
- Vital signs during transfusion for 15-30 minutes.
- Vital signs after transfusion every hour.
- Watch for transfusion reactions (fever, chills, rash).
- Older adults should not have blood products older than 1 week.
Enoxaparin (Lovenox) Administration
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Education
- Administer subcutaneously, usually in the abdomen 2 inches from umbilicus.
- Use prefilled syringe, do not expel air bubble before injection.
- DO NOT ASPIRATE.
- Inject at 90-degree angle.
- DO NOT rub site for 1 to 2 min after injection.
Clopidogrel (Plavix)
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Purpose and Complications
- Antiplatelet agent to prevent strokes and heart attacks, by preventing platelets from clumping together.
- Complications: Bleeding, thrombocytopenia, gastrointestinal issues (diarrhea, dyspepsia, pain).
- Adverse effects: NSAIDs, anticoagulants/antiplatelets & thrombolytics increase risks for bleeding. Proton pump inhibitors (pantoprazole) fluoxetine, or fluconazole decrease effectiveness.
- Timing with surgery: Discontinue 5-7 days prior.
Hydrochlorothiazide
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Adverse Effects
- Hypokalemia, hyperglycemia, Hypomagnesium (weakness, muscle twitching) dehydration, weight loss, dizziness, etc.
- Interactions: NSAIDs may reduce effectiveness & Antihypertensives cause additive hypotensive effects.
Aspirin Education
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Adverse Effects
- Gastrointestinal bleeding, tinnitus (hearing loss), nausea, vomiting, dyspepsia.
- Take with food/water to reduce gastric irritation. Enteric-coated aspirin should not be crushed.
Epoetin Alfa
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Dietary Needs
- Adequate iron, folic acid, & Vit B12 intake is crucial for effectiveness.
Thrombolytic therapy
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Adverse Effects
- Internal bleeding: GI or GU and Cerebral
- Superficial bleeding: wounds, IV catheter sites.
Spironolactone
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Electrolyte Imbalances
- Hyperkalemia (weakness, fatigue, dyspnea, dysrhythmias); monitor potassium levels closely & ECG.
Loop Diuretics
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Mechanism of Action
- Block sodium, chloride, and water reabsorption in the loop of Henle.
- Used for emergent needs for mobilization of fluid (pulmonary edema, liver, cardiac, kidney disease.)
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Fluid Volume Management
- Monitor input/output at least every 30 ml/hr.
- Weigh daily, same time, same clothes.
Initial Diuretics for Hypertension
- Thiazide diuretics are commonly used as first-line treatment (hydrochlorothiazide).
Diuretics Administration Timing
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Importance
- Take in the morning to prevent nocturia.
- If dosing TWICE a day, make sure 2nd dose is given before 1400.
Potassium Deficiency with Loop Diuretics
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Manifestations
- General weakness, fatigue, LEG CRAMPS, nausea, vomiting.
Heparin-Induced Thrombocytopenia (HIT)
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Immunity mediated clotting disorder causes UNEXPLAINED low blood platelet count as result of HEPARIN TREATMENT.
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Monitoring
- Check platelet counts regularly (typically falls >50%).
Albuterol and Cromolyn Administration
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Education
- Albuterol: Use as needed for acute asthma symptoms. (Use FIRST).
- Cromolyn: Used as a preventive measure; must be taken regularly.
Montelukast
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Timing and Effects
- Take it once daily at BEDTIME & 2 hrs. before exercise.
- If taking daily, no additional dose is needed prior to exercise.
- Therapeutic effect: Long term therapy of asthma in children & adults and to prevent exercise induced bronchospasm.
- Evaluation: Long term control of asthma.
Status Asthmaticus
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Priority Intervention
- Administer a short-acting beta agonist (SABA) like albuterol.
- Take before glucocorticoids.
Medication Side Effects
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Theophylline, Montelukast, Fluticasone/Salmeterol
- Theophylline: Monitor for toxicity (nausea, seizures, tachycardia).
- Montelukast: Depression, suicidal ideation, Headache, abdominal pain.
- Fluticasone/Salmeterol: Oral thrush, hoarseness.
- Rifampin: Hepatotoxicity (jaundice, anorexia, fatigue), Orange urine, saliva, sweat or tears.
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Test your knowledge on the management of Warfarin (Coumadin) therapy. This quiz covers important interactions with medications, OTC products, and dietary considerations, as well as health promotion strategies for patients on Warfarin. Ensure you understand the importance of INR monitoring and potential signs of complications.
