Warfarin Management Quiz

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Questions and Answers

What is a common adverse effect of aspirin?

Gastrointestinal bleeding (correct)

Weight gain

Hypertension

Sleep disturbances

Which vitamin is necessary for the effectiveness of Epoetin Alfa?

Vitamin C

Vitamin D

Vitamin K

Folic acid (correct)

Why should loop diuretics be administered in the morning?

To prevent electrolyte imbalances

To enhance absorption

To avoid dehydration

To prevent nocturia (correct)

What symptom is a manifestation of potassium deficiency with loop diuretics?

Leg cramps Signup and view all the answers

What is the priority intervention for status asthmaticus?

Administer a short-acting beta agonist Signup and view all the answers

What should patients be monitored for when taking Theophylline?

Tachycardia and toxicity Signup and view all the answers

What timing instruction is given for taking Montelukast?

Once daily at bedtime Signup and view all the answers

Which factor can cause Heparin-Induced Thrombocytopenia (HIT)?

Heparin treatment Signup and view all the answers

Which medication interaction with Warfarin is particularly concerning for increasing bleeding risk?

Metronidazole Signup and view all the answers

What is the target INR range for a patient on Warfarin therapy?

2.0-3.0 Signup and view all the answers

What sign should a patient taking Warfarin be educated to watch for as a sign of potential bleeding?

Bruising Signup and view all the answers

Which dietary supplement should be avoided when taking Warfarin due to its interaction?

Garlic Signup and view all the answers

What is essential to do before and during a blood transfusion?

Verify patient ID and blood type Signup and view all the answers

What common complication should a nurse monitor for patients taking Clopidogrel?

Thrombocytopenia Signup and view all the answers

What position should the injection be administered when giving Enoxaparin?

At a 90-degree angle Signup and view all the answers

What should a patient taking Hydrochlorothiazide be aware of as a potential adverse effect?

Hypokalemia Signup and view all the answers

Study Notes

Warfarin (Coumadin) Management

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).
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.
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).
Antidotes
- Warfarin: Vitamin K.
- Heparin: Protamine sulfate.

Blood Transfusion Management

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

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)

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

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

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

Dietary Needs
- Adequate iron, folic acid, & Vit B12 intake is crucial for effectiveness.

Thrombolytic therapy

Adverse Effects
- Internal bleeding: GI or GU and Cerebral
- Superficial bleeding: wounds, IV catheter sites.

Spironolactone

Electrolyte Imbalances
- Hyperkalemia (weakness, fatigue, dyspnea, dysrhythmias); monitor potassium levels closely & ECG.

Loop Diuretics

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.)
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

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

Manifestations
- General weakness, fatigue, LEG CRAMPS, nausea, vomiting.

Heparin-Induced Thrombocytopenia (HIT)

Immunity mediated clotting disorder causes UNEXPLAINED low blood platelet count as result of HEPARIN TREATMENT.
Monitoring
- Check platelet counts regularly (typically falls >50%).

Albuterol and Cromolyn Administration

Education
- Albuterol: Use as needed for acute asthma symptoms. (Use FIRST).
- Cromolyn: Used as a preventive measure; must be taken regularly.

Montelukast

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

Priority Intervention
- Administer a short-acting beta agonist (SABA) like albuterol.
- Take before glucocorticoids.

Medication Side Effects

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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Description

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.