Anticoagulant

Question 1

Warfarin Lab Draws

Answer 1

• Dose change = next lab in 3 days
• Long term monitoring = weekly or monthly

Question 2

Wafarin Dosing

Answer 2

• Daily: usually in evening or HS
• If INR is greater than 3.0: HOLD & call prescribing provider
• Expect an order for vit K if INR is greater than 4.0 (PO or SQ)

Question 3

Foods High in Vitamin K

Answer 3

• Kale
• Collard greens
• Spinach
• Brussel sprouts
• Broccoli
• Asparagus
• Saurkraut
• Soybeans
• Edamame

Question 4

Herbals to Avoid w/ Warfarin

Answer 4

• Dcrd effect:
  > St. John’s Wort
• Incrd effect
  > garlic
  > gingko
  > ginger root
  > chamomile

Question 5

Warfarin Therapeutic INR

Answer 5

2.0-3.0

Question 6

Anticoagulation Drugs Assessment

(warfarin)
physical
labs
d-d

Answer 6

• Physical assessment w/ focus on cardiovascular & S/S of bleeding
• Labs: aPPT, PT, INR, H/H, platelets
• Drug-Drug: more than 1 anticoag/antiplatelet (Aspirin, warfarin) herbal supplements, antibiotic therapy

Question 7

Anticoagulantion Drugs Expected Outcomes

Answer 7

• Therapeutic effect w/ limited AEs
  > absence of DVT, PE, stroke
• PT understanding of drug therapy, AEs, safety

Question 8

Anticoagulation Drugs Interventions

Answer 8

• Bleeding precautions
• Reduce risk for falls
• Hold for procedures
• Educate PT: S/S bleeding, lab monitoring, & diet if indicated

Question 9

Anticoagulation Drugs Evaluation

Answer 9

• Therapeutic Response: absence of blood clots, restored perfusion
• AEs: S/S bleeding
• Teaching; was it effective?

Question 10

Anticoagulants General Nursing Considerations

precautions
contraindication
d-d

Answer 10

• All anticoags have AE of bleeding
  > non-fatal: hematuria, epistaxis, bruising
  > fatal: hemorrhagic stroke, internal bleeding, GI bleeding (older adults higher risk)
• Fall precautions
• Bleeding precautions
• Contraindications
  > pregnancy (except heparin/enoxaparin), bleeding disorders, hx of bleed, thrombocytopenia
• Drug-Drug
  > antiplatelet agents, NSAIDs, herbals

Question 11

Heparin - Class & MOA

Answer 11

• Class: Indirect Thrombin Inhibitor
• MOA: disrupts clotting cascade; prolongs bleeding time

Question 12

Heparin - Indications & Route/Dose

Answer 12

• Route/Dose
  > 5000 units SQ q8hr (prevention)
  > IV drip (protocol dosing)
• Indications
  > prevent DVT (SQ)
  > treat DVT (SQ)
  > treat PE (IV)

Question 13

Heparin - Contraindications

Answer 13

• Pork allergy
• Pork abstention for religion
  > Judaism, Muslim

Question 14

Heparin - AEs

Answer 14

• Bleeding
• Heparin-Induced thrombocytopenia (HIT)
• Bruising at injection site

Question 15

Heparin - Nursing Considerations

Answer 15

• Rotate/moonitor injection sites for SQ
  > DO NOT admin IM
• Monitor platelet count
• Monitor aPTT
  > therapeutic: 45-70sec
• Monitor Anti-Xa

Question 16

Heparin Reversal Agent

Answer 16

• Protamine sulfate
• Heparin has a short half-life so stop infusion immediately