ATI section 6: Medications for the Hematologic system Flashcards
Blood and Blood Products
-Whole blood, Packed red blood cells (RBCs), Platelet concentrations
Nursing Interventions and Client Education:
-Client ID, name, and blood types must be verified by 2 nurses
-Prior to administration, assess baseline vital signs, including temp
-Establish IV access, 18-guage or larger catheter
-Must have 0.9% sodium chloride primed tubing
-For the first 15 min, stay with the client and infuse slowly, monitoring for any reaction
-If reaction occurs perform the following:
Stop blood immediately and take vital signs
Infuse 0.9% sodium chloride
Notify the provider
Follow facility policy (send urine sample, CBC, and bag tubing to lab for analysis
-Complete infusion of product within 4hrs
Whole Blood
Time completed:
-2-4 hrs
Action/Therapeutic Use:
-Replace volume: Hemorrhage, surgery, trauma, burns, shock
Monitor for Reaction:
-Acute hemolytic, febrile, anaphylactic, mild allergic, hypervolemia, sepsis
Packed RBCs
Time completed:
-2-4 hrs
Action/Therapeutic Use:
-Increase available RBC, severe anemia, hemoglobulinopathies, hemolytic anemia, erythroblastosis fetalis
Monitor for Reaction:
-Acute hemolytic, febrile, anaphylactic, mild allergic, sepsis
Platelets
Time completed:
-15-30 min
Action/Therapeutic Use:
-Increase platelet count, active bleeding, thrombocytopenia, aplastic anemia, bone marrow suppression
Monitor for Reaction:
-Febrile, sepsis
FFP
Time completed:
-30-60 min
Action/Therapeutic Use:
-Replace clotting factors, hemorrhage, burns, shock, thrombotic thrombocytopenia purport (TTP), reverse effects of warfarin
Monitor for Reaction:
-Acute hemolytic, febrile, anaphylactic, mild allergic, hypervolemia, sepsis
Pheresed granulocytes
Time completed:
-45-60
Action/Therapeutic Use:
-severe neutropenia, neutrophil dysfunction, neonatal sepsis
Monitor for Reaction:
-Acute hemolytic, febrile, anaphylactic, mild allergic, hypovolemia, sepsis
Albumin
Time completed:
-5% (1-10 mL/min), 25% (4mL/min)
Action/Therapeutic Use:
-Expand vol via oncotic changes, hypovolemia, hypoalbuminemia, burns, severe nephrosis, hemolytic disease of the newborn
Monitor for Reaction:
-Risk for hypervolemia and pulmonary edema
Hematopoietic Growth Factors
Action: stimulate the bone marrow to synthesize the specific blood cells
-Epoetin alfa (Procrit), Filgastrim (Neupogen) injection, Pegfilgastrim (Neulasta) IV, Orelvekin (Neumega)
Epoetin alfa (Procrit)
Therapeutic Uses:
-stimulate RBC production
-Anemia related to:
CKD, Retrovir therapy, chemo
Side/Adverse effects:
-Hypertension
Nursing Interventions:
-SubQ or IV: do not agitate vial, monitor Hct
Filgastim (Neupogen) injection
Peffilgrastim (Neulasta) IV over 2-4 hrs
Therapeutic Uses:
- Stimulate WBC production
- Neutropenia related to cancer
Side/Adverse effects:
- Bone pain
- Leukocytosis
Nursing Interventions:
- SubQ or IV
- Do not agitate vial
- Monitor CBC
Oprelvekin (Neumega)
Therapeutic Uses:
- Stimulate platelet production
- Thrombocytopenia related to cancer
Side/Adverse effects:
- Fluid retention
- Papilledema
- Cardiac dysrhythmia
Nursing Interventions:
- Administer within 6-24 after chemo
- SubQ
Iron Preparations
Oral
- Dilute with water or juice and administer with a plastic straw or medication dosing syringe (avoid contact with teeth)
- Encourage OJ fortified with vitamin C (facilitates absorption)
- Avoid antacids, coffee, tea, dairy products, or whole grain breads concurrently and for 1 hr after admin due to decreased absorption
- Monitor the client for constipation and gastrointestinal upset
Iron Preparations
IM
- Use a large-bore needle (19-20 gauge, 3 inch)
- Change needle after drawing up from vial
- Z-track (ventrogluteal preferable)
- Do not massage injection site
Anticoagulants
-Heparin Sodium and Enoxaparin (Levenox) (Parenteral medication)
Therapeutic Uses:
- Evolving stroke
- Pulmonary embolism
- Massive deep-vein thrombosis
- Cardiac catheterization
- MI
- DIC
Precautions/Interactions:
- Must be given subQ or IV
- Incompatible with many medications
- Avoid NSAIDs, aspirin, or medication containing salicylate
Side/Adverse effects:
- Hemorrhage
- Heparin-induced thrombocytopenia
- Toxicity/overdose
Anticoagulant
Nursing Interventions and Client Education
- Clients receiving heparin: monitor aPPT every 4-6 hrs for IV administration
- Monitor for signs of bleeding
- Safety precautions to prevent bleeding
- Administer subQ heparin to abdomen, 2 inches form umbilicus (do not aspirate or massage)
- Rotate injection site and observe for bleeding hematoma
- Administer protamine sulfate for heparin toxicity (1 mg neutralizes 100 units of heparin)
Warfarin (Coumadin) oral medication
Therapeutic Uses:
- Venous thrombosis
- Thrombus prevention for clients with atrial fibrillation or prosthetic heart valves
- Prevention of recurrent MI
- Transient ischemic attacks (TIAs)
Precautions/Interactions:
- Pregnancy
- Contraindications: thrombocytopenia, carbamazepine (Tegretol, phenytoin (Dilantin), oral contraceptives
- Food sources high in vitamin K may decrease effects
Side/Adverse effects:
- hemorrhage
- toxicity/overdose
Warfarin (Coumadin) oral medication
Nursing Interventions and Client Education
- Administer once daily
- Monitor INR or PT
- Teach client that bleeding risk remains put to 5 days after discontinued therapy
- Avoid NSAIDs, and medication with aspirin
- Teach client to wear a medical alert bracelet
- Client may self-monitor for PT/INR
- Teach measures to prevent injury and bleeding
- Administer vitamin K for warfarin toxicity
- Garlic, ginger, ginko, and ginseng may increase risk of bleeding
Dabigatran (Pradaxa) (Oral medication)
Therapeutic Uses:
-reduces the risk of stroke and embolism for clients with nonvalvular atrial fibrillation
Precautions/Interventions:
- Must discontinue warfarin and start dabigatran when INR is below 2.0
- When possible , discontinue 1-2 days prior to surgical procedure
Side/Adverse effects;
- Bleeding
- GI discomfort
Dabigatran (Pradaxa) (Oral medication)
Nursing Interventions and Client Education
- Take med daily and avoid skipping doses
- If a dose is missed, it should not be taken within 6hrs of the next scheduled dose
- Tabs should not be crushed, broken, or chewed
- Teach client to avoid NSAIDs and medications with aspirin
- Teach client to monitor for signs of GI bleeding
Antiplatelet Medications
-Aspirin, Abciximab, clopidogrel, ticipidine, pentoxifylline, dipyridamole
Therapeutic Uses:
- prevention of acute myocardial infarction or acute coronary syndromes
- prevention of stroke
- Intermittent claudication
Precautions/Interactions:
- Contraindicated in thrombocytopenia
- Caution with peptic ulcer disease
Side/Adverse effects:
- Prolonged bleeding
- Gastric bleeding
- Thrombocytopenia
Nursing Interventions and Client Education
- Monitor for signs of prolonged bleeding
- Teach client to report tarry stool, ecchymosis
Thrombolytic Medications
-Suffix: teplase
Therapeutic Uses:
- Acute myocardial infarction
- Deep vein thrombosis (DVT)
- Massive pulmonary emboli (PE)
- Ischemic stroke (alterplase)
Precautions/Interactions:
- Contraindicated for intracranial hemorrhage, active internal bleeding, aortic dissection, brain tumors
- Use cautiously when using gin clients who have severe hypertension
- Concurrent use of anticoagulants or anti platelet meds increases risk for bleeding
Side/Adverse effects:
- Serious bleeding risks from recent wounds, puncture sites, weakened vessels
- Hypotension
- Possible anaphylactic reaction
Nursing Interventions and Client Education:
- Administer must take place within 4-6 hrs of symptom onset
- Continuous monitoring is required
- Clients will begin anticoagulant therapy to prevent repeated thrombotic event
